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The administration of a single subcutaneous dose of clenbuterol to rats altered the level of taurine in certain tissues. Taurine levels in cardiac tissue were significantly decreased 3 h after the administration of 250 μg/kg of clenbuterol and remained significantly depressed at 12h post-dose only returning to control values by 24h. The level of taurine in the liver increased 3 h after clenbuterol administration but was lower than the control value at 24 h post dose. Lung taurine levels were significantly lower than the control value at 12 hr post dose and remained depressed until 24h post dose. Clenbuterol caused a significant increase in taurine levels in serum and muscle at 3 and 6 hr postdosing respectively but not at other time points. Serum creatine kinase (CK), activity was slightly but significantly raised at the 12 and 24 h time point. The effects of clenbuterol on tissue taurine content were not dose-dependent over the range studied (63–500 μg/kg). However taurine levels in the lung were significantly reduced at all doses and in the heart were significantly lower in the treated groups at all except the lowest dose, 12h post dosing. Liver taurine levels were significantly increased at the highest dose of 500 μg/kg. The reduction of taurine concentrations in the heart, caused by clenbuterol, is of concern as taurine has been shown to have protective properties in many tissues especially the heart. [ABSTRACT FROM AUTHOR]

Aims: The COVID-19 pandemic hit Sweden harder than the other Nordic countries in the early phase, especially among older persons. We compared the impact of the COVID-19 pandemic on mortality especially among older persons during the period 2020-2022 in Sweden, Denmark, Finland and Norway, using four different outcome measures., Methods: We compared publicly available information on reported cases and deaths in COVID-19 from the World Health Organization COVID-19 Dashboard, age-specific mortality rates, life expectancy at age 65 years and excess mortality from Nordic Statistics database and national statistics and health agencies in Sweden, Denmark, Finland and Norway., Results: The pandemic peaked earlier in Sweden than in Denmark, Finland and Norway, where cases and deaths increased more during 2021 and 2022, also reflected in age-specific death rates among persons aged 70+ years. COVID-19 mortality was highest in Sweden, followed by Finland, Denmark and Norway. Life expectancy declined during 2020 in Sweden but more during 2021 and 2022 in Denmark, Finland and Norway. Excess mortality during 2020-2022 was nearly twice as high in Finland as in the other countries., Conclusions: COVID-19 mortality was higher in Sweden than in Denmark, Finland and Norway. Life expectancy declined during 2020 in Sweden, was partly regained in 2021 and 2022, while it declined during 2021 and 2022 in Denmark, Norway and Finland. However, excess mortality during 2020-2022 was similar in Sweden, Denmark and Norway and twice as high in Finland. Different mortality outcomes reflect the complexity of the mortality impact of COVID-19., Competing Interests: Declaration of conflicting interestsThe authors have no conflicts of interest to declare.

Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers' scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field., (© 2024 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.)

Schwanniomyces capriottii is a member of the Debaryomycetaceae family in the order Saccharomycetales. Here, we present the genome sequence of S. capriottii UCD805, which was isolated from soil in Dublin, Ireland. This genome is 12.2 Mb and was assembled into 14 scaffolds plus a mitochondrial genome scaffold., Competing Interests: The authors declare no conflict of interest.

Background: In Norrtälje municipality, within Region Stockholm, there is a joint integrated care organisation providing health and social care, which may have facilitated a more coordinated response to the covid-19 pandemic compared to the otherwise decentralised Swedish system. This study compares the risk of covid-19 mortality among persons 70 years and older, in the municipalities of Stockholm, Södertälje, and Norrtälje, while considering area and individual risk factors., Methods: A population-based study using linked register data to examine covid-19 mortality among those 70 + years (N = 127,575) within the municipalities of interest between the periods March-August 2020 and September 2020-February 2021. The effect of individual and area level variables on covid-19 mortality among inhabitants in 68 catchment areas were examined using multi-level logistic models., Results: Individual factors associated with covid-19 mortality were sex, older age, primary education, country of birth and poorer health as indicated by the Charlson Co-morbidity Index. The area-level variables associated were high deprivation (OR: 1.56, CI: 1.18-2.08), population density (OR: 1.14, CI: 1.08-1.21), and usual care. Together, this explained 85.7% of the variation between catchment areas in period 1 and most variation was due to individual risk factors in period 2. Little of the residual variation was attributed to differences between catchment areas., Conclusion: Integrated care in Norrtälje may have facilitated a more coordinated response during period 1, compared to municipalities with usual care. In the future, integrated care should be considered as an approach to better protect and meet the care needs of older people during emergency situations., (© 2024. The Author(s).)

