Conscious perception and the modulatory role of dopamine: no effect of the dopamine D2 agonist cabergoline on visual masking, the attentional blink, and probabilistic discrimination.

RATIONALE: Conscious perception is thought to depend on global amplification of sensory input. In recent years, striatal dopamine has been proposed to be involved in gating information and conscious access, due to its modulatory influence on thalamocortical connectivity. OBJECTIVES: Since much of the evidence that implicates striatal dopamine is correlational, we conducted a double-blind crossover pharmacological study in which we administered cabergoline-a dopamine D2 agonist-and placebo to 30 healthy participants. Under both conditions, we subjected participants to several well-established experimental conscious-perception paradigms, such as backward masking and the attentional blink task. RESULTS: We found no evidence in support of an effect of cabergoline on conscious perception: key behavioral and event-related potential (ERP) findings associated with each of these tasks were unaffected by cabergoline. CONCLUSIONS: Our results cast doubt on a causal role for dopamine in visual perception. It remains an open possibility that dopamine has causal effects in other tasks, perhaps where perceptual uncertainty is more prominent.

[Challenges in the diagnostic management of fat embolism syndrome - from divergence in clinical presentation to diagnosis]. / Diagnostische uitdagingen van het vetemboliesyndroom.

This article discusses the diagnosis and management of two patients with cerebral fat embolism syndrome after traumatic femoral fractures. Fat embolism syndrome is a condition which is caused by fat globules in the systemic circulation; it most often occurs in patients with femoral fractures. Patients develop systemic dysfunction, particularly a triad of a petechial rash, respiratory and neurological dysfunction. The syndrome is characterized by a diverse clinical presentation which often necessitates a wide differential diagnosis. The pathogenesis of fat embolism syndrome has not yet been fully elucidated. Although it has been a formally recognised clinical diagnosis for years, new diagnostic imaging capabilities have provided a shift towards a visualisable disorder. Presently, there is no clear evidence and indication for dedicated treatment and therefore supportive measures remain the only treatment modality.

Risk factors for central bile duct injury complicating partial liver resection.

BACKGROUND: Bile duct injury is a serious complication following liver resection. Few studies have differentiated between leakage from small peripheral bile ducts and central bile duct injury (CBDI), defined as an injury leading to leakage or stenosis of the common bile duct, common hepatic duct, right or left hepatic duct. This study analysed the incidence, risk factors and consequences of CBDI in liver resection. METHODS: Patients undergoing liver resection between 1990 and 2007 were included in this study. Those having resection for bile duct-related pathology or trauma, or after liver transplantation were excluded. Characteristics and outcome variables were collected prospectively and analysed retrospectively. RESULTS: There were 19 instances of CBDI in 462 liver resections (4·1 per cent). One-third of patients with CBDI required surgical reintervention and construction of a hepaticojejunostomy. Resection type (P < 0·001), previous liver resection (P = 0·039) and intraoperative blood loss (P = 0·002) were associated with an increased risk of CBDI. Of all resection types, extended left hemihepatectomy was associated with the highest incidence of CBDI (2 of 9 procedures). CONCLUSION: Patients undergoing extended left hemihepatectomy or repeat hepatectomy were at increased risk of CBDI.

Syndromic management of sexually transmitted diseases in Botswana's primary health care: quality of care aspects.

OBJECTIVES: To evaluate the quality of care of the syndromic management of sexually transmitted diseases (STDs) in Botswana's primary health care. METHODS: Participative observations of 224 consecutive consultations of patients with STDs (135 females and 89 males) by nurses. Twenty-one cases were excluded because no STD checklist was filled in. Criteria for acceptable history taking, physical examination and correct treatment were agreed upon. RESULTS: The quality of history taking and physical examination was acceptable for 25% and 23% of the women and for 54% and 57% of the men, respectively. Approximately, 65% of the women and 81% of the men received appropriate treatment. On average, consultations took 5.4 min for women and 4.6 min for men. STD contacts comprised 11% of STD cases. Advice on partner notification was provided to 66% of the women and 86% of men, and 75% and 89%, respectively, were counselled on the use of condoms. In half of the health facilities the lack of a fixed light source was the main constraint in carrying out a vaginal speculum examination. The availability of antibiotics and condoms was excellent. In 40% of the health facilities, all STD algorithms were displayed in the consultation room. CONCLUSION: One-third of women and one-fifth of men did not receive appropriate treatment for their STD, in spite of excellent provision of drugs. Although Botswana health workers perform relatively well on partner notification and counselling, there is considerable scope for improving the quality of medical history and clinical examination, especially in women. Emphasis should be given on training health workers in clinical examinations, in particular in pelvic examinations, and to supervision and in-service training.

