Folic acid nutrition in marasmic infants

To determine the prevalence of low folic acid levels in infants with marasmic malnutrition and to study its response to daily supplements of folic acid, a group of 80 malnourished infants 2 to 22 months of age were studied. In 12.5% of the group, serum folic acid levels were under 3ug/l and in 16.3%, red cell folic acid levels were under 140ug/l. In a sub group of 28 infants we determined the levels of folic acid on admission and discharge from a nutritional recovery center. During their hospital stay (median 117 days with a range of 94 to 130) infants received exclusively cow's milk with a daily supplement of 100ug of folic acid. On discharge, a significant increase of serum folic levels to normal values was observed. A similar improvement, but not to the same extent, was appreciated in red cell folates. Inadequate quantity of supplementation or short time of observation could explain the lack of complete correction in the erythrocyte folic concentration.     

Suicide in Northern Ireland: a comparison of two quinquennia (1982–1986 and 1987–1991)

This study compares government records of death by suicide, in Northern Ireland, during two quinquennia in the decade 1982–1991. Specifically these quinquennia are 1982–1986 l 1987–1991. During the latter quinquennium there was an increse m rate for males in most age groups, except the 45–54 and the over 65 years age groups. However, females had an increased rate in the 15–24 and 35–54 years age groups, but have a decreased rate in the other age groups. There has been a decrease in the rate of suicides by poisoning with solids and liquids for both sexes. However, male suicide rates by more violent methods have increased substantially during the latter quinquennium. Three cohorts of males, those in the 15–24, 25–34, and 55–64 age groups, have shown substantial increases during the latter quinquennium. Suggestions for psychiatric intervention strategies are made.     

Thrombotic Arteriopathy in Rheumatoid Erysipelas-Polyarthritis: Thrombosierende Arteriopathie bei der rheumatoid verlaufenden Rotlauf-Polyartluitis der Ratte

While the pathogenic importance of thrombosis is known for the latter, this possibility is also discussed for the former group.The topographic coincidence of coagulopathies, plasmatic insudation, mesenchymal activation and proliferation can be observed in experimental erysipelas, especially in the aorta and arteries. We attempted to standardize the corresponding intimal processes in relation to the age of the experimental animals.Material and methods: In 19 experiments a total of 625 rats were parenterally infected with standardized B-strain-T 28 (Table 1). To attain the rate of thrombosis 506 of these animals were subdivided into the following groups (Table 2): Group A<200 g body weight (b.w.), group B>200 g b.w., group C>200 g b.w. with additional ether nebulization stress. For the histomorphological examination, the heart and aorta were embedded in paraplast and, following sectioning and staining, were morphometrically examined for lesions. In addition the following histochemical reactions were carried out: acid and alkaline phosphatase, adenosine triphosphatase and succinodehydrogenase.Coagulation tests were also performed: 1. Thromboplastin time, 2. Partial thromboplastin time, 3. Thrombin time, 4. Determination of factors V, VII, XII and of thrombocytes (reagents: Merz and Dade Co.) and 5. of fibrinogen according to the Ratnoff-Menzie method. The skin temperature was studied with an infrared thermometer (Thermophil M 202).Results: One hour after subcutaneous injection erysipelas bacteria were in loose contact with the endothelium coinciding with an increase of pinocytotic activity in all three groups. First endothelial reactions occur 36 hours later: thrombocytes adhere, leucocytes and monocytes show the sticking effect.On the third day plasma containing fibrinogen is abundant beneath the aortic endothelium which shows arcadian formation. While the adjoining muscle cells proliferate with radial orientation to the cell axis, simultaneous disruption of the membrana elastica interna begins on the 4th day after inoculation. This is particularly apparent between the 6th and 12th day. Endothelial regression and thrombosis development occur in older rats only if subjected to stress (Group C). On the other hand, young rats (200 g b.w.) usually develop thrombosis (average 68.24% in S experiments) with its base at the aorta's origin. The subintimal transformation of muscle cells converts to foam cells in a transient form, healing as a fibroelastic plaque.In young animals cyanosis of the tail tip occurs 4-6 days following injection, leading to necrosis after 10-12 days. The smooth muscle cells of the aorta show an increase in acid and alkaline phosphatase (4-S days after injection) and ATP'ase (10-12 days after injection). There is marked consumption of factors V, VII, XII and of thrombocytes. Fibrinogen increases analogously from 200 to 700 mg/% in young rats.Discussion: Different arterial changes occur parallel to the manifestation of erysipelas arthritis, pending on age. While only a subintimal mesenchymal reaction is observed in the arteries following inoculation, coagulation crisis and exudation, the changes occurring in the connective tissue of joints and other organs infected with erysipelas have the symptomatology of rheumatoid arthritis. The pathogenetically important disturbances of coagulation are induced by the erysipelas bacteria, not by anaphylactoid immune processes. However, immune complexes exist in the chronic stages of erysipelas. The clear topographical behavior of the aortic intima during the exudative shock phase of the erysipelas infection is especially suitable for examining the effect of serum and plasma factors on the mesenchym.     

Managing to care: the importance of using existing information to guide service provision for informal carers

All managerial deciions are taken on the basis of the information. It is important that managers use appropriate information to base their decisions upon about service provision to ensure erhcient use or resources. This basic premise serves as a framework for examining how quantitative and qualitative information can be of help to nurse managers in taking these decisions in the context of developing services for informal carers. The current emphasis on surveys as a means of assessing client need is questioned, and it is suggested that a wealth of evidence, relating to the experience of carers, already exists. Examples of accounts which express the needs of informal carers are presented and their utility, in terms of highlighting the carers' perspective, is discussed to reinforce the importance of utilizing this information. The paper concludes that nurse managers can use these sources as a basis for decision-making in the area of service provision and this may result in a more effective use of resources through a needs-based approach.     

Managing nurses and nursing: short courses as role development

This paper describes the development over a 3-year-period of short management courses for registered nurses offered as part of a professional development educational programme by Oxfordshire Health Authority (OHA) Clinical Education and Practice Team (OXCEPT). The courses were seen as role development for staff nurses, team leaders, sisters, charge nurses and senior sisters, and the content and length of courses were altered, extended and developed in response to evaluation of the courses by tutors and participants. The emphasis is on integrating participants' clinical, managerial and educational roles, as professional practitioners managing nurses and nursing.