Mapping a comprehensive assessment tool to a holistic definition of health for person-centred care planning in home care: a modified eDelphi study.

BACKGROUND: Researchers in the Netherlands proposed the Pillars for Positive Health (PPH) as a broadly encompassing health definition to support more realistic and meaningful care planning for people living with chronic disease and other life-long health conditions. The PPH was subsequently converted to the My Positive Health (MPH) spider web visualization tool. This study sought to identify opportunities for more person-centred care planning at the point of care in home care, using the MPH tool as a framework to link comprehensive assessment and dialogue-based goal-setting. METHODS: A modified eDelphi method was used to conduct domain mapping with a purposively sampled expert panel (n = 25). The panel consisted of researchers, health care providers, older adults and caregivers. A two-stage eDelphi process was conducted, with each stage consisting of three survey rounds. In the first stage, participants were asked to map 201 elements of the interRAI Home Care (interRAI HC) comprehensive assessment tool to the six MPH domains or "No pillar of best fit". The second stage focused on identifying opportunities to adapt or expand comprehensive assessment as it relates to the MPH domains. RESULTS: In Stage 1, 189 of 201 elements reached consensus in domain mapping. These included: 80 elements for Bodily Functions, 32 for Daily Functioning, 32 for Mental Wellbeing, 24 for Quality of Life, 10 for Participation, and 1 for Meaningfulness. Ten elements were identified to have no pillar of best fit. The 12 elements that did not reach consensus in Stage 1 formed the basis for Stage 2, where expert panel participants proposed four new assessment elements in Meaningfulness and Participation and 11 additional descriptors across the six MPH domains. Of these, two elements and nine of the 11 descriptors reached consensus. CONCLUSION: Findings show that elements of the interRAI HC are oriented toward the physical, functional, and mental health domains. Consequently, complementary assessment elements and/or tools may be needed to support comprehensive assessment of 'Meaningfulness' and 'Participation' in person-centred home and community care. Additional descriptors may also be needed to aid communication regarding the understanding and application of MPH domains.

Iron in boreal river catchments: Biogeochemical, ecological and management implications.

Iron (Fe) is an important element in aquatic ecosystems worldwide because it is intimately tied with multiple abiotic and biotic phenomena. Here, we give a survey of manifold influences of Fe, and the key factors affecting it in the boreal catchments and their waters. It includes the perspectives of biogeochemistry, hydrology, ecology, and river basin management. We emphasize views on the dynamics and impacts of different forms of Fe in riverine environments, including organic colloids and particles, as well as inorganic fractions. We also provide perspectives for land use management in boreal catchments and suggest guidelines for decision making and water management. Based on our survey, the main emphases of water protection and management programs should be (i) prevention of Fe mobilization from soil layers by avoiding unnecessary land-use activities and minimizing soil disturbance in high-risk areas; (ii) disconnecting Fe-rich ground water discharge from directly reaching watercourses; and (iii) decreasing transport of Fe to watercourses by applying efficient water pollution control approaches. These approaches may require specific methods that should be given attention depending on catchment conditions in different areas. Finally, we highlight issues requiring additional research on boreal catchments. A key issue is to increase our understanding of the role of Fe in the utilization of DOM in riverine food webs, which are typically highly heterotrophic. More knowledge is needed on the metabolic and behavioral resistance mechanisms that aquatic organisms, such as algae, invertebrates, and fish, have developed to counter the harmful impacts of Fe in rivers with naturally high Fe and DOM concentrations. It is also emphasized that to fulfil the needs presented above, as well as to develop effective methods for decreasing the harmful impacts of Fe in water management, the biogeochemical processes contributing to Fe transport from catchments via rivers to estuaries should be better understood.

Fear conditioning is associated with synaptogenesis in the lateral amygdala.

