The effect of alternative feeding strategies on the feeding motivation of broiler breeder pullets.

Due to genetic selection for fast growth and high breast meat yield, commercial strains of broiler chickens and broiler breeders are predisposed to high feed intake; however, feeding broiler breeders ad libitum impairs their health and reproductive performance. Broiler breeders are feed-restricted throughout rearing to maintain health and performance, yet feed restriction results in hunger, feeding frustration and lack of satiety. The objective of this study was to examine the effect of alternative feeding strategies, including feed additives (separately or combined) and a fixed non-daily feeding schedule, on the feeding motivation and welfare of broiler breeders during rearing. At 3 weeks of age, 180 Ross 308 breeder pullets were allocated to 90 cages and fed with one of five isocaloric treatments: (1) daily control diet (control), (2) daily calcium propionate diet (CaP), (3) daily soybean hull diet (SBH), (4) daily alternative diet (alternative: CaP + SBH) and (5) 4/3 control diet (four on-feed days and three non-consecutive off-feed days per week). The CaP diet included calcium propionate at 1.4% from 3 to 6 weeks of age, and at 3.2% from 7 to 12 weeks of age, and the SBH diet contained soybean hulls included at 40%. The alternative diet included both soybean hulls and calcium propionate at the same inclusion rate as the SBH and CaP diets, respectively. Pullets were weighed and scored for feather coverage every week. A feed intake test was conducted at 3, 4, 8, 10 and 11 weeks of age for 10 min during on- and off-feed days. At 12 weeks of age, feather samples were analysed for fault bars. Data were analysed using linear mixed regression models, with cage nested in the models and age as a repeated measure. At 4 weeks of age, pullets fed soybean hull-enriched diets (SBH and alternative diets) and those on the 4/3 schedule had lower feed intake than control pullets (P = 0.02). Feathers from pullets fed the SBH diet had fewer fault bars than those fed the CaP diet (P = 0.04). The results indicated that the inclusion of soybean hulls (alone or combined with calcium propionate) and a 4/3 feeding schedule can reduce feeding motivation of broiler breeders during early rearing.

The effect of alternative feeding strategies for broiler breeder pullets: 2. Welfare and performance during lay.

Feeding broiler breeders to satiety has negative consequences on their health and reproduction. Alternative feeding strategies during rearing can improve welfare, although their implications during lay are not well understood. The objective was to examine the effect of rearing feeding treatments on the reproductive performance and feeding behavior of broiler breeders under simulated commercial conditions. At 3 wk of age, 1,680 Ross 308 pullets were allocated to 24 pens under 1 of 4 isocaloric treatments: 1) daily control diet; 2) daily alternative diet (40% soybean hulls and 1 to 5% calcium propionate); 3) 4/3 control diet (4 on-feed days, 3 non-consecutive off-feed days per week); and 4) graduated control diet. Feeding frequency of the graduated treatment varied with age and finished on a daily basis. At 23 wk of age, group sizes were adjusted to 40 hens, and 5 mature Yield Plus Males roosters were introduced to each pen. Pens were under the same daily feeding management and same diet during lay. The performance of broiler breeders (growth rate, body weight uniformity, and reproductive performance) was determined until 64 wk of age. At the end of lay, feeding motivation was examined with a feed intake test and a compensatory feeding test. Data were analyzed using linear mixed regression models, with pen nested in the models and age as a repeated measure. The laying rate of hens reared on the graduated treatment decreased slower compared to control hens, resulting in a higher cumulative egg production (178.2 ± 3.8 eggs/hen) than control hens (165.2 ± 3.8 eggs/hen, P < 0.01) by 64 wk of age. Hens reared on non-daily feeding treatments laid lighter eggs with relatively heavier yolks and had higher feed intake at the end of lay than hens fed daily during rearing (P = 0.02). In conclusion, rearing feeding treatments impacted the growth rate and body weight uniformity during lay, feeding motivation at the end of lay, and the laying rate and hatchability depending on hens' age.

Utilization of soy hulls, oat hulls, and flax meal fiber in adult broiler breeder hens.

