Antinociceptive States and Hypertension

Antinociception and Hypertension. A review of available data indicates that acute and chronic increases in arterial blood pressure (ABP) are associated with antinociception in animals and hypoalgesia in humans. The primary issues of concern are whether increases in ABP are directly responsible for altered nociceptive function, and the extent to which carotid sinus, aortic depressor, and/or vagal afferents contribute to the changes in nociceptive function.     

Alcohol consumption and related problems among primary health care patients: WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption—I

This WHO collaborative project is the first phase of a programme of work aimed at developing techniques for early identification and treatment of persons with hazardous and harmful alcohol consumption. The aim of the present study was to determine the prevalence of hazardous and harmful alcohol use among patients attending primary health care facilities in several countries, and to examine the correlates of drinking behaviour and alcohol-related problems in these culturally diverse populations. The broader purpose was to determine whether there was justification for developing alcohol screening instruments for cross-national use. One thousand, eight hundred and eighty-eight subjects in Australia, Bulgaria, Kenya, Mexico, Norway and the USA underwent a comprehensive assessment of their medical history, alcohol intake, drinking practices, and any physical or psychosocial problems related to alcohol. After non-drinkers and known alcoholics had been excluded, 18% of subjects had a hazardous level of alcohol intake and 23% had experienced at least one alcohol-related problem in the previous year. Intrascale reliability coefficients were uniformly high for the drinking behaviour (dependence) and adverse psychological reactions scales, and moderately high for the alcohol-related problems scales. There were strong correlations between the various alcohol-specific scales, and between these scales and measures of alcohol intake. Although the prevalence of hazardous and harmful alcohol consumption varied from country to country, there was a high degree of commonality in the structure and correlates of drinking behaviour and alcohol-related problems. These findings strengthen the case for developing international screening instruments for hazardous and harmful alcohol consumption.     

The Technology and Use of Blastomere Analysis

With the use of blastomere analysis, it is possible to screen for serious genetic disease before initiating pregnancy through in vitro fertilization. The analysis provides information about an embryo's genetic composition before implantation. This article describes the technique of blastomere analysis and its current and potential uses. Implications for nursing practice and education are identified.     

Circadian distribution of motor activity and immobility in narcolepsy: Assessment with continuous motor activity monitoring

The circadian distribution of motor activity and immobility of 14 unmedicated narcoleptics and matched controls was evaluated by monitoring continuous wrist motor activity 5 successive days and nights at home. Sleep was also assessed by sleep logs. The amplitude of the circadian rhythm of motor activity and immobility was significantly lower in narcoleptics than in controls. The variables that best distinguish narcoleptics from controls were the diurnal and nocturnal mean duration of uninterrupted immobility, which can be explained by excessive daytime sleepiness and frequent nocturnal awakenings, respectively. Thus, measures of diurnal and nocturnal motor activity and immobility appear useful for the objective assessment of some of the sleep-wakefulness manifestations of narcolepsy.     

Physical activity measurement instruments for children with cerebral palsy: a systematic review

Aim This paper is a systematic review of physical activity measurement instruments for field‐based studies involving children with cerebral palsy (CP). Method Database searches using PubMed Central, MEDLINE, CINAHL Plus, PsycINFO, EMBASE, Cochrane Library, and PEDro located 12 research papers, identifying seven instruments that met the inclusion criteria of (1) having been developed for children aged 0 to 18 years, (2) having been used to evaluate a physical activity dimension, and (3) having been used in a field‐based study involving children with CP. The instruments reviewed were the Activities Scale for Kids – Performance version (ASKp), the Canada Fitness Survey, the Children’s Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC), the Compendium of Physical Activities, the Physical Activity Questionnaire – Adolescents (PAQ‐A), StepWatch, and the Uptimer. Second‐round searches yielded 11 more papers, providing reliability and validity evidence for the instruments. Results The instruments measure physical activity frequency, mode, domain, and duration. Although most instruments demonstrated adequate reliability and validity, only the ASKp and CAPE/PAC have established reliability and validity for children with physical disabilities; the Uptimer has established concurrent validity. No instrument measuring intensity in free‐living has been validated or found reliable for children with CP. Interpretation The findings suggest that further studies are needed to examine the methodological properties of physical activity measurement in children with CP. Combining subjective and objective instruments is recommended to achieve better understanding of physical activity participation.     