Aims: Polypharmacy and potentially inappropriate medications (PIM) are risk factors for negative health outcomes among older people. This study aimed to investigate socio-demographic differences in polypharmacy and PIM use among older people with different care needs in a standard versus an integrated care setting., Methods: Population-based register data on residents aged ⩾65 years in Stockholm County based on socio-demographic background and social care use in 2014 was linked to prescription drug use in 2015. A logistic regression analysis was used to estimate socio-demographic differences in polypharmacy and PIM, adjusting for education, age group, sex, country of birth, living alone, morbidity and dementia by care setting based on area and by care need (i.e. independent, home help or institutionalised)., Results: The prevalence of polypharmacy and PIM was greater among home-help users (60.4% and 11.5% respectively) and institutional residents (74.4% and 11.9%, respectively). However, there were greater socio-demographic differences among the independent, with those with lower education, older age and females having higher odds of polypharmacy and PIM. Morbidity was a driver of polypharmacy (odds ratio (OR)=1.19, confidence interval (CI) 1.16-1.22) among home-help users. Dementia diagnosis was associated with reduced odds of polypharmacy and PIM among those in institutions (OR=0.78, CI 0.71-0.87 and OR 0.52, CI 0.45-0.59, respectively) and of PIM among home-help users (OR=0.53, 95% CI 0.42-0.67)., Conclusions: Polypharmacy and PIM were associated with care needs, most prevalent among home-help users and institutional residents, but socio-demographic differences were most prominent among those living independently, suggesting that municipal care might reduce differences between socio-demographic groups. Care setting had little effect on inappropriate drug use, indicating that national guidelines are followed.

Objectives: To investigate the association between inpatient care expenditure (ICE) and income group and the effect of demographic factors, health status, healthcare and social care utilisation on ICE in the last year of life., Design: Retrospective population-based study., Setting: Stockholm County., Participants: Decedents ≥65 years in 2015 (N=13 538)., Outcome: ICE was calculated individually for the month of, and 12 months preceding death using healthcare register data from 2014 and 2015. ICE included the costs of admission and treatment in inpatient care adjusted for the price level in 2018., Results: There were difference between income groups and ICE incurred at the 75th percentile, while a social gradient was found at the 95th percentile where the highest income group incurred higher ICE (SEK45 307, 95% CI SEK12 055 to SEK79 559) compared with the lowest income groups. Incurring higher ICE at the 95th percentile was driven by greater morbidity (SEK20 333, 95% CI SEK12 673 to SEK29 993) and emergency department care visits (SEK77 995, 95% CI SEK64 442 to SEK79 549), while lower ICE across the distribution was associated with older age and residing in institutional care., Conclusion: Gaining insight into patterns of healthcare expenditure in the last year of life has important implications for policy, particularly as socioeconomic differences were visible in ICE at a time of greater care need for all. Future policies should focus on engaging in advanced care planning and strengthening the coordination of care for older people., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies are an excellent indicator of past COVID-19 infection. As the COVID-19 pandemic progresses, retained sensitivity over time is an important quality in an antibody assay that is to be used for the purpose of population seroprevalence studies. We compared 5,788 health care worker (HCW) serum samples by using two serological assays (Abbott SARS-CoV-2 anti-nucleocapsid immunoglobulin G (IgG) and Roche anti-SARS-CoV-2 anti-nucleocapsid total antibody) and a subset of samples (all Abbott assay positive or grayzone, n  = 485) on Wantai SARS-CoV-2 anti-spike antibody enzyme-linked immunosorbent assay (ELISA). For 367 samples from HCW with a previous PCR-confirmed SARS-CoV-2 infection, we correlated the timing of infection with assay results. Overall, seroprevalence was 4.2% on Abbott and 9.5% on Roche. Of those with previously confirmed infection, 41% (150/367) and 95% (348/367) tested positive on Abbott and Roche, respectively. At 21 weeks (150 days) after confirmed infection, positivity on Abbott started to decline. Roche positivity was retained for the entire study period (33 weeks). Factors associated ( P ≤ 0.050) with Abbott seronegativity in those with previous PCR-confirmed infection included sex (odds ratio [OR], 0.30 male ; 95% confidence interval [CI], 0.15 to 0.60), symptom severity (OR 0.19 severe symptoms; 95% CI, 0.05 to 0.61), ethnicity (OR, 0.28 Asian ethnicity; 95% CI, 0.12 to 0.60), and time since PCR diagnosis (OR, 2.06 for infection 6 months previously; 95% CI, 1.01 to 4.30). Wantai detected all previously confirmed infections. In our population, Roche detected antibodies up to at least 7 months after natural infection with SARS-CoV-2. This finding indicates that the Roche total antibody assay is better suited than Abbott IgG assay to population-based studies. Wantai demonstrated high sensitivity, but sample selection was biased. The relationship between serological response and functional immunity to SARS-CoV-2 infection needs to be delineated. IMPORTANCE As the COVID-19 pandemic progresses, retained sensitivity over time is an important quality in an antibody assay that is to be used for the purpose of population seroprevalence studies. There is a relative paucity of published literature in this field to help guide public health specialists when planning seroprevalence studies. In this study, we compared results of 5,788 health care worker blood samples tested by using two assays (Roche and Elecsys, anti-nucleocapsid antibody) and by testing a subset on a third assay (Wantai enzyme-linked immunosorbent assay [ELISA] anti-spike antibody). We found significant differences in the performance of these assays, especially with distance in time from PCR-confirmed COVID-19 infection, and we feel these results may significantly impact the choice of assay for others conducting similar studies.