A total of 72, 65-week-old broiler breeder hens (Ross 308, BW 4,190 ± 45 g) was placed in individual cages to investigate utilization of fiber in soy hulls (SH), oat hulls (OH), and flax meal (FM). Birds were adapted to cages for 10 d prior to allocation (n = 18) to broiler breeder ration (control) or control mixed with either of the 3 fiber sources (wt/wt) added to supply equal amounts of neutral detergent fiber (NDF) ∼21% and TiO2. The daily feed allocation was based on 4% BW. Feed intake (FI) was monitored daily, and grab excreta samples were taken on d 16 and 17. On d 18, all birds were weighed and killed 2 h post feeding to measure ceca digesta pH and short chain fatty acids (SCFA). Relative to the control birds, birds receiving fiber lost (P < 0.05) BW due to decreased (P < 0.05) FI. The BW changes were respectively +80, -174, -133, and -585 g/bird for control, SH, OH, and FM, and corresponding FI was 1,062, 918, 885, and 590 g/bird. Birds fed FM retained higher (P < 0.05) NDF than birds fed either SH or OH. The ceca digesta pH was lower (P < 0.05) in birds receiving added fiber relative to control. However, ceca digesta pH of FM fed birds was lower (P < 0.05) than in birds fed either SH or OH, which were in turn similar (P > 0.05). Birds fed FM had higher (P < 0.05) concentration of butyric acid than birds fed the control diets, while birds fed SH and OH had intermediate butyric acid concentration. Acetic acid and total SCFA concentrations were higher (P < 0.05) in birds fed OH diet than in birds fed control but was similar (P > 0.05) to that in birds fed either SH or FM. In conclusion, short term feeding of fibrous feed ingredients reduced BW linked to reduced FI. Fiber sources exhibited differences in utilization reflective of chemical characteristics.

Oxysterols: A world to explore.

Oxysterols (oxidized derivatives of cholesterol and phytosterols) can be generated in the human organism through different oxidation processes, some requiring enzymes. Furthermore, oxysterols are also present in food due to lipid oxidation reactions caused by heating treatments, contact with oxygen, exposure to sunlight, etc., and they could be absorbed from the diet, at different rates depending on their side chain length. In the organism, oxysterols can follow different routes: secreted into the intestinal lumen, esterified and distributed by lipoproteins to different tissues or degraded, mainly in the liver. Cholesterol oxidation products (COPs) have shown cytotoxicity, apoptotic and pro-inflammatory effects and they have also been linked with chronic diseases including atherosclerotic and neurodegenerative processess. In the case of phytosterol oxidation products (POPs), more research is needed on toxic effects. Nevertheless, current knowledge suggests they may also cause cytotoxic and pro-apoptotic effects, although at higher concentrations than COPs. Recently, new beneficial biological activities of oxysterols are being investigated. Whereas COPs are associated with cholesterol homeostasis mediated by different mechanisms, the implication of POPs is not clear yet. Available literature on sources of oxysterols in the organism, metabolism, toxicity and potential beneficial effects of these compounds are reviewed in this paper.

[The cost of cerebrovascular accident]. / Coste de la enfermedad cerebrovascular aguda.

INTRODUCTION AND AIM: One out of three persons will die of cerebrovascular accident (CVA), another one will be disabled, and the third one will recover. This research has been taken to estimate the costs of CVA in the Basque Country. MATERIALS AND METHODS: The cost of illness is studied from a societal perspective. It is based on the prevalence of the disease. Population costs has been estimated from the use of resources of a randomized sample of patients admitted to hospital with stroke during the year 2000, and followed for 12 months. Transitions costs (those that happen just once) and state costs (those remaining in patients lifetime) have been studied separately. RESULTS: The prevalence of CVA was 1.780 x 10(5). Average transition cost per patient was 4,762 euros and average state cost for patient/year was 10,506 euros. The estimated cost for the Basque Country is 120,249,986 euros in the year 2000. Transition costs were 16,460,729 euros and state costs 103,789,257 euros in the same year. State costs were due to disability. CONCLUSIONS: The analysis of the costs of CVA from a societal perspective gets us to the heart of illness causing disability, the social costs of CVA are 74.3% of the total cost.

