On the differential suppression of cholesterol synthesis by low density lipoprotein in B and T lymphocytes.

Cholesterol synthesis and its suppression by low density lipoprotein cholesterol were measured in purified B and T peripheral blood lymphocytes. After preincubation for 53 h in lipoprotein-deficient serum, both B and T cells exhibited increased cholesterol synthesis as compared with synthesis measured in cells immediately after their isolation from blood and without preincubation with lipoprotein-deficient serum. The magnitude of this increase was far greater in T cells in comparison with that in B cells in all subjects studied. But, whereas there was an immediate and progressive suppression of cholesterol synthesis in lipoprotein-deficient serum-incubated T cells as the concentration of low density lipoprotein cholesterol in the medium was increased, synthesis in lipoprotein-deficient serum-incubated B cells remained insensitive to the presence of low density lipoprotein in the medium. Hydroxymethylglutaryl-CoA reductase activity was observed also to follow a similar pattern in both cell types. These observations may imply that one or more events, including binding of low density lipoprotein to its receptor, internalization and degradation of low density lipoprotein receptor complex finally leading to suppression of hydroxymethylglutaryl-CoA reductase activity and cholesterol synthesis, fail to take place in B cells.

A European perspective on organ procurement: breaking down the barriers to organ donation.

A worldwide shortage of donor organs has led to the development of national and international systems for organ procurement and allocation. Such systems promote organ donation and ensure fair distribution of available donor organs through a combination of legislation, organ exchange organizations (OEOs), transplant coordinators, publicity campaigns, donor cards, and professional training programs. The development of national and international OEOs is central to this process because they maintain waiting lists and allocate organs in the most appropriate way. Most countries also employ transplant coordinators whose role involves promoting links between transplant centers and intensive care units, establishing protocols for organ donation, and helping hospital staff deal with the sensitive issues involved in organ donation. Educational initiatives, such as the European Donor Hospital Education Programme developed by Eurotransplant is now used in over 30 countries worldwide. The program aims to improve professionals' understanding of the legal and ethical issues involved in transplantation, to help them communicate effectively and sympathetically with bereaved families, and to increase organ donation rates. Other initiatives include programs such as the Donor Action Programme, which was set up by professional organizations in the US and Europe aiming to help hospitals establish tailor-made organ procurement policies to ensure that all potential donors can be identified and reported and the needs of unfortunate families can be met in a caring and sensitive manner.

Gastric outflow obstruction caused by gall stones and leading to death by complex metabolic derangement.

A 67 year old woman was admitted with a three week history of vomiting, having become increasingly confused for three days. Investigations revealed deranged serum biochemistry consistent with a combination of a diabetic non-ketotic hyperosmolar state and a metabolic alkalosis consistent with gastric outflow obstruction. She was treated with intravenous saline, intravenous insulin, and subcutaneous heparin, but did not improve clinically and had an asystolic cardiac arrest the following day; she was transferred to the intensive care unit and despite treatment with inotropes she died 40 hours after admission. Necropsy revealed that the stomach was massively dilated with gas and stomach contents, and contained many small black faceted gall stones. In addition a large nonfaceted brown-yellow gall stone was wedged in the pyloric antrum causing total obstruction. The patient had died from a complex metabolic derangement including non-ketotic hyperosmotic diabetic coma and metabolic alkalosis precipitated by the acute gastric outflow obstruction complicated by previously undiagnosed type II diabetes mellitus.

Oral hygiene habits, denture plaque, presence of yeasts and stomatitis in institutionalised elderly in Lothian, Scotland.

The purpose of the present study was to examine the relation between oral hygiene habits, denture plaque, presence of yeasts and stomatitis in institutionalised elderly. A sample of 201 residents, 48-99 yr of age (mean age 82 yr), was selected from four different institutions in Lothian, Scotland. Clinical recordings were carried out under standardised circumstances using well recognised indices. Information about oral hygiene habits was obtained through structured interviews conducted immediately before the clinical examination. A multivariate analysis, principal component, was carried out on the correlated five maxillary denture plaque scores and two components, accounting for 74% and 12% of the variation, were identified. Using these two independent variables, an analysis of variance was carried out testing for significance between the four effects: soaking habits, brushing habits, denture stomatitis and growth of yeasts in the palate together with their interactions. The analysis showed a significant relation between maxillary denture plaque, soaking habits and the presence of denture stomatitis. There was no relation between denture plaque and brushing habits or between denture plaque and growth of yeasts.

