Behavioral and electrophysiological taste responses change after brief or prolonged dietary sodium deprivation.

Dietary Na+ deprivation elicits a hormonal response to promote sodium conservation and a behavioral response to increase sodium ingestion. It has generally been accepted that the former occurs within 24 h after sodium deprivation, while the latter is delayed and may not appear until as much as 10 days later. Na+ deprivation of similar duration also decreases the sensitivity of the chorda tympani nerve (CT) to NaCl, suggesting that changes in CT responses are necessary for increased NaCl intake. However, previous work from our laboratory showed that licking responses to NaCl solutions increase after only 2 days of Na+ deprivation, suggesting rapidly occurring changes in response to NaCl taste. The present experiments examined the effects of 2 days of dietary Na+ deprivation on CT responses to NaCl and patterns of NaCl consumption and found that Na+-deficient rats licked significantly more during the first NaCl intake bout compared with control rats. CT responses to NaCl were reduced at all concentrations after brief Na+ deprivation compared with Na+-replete control rats and did not decrease further with prolonged (10 days) dietary Na+ deficiency. Moreover, amiloride, which suppressed CT responses to NaCl by approximately 30% in control rats, had virtually no effect on CT responses in Na+-deprived rats. Thus, 2 days of Na+ deprivation is sufficient to alter patterns of ingestion of concentrated NaCl and to reduce gustatory responses to NaCl. Furthermore, changes in gustatory responses to NaCl during dietary Na+ deprivation may involve the amiloride-sensitive component of the CT.

Patient satisfaction as a predictor of return-to-provider behavior: analysis and assessment of financial implications.

Although customer loyalty is frequently cited as a benefit of patient satisfaction, an empirical link between the two has not, to our knowledge, ever been statistically established in a hospital setting. The goal of the present study was to evaluate the relationship between self-reported patient satisfaction measures and subsequent return to the provider for care at a large academic medical center. Data from all adult medical patients responding to a patient satisfaction survey distributed by a large midwestern academic medical center during fiscal year 1997 (n = 1485) were analyzed. Response patterns were examined as they related to whether patients returned to the provider during the subsequent 2-year period. Analyses suggested that return-to-provider was associated with only a minority of the satisfaction items (approx. 11%). All items showing a significant relationship measured perceptions of how well physicians and nurses attended to, and provided information to, patients and their families. Although the size of these relationships was generally small, the estimated financial implications are substantial. Other implications of these findings for planning effective service improvement initiatives as well as improving patient survey design are discussed.

Cardiac 5-HT(4) serotoninergic receptors, 52kD SSA/Ro and autoimmune-associated congenital heart block.

It was recently reported that sera from patients with systemic lupus erythematosus contain antibodies reactive with the second extracellular loop of the serotoninergic 5-HT(4) receptor expressed in the human heart. This antibody response was associated with antibodies to 52kD SSA/Ro, a reactivity prevalent in mothers of children with congenital heart block (CHB). The current study was undertaken to determine whether the 5-HT(4) receptor is a target of the immune response in these mothers. Initial experiments demonstrated mRNA expression of the 5-HT(4) receptor in the human foetal atrium. Electrophysiologic studies established that human foetal atrial cells express functional 5-HT(4) receptors. Sera from 116 mothers enrolled in the Research Registry for Neonatal Lupus, whose children have CHB, were evaluated. Ninety-nine (85%) of these maternal sera contained antibodies to SSA/Ro, 84% of which were reactive with the 52kD SSA/Ro component by immunoblot. None of the 116 sera were reactive with the peptide spanning aa165-185 of the serotoninergic receptor. Rabbit antisera which recognized this peptide did not react with 52kD SSA/Ro or peptide aa365-382 in the C terminus. Although 5-HT(4) receptors are present and functional in the human foetal heart, maternal antibodies to the 5-HT(4) receptor are not associated with the development of CHB.