Coste de la enfermedad cerebrovascular aguda / The cost of cerebrovascular accident

Introducción y objetivo. Una de cada tres personas habrá muerto al año de padecer una enfermedad cerebrovascular aguda (ECVA), otra presentará algún grado de dependencia y la tercera estará completamente recuperada. Este trabajo se ha realizado para conocer el coste de la ECVA en el País Vasco. Pacientes y métodos. Realizamos un análisis del coste de la enfermedad desde la perspectiva de la sociedad, en base a la prevalencia. Los costes poblacionales se han estimado a partir de los consumos de una muestra aleatoria de pacientes ingresados por ECVA el año 2000 y seguidos durante 12 meses tras el alta. Se han diferenciado costes de transición, que ocurren una única vez, y costes de estado, que permanecerán el resto de la vida del paciente. Resultados. La prevalencia de la ECVA el año 2000 fue de 1.780 × 10 5 . El coste medio de transición por paciente alcanzó los 4.762 € , y el de estado, 10.506 € /paciente/año. El coste estimado en un año para el País Vasco fue de 120.249.986 €. Los costes de transición supusieron 16.460.729 € y los de estado 103.789.257 € . Estos últimos fueron producidos casi en su totalidad por la atención a las personas dependientes. Conclusiones. El análisis del coste de la ECVA desde una perspectiva del conjunto de la sociedad nos sitúa en el núcleo de la discusión sobre las enfermedades generadoras de dependencia: los costes sociales de esta enfermedad representan el 74,3% del total

Introduction and aim. One out of three persons will die of cerebrovascular accident (CVA), another one will be disabled, and the third one will recover. This research has been taken to estimate the costs of CVA in the Basque Country. Materials and methods. The cost of illness is studied from a societal perspective. It is based on the prevalence of the disease. Population costs has been estimated from the use of resources of a randomized sample of patients admitted to hospital with stroke during the year 2000, and followed for 12 months. Transitions costs (those that happen just once) and state costs (those remaining in patients lifetime) have been studied separately. Results. The prevalence of CVA was 1.780 × 10 5 . Average transition cost per patient was 4,762 € and average state cost for patient/year was 10,506 € . The estimated cost for the Basque Country is 120,249,986 € in the year 2000. Transition costs were 16,460,729 € and state costs 103,789,257 € in the same year. State costs were due to disability. Conclusions. The analysis of the costs of CVA from a societal perspective gets us to the heart of illness causing disability, the social costs of CVA are 74,3% of the total cost

[Hospital care of cerebrovascular accident and the state of patients 12 months after]. / Atención hospitalaria a la enfermedad cerebrovascular aguda y situación de los pacientes a los 12 meses.

OBJECTIVES: Cerebrovascular accident should be of key importance due to its magnitude in terms of mortality and disability. In this study we describe hospital care of patients and follow them one year after. The aims is to uncover areas of improvement in the care of patients. PATIENTS AND METHODS: Observational study of a randomized sample of 535 patient with a diagnosis of cerebrovascular disease, during de acute phase and 12 months after, using clinical records and telephone interview. RESULTS: Thirty five percent of patients arrived within 6 hours of the occurrence of the event. Thirty six percent had a CAT/MNR within 6 hours. Mortality at hospital was 13.8% increasing up to 26% at 12 months. At discharge 49% had a neurological deficiency. At 12 months 35.8% of the survivors interviewed showed a Barthel Index of less than 95 points. CONCLUSIONS: Organizational measures that guarantee a quick and systematic assessment of brain lesions, early diagnosis and active therapeutic offer, have to be implemented. In the sample studied, only 3% of the patient were candidates to thrombolytic therapy. Rehabilitation can and should play a more relevant role in the prevention of sequelae.

[Population-based epidemiology of colorectal cancer: causality review]. / Epidemiología poblacional de cáncer colorrectal: revisión de la causalidad.

The estimated number of new cases of colorectal cancer per year in Spain (no. 19,166) is higher than other tumour locations. 1.56 times more cases of colon cancer are registered than of the rectum, and there are 1.44 times more cases in men than in women. Incidence and mortality are lower than the average for European countries; in historical series (1973-1999) an increase can be observed by age, period and birth cohorts between 1898 and 1932. On the contrary, in the USA a reduction of mortality can be observed from 1973 to 1999 (-20.8%) and of incidence from 1985 to 1999 (-7.4%). In Spain, the average duration of the disease in years is 4.29, lower than that of the European Community (4.57), and 72% of the figure for the most favourable country (5.93). Relative survival after five years in Spain is lower than in the USA (61.9% vs. 54%). Several dietary, environmental and lifestyle factors appear to be associated with colorectal cancer, but the risk or protection of these factors are of little weight and the results of studies are at times contradictory. The reduction of incidence in the USA indicates that intervention is possible to bring about a change of trend, predictably by means of secondary prevention.