Labelling and patient knowledge of dispensed drugs as quality indicators in primary care in Botswana.

OBJECTIVES: To assess the quality of dispensing and patient knowledge of drugs dispensed in primary care in Botswana. SETTING: Thirty randomly assigned primary healthcare facilities in three districts of Botswana. PARTICIPANTS: Patients visiting clinics and health posts. DESIGN: Analysis of data from prospective participative observations of the drug dispensing process and interview of patients about their knowledge of drugs received immediately after dispensing. The quality of drug labelling was assessed by calculating mean labelling scores composed of five dispensing attributes: name of patient, and name, strength, dosage, and volume of the drug (incorrect or no labelling=0, 1 point for each correct labelling attribute; maximum score=5). Mean knowledge scores were obtained immediately after dispensing from patient recall of name and dosage of drug, duration of treatment, and reason for prescription (incorrect recall=0, 1 point for each correct recall attribute; maximum score=4). RESULTS: 2994 consecutive patient consultations were analysed. The mean labelling score was 2.75. Family welfare educators and pharmacy technicians scored highest (3.15 and 2.98, respectively) and untrained staff lowest (2.60). Factors independently associated with the labelling score were analgesics v other drugs, district, health posts v clinics, education of prescriber (nurse best), and years of experience of prescriber (4-11 years best). The mean patient knowledge score was 2.50. The reason for prescription of the drug(s), dosage, duration of treatment, and name of the drug(s) was recalled by 92%, 83%, 44%, and 31% of patients, respectively. The qualification level of the dispenser was the strongest factor independently associated with the knowledge score. Antibiotics had the second lowest score, both for labelling (2.39) and patient knowledge (2.39). CONCLUSION: Only trained dispensing staff provided satisfactory quality of labelling. Patients had a fair knowledge of the drugs dispensed. The knowledge of drugs dispensed by family welfare educators was less than satisfactory. The labelling score is a useful indicator of the quality of dispensing, and the knowledge score of both the quality of prescribing and of dispensing. These indicators should be added to the WHO list of patient care indicators.

Adherence to treatment guidelines in primary health care facilities in Botswana.

OBJECTIVES: To assess the quality of nurses' prescribing through an assessment of their prescription in relation to diagnosis, and to investigate trends in drug use in Botswana primary health care. METHODS: Key data regarding nurses' adherence to national prescription and treatment guidelines were obtained through participatory observation using a questionnaire, related to each consultation. Adherence was categorized into (i) Full adherence, (ii) acceptable adherence, (iii) acceptable adherence, but one or more useless, but not dangerous, drugs and (iv) insufficient or dangerous treatment. The study comprises data on nurses' prescriptions, diagnoses and quality of dispensing in 2994 consecutive consultations in 30 primary health care facilities in three districts of Botswana: Ngami East, Gaborone and Kgalagadi North. RESULTS: The average number of drugs prescribed per patient was 2.3. Antibiotics were prescribed in 27% of all encounters. Full adherence was found in 44%, acceptable compliance in 20%, 'acceptable, but one or more useless, but not dangerous, drugs' in 33% and 'insufficient or dangerous treatment' in 3% of the consultations. Four factors were found to be independently associated with full adherence: patient age 16-31 years, specified diagnosis, type of health facility and nurses' years of practice (4-11 years best). CONCLUSION: Although Botswana's health workers perform relatively well in terms of drug use indicators, there is a clear potential for improving health workers' adherence to national treatment guidelines.

Cattle eradication and malnutrition in under five's: a natural experiment in Botswana.

BACKGROUND: An outbreak of contagious bovine pleuropneumonia (CBPP) in the northern part of Botswana in 1996 was contained through eradication of all heads of cattle in Ngamiland district (Ngami East and West) in the period April 1996 to February 1997. This disaster posed a serious threat to those who depended on the livestock sector for sustenance and to the nutrition security of the population, especially the under five's. AIM: The aim of this study was to assess the impact of the cattle eradication on the nutritional status of children. METHOD: A secondary analysis of existing data from the Botswana National Nutrition Surveillance System enabled us to study the impact of this disaster on malnutrition in the under five's by comparing quarterly malnutrition rates for Ngami East with national figures for the period of January 1995 to March 1998. RESULTS: While the risk for malnutrition among under five's in Ngami East increased from 0.046 to 0.105 during the study period, giving a relative risk of 2.299, the increase in risk for Botswana was from 0.133 to 0.139, giving a relative risk of 1.048. The attributable risk for cattle eradication impact on malnutrition was 4.6% for Botswana and 54.4% for Ngami East. CONCLUSION: The cattle eradication impacted seriously on the food and nutrition security of the under five's in Ngami East, compared with the country as a whole.