Objective: To investigate the association between the implementation of an integrated care (IC) system in Norrtälje municipality and changes in trends of the rate of emergency department (ED) visits., Design: Interrupted time series analysis from 2000 to 2015., Setting: Stockholm County., Participants: All inhabitants 65+ years in Stockholm County on 31 December of each study year., Intervention: IC was established by combining the funding, administration and delivery of health and social care for older persons in Norrtälje municipality, within Stockholm County., Outcome: Rates of hospital-based ED visits., Results: IC was associated with a decrease in the rate of ED visits (incidence rate ratio: 0.997, 95% CI 0.995 to 0.998) among inhabitants 65+ years in Norrtälje. However, the rate of ED visits remained higher in Norrtälje than the rest of Stockholm in the preintervention and postintervention periods. Stratified analyses showed that IC was associated with a decline in the trend of the rate of ED visits among those 65-79 years, the lowest income group and born outside of Sweden. However, there was no significant decrease in the trend among those 80+ years., Conclusion: The implementation of IC was associated with a modest change in the trend of ED visits in Norrtälje, though the rate of ED visits remained higher than in the rest of Stockholm. Changes in the composition of the population and contextual changes may have impacted our findings. Further research, using other outcome measures is needed to assess the impact of IC on healthcare utilisation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Background: In Sweden, the number of older people using emergency department (ED) care is rising. Among older persons an ED visit is a stressful event, which potentially could have been prevented or treated at other levels of care. Frequent ED use (> 4 visits a year) by older persons might reflect issues in the organisation of health care system to address their needs. We aimed to explore socio-demographic differences among older people seeking ED care in terms age and gender, and to investigate the association between income and frequent ED use., Methods: A population-based study analysing the utilisation of ED care by (N = 356,375) individuals aged 65+ years. We linked register data on socio-demographic characteristics from 2013 to health care utilisation data in 2014. Multivariable logistic regression was used to estimate the income differences in the frequent use of ED care, adjusting for living situation, country of birth, residential area, age in years, multi-morbidity and the use of other health care services., Results: Those 65+ years accounted for (27%) of all ED visits in Stockholm County in 2014. In the study population (2.5%) were identified as frequent ED users, who were predominantly in the lower income groups, living alone or in an institution, had more multi-morbidity, and utilised more of other health care services. The lowest income groups had a three-fold greater odds of being a frequent ED user than those in the highest income group. In the adjusted models, the odds were reduced by 12-44% for those in the lowest income groups. However, age and gender differences were observed with men 65-79 years (OR 1.75 CI: 1.51-2.03) and women 80+ years (OR 1.50, CI 1.19-1.87) in the lowest income groups having a higher odds of frequent ED use., Conclusion: This study observed that ED visits by older persons are driven by a need of care, and those that frequently visit hospital-based EDs are a socially disadvantaged group, which suggests that the organisation of care for older people should be reviewed in order to better meet their needs in other levels of care.

