Evaluation of an Educational Programme for Telephone Advisers in Primary Health Care

Marklund B, Silfverhielm B and Bengtsson C. Evaluation of aneducational programme for telephone advisers in primary healthcare. Family Practice 1989; 6: 263–267. Telephone advisers, usually registered nurses, have a very importantrole in the Swedish primary health care service. In order toimprove this service, a special educational programme has beenworked out for registered nurses working at a Swedish healthcentre. The purpose of this paper is to evaluate this educationalprogramme at one of the health centres. The quality of the telephoneadvice was evaluated by a blind observer. After the educationalprogramme the quality of advice was improved. Among the participatingnurses, the confidence and the satisfaction with the work increasedafter the educational programme.     

Using socio-economic differences in knowledge and attitudes to shape community alcohol programmes: experiences from the Kirseberg Project

Community-based public health projects have become increasinglyimportant as a tool for health promotion. This approach hasbeen considered appropriate also in addressing socio-economicdifferences in health, although little is known about socio-economicdifferences in perception of health as a community issue. Ouraim was to study socio-economic differences in awareness andknowledge about the Kirseberg Project and in attitudes towardsthe concept of health as a local community issue. The KirsebergProject was initiated in 1988. The primary prevention aims areto reduce alcohol consumption in the population in order todecrease the incidence of alcohol-related problems. Kirsebergis an area with 10000 inhabitants in the north-eastern partof the city of Malmö (population 230000), Sweden. A sampleof 400 people in the area between the ages of 20 and 75 yearsof age was randomised from the population register and interviewedby telephone. Of the sample, 73.3% responded. Of the respondents,65.2% were aware of the project and 38.6% had knowledge aboutit. Socio-economic differences were found both regarding knowledgeand attitudes. Individuals in the high socio-economic status(SES)-group were better informed about the project than thelow SES-group, more often associated the project with the promotionof the community spirit, tended to give more positive answersto the questions about important local health issues, demonstratedhigher adherence to the social environment issues and were moreinterested in local health promotion activities. Our conclusionis that the socio-economic knowledge differences which werefound in the Kirseberg Project should be seen as shortcomingsin the health educational campaign rather than as a first stepin a determined social process. The issue of how the explicitnotions and the hidden agenda of a health promotion campaigncorrespond with central attitudes and values in different populationgroups in the target community must be carefully investigated.     

SEVERE HEMOSIDEROSIS POST ALLOGENEIC BONE MARROW TRANSPLANTATION

Abnormal liver function persisting late after allogeneic BMT is usually attributed to chronic GvHD, viral hepatitis or drug toxicity. We describe a patient who had negative hepatitis serology, was on no hepatotoxic medication, had no evidence of GvHD but had abnormal liver function 15 months post MBT. She was diagnosed as having grade IV hemosiderosis of the liver. Her total red cell support had only been 52 units. We therefore postulate that in a proportion of patients receiving allogeneic BMT impaired intestinal iron absorption may be an important cause of hemosiderosis.     

Shades of gray matter: Noninvasive optical images of human brain reponses during visual stimulation

Recent theories about human brain function emphasize the need for imaging methods that allow the study of dynamic interactions among different structures. In this paper, we report on a new technique, based on the measurement of parameters of migration of near-infrared photons, that yields functional images of the human occipital cortex, combining a spatial resolution of 0.5 cm and a temporal resolution of 50 ms. This technique appears to be suitable for studying the dynamics of cortical activation.     

GASTRIC EMPTYING IN PRETERM INFANTS

ABSTRACT. Cavell, B. (Department of Paediatrics, University of Lund, Lund, Sweden). Gastric emptying in preterm infants. Acta Paediatr Scand, 68: 725, 1979.—The gastric emptying of meals of human milk and infant formula was studied in 11 healthy preterm (AGA) infants at a postnatal age of 1–9 weeks corresponding to 33–38 weeks of gestational age. A total of 30 studies were performed using a marker dilution technique. Gastric emptying of meals of human milk followed a biphasic emptying pattern with an initial fast phase. In about 25 min half of the meal had left the stomach. The emptying of meals of adapted infant formula usually followed a linear pattern and half the meal had left the stomach after 51 min. After one hour an average of 24.8 ml of human milk and 19.2 ml of infant formula had left the stomach.     

The Role of Glucagon,Catecholamines and Cortisol in Counterregulation of Insulin-induced Hypoglycemia in Normal Man

ABSTRACT To study the response of glucose counterregulation to insulin-induced hypoglycemia, six normals were given a 4-hour infusion of insulin (2.4 U/h) ± somatostatin (50 μg/h). Supplementary glucagon (1.5 or 3.0 ng/kg/min) was given in additional experiments. In a separate study, glucagon was supplemented for 4 hours as a constant rate infusion (3.25 ng/kg/min) or at rates stepwise increasing from 1.5 to 5.0 ng/kg/min. Insulin decreased blood glucose by 1.5 mmol/1 and simultaneous suppression of glucagon resulted in a more pronounced hypoglycemia enhancing the adrenaline and Cortisol responses. The hyperglycemic effect of glucagon substitution (3 ng/kg/min) faded out after about 2 hours, whereafter exaggerated adrenaline and Cortisol responses to hypoglycemia were seen. A comparison between the effects of steady state hyperglucagonemia and gradually appearing hyperglucagonemia on the counterregulation of hypoglycemia revealed no significant differencies in glucose, adrenaline and Cortisol responses to insulin. It is concluded that the glycemic effect of glucagon is transient in the hypoglycemic state. When the hepatic responsiveness to this hormone is decreased during hypoglycemia, adrenaline becomes the essential protective factor.