Oral health promotion for institutionalised elderly.

The purpose of the present study was to develop and evaluate educational approaches specifically for improvement of oral hygiene behaviour amongst institutionalised elderly. A sample of 201 residents, 48-99 yr of age (mean age 82 yr), was selected from four different institutions in Lothian, Scotland. A clinical examination and a structured interview were conducted immediately before and 2 months after the termination of the programme. The four institutions were blind to the examiner and randomly allocated to a control group or one of the three programmes; 1) active involvement of staff only; 2) active involvement of residents only; 3) active involvement of both residents and staff. The programme comprised three 1-h sessions at monthly intervals in groups of five to six residents or members of staff. The analysis of the results showed poor oral health and oral hygiene, high objective need for oral care but low perceived need. The programme had little impact on most of the included variables and only about half of the participants remembered the programme 2 months after its termination. The implications of the study are that groups of elderly need to be differentiated further so that only well and not confused elderly participate in programmes such as this and less well and confused elderly receive regular professional support with oral hygiene.

Dental caries experience and defects of dental enamel among 12-year-old children in north London, Edinburgh, Glasgow and Dublin.

A multi-center study of caries experience and defects of dental enamel was conducted among 12-yr-old children in north London, Edinburgh, Glasgow and Dublin. None of the cities had water fluoridation except Dublin, which was included in the national program introduced in the Republic of Ireland in 1964. A random sample of children was drawn from state schools in each location and identical methods of clinical examination were used throughout under the same standardized conditions. All examiners were trained and calibrated with a reference examiner and achieved high levels of inter- and intra-examiner consistency. Mean DMFT values for the 4 cities were 1.27 (London), 1.39 (Edinburgh), 2.70 (Glasgow) and 1.48 (Dublin) (P < 0.001). Proportions of subjects free from caries in the same order were, 50, 47, 24 and 43% (P < 0.001), and child prevalence of diffuse opacities, 28, 29, 7 and 17% (P < 0.001), respectively. The relatively low caries levels recorded in London and Edinburgh (lower than Dublin) were considered to be related most probably to fluoride effects other than water fluoridation.

Does dental health education affect inequalities in dental health?

The aim of the study was to evaluate the Lothian 1991 dental health campaigns on 5-year-old schoolchildren's oral hygiene and gingival health in relation to deprivation. A stratified random sample of 486 children was selected from 92 primary schools in the city of Edinburgh. Clinical examinations took place immediately before (T1), a month after (T2) and 4 months after the campaign (T3). A total of 342 (70 per cent) children received all 3 examinations. Oral hygiene and gingival health were examined using a modified Silness and Löe and the Ainamo and Bay Index. Toothbrushes and take-home materials were distributed to all children. Dental officers provided 20 minute information sessions for each class and encouraged teachers to continue dental health activities within the classes. For the purpose of the evaluation, schools were categorised as deprived and non-deprived according to established social indicators. The results showed a statistically significant improvement in plaque scores at T2 and T3 (P < 0.05, P < 0.01). Also gingival health improved at T2 and T3 (P < 0.01, P = 0.001). However, the improvements took place only in the non-deprived schools. Thirty-one per cent of children in non-deprived schools and 18 per cent in deprived schools had a total plaque score of 0 at T1 and 41 per cent and 19 per cent respectively at T3. The differences in gingival health scores between deprived and non-deprived schools were statistically significant at T2 and T3 but not at T1. The campaign was therefore successful when evaluating the population as a whole.(ABSTRACT TRUNCATED AT 250 WORDS)

Deprivation and dental health. The benefits of a child dental health campaign in relation to deprivation as estimated by the uptake of free meals at school.