Ireland's National Men's Health Policy recommended developing training programmes tailored to the needs of those working in health and allied health professionals and ENGAGE was developed to meet that recommendation. This study evaluated the impact of ENGAGE on frontline service providers' self-reported knowledge, skills, capacity and practice up to 5-months post training. Between 2012 and 2015, ENGAGE Trainers (n = 57) delivered 62 1-day training programmes to 810 participants. This study was conducted on a subset of those training days (n = 26) and participants. Quantitative methodologies were used to collect pre (n = 295), post (n = 295) and 5-month post (n = 128) training questionnaire data. Overall, participants were highly satisfied with the training immediately post training (8.60 ± 1.60 out of 10) and at 5-month follow up (8.06 ± 1.43 out of 10). Participants' self-reported level of knowledge, skill and capacity in identifying priorities, engaging men and influencing practice beyond their own organisation increased immediately following training (P < 0.001) and, with the exception of improving capacity to engage men and influencing practice beyond their organisation, these improvements were sustained at 5-month post training (P < 0.001). The vast majority of service providers (93.4%) reported that ENGAGE had impacted their work practice up to 5-month post training. The findings suggest that ENGAGE has succeeded in improving service providers' capacity to engage and work with men; improving gender competency in the delivery of health and health related services may increase the utilisation of such services by men and thereby improve health outcomes for men.

Background: Interdisciplinary care for patients with traumatic brain injury focuses on treating the primary brain injury and limiting further brain damage from secondary injury. Intensive care unit nurses have an integral role in preventing secondary brain injury; however, little is known about factors that influence nurses' judgments about risk for secondary brain injury., Objective: To investigate which physiological and situational variables influence judgments of intensive care unit nurses about patients' risk for secondary brain injury, management solely with nursing interventions, and management by consulting another member of the health care team., Methods: A multiple segment factorial survey design was used. Vignettes reflecting the complexity of real-life scenarios were randomly generated by using different values of each independent variable. Surveys containing the vignettes were sent to nurses at 2 level I trauma centers. Multiple regression was used to determine which variables influenced judgments about secondary brain injury., Results: Judgments about risk for secondary brain injury were influenced by a patient's oxygen saturation, intracranial pressure, cerebral perfusion pressure, mechanism of injury, and primary diagnosis, as well as by nursing shift. Judgments about interventions were influenced by a patient's oxygen saturation, intracranial pressure, and cerebral perfusion pressure and by nursing shift. The initial judgments made by nurses were the most significant variable predictive of follow-up judgments., Conclusions: Nurses need standardized, evidence-based content for management of secondary brain injury in critically ill patients with traumatic brain injury.

Healthy People 2010 is the latest publication developed by the United States Public Health Service (USDHSS, 2000) to identify the most significant and preventable threats to health and to establish national goals to reduce these threats. This document contains two major goals, 467 objectives, 28 focus areas, and 10 leading indicators. Orthopaedic nurses are in ideal positions to assume leadership roles in promoting healthier behaviors in neighborhoods and communities as individuals, groups, and organizations begin to incorporate Healthy People 2010 into health promotion planning. Healthy People 2010 is designed to be a valuable resource for participating most effectively in improving the nation's health. By using this document to plan health promotion and disease prevention programs, orthopaedic nurses, regardless of practice setting, can impact the health of future generations of Americans.

The purpose of this study was to examine the relationships between depression, codependency, self-coherence, and alcohol use and health outcomes in women 65 years of age and older. The framework is Erikson's ego-development theory. A convenience sample of 238 women was obtained from women attending flu shot clinics. This cross-sectional field study used survey methodology. Measures included the Beck Depression Inventory, Codependency Assessment Tool, Self-Coherence Survey Form C, Alcohol Use Disorders Identification Test, Alcohol Use Questionnaire, Self-Rated Health Tool, Quality of Life Visual Analogue Scale, Functional Ability Scale, Illness Prevention Screening Behaviors Checklist, and Sociodemographic Data. Results indicate a low consumption and little variation in use of alcohol. There were no significant associations between alcohol consumption and the dependent variables. Depression was significantly related to all the health outcomes; codependency was significantly related to all health outcomes except perceived quality of life; and self-coherence was significantly related to all health outcomes except illness prevention behavior. These findings have important implications for those providing care for older women.