Epidemiología poblacional de cáncer colorrectal: revisión de la causalidad / Population-based epidemiology of colorectal cancer: causality review

El número de casos nuevos estimados al año de cáncer colorrectal en España (19.166) es superior al del resto de localizaciones tumorales. Se registran 1,56 veces más de cáncer de colon que de recto y 1,44 veces más en hombres que en mujeres. La incidencia y la mortalidad son inferiores al promedio de los países europeos; en series históricas (1973-1999) se observa un incremento según la edad, el período y las cohortes de nacimiento entre 1898 y 1932. Por el contrario, en EE.UU. se observa una reducción de la mortalidad desde 1973 a 1999 (-20,8%) y de la incidencia (-7,4%) desde 1985 a 1999. En España, la duración promedio en años de la enfermedad es de 4,29, inferior a la de la comunidad europea (4,57) y el 72% respecto al país más favorable (5,93). Varios factores dietéticos, ambientales y de estilos de vida se muestran asociados al cáncer colorrectal, pero el riesgo o la protección de tales factores son de escasa fuerza y los resultados de los estudios son a veces contradictorios. La reducción de la incidencia en EE.UU. plantea que es posible la intervención para un cambio de la tendencia, previsiblemente a través de la prevención secundaria (AU)

The estimated number of new cases of colorectal cancer per year in Spain (no. 19,166) is higher than other tumour locations. 1.56 times more cases of colon cancer are registered than of the rectum, and there are 1.44 times more cases in men than in women. Incidence and mortality are lower than the average for European countries; in historical series (1973-1999) an increase can be observed by age, period and birth cohorts between 1898 and 1932. On the contrary, in the USA a reduction of mortality can be observed from 1973 to 1999 (-20.8%) and of incidence from 1985 to 1999 (-7.4%). In Spain, the average duration of the disease in years is 4.29, lower than that of the European Community (4.57), and 72% of the figure for the most favourable country (5.93). Relative survival after five years in Spain is lower than in the USA (61.9% vs. 54%). Several dietary, environmental and lifestyle factors appear to be associated with colorectal cancer, but the risk or protection of these factors are of little weight and the results of studies are at times contradictory. The reduction of incidence in the USA indicates that intervention is possible to bring about a change of trend, predictably by means of secondary prevention (AU)

Efectos adversos y cuidados de enfermería en la administración de ritodrina / Adverse effects and nursing care in ritodrine administration

Cuando las contracciones uterinas comienzan antes del término, entre las semanas 20-37 de gestación, es a veces necesario detener el trabajo del parto prematuro hasta que el feto madure lo suficiente para asegurar su supervivencia. El tratamiento farmacológico se realiza con relajantes uterinos; actualmente se emplean los beta-2-adrenérgicos. En nuestro estudio hemos utilizado ritodrina. Los objetivos del trabajo son detectar y cuantificar los efectos adversos del fármaco y prestar cuidados de enfermería en su administración para una mejor prevención de éstos. Se ha realizado un estudio observacional en una muestra de 50 pacientes diagnosticadas de amenaza de parto prematuro y en tratamiento con ritodrina. Nuestros resultados indican que se consiguió detener el parto en todos los casos; sin embargo, ninguna paciente estuvo exenta de sufrir efectos adversos cuando la administración se realizó por vía intravenosa, observándose con mayor frecuencia taquicardia materna y fetal. Concluimos con la necesidad de monitorizar a las pacientes y prestar cuidados de enfermería para evitar las complicaciones derivadas de la administración a fin de conseguir una medicación más inocua y con menos riesgos (AU)

Complicaciones más frecuentes de la administración intravenosa de fármacos: flebitis y extravasación / The most common complications of intravenous drug administration: phlebitis and extravasation

