Parental Education and Family Dissolution: A Cross-National and Cohort Comparison.

This is the first study to systematically analyze whether the association between parental education and family dissolution varies cross-nationally and over time. The authors use meta-analytic tools to study cross-national variation between 17 countries with data from the Generations and Gender Study and Harmonized Histories. The association shows considerable cross-national variation, but is positive in most countries. The association between parental education and family dissolution has become less positive or even negative in six countries. The findings show that the association between parental education and family dissolution is generally positive or nil, even if the association between own education and family dissolution is in many countries increasingly negative. The authors find suggestive evidence that the association is related to the crude divorce rate, but not to the generosity of the welfare state in these countries. The implications of these findings for understanding the stratification in family dissolution are discussed.

Design and methodology of the COACH-2 (Comparative study on guideline adherence and patient compliance in heart failure patients) study: HF clinics versus primary care in stable patients on optimal therapy.

BACKGROUND: Since the number of heart failure (HF) patients is still growing and long-term treatment of HF patients is necessary, it is important to initiate effective ways for structural involvement of primary care services in HF management programs. However, evidence on whether and when patients can be referred back to be managed in primary care is lacking. AIM: To determine whether long-term patient management in primary care, after initial optimisation of pharmacological and non-pharmacological treatment in a specialised HF clinic, is equally effective as long-term management in a specialised HF clinic in terms of guideline adherence and patient compliance. METHOD: The study is designed as a randomised, controlled, non-inferiority trial. Two-hundred patients will be randomly assigned to be managed and followed in primary care or in a HFclinic. Patients are eligible to participate if they are (1) clinically stable, (2) optimally up-titrated on medication (according to ESC guidelines) and, (3) have received optimal education and counselling on pre-specified issues regarding HF and its treatment. Furthermore, close cooperation between secondary and primary care in terms of back referral to or consultation of the HF clinic will be provided.The primary outcome will be prescriber adherence and patient compliance with medication after 12 months. Secondary outcomes measures will be readmission rate, mortality, quality of life and patient compliance with other lifestyle changes. EXPECTED RESULTS: The results of the study will add to the understanding of the role of primary care and HF clinics in the long-term follow-up of HF patients.

Explosion of limit cycles and chaotic waves in a simple nonlinear chemical system.

We consider a simple model of an autocatalytic chemical reaction where a limit cycle rapidly increases to infinite period and amplitude, and disappears under variation of a parameter. We show that this bifurcation can be understood from seeing the system as a singular perturbation problem, and we find the bifurcation point by an asymptotic analysis. Scaling laws for period and amplitude are derived. The unphysical bifurcation to infinity disappears under generic modifications of the model, and for a simple example we show is replaced by a canard explosion, that is, a narrow parameter interval with an explosive growth of the amplitude. The bifurcation to infinity introduces a strong sensitivity that may result in chaotic dynamics if diffusion is added. We show that this behavior persists even if the kinetics is modified to preclude the bifurcation to infinity.

Local and global bifurcations at infinity in models of glycolytic oscillations.

We investigate two models of glycolytic oscillations. Each model consists of two coupled nonlinear ordinary differential equations. Both models are found to have a saddle point at infinity and to exhibit a saddle-node bifurcation at infinity, giving rise to a second saddle and a stable node at infinity. Depending on model parameters, a stable limit cycle may blow up to infinite period and amplitude and disappear in the bifurcation, and after the bifurcation, the stable node at infinity then attracts all trajectories. Alternatively, the stable node at infinity may coexist with either a stable sink (not at infinity) or a stable limit cycle. This limit cycle may then disappear in a heteroclinic bifurcation at infinity in which the unstable manifold from one saddle at infinity joins the stable manifold of the other saddle at infinity. These results explain prior reports for one of the models concerning parameter values for which the system does not admit any physical (bounded) behavior. Analytic results on the scaling of amplitude and period close to the bifurcations are obtained and confirmed by numerical computations. Finally, we consider more realistic modified models where all solutions are bounded and show that some of the features stemming from the bifurcations at infinity are still present.

Stability of health status measurement in rheumatoid arthritis.

Health status measures in rheumatoid arthritis that have been extensively validated for use in clinical trials are generally used also in correlative studies, e.g. to predict future health status. This application requires stability (repeatability of measurements). The purpose of our study was to determine the stability of commonly used health status measures. Two measurements at an interval of 6 months were then in 99 patients. High stability (alpha = 0.78 to 0.94) was observed for five biomedical measures (grip strength, walking time, platelet count, haemoglobin and erythrocyte sedimentation rate) and five self-report measures (mobility, self care, impact daily activities, anxiety and cheerful mood). Moderate stability (alpha = 0.65 to 0.72) was observed for joint scores, pain, C-reactive protein and depressive mood. The highly stable measures most adequately reflect individual differences, may be applied most reliably in correlative studies and appear to have the largest clinical utility with regard to long-term prediction of health status.

The effect of cognitive behavior therapy in patients with rheumatoid arthritis.

