Eating despite severe difficulties: assessment of poststroke eating

• ? A programme for the assessment and nursing diagnoses of eating difficulties among stroke patients was tested. The patients' experiences regarding eating were expressed in interviews and dialogues. Eating was observed during both a test meal and regular meals.
• ? The assessments included the prerequisites for eating as well as oral, pharyngeal and oesophageal functions.
• ? General and specific nursing diagnoses as well as life consequences (handicap) were established, based on assessment of disabilities and impairments, and interviewing the patients and their families, respectively. The general nursing diagnoses were formulated on admission after the test meal and these were reformulated to form specific nursing diagnoses after assessments of the functions.
• ? The programme presented proved to be useful in clinical practice. It is emphasized that many assessments must be co-ordinated for each individual.

     

Nitric oxide inhibits establishment of macroschizont-infected cell lines and is produced by macrophages of calves undergoing bovine tropical theileriosis or East Coast fever

Nitric oxide (NO) was produced when bovine peripheral blood mononuclear cells (PBMC) or purified, adherent PBMC (macrophages) were incubated in vitro with bovine recombinant interferon gamma (Bo rIFN-γ). NO was produced by cells from naive, uninfected calves as well as by cells from cattle either infected with or recovered from infection with Theileria annulata or Theileria parva. PBMC of cattle undergoing tropical theileriosis (T. annulata infection) or East Coast fever (T. parva infection) synthesized NO spontaneously in vitro. NO was also induced when PBMC of immune, but not of naive, cattle were cultured with T. annulata macroschizont-infected cell lines. Macrophages alone were not stimulated to produce NO by such infected cells. In vitro establishment of macroschizont-infected cell lines was suppressed either by incubating sporozoites with S-nitroso-N-acetyl-DL-penicillamine (SNAP), a NO releasing molecule, prior to invasion of PBMC or by pulsing developing cultures of trophozoite-infected cells with SNAP. Proliferation of established macroschizont-infected cell lines was not affected by SNAP. Taken together with the well documented roles of NO in neurotransmission, vasodilatation, cell and tissue damage and immunosuppression, the results presented here indicate that NO may not only protect cattle against T. annulata and T. parva but, if produced in excess, play a prominent role in the pathogenesis of tropical theileriosis and East Coast fever.     

Regional differences in hospital use by adults in Spain

The purpose of this paper was to study regional differencesin the use of in-patient hospital services by adults in Spainand to explore how several factors are related to hospital utilization.We studied a sample of 20,741 individuals representative ofthe non-institutionalized Spanish population older than 15 yearsold interviewed in the Spanish health interview survey, carriedout in 1993. A logistic regression model was used to obtainthe odds ratios of using the in-patient hospital services forsocioeconomic status, health care need, health services resourcescharacteristics and for the 17 autonomous communities into whichSpain is divided. Aragon, Baleares and Navarra showed a highpercentage of people using hospital services while in Madridand Asturias a low percentage was found. Indicators of needfor health care were the most important predictive factors ofhospital utilization and neither socioeconomic status nor healthcare system characteristics were associated with the use ofhospital services. Although only 5 autonomous communities showeda high or low percentage of people using hospital services,the unexplained variance needs further research in order toidentify unnecessary reasons for utilization and accessibilityproblems.     

Neutral steroid metabolites in patients with uraemia and after renal transplantation: a quantitative and qualitative study in body fluids

Steroid metabolites enriched from urine, haemofiltrate, and CAPD-dialysate (Continuous Ambulatory Peritoneal Dialysis) were identified by gas chromatography-mass spectrometry and quantified by capillary gas chromatography. The study included twenty healthy controls, twenty-six non-dialysed uraemics, thirty-nine patients on regular dialysis treatment, and twenty-two allograft recipients. Compared to the 24 h urinary excretion rates of controls the excretion rates of androsterone and etiocholanolone were in the lower normal range up to significantly decreased in the body fluids of all patients, and those of the corticoid metabolites were also significantly decreased. 11-Oxygenated androstanolones in urine from non-dialysed uraemics correlated significantly decreased. 11-oxygenated androstano-levels and were significantly increased, but normal in haemofiltrate and CAPD-dialysate, while in urine of allograft recipients the values were significantly lower.     

