"Flooding in vivo" during the circadian phase of minimal cortisol secretion: anxiety and therapeutic success without adrenal cortical activation.

Seven patients with maximally severe phobias for physical objects were treated by "flooding in vivo", i.e. live confrontation with the feared object. Each reported to the laboratory for 3 hr on five separate occasions, all in the early evening during the circadian phase of minimal adrenal cortical activity. At 20-min intervals during each session, blood was taken for cortisol assay, and anxiety was self-rated on a scale of 0 to 100. Treatment was carried out during the 2nd hr of the third and fourth sessions. The remaining time provided control observations. By behavioral and subjective criteria, the treatment hours produced very intense anxiety. However, they failed to evaluate plasma cortisol levels. The remission of the phobias was 100%. Anxiety, even when intense and dramatic, does not necessarily activate the adrenal cortex, and an adrenal "stress" response is not necessary for the therapeutic effect.

Opioid-binding cell adhesion molecule (OBCAM)-related clones from a rat brain cDNA library.

A rat brain cDNA library was screened with probes constructed from portions of the cDNA (OBCAM) encoding the opioid-binding cell adhesion molecule (OBCAM). Three clones of interest were isolated and sequenced. The largest clone, DUZ1, had a putative open reading frame (ORF) essentially identical to OBCAM in its C-terminal 318 amino acids (aa), but differing in its N-terminal aa (20 vs. 27 in OBCAM), and in all of its 5'-noncoding regions. The other clones, SG8 and SG13, had a putative ORF essentially identical to that of OBCAM, but differed from each other in a portion of their 5'-noncoding region. This study suggests that there is a family of OBCAM-like genes.

Plasma growth hormone: effect of anxiety during flooding in vivo.

The treatment of phobias by rapid in vivo exposure to the feared situation was accompanied by an increase in plasma growth hormone levels on at least one of two occasions in 8 of 11 subjects. The average growth hormone response was greater on the second occasion, even though subjective anxiety was less. Plasma growth hormone was not elevated during the subjects' adaptation to the laboratory. Strong subjective and behavioral anxiety responses failed to elevate plasma growth hormone levels in some subjects. The probability of a growth hormone response was the same whether or not baseline levels were elevated prior to exposure.

Teaching culturally competent care: nursing students experience rural Appalachia.

This article describes two courses, Health in Rural Appalachia and Clinical Practice in Appalachia, developed by one of the authors to increase students' cultural competence as professional nurses. Characteristics of the Appalachian culture are described as well as the need for cultural awareness and sensitivity in those providing health care. Both the three-credit seminar course and the one-credit clinical course are described. Students' comments, from journals and other assignments, are interspersed throughout to illustrate various aspects of the cultural heritage they experienced as they worked with nurses and patients in eastern Kentucky.

Contraception and family planning: finding the best method. Part one.

PIP: This summary of the advantages and disadvantages of oral contraceptives, IUDs, and diaphragms is written for the nurse who gives family planning counseling. Theoretical effectiveness vs. use-effectiveness is discussed, emphasizing that in practical work use-effectiveness is the more important. Before prescribing any method, the nurse should talk with the patient, learn about her life style, find out how she feels about various methods, and make every effort to match patient with proper contraceptive. The cautions the nurse should give are included.^ieng

Role-modeling experience improves nursing students' attitudes toward people living with AIDS.

Two groups of student nurses were given on AIDS Knowledge/Attitudes survey before different clinical experiences. Group One worked with nurses experienced in the care of persons living with AIDS (PLWA) on a high-acuity unit with many AIDS patients. The other group were precepted on a acute-care unit with no AIDS patients. Outcomes measures revealed significantly better student attitude scores for Group One on scales measuring (1) avoidance intentions to working with PLWA and (2) attitude toward homosexuals.

Nursing's image on the university campus.

Our study found that the faculty sampled held a different and more positive view of nursing than the one presented by the media. Nurses were perceived as educated, autonomous and compassionate individuals whose role is vital in health care. These findings might be explained by the high degree of personal contact that the sample had with nurses. It is possible that personal contact with nurses may mediate against the negative media image of nursing. As one respondent wrote, "Nursing care after recent surgery certainly erased all stereotyped notions...." The implications are tremendous for the role of the nurse in every encounter with the public. Nursing's energies might be best directed toward promoting nursing, not as it is portrayed in the media world of make-believe, but as it is lived by real nurses and their clients. Nurses must convey an image of caring, competent professionals who are capable of addressing society's health care needs. In the words of another respondent, "Unfortunately, the American public does not know the reality of professional nursing and the nurses have been treated unfairly, far from what they deserve.... I hope the American public will look on nursing as one of the most respectable professions and give the nurses credit for their efforts, devotion, and knowledge...."

