Health care provider communicator style and patient comprehension of oral contraceptive use.

PURPOSE: To explore reasons for the incorrect usage of oral contraceptive pills (OCPs) by examining the relationship between patients' abilities to comprehend and/or recall information presented to them by nurse practitioners (NPs) and the communicator style of their NP. DATA SOURCES: A convenience sample of 46 OCP users completed an instrument designed to test their comprehension of OCP use and an instrument designed to measure the communicator style of their NP. CONCLUSIONS: A multiple stepwise regression revealed that attentive and friendly communicator styles were positive predictors and the communicator image and dramatic styles were negative predictors of comprehension. PRACTICE IMPLICATIONS: Unwanted pregnancies that result from non-compliance with OCP regimens can have significant social and financial effects. A lack of understanding of proper OCP use may depend on the style of communication a NP uses to convey crucial information regarding the regimen.

Radiation disasters and emergency department preparedness.

There are few radiation disasters that have occurred worldwide. These events, however, give some insight as to the potential for theoretical radiation disaster events of the future. Some of our current fears, such as terrorist uses of radiation, currently have no historical basis for planning guidance. Hospital facilities should assess the potential for radiation accidents and potential radiation disaster scenarios when in the process of disaster planning. Preparation and training will lead to confidence and improved emergency management of potentially chaotic events.

Acute changes in intracellular ions or pH and regulation of aldose reductase activity.

Sorbitol production in the renal medulla increases in dehydrated rats, indicating that aldose reductase activity varies with the state of hydration. This response could be due to an increased synthesis of the enzyme (Moriyama T et al. J Biol Chem 1989:264:16810-16814) and/or a change in aldose reductase activity caused by acute changes in intracellular ionic composition, ionic strength, osmolality, or pH. Aldose reductase activity in tubules dissected from kidneys of control rats and rats undergoing water diuresis was measured, and the tubules were permeabilized so that changes in intracellular composition that would occur during dehydration could be induced experimentally. Aldose reductase activity did not change consistently as sodium, potassium, chloride, or osmolality were varied. Aldose reductase activity did increase acutely when sulfate was raised or when pH was lowered to pH 6.2 to 6.8, corresponding to the pH optimum of the enzyme. The small magnitude of change in enzyme activity suggests that the major influence of dehydration on aldose reductase activity is to increase enzyme synthesis. It was concluded that aldose reductase activity is not acutely regulated by changes in sodium, potassium, chloride, or osmolality. The stability of aldose reductase activity despite changes in ionic composition or osmolality supports the hypothesis that acute regulation of intracellular sorbitol content occurs by variation in cell sorbitol permeability and not by variation in cell sorbitol production.

An independent effect of osmolality on urea transport in rat terminal inner medullary collecting ducts.

We have shown that urea transport across the terminal inner medullary collecting duct (terminal IMCD) is mediated by a vasopressin-stimulated, facilitated diffusion process exhibiting properties consistent with a transporter. To investigate whether hypertonic NaCl, as exists in vivo in the inner medulla, affects urea permeability, we studied isolated perfused rat terminal IMCD segments. Perfusate and bath osmolality were varied symmetrically by adding or removing NaCl or mannitol. Urea permeability rose progressively when osmolality was increased with NaCl or mannitol from 290 to 690 mOsm/kg H2O in the absence of vasopressin; there was no further increase at 890 mOsm/kg H2O. In the presence of 10(-8) M arginine vasopressin, urea permeability increased when NaCl was added to raise osmolality from 290 to 490 mOsm/kg H2O but there was no further increase at 690 mOsm/kg H2O. When 1 mM 8-bromo cyclic AMP was added to the bath, raising NaCl still increased urea permeability. These results suggest that urea transport across the rat terminal IMCD is regulated both by vasopressin and by osmolality at values present in the renal inner medulla. Osmolality seems to activate urea transport across the rat terminal IMCD by mechanisms distinct from those of vasopressin or cyclic AMP.

Coordinated response of renal medullary enzymes regulating net sorbitol production in diuresis and antidiuresis.

The renal response to changes in hydration includes variation in intracellular sorbitol, a major inner medullary osmolyte. To examine the mechanism for changes in net sorbitol production, we measured activities of enzymes regulating sorbitol production (aldose reductase) and degradation (sorbitol dehydrogenase) in untreated, water diuretic, and antidiuretic (water restriction and/or vasopressin administration) rats. Collecting duct segments dissected from collagenase-treated kidneys of Sprague-Dawley rats were divided into outer medullary and three distinct inner medullary regions. Aldose reductase activity increased during antidiuresis and decreased during diuresis. In contrast, sorbitol dehydrogenase activity was very low during antidiuresis and increased during diuresis. These changes in enzyme activity were found after 3 days, but not after 1 day, of water diuresis/antidiuresis. Enzyme activity changed only in the deepest 50% of the inner medullary collecting duct. Thus, there is coordinated regulation of aldose reductase and sorbitol dehydrogenase activities so that (a) during water diuresis, aldose reductase activity decreases while sorbitol dehydrogenase activity increases; and (b) during antidiuresis (water restriction and/or vasopressin administration), aldose reductase activity increases while sorbitol dehydrogenase activity remains low. We conclude that long-term osmoregulation in response to physiologic stimuli involves both aldose reductase and sorbitol dehydrogenase activities in rat terminal inner medullary collecting duct segments.