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PubMed2006

The Zero-vision: potential side effects of communicating health perfection and zero risk.

Public health education may have harmful side effects: generate fear, give rise to healthism and contribute to a medical sorting society. To prevent these adverse reactions a new deal for public health communication is presented. It is commended to move public health from omnipotence to moderation, from life style to living conditions, from risk to the bright sides of health, from statistical clone to the holy individual. Furthermore public health communication ought to include uncertainty as authoritarian truth mongering erodes trust. The public health educator must convey compassion and dedication. Rational techno-info is not sufficient. The last golden rule for a new public health is to respect the people. The people are not an inferior mass subjected to basic instincts and irrational fears. Common sense and lay experiences may contribute to the wise management of risk. Therefore public health should develop a people-centered method, recognizing people's own values, perceptions and potentials for preventing disease and promoting health.

Attitude to Health↗
PubMed2004

NPY--an endearing journey in search of a neurochemical on/off switch for appetite, sex and reproduction.

Although a dynamic link between the two innate drives, appetite for food and the urge to reproduce, in vertebrate evolution has been known for a long time, a distinct neurochemical pathway mediating this integration has only recently been appreciated. Study of the precise anatomy of the neural track began in the early to mid 20th century after the sites of genesis of the two instincts were localized to the hypothalamus. This report narrates the birth and fruition to maturity of insights into the commonality of hypothalamic neuropeptide Y (NPY) signaling for the two instinctual drives along two distinct pathways.

Animals↗
PubMed1999

Behavioral effects of anti-muscarinic, anti-serotonergic, and anti-NMDA treatments: hippocampal and neocortical slow wave electrophysiology predict the effects on grooming in the rat.

Previous research has shown that hippocampal and neocortical activation accompanies the postural changes occurring during self-grooming in rats but is absent or reduced during the stereotyped components of grooming, including head-washing and licking or biting. Since electrocortical activation is dependent on ascending cholinergic and serotonergic projections, we hypothesized that central muscarinic and serotonergic blockade would disrupt grooming by degrading cerebral control of changes in posture. Consistent with this, we find that systemic injections of scopolamine: (a) markedly reduce the occurrence of adaptive changes in posture during grooming; (b) reduce the probability of transitions from head-washing to body grooming; (c) reduce both the probability and duration of sequences of body grooming; and (d) do not affect the duration of head-washing or the probability of transitions from washing the snout to washing over the top of the head. Destruction of central serotonergic neurons with intracerebral injections of 5,7-dihydroxytryptamine increases the tendency of scopolamine to shorten the duration and increase the number of separate sequences of grooming. Systemic injections of a NMDA antagonist (CGS 19755) also impair grooming behavior. The data show that blockade of muscarinic and glutamatergic transmission impairs instinctive behavior as well as learned behavior and that the behavioral effects of muscarinic and serotonergic blockade are consistent with data obtained from the study of cortical slow wave electrophysiology.

5,7-Dihydroxytryptamine↗
PubMedDate not supplied

[The practice of restraint in a psychiatric emergency unit].

