Child psychiatric skills in primary healthcare--self-evaluation of Finnish health centre doctors.

OBJECTIVE: To study Finnish general practitioners' (GP's) perceptions of their child psychiatric skills. METHODS: The study sample consisted of physicians (n=755) working in health centres situated in the special response area of the Tampere University Hospital, Finland. They were requested to assess their competence in 16 areas on a four-step Likert scale. The response rate was 66.1% (n=499). RESULTS: Physicians evaluated their child psychiatric skills as inadequate on many issues. The ability to identify depression was poorer the younger the child in question. Only a minority (14%) felt they were well able to identify a depressed infant. Many physicians considered themselves poorly skilled in assessing the relationship between infant and parents (39.8%), in assessing a child's need for psychiatric treatment (42.7%) and in identifying a child with attention-deficit disorder (40.7%). A majority (75.9%) rated their skills poor in co-operating with daycare personnel or school staff in matters concerning a child with conduct disturbance. Only 26.8% could assess the necessity of taking a child into custody. Women gave higher ratings of their skills in identifying depressed infants and in assessing the infant-parent relationship than men, whereas men assessed their skills as better in cases in which there were problems in co-operation with parents. CONCLUSIONS: In order to provide good psychiatric services for children, attention should be paid to the GPs' child psychiatric skills.

Inhibition of the rise in FFA by Acipimox partially prevents GH-induced insulin resistance in GH-deficient adults.

To test the hypothesis that GH-induced insulin resistance is mediated by an increase in FFA levels we assessed insulin sensitivity after inhibiting the increase in FFA by a nicotine acid derivative, Acipimox, in nine GH-deficient adults receiving GH replacement therapy. The patients received in a double blind fashion either Acipimox (500 mg) or placebo before a 2-h euglycemic (plasma glucose, 5.5 +/- 0.2 mmol/liter) hyperinsulinemic (serum insulin, 28.7 +/- 6.3 mU/liter) clamp in combination with indirect calorimetry and infusion of [3-(3)H]glucose. Acipimox decreased fasting FFA by 88% (P = 0.012) and basal lipid oxidation by 39% (P = 0.015) compared with placebo. In addition, the insulin-stimulated lipid oxidation was 31% (P = 0.0077) lower during Acipimox than during placebo. Acipimox increased insulin-stimulated total glucose uptake by 36% (P = 0.021) compared with placebo, which mainly was due to a 47% (P = 0.015) increase in glucose oxidation. GH induced insulin resistance is partially prevented by inhibition of lipolysis by Acipimox.

Impaired insulin-stimulated expression of the glycogen synthase gene in skeletal muscle of type 2 diabetic patients is acquired rather than inherited.

To examine whether defective muscle glycogen synthase (GYS1) expression is associated with impaired glycogen synthesis in type 2 diabetes and whether the defect is inherited or acquired, we measured GYS1 gene expression and enzyme activity in muscle biopsies taken before and after an insulin clamp in 12 monozygotic twin pairs discordant for type 2 diabetes and in 12 matched control subjects. The effect of insulin on GYS1 fractional activity, when expressed as the increment over the basal values, was significantly impaired in diabetic (15.7 +/- 3.3%; P < 0.01), but not in nondiabetic (23.7 +/- 1.8%; P = NS) twins compared with that in control subjects (28.1 +/- 2.3%). Insulin increased GYS1 messenger ribonucleic acid (mRNA) expression in control subjects (from 0.14 +/- 0.02 to 1.74 +/- 0.10 relative units; P < 0.01) and in nondiabetic (from 0.24 +/- 0.05 to 1.81 +/- 0.16 relative units; P < 0.01) and diabetic (from 0.20 +/- 0.07 to 1.08 + 0.14 relative units; P < 0.01) twins. The effect of insulin on GYS1 expression was, however, significantly reduced in the diabetic (P < 0.003), but not in the nondiabetic, twins compared with that in control subjects. The postclamp GYS1 mRNA levels correlated strongly with the hemoglobin A1c levels (r = -0.61; P < 0.001). Despite the decrease in postclamp GYS1 mRNA levels, the GYS1 protein levels were not decreased in the diabetic twins compared with those in the control subjects (2.10 +/- 0.46 vs. 2.10 +/- 0.34 relative units; P = NS). We conclude that 1) insulin stimulates GYS1 mRNA expression; and 2) impaired stimulation of GYS1 gene expression by insulin in patients with type 2 diabetes is acquired and most likely is secondary to chronic hyperglycemia.

