[Detection of Borrelia DNA in synovial fluid for diagnosis of Lyme arthritis]. / Nachweis von Borrelien-DNA in der Synovialflüssigkeit zur Diagnose der Lyme-Arthritis.

AIM: To test sensitivity and specificity of a polymerase chain reaction (PCR) targeting the Borrelia specific outer surface protein (Osp) A gene in synovial fluid for the diagnosis of Lyme arthritis, and thus permit an earlier start to treatment. PATIENTS AND METHODS: Prospectively we examined the synovial fluid of 37 patients with the clinical diagnosis of Lyme arthritis or with other arthropathies of known or unknown origin, searching for the presence of detectable borrelial DNA in both arms of the study. Retrospectively we examined the stored synovial fluid from 50 patients of the Department of Rheumatology of the University Hospital, Berne, with the clinical diagnosis of monarthritis or oligoarthritis of unknown etiology, juvenile chronic arthritis or rheumatoid arthritis. The laboratory biologist was unaware of the clinical diagnosis. RESULTS: In the prospective study no true false positive results were found: of the 28 patients without strong clinical suspicion of Lyme arthritis 27 were PCR negative. In one case with positive PCR for borrelial DNA the diagnosis could not be clarified, Lyme arthritis remaining a possibility. Therefore the specificity in the prospective study was at least 96%. Borrelial DNA in the synovial fluid was found in 5 out of 9 patients with strong clinical suspicion of Lyme arthritis. All 7 patients in this group were new, untreated cases. All the 5 PCR positive results belonged to this group, thus the "sensitivity" of the tested method was 71% in untreated cases of Lyme arthritis. In the retrospective study we found borrelial DNA in the synovial fluid of 2 patients. These 2 patients had gonarthritis of unknown origin. Retrospectively these 2 cases could be diagnosed as Lyme arthritis. CONCLUSION: In cases with clinical suspicion of Lyme arthritis the PCR method targeting a borrelial Osp A gene fragment common to all 3 European genospecies shows very good specificity and in untreated cases acceptable sensitivity. Introduction of the method studied into clinical practice is justified.

[Work psychological evaluation of the activity of counseling in community nursing. A pilot study]. / Arbeitspsychologische Bewertung der Beratungstätigkeit in der Gemeindepflege. Eine Pilotstudie.

Working conditions of community health nurses were investigated with the assistance of patient education rating. The subject of the study was: "Is it possible for community health nurses to perform the activity of patient education completely? Are there conditions for patient education which allow only a partial activity? How do community health nurses experience the weak points at their work-place in community health nursing?" Industrial psychology developed an activity rating system (TBS), which has been completed by the observations made by community health nurses during patient education and checked in interviews. The criteria of complete and incomplete activity and the experience of the community health nurses concerning patient education have been collected, analysed and interpreted. The analysis and rating of patient education carried out by community health nurses enables conclusions to be drawn about the whole system (structure of organisational activity and individuals approach). The unclear definition of the activity of patient education is the reason why the quality of the activity is insufficient. The role of the community health nurse is vague for herself, the employer and the patient. The organisational structure lacks professional support, which is indicated for community health nurses in the education of patients who have to deal with the challenges of illness. Inter-connected organisational and personnel development is recommended, to motivate the staff, promote the efficiency and improve the quality of the work.

[How do daughters experience their elderly mothers move into a nursing home? A pilot study]. / Wie erleben Töchter den Eintritt ihrer betagten Mütter in ein Pflegeheim? Eine Pilotstudie.

A pilot study explored the experiences of three daughters, whose mothers were being admitted to nursing homes. An inductive, qualitative research approach, commonly used in the social sciences, was used. It was assumed that nursing care would be health promoting and would be supportive, not only of patients and clients, but also of the significant others, who had to cope with the crisis. Research on stress has shown that social support positively affects health. The results and the discussion confirm that daughters experience coping with the admission of their mothers to a nursing home as a stressful challenge. Caring for relatives and for patients in crisis situations is very demanding on nursing staff. Recommendations are made for the education of staff concerned with health promotion and with nursing care in the community and in nursing homes.

T3 plus high doses of beta-blockers: effects on energy intake, body composition, bat and heart in rats.

The effects of a combined treatment with supraphysiological doses of the thyroid hormone T3 (15 micrograms/kg BW/day, s.c.) and high doses of a predominant beta 1-blocker (atenolol, 12.5 and 25 mg/kg BW, 3X/day, s.c.) or a non-specific beta-blocker (propranolol, 5 mg/kg BW s.c. and 33 mg/kg BW p.o., each 3X/day) on energy intake, body composition and the heart were studied in overfed rats with an increased body fat content. The goal of the study was to investigate whether the above treatment constitutes a therapy for obesity in that T3 causes weight and fat loss and the beta-blockers prevent the unwanted T3-effects on the heart (tachycardia and increased heart weight). T3 did not increase energy intake above the level seen in overfed animals. It caused loss of body weight due to loss of fat but not protein, an increase in interscapular brown adipose tissue (IBAT) weight and fat, tachycardia and an increase in heart weight. Atenolol and propranolol blocked T3-induced tachycardia. With the exception of the highest propranolol dose which abolished the T3-induced increase in IBAT fat content, the beta-blockers did not modify the other T3 effects. Thus, in spite of the weight and fat loss and the lack of significant protein loss and tachycardia observed under T3/high dose beta-blockers treatment, the T3-induced increase in heart weight makes this treatment unsuitable as a therapy for obesity.