The practice of physical restraint is relatively frequent in medical emergency and geriatric units. Its use in psychiatry is controversial. Although distinct, it is often associated with seclusion, as a response to or prevention of agitated mentally ill patients'behavior. A detailed review of the literature shows the scarceness of work defining the exclusive use of restraint without seclusion. We report a naturalistic study over 6 Months, covering 76 cases having required restraint. The study of the international literature concerns nursing care, geriatric, child-adolescent psychiatric and adult psychiatric reviews. The restraint is a usual practice in general care like emergency, intensive care or geriatric units in order to prevent the patients from falling or to administrate certain care. Legal action has been reported as a consequence of lack of information or agreement of the family. The psychiatric use of restraint is conceived as an additional measure to seclusion, which is a controversial procedure from a therapeutic point of view as well as because of its long duration of application. The practice of restraint described in French literature, from Pinel (in to Daumézon and from French hospital regulations to "transparency forms", seems to be more easily accepted for its short duration and its careful prescription in order to maintain relations with the patients, including agitated children. We made a 6 Months retrospective study in a Parisian psychiatric emergency unit receiving an average of 30 patients a day. The rate of restraint is 1.4%. The objective was to describe the main clinical, epidemiological and situational characteristics and to define quality criteria concerning restraint regarding to the existing standards. We had at our disposal a restraint protocol in order to avoid its prescription as a punishment or for the comfort or the convenience of an insufficient staff. The decision of the restraint is directly prescribed by a physician or decided in emergency by the nurses and then rapidly confirmed by medical prescription. In short, most restrained patients are male, the average age is 32 Years old, and the diagnoses associated with restraint in order of frequency are schizophrenia, personality disorders, acute psychotic episodes, manic episodes and toxic abuses. The main early-warning signs are aggressiveness, delusions, opposition, paranoiac thoughts and distrust. The average duration is 2 hours with continuous clinical supervision and a relational contact maintained. Our study confirms the notion of cumulate restraint days. Actually, 43% of the restraints happen on the same day as others do. The high rate on those days could be as Fischer hypothesized the result of instinctive, aggressive and sexual release of the staff, as well as the consequence of an increase in anxiety and agitation of the other patients. The legal framework is more the duty of assistance to a person in danger than constrained hospitalization, which is not systematically pronounced. No injury or somatic complication occurred during restraint. Neither complaint from the patient or his family nor sick leave of staff was recorded. The specific use of restraint can be compared to the existing standards for using the seclusion room. Among those standards only 1 of 23 criteria was not verified. The others was applicable or without object. The therapeutic use of restraint requires the development of specific quality standards, and the existing criteria concerning seclusion represent a necessary but insufficient answer. We emphasize the need to take into account the early warning signs, a response to the cumulative restraint days, as well as a satisfaction study on patients and the feasibility of such a study in an emergency service.

Adult↗
PubMed2003

Substance abuse in adolescents: a complex conundrum for the clinician.

Substance abuse remains a complex and pervasive conundrum for society and for clinicians seeking to improve the lives of their pediatric patients. Substance abuse is linked to the human instinct for pleasure at any cost and is fueled by enticing encouragement of the media teaching society to seek drug-induced pleasure without fear of negative consequences. Other complications are the limited education about psychoactive substances provided to youth and the health care profession pledged to serve them. Primary care clinicians must provide their adolescent patients with adequate screening and counseling about substance abuse. Treatment of the substance-abusing patient is often a combination of behavioral interventions (including family therapy), and, in limited situations, addiction-specific medications. Research suggests that female drug addicts have a better outcome in female-only drug treatment programs. In addition, new drugs are being developed that target specific brain mechanisms involved in drug addiction; these drugs will have less toxicity and less abuse potential than illicit drugs such as cocaine. Vaccines are being developed that will block the effects of such drugs as cocaine and PCP. Medications developed for the treatment of depression and epilepsy will be a source of medications for the treatment of drug addiction. The study of endorphins and the neurobiology of stress and substance abuse promise to develop potent anti-addiction chemicals, greatly aiding in the war on drug abuse.

Adolescent↗
PubMed2002

Including 'learned sexuality' in the organization of sexual behavior.

Learning plays numerous important roles in sexual development. Yet, the possible impacts on sexuality, of learning from experience, are rarely included in discussions of the organization of behavioral sex differences and the differentiation of psychosexual function. This article reviews the empirical evidence for 'learned sexuality' with a goal of reintroducing the topic of nurture into discussions of the ontogenetic processes that lead to sexual reproduction in nature. Evolutionarily relevant examples of sexual learning are broadly represented in the animal kingdom, and can occur relatively early in development, leading to lasting changes in behaviors that might otherwise appear to be instinctive, or in other cases, maladaptive. The lasting effects of social and sexual experiences across the lifespan provide an essential link between steroid-mediated events occurring during development, behavioral plasticity, and changes in motivational states in adulthood.

Animals↗
PubMed2003

Pharmacological aspects of anticancer drug-induced emesis with emphasis on serotonin release and vagal nerve activity.