Insulin-regulated mitochondrial gene expression is associated with glucose flux in human skeletal muscle.

To identify abnormally expressed genes contributing to muscle insulin resistance in type 2 diabetes, we screened the mRNA populations from normal and diabetic human skeletal muscle using cDNA differential display and isolated abnormally expressed cDNA clones of mitochondrial-encoded NADH dehydrogenase 1 (ND1), cytochrome oxidase 1, tRNA(leu), and displacement loop. We then measured mRNA expression of these mitochondrial genes using a relative quantitative polymerase chain reaction method in biopsies taken before and after an insulin clamp in 12 monozygotic twin pairs discordant for type 2 diabetes and 12 matched control subjects and in muscle biopsies taken after an insulin clamp from 13 subjects with type 2 diabetes, 15 subjects with impaired glucose tolerance, and 14 subjects with normal glucose tolerance. Insulin infusion increased mRNA expression of ND1 from 1.02 +/- 0.04 to 2.55 +/- 0.30 relative units (P < 0.001) and of cytochrome oxidase 1 from 0.80 +/- 0.01 to 1.24 +/- 0.10 relative units (P < 0.001). The ND1 response to insulin correlated with glucose uptake (r = 0.46, P = 0.002). Although the rate of insulin-mediated glucose uptake was decreased in the diabetic versus the nondiabetic twins (5.2 +/- 0.7 vs. 8.5 +/- 0.8 mg x kg(-1) fat-free mass x min(-1), P < 0.01), insulin-stimulated ND1 expression was not significantly different between them (2.4 +/- 0.5 vs. 2.7 +/- 0.5 relative units). Neither was there any significant intrapair correlation of ND1 expression between the monozygotic twins (r = -0.15, NS). We conclude that insulin upregulates mitochondrial-encoded gene expression in skeletal muscle. Given the positive correlation between ND1 expression and glucose uptake and the lack of intrapair correlation between monozygotic twins, mitochondrial gene expression may represent an adaptation to intracellular glucose flux rather than an inherited trait.

Shelf life of sliced raw potatoes of various cultivar varieties--substitution of bisulfites.

The effects of potato variety (Van Gogh, Bintje and Fambo), washing with browning prevention chemicals in place of sodium bisulfite, percentages of CO2, O2, and N2 in the package headspace, and storage time (1, 4, and 7 days) on the sensory and microbiological quality of potato slices were examined. Citric acid and ascorbic acid (at 0.1% each and at 0.5% each) were used as browning prevention chemicals. In the packaging atmosphere the percentage of N2 was 75 or 80%, the percentage of O2 was 5 or 0%, and the percentage of CO2 was 20% at the beginning of storage. Packed potato slices were stored in the dark at 5 degrees C. Darkening was the most important factor limiting the sensory quality of raw potato slices. Darkening occurred quickly with Fambo slices; it seems that Fambo is not a suitable potato variety if slices are to be stored. Water-washed and cooked Van Gogh slices were still acceptable for retailing after a storage period of 7 days. After 7 days of storage the best sensory quality of both raw and cooked Bintje slices was obtained with washing solutions containing 0.1 to 0.5% citric and ascorbic acids and with the gas mixture containing 20% CO2 and 80% N2. The number of microorganisms was higher in samples stored in the atmosphere containing 5% O2 than samples stored in the atmosphere containing 0% O2. Washing of potato slices with browning prevention chemicals decreased the number of microorganisms compared to potato slices not washed or potato slices washed with water after 7 days of storage.

