Isolation, characterization, and emulsifying properties of wattle seed (Acacia victoriae Bentham) extracts.

Extracts from either ground whole wattle seeds or uncoated cotyledons were obtained using water, alkali, or ethanol. These extracts were then analyzed for their protein molecular weight and electrophoretic profiles using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and capillary electrophoresis, respectively. Water extracts and those from the cotyledons gave higher material yield and contained significantly more proteins than other extracts. Furthermore, the proteins ranged in molecular weight from 6 to 92 kDa, with the highest concentration between 27 and 61 kDa. Water extracts, even at very low protein concentrations (0.17-1.12%), formed stable emulsions, containing up to 50% canola oil, and these emulsions were affected by pH (4-9), ionic strength (0.25-1% NaCl), and retorting (115 degrees C for 30 min). The study showed that water-soluble wattle extracts have great potential as emulsifiers and stabilizers for the food industry, especially at low pH levels.

Detección de la Depresión mediante cuestionarios: Comparación de una sola pregunta con los datos de la entrevista en una muestra de adultos de edad avanzada

El objetivo de este estudio fue el de determinar qué relación existía entre una pregunta sobre el humor depresivo, incluida en un cuestionario, y el diagnóstico de depresión establecido según los criterios DSM-III-R. Se envió un cuestionario por correo a una muestra de personas con edades comprendidas entre los 57 y 79 años, elegida al azar en la población del Condado de Dalama, en Suecia central. La proporción de respuestas fue del 74,1 per cent (1.328 personas). Todos aquellos individuos que, en el cuestionario, habían admitido estar deprimidos fueron seleccionados para una entrevista, de ellos, 28 aceptaron participar (el 74 per cent de los que habían sido elegidos). En el momento de ser entrevistadas, 21 personas (el 75 per cent) padecían trastornos afectivos según los criterios DSM-III-R o estaban bajo tratamiento debido a su depresión. 12 personas (el 42,9 per cent) padecían depresión mayor o estaban bajo tratamiento. Asimismo, 9 individuos (el 32,1 per cent) padecían distimia. Incluso los niveles moderados de depresión fueron relacionados con una incapacidad funcional. Una sola pregunta sobre el humor depresivo supone un buen punto de referencia y aunque una respuesta afirmativa no puede considerarse como decisiva a la hora de llegar a un diagnóstico, ésta merece un estudio más profundo. (AU)

Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population.

OBJECTIVES: Only a few prospective surveys have been performed to investigate the relationship between sleep complaints and coronary artery disease (CAD) mortality. This study was conducted to determine whether sleep complaints in a middle-aged population predicted total mortality and CAD mortality. DESIGN: A population-based prospective study. Setting. The County of Dalarna, Sweden. SUBJECTS AND METHODS: In 1983, a random sample of 1870 subjects aged 45-65 years responded to a postal questionnaire (response rate 70.2%) including questions about sleep complaints and various diseases. Mortality data for the period 1983-95 were collected, and Cox proportional hazard analyses were used to examine the mortality risks. RESULTS: At 12-year follow-up 165 males (18.2%) and 101 females (10.5%) had died. After adjustment for a wide range of important putative risk factors, difficulties initiating sleep (DIS) were related to CAD death in males [relative risk (RR), 3.1; 95% confidence interval (CI), 1.5-6.3; P < 0.01], but not in females. Short or long sleep duration did not influence risk of CAD mortality or total mortality for either gender. Depression in males increased the risk of death attributed to CAD (RR, 3.0; 95% CI, 1.1-8.4; P < 0.05) and total mortality (RR, 2.2; 95% CI, 1.1-4.5; P < 0.05). CONCLUSION: These results provide evidence that there is an association between difficulties falling asleep and CAD mortality in males.

Telemedicine in vascular surgery: does it work?