Cytotoxic drug-induced nausea and vomiting are the side effects most feared by cancer patients. Emesis is an instinctive defense reaction caused by the somatoautonomic nerve reflex, which is integrated in the medulla oblongata. Emesis caused by cytotoxic drugs such as cisplatin is associated with an increase in the concentration of 5-hydroxytryptamine (5-HT) in the intestine and the brainstem. It is proposed that cytotoxic drugs evoke 5-HT release from the enterochromaffin (EC) cells in the intestinal mucosa and that the released 5-HT stimulates the 5-HT receptors on the adjacent vagal afferent nerves. The depolarization of the vagal afferent nerves stimulates the vomiting center in the brainstem and eventually induces a vomiting reflex. 5-HT released from EC cells seems to mediate the cisplatin-induced emesis sensitive to 5-HT(3) receptor antagonists. The release of 5-HT from the EC cells, however, is regulated by polymodal mechanisms on autoreceptors or heteroreceptors. The precise role of 5-HT on the occurrence of vomiting has not been fully elucidated. The present review aims to describe the role of 5-HT in anticancer drug-induced emesis from the viewpoint of 5-HT release and afferent vagus nerve activity. Various methods for predicting emesis are also evaluated.

Antineoplastic Agents↗
PubMed2001

Combinatorial amygdalar inputs to hippocampal domains and hypothalamic behavior systems.

The expression of innate reproductive, defensive, and ingestive behaviors appears to be controlled by three sets of medial hypothalamic nuclei, which are modulated by cognitive influences from the cerebral hemispheres, including especially the amygdala and hippocampal formation. PHAL analysis of the rat amygdala indicates that a majority of its cell groups project topographically (a) to hypothalamic behavior systems via direct inputs, and (b) to partly overlapping sets of hypothalamic behavior control systems through inputs to ventral hippocampal functional domains that in turn project to the medial hypothalamus directly, and by way of the lateral septal nucleus. Amygdalar cell groups are in a position to help bias or prioritize the temporal order of instinctive behavior expression controlled by the medial hypothalamus, and the memory of associated events that include an emotional or affective component.

Amygdala↗
PubMed1997

The structural organization of connections between hypothalamus and cerebral cortex.

Motivated behavior requires coordinated somatic, autonomic, and endocrine responses, and may be divided into initiation, procurement, and consummatory phases (Swanson, L.W. and Mogenson, G.J., Neural mechanisms for the functional coupling of autonomic, endocrine and somatomotor responses in adaptative behavior, Brain Res. Rev., 3 (1981) 1-34). Obviously, such behavior may involve the entire central nervous system, although it is important to identify circuitry or systems that mediate the behavior directed toward specific goal objects. This problem has recently been clarified by the identification of hypothalamic subsystems important for the execution of instinctive behaviors related to ingestion, reproduction, and defense. These subsystems are modulated by sensory (reflex), central control (e.g., circadian), and voluntary (cortical) inputs. The latter are dominated by inputs from the ventral temporal lobe and medial prefrontal region, which are both direct and via associated parts of the basal nuclei (ganglia). Hypothalamic output is characterized by descending projections to brainstem and spinal motor systems, and by projections back to the cerebral cortex, which are both direct and via a continuous rostromedial part of the dorsal thalamus. This thalamic region includes the anterior, medial, and midline groups, which in turn innervate a continuous ring of cortex that includes the hippocampal formation and the cingulate, prefrontal, and insular regions. Parts of this thalamic region also innervate the ventral striatum, which receives a massive input from the cortical rings as well.

Animals↗
PubMed1997

Clinical trials with multiple outcomes: a statistical perspective on their design, analysis, and interpretation.

This article tackles both practical and statistical issues in the handling of multiple outcomes in clinical trials, with relevance to trial design, analysis, and reporting. Specific topics illustrated by examples include: the advantage of prespecifying priorities amongst outcomes and analyses, corrections for multiple significance testing and their limited value, problems with adverse event data, the use of a single global test of significance for clinically related outcomes, the use of a combined outcome for clinical event data, and the value of exploring interrelationships amongst outcomes. The problems in handling multiple outcomes are enhanced by trials being too small, dichotomous attitudes (is the trial "positive" or not?), obsession with p-values, and the manipulative instincts of human nature. While predeclarations of priorities in analysis and reporting of multiple outcomes are important in suppressing distortive claims, it would be unfortunate if too inflexible an approach suppressed unpredictable findings from being seriously considered.

