Quality of life assessment for patients with eating disorders.

The purpose of this study was to examine the construct validity of Visual Analogue Scale (VAS)-quality of life for patients with eating disorders in relation to the following instruments: Body Awareness Scale Health, (BAS-H) and its Interview Scale for Body Ego (ISBE), Eating Disturbances Scale (EDS-5), Body Attitude Test (BAT) and Comprehensive Body Examination (CBE), part of respiration, subscale 1. In total 87 individuals were examined: 26 patients with anorexia nervosa (AN), 20 patients with bulimia nervosa (BN) and 41 patients with eating disorders not otherwise specified (EDNOS). The highest significant correlations (0,43-0,61) were found between VAS-quality of life and BAS-H (subscale grounding), variables of EDS-5 (feeling of control and guilt), BAT (subscale 2) and CBE (breathing variables). In conclusion, this study indicated that VAS-quality of life seemed to more accurately capture mental and psychosomatic factors than physical and health-related factors.

A descriptive analysis of disorders in patients 17 years following motor vehicle accidents.

Whiplash-associated disorders (WAD) are described and analysed 17 years after involvement in a motor vehicle accident. A self-report questionnaire was mailed to 121 patients registered at emergency departments in Gothenburg in 1983 because of neck complaints following a car collision. The questionnaire contained items on symptoms referred to WAD, treatment, work disability, involvement in settlement of claims, medical disability and the Neck Disability Index (NDI). Of the 121 patients, 108 (89%) chose to participate in the present study. Fifty-nine (55%) had residual disorders referable to the original accident. Neck pain, radiating pain and headache were the most common symptoms. One-third of the patients with residual symptoms suffered from work disability, compared to 6% in the group of patients without residual disorders. All 25 patients who had reached a final claim settlement (42%) had a poor outcome, and 15 of the claiming patients had been assigned a medical disability ranging from 5 to 30%. Patients with WAD reported a significantly higher score on the NDI than those without residual disorders. There was no significant correlation between the patients' degree of medical disability and the scores on the NDI. The results of the study show that approximately half of the patients with neck complaints following motor vehicle accidents in Gothenburg in 1983 suffered frequent residual symptoms 17 years after the accident, mostly comprising neck pain, radiating pain, and headache. The residual disorders contributed to the patients' overall disability.

Reliability of an interview approach to the Functional Independence Measure.

OBJECTIVE: To establish the reliability of an interview approach to the Functional Independence Measure (FIM). DESIGN: Two raters were present at the same time during the interviews in the home and did independent ratings of the 18 FIM items. The interview procedure was repeated within a week by another two raters in the clinic. SUBJECTS: Sixty-three stroke survivors (median age 63 years, range 18-71 years) were studied approximately two years after onset. RATERS: Three occupational therapists and one nurse. METHODS: Reliability was calculated as unweighted kappa statistics, percentage agreement (PA), and intraclass correlation coefficient (ICC). RESULTS: Best agreement was found in the motor items of FIM. The kappa statistics showed good to excellent inter-rater values during the same interview except for the Social interaction item. The ICCs based on sum-score for motor (0.92) and social-cognitive items (0.75) respectively, were similar to those reported in the literature. The repeated interview by different raters showed less stable agreement according to kappa values for the items dealing with transfers, locomotion and social-cognition. CONCLUSIONS: FIM assessments showed high inter-rater agreement for the same interview setting (home as well as clinic), but the stability of the measure over time with a repeated interview by different raters was somewhat less satisfactory.

Community-based rehabilitation in Moshupa village, Botswana.

This article presents a summary of findings from the 'Moshupa Community Based Rehabilitation (CBR) project', which to date have been the subject of three studies: one initial survey of disabled people and two follow-up studies. Of the 132 disabled people who were identified in the survey, all but three could be accounted for in the first follow-up. Seventy-seven were interviewed about independence of activities of daily living, school/jobs and quality of life. A high percentage of elderly (17% were 65 and over) were alive, and most had maintained high levels of ADL skills. Twenty per cent of the adult disabled were working, 10 out of 14 school-aged children were enrolled in schools, and life satisfaction was high. The second follow-up study indicated that personnel, although acknowledging the benefits of the programme, pointed to several remaining problems such as lack of rehabilitation education for the personnel. The results are discussed with reference to the CBR programme's aims, and implications drawn for industrialized countries.