Osteoporosis is an age related metabolic disease that primarily affects women and causes bone demineralization that results in fractures. Early identification of risk factors for osteoporosis and development of prevention programs is needed to halt the increasing incidence of the disease. Public health nurses (PHNs), with their emphasis on primary, secondary, and tertiary prevention with individuals and families, are in a unique position to protect the health of these vulnerable populations who are at risk for osteoporosis. This article describes the implementation and program evaluation of three osteoporosis prevention educational programs that use three levels of intensity of design. Each design is based upon the learning needs of the targeted audience. The goals of each program were to increase knowledge of osteoporosis, increase health beliefs, and increase the frequency of osteoporosis preventing behaviors. Theoretical aspects from adult learning and the Health Belief Model (HBM) were used to develop the programs. For the program evaluation, participants completed evaluation instruments before and 3 weeks after participating in an osteoporosis health education program. Participants in all programs had significantly higher levels of knowledge after completing the programs; however, overall, there was no change in health beliefs or behaviors. Implications of these findings are discussed.

Osteoporosis is a major nursing and health concern. Outcomes of this disease result in major body image changes including loss of height, curved spine, and protruding abdomen. Individuals with osteoporosis are not usually disabled but may perceive themselves as unattractive and experience social isolation due to ill fitting clothes that accentuate the physical changes. This article describes fashion tips on how to select clothes that are attractive, comfortable, and easy to wear.

Codependency is a controversial concept especially for feminist scholars who are concerned about pathologizing traditional female roles. This study's purpose was to determine: (1) the prevalence of codependency in a sample of older women who because of age may ascribe to traditional roles; (2) how the Hughes-Hammer/Martsolf theoretical model of codependency relates to other health variables; and (3) whether previous findings about the relationship between codependency and depression replicate. Survey design was used with a sample of 238 women (ages 65 to 91) attending a flu shot clinic. Subjects completed the Codependency Assessment Tool, Beck Depression Inventory, Quality of Life Scale, Perceived Health Report, Measurement of Patient Functional Abilities, and Illness Prevention Screening Behaviors Checklist. Of these women, 99% had low codependency scores. Statistically significant correlations existed between codependency and perceived health (p < .01), and functional ability (p < .01). Codependency was not significantly correlated with illness prevention behaviors and quality of life. Codependency and depression, as in previous studies, were significantly correlated (r = .446, p = .0001). Using analysis of variance, 3 codependency subscales had significant positive effect on depression: Low Self-Worth, Medical Problems, and Hiding Self. Further studies should examine the degree of ascribing to traditional female roles in women dealing with codependency issues.

Purpose: The purpose of this theory-based descriptive study was to describe older men's (> or = 65 years of age) knowledge of osteoporosis, their health beliefs about osteoporosis (specifically their perceived susceptibility), their confidence to perform osteoporosis-prevention behaviors, and actual performance of osteoporosis-prevention behaviors., Design: A descriptive design was used to determine men's knowledge and health beliefs of osteoporosis, confidence to perform osteoporosis prevention behaviors, and performance of osteoporosis prevention behaviors., Sample: A community-based convenience sample of 138 men 65 years of age and older was obtained in Northeastern Ohio community centers where men were likely to gather., Method: Men completed a questionnaire that included the Osteoporosis Knowledge Test, Osteoporosis Health Belief Scale, Osteoporosis Self-Efficacy Scale (Kim, Horan & Gendler, 1991), and the Osteoporosis Preventing Behaviors Survey (Doheny & Sedlak, 1995)., Main Research Classifications: Osteoporosis, Men, Prevention, Health Beliefs, Orthopaedic Nursing., Findings: Men had poor knowledge of osteoporosis, did not perceive themselves as susceptible to osteoporosis, and engaged in few osteoporosis preventing behaviors such as weight-bearing exercises and dietary calcium intake., Conclusion: Men need osteoporosis education and modification of lifestyle to include osteoporosis prevention behaviors., Implications for Nursing Research: Future research should include the development of osteoporosis awareness programs for men.

This article describes the historical development of an electronic nursing journal, (OJIN), from inception to reality. Planning focused on a needs analysis for an electronic journal, audience and marketing concerns, editorial board membership, and financing of the journal. Included are recommendations for those considering starting an online journal.

