Influence of immunostimulant polysaccharides, nucleic acids, and Bacillus strains on the innate immune and acute stress response in turbots (Scophthalmus maximus) fed soy bean- and wheat-based diets.

Immunostimulants are widely applied in aquaculture practice and may have beneficial effects on the immune system and physical functions allowing higher tolerance to stress. In the current study, the impact of four (i-iv) dietary active ingredients on the immune and stress response of turbot was examined in two experiments (I and II). A basal low fish meal (FM; 32%) diet was formulated and supplemented with (i) yeast ß-glucan and mannan oligosaccharide (GM), (ii) alginic acid (AC), (iii) yeast nucleotides and RNA (NR), or (iv) Bacillus strains (BS). The basal diet (C-LF) and a high FM (59%) control (C-HF) were maintained. All six diets were fed to juvenile turbots for 84 days in experiment I and for additional 28 days prior to experiment II. Immunological and hematological parameters were determined in experiment I. In experiment II, physical stress response to a typical short-term (<1 day) aquaculture handling procedure (combination of capture, netting/transfer, and crowding) was investigated. For this, turbot blood was sampled before and at 0.5, 1, 4, and 24 h post stress. Plasma lysozyme activity, neutrophil reactive oxygen species (ROS) production, and total plasma protein levels did not significantly differ between treatment groups; however, plasma cholesterol increased significantly in fish fed GM, AC, NR, and C-HF compared to C-LF (I). A significant increase in plasma glucose and triglyceride was observed in GM and NR treatments, while glucose levels were significantly higher in C-HF compared to C-LF. Moreover, the immunostimulant-supplemented diets exhibited significantly lower cortisol levels compared to controls C-LF (at 0.5 h) and C-HF (at 1 h) post stress, respectively (II). According to our findings, FM substitution did not modulate the innate immune response but was associated with reduced levels of cholesterol. Dietary immunostimulants were not effective enough to boost the immune response, but we believe they might be helpful to trigger metabolic advantages during stressful handling events on fish farms.

Sex differences in economic well-being.

Despite large structural changes in the economy and major antidiscrimination legislation, the economic well-being of women in comparison with that of men did not improve between 1959 and 1983. The women to men ratio of money income almost doubled, but women had less leisure while men had more, an increase in the proportion of adults not married made more women dependent on their own income, and women's share of financial responsibility for children rose. The net result for women's access to goods, services, and leisure in comparison with that of men ranged from a decrease of 15 percent to an increase of 4 percent, depending on assumptions about income sharing within households.

The health sector's share of the gross national product.

Between 1947 and 1987 expenditures for health care in the United States grew 2.5 percent per annum faster than expenditures for other goods and services. The health sector's share of the gross national product rose from well under 5 percent in the late 1940s to more than 11 percent in the late 1980s. The expenditures gap has two components: health care prices rose 1.6 percent per annum more rapidly than other prices, while the quantity of health care grew 0.9 percent per annum faster than other quantities. Many factors, including wages, productivity, technology, and insurance contributed to these trends. No single explanation suffices, and no simple solution is apparent.

America's children: economic perspectives and policy options.

American children are worse off than those in the previous generation in several important dimensions of mental, physical, and emotional well-being. During the 1960s cultural changes adversely affected children while their material condition improved substantially. By contrast, material conditions deteriorated in the 1980s, especially among children at the lower end of the income distribution. Public policies to improve the material condition of children require a transfer of resources from households that do not have children to those that do. Government programs such as tax credits and child allowances are more efficient and equitable than employer-mandated programs.

[Impact of family support over food intake and depressive status in cervical cancer patients during hospitalization]. / Impacto del acompañamiento familiar sobre la ingestión de alimentos y el estado depresivo en pacientes con cáncer cervicouterino hospitalizadas.

INTRODUCTION: Uterine cervical cancer represents a public health problem in Mexico; the patients suffer physical and psychological stress leading to depression and weight loss. Eating with a relative has positive effects in food ingestion and depressive status in hospitalized patients. In our society, food is the closest way that family members have to bring care and to show affection to the patient that has less appetite as disease goes on. OBJECTIVE: To establish the relationship between presence of the family during the meals and depresion, food intake, and weight variation during hospitalization. METHODOLOGY: 106 women admitted to the Oncology Department at the General Hospital of Mexico with a diagnosis of CUCA clinical stage II and III were studied in order to improve their condition. Weight and height, diet by means of 24 hour recalls were assessed both at hospital admission and discharge, and Beck's depression inventory was applied; the frequency with which the relatives escorted the patient was recorded. RESULTS: Patients were classified in two groups according to the frequency of family escorting; it was found that 43 patients (40.6%) were accompanied, and 63 patients (59.4%) were not. We did not find significant differences in age and days of hospital stay between the groups (p > 0.05). The escorted patients had more foods available during hospitalization (p < 0.05). Energy consumption (kcal) in escorted patients was higher by 12.7% as compared to non-escorted patients. 76.7% of the escorted patients were depressed, as compared to 55% in the non-escorted group. Significant differences were found with regards to clinical status and presence of depression (p < 0.05) between the study groups. CONCLUSIONS: Family escorting does not have an influence on the amount of foods consumed during hospitalization or body weight variation; however, it does have an influence on the presence of depression.