Australian speech pathologists' views of what professional practices lead to successful outcomes of therapy.

The relative importance attributed to factors perceived by speech pathologists as contributing to successful levels of therapeutic outcomes were addressed in a survey of 372 practicing therapists in Australia. The survey consisted of 42 items derived from interviews with a sample of ten speech pathologists in Sydney. Therapists were asked to rate the importance of each item on a seven-point scale ranging from "not at all important" to "critically important." The findings indicate that the most important ingredients of successful therapy incorporate a mix of support and therapeutic activity outside the clinic; the clinicians' organizational skills and involvement in conducting therapy and their use of techniques; the positive therapeutic relationship between clinician and client; and, finally, the client's attitude to therapy. These findings suggest that speech pathologists, like other allied health professionals, endorse a humanistic or holistic approach to health care. The results provide insights into the practices that should be addressed and fostered in undergraduate speech pathology programs.

Self-assessment of well-being in a group of children with epilepsy.

Epilepsy is common in childhood, the prevalence being about five per 1000 children. The purpose of this study was to assess well-being in children with controlled epilepsy (but did not include those with obvious neurodeficits such as mental retardation or cerebral palsy) and compare them with age-matched healthy children. The patient group comprised of 31 children, 12 boys and 19 girls, whereas the control population group consisted of 342 children, 176 boys and 166 girls who were all in good health. All children involved in the study were aged between 9-13 years. A questionnaire was distributed to the children to complete. It consisted of 39 bipolar adjectives and a visual analogue scale was employed. The results show that the group of children with controlled epilepsy did not differ significantly from the age-matched control group. There was no significant difference between the sexes except for the dimension of vitality, where the boys scored better than the girls. Thus the well-being of children with controlled epilepsy seems to be similar to that of children from a control population. The psychometric properties of the instrument were also assessed. An assessment of well-being in children with intractable epilepsy, using a similar approach, is in progress.

Respiratory effects of glutamate receptor antagonists in neonate and adult mammals.

We determined the conditions (immaturity, species, anesthesia, receptor blockade selectivity) under which glutamate receptor blockade produces respiratory depression in mammals. In unrestrained 0- to 2-day-old neonate and adult mice and cats, ventilation was measured by the barometric method, before and after separate or sequential administration of a non-NMDA receptor antagonist, NBQX (2,3-dihydroxy-6-nitro-7-sulfamoylbenzo(F)quinoxaline, 2-200 mg kg(-1) in mice, 10-40 mg kg(-1) in cats), and a NMDA receptor antagonist, dizocilpine (3 mg kg(-1) in mice, 0.15-1.0 mg kg(-1) in cats). NBQX or dizocilpine alone did not decrease ventilation in awake adults, but NBQX strongly depressed ventilation in neonate awake mice and in adult anesthetized animals. Given together, dizocilpine and NBQX always profoundly depressed ventilation by producing a lethal apnea in neonate mice, and an apneustic pattern of breathing in adults of both species and in neonate cats. We conclude that blockade of either NMDA or non-NMDA receptors is innocuous in awake adults. The factors which may potentiate respiratory depression are (1) anesthesia, (2) immaturity, and (3) combined blockade of both receptors types. The mechanism of depression is species-dependent and age-dependent.

Risk of long-term disability among patients with back pain.

The aim of this study was to find predictors of length of time on sick-leave and the change in sick-leave as a result of intervention. Many studies of back pain show that medical and psychosocial factors covary with length of sick-leave. The results are based on the questionnaire responses of 240 patients. A stepwise multiple regression showed that the significant predictors of number of sick-days the year after intervention were the number of sick-days before the intervention and also hypochondria. Significant predictors of sick-leave change were sleep disturbance and number of sick-days before intervention. A discriminant function analysis comparing a group that had decreased its sick-leave with one that had increased its sick-leave showed 7 predictors of increased sick-leave: high risk of somatisation; many children and family members living at home; a change in tasks at work owing to pain; brothers and sisters with longstanding pain problems; frequent pain, and sleep disturbance. It is important for physiotherapists to enquire about patients' earlier sick-leave patterns in order to identify risk factors for long-term disability among patients with back pain. Some of these factors have been identified in this study.

The impact of community-based rehabilitation as perceived by disabled people in a village in Botswana.