The identification of urinary bile alcohols by gas chromatography–mass spectrometry in patients with liver disease and in healthy individuals

Abstract. The neutral steroid fractions in the urine of eleven patients suffering from various forms of liver disease with cholestasis and of ten healthy individuals were studied by glass capillary gas chromatography-mass spectrometry. The steroid conjugates in urine were enzymatically solvolysed, the liberated steroids extracted and transformed into the trimethylsilylether for measurements.
The excretion rates of androstane and pregnane metabolites of patients with liver disease were far lower than those of healthy persons. The main compounds in the urine of the former were the bile alcohols 27 - nor -3α, 7α, 12α, 24, 25 - pentahydroxy - 5β - cholestane and 3α, 7α, 12α, 25, 26 - pentahydroxy - 5β - cholestane. Our data suggest a correlation between the excretion rates of these bile alcohols and the serum levels of bilirubin. While the excretion rate of the two bile alcohols in the urine of healthy individuals was approximately 0.24 mg/24 h (0.6 μmol/24 h) a patient with a serum bilirubin of 841 μmol/1 excreted 4 mg/24 h (9 μmol/24 h). The accumulation of bile alcohols described in this study possibly indicates alternative pathways of cholic acid formation in liver disease.     

Dissimilar Action of Two Cyclic Adenosine-Monophosphate Analogues on the Sodium Current in Intact Rat Papillary Muscle

In intact papillary muscles from rat we have found with the loose-patch-clamp technique an increase of the fast cardiac sodium current (I_Na⁺) by isoproterenol (ISO). In this study we have tested two membrane permeable analogues of the intracellular second messenger cyclic adenosine-monophosphate (cAMP) to investigate the intracellular pathway: 8-Br-cAMP (50 μM) and the newer developed S_p5,6-Dichloro-1-β-D-ribofuranosylbenzimidazole-3′, 5′-cyclic-monophosphor-othioate (5,6-DCl-cBiMPS, 20 μM). The availability of I_Na⁺ was determined with test pulses to ± 0 mV every 3.5 seconds after 2.5-second conditioning between -130 mV and-50 mV and a holding potential at the resting potential of the cell under examination, and after wash-in of either compound. The peak currents were fit to a Boltzmann equation, and expressed by the maximal attainable current INa⁺_Na,max the mid-point potential V½, and a steepness parameter a. Values are given by mean ± SEM. 8-Br-cAMP showed a significant shift of the availability curve in the hyperpolarized direction (V½= -82 ± 2 mV vs - 66 ± 2 mV, n = 5, P < 0.05) with only minor changes of I⁺_No,max and a. In contrast, 5,6-DCI-cBiMPS had no significant effect on V½ but increased I⁺_Na,max by 8%± 2% versus control (n = 5. P < 0.05). In an intact muscle preparation we have found that 5,6-DCI-cBiMPS has a similar effect as that observed with the β-adrenergic agonist ISO (100 nM), whereas 8-Br-cAMP exhibited a dissimilar action. This indicates, that ihe effects of ISO are transmitted by the cAMP system. On the other hand, 8-Br-cAMP, which is not as permeable and specific an activator of the cAMP dependent proteinkinase, may have other effects on the sodium channel, perhaps mediated through purinergic receptors.     

Attitude of the Norwegian population to drug policy and drug-offences

A national survey on people's conceptions of various intoxicants and their attitudes towards such substances shows a high degree of support in Norway for the current very restrictive drug policy. Only 6% were in favour of a more liberal practice with regard to use of cannabis. The attitudes had changed little from 1968, when a similar study was carried out. Even a majority of those who reported having used cannabis themselves said that all use should be prohibited. A comparison of the crime of possessing quite a small quantity of cannabis with other commonplace violations of the law showed that the drug offence was considered a serious crime. Although the penalties for drug offences have been raised dramatically several times since the end of the 1960s, a majority still said that the punishment prescribed by the Norwegian law for being involved with drugs is too mild.