Subclavian Venogram as a Guide to Lead Implantation

Recent reports have raised doubts regarding the safety and efficacy of the blind subclavian venipuncture technique for intra-cardiac lead implantation. To permit a more lateral entry, we used a simple subclavian venogram performed through the brachial vein of the ipsilateral arm of 22 consecutive unselected patients undergoing had implantation (19 permanent pacemakers and 3 intracardiac defibriUators). A total of 35 leads were implanted (31 left pectoral and 4 right pectoral). Lead insertion by venogram technique was used successfully in all patients. Two inconsequential arterial punctures occurred. There were no pneumotho-races, infections, or other complications. Lateral placement should facilitate lead manipulation and minimize "subclavian crush." The method of ipsilateral venogram guided lead insertion appears to be safe and reliable and deserves consideration in patients who require permanent lead placement via the subclavian vein approach.     

Examination of the Local Lymph Node Assay for Use in Contact Sensitization Risk Assessment

The purpose of this study was to evaluate the utility of themurine local lymph node assay (LLNA) for contact sensitizationrisk assessment. Cellular proliferative activity in draininglymph nodes was determined for individual animals on Day 5 followingfour daily epicutaneous applications of the test chemical tothe ears. Seventeen chemicals were tested, covering a rangeof materials including preservatives, drug actives, and perfumeraw materials. The assay was found to be useful for identifyingstrong, moderate, and some weak sensitizers as defined by othertesting methods (guinea pig, human). For evaluating the antigenspec ificity of the LLNA proliferative response, an in vitroblastogenesis assay was used. Dendritic cells (DC) isolatedfrom lymph nodes of mice treated 24 hr earlier with trinitrochlorobenzene(TNCB) were capable of in vitro stimulation of lymphocytes fromTNCB-sensitized mice, but not lymphocytes from mice sensitizedto the preservative mixture of 5-chloro-2-methylisothiazolinoneplus 2-methylisothiazolinone (MCI/MI). Conversely, DC from micetreated 24 hr earlier with MCI/MI were capable of stimulatinglymphocytes from MCI/MI-sensitized mice, but were unable tostimulate lymphocytes from TNCB-sensitized mice, demonstratingthe specificity of the response. The results of these studiessupport the use of the marine LLNA for both investigative andpredictive contact sensitization testing. The LLNA offers theadvantages of requiring less time for completion, incorporatingan objective endpoint, requiring approximately half the numberof animals, and being less costly than most currently employedguinea pig test methods. In addition, we believe the murineLLNA is a useful test to incorporate into a scheme for contactsensitization risk assessment. The major advantage of this approachis that the LLNA will provide information which will allow oneto proceed directly to confirmatory human predictive testingwithout performing guinea pig testing.     

Can the Dartmouth COOP/WONCA Charts be Used to Assess the Functional Status of Chinese Patients?

This is the first study on the use of the Dartmouth functionalhealth assessment charts COOP/WONCA in the assessment of thefunctional status of Chinese patients. The Chinese are the world'slargest ethnic group and make up more than one-fifth of theworld's population. We have developed a Chinese translationof the Dartmouth COOP/WONCA charts that satisfies the two minimaland one intermediate criteria on translation of scales and instrumentsset by the European Research Group in Health Outcome (ERGHO).We tested the charts on 84 Chinese patients with previous strokeswhen they attended follow-up at the General Practice Unit ofthe University of Hong Kong from 1 August to 30 November 1992.We found that the Dartmouth COOP/WONCA charts in Chinese wereeasy to administer and were well accepted by our patients. Allbut one patient understood all the charts. There was good facevalidity in the results obtained by the charts. The consultingdoctors found that the information detected by the charts wasmoderately useful in 64% of the patients and was very usefulin 5% of the patients. Our translation can be applied to otherChinese in Hong Kong as well as other countries, because thereis only one written Chinese language. It is hoped that our pilotstudy will stimulate further research to establish the reliability,validity and clinical application of the COOP/WONCA charts inChinese.