The purpose of the present study was to investigate the impact of community-based rehabilitation (CBR) on the lives of disabled people in Moshupa village in Botswana. Of the 132 disabled people, identified in a previous epidemiological study, all but three could be accounted for, and 77 were interviewed during a 5-week field period. The interviews took place in the homes of the clients, and focused on independence in activities of daily life, schooling/jobs and quality of life. The results indicated that a remarkably high percentage of elderly were alive (17% were 65 and over), and that most people had maintained high levels of independence in ADL. Furthermore, 20% of adults were working, 10 out of 14 children of school age were in school, and life satisfaction was high, although somewhat higher for younger people than for older ones. Significantly more younger people reported that life had improved, while most elderly people believed life to be worse now.

Chemical structure of sterols that activate oocyte meiosis.

Gonadotrophins and various growth factors, but not sex steroids, can induce resumption of meiosis in vitro, but only in oocytes enclosed by cumulus-granulosa cells. Follicular purines prevent resumption of meiosis. This process can be overcome, in vitro, by a transient elevation of cyclic AMP resulting in the production of a diffusible meiosis-inducing substance secreted by the cumulus cells. A meiosis-inducing activity has been detected in gonads of different species, for example, in preovulatory follicular fluid of women and in mouse testes. We report here the isolation and characterization of meiosis-activating sterols from human follicular fluid and bull testes and the synthesis of two closely related C29 sterols. All these sterols induce a resumption of meiosis in cultured cumulus-enclosed and naked mouse oocytes indicating their nonspecificity across species and sex. This family of sterols is for the first time considered crucial to meiosis.

Australian physiotherapists' and occupational therapists' views on professional practice.

The extent to which physiotherapists and occupational therapists endorse a humanistic, holistic approach to health care was addressed in a survey of attitudes of practicing occupational therapists (N = 378) and physiotherapists (N = 558). A 22-item questionnaire including aspects of therapist's knowledge and techniques, holistic approach, client characteristics, client/therapist relationship, and approaches to professional practice was employed. The findings indicate that the professional practices reflecting the new public health model prevailed. This model emphasizes client/therapist interaction, the client's own ability to change and improve, and holistic attitudes towards health care, along with the therapist's knowledge and skills. However, comparative analyses of the two therapy groups reveal that although both groups support a humanistic approach to client care, occupational therapists promote the client's resources and coping skills to a greater extent, place more emphasis on the client in terms of the client's capacity for recovery and coping abilities, were more involved with the social, personal, and psychological problems of the client, and place less emphasis on treatment methods and techniques than physiotherapists. Demographic variables including gender, age, and workplace setting (public/private) were found to be significantly related to views of professional practice. Recommendations for the training of therapists and the implications for practitioners are made and suggestions for further research are given.

Evaluation of a Swedish version of the arthritis self-efficacy scale in people with fibromyalgia.

The major purpose of this study was to determine the utility and construct validity of the Swedish version of the Arthritis Self-Efficacy Scale (ASES-S). Ninetynine women with fibromyalgia (FS) were included in a randomized, controlled trial of fibromyalgia efficacy-based self-management education and physical training. Several self-report instruments were used to evaluate the outcome of the intervention. Evidence of construct validity of the ASES-S was revealed in the factor analysis which produced a three factor solution similar to previous results. Significant correlations between ASES-S and pre and post health status measures were consistent with theoretically derived hypotheses, further testifying to construct validity. Multiple regression analyses confirmed that pretest ASES-S was the strongest predictor of posttest ASES-S. The results indicated that the intervention had produced a significant change in ASES-S and that this positive change in self-efficacy was associated with changes in health status. In conclusion, this study has shown the ASES-S to be a valid measure of treatment effects also for patients with FS.

Swedish physical therapists' beliefs on what makes therapy work.

