Work in the cold--an information and research program in occupational health.

Hundreds of thousands of employees work in the cold. The problems concerning cold are, to a great extent, well known. There are also good suggestions about how to deal with these problems. This project deals with: Cold stress, as an important risk factor for medical illness; the problems concerning clothing and equipment; how to change the snowmobile into a modern low risk piece of equipment: international standardization usable in the field; different approaches for information to reach and be used by the workers and their chiefs.

Plasma beta-endorphin during clinical and experimental ischaemic pain.

An improved radio-immunoassay using an antiserum directed towards the N-terminal part of the endogenous opioid peptide beta-endorphin 1-31 (beta-EP) was validated and applied to a study of beta-EP in plasma during ischaemic pain. Experimental ischaemic pain induced in seven healthy volunteers by the submaximal effort tourniquet test did not change plasma beta-EP or adrenocorticotrophin. Plasma beta-EP was determined in 21 patients with acute myocardial infarction (AMI) and in seven patients with unstable angina pectoris. Plasma beta-EP was 4.9 fmol/ml with 95% confidence limits, 3.2-7.8 fmol/ml in AMI patients at admittance, and 2.9 (2.0-3.4) fmol/ml one week later in stable and pain-free condition (p less than 0.05). The level in 49 healthy persons was 2.8 (2.4-2.9) fmol/ml. Elevated beta-EP levels were found in five AMI patients with cardiogenic shock and in four AMI patients dying within 24 h after admittance compared to the rest of AMI patients (p less than 0.02). beta-EP was not elevated during unstable angina pectoris, although pain scores were similar to AMI. The AMI group revealed a significant, although weak, positive correlation between plasma beta-EP and pain score (Spearman r = 0.49, p less than 0.05), while there was no correlation during unstable angina pectoris. beta-EP was not correlated to the amount of morphine required within the 48 h after admittance of AMI patients. We conclude that the increase of beta-EP in plasma during AMI may be due to stressful factors other than ischaemic pain and that it is questionable whether beta-EP in plasma is related to antinociception.

The 24 hour variation of salivary carbamazepine and carbamazepine-10,11-epoxide concentrations in children with epilepsy.

Variations in carbamazepine (CBZ) and carbamazepine-10,11-epoxide (CBZ-EP) concentrations were measured in saliva over 24 hours in 33 children with complex partial seizures and/or generalized tonic-clonic seizures; all patients received CBZ as monotherapy. CBZ varied between 37-104% and CBZ-EP varied between 26-119%. One venous blood sample was obtained simultaneously with the first saliva sample before the morning dose of CBZ. The free fraction of plasma CBZ was 25.5%. Medication side effects are most likely to appear within 3-4 hours of drug intake; therefore, it is advisable to take another sample in children demonstrating time-related side effects. A controlled release formulation of CBZ should minimize the fluctuations of salivary drug levels of CBZ and CBZ-EP.

Problems with the immunoassay of digoxin.

Factors that affect the standardization and reliability of the radioimmunoassay of digoxin are reviewed. Some new data are presented on standardization and suggestions are made for dealing with problems in the design and techniques of assays.

Impact of administrative technology on acute care bed need.

This article reports an evaluation of the impact of three administrative technologies--Admission Scheduling (AS) Systems, Outpatient Surgery (OPS) Programs, and Preadmission Testing (PAT) Programs--on the number of acute care beds required by a hospital. The evaluation mechanism reported here is called the ADTECH Computerized Planning Model. ADTECH uses parameters of each technology, identified from previous literature and discussions with health care professionals, to predict the changes in bed requirements resulting from implementation of these programs. Data from eight hospitals of various characteristics and sizes were run to test the ADTECH model. The results from these test runs indicate that the proper implementation of AS, OPS, and PAT can significantly influence a hospital's required bed complement.

A computer-aided system for planning acute care bed need in Michigan.

As part of an effort within Michigan to promote cost containment and equitably distribute hospital resources, the Acute Care Bed Need Methodology (ACBNM), a model for determining bed need based on normative use rates, was created. We describe herein the ACBNM, the associated interactive computer system, and the data base requirements, and make suggestions for improving the methodology. We also discuss the functions the ACBNM has served in Michigan and the role it could serve in future health planning efforts.

Reproducibility of standard preparation in digoxin radioimmunoassay in plasma and serum.

We studied the reproducibility of standard preparations in digoxin radioimmunoassay in a randomized trial using serum and plasma as matrices. The errors expressed relative to the observed counts per minute (cpm) attributable to each of the procedures involved in the preparation of standards were as follows: preparation of stock solutions and dilutions, 1.3%; addition of diluted solutions to the medium, 1.2%; and residual error due to the assay procedure, 3.7%. No error caused by mixing, portioning, and storage was detected. Heparinized plasma gave lower cpm values than serum at 4.0 ng/ml (p less than 0.01), an effect that would give over- or underestimations by about 5% at that level, depending on the medium used. This suggests that standard and sample matrices should be similar. Our procedure for preparing the standards seems to be reasonably reliable; this is necessary for satisfactory monitoring of patients on digitalis therapy.