[Nutritional status in hospitalized patients in a public hospital in Mexico City]. / Estado nutricio en pacientes internados en un hospital público de la ciudad de México.

OBJECTIVE: To determine the frequency of malnutrition among hospitalized patients and to relate nutrition status with body mass index, fasting time, adequacy intake of protein and energy during hospitalization and length of stay. METHODS (STUDY POPULATION, SUBJECTS, INTERVENTION): We evaluated weight loss in the last 6 months prior to admission, body mass index (BMI), ideal and usual body weight percentages, days of hospitalization, energy and protein intake adequacy, fasting days and cause in hospitalized patients at different wards at Hospital General de Mexico. Patients were divided into groups according to their nutritional status (at risk/with malnutrition or normal) and data was assessed descriptively and comparatively by t-tests to determine mean differences. RESULTS: We assessed 561 hospitalized patients. We found different frequencies of malnutrition according to various indicators: 21.17% according to BMI, 38.07% and 19.57% by percentages of habitual and ideal weights--respectively-- and a weight loss in 69.57% of the patients. Mean daily energy intake was found to be of 1,061+/-432.7 kcal, while mean protein intake was 42.1 + 22.7 g, representing only the 69.4% and 54.9% of the energy and protein requirements. We found statically significant differences among malnourished and normal patients in relation to BMI (p < 0.001), length of stay (p < 0.05), energy adequacy (p < 0.001) and protein intake (p < 0.05). CONCLUSION: Malnutrition is common in hospitalized patients. An important factor in hospital malnutrition is the lack of compliance in the patient's requirements, preventing a fast recovery and increasing their length of stay. Thus, it is important to make changes and improvements in the institutional health system so that there is trained personnel in order to provide and adequate nutrition care attention to the critically ill patient, improving their condition and general prognosis.

[Effect of an intensive nutritional treatment in nutritional status of head and neck cancer patients in stages III and IV]. / Evaluación del impacto de un tratamiento nutricional intensivo sobre el estado nutricional de pacientes con cáncer de cabeza y cuello en estadio III y IV.

OBJECTIVE: Malnutrition and accelerated weight loss are frequent secondary diagnosis in patients with cancer. Head and neck cancer (H & N Cancer) affects nutritional status because of the tumor type and localization. The aim of the study was to assess the effect of an intensive nutritional treatment (INT) on nutritional status of H & N cancer patients, stages III and IV and to compare that with a historical control whose nutritional treatment was conventional (CT). METHODS: All patients were nutritionally assessed before oncological treatment started (anthropometrical, biochemical, and dietetically). A nutritional feeding plan according to their nutritional personal need was calculated. In case it was impossible to cover all the nutritional requirements orally, a feeding tube was placed. Nutritional follow up was performed each 21 days, during their oncological treatment in four occasions. The results obtained were compared with those obtained from the patients who received the CT that consisted only in nutritional counseling by the attending physician; the statistical test used was Mann Whitney U test. RESULTS: The INT was associated with maintenance of the nutritional status along their oncological treatment. The statistical significant parameters were: weight 55 to 47 kg in the CT group vs 59 a 58 kg in the INT group (p < 0.0001), and hemoglobin: from 13 to 11 g/dl in the CT group vs 14 to 13 g/dl in the INT group (p < 0.002) as the most important ones. In the rest of the data we can observe a clear tendency of increasing the nutrition parameters in patients the INT group, while in the CT group, they showed a persistent decrease. CONCLUSION: We concluded that patients who received the INT as part of their oncological treatment deteriorated less their nutritional status than those who received a CT.

[An efficient example of a Swiss pre-hospital chain of survival: the state of Vaud model]. / La chaîne des secours: le modèle vaudois.

The state of Vaud model of the pre-hospital chain of survival is an example of an efficient way to deal with pre-hospital emergencies. It revolves around a centrally located dispatch center managing emergencies according to specific key words, allowing dispatchers to send out resources among which we find general practitioners, ambulances, physician staffed fast response cars or physician staffed helicopters and specific equipment. The Vaud pre-hospital chain of survival has been tailored according to geographical, demographical and political necessities. It undergoes constant reassessment and needs continuous adaptations to the ever changing demographics and epidemiology of pre-hospital medicine.

The effect of ethanol and haloperidol on dopamine receptor (D2) density.