NAONline is a valuable Internet resource for obtaining current information about topics related to orthopaedic nurses. NAONline provides up-to-date information about NAON, upcoming events and registration information, membership information, NAON products, continuing education offerings, the Orthopaedic Nursing journal, online continuing education offerings, and a forum to exchange information on practice topics. This article highlights various aspects of NAONline, how to access the site, and a brief discussion on how to connect to the Internet.

Facilitating the development of critical thinking in beginning nursing students is challenging and exciting. Peer review through student-led clinical rounds can be an effective way to promote students' critical thinking in communicating assessment data and identifying client strengths and problems. Nineteen beginning baccalaureate nursing students participated in a peer review clinical round experience and were then asked to describe their critical thinking. Strengths of using the peer-led rounds include promotion of active student learning and encouragement of collaboration among peers.

Purpose: To assess whether young women who participate in an osteoporosis prevention program based on the Health Belief (Rosenstock, 1966) and Self-Efficacy Models (Bandura, 1977) demonstrate higher levels of knowledge regarding osteoporosis prevention than young women who do not participate in such a program., Design: A classic experimental design with one treatment group and one control group was used to test the efficacy of the osteoporosis prevention program. Pretest data on knowledge, health belief attitudes (7 subscales), and self-efficacy (2 subscales) were collected in the treatment and control groups., Sample: A convenience sample of 31 young college women were randomly assigned to an experimental group or to a control group to receive an osteoporosis prevention program., Method: Subjects in the experimental and control groups completed the Osteoporosis Knowledge Test, the Osteoporosis Health Belief Scale, and the Osteoporosis Self-Efficacy Scale (Kim et al., 1991) at two times. The experimental group received an osteoporosis prevention program., Main Research Classifications: Osteoporosis, Health Belief, Self-Efficacy, Women's Health., Findings: Subjects in the experimental group had significantly higher knowledge and health belief scores after receiving the intervention than their pretest scores while subjects in the control group had no change in scores., Conclusion: The osteoporosis program was effective in increasing awareness of osteoporosis prevention in this group of young women., Implications for Nursing Research: The results may be useful for developing young women's awareness and knowledge of osteoporosis prevention. Future research could include developing osteoporosis prevention programs at an earlier age when girls are in grade school and junior high school. Teaching health promotion strategies for bone health is essential to all women across the life span.

Therapeutic drug monitoring of a variety of antiepileptic drugs is used routinely as a guide to individualising the drug treatment of patients with epilepsy. Thin dry film multilayer immunoassays (OPUS) for carbamazepine, phenytoin, phenobarbitone, and valproic acid were evaluated and compared with fluorescence polarisation immunoassay (TDx), using commercially available control material and patient sera. For the OPUS, the within-batch coefficient of variation (CV) for the different drugs in the control material varied between 3.9% (phenobarbitone) and 8.1% (valproic acid). The between-batch CVs varied between 5.3% (valproic acid) and 18.3% (carbamazepine). The comparative between-batch CVs for the TDx varied between 2.0% (phenytoin) and 7.0% (valproic acid). Analysis of 209 patient samples containing carbamazepine, phenytoin, phenobarbitone, or valproic acid demonstrated significant correlation between the two analytical methods, with correlation coefficients of 0.9336, 0.9560, 0.9448, and 0.9618, with slopes of the regression lines of 0.9042, 0.8663, 1.1368, and 1.1244, respectively. It is concluded that both the TDx and OPUS instruments exhibit comparable performance for the analysis of carbamazepine, phenobarbitone, phenytoin, and valproic acid in patient samples. Moreover, the OPUS instrument, with its facilities of random assay access and statim analysis, may be useful in an outpatient setting in which a major consideration would be a rapid turnaround of patient assay results.

