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[Alcohol--historical aspects].

Alcoholic beverages have been produced already in a remote past. The recipe for distillated wine dates about 1100 A.D. Up to 1990 and longer, wine and alcoholic spirits were taken as an universal medicine. Alcohol has, moreover, socially integrative elements. Individual problems of alcohol abuse are as old as the production, but have become an epidemic problem with the pauperisation of the industrial proletarians in the 18th and 19th century, where private and government actions have been taken.

Alcohol Drinking↗

Aggregate economic losses from disability in the United States: a preliminary assay.

Interest in particular demographic subgroups with disabilities--such as working-age adults, the elderly, and young children--obscures seeing the populations as integral elements of a broad policy issue. Calculations based on national surveys indicate that functional disability exacted an estimated total of $177 billion in aggregate economic losses in the United States in 1980. Refinements in collecting information on disability and its consequences are needed to gauge the causes and correlates of chronic activity limitations. Policy makers will otherwise find it difficult to assess the scope that disabilities pose to people, or to monitor the effect of changes in disability policy.

Adolescent↗

Role of calcium in arrhythmogenesis.

Cardiac arrhythmias are generated as the result of disorders of automaticity or impulse conduction. Regardless of the mechanism, however, calcium is likely to be involved. The rate of Ca2+ flux across the membrane of automatic cells alters their firing rate. Myocardial cells that do not ordinarily initiate action potentials can do so when they are partially depolarized. Low extracellular Ca2+ concentrations or Ca2+ channel-blocking drugs can reduce or abolish such ectopic firing. Early afterdepolarizations are also induced in cardiac cells by partial depolarization, whereas delayed afterdepolarizations are induced by Ca2+ overloading. Early afterdepolarizations and delayed afterdepolarizations can both be suppressed by low external Ca2+ concentrations or by Ca2+ channel blockers. With respect to arrhythmias ascribable to disorders of conduction, Ca2+ channel blockers can aggravate conduction disturbances in the sinoatrial node or atrioventricular junction. Furthermore, these drugs can abolish those reentrant arrhythmias in which a cardiac impulse rotates around a loop in which nodal tissue is an integral element. Ca2+ channel blockers can also reduce the susceptibility for ventricular fibrillation to supervene in ischemic hearts, especially when the sympathetic nervous system is overactive.

Animals↗

Experiences with self-assessment and peer review among general practitioners in The Netherlands.

The relation between peer review and postgraduate training proved to be complex. Involvement occurred by way of three projects (PI, PII, and PIII) involving 1,200 general practitioners by directed or self-motivated assessment. The simple assumption that the discovery by audit of knowledge, skills of attitude gaps, automatically lead to appropriate training, proved to be untrue. Experience learned that auditing itself is an educational process which links up with the individual needs of the participants. More study, research and experience is needed with regard to the interrelationship between peer review and postgraduate training, but both are essential and integral elements of the striving for excellence and quality.

Educational Measurement↗

Integration of direction signals of image motion in the superior temporal sulcus of the macaque monkey.

Using anesthetized and paralyzed monkeys, we have studied the visual response properties of neurons in the cortical area surrounding the middle temporal area (MT) in the superior temporal sulcus (STS). Systematic electrode penetrations revealed that there is a functionally distinct region where three classes of directionally selective cells with large receptive fields cluster. This region is anteriorly adjoined to the dorsal two-thirds of MT, has a width of 4-5 mm mediolaterally, and therefore may correspond to the dorsal part of the medial superior temporal area (MST), which was previously defined as a MT-recipient zone. One class of cells responded to a straight movement of patterns in the frontoparallel plane with directional selectivity (D cells: 217/422, 51.4%). The second class of cells selectively responded to an expanding or contracting size change of patterns (S cells: 66/422, 15.7%). These cells responded neither to a change in width of a slit of any orientation or any length, nor to a change in brightness. The third class of cells responded only to a rotation of patterns in one direction (R cells: 58/422, 13.7%). A majority of these cells (41/58) responded to the clockwise or counterclockwise rotation of patterns in the frontoparallel plane (Rf cells), while the rest responded to a rotation of patterns in depth (Rd cells). We will suggest that these cells acquire the ability to discover whole events of visual motion--i.e., unidirectional straight movement, size change (radial movement), and rotation--by integrating elemental motion information extracted by MT cells. The receptive fields of D, S, and Rf cells can be constructed by converging signals of MT cells, the preferred directions of which are arranged in parallel (D cells), radially (S cells), and circularly (Rf cells). The receptive fields of Rd cells can be constructed, in turn, by the convergence of signals of S cells.

Animals↗

[Microcirculatory bed of the human duodenum].