The study was performed to investigate the influence of ethanol on haloperidol-induced changes of the dopamine (D2) receptors in rat striatal membrane preparations. Subchronic administration of the neuroleptic in the drinking water resulted in an increase of the number of binding sites in a dose-dependent manner. Simultaneous treatment with both haloperidol and ethanol prevented the rise of D2 receptors.

Inhibition of human leukocyte elastase (HLE) by N-substituted peptidyl trifluoromethyl ketones.

A series of tripeptides possessing trifluoromethyl or aryl ketone residues at P1 were prepared and evaluated both in vitro and in vivo as potential inhibitors of human leukocyte elastase (HLE). Tripeptides containing non naturally occurring N-substituted glycine residues at the P2-position have been demonstrated to be potent in vitro inhibitors of HLE, with IC50 values in the submicromolar range. Sterically demanding substituents on the P2-nitrogen have no detrimental effect on in vitro potency. The inhibition process presumably acts via hemiketal formation with the active site Ser195 of HLE, and is facilitated by the strongly electron withdrawing trifluoromethyl functionality. Deletion of the amino acid at the P3-subsite region affords inactive compounds. Valine is the preferred residue at the P1-position, whereas the corresponding glycine, alanine, alpha,alpha-dimethylglycine, or phenylalanine analogues are all inactive. The compounds described herein all confer a high degree of in vitro specificity when tested against representative cysteine, aspartyl, metallo, and other serine proteases. One of the most potent in vitro inhibitors is (3RS)-N-[4-[[[(4-chlorophenyl)sulfonyl]amino]carbonyl]phenyl] oxomethyl]-L-valyl-N-(2,3-dihydro-1H-inden-2-yl)glycine N-[3-(1,1,1-trifluoro-4-methyl-2-oxopentyl)]amide (20i; BI-RA-260) (IC50 = 0.084 microM). Compound 20i was also tested in hamsters in an elastase-induced pulmonary hemorrhage (EPH) model. In this model, intratracheal (it.) administration of 20i, 5 min prior to HLE challenge, effectively inhibited hemorrhage in a dose-dependent manner with an ED50 of 4.8 micrograms. The inhibitor 20i, 20 micrograms administered it. 24, 48, and 72 h prior to HLE challenge, exhibits significant inhibition against hemorrhage at all time points (97%, 64% and 49%, respectively). In a 21-day chronic model of emphysema in hamsters, 200 micrograms of HLE administered it. caused an elastase-induced emphysema in the lungs which can be quantitated histologically utilizing image analysis. In this assay, 20i significantly inhibited pulmonary lesions associated with septal destruction and increased alveolar spaces, when dosed at 20 micrograms it. 5 min prior to challenge with HLE.

Novel non-nucleoside inhibitors of HIV-1 reverse transcriptase. 1. Tricyclic pyridobenzo- and dipyridodiazepinones.

Novel pyrido[2,3-b][1,4]benzodiazepinones (I), pyrido[2,3-b][1,5]benzodiazepinones (II), and dipyrido[3,2-b:2',3'-e][1,4]diazepinones (III) were found to inhibit human immunodeficiency virus type 1 (HIV-1) reverse transcriptase in vitro at concentrations as low as 35 nM. In all three series, small substituents (e.g., methyl, ethyl, acetyl) are preferred at the lactam nitrogen, whereas slightly larger alkyl moieties (e.g., ethyl, cyclopropyl) are favored at the other (N-11) diazepinone nitrogen. In general, lipophilic substituents are preferred on the A ring, whereas substitution on the C ring generally reduces potency relative to the corresponding compounds with no substituents on the aromatic rings. Maximum potency is achieved with methyl substitution at the position ortho to the lactam nitrogen atom; however, in this case an unsubstituted lactam nitrogen is preferred. Additional substituents on the A ring can be readily tolerated. The dipyridodiazepinone derivative 11-cyclopropyl-5,11-dihydro-4-methyl-6H-dipyrido[3,2-b:2',3'-e] [1,4]diazepin-6-one (96, nevirapine) is a potent (IC50 = 84 nM) and and selective non-nucleoside inhibitor of HIV-1 reverse transcriptase, and has been chosen for clinical evaluation.

Modification of different morphine actions by 6-hydroxydopamine and 6-hydroxydopamine plus desmethylimipramine.