Fear conditioning in the rat typically involves pairing a conditioned stimulus (tone) with an aversive unconditioned stimulus (foot shock) which elicits a freeze response. Although the circuitry that underlies this form of learning is well defined, potential synaptic changes associated with this form of learning have not been fully investigated. This experiment examined synaptic structural plasticity in the lateral amygdala which is critical for the acquisition of the conditioned fear response. Adult male rats were randomly allocated to either a paired, unpaired or tone only condition. One day after the initial fear conditioning session and 1 h after a probe trial confirmation of a conditioned fear response, the rats were perfused and the relevant tissue was embedded for electron microscopic analysis. Synaptic changes were quantified in the lateral amygdala using a stereological approach. The results showed a significant increase in the number of synapses in the conditioned animals compared to controls. This finding suggests that an increase in synaptic compliment in the amygdala may underlie the acquisition of the conditioned fear response.

Detection of aneuploidy in human spermatozoa of normal semen donors by fluorescence in situ hybridization.

We have studied human spermatozoa from 24 normal, healthy unexposed men, 18 of whom were semen donors at the Sperm Bank in Turku, using multicolor fluorescence in situ hybridization with two chromosome-specific probes. The possible age-related increase in aneuploidy frequencies was assessed. Ten thousand spermatozoa were scored per individual for the presence of hyperploid, i.e., disomic and diploid, cells. The overall hybridization efficiency was 98.8%. The frequency of spermatozoa with two chromosome 1 signals was 11.5 +/- 5.2/10,000. The frequency of spermatozoa with two chromosome 7 signals was 6.4 +/- 3.9/10,000. Diploidy was present in 15.0 +/- 8.9/10,000 spermatozoa. Interindividual variation was quite large. No statistically significant correlation between age of the donors (range = 20-46 years) and the frequency of hyperploid spermatozoa was observed. The results give background information on the incidence of hyperploid spermatozoa in unexposed men and encourage the use of this novel technique of future studies on genetic effects in men exposed to potentially aneuploidogenic agents.

Incidence of aneuploid spermatozoa among infertile men studied by multicolor fluorescence in situ hybridization.

We studied by fluorescence in situ hybridization the frequency of aneuploidy in spermatozoa of 12 infertile men: 8 with normal or nearly normal semen analysis values and 4 with oligo-astheno-teratozoospermia. The control group consisted of 18 normal healthy fertile men. Probes for chromosome 1 and 7 were used and 10,000 spermatozoa per individual were scored. The hybridization efficiency was good (higher than 98%). In the group with nearly normal semen analysis values the frequencies of spermatozoa disomic for chromosome 1 or chromosome 7 were 0.08% and 0.07%, respectively, and not elevated compared to controls (0.10% and 0.06%, respectively). The frequency of diploid spermatozoa was 0.17%, not significantly different from the control group (0.15%) either. In the group of oligoastheno-teratozoospermic men both the frequencies of disomic cells for chromosome 1 (0.22%) and for chromosome 7 (0.13%) and of diploid spermatozoa (0.56%) were significantly higher compared to controls, although this was mainly due to one patient with high frequencies of hyperploid sperm. The results indicate that infertility may be a risk factor for chromosomal aneuploidy in spermatozoa.

Acquired toxoplasmic chorioretinitis.

A patient developed an acquired toxoplasmic chorioretinitis 11 days after exposure to infected animals. As systemic manifestations of the disease, the patient had rhinitis, sore throat, muscular pains, fatigue, cervical lymphadenopathy, and cardiac symptoms, with highly elevated Toxoplasma antibody titers. During treatment with prednisone, the chorioretinal lesion progressed to the macular area, but improvement was seen when pyrimethamine and sulfonamide therapy was started. The importance of this case relates to the unusual occurrence of acquired infection with systemic manifestations in toxoplasmic chorioretinitis and to the possibility of the transmission of toxoplasmosis by trophozoites in excretions.

Neonatal 6-hydroxydopamine alters the behavior of enriched-impoverished rats in a novel test environment.

The hypothesis that neonatal norepinephrine (NE) depletion lessens the behavioral consequences of differential housing was tested. Male Wistar rats were injected with 6-hydroxydopamine (6-OHDA) or vehicle twice within 24 hr of birth, weaned at 25 days, and reared under either impoverished (IC) or enriched conditions (EC) for 30 days. In 3 experiments, rats were tested in the Morris water maze, the colony-intruder test, and 2 tests of dominance. 6-OHDA treatment reduced cortical and hypothalamic NE concentrations and increased brainstem NE concentrations. EC housing increased cortical dopamine (DA). Behavioral differences caused by postweaning enrichment-isolation were reduced by neonatal NE depletion, primarily in early test trials. The authors conclude that forebrain NE afferents from the locus coeruleus are important for housing-related behavioral changes and responsivity to novel testing environments.