The objectives of the present study were to evaluate the overall effect of the 1989 Lothian dental health education campaign on 8-year-old school children's dental health knowledge and behaviour and to examine the relationship between free meals and the children's benefit from the campaign. Altogether 874 children were randomly selected and included in the study. Sugar-free meals and drinks were provided in all primary schools throughout the campaign week. Dental officers held 30-minute information sessions with each class and encouraged teachers to continue dental health activities. Dental knowledge and behaviour were evaluated by interviews immediately before and after the campaign. The results showed a significant increase in knowledge about diet and dental health and a significantly higher proportion of children claimed to choose non-cariogenic foods and drinks as a result of the campaign. Toothbrushing frequency also increased significantly. Ninety-eight per cent of the children enjoyed the campaign and 66 per cent discussed it with their family. Each school was classified according to the proportion of children receiving free school meals, and this showed a statistically significant negative correlation with the proportion of children who chose non-cariogenic meals and drinks before the campaign but not afterwards. Toothbrushing frequency showed a significant negative correlation with free meals both before and after the campaign. A positive correlation was found between free meals and the proportion of children who claimed to have received new information during the campaign and ate healthier food because of it.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparative support evaluation of three ankle orthoses before, during, and after exercise.

The purpose of this study was to compare the support effectiveness of three ankle orthoses before, during, and after a 90 minute softball practice. The effect of each support method on the athletes' base running ability was also assessed. Twenty-four ankles with no history of ankle pathology were divided into three groups (n = 8), and randomly assigned to wear one of the ankle devices. Passive inversion-eversion ROM was measured on an ankle stability test instrument during five testing sessions: 1) pre-support, 2) pre-exercise, 3) 20 minutes during exercise, 4) 40 minutes during exercise, and 5) post-exercise. The data analyses revealed significant differences in support effectiveness among the three orthoses (p < 0.01). The support provided post-exercise by the Swede-O was reduced by 35% compared to its initial level of support. The support reductions for the Air-Stirrup and the Ankle Ligament Protector (ALP) were 12% and 8%, respectively. The application of the ALP and the Swede-O orthoses had no significant effect on the athletes' ability to run the bases; while the Air-Stirrup application resulted in significantly slower base running times. These results suggest that the ALP may be more effective than the other orthoses tested in guarding against initial inversion sprain trauma and protecting the ankle joint against chronic re-injury. J Orthop Sports Phys Ther 1990;11(10):453-466.

Donor Action: an international initiative to alleviate organ shortage.

CONTEXT: Donor Action, an international initiative to alleviate organ shortage, provides a comprehensive state-of-the-art methodology that helps critical care units develop a tailor-made approach to optimize donation practices and performance. OBJECTIVE: To report the impact of the Donor Action methodology on organ donation rates in 8 countries (70 critical care units) in North America and Europe. DESIGN: Baseline data on the clinical potential for donation, staff attitudes, knowledge toward donation, self-reported confidence in performing a range of donation roles, and educational requirements were gathered. These data were analyzed using the Donor Action database and improvement measures were introduced to address identified weaknesses. RESULTS: Following introduction of the program's improvement measures, which addressed identified weaknesses, donations increased on average by 53% (P = .0017) per country at 1 year. Sustained improvements settled at 70% to 160% increases at 3 years. Although Donor Action is at various stages of implementation in different countries, the number of centers and countries demonstrating an immediate awareness effect is increasing and sustained effects in centers with the longest follow-up promise a significant impact on donation rates as more countries implement this methodology.

Organ procurement: the role of the transplant coordinator.

The role of the Transplant Co-ordinator was first established in the United States of America in the early 1960s. For the first time an individual was appointed with a full-time commitment to increasing the number of donor organs made available for transplantation. Simultaneous with the appointment of transplant coordinators was the development of Organ Procurement Agencies (OPAs). The initial function of the OPAs was to assist with the movement of donor kidneys that could not be transplanted in the region of removal. The role of the coordinator has developed in two areas, education and organisation of the donor and recipient procedures, and has become crucial with the increase of multiple organ donation. The OPAs have become national data bases and along with the transplant coordinators have developed strong international links in the effort to increase organ donation and to avoid wastage of this precious resource.