Anxiety and plasma cortisol at the crest of the circadian cycle:reappraisal of a classical hypothesis.

Near-maximal anxiety by subjective and behavioral criteria was evoked and terminated in phobic patients by initiation and termination of rapid live confrontation ("flooding in vivo") with the specific stimulus that each avoided, at a time approximating the crest of the circadian cycle of adrenal cortical function. The procedure was associated with moderate, but not marked, elevations of plasma cortisol above control levels in some, but not all, subjects. Differences in anxiety levels as self-rated by the patients did not account for differences in cortisol response. The findings should stimulate further reevaluation of the hypothesis that affective arousal is the key psychological determinant of adrenal cortical function. Dissociation between subjective-behavioral arousal and plasma cortisol during flooding may be a manifestation of what behavior therapists call "desynchrony of fear."

Attitudes of Ontario psychiatrists towards health insurance.

In 1979 the opinions of Ontario psychiatrists were sought regarding the influence of the Ontario Health Insurance Plan (OHIP) on the practice of their specialty. Full replies to a 44-item questionnaire were received from more than half the certified psychiatrists in Ontario, half of whom had been in practice before the introduction of OHIP. Both satisfaction and uneasiness were expressed about most aspects of health insurance. Many of the 416 psychiatrists stated that OHIP had improved access to psychiatric care, providing a more socially diverse practice, especially with respect to psychotherapy. Only one quarter believed that OHIP constituted a major intrusion on the doctor-patient relationship, and the majority reported that OHIP had been beneficial to themselves as psychiatrists (70%) and to their patients (86%). Almost half reported having raised their concern about the confidentiality of OHIP records with their patients; the patients less often brought up the issue. Although most psychiatrists in practice before the introduction of OHIP reported no change in their conduct of psychotherapy, a minority reported a decrease in the duration of treatment and an increase in the frequency of missed appointments. Also noted was an increase in the number of referrals for consultation, which led at times to overutilization of these specialists' services.

Food intake and energy expenditure of male and female farmers from Upper-Volta.

1. The energy balance of eleven male and fourteen female adult farmers was measured for 6 d after the harvest, in December-January. Their energy intake was recorded by weighing their food consumption and their energy expenditure was determined using indirect calorimetry. 2. Body-weight, expressed as percentage of expected weight-for-height was 91 and 86% of the Inter-departmental Committee on Nutrition for National Development (1963) standard for women and men respectively. 3. The staple foods were sorghum (Sorghum vulgare) and millet (Pennisetum typhoïdes); carbohydrates, fat and protein supplied approximately 80, 13 and 12% of the total energy of the diet respectively. 4. In the male group, the mean energy intake (9.0 MJ (2148 kcal)) was in good agreement with the average energy output (8.91 MJ (2130 kcal)). By contrast, in the female group, the mean energy expenditure (8.11 MJ (1941 kcal)) exceeded the mean energy intake (6.3 MJ (1515 kcal)) and the deficit was statistically significant. 5. This study allows an evaluation of the adequacy of food intake for subjects living in a particular hostile environment, by using their actual energy output instead of current standard values. The energy deficit found for female farmers whose energy intake was similar to that reported in other developing countries emphasizes the need for a better understanding of the regulation of energy balance in such conditions.

Opioid agonist and antagonist effects of configurational stereoisomers of 3-(dimethylamino)-2,2-dimethyl-7-hydroxy-1-tetralol.

The opioid agonist and antagonist effects of two configurational aminotetralin stereoisomers, namely, the cis-(MRSAL) and trans-(RMG) diastereo isomers of 3-(dimethylamino)-2,2-dimethyl-7-hydroxy-1-tetralol were studied using the guinea pig ileum longitudinal muscle preparation. MRSAL demonstrated opioid antagonist activity but failed to show agonist effects. In contrast, RMG showed agonist activity which was partially reversed by NX and MRSAL. RMG also exhibited weak antagonist activity towards DHM, NM and DADLE. These results showed that MRSAL was an opioid antagonist while RMG possessed weak mixed opioid agonist-antagonist activities.

Opioid receptor effects of two 3-amino-2,2-dimethyltetralin analogs in guinea pig ileum longitudinal muscle.

Two substituted analogs of 3-amino-2,2-dimethyltetralin, namely 3-dimethylamino-2,2-dimethyl-7-hydroxy-1-tetralone HBr (J) and 3-dimethylamino-2,2-dimethyl-7-hydroxy-1-tetralol (MRSAL), were evaluated for opioid agonist and antagonist activity using the electrically driven guinea pig ileum longitudinal muscle preparation (GPI). Compound J appeared to be an opioid agonist with a preference for mu receptors while MRSAL was an opioid antagonist with little selectivity for mu or kappa receptors.