Clinical Trials as Topic↗
PubMed2000

Neurochemistry and neuropharmacology of emesis - the role of serotonin.

Emesis is an instinctive defense reaction caused by the somato-autonomic nerve reflex which is integrated in the medulla oblongata. Emesis caused by cytotoxic drugs and radiation is associated with an increase in the concentration of 5-hydroxytryptamine (5-HT) in the intestinal mucosa and in the brainstem. 5-HT released from enterochromaffin (EC) cells, which synthesize and secrete 5-HT, stimulates the 5-HT(3) receptors on the adjacent vagal afferent nerves. This vagal afferent nerve depolarization may evoke the vomiting reflex. This review describes the role of 5-HT in anticancer drug-induced emesis from the viewpoint of 5-HT release from EC cells and afferent vagus nerve activity.

Animals↗
PubMed1999

Antinociceptive effects of the tubercles of Anredera leptostachys.

The tubercles of Anredera leptostachys are used as an antinociceptive and anti-inflammatory in the popular medicine of the Caribbean basin. In the present work, the anti-nociceptive and central nervous system depressant (CNS) effects of the methanolic extract from the tubercles of A. leptostachys have been evaluated. The antinociceptive activity was assayed in several experimental models in mice: acetic acid, formalin and hot plate tests. The methanolic extract (250 and 500 mg/kg) significantly and in a dose-dependent manner reduced the nociception induced by the acetic acid (P < 0.001). In the hot plate test, the extract significantly increased the latency time of jump although it slightly increased the licking time. The naloxone partially reversed the antinociception of the extract in the hot plate test. In the formalin test, the methanolic extract also significantly reduced the painful stimulus but the effect was not dose-dependent. In the study of the CNS-depressant effects, the extract was found to produce a significant reduction of the exploratory capacity with both doses assayed (P < 0.001). The muscular relaxation only decreased with the higher doses assayed (P < 0.001). The escape instinct was also significantly reduced (P < 0.001) by the two doses of the extract and both were more effective than standard drugs morphine and diazepam.

Acetic Acid↗
PubMed1999

Emergency physicians' role in end-of-life care.

End-of-life care, as it merges with emergency medicine, raises as many ethical issues as it does clinical judgments. The role of the ED physician as it pertains to end-of-life treatment options encompasses a vast array of variables that should nevertheless center on patient welfare. The choice between ethical responses and trained reactions is an ever-present reality in emergency medicine, and the instinct to perform aggressive procedures may overshadow the professional purpose to inform, comfort, counsel, and treat. The exercise of clinical judgment should be balanced by previously reasoned ethical conduct codes when it comes to end-of-life emergent care.

Algorithms↗
PubMed1987

The relationship of addiction, tolerance, and dependence to alcohol and drugs: a neurochemical approach.

Alcohol and drug addiction are defined in behavioral terms as the preoccupation with, compulsive use of, and relapse to drugs that are descriptive and confirmatory. The basis of addiction may involve neurochemical changes in the brain that distort and redirect the drive states (instincts). Tolerance and dependence may only be incidentally associated with addiction as a result of a nonspecific adaptation by the body to the presence of a drug. The cellular adaptation may be the same in all organs. Addiction to alcohol and drugs may have no specific relationship to tolerance and dependence. Addiction occurs in the absence of observable tolerance and dependence to alcohol and drugs. Alcohol and drug addiction is probably more complex than tolerance and dependence. Addiction is difficult to study because of the variability of behavioral phenomena and the underlying intricacies of the neurosubstrates. Tolerance and dependence are still useful as they are indicators of drug use. It is a misconception that long term chronic use is necessary for tolerance and dependence to develop. Some studies have shown that tolerance can develop within hours and days to a single dose of alcohol or other drugs. Anxiety, depression and insomnia can occur after a single dose of ethanol in humans. These symptoms of withdrawal from the alcohol or drug constitute dependence. Redefining the criteria for addiction tolerance and dependence to alcohol and other drugs may be in order. A neurochemical model may provide a more definitive and uniform basis for considering addiction, tolerance, and dependence to alcohol and drugs.

Brain Chemistry↗
PubMed1990

Oral fluid therapy in neonatal ruminants and swine.