Intraventricular 6-hydroxydopamine in the newborn rat and locomotor responses to drugs in infancy: no support for the dopamine depletion model of minimal brain dysfunction.

Bilateral intraventricular injections of 6-hydroxydopamine (6-OHDA) after desmethylimipramine (DMI) in rats 1 and 2 days of age, severely depleted brain dopamine (DA) particularly in the neostriatum, where levels in adulthood were about 7% of control. Compared to vehicle-injected controls these rats were hyperactive only at 15 and 20 days of age, and in adulthood were impaired in a two-way avoidance. Rats with similar 6-OHDA treatment but without DMI pretreatment showed severe depletion of brain norepinephrine (NE) as well as DA, and were behaviorally similar to the DA-depleted only rats. This behavioral syndrome is similar to that reported after intracisternal injection of 6-OHDA in 5-day-old rats, which has been argued as a model for minimal brain dysfunction (MBD). Contrary to expectation from this model, however, challenge doses of either d-amphetamine or methylphenidate did not reduce, but instead increased activity of these rats. The 6-OHDA treatments also did not alter the enhancement of locomotor activity by scopolamine, which was present at 30 days but not at 15 days.

Neonatal 6-hydroxydopamine attenuates the neural and behavioral effects of enriched rearing in the rat.

Newborn male rats were administered subcutaneous 6-hydroxydopamine (6-OHDA) to deplete forebrain norepinephrine and after weaning were reared in normal or enriched environments. Subsequently the 6-OHDA treated rats and their vehicle controls were trained in a Lashley type III maze and then sacrificed for assay of regional brain weights and brain catecholamines. Whereas for the control rats, enriched rearing was found to: (1) increase hypothalamic and posterior cortical dopamine; (2) increase forebrain and decrease hypothalamic weight; and (3) to enhance maze acquisition, none of these consequences of enriched rearing was found in the 6-OHDA treated rats. We conclude that forebrain norepinephrine plays a permissive role in the neuroanatomical, neurochemical and behavioral alterations induced by the enriched rearing of weanling rats and that it is essential to at least some aspects of the shaping of the brain by experiential factors.

Fuchs's heterochromic cyclitis: a simultaneous bilateral fluorescein angiographic study of the iris.

Twelve patients with Fuchs's heterochromic cyclitis (FHC) were studied with simultaneous bilateral flucrescein angiography of the iris. The flow began a little earlier in the contralateral iris in 4 cases, and simultaneously in both irides in 8 cases. The radial iris vessels were narrow in 7 eyes with FHC and in the contralateral eyes of 2 elderly patients and 1 patient with pigmentary retinal dystrophy and FHC. An ischaemic sector of the iris was seen in 6 eyes with FHC, neovascularisation of the iris in 8 eyes, and fluorescein leakage of the iris vessels was seen in all eyes with FHC. No neovascularisation of the iris occurred in the contralateral eyes, and only minimal fluorescein leakage was seen at the pupillary border of 5 contralateral eyes. The results support the hypothesis of vascular pathomechanism in FHC.

Infra-red transillumination stereophotography of the iris in Fuchs's heterochromic cyclitis.

The structural pattern of the iris in 13 patients with Fuchs's heterochromic cyclitis (FHC) was studied by infra-red transillumination stereophotography. All eyes with FHC showed atrophic changes of the iris. Extensive iris atrophy appeared as light, even translucence of the iris, associated in some cases with occasional dense small patches or pigment clumps. Moderate punctate, patchy or radiate, or extensive atrophy of the sphincter muscle was seen in all eyes with FHC. Radial contraction folds of Schwalbe, structural folds of Schwalbe, and circular contraction folds on the posterior surface of the iris were visualised in few eyes with FHC, whereas they were seen in most contralateral eyes. The results suggest that infra-red transillumination sterophotography can be used as a diagnostic method in FHC.