In preparations impregnated with silver nitrate (25 corpses of mature persons), the hemomicrocirculatory bed of the intestine wall tunics has been stated to possess a layer-by-layer organization. The most powerful submucosal vascular plexus, formed by branches of the arteries perforating the external tunics of the intestine, supplies with blood all the layers of the intestinal wall and their main working and integrating elements: intestinal and duodenal glands, villi, neural ganglia and trunks of the submucosal and intermuscular plexuses. Summarizing morphometrical criteria for estimating the capillary bed of the tunics of all the anatomical parts and the large duodenal papilla, it is clear that there are specific conditions in microvascularization of the upper part of the organ.

Adolescent↗

[Planning the pathological departments of modern large clinics].

With the increasing importance of pathomorphological research as an integral element of optimization of therapeutic-diagnostic service of a modern hospital, it is important to improve the structure and technical basis of the pathology departments. The experience of pathological service and the analysis of projects of pathology departments included in the current type projects of clinical and other hospitals reveal some unsatisfactory features in architectural planning and in medico-technological aspects. This handicaps the improvement of the pathological service as an element of medical service and the subject of teaching. Recommendations on these problems are presented.

Hospital Bed Capacity, 500 and over↗

[Activities in social gynaecology for prepartal - prenatal attention (author's transl)].

An account is given of what is being done in the GDR in the context of social gynaecology, with reference being made to the subject proper as well as to its position in society and the tasks relating to it. Prepartal attention is described as an example. An appraisal of various concepts of social gynaecology has shown that these have always depended on the social conditions under which they have come into being. Their potentials and outcome are in conformity with those conditions, as well. Attempts have been made to define social gynaecology by the ways it is practised in certain "charitable" institutions or with closer reference to certain groups of people. However, such attempts have proved to be unacceptable to practitioners in the GDR where social gynaecology is considered a discipline of research and education to provide a profound scientific basis for action in reality. It is a social component of public health and an integral element of gynaecology and obstetrics.

Female↗

[Control of breathing].

The control system of breathing can be considered as a closed loop system, consisting of two subsystems: the controlling system and the controlled system. Both systems are defined by their input-output relationships. The controlling system is defined by the Respiratory Centers that are responsible for two separate, but overlapping, patterns: the automatic control pattern and the behavioral or voluntary control. In the controlling system the input is the blood gas value and the output is some parameters of ventilation. The controlled system is characterized by an input of ventilation and an output of blood gas values. In this closed loop system breathing is normally regulated by two anatomically distinct but functionally integrated elements, referred to as the metabolic and behavioral respiratory control systems. The metabolic control is concerned with blood gas homeostasis and the voluntary control relates with activities such as phonation and singing that use the ventilatory apparatus for purposes other than gas exchange.

Brain↗

The cAMP-responsive element in the corticotropin-releasing hormone gene mediates transcriptional regulation by depolarization.

Membrane depolarization is a critical element of neuronal signaling. In this study, the biochemical and molecular mechanisms involved in transcriptional regulation of the corticotropin-releasing hormone (CRH) gene by depolarization were investigated. In PC-12 cells, potassium-induced membrane depolarization increased expression of a CRH-reporter construct in a cAMP-dependent manner. This synergistic activation was mediated via calcium influx, predominantly via L-type calcium channels, and calmodulin. RNase protection assays demonstrated increased levels of CRH-reporter transcripts in stably transfected cells after treatment with cAMP and potassium, with the induced transcripts initiating at the major transcription initiation site of the human CRH gene. At the genomic level, the CRH cAMP-responsive element conferred both positive cAMP and synergistic cAMP/depolarization regulation to a heterologous promoter. Additionally, DNase I protection assays demonstrated similar nuclear protein/DNA binding profiles across the cAMP-responsive element after treatment of PC-12 cells with potassium or potassium/cAMP. These results support a model in which the protein(s) binding to the cAMP-responsive element integrates signals initiated by multiple pathways (cAMP and calcium) and transmits that integrated signal to the basal transcription machinery, resulting in increased levels of gene expression.

Animals↗

Ethics in the age of health care reform.

The health care reform movement includes four ideological models. True reform will capture and integrate elements of each model and agenda, along with an underlying respect for human dignity.

Cultural Diversity↗

Dental office ergonomics: how to reduce stress factors and increase efficiency.