BACKGROUND AND PURPOSE: The purpose of this study was to find out what practicing physical therapists believe to be the most important factors in successful treatments. SUBJECTS: A national random sample of 187 Swedish physical therapists received the survey instrument by mail. The response rate was 76%. METHODS: On the basis of a pilot interview study and literature review, a survey instrument was constructed consisting of 22 Likert-type items and various demographic variables. RESULTS: The findings indicated that a majority of the respondents believed that the patient's own resources and the patient-therapist relationship rather than the treatment techniques are the most important factors in explaining why physical therapy works. Most physical therapists endorsed a holistic view of treatment (pertaining to the whole person, not just body parts), although significantly more women than men supported this viewpoint. Other background factors had no relationship to the beliefs and attitudes expressed. CONCLUSION AND DISCUSSION: The findings are discussed within the framework of attribution theory, and in the context of viewing physical therapy as an applied biomedical science or a caring profession. In this study, the view of physical therapy as a caring profession prevailed among the majority of the physical therapists.

Pharmacokinetics of the neuroprotective glutamate antagonist NBQX (6-nitro-7-sulfamoyl-benzo(f)quinoxaline-2,3-dione) in mice, rats, and dogs. Interactions with probenecid.

NBQX [6-nitro-7-sulfamoyl-benzo(f)quinoxaline-2,3-dione] has proven effective in protecting against cerebral ischemic insult in rodents. The preclinical development included pharmacokinetic and toxicological investigations in mice, rats, and dogs. For these purposes, NBQX was given as an intravenous bolus dose (in mice, rats, and dogs) or as a constant infusion for up to 4 weeks in rats and dogs. In NMRI mice t1/2, CL, and V2 were 1-4 hr, 0.6-1 liter/kg/hr, and 1-4 liters/kg following 3, 10, or 30 mg/kg. In Wistar and Sprague-Dawley rats, the mean +/- SD values of t1/2, CL, and Vz were 0.8 +/- 0.35 hr, 3.2 +/- 1.0 liters/kg/hr, and 4.0 +/- 1.1 liters/kg, respectively. About 33 +/- 5.2% of the dose was excreted unchanged in urine. The CLR was 0.90 +/- 0.20 liter/kg/hr. The pH of the urine samples ranged from pH 6.2 to 8.8, with a mean of 7.9 +/- 0.72. The plasma concentrations were proportional to the dose rate in the dose range 0.3-10 mg/kg/hr, independent of sex, and did not change during 4 weeks of infusion. CL and CLR were decreased to half their value when NBQX was administered in combination with probenecid. In beagle dogs, t1/2 and Vz were 1-3 hr and 1-3 liters/kg, respectively. The CL was determined to be 1.5 +/- 0.4 liters/kg/hr (N = 18) following 2 days of infusion (0.2-1 mg/kg/hr), but after 1 month CL had decreased significantly (p < 0.0001) to 1.0 +/- 0.1 liter/kg/hr.(ABSTRACT TRUNCATED AT 250 WORDS)

Characteristics of low back pain patients who do not complete physiotherapeutic treatment.

Patients' problems in following recommendations of health professionals is an issue of great concern. The purpose of the present study was to investigate whether patients with low back pain (n = 46) who dropped out of a treatment programme differed in characteristics measured prior to treatment from a matched comparison group (n = 46) who completed the programme. Data collected on work disability and sick leave, frequency, duration and intensity of pain, physical function, and personality characteristics were compared. The results indicated that the groups differed significantly on 3 of 16 variables. The non-completers had been on sick leave for a longer time period prior to treatment, experienced more intense pain and performed at a lower level on the test of physical function than those who completed the treatment programme.

Interaction of the competitive AMPA receptor antagonist NBQX with hexobarbital.

IP administration of hexobarbital to rats caused a mean sleeping time of 93.6 min (SD 21.5). IV infusion of 2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo(f)quinoxaline (NBQX) at a dose rate of 0.11 mg/kg/min starting 30 min after administration of hexobarbital prolonged the mean sleeping time to 132.2 min (SD 14.9). Dose rates of 0.33 and 1.10 mg/kg/min prolonged the mean sleeping times to 176.4 min (SD 33.3) and 444.1 min (SD 72.0), respectively. Measured 180 and 450 min after the start of the study, there were no differences in the plasma concentrations of hexobarbital in groups receiving hexobarbital alone compared to groups receiving the high-dose rate of NBQX starting 30 min after administration of hexobarbital. The present results demonstrate that by IV infusion NBQX dose dependently prolonged the sleeping time of hexobarbital. There were no indications of interactions on hexobarbital elimination of either isomer. It is therefore likely that NBQX acts synergistically with hexobarbital to depress the central nervous activity.

