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[Intensive care for newborns. Evaluation of questionaires (author's transl)].

This report contains three sections: A general definition of aims and tasks of neonatal intensive care is followed by the description of four regions and four neonatal units of different structure with some relevant statistics. According to this inquiry about 1.5 cots for maximum neonatal care and 4 cots for intermediate care per 1000 live births are needed. Considering efficiency and effectivity the smallest independent intensive care unit should "cover an area" of 4000 deliveries per year; it should be closely connected to a least one obstetrical unit. Where and how this neonatal unit may be integrated into a childrens hospital can be derived from the four examples given. It should be recognized that 1) high quality intensive care depends on the availability of additional pediatric services, 2) comprehensive care of newborn infants necessitates regional organization including a newborn ambulance system. Thus, close contacts with obstetrical, but also with pediatric units offering better facilities should be established. In yearly intervals results are to be self-controlled by statistical means. The following incidences of normal survival of infants referred to childrens hospitals can be gained currently [2]: Birth weights below 1000 g: above 20%; 1000--1499 g: above 85%; above 1500 g: better than 95%. Less favorable figures call for analyses of reasons and measures to abolish them.

Austria↗

Quality of life in inflammatory bowel disease: the interaction of disease activity with psychosocial function.

OBJECTIVES: To evaluate the disease-specific and psychological factors that influence quality of life (QOL) in patients with inflammatory bowel disease (IBD) as measured by the recently developed IBD disease-specific QOL measure the Inflammatory Bowel Disease Questionnaire (IBDQ). METHODS: Twenty-two patients (eight males and 14 females) were studied, 16 with Crohn's disease and six with ulcerative colitis (mean age 32 yr). Patients' disease activity was measured with the Dutch Crohn's activity index and the St. Mark's colitis activity index, and QOL was measured by the IBDQ. All patients completed self-report questionnaires for psychological function, which included the Sickness Impact Profile (SIP), the Symptom Checklist-90-R (SCL), and the Self-Control Schedule (SCS). RESULTS: By combining the psychological measures and the disease activity into a single variable, this composite variable significantly predicted QOL (r = 0.53, p < 0.02), but disease activity alone did not predict overall QOL. Improved psychosocial functioning (Sickness Impact Profile) predicted greater overall QOL (IBDQ total: r = -0.49, p < 0.05) and better social functioning (r = -0.65, p < 0.01). Greater psychological distress (SCL) and disease activity predicted more systemic symptoms [SCL-Positive Symptom Total (PST): r = -0.48, p < 0.05; disease activity: r = -0.65, p < 0.03) and poorer emotional functioning (SCL-PST: r = minus] 0.75, p < 0.001; disease activity: r = -0.82, p < .03). Disease type, gender, age of onset, and psychological coping (SCS) were not predictive of disease-specific QOL, but coping (SCS) was significantly correlated with psychological distress (r = -0.58, p < 0.05 for the SCL-90-PST). CONCLUSION: This study confirms the importance of psychological functioning in determining QOL of IBD patients and must be considered jointly with disease activity.

Adaptation, Psychological↗

The relationship between obesity, dieting and eating disorders.

Obesity is not only a major health problem in Western society. It is also a social and personal one. Staying on a diet demands constant self-control. Failure to stay on a diet causes stress to dieters. Unsuccessful dieting could be more harmful than not dieting at all.

Diet, Reducing↗

[Sleep and sleepers in literature].

Sleep sets specific limits to self-control or self-disposal of man. Freud's statement that one third of our own self is still unborn points to a certain amount of uncertainty, linked permanently to our existence during sleep and associated with our loss of control over our rational thinking. Therefore, in the literature, sleep is quite often correlated with mythic, magic and religious conceptions. In particular, the experience of innocence is compellingly linked to sleep, necessarily followed by the question of guilt and evil. Goethe describes sleep as a process of working up and surmounting guilt as a basic event of spiritual and physical healing. Shakespeare's Macbeth, however, shows from an archaic-mystical as well as a modern psychological view how sleep is destroyed by crime.

Humans↗

[Evaluation of the practical use of the Becton-Dickinson (B-D) insulin pen injector].