Shelf-life of prepeeled potato cultivated, stored, and processed by various methods.

The effects of cultivation conditions, winter storage, peeling method, browning prevention chemicals replacing sodium bisulfite, and packing methods on the sensory, nutritional and microbiological quality of pre-peeled potato were examined. Two different cultivation lots of the potato variety Van Gogh were used. Cultivation and harvesting conditions and peeling method were the most important facts reducing the sensory quality, especially the appearance, of prepeeled and sliced potatoes. Cooking and baking of potatoes decreased the appearance defects detected in raw potatoes. The levels of vitamin C in packaged samples decreased during winter storage. Cooking for 10 min and keeping potatoes at 60 degrees C for 1 h after cooking also decreased the content of vitamin C. In potato samples immediately after treatments aerobic bacteria were present at levels of 400 to 2,950 CFU/g and lactic acid bacteria at levels of 8 to 16 CFU/g. The number of aerobic bacteria did not increase during storage, and the number of lactic acid bacteria increased at the most to 90 CFU/g. Peeling, washing and packaging methods, cultivation conditions, and winter storage did not have important effects on the number of microbes present.

Human hexokinase II gene: exon-intron organization, mutation screening in NIDDM, and its relationship to muscle hexokinase activity.

In muscle, hexokinase II (HK2) regulates phosphorylation of glucose to glucose 6-phosphate, which has been reported to be impaired in patients with non-insulin-dependent diabetes mellitus (NIDDM). Here we report decreased HK2 enzyme activity in skeletal muscle biopsies from patients with impaired glucose tolerance compared with healthy control subjects (2.7 +/- 0.9 vs 4.9 +/- 1.1 nmol.min-1.mg protein-1). Therefore, mutations in the HK2 gene could contribute to skeletal muscle insulin resistance in NIDDM. To address this question, we first determined the exon-intron structure of the human HK2 gene and using this information, we screened all 18 exons with single-strand conformation polymorphism technique in 80 Finnish NIDDM patients. Nine nucleotide substitutions were found, one of which was a missense mutation (Gln142-His142) in exon 4. In human muscle, a single HK2 mRNA transcript with a size of approximately 5500 nucleotides was detected with Northern blot analysis. We also describe an HK2 pseudogene (HK2P1), which was mapped to chromosome 4, band q26, by fluorescence in situ hybridization to metaphase chromosomes. The clinical characteristics and HK2 enzyme activities of the subjects with either Gln or His at residue 142 did not differ from each other. Instead, HK2 activity correlated inversely with fasting blood glucose levels, suggesting that changes in HK2 activity could be secondary to other metabolic abnormalities (r = 0.55; p < 0.0003; n = 39). In conclusion; the data suggest that impaired HK2 activity in prediabetic individuals is a consequence of impaired glucose tolerance rather than of a genetic abnormality. The data thus seem to rule out mutations in the HK2 gene as a major cause of inherited insulin resistance in NIDDM.

Determinants of insulin-stimulated skeletal muscle glycogen metabolism in man.