[Chief medical officers and preventive health care]. / Den medisinsk-faglig ansvarlige lege og det forebyggende helsearbeidet.

A survey conducted among all Norwegian Chief Municipal Medical Officers, provided information about their formal role and involvement in health promotion work. Of the total respondents, 71% regularly attended meetings of the Municipal Board of Health and 32% attended meetings of the Building Council; 80% had authority to forward proposals to the Board of Health on matters of environmental health. On average, the Chief Municipal Medical Officers spent one-fifth of their working time on community health promotion activities. 80% of the respondents would have liked to spend more time on these activities. These officials should have a stronger formal position in the field of health promotion, and they themselves should give higher priority to health promotion work.

[Locally based health promotion. Meetings of citizens as a tool for population mobilization]. / Naermiljøbasert helsefremmende arbeid. Folkemøter som redskap i befolkningsmobilisering.

It is necessary to involve the local population to a greater extent in the work of health promotion and prevention of disease. In the municipality of Askvoll the results of a household survey were used as an educational tool at popular meetings in the different settlements. At these meetings, the local citizens themselves chose actual health promotion projects and elected committees to carry them out. The article describes our experiences from this way of mobilizing the community. The attendance rate varied from 3% to 29% of the local population aged over 15 years. More women than men participated. A total of 17 local projects were chosen. We conclude that popular meetings can be a useful tool in local health promotion work.

[Registration in practice as a tool in the compilation of a community diagnosis in Askvoll municipality]. / Praksisregistrering som redskap i utarbeiding av kommunediagnose for Askvoll.

When trying out various models for community diagnosis we registered a sample of doctor-patient contacts in Askvoll municipality over one year. One fifth of all contacts, 2,743, were registered. The contact rate per year was 3.8 per inhabitant. 79% of the contacts were consultations, 10% home visits and 11% telephone consultations. The three most commonly registered diagnostic groups were musculoskeletal diseases, cardiovascular diseases and "preventive medicine". Together with a household survey and an analysis of public statistics on mortality, morbidity and disability in our municipality, the registration of doctor-patient contacts form the basis of a community diagnosis. This community diagnosis will help to steer health planning and preventive work in our district in the right direction.

Dose-response characteristics for glucose-stimulated insulin release in man and assessment of influence of glucose on arginine-stimulated insulin release.

Glucose potentiates arginine-induced insulin release. We investigated the dose-response characteristics for both phases of glucose-induced insulin release in normal man, and studied the influence of hyperglycemia on arginine-induced insulin secretion. Dose-response curves of plasma C-peptide increments achieved during 60-minute hyperglycemia clamps (7, 11, 17, 24, and 32 mmol/L) with and without a primed continuous infusion of arginine (infusion rate, 15 mg/kg/min) were analyzed with a modified Michaelis-Menten equation. The ED50 (half-maximally stimulating blood glucose concentration) of first-phase insulin release (determined from plasma C-peptide increments at 5 minutes) was significantly lower than the ED50 for the second phase (60 minutes; 8.4 +/- 0.8 v 14.3 +/- 1.3 mmol/L, respectively, P less than .002). Combined glucose-arginine stimulation significantly increased insulin release. Vmax of both phases of glucose-arginine-stimulated insulin release were positively correlated (r = .75, P less than .05). The ED50 of the influence of glucose on first-phase arginine-induced insulin release was significantly lower than the ED50 for the second phase (9.0 +/- 1.1 v 12.7 +/- 1.0 mmol/L, respectively, P less than .02). For each insulin secretion phase separately, the ED50 for the influence of hyperglycemia on arginine-induced insulin release were not significantly different from the ED50 for glucose-induced insulin secretion (without arginine). When dose-response curves of plasma insulin increments were analyzed with the same equation, the ED50 of second-phase glucose-induced plasma insulin increments was significantly higher than the ED50 assessed from the plasma C-peptide increments (21.6 +/- 2.8 v 14.3 +/- 1.3 mmol/L, respectively, P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Use of public health statistics in the development of community diagnosis]. / Bruk av offentlig helsestatistikk i utvikling av kommunediagnose.

A community diagnosis which describes the health of the local population may be an important instrument in promoting health and preventing disease. Most general practitioners do not have time to carry out individual surveys in the local community. Therefore it seems relevant to look into the possibility of utilizing official health statistics as a basis for community diagnosis. We obtained and analysed demographic data, mortality data, statistics on cancer, data on causes of invalidity and risk factors for cardiovascular diseases for Askvoll municipality. This article demonstrates possibilities, obstacles and constraints in the use of such statistics. Suppliers of register data should make routine health statistics more available for use in the district health services. In this connection we recommend the development of a central health data information system.