UNLABELLED: The aim of this study was to assess insulin pen-injector in respect to: 1) improvement of metabolic control of diabetic patients, 2) improvement quality of life as well as complications connected with the use of pen patients. 23 IDDM and 7 NIDDM patients were enrolled to the study. Monthly check-up, control of diabetic complications, biochemical tests and glycemic profile and level of HbA1 c were performed. Human insulin containers of Eli Lilly-were used with the pens. Each month the glycemic profile and after 3 months HbA1c were tested. Special questionnaire was used to gather patients comments and remarks on the use of pens. RESULTS: 1. After 3 months of the pen use the mean levels of glucose were lower as well as the level of HbA1c. 2. Patients found the pens as easy and convenient way of insulin use, impairing their comfort of life. The moment of initiation of B-D pen injector was combined with the intensive insulin therapy, application of human insulin and both education and self-control. The assessment of the one only parameter among the others is hardly possible nevertheless it should be stressed that in intensive conventional insulin therapy, insulin pen injector was found as practical element improving treatment regimen.

Adult↗

[The frontal-motor interneuronal interactions in cats realizing a free choice of reinforcement].

Instrumental delayed reflexes with reinforcement of different quality were elaborated in six cats by the method of "active choice", where the time of delay of the motor reaction served as a signal of quality of the reinforcement. Individually varying ability to choose the quality of the reinforcement was used for classification of typological features of cats (self-control and impulsiveness). Multiunit activity was recorded by nichrome semimicroelectrodes from the frontal and motor cortical areas. Crosscorrelation analysis of interneuronal connections was carried out. The interneuronal frontal-motor relationships with different temporal delays (0-30; 30-60; 60-100 ms) were equally manifested in both groups of cats. We suggested that the organization of the frontal-motor relations did not characterize the individual typological features of the cats. During short-delayed reflexes in cats of both groups the identified functional connections with delays 0-30 ms were more significant. The question is discussed on the role of the frontal-motor coordination in definition of the kind of behaviour of cats to fulfil either short- or long-delayed conditioned reactions.

Animals↗

[Patient-controlled analgesia in treatment of postoperative pain].

Patient-controlled analgesia (PCA) is a newer technique for pain management. Patients are allowed to self-administer small analgesic bolus doses, which have been preprogrammed by the physician, into a running intravenous infusion, intramuscularly, subcutaneously or even into the epidural space. Patients' demands are mostly controlled by computer-driven infusion pumps, but can also be delivered by simple disposable devices. Lockout times, concomitant infusions and hourly maximum doses can be set in most PCA pumps. Clinical experience with PCA demonstrates that individual variability in pain sensitivity and analgesic needs are of utmost importance. In contrast to earlier expectations, PCA opiate consumption is usually higher than with restrictive conventional dosing regimes, but without an increase of serious side effects. Such results let assume that many patients under conventional i.m. techniques must be considered to be underdosed. Patients acceptance is generally enthusiastic for self-control. It is suggested that PCA results should be used for the improvement of conventional techniques. PCA has also been found valuable for scientific pain studies, e.g. to determine predictors of postoperative pain, drug interactions and pharmacokinetic experiments. This review concentrates on intravenous PCA during the early postoperative period.

Analgesia, Patient-Controlled↗

Systemic interferon alpha 2b treatment in Behçet's syndrome.

OBJECTIVE: To test the efficacy of systemic interferon alpha 2b (IFN alpha 2b) treatment in the mucocutaneous and joint symptoms of Behçet's syndrome. METHODS: The 48-week open, self-controlled trial was conducted in 3 phases. After the pretreatment phase of 16 weeks, 20 patients (8 men, 12 women; mean age 37 +/- 7 years SD) were treated with IFN-alpha 2b at a dose of 5 million units 3 times a week for 6 weeks followed by 5 million units once a week for 10 weeks. The subsequent 16 weeks not taking the medication was the posttreatment phase. RESULTS: Treatment with IFN-alpha 2b significantly reduced the mean number of arthritis attacks (F = 3.48; p < 0.05), their mean duration (F = 3.77; p < 0.05), and the mean erythrocyte sedimentation rate (F = 6.66; p < 0.001). The mean number of mucocutaneous lesions also showed a decrease, but this was not statistically significant. Except for the duration of arthritis, the mean number and frequency of all symptoms tended to return to pretreatment levels in the posttreatment phase. CONCLUSION: This pilot study shows that systemic IFN may be effective in the treatment of arthritis of Behçet's syndrome.

Adult↗

Witnessing domestic violence during childhood and adolescence: implication for pediatric practice.

