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.     

PHYSIOLOGICAL AND PHARMACOLOGICAL CHARACTERIZATION OF AN INVITRO VAGUS NERVE-TRACHEA PREPARATION FROM GUINEA-PIG

• 1 The trachea with the vagus nerves attached was isolated from guinea-pigs. Contractile responses to nerve stimulation or to drugs were measured as pressure changes in the fluid-filled lumen.
• 2 Electrical stimulation of the vagus nerves caused a prompt increase in the intratracheal pressure with an optimum frequency of stimulation between 20 and 30 Hz. The response to the left vagus was somewhat stronger than the response to the right vagus.
• 3 Carbachol caused a maximum pressure increase which was about twice that achieved by bilateral stimulation of the vagus nerves at 20 Hz. In the presence of physostigmine the two sources of stimuli were equally effective.
• 4 The excitatory response to stimulation of the vagus nerves was completely inhibited by hexamethonium, atropine and terbutaline. This indicates that the excitatory response is mediated via ganglia with end-organ responses mediated exclusively by muscarinic receptors and functionally antagonized by stimulation of β₂-adrenoreceptors.
• 5 The trachea preparation exhibited an intrinsic tone which was reduced by terbutaline and indomethacin but not by atropine or hexamethonium. It is probable that prostaglandins are involved in the generation of intrinsic tone.
• 6 Noradrenaline caused a concentration dependent inhibition of the vagally mediated contractions of the trachea which was antagonized by propranolol and yohimbine. When tracheal tone was induced by carbachol only propranolol was effective thus indicating both pre- and postsynaptic effects of noradrenaline.
• 7 The present study has shown that the isolated vagus nerve-trachea is a stable and useful preparation for the evaluation of drugs acting at various levels of the contractile responses of the trachea.

     

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.     

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.     

Early experiences from the Kirseberg Public Health Project in Malmo, Sweden An alcohol prevention campaign

This article reports on a pilot demonstration to implement analcohol reduction campaign in the community of Kirseberg (population10 000) located in Malmö, Sweden. Begun in 1988, this publichealth project integrates many aspects of the comprehensivecommunity based models for heart disease and cancer preventionreported in the literature during the past two decades. Utilizinga five stage model of preventive action, the paper details theintervention activities and experiences encountered during theearly phases of community implementation. Overall, the projecthypothesizes a 25% reduction in alcohol use by the year 2000and the prevention of alcohol related problems. The varioustheoretical bases supporting the interventions are discussesedThe role of local organizations and citizen groups activelyinvolved in this partnership strategy is described. Projectobjectives and evaluation plans are presented.     

INVESTIGATION AND PROGNOSIS IN THE RETINAL PIGMENT EPITHELIOPATHIES

Eighty-three patients with retinal pigment epitheliopathy have been identified from the photographic and fluorescein records of the Tennent Institute of Ophthalmology in Glasgow. Many have been brought back for follow-up assessment. Twenty-seven patients had placoid lesions. 22 geographic lesions and 15 a condition which we propose to rename the 'not ocular histoplasmosis' (NOH) syndrome. Patients with placoid lesions could be divided into typical acute multifocal placoid pigment epitheliopathy (AMPPE), where the long-term visual prognosis was poor because of recurrent disease leading to extensive areas of atrophy, and acute diffuse placoid pigment epitheliopathy which seemed to be self-limiting. No consistent evidence of viral or immunological abnormality was found in either group of patients
Geographic lesions appeared to result either from a coalescence of focal lesions or from a slow (serpiginous) spread from a single focus.
Four patients with helicoid atrophy lost central vision from disciform lesions.
Seven patients had pigment epithelial disorder associated with sarcoidosis. The pigment epithelial disease was unresponsive to systemic corticosteroid therapy and tended to be complicated by disciform lesions.
Disciform lesions may occur in any type of pigment epitheliopathy, as may serous retinal detachment or pigment epithelial detachment.
A technique for the biopsy of choroid and retinal pigment epithelium is described. This may lead to a better understanding of these disorders.