AMPA, but not NMDA, receptor antagonism is neuroprotective in gerbil global ischaemia, even when delayed 24 h.

The selective alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) antagonist 2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo(f)quinoxaline (NBQX) and the selective N-methyl-D-aspartate (NMDA) receptor antagonists MK 801 and ifenprodil were administered to Mongolian gerbils following a 5 min period of bilateral carotid artery occlusion. NBQX when given 4, 6 or 24 h after ischaemia gave a reduced loss of hippocampal CA1 neurones compared to control animals receiving vehicle only. Dizocilipine (MK 801) (1-10 mg/kg i.p.) and ifenprodil (a total of 45 mg/kg i.p.) gave no protection. The peak levels of NBQX obtained in the cerebrospinal fluid of gerbils receiving the neuroprotective dose (3 x 30 mg/kg i.p.) was 1 microM. In gerbil cortex slices, this concentration had no effect on NMDA-evoked depolarization, but had a moderate effect on kainate and gave a total blockade of AMPA depolarizations. It is concluded that antagonists of non-NMDA glutamate receptor subtypes, possibly AMPA, may be a useful therapeutic approach for cerebral ischaemia-related brain damage following global ischaemia.

Community-based rehabilitation--a survey of disabled in a village in Botswana.

The present study was undertaken in the context of developing community-based rehabilitation (CBR) in Botswana. A door-to-door survey was conducted in Moshupa village during 1990, identifying 1.4% disabled persons. Twenty-two per cent of the disabled were younger than 15 years of age and 17% were more than 65 years old. A high proportion (30%) of disabled persons had parents who were related to one another. A majority of the disabled had difficulties with mobility (65%) and 21% had two or more disabilities. Thirty-four per cent received treatment (predominantly modern medicine) and there was a positive association between treatment and education. The results are compared with other disability studies and discussed with reference to the CBR programme aims.

Establishing a Swedish instrument measuring hope.

Hope has been identified as an important component for individuals coping with stress in life-threatening situations. The purpose of this study was to establish a Swedish instrument measuring hope. The instrument is based on an American hope scale developed by J.F. Miller to measure hope in adults. The Miller Hope Scale (MHS) is a 40-item 5-point Likert-type scale with a score range of 40-200. The MHS was translated into Swedish and examined in three stages before it was tested on a group of nursing students (n = 120). The test results in the Swedish sample were in accordance with Miller's evaluation of the psychometric properties of the MHS. The mean hope score was 170.4 (SD = 16.52) and the internal alpha coefficient was 0.88. The factor analysis on the Swedish sample resulted in the factors: I. Satisfaction with self, others and life; II. Avoidance of hope threats; III. Ability, capacity to influence the outcome in life.

AMPA receptor competitive antagonism reduces halothane MAC in rats.

Various subtypes of receptors have been identified for glutamate, an excitatory neurotransmitter. Previous studies have shown that antagonism of glutamate at the NMDA receptors reduces minimum alveolar concentration (MAC) for volatile anesthetics. NBQX (2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo(f)quinoxaline) is a selective antagonist at the glutamatergic AMPA receptor. The purpose of this experiment was to determine whether AMPA receptor antagonism influences halothane MAC in the rat. Sprague-Dawley rats were anesthetized with halothane in 50% O2/balance N2, tracheally intubated and the lungs were mechanically ventilated. Increasing doses of NBQX were intravenously infused in three groups while the control group was infused with vehicle (D5W). Halothane MAC was then determined by the tail-clamp method. Halothane MAC was log-linearly related to plasma NBQX concentrations (MAC = 0.125 (In plasma concentration NBQX) + 1.035, r2 = 0.77). A maximal 58% reduction of halothane MAC was achieved with an NBQX loading dose of 42 mg/kg followed by a continuous infusion rate of 36 mg x kg-1 x h-1 (control = 1.02 +/- 0.07%; NBQX = 0.43 +/- 0.12%; P < .01). Larger doses of NBQX were not possible because of the poor aqueous solubility of this compound. In a separate experiment, awake rats were randomly assigned to groups based on the dose of NBQX infused. Pa(CO2) and mean arterial pressure were measured at time 0 and at 5 and 30 min after start of NBQX infusion. The infusion was then stopped. Time until recovery of the righting reflex was recorded.(ABSTRACT TRUNCATED AT 250 WORDS)