[Working memory in multiple sclerosis: a review]. / La mémoire de travail dans la sclérose en plaques: revue de la littérature.

INTRODUCTION: Impairment of working memory (WM) is frequently reported in multiple sclerosis (MS) patients. However, the various methodologies used, as well as the populations selected for study, hinder the interpretation of results. The aim of this study is to propose a review about WM in MS. METHOD: Twenty studies have presented results on WM with neuropsychological assessment. RESULTS: All studies conclude that WM is impaired in MS. Reduced processing speed would be central, with major impact on WM performance. According to Baddeley's model, difficulties may be located at the level of the central executive. MS patients would be sensitive to tasks with a high cognitive load. However, performances seem to become better when the processing speed is adapted. Explanatory models relating to this kind of impairment have been proposed from imaging studies. Compensation could mask deficits in WM at the early stage of the disease, but would become blurred with advancing illness and increasing load required for the task. CONCLUSIONS/PROSPECTS: In order to assess WM, adapted tools should be proposed to MS patients. Focus should be placed on processing speed. Further studies are needed, for instance to examine the dissociation of the processes operating within the central executive as described in Miyake's model. Imaging investigations have provided essential data helpful for understanding compensation mechanisms. These data should be useful for developing adapted remediation plans to compensate for the crippling impairment observed in everyday life.

Leptin expression is reduced with acute endotoxemia in the pig: correlation with glucose, insulin, and insulin-like growth factor-1 (IGF-1).

Leptin has been implicated in the regulation of anorexia associated with cachexia in rodents and humans. Regulation of leptin expression is under complex endocrine and metabolic control. To determine if leptin expression is regulated by acute inflammation and to define the endocrine and metabolic factor(s) that regulates leptin expression during acute inflammation, castrate male pigs (ad libitum fed, used as their own controls) were treated with saline (control period) and endotoxin (lipopolysaccharide [LPS] period). Frequent blood samples were collected to identify dynamic changes in hormones and metabolites that are known to regulate leptin expression. LPS caused fever and elevated plasma cortisol (p < 0.0004), tumor necrosis factor-alpha (TNF-alpha) (p < 0.0001), and plasma nonesterified fatty acids (NEFA) (p < 0.001) compared with control. Circulating insulin (p < 0.01), glucose (p < 0.003), and insulin-like growth factor-1 (IGF-1) (p < 0.0001), as well as adipose leptin mRNA abundance (p < 0.01), were profoundly reduced following LPS treatment compared with control. Our data indicate that during acute endotoxemia (1-10 h after injection), leptin gene expression is decreased compared with ad libitum fed animals and is more closely related to energy homeostasis than cytokine profiles in plasma.

Physiological response to acute endotoxemia in swine: effect of genotype on energy metabolites and leptin.

Certain high lean gain swine genotypes have greater sensitivity to pathogen and nonpathogen stressors evident by reduced productivity and increased mortality during disease stress or in suboptimal production environments. Saline (control) and an immunologic challenge (LPS; 25 microg lipopolysaccharide/kg BW) were administered to three genetic populations (each pig used as its own control): high lean (H), moderate lean terminal cross (MT), and moderate lean maternal cross (MM). LPS induced anorexia, and significantly increased body temperature and circulating TNF-alpha, cortisol, and NEFA in all genotypes (P < 0.0004). LPS reduced circulating glucose, insulin, and IGF-1 in all genotypes (P < 0.05). The LPS-induced hypoglycemia was significantly greater in MM versus MT and H pigs (P < 0.03). The hypoinsulinemia was significantly greater in MM versus H pigs (P < 0.02). MM pigs recovered from hypoinsulinemia slower than MT pigs (P < 0.03). Control insulin was higher in H versus MT pigs (P < 0.08), but relative to basal, the insulin response to LPS was similar. Plasma haptoglobin response to LPS was lower for MM versus MT and H pigs (P < 0.02), and tended to be lower in MT versus H pigs (P < 0.09). LPS treatment caused similar decreases in plasma IGF-1 concentrations among genotypes. Ten hours after LPS treatment, leptin mRNA abundance in adipose tissue was significantly reduced (relative to control) in MM and H pigs (P < 0.02) but not in MT pigs (P > 0.05). Physiological differences in leptin, a potent regulator of food intake and energy metabolism, may be important factors in the genetic variation in sensitivity to environmental stress.