After intracisternal 6-hydroxydopamine (6-OHDA) in mice, brain noradrenaline (NA) and dopamine (DA) are diminished, although the reduction of NA is more pronounced. Intracisternal injection of 6-OHDA in desmethylimipramine (DMI)-pretreated animals strengthens the depletion of DA while NA is partly protected. The concentration of 5-hydroxytryptamine (5-HT) is not influenced by 6-OHDA or 6-OHDA + DMI. Chronic morphine treatment to some extent enhances reduced NA and DA levels after 6-OHDA, but the decreased central catecholamine (CA) content after 6-OHDA + DMI is not raised. Morphine analgesia is highly attenuated in 6-OHDA and 6-OHDA + DMI mice. The reduction occurs in non-tolerant as well as in tolerant animals. The acute effect of morphine on body temperature is abolished with 6-OHDA, but not with 6-OHDA + DMI, whereas the interaction of central CA in morphine-induced running shows distinctly marked reduction with 6-OHDA + DMI, but not with 6-OHDA. Acute toxicity is enhanced by 6-OHDA + DMI whereas the development of tolerance against the toxicity of morphine is diminished by 6-OHDA. Lack of CA in the brain decreases sensitivity against naloxone withdrawal in acute as well as in chronic experiments.

Overview: the next step.

If we are going to reform our healthcare system, we will have to start by providing access to basic care for everyone. This can be done through embracing a strategy that is built around integrated healthcare delivery systems. Payment should be via a universal tax for the basic plan, and there should be ways in which to pursue options beyond the basic plan, to be paid for by individuals. What is provided by way of care will need to be evaluated through a central technology assessment institute. The system will have to slow the rate of growth of spending in an intelligent way, not using price controls, caps, or repressive methodologies. The trick will be to still preserve a certain amount of freedom and flexibility, and include the capacity for change. There will have to be a significant reorientation of what has been our traditional approach to malpractice. Through the course of this symposium there has not been a great deal to be positive about. There are many physicians today who are well described by the English poet A. E. Housman's line, "A stranger and afraid in a world I never made." Change is inevitable; it is here and more is coming. The great medical historian Henry Sigerist noted that: "The physician's position in society, the task assigned to him, and the rules of conduct imposed on him changed in every period. They were determined primarily by the social and economic structure of society and by the technical and scientific means available to medicine at the time."(ABSTRACT TRUNCATED AT 250 WORDS)

The Clinton plan: a researcher examines reform.

The Clintons are commended for bringing health care reform to the top of the domestic policy agenda. Their plan's basic elements are summarized and critiqued, with emphasis on the problems posed by its complexity. Five false assumptions that underlie most reform proposals are examined. They concern the burden of health care costs, the significance of firm size, the effect of health care costs on global competitiveness, the relation between insurance coverage and expenditures, and the implications of health care reform for the health of the population. Three critical issues for the future of health policy are discussed: the disengagement of health insurance from employment, the taming of technologic change, and coping with an aging society.

Health care for the elderly: how much? Who will pay for it?

Health care expenditures on the elderly tend to grow about 4 percent per year more rapidly than the gross domestic product (GDP). This could plunge the nation into a severe economic and social crisis within two decades. This paper describes recent growth in age/sex-specific health care utilization by the elderly and discusses the important role of technology in that growth. It also explores the potential for the elderly to pay for additional care through increases in work and savings. Efforts to "save Medicare" will prove to be "too little, too late" unless they are embedded in broader policy initiatives that slow the rate of growth of health care spending and/or increase the income of the elderly.

Physicians' views of the relative importance of thirty medical innovations.

In response to a mail survey, 225 leading general internists provided their opinions of the relative importance to patients of thirty medical innovations. They also provided information about themselves and their practices. Their responses yielded a mean score and a variability score for each innovation. Mean scores were significantly higher for innovations in procedures than in medications and for innovations to treat cardiovascular disease than for those to treat other diseases. The rankings were similar across subgroups of respondents, but the evaluations of a few innovations were significantly related to physicians' age. The greatest variability in response was usually related to the physician's patient mix.

The influence of antihistamine compounds on the oral intake of different addictive drugs.

The influence of two antihistamines on the oral intake of various drugs with addictive potency was investigated in rats. Under the chosen conditions neither tripelennamine nor diphenhydramine have reinforcing properties. The reinforcing potency of addictive drugs is not augmented by the both substances. On the contrary, in some cases they led to a decrease in oral intake of the drug solutions offered.

Development of dependence on levorphanol in rats by oral intake of the drug -- the influence of taste on drinking behaviour in rats physically dependent on levorphanol.

Oral administration of levorphanol solution induces physical dependence in rats within a few days, as demonstrated by abstinence symptoms such as loss of body weight, sensitivity to touch and inversion of locomotor activity after withdrawal from the drug. In order to examine whether the physically dependent rats show an active drug-seeking behaviour they were given successively free choice between sweetened levorphanol solution (LSa) and two alternative drinking liquids -- sweetened tap water (WSa) and unadulterated water (W). In the case of LSa and W the rats chose LSa, but they preferred WSa to LSa. Another group of rats made dependent on unsweetened levorphanol solution (L) had the choice between L and W. They rejected L immediately.