Una de las mayores responsabilidades del enfermero en el ámbito hospitalario es la administración de los medicamentos, la observación del paciente y la detección de los posibles efectos no deseados. Las complicaciones más frecuentes que se derivan de la administración intravenosa de los fármacos son las flebitis y la extravasación. La incidencia de éstas en ambos casos es alta, por lo que nos plateamos la hipótesis de si podía deberse al desconocimiento de los fármacos que las originan, de los factores de riesgo y a la inexistencia de protocolos de actuación en fármacos no citostáticos. Por estas razones se ha realizado un estudio cuyos objetivos han sido elaborar una lista de medicamentos no citostáticos que con mayor frecuencia pueden presentar estos efectos adversos y elaborar unas normas para su prevención y tratamiento en el caso de que se produzcan. Concluimos que son los antibióticos los fármacos que con mayor frecuencia pueden producir flebitis, mientras que las soluciones hiperosmolares, electrolíticas y de glucosa, los fármacos adrenérgicos y los agentes de diagnóstico son los que con mayor frecuencia producen daño tisular una vez extravasados. Destacamos la necesidad de su conocimiento por el personal de enfermería, a fin de aplicar medidas preventivas que garanticen la calidad asistencial (AU)

Importancia clínica de los factores de crecimiento hematopoyético mieloides / Clinical importance of myeloid hematopoietic growth factors

Los factores mieloides de crecimiento hematopoyético (FCH) son glucoproteínas que regulan la proliferación y diferenciación celular y que se producen de forma natural en diversas células del organismo. En la actualidad se obtienen por ingeniería genética a través de técnicas recombinantes. En nuestro estudio, exponemos la importancia de los cuidados de enfermería a los que precisan la administración de estos fármacos, las indicaciones de uso, los efectos deseados y adversos que se pueden presentar y la educación sanitaria que la enfermera debe realizar al paciente y a los familiares. Existen factores de crecimiento de colonias de granulocitos (G-CSF) y de colonias de granulocitos-monocitos (GM-CSF). Están indicados en la agranulocitosis, granulocitopenia secundaria al tratamiento quimioterápico, y en la obtención de progenitores hematopoyéticos de sangre periférica para el trasplante de médula ósea. En su uso se deben seguir las recomendaciones de la Asociación Americana de Oncología Clínica (ASCO).Como señalamos en las conclusiones, estos fármacos son fáciles de administrar, suelen tolerarse bien, mejoran la morbimortalidad y acortan la estancia hospitalaria, lo que supone una importante disminución del coste económico y una mayor calidad de vida para el paciente (AU)

[Can we help our patients to stop smoking?: the experience of the Smoking Cessation Program]. / Podemos ayudar a nuestros pacientes a dejar de fumar?: la experiencia del Programa de Abandono del Tabaco.

OBJECTIVE: To describe the process and results of the Smoking Cessation Program in order to answer this question: Does the lack of time and resources justify poor involvement of physicians in helping patients to stop smoking? METHODS: Prospective series of cases that included all smokers (n = 1203) who for any reason attended seven general practices over a period of one year. The behaviour of smokers when the program was offered as well as the workload generated by the implementation of the process are described. Subjects who stopped smoking were those who did not smoke two years after enrolment in a sustained and validated form for least 12 months. RESULTS: A total of 7.3% of all smokers quit (95% confidence interval [CI]: 5.9-8.9). Enrolment of subjects caused an increase in the consultation time of 23 seconds and decreased from a mean of 30 new smokers per month per practice during the first three months to 12 at the end of the first year. All received advise to stop smoking (mean increase of 3 min and 33 s) but only 17.5% accepted the therapeutic plan during the first year (95% CI: 15.4-19.9) that had a duration of 72:11 min and generated a mean of six programmed appointments a month in each practice. Twenty percent of subjects who participated in the therapeutic plan stopped smoking (95% CI: 14.8-26.1). CONCLUSIONS: Identification and universal advice to smokers, together with treatment of those who are motivated to quit, achieved important success rates without increasing excessively ordinary work loads.