Gadsup of Papua New Guinea revisited: a three decade view.

The purpose of this article is to share some highlights of the author's revisits to Papua New Guinea covering three decades (1962-1992) with focus on the Gadsup of the Eastern Highlands of New Guinea. In addition, some recent developments in the country are covered as well as special visits with members of the Papua New Guinea Nurses Association. A comparative analysis of the world view, social structure, and related factors is made with respect to the theory of Culture Care Diversity and Univers-ality with two Gadsup villages. In general, the researcher found limited progress and beneficial health care changes in the two villages. Rascalism with violence was discovered which had cultural functions to redress some of the socioeconomic inequities and dissatisfactions of the indigenous people. Major tenets of the Culture Care theory were supported with the Gadsup, especially related to diverse forms, meanings, and lifestyle processes.

Transcultural care principles, human rights, and ethical considerations.

During the past three decades, the author has developed and used some general principles to guide transcultural instruction, practice and research. These principles were developed from my transcultural care theory, research studies and direct clinical experiences, consultation and general writings on the subject [Leininger 1967, 1970, 1973, 1976, 1978, 1979, 1980, 1981, 1984a, 1984b, 1988, 1989, 1990]. The principles include some assumptive premises with regard to universal and diverse considerations of human beings with the importance to know and respect the cultural rights of people in order to provide meaningful, satisfying and appropriate culture care to people. Through the years, a number of nursing students, faculty, and clinicians have used these principles, rights and ethical considerations to guide them in their thinking and to protect client's human and ethical rights. Since many nurses frequently request copies of these statements for teaching, consultation and clinical work, they are published below with this intent in mind.

Transcultural nursing care values, beliefs, and practices of American (USA) Gypsies.

This ethnonursing qualitative investigation was focused on the domain of culture care values, expression and meanings of selected American Gypsies. The purpose of the study was to explicate culture care American Gypsy lifeways in order to help nurses understand this largely unknown culture, and to offer guidelines for providing culturally congruent nursing care. Leininger's theory of Culture Care Diversity and Universality was the appropriate theory to use for this study, along with the ethnonursing research method to generate emic and etic grounded data. Findings substantiated that the world view, ethnohistory, religion (moral code), kinship and cultural values, and generic folk practices were powerful influences of Gypsy lifeways and supported culture congruent nursing care. Ethnohistorical facts strongly buttressed the cultural values, norms, and moral codes for culture specific care practices. Several Gypsy culture specific and dominant care meanings, expressions, and actions were confirmed and made credible from raw data and thematic analysis. They were: 1) protective in-group caring; 2) watching over and guarding against Gadje; 3) facilitating care rituals; 4) respecting Gypsy values; 5) alleviating Gadje harassment; 6) remaining suspicious of outsiders; and 7) dealing with purity and impurity moral codes and rules. Culture specific and congruent care generated from Leininger's theory with the three predicted modes were identified to guide nursing decisions and actions.

Culture care theory, research, and practice.

Today nurses are facing a world in which they are almost forced to use transculturally-based nursing theories and practices in order to care for people of diverse cultures. The author, who in the mid-50s pioneered the development of the first transcultural nursing theory with a care focus, discusses the relevance, assumptions, and predictions of the culture care theory along with the ethnonursing research method. The author contends that transcultural nursing findings are gradually transforming nursing practice and are providing a new paradigm shift from traditional medical and unicultural practice to multiculturally congruent and specific care modalities. A few research findings are presented to show the importance of being attentive to cultural care diversities and universalities as the major tenets of the theory. In addition, some major contributions of the theory are cited along with major challenges for the immediate future.

Quality of life from a transcultural nursing perspective.

The author presents research findings derived from Leininger's theory of culture care diversity and universality bearing upon quality of life. She holds that since quality of life is culturally constituted and patterned, it needs to be studied and understood from a transcultural nursing perspective in order to advance nursing as a discipline and profession. Five major cultures are presented to illustrate culturally constituted dominant care patterns related to quality of life. These comparative data reflect more diversity than universality among the cultures. The author encourages nurse researchers to move beyond present-day overemphasis on individualism and to discover dominant transcultural care values and patterns of emic and etic knowledge focused on quality of life, health, and well-being.