To examine factors which influence skeletal muscle glycogen synthesis in man, we related insulin sensitivity measured by euglycaemic insulin clamp in 43 healthy males to muscle glycogen synthase (GS) activity, GS protein content (Western blot), glycogen concentrations and fibre composition. Insulin increased muscle glycogen content (P < 0.05) and the change in glycogen content correlated with the GS protein content (r = 0.90, P = 0.01). GS protein concentration correlated inversely with age (r = -0.69, P = 0.04). Non-oxidative glucose disposal was inversely related to per cent type 2B fibres (r = -0.52, P < 0.05). The influence of age on these relationships was separately studied in young (n = 12, age = 26 +/- 2 years) and elderly (n = 15, age = 56 +/- 2 years) males. Insulin increased GS activity significantly only in young subjects (from 17.8 +/- 3.0 to 25.3 +/- 3.2 nmol mg protein-1 min-1; P = 0.015). GS activity and non-oxidative glucose disposal correlated in young (r = 0.69, P = 0.01) but not in the elderly (r = 0.064, P = 0.82) males, and this relationship was not influenced by the degree of obesity. In conclusion, muscle fibre type and GS activity are both determinants of muscle glycogen metabolism in healthy, normoglycaemic males. The close relationship between non-oxidative glucose metabolism and GS activity in young males is altered in ageing.

Clinical trial of a new trivalent measles-mumps-rubella vaccine in young children.

Trivalent measles-mumps-rubella virus vaccines, containing either Schwarz (two dosage levels), Urabe Am 9, and RA 27/3 strains or Moraten, Jeryl Lynn, and RA 27/3 strains, were evaluated in 174 children aged 14 to 24 months. Each of the three vaccines induced a nearly 100% seroconversion for measles and mumps and a full 100% seroconversion for rubella. Close home monitoring disclosed a high incidence and a relatively constant pattern of vaccine-associated reactions, similar for all three vaccines. Febrile reactions of greater than or equal to 39 degrees C between days 5 and 12 after vaccination were more frequent among the recipients of "high"-dose Schwarz strain vaccine (35%) than among the recipients of corresponding "low"-dose vaccine (13%). The Schwarz-Urabe Am 9-RA 27/3 was equally immunogenic and, with a low dose of measles virus, no more reactogenic than the Moraten-Jeryl Lynn-RA 27/3 trivalent vaccine.

Evaluation in young children of the Urabe Am 9 strain of live attenuated mumps vaccine in comparison with the Jeryl Lynn strain.

Urabe Am 9, a new strain of mumps vaccine, originally developed in Japan, was evaluated in children 14 to 20 months of age in a comparative trial with the Jeryl Lynn strain. Both vaccines performed well. The antibody responses were measured using a neutralization test and a haemolysis-in-gel test. The seroconversion rates at six weeks, as detected with either one or both tests, were 55/58 (94.8%) after the Urabe Am 9 and 58/60 (96.7%) after the Jeryl Lynn vaccine. Only mild infrequent adverse reactions were observed. It is concluded that both strains of live attenuated mumps vaccine are immunogenic and well-tolerated in this age group.

Comparison of the Urabe Am 9-Schwarz and Jeryl Lynn-Moraten combinations of mumps-measles vaccines in young children.

Two mumps-measles vaccine combinations were evaluated for their reactogenicity and immunogenicity in children aged 14 to 20 months. The Urabe Am 9-Schwarz combination vaccine was given to 108 double seronegative children. The seroconversion rate at six weeks after vaccination was 99.1% for measles (haemagglutination-inhibition test) and 92.6% for mumps (neutralization and haemolysis-in-gel tests). The Jeryl Lynn-Moraten vaccine was administered to 85 double seronegative children; the seroconversion rates were 95.3% for measles and 83.5% for mumps. The reported post-vaccination signs and symptoms resembled those seen after monovalent measles vaccine but were more accentuated. Fever over 37.5 C degrees was reported in 66.7% and unusual restlessness and irritability in 68.5% of the Urabe Am 9-Schwarz double seronegative vaccines compared to 55.3% (p less than 0.05) and 54.1% (p less than 0.05), respectively, in the recipients of the Jeryl Lynn-Moraten vaccine. These relatively high reaction rates probably reflect the close observation of the children by their parents during the study. Nevertheless, the tendency towards increased reaction rate and, possibly, reduced immunogenicity of bivalent mumps-measles vaccines as compared to the corresponding single vaccines should be taken into account in the planning of large scale vaccination of young children.