Programa de enfermedades oncológicas / Cancer programme

No disponible

Síndrome febril en el niño e intoxicación por paracetamol. Cuidados de enfermería / Febrile syndrome in children and paracetamol poisoning. Nursing care

La mayoría de las intoxicaciones se producen por fármacos, siendo el paracetamol el que con mayor frecuencia las produce en niños. El tratamiento de la intoxicación originada por la sobredosis de paracetamol requiere una especial atención por parte del profesional de enfermería con la aplicación de medidas generales y específicas. Los objetivos planteados son prestar cuidados de enfermería a niños con síntomas febriles y sobredosis de paracetamol y detectar los posibles efectos adversos que puede producir este fármaco y la N-acetilcisteína, utilizada en la profilaxis de la toxicidad aguda originada por sobredosis de paracetamol. Nuestra experiencia es de una muestra de 43 niños, 6 de ellos tratados por una posible sobredosis de paracetamol. Se detectó una reacción alérgica a la N-acetilcisteína utilizada como antídoto. Concluimos destacando la importancia de las actuaciones de enfermería en la prevención y tratamiento de las reacciones adversas a los medicamentos (AU)

¿Podemos ayudar a nuestros pacientes a dejar de fumar?: la experiencia del Programa de Abandono del Tabaco / Can we help our patients to stop smoking?: the experience of the Smoking Cessation Program)

Objetivo: Describir el proceso y resultados al año del Programa de Abandono del Tabaco, para responder a la siguiente pregunta: «¿Justifica la falta de tiempo y recursos la escasa intervención de los médicos sobre el tabaquismo?».Métodos: Serie de casos prospectiva formada por todos los fumadores (1.203) que acudieron durante un año por cualquier motivo a la consulta de siete médicos de familia. Se describe el comportamiento de los fumadores ante el programa y las cargas de trabajo que genera. Se consideró que habían abandonado el tabaco aquellos que estaban sin fumar a los2 años de su captación de forma validada y mantenida durante al menos 12 meses. Resultados: Dejaron de fumar el 7,3% de todos los fumadores (intervalo de confianza [IC] del 95%: 5,9-8,9). La captación incrementó el tiempo de consulta en 23 s y descendió desde un promedio de 30 nuevos fumadores al mes por consulta durante los tres primeros meses hasta 12 al final del primer año. Todos fueron aconsejados (incremento promedio de3 min y 33 s) pero sólo un 17,5% realizó el plan terapéutico durante el primer año (IC del 95%: 15,4-19,9), que tuvo una duración promedio de 72 min y 11 s, y generó una media de6 citas programadas al mes por consulta. El 20% de los que realizaron dicho plan lograron dejar de fumar (IC del 95%: 14,8-26,1).Conclusiones: La identificación y el consejo universal a los fumadores, junto con el tratamiento de los motivados, logra importantes éxitos sin incrementar excesivamente las cargas de trabajo habituales (AU)

Objetive: To describe the process and results of the «Smoking Cessation Program» in order to answer this question: Does the lack of time and resources justify poor involvement of physicians in helping patients to stop smoking? Methods: Prospective series of cases that included all smokers(n = 1203) who for any reason attended seven general practices over a period of one year. The behaviour of smokers when the program was offered as well as the workload generated by the implementation of the process are described. Subjects who stopped smoking were those who did not smoke two years after enrolment in a sustained and validated form for least 12 months. Results: A total of 7.3% of all smokers quit (95% confidence interval [CI]: 5.9-8.9). Enrolment of subjects caused an increase in the consultation time of 23 seconds and decreased from a mean of 30 new smokers per month per practice during the first three months to 12 at the end of the first year. All received advise to stop smoking (mean increase of 3 min and 33 s) but only 17.5% accepted the therapeutic plan during the first year (95% CI: 15.4-19.9) that had a duration of72:11 min and generated a mean of six programmed appointments a month in each practice. Twenty percent of subjects who participated in the therapeutic plan stopped smoking(95% CI: 14.8-26.1).Conclusions: Identification and universal advice to smokers, together with treatment of those who are motivated to quit, achieved important success rates without increasing excessively ordinary work loads (AU)

An evidence-based programme for smoking cessation: effectiveness in routine general practice.