Plasma ANP and cyclic GMP after physical exercise in patients with mitral valve disease and in healthy subjects.

Plasma levels of both atrial natriuretic peptide (ANP) and cyclic GMP are elevated in patients with various heart diseases as compared to healthy subjects. In this study patients with advanced mitral valve disease (Group A) and healthy subjects (Group B) were exposed to symptom-limited upright stepwise physical exercise on a cycle ergometer. Concentrations of ANP and cyclic GMP were measured in plasma at rest (20 min in supine position) or 5 min after physical exercise by specific radioimmunoassays. Here we show that short dynamic exercise caused a significant increase in plasma levels of ANP and cyclic GMP, in both groups. In Group A strong correlation between plasma ANP and cyclic GMP was found at rest (r = 0.91, P < 0.001, n = 11) and after physical exercise (r = 0.85, P < 0.001, n = 11). In contrast, there was no correlation between plasma concentrations of ANP and cyclic GMP in Group B at rest (r = -0.16, P > 0.05, n = 10) or after exercise loading (r = 0.14, P > 0.05, n = 10). Absolute increases in circulating levels of both substances were not found to correlate in either group. These data suggest that exercise-induced elevations in plasma cyclic GMP may be due not only to ANP release but also to an as yet undetermined factor, possibly EDRF/NO.

Forebrain norepinephrine and neurobehavioral plasticity: neonatal 6-hydroxydopamine eliminates enriched-impoverished experience effects on maze performance.

Newborn male rats were depleted of forebrain norepinephrine (NE) by systemic 6-hydroxydopamine injection and then reared from 25 to 60 days under either isolated or enriched conditions. They were subsequently tested for acquisition of either the Lashley III maze or the Hebb-Williams maze problems. Isolated rearing impaired Lashley maze performance of the controls but not the 6-OHDA injected rats. Similarly, for the Hebb-Williams maze, the isolation-reared controls made more errors than their enriched-reared counterparts while no differences were observed between the isolated and enriched reared, 6-OHDA injected rats. These results are consistent with the hypothesis that forebrain NE is permissive to the deleterious behavioral consequences of restricted experience during maturation.

Enriched housing masks deficits in place navigation induced by neonatal monosodium glutamate.

Monosodium-L-glutamate (MSG)-induced behavioural deficits were examined under two housing conditions. Male Wistar rat pups were cross-fostered at birth and injected with MSG on days 2 to 11 postpartum. Control pups were injected with saline (Sal) of equivalent volume. Following weaning at day 25 the rats were allocated to either "enriched" (EC) or "impoverished" (IC) housing, thus forming four treatment groups: MSG-EC, MSG-IC, Sal-EC, and Sal-IC. Thirty-five days later all rats were tested in the open field and in the place navigation task. Multivariate analysis of variance (MANOVA) revealed a significant two-way interaction of the housing x drug variables. While the MSG-IC rats were deficient in the water maze, the performance of the MSG-EC approached that of saline-injected controls. Although the Sal-IC rats developed higher body weights than the Sal-EC rats the MSG-EC and MSG-IC rats did not differ in body weight. The housing by drug treatment interaction was not apparent in the open field.

The postweaning housing environment determines expression of learning deficit associated with neonatal monosodium glutamate (M.S.G.).

Perinatal M.S.G. treatment causes a syndrome characterized by damage to the hypothalamic arcuate nucleus, other circumventricular areas, parts of the visual system and the dentate gyrus of the hippocampus. The resulting hormonal dysfunction may be responsible for developmental anomalies of organ systems, obesity, and alterations in sensory/motor performance. We have shown that some behavioral indicators of M.S.G. toxicity in rats can be masked by rearing them in enriched housing conditions. Here, we evaluated the impact of six housing conditions on M.S.G.-induced alterations of organ systems and behavior. Perinatal M.S.G. treatment reduced adrenal, heart and testes weights, as well as total white blood cell (WBC) counts, and increased tail flick latencies. These measures were unaffected by the housing condition. M.S.G.-induced reductions in body weight, grip strength, water maze and dominance task performance varied as a function of housing. Deficits in water maze performance were most evident following social and isolated single-cage housing. We propose that deficits in water maze performance following perinatal M.S.G. may be attributable to hippocampal damage that can be alleviated by rearing the rats in stimulating environments.