Telemedicine (TM) using closed-circuit television systems allows specialists to evaluate patients at remote sites. Because an integral part of the vascular examination involves palpation of peripheral pulses the applicability of TM for the evaluation of vascular surgery patients is open to question. This study was carried out to test the hypothesis that TM is as effective as direct patient examination for the development of a care plan in vascular patients. Sixty-four vascular evaluations were done in 32 patients. The patients presented with a variety of vascular problems and were seen in regularly scheduled rural outreach vascular clinics. Two faculty vascular surgeons evaluated each patient; one was on site and the second, using TM, remained at the medical center. Each surgeon was blinded to the other's findings. The TM physician was aided by a nonphysician assistant, who obtained blood pressures, utilized a continuous-wave Doppler probe, positioned the patient, and operated the TM equipment. The results of each surgeon's evaluations were compared. Patient and physician satisfaction with the TM evaluation was appraised by questionnaires. Eight patients were seen for initial evaluations; 24 patients were seen for follow-up visits. Patients were seen with a variety of diagnoses, including aneurysm (seven), cerebrovascular disease (five), lower extremity occlusive disease (13), multiple vascular problems (three), and other disease (four). The average duration for the TM and on-site evaluations were 20.6+/-1.4 and 19.0+/-1.3 minutes, respectively (P = not significant). Physician concordance, as determined by treatment recommendations, was the same in 29 (91%) patients. Physician confidence in the ability to obtain an accurate history via TM was rated as excellent in 97 per cent; confidence in the TM physical examination was rated as excellent in 70 per cent. All patients rated the TM evaluation as the "same as" or "better than" the on-site examination, and all indicated a preference for being seen locally using TM as opposed to traveling to a regional medical center. We conclude that the TM evaluation of vascular patients is accurate and is as effective as on-site evaluations for a variety of vascular problems. Important adjuncts to enhance the success of a TM evaluation are physician experience with the technology and the presence of a knowledgeable on-site assistant. This technology can be easily adapted to other clinical situations.

Relationship between insomnia, depression, and mortality: a 12-year follow-up of older adults in the community.

The purpose of the study was to investigate the natural history of insomnia and its association with depression and mortality. In 1983, 1,870 randomly selected subjects aged 45-65 years answered a questionnaire on sleep and health. Of the 1,604 survivors in 1995, 1,244 (77.6%) answered a new questionnaire with almost identical questions. Mortality data were collected for the 266 subjects that had died during the follow-up period. Chronic insomnia was reported by 36.0% of women and 25.4% of men (chi2 = 9.7; p < .01). About 75% of subjects with insomnia at baseline continued to have insomnia at follow-up. Insomnia in women predicted subsequent depression (odds ratio [OR] = 4.1; 95% confidence interval [CI] 2.1-7.2) but was not related to mortality. In men, insomnia predicted mortality (OR = 1.7; 95% CI 1.2-2.3), but after adjustment for an array of possible risk factors, this association was no longer significant. Men with depression at baseline had an adjusted total death rate that was 1.9 times higher than in the nondepressed men (95% CI: 1.2-3.0).

Effects of consulting psychiatrist in primary care. 1-year follow-up of diagnosing and treating anxiety and depression.

OBJECTIVE: Epidemiological screening of anxiety and depressive disorders in primary care and evaluation of how these patients are identified and treated. Follow-up after 1 year of psychiatric consultation/liaison (C/L) and educational activities. SUBJECTS AND DESIGN: In the baseline study 374 unselected and consecutive patients, and in the follow-up study 254 patients (response rate 94.5% and 90.3%, respectively) answered the screening instrument HAD scale (Hospital Anxiety and Depression scale). The HAD results were compared to clinical diagnosis and treatment according to the medical records. Differences after 1 year were analysed. RESULTS: At follow-up the prevalence of anxiety had increased from 11.8% to 16.5% (p < 0.05), and of depression from 3.7% to 4.7% (NS) according to HAD. Also, at the follow-up more cases of anxiety disorders were clinically diagnosed--13% vs 8%--as well as an increased number of cases of depressive disorders--7.9% vs 4.0%. The agreement between HAD diagnosis and clinical judgement had increased significantly (p < 0.001) for anxiety disorders from 37% to 70%, and for depression from 20% to 45%. Treatment prevalence had also improved (p < 0.001) at the follow-up for anxiety disorders from 33% to 55% and for depression from 47% to 80%. In total, 4.0% of the baseline and 11.4% of the follow-up population were treated for anxiety and/or depression. CONCLUSIONS: Anxiety and depressive disorders are prevalent in primary care. However, only a minority of these patients are identified and treated. Psychiatric consultant support seems to be effective in improving GP's diagnostic and therapeutic skills thus enabling these widespread disorders to be identified at an early stage and properly treated.

[Restless legs. A much neglected syndrome]. / Restless legs. Föga uppmärksammat syndrom.