Marked abnormalities of the magnetic resonance intensity of N-acetylaspartate (NAA) have been reported in patients with various neurological disorders, but the neurochemical consequences of these alterations are difficult to assess because the function of NAA remains speculative. The purpose of this study was to examine whether NAA plays a role in protecting neurons against osmotic stress. Intracerebral microdialysis was used to expose a small region of the rat dorsolateral striatum to an increasingly hyposmotic environment and to measure resulting changes in NAA extracellular concentrations. NAA changes in the extracellular fluid (ECF) were compared with those of the amino acids, in particular, taurine, known to be involved in brain osmoregulation. Stepped increases in cellular hydration produced by hyposmotic perfusion media induced a marked increase in ECF NAA, reflecting a redistribution of NAA from intra-to extracellular space. Parallel experiments showed that, of all the extracellular amino acids measured, only taurine markedly increased with hyposmolar perfusion medium, indicating that the ECF NAA increase associated with hyposmotic stress was a specific response and not passive leakage out of the cells. As NAA is predominantly neuronal, it may contribute to the protection of neurons against swelling (i.e., regulatory volume decrease). In conditions with impaired blood-brain barrier and cytotoxic oedema, efflux of intracellular NAA subsequent to sustained cellular swelling might lead to a reduction in total brain NAA detectable by magnetic resonance spectroscopy. Alternatively, redistribution of NAA from intra-to extracellular space implies changes in its chemical environment that may alter its magnetic resonance visibility.

The metabolic response to trauma is related to a variety of factors, including severity of injury, age, and previous state of health and nutrition (Cardona et al., 1994). This article addresses nutritional considerations of an orthopaedic trauma patient. A case study has been developed with common findings associated with malnutrition, including postoperative infection. Three concepts are discussed: (a) pretrauma nutritional status, (b) post-trauma metabolism, and (c) nutritional assessment parameters. A brief comment on nursing diagnoses related to nutrition concludes this article.

Nursing educators expect that students will learn psychomotor skills and demonstrate competence in these skills. However, current emphasis on cognitive and psychosocial skills concerns nursing educators because psychomotor skills are necessary for safe practice. One possible strategy, based on a holistic framework, is mental practice. This is the same type of practice that athletes use when preparing to perform a sports activity. The purpose of this study was to determine whether mental imaging practice for nursing students affected the learning and performance of giving an intramuscular injection. Findings suggest that mental practice does affect learning and performance of motor skills.

Sickle cell disease (SCD) is an inherited, chronic, painful condition seen primarily in blacks and populations from the Mediterranean and Caribbean areas. The crescent or sickle shaped red blood cells have a shorter lifespan causing severe anemia; they are sticky and easily clump together causing intravascular occlusions which eventually damage vital organs. Providing nursing care for patients with sickle cell disease can be very challenging because of the chronic nature of the illness. Understanding the disease phenomena can facilitate nursing assessments and help nurses individualize care for these clients.

1. Milacemide is a glycine prodrug which is both an inhibitor and a substrate for monoamine oxidase-type B (MAO-B) and also an inhibitor of MAO-type A (MAO-A). Its effects on dopamine and 5-hydroxytryptamine (5-HT) metabolism in rat frontal cortex tissue and dialysate were evaluated. 2. Dialysate dopamine concentrations increased linearly and dose-dependently after milacemide administration (100, 200, 400 mg kg-1, i.p.), peaking at 1 h. A concomitant dose-dependent decrease in dialysate 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) concentrations was observed but these changes were smaller (27% and 40% respectively) than the change in dopamine (125% after 400 mg kg-1 milacemide). 3. Dialysate 5-HT was significantly increased only at 1.5 h after giving milacemide 400 mg kg-1. Dialysate 5-hydroxyindoleacetic acid (5-HIAA) concentration was not affected. 4. Milacemide (400 mg kg-1) at 1.5 h post-administration significantly increased frontal cortex tissue concentrations of dopamine and 5-HT; the percentage increase in dopamine being about four times that of 5-HT. Metabolite concentrations, including 5-HIAA, decreased. Changes in tissue and dialysate dopamine, DOPAC and HVA were approximately proportionate to each other. 5. The results are explicable in terms of an inhibition by milacemide of MAO-A.

The purpose of the study was to assess the prevalence of undiagnosed bulimic or pre-bulimic behaviours in a normal, but high risk population. A questionnaire eliciting information about eating habits and potential binge episodes, demographic background, and information about height and weight was completed by 479 college students. Subjects were designated as a non-binger, a non-labelled binger, or labelled binger according to their responses. Consistent with previous literature, findings showed a high prevalence of bulimia in the young, female, middle income population. Findings also revealed a group of students who described frequent binge episodes but did not consider themselves to have an eating disorder in that they did not label themselves as 'binge eaters' (the non-labelled binge group).