Ergonomics, the science that studies human stress and strain related to activities, has one primary objective-to prevent work related musculoskeletal disorders, or symptoms that aggravate these disorders. Smart business owners have adopted the practice of ergonomics as an integral element in their ongoing strategies to increase productivity and ensure reduced workers' compensation liability. In British Columbia, however, potentially expensive ergonomic draft regulations created by the province's Workers' Compensation Board in 1993, have been put on hold. These ergonomic standards-described as the stiffest in the world -were to have been implemented across the province in early 1995. Nonetheless, ergonomic practices are alive and thriving in Canadian businesses that are devoted to ensuring a reduction in work-related injuries and salvaging potentially lost productivity. Although it is difficult to document lost productivity, Ontario's Workers' Compensation Board reported that it received 707 repetitive stress injury claims from office workers in 1992, with a per person cost of $7,703. In addition to these costs, each claimant took about 93 days off work. In dentistry, poor working habits, along with repetitive tasks, such as scaling and root planing, contribute greatly to musculoskeletal disorders, stress claims and lost productivity. Our tendency is to adapt awkward and illogical physical postures to access the oral cavity. The key objective for clinicians is to find a position that allows them to achieve optimum access, visibility, comfort and control at all times. With the professional goal to deliver the highest quality of care for a reasonable profit, the practice of ergonomics becomes a core focus in determining how to achieve practice success with less stress.

Absenteeism↗

[Functions of the social worker in a multi-professional team in inpatient psychosomatic rehabilitation].

The task of rehabilitation as defined by law and the concept of psychosomatic-psychotherapeutic treatment require cooperation of different professions in a clinical team. This approach implies a concept of interdisciplinary cooperation in which the contributions towards treatment to be made by the individual members of the multiprofessional team are defined by means of functions and tasks. Participation of the social worker is an integral element of psychosomatic teamwork. The social worker makes an important contribution towards the interdisciplinary arrangement of psychosomatic rehabilitation treatment by taking over functions for maintaining the ward setting, for the psychotherapy process and the rehabilitation task as well as for the working of the team. On the basis of his specific competence he provides independent knowledge, particular ways of interaction, and singular methods of intervention of social work for the psychosomatic treatment carried out by the multiprofessional team.

Combined Modality Therapy↗

[Breast feeding as family planning in a global perspective].

The contraceptive effect of lactation has been recognised for a long time, but detailed knowledge concerning the size and duration of this effect, and necessary preconditions has been lacking. Research on the lactational amenorrhoea method has given new insight into these matters. A consensus statement from 1988 concluded that women are protected against a new pregnancy during the first six months post-partum, provided they practise exclusive breast-feeding and remain amenorrhoeic. Recent research indicates that supplementary feeding does not disrupt this protection, which may last even beyond six months. Breast-feeding has a contraceptive effect also after resumption of menses, but this is too uncertain to be used in systematic family planning. The lactational amenorrhoea method should become an integrated element of family planning programmes.

Breast Feeding↗

[Molecular analysis of a copy of the novel mobile element Burdock and the region of its insertion into the cut locus of Drosophila melanogaster].

Molecular analysis of a copy of the novel mobile element burdock and its insertion region into the cut locus of Drosophila was performed. The burdock was shown to be a retrotransposon containing a single open reading frame (ORF). It does not contain domens coding for protease, RNAse H, reverse transcriptase, and integrase, which are required for transposition. However, multiple insertions of this copy of the mobile element into a definite region of the cut locus (hot site) were observed earlier. The polypeptide encoded by the burdock ORF contains two successive regions homologous to the proteins encoded by the ORF1 and ORF2 of the gypsy retrotransposon in N and C regions, respectively. The burdock insertion into this region of the cut locus interrupts its ORF, since the mobile element is transcribed in the opposite direction compared with the transcription in the locus. This is presumed to account for the arising of a lethal mutation. The hot site of this element integration into the locus corresponds to the recognition site of Drosophila topoisomerase II.

Amino Acid Sequence↗

Functional reconstruction of the jaws: new concepts.

This paper describes the surgical reconstruction of the maxilla and mandible after ablative surgery. The methods described are original and recently developed with illustrative clinical data presented. Presurgical planning of the occlusion, titanium mesh design supporting the bone graft, and implant-borne prostheses are integral elements of the concepts described to achieve functional reconstruction of the jaws.

Adolescent↗

[Social-medical aspects of the demographic situation in contemporary Poland].

New approaches to the solution of a complex of medicosocial problems which should be not disregarded when developing the strategy of public health development under conditions of reformation of the Russian economy are discussed. An intergral system of medicosocial care of the population both at the federal and regional levels should be formed and the mechanisms and methods of its realization developed in order to pursue an effective medicosocial policy, which represents an integral element of the strategy of public health development, with due consideration for the social, economic, demographic, ecological, sociohygienic, and other factors. The author believes that medicosocial policy should be characterized by clear-cut strategic direction as regards all public health services.

Adolescent↗