Ekbom's syndrome, or 'restless legs syndrome' (RLS), not only causes symptoms in the extremities during waking hours, but also sleep disturbance and daytime fatigue. Although the prevalence of RLS has been estimated to be 1-5%, the condition is probably underdiagnosed and undertreated. Its onset may occur at any age, and there may be long periods of remission, but the condition is generally chronic. In its primary form, there is often a family history of the disorder suggestive of an autosomal dominant mode of inheritance, where the results of EMG (electromyography) and nerve conduction studies are normal. In secondary forms, clinical signs and laboratory evidence of an associated abnormality are present. The most characteristic symptom of RLS is the spontaneous occurrence of paraesthesia or dysaesthesia during waking hours. The symptoms of RLS are worse or exclusively present during rest, and are partially or temporarily relieved by activity. About 80 per cent of RLS patients also suffer from 'periodic limb movements during sleep' (PLMS), which may cause microarousals during sleep. The diagnosis of RLS is based on characteristic clinical criteria, and the sleep disturbance is diagnosed polysomnographically. L-dopa and clonazepam have been found successful in the treatment of primary RLS, though lifelong treatment is often necessary.

Perceived sensitivity of mammographic screening: women's views on test accuracy and financial compensation for missed cancers.

OBJECTIVES: To estimate women's expectations of the accuracy of screening mammography and to explore attitudes towards compensation for missed cancers. DESIGN: Cross sectional survey (by telephone). SETTING: Australia; population-based survey conducted in April 1996. PARTICIPANTS: Random sample of women aged 30-69 years. A total of 2935 women completed the Breast Health Survey (adjusted response rate 65%). A random sample of 115 completed this sub-survey on perceived sensitivity of mammographic screening and compensation for missed cancers. RESULTS: About one third of women (32.2%, 95% CI 23.7, 40.7) had an unrealistically high expectation of the sensitivity of screening mammography, reporting it to be 95% or higher. Approximately 40% of the women (43.5%, 95% CI 34.4, 52.6) thought that screening mammography should pick up all cancers (should have a sensitivity of 100%). Just under half the women (45.2%, 95% CI 36.1, 54.3) said financial compensation should be awarded for a cancer missed by screening mammography even if the cancer was missed as a consequence of the small failure rate of the test. Younger women living in metropolitan areas and women who had realistic expectations of the accuracy of the tests were more likely to favour financial compensation. CONCLUSION: Unrealistically high expectations of the sensitivity of screening mammography were common in this group of women. Many women favoured financial compensation for missed cancers even if the cancer was missed solely because of the failure rate of the test. Public education is required to inform women of the limited sensitivity of breast cancer tests but this may not reduce claims for financial compensation when cancers are missed.

Epilepsy and the law-medical records.

This paper reviews the need to keep medical records and concludes that Section 126 of the New South Wales Medical Practice Act, 1992, requires such provision to comply with adequate "professional conduct". This was above and beyond other possible mandatory maintenance of appropriate records, such as may be covered by the notifiable diseases provisions of the Public Health Act. Ethical codes of conduct imposed further obligations to maintain appropriate records, and legal defence against claims of misconduct or negligence required documented evidence to refute false accusations. The emphasis of records has changed with greater need to stipulate risk exposure associated with proposed treatments and advice provided for such things as necessary follow-up. It was further shown that appointment diaries, extra file entries and indications of any failed attendance and resultant subsequent actions were all part of adequate record-keeping. Finally, the paper reviews ownership of medical records and refers to the New South Wales case of Ms Breen, in which it was found that ownership of records, as at the printing of this paper, resided with the doctor.

A survey of sleep habits and sleeping difficulties in an elderly Swedish population.

A random sample of 876 subjects aged 65-79 years were investigated by means of a questionnaire concerning sleep and related factors. Sleep problems were reported by 23.8% of females and 13.3% of males. Moderate or major complaints of maintaining sleep were reported by 43.5% of subjects, early morning awakening 33.4% and difficulties falling asleep 31.4%. Daytime sleepiness was more common among males, and a relationship between daytime sleepiness and perceived poor sleep was found. Daytime napping was common, but not related to poor sleep. The prevalence of regular sleeping pill users was 7.6% for females and 3.0% for males and a relationship between sleep problems, sleeping pill usage and psychiatric symptoms was established. Among the regular sleeping pill users 39.1% had possible depression (PD) and 63.0% had possible anxiety disorder (PA). Among respondents with sleep complaints 29.8% had PD and 48.7% had PA. Sleep problems were also related to impaired physical health. Various medical illnesses contributed to sleep complaints among males, and depression affected sleep the most among females.