Pulmonary distribution and clearance of two beclomethasone liposome formulations in healthy volunteers.

The pulmonary distribution and clearance of 99mTc-labelled beclomethasone dipropionate (Bec) dilauroylphosphatidylcholine (DLPC) and dipalmitoylphosphatidylcholine (DPPC) liposomes were compared in 11 healthy volunteers using gamma scintigraphy. As delivered by using the Aerotech jet nebulizer both liposome aerosols had a suitable droplet size (mass median aerodynamic diameter 1.3 microm) allowing deep pulmonary deposition. However, in the total drug output during the inhalation there was a relatively large difference between DLPC and DPPC of 11.4 and 3.1 microg, respectively. In a gamma camera study no significant differences existed in the central/peripheral lung deposition between the DLPC and DPPC formulations. Progressive clearance of both Tc-labelled Bec liposomes was seen: 24 h after inhalation, 79% of the originally deposited radioactivity of DLPC liposomes and 83% of that of DPPC liposomes remained in the lungs. Thus there was slightly slower clearance of inhaled liposomes using DPPC instead of DLPC. We conclude that both liposome formulations are suitable for nebulization, although aerosol clouds were more efficiently made from the DLPC liposome suspension. Our results support the view that liposome encapsulation of a drug can offer sustained release and drug action in the lower airways.

Clinical characteristics of familial acute anterior uveitis.

Of 24 patients with familial acute anterior uveitis (AAU) 22 cases were non-granulomatous and 2 granulomatous. Of the 23 HLA tested patients 19 had the antigen HLA-B27. The 2 granulomatous and 2 non-granulomatous AAU cases were HLA-B27 negative. The iritis associated with the antigen HLA-B27 was unilateral, acute and recurrent, with cells and flare in the aqueous humor, and it lasted on an average 5 weeks. Keratic precipitates were never mutton fat, if the antigen B27 was present. X-ray examination of 8 patients revealed sacroilittis in 5. It is concluded that certain factors like trauma or infective agents may provoke familial AAU which is in close relationship with the HLA-B27 associated rheumatic group of diseases.

Infrared transillumination stereophotography of normal iris.

We studied the structure of the normal iris as seen in infrared transillumination photographs of variously pigmented eyes in subjects of different age and sex. To transilluminate the iris infrared light was passes via a fiber-glass optic through the lateral wall of the globe and photographs were taken with a Zeiss stereo slit-lamp camera. The photographs showed that the structural pattern of the iris was similar in both blue and brown eyes of either sex. The iris was rather dense in children, well developed in adults and somewhat atrophic in the elderly. On the posterior surface of the iris the radial contraction folds and the structural folds of Schwalbe and circular contraction folds were seen; they were delicate in children and more pronounced in adults and the elderly. The pupillary part of the iris ballooned forward in young people whereas in the elderly the whole iris had this configuration.

Uveitis: report of a 10-year survey in Northern Finland.

In order to determine the distribution of etiologic and diagnostic categories of uveitis at the Oulu University Eye Hospital, 653 patients with uveitis treated during the years 1964-1974 were reviewed. Of the 653 patients, 321 were men and 332 women; 547 had anterior, 64 posterior and 42 generalzied uveitis; 524 unilateral and 129 bilateral; 570 acute and 83 chronic; and 446 single and 207 recurrent. The etiologic factors were distributed into rheumatoid (7.2%), streptococcal (4.1%), tuberculosis (3.7%), toxoplasmosis (3.3%), varicella-zoster (1.7%), sarcoidosis (1.4%), staphylococcal (1.1%), leptospirosis (0.6%), lymphatic leucemia (0.5%), herpes simplex (0.5%), yersinosis (0.1%) and undetermined cases (75.8%). There were no cases of syphilis. Most of the cases in this series were anterior and acute uveitis occurring mainly in the age group 20-59 years.