BACKGROUND: Smoking cessation clinical practice guidelines are based on randomised clinical trials reporting outcomes in persons who participate in these studies. However, many practitioners are sceptical about the effectiveness of these recommendations when applied to the general population in everyday routine consultation. AIM: To evaluate the results of a comprehensive smoking cessation programme in routine primary care practice. METHOD: All smokers consulting in 10 general practices during one year participated in a non-randomised controlled trial. The percentages of subjects in the intervention (n = 1203, seven practices) and control (n = 565, three practices) groups who reported sustained abstinence between six and 12 months follow-up and were validated biochemically were compared. The effect of the programme was adjusted to baseline differences in both groups by multiple logistic regression analyses. RESULTS: The programme resulted in an increase of five percentage points (95% CI = 3.1%-6.8%) in the validated and sustained one-year abstinence probability, with 7.1% for all of the intervention practices (adjusted OR = 3.7, 95% CI = 2.4-5.7). CONCLUSION: Programmes that combine advice to stop smoking to all smokers attending general practices with the offering of support, follow-up, and nicotine patches to those willing to stop are feasible and effective in routine practice, as primary care clinicians need only identify 20 smokers to get one additional success attributable to the programme.

Enhanced Na(+)-H+ exchanger activity and NHE-1 mRNA expression in lymphocytes from patients with essential hypertension.

It has been demonstrated that the activity of the sodium-proton exchanger (NHE-1 isoform) is increased in lymphocytes and other blood cells from patients with essential hypertension. In the present study, we investigated whether an increased level of NHE-1-specific mRNA in lymphocytes from patients with essential hypertension would explain the enhanced transport activity. Twenty-two hypertensive patients and 21 normotensive subjects were studied. Basal cytosolic pH was measured by the pH-sensitive fluorescent probe 2',7'-bis(2-carboxyethyl)-5(6)-carboxyfluorescein. Maximal sodium-proton exchange activity was determined by acidifying cell pH and measuring the initial rate of the net sodium-dependent proton efflux driven by an outward proton gradient. The transcript level of NHE-1 was measured by reverse transcription-polymerase chain reaction in comparison with a constitutively expressed reference gene (beta-actin). Intracellular pH was lower in hypertensive patients than normotensive subjects (7.34 +/- 0.01 versus 7.39 +/- 0.01, mean +/- SEM, P < .001). The maximal activity of the sodium-proton exchanger was higher in hypertensive patients than in normotensive subjects (1262 +/- 100 versus 881 +/- 56 mmol/L cells per hour, P < .01). NHE-1 mRNA was increased in hypertensive patients compared with normotensive subjects (ratio of NHE-1 mRNA to beta-actin mRNA, 0.16 +/- 0.01 versus 0.12 +/- 0.02, P < .05). These data suggest that the increased sodium-proton exchange activity in essential hypertension may be related to the de novo synthesis of exchanger protein.

Association of increased erythrocyte Na+/H+ exchanger with renal Na+ retention in patients with essential hypertension.

The goal of this study was to investigate the activity of the Na+/H+ exchanger in erythrocytes of patients with essential hypertension and its relation with urinary Na+ excretion. The study was performed in cells from 27 untreated hypertensive patients and 30 normotensive controls with similar age and sex distribution. All subjects were studied after 4 days on a controlled Na+ diet (145 mmol/day). The activity of the Na+/H+ exchanger was determined by acidifying cell pH and measuring the initial rate of the net Na(+)-dependent H+ efflux. The activity of the Na+/H+ exchanger was higher in hypertensive patients than in controls (301 +/- 45 v 162 +/- 23 mmol/L cells/h, mean +/- SEM; P < .01). With the upper limit of the normotensive population as a cut-off point (385 mmol/L cells/h), a subgroup of 12 hypertensive patients had an abnormally high activity of Na+/H+ exchanger. Compared with controls and with patients with normal exchanger activity, patients with increased exchanger activity were characterized by lower net (P < .01) and fractional (P < .05) Na+ excretion. The accumulative Na+ balance was higher (P < .01) in hypertensive patients with increased activity of the exchanger (39.90 +/- 3.47 mmol) than in the remaining hypertensive patients (0.59 +/- 6.96 mmol) or in the normotensive population (-5.71 +/- 6.12 mmol). After analyzing the relationship of renin activity with Na+ excretion it was observed that renin activity was inappropriately low in 9 (75%) patients with increased exchanger, in 6 (40%) patients with normal exchanger, and in 6 (20%) normotensives, these differences being significant (P<.01).