The traditional role of the pediatrician, which consisted primarily of making diagnoses and prescribing treatments for specific disease entities in children, has expanded dramatically to include psychosocial aspects of health care as well as problems that are primarily psychological, emotional, or social in nature and that extend in various ways to the family and to the child's environment. One of these problems has been identified as the manner in which witnessing domestic violence, a significant and relatively commonplace event for many children today, affects child development and behavior. This paper reviews our existing knowledge of such events and explores how exposure to conflict and violence plays a major role in how children learn to relate to others, how they develop their self-concept and self-control, and how they interact with dating and marital partners in the future. We conclude with a discussion of the role of the pediatrician in interviewing children and other family members and in identifying appropriate avenues for prevention and treatment. Major recommendations derived from this paper include: decreasing the attitudinal barriers to exploring this issue; increasing sensitivity to clinical features and behavioral symptoms of children who witness domestic violence; and increasing knowledge of available resources for treatment and prevention.

Adolescent↗

Parents' and children's adiposity and eating style.

OBJECTIVE: To investigate children's ability to self-regulate energy intake and to determine whether individual differences in the precision of food intake regulation are related to children's anthropometric measures. We collected information pertaining to parental adiposity and dieting practices, as well as mothers' child-feeding practices. Of special interest was the degree of control imposed by mothers over their children's food intake. Our intent was to explore whether these variables might influence children's regulation of energy intake. SUBJECTS AND SETTING: Seventy-seven 3-5-year-old children who attended a university preschool setting and their parents participated in this experiment. MEASUREMENTS AND MAIN RESULTS: Children completed controlled, two-part meals used to estimate their ability to adjust food intake in response to changes in caloric density of the diet. An eating index, reflecting children's precision in the ability to regulate energy intake, was correlated to children's anthropometric measures. These correlations provided evidence for a relation between children's body fat stores and their responsiveness to caloric density cues: Pearson correlation coefficients revealed that children with greater body fat stores were less able to regulate energy intake accurately. The best predictor of children's ability to regulate energy intake was parental control in the feeding situation: mothers who were more controlling of their children's food intake had children who showed less ability to self-regulate energy intake (r = -.67, P < .0001). CONCLUSIONS: These findings suggest that the optimal environment for children's development of self-control of energy intake is that in which parents provide healthy food choices but allow children to assume control of how much they consume.

Body Weight↗

[Clinical study on xinkening in treating asymptomatic myocardial ischemia in coronary heart disease].

31 cases of asymptomatic myocardial ischemia in coronary heart disease were studied. According to Cohn's classification system, 4 cases were totally asymptomatic (type 1), 18 cases were asymptomatic with previous myocardial infarction (type 2) and 9 cases were asymptomatic ischemia with angina (type 3). Randomized crossing self-controlled observation methods were applied. Xinkening were used in treated group, while persantin and aspirin were used in control group. The result showed that ST-segment depression were reduced in treated and control group in comparing with those obtained before treatment, difference was significant (P < 0.01). The efficacy of treated group compared with control also were significantly different (P < 0.01), the former was better. Total time of ST-segment depression showed similar result. There was no adverse effect to heart, liver, kidney and blood. No allergic reaction was found in this observation.

Aged↗

[The human embryo as a teleologically defined entity].

The development of the embryo can be regarded as a process of teleological self-control. The teleological state of the embryo manifests itself as a unity of essence-being, process, and potentiality. It is an expression of the embryo's end-in-itself character. This character forbids experiments with human embryos in which they are exclusively used and consumed as objects.

Embryo, Mammalian↗

[Difficulties in maintaining metabolic control in children with insulin-dependent diabetes mellitus during war].

In this study we analyzed the quality of metabolic control in 42 diabetic children aging 5-20 years (x 14 + 5.1) during the war 92/93 year. We estimated metabolic control in these patients by traditional methods: 24 hours glycaemia (every 3 months), 24 hours glycosuria and home monitoring of glycosuria (self-control 4 times daily) Glicolizated HbA1C and the other up to date laboratory findings we were not able to do in any of diabetics. Metabolic control in all analysed patients was unsatisfactory metabolic control only in 19.1% of diabetics. High level of blood glucose were influenced by in coordinated doses of human insulin and bad correlated food intake during the war. Long duration of hyperglycaemia would have high influence onto early development of microvascular complications.

Adolescent↗

[Automatic regulation in the auditory analyzer and the phenomenon of accelerated growth of loudness].