In order to examine the effectiveness of cognitive behavioral therapy for patients with rheumatoid arthritis (RA) three patients groups were studied: a cognitive behavioral therapy group (CBT), an occupational therapy group (OT), and a waiting-list control group. The CBT received a comprehensive, 10-session treatment package that taught progressive relaxation, rational thinking and the differential use of pain coping strategies. CBT resulted in minor changes in pain coping behavior at posttreatment, while CBT and OT showed an increase of knowledge of RA. No therapeutic effects with regard to health status were demonstrated at posttreatment and at 6 months follow-up. Clinical and laboratory measures of disease activity revealed progressive deterioration of the patients during the course of the study. It is suggested that the ineffectiveness of CBT might be due to the progressive course of RA in the patients studied, as well as to the rather small changes in coping behavior.

[Immunosuppression with cyclosporin induces clinical remission and improved beta cell function in patients with newly diagnosed insulin-dependent diabetes. A national and international multicenter study]. / Immunosuppression med ciklosporin inducerer klinisk remission og forbedret beta-cellefunktion hos patienter med nykonstateret insulinkraevende diabetes. En national og international multicenterundersøgelse. The Canadian-European Randomized Control Trial Group.

A prospective, randomized, double-blind, placebo-controlled international multicenter trial including 188 newly diagnosed insulin-dependent diabetic (IDDM) patients was undertaken with the aim of investigating whether immunosuppression for one year with ciklosporin (Cs) could induce and maintain clinical remission and improvement of beta-cell function. The relative odds for non-insulin-requiring remission at one year were increased approximately five times in the Cs-treated group. After three months Cs-treated patients achieved more than a doubling of beta-cell function compared to baseline than did placebo-treated patients, and the Cs-treated group maintained this improvement in beta-cell function for 12 months, whereas the placebo-group lost beta-cell function during the same period. Short duration of disease (less than or equal to six weeks of symptoms, less than or equal to two weeks of insulin treatment) was associated positively with remission, as was an elevated proinsulin/C-peptide ratio, especially in patients with the tissue-type HLA-DR 3,4; 4,X and X,X. Cs-treatment inhibited the formation of antibodies against insulin and islet cell components, but islet cell antibody status at entry was not predictive of remission. Cs-treatment caused a reversible decrement of kidney function as measured with serum creatinine and the calculated creatinine clearance, but studies of renal physiology and kidney biopsies performed on a limited subset of patients indicated that Cs treatment in IDDM patients for one year induced a slight chronic nephropathy in some of these.(ABSTRACT TRUNCATED AT 250 WORDS)

The value of provoked expectoration in obtaining sputum samples for cytologic investigation. A prospective, consecutive and controlled investigation of 134 patients.

A prospective controlled investigation in 134 consecutive outpatients compared the cytologic adequacy of sputum samples obtained by spontaneous and provoked expectoration. Inhalation of nebulized 10% sodium chloride was used for provoked expectoration. A significantly higher number of adequate samples was produced after provocation, as judged by the presence of alveolar macrophages (X2 = 5.63; p less than 0.02). The improvement in sample adequacy was limited to the nonsmokers and ex-smokers in the study. This result, together with the relatively high cost of cytologic sputum examinations, indicates that provoked expectoration should at least be applied to the collection of sputum samples from nonsmokers and ex-smokers.

Plasma renin concentration, activity and substrate in normal children.

Plasma renin concentration (PRC), activity (PRA) and substrate concentration (PRSC) were measured in 27 males and 31 female children aged 3 days to 14.5 years (median age 10 months). No sex difference between the three parameters was found and the data were therefore combined for boys and girls. Logarithmic transformation were used for all parameters. PRC, PRA and PRSC were significantly higher in children than in adults and were negatively correlated by age or body surface area. As expected, PRA was strongly positively correlated to PRC (r = 0.98, P less than 0.001) and to PRSC ( r = 0.55, P less than 0.001). From the second order partial correlation coefficients it is concluded that PRSC and PRC in children decrease with age or body surface area, and that PRA consequently also decreases. A negative feed-back regulatory mechanism between PRSC and PRC is suggested. Because of the decline in PRSC during childhood, it is recommended to measure PRC instead of PRA and to use age related reference values.

Antihypertensive effect of atenolol (100 mg once a day) and methyldopa (250 mg thrice a day). A double-blind cross-over multicentre study.

In a double-blind cross-over multicentre study lasting for 16 weeks, the antihypertensive effect of atenolol (100 mg once a day) was compared with that of methyldopa (250 mg thrice a day) in 48 patients with mild to moderately severe hypertension. At the end of the trial, atenolol was superior to methyldopa in achieving clinically relevant BP levels, less than 150/95 mmHg (p less than 0.001), and in respect to patients' drug preference (p less than 0.04). The BP levels after the first 2 weeks of treatment with either drug were identical but, in contrast to methyldopa, atenolol caused further significant reduction in BP during the following 4 weeks. This finding implies that one should hesitate to start additional therapy until after at least six weeks of atenolol treatment, whereas no further reduction in BP can be expected after the first 2 weeks of treatment with methyldopa. Two patients had to be withdrawn from the study during treatment with atenolol, as they developed severe bradycardia and dyspnoea, respectively. Other side-effects were few and of minor clinical importance.