Definitive recommendations regarding the best method to treat the diarrheic calf cannot be made at this time. The exact recommendation will probably depend on the situation. At the present time, I do not believe it is detrimental to withdraw milk from the diet for periods up to 24 to 36 hours, as long as the calf is in good condition and is returned to a full ration (maintenance plus) of milk within 3 to 5 days from the start of milk withdrawal. Milk withdrawal is most likely to be beneficial in those situations in which the calf is depressed and has lost its sucking reflex. Oral electrolyte solutions should be fed at the rate of 4-6 L/day if diarrhea is profuse or if the calf is depressed. As the calf feels better and the severity of diarrhea decreases, the amount of oral electrolyte solution can be reduced. It is sensible to continue feeding oral electrolyte solution, perhaps at the rate of 2 L/day, as long as the calf scours. Products containing 40-80 mEq/L of alkalizing agent give the best results. The higher concentrations may be more effective in older calves. Products containing bicarbonate or metabolizable base can be used when the calf is held off milk, whereas only solutions that contain a metabolizable base should be used if the calf is fed milk that day. Milk withdrawal may only be beneficial in calves that are losing their interest in sucking. Early reintroduction to milk and avoidance of milk deprivation in bright calves will help maintain condition and may boost immune function and mucosal repair. Calves that are held off milk for more than 2 days and calves that are deprived of milk while in poor condition should be fed a high-energy electrolyte solution. Beef calves tend to be treated while they are still on the dam, and if they are separated from the cow, it is usually only for a short period. This maintains the cow's lactation and maternal instincts. Cow's milk is better digested than many milk replacers and is available at a steady rate because calves suck frequently. Calves maintained on cow's milk should be fed an oral electrolyte solution containing a metabolizable base. Gastric fill from the electrolyte solution will tend to reduce milk consumption. It is important to prevent the calf from gorging on milk, which sometimes happens when a calf that is depressed and not sucking regains its appetite and has access to a very full udder. Cows that have been separated from their calf or that have distended udders should be milked out.

Animals↗
PubMed1992

Training the novice stallion for artificial breeding.

Although the act of breeding is instinctive to the stallion, the use of a phantom mare and AV represent an unnatural element to this act. The use of these devices, as well as proper breeding manners and etiquette, must be taught to the stallion. The novice stallion usually learns these techniques rapidly and is quite manageable if proper restraint is used during training. Positive reinforcement for good behavior is essential. The ultimate goal in training the novice stallion is to develop an individual that will enter the breeding area with controlled enthusiasm, develop an erection and gracefully mount the phantom or mare in a quiet manner, and rapidly ejaculate into an AV.

Animals↗
PubMed1989

Diagnostic and prognostic procedures for equine colic surgery.

Evaluation of the horse with colic has always been challenging since the patient's large size precludes many of the diagnostic imaging procedures commonly used in human medicine. Diagnostic methods such as radiography, laparoscopy, endoscopy, and peritoneal fluid analysis can serve to increase the accuracy of presurgical evaluation. Prognosis in individual cases can be best predicted by careful analysis of selected clinicopathological data, physical examination findings, and surgical biopsies. However, no predictive model is 100 per cent accurate, and clinicians must continue to rely on clinical evidence and instinct and to use these diagnostic and prognostic procedures only as guides for case management.

Abdomen, Acute↗
PubMed1997

Consciousness in a Self-Learning, Memory-Controlled, Compound Machine.

A memory-controlled, sensor/actuator machine senses conditions in its environment at given moments, and attempts to produce an action based upon its memory. However, a sensor/actuator machine will stop producing new behavior if its environment is removed. A sensor/sensor unit can be added to the sensor/actuator machine, forming a compound machine. The sensor/sensor unit produces a stream of internally created sensed conditions, which can replace the sensed conditions from the environment. This illusion of an environment is similar to consciousness. In addition, actuator/sensor and actuator/actuator units can be added to this compound machine to further enhance its ability to function without an environment. Predetermined and empirical memory cells can be distributed throughout the control units of this compound machine to provide instinctive and learned behavior. The internal and exterior behavior of this compound machine can be modified greatly by changing the cycle start and ramp signals that activate these different kinds of memory cells. These signals are similar in form to brain waves.

Journal Article↗