Physical analysis of the ear periphery structure and the data on loudness perception have been used to develop a model of loudness measurement and self-control in the hearing analyzer. The experimental results obtained recently by different researchers are shown to confirm that the basic ideas of this model are reasonable, and the model is of considerable heuristic importance. The author provides treatment of the main hearing "paradox", that is the existence of a wide dynamic range of loudness perception for a narrow range of afferent pulsation in auricular nerve fibers. A simple explanation is found for the so-called adaptation phenomenon. The explanation of the phenomenon of loudness increase acceleration typical for many forms of neurosensory hypoacousis opens up new perspectives in the diagnostics and treatment of these diseases.

Adaptation, Physiological↗

[Testing the acid-binding capacity of Tisacid suspension and tablets by intragastric pH determination in patients with hyperacidity].

The effect of a Hungarian Al-Mg-containing drug, called Tisacid was studied using of 2.0, 1.0 and 0.5 gram doses. Two administration forms, suspension and tablet were compared. Ten informed, adult hyperacid volunteers were included into the program and three times 5-hour intragastric pH-metry was carried out in a randomized, self-controlled open clinical study (Control, after administration of tablet or suspension). Both forms were found effective in gastric acid reduction at doses of 2.0 and 1.0 g. Tisacid suspension revealed a more pronounced efficacy at the dose of 2.0 g in comparison to the same dose of tablet form. The 0.5 g dose seemed insufficient in reduction of gastric acidity in hyperacid patients applied in tablet or suspension forms. The authors emphasize the role of continuous intragastric pH-metry in clinical practice and investigation of antacids and antisecretory drugs.

Adult↗

Comparison of two intensified conventional insulin regimens with three and four daily injections.

When choosing an intensified conventional insulin therapy, no specific differentiation is made between the three-injection regimen (regular insulin at breakfast and lunch, and regular+intermediate-acting insulin at dinner) and the four-injection regimen (regular insulin at breakfast, lunch and dinner, and intermediate-acting insulin at bedtime). No published studies have evaluated to our knowledge the differences between these two regimens. In 1991, we proposed to 30 stable type 1 diabetic patients without residual insulin secretion a change from three to four daily injections: 7 refused, 4 were later excluded for intercurrent events; 19 followed the four daily injection regimen for 2 years. In these non randomized 19 patients, the Student's test for paired data was used to compare with a self-controlled study the 1989-90 three-daily injection period with the 1991-92 four-daily-injection period in order to evaluate any differences in daytime blood glucose values (bi-monthly out-patient measurements taken at 8 am, 10 am, 3 pm and 5 pm), nocturnal blood glucose levels at 3 am (bi-monthly patient self-monitoring by means of a blood glucose meter, for a total of 188 vs 188 measurements), HbA1c (a total of 203 vs 207 bi-monthly out-patient measurements), the number of nocturnal hypoglycaemic attacks, body weight and mean insulin requirement.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Comparative clinical examination of Loderix (setastinum) and astemizole in pollenosis.

The action and side-effects of Loderix (EGIS) were examined in comparison with Hismanal (Janssen) containing the non-sedative H1-receptor antagonist astemizole, by double-blind, cross-over, self-controlled method. On the basis of the changes observed in response to the two drugs in the symptoms of rhinoconjunctivitis and asthma of 21 patients suffering from pollenosis Loderix proved to be of the same value as Hismanal considering both clinical effectivity and side-effects.

Adult↗

Use of Taleum 1-mg inhalation aerosol in bronchial asthma patients.

The effect of 2 sodium chromoglycate products: Taleum 1-mg aerosol (EGIS) and Intal powder capsule (Fisons) has been examined for 4-4 weeks in 15 extrinsic asthma patients by cross-over self-controlled open method. The patients measured peak expiratory flow (PEF) 5 times daily and recorded the time of dyspneic periods in a diary as well as the amount of bronchodilator spray (Berodual, Boehringer) used as adjuvant therapy during dyspnea. The results of the weekly evaluation of the complaints and PEF values proved that both drugs are similarly effective in the prevention of dyspnea caused by bronchial asthma. The adjuvant inhalation betamimetic and anticholinergic drug requirement was lowered, the number, intensity and total time of dyspneic episodes decreased. In the course of the examinations Taleum 1-mg inhalation aerosol proved to be of identical value with Intal powder capsule. Some patients who do not like powder inhalation found the Taleum aerosol drug form to be more advantageous. Side-effect of drug was not observed.

Administration, Inhalation↗