Characterization of basal and re-inflammation-associated long-term alteration in pain responsivity following short-lasting neonatal local inflammatory insult.

Recently, several studies have suggested that neonatal noxious insult could alter future responses to painful stimuli. However, the manifestations, mechanisms, and even developmental nature of these alterations remain a matter of controversy. In part, this is due to the lack of detailed information on the neonatal sensitive period(s) during which noxious stimulation influences future nociception, and the time-course and distribution of the resultant abnormalities. The present paper describes these parameters in a rat model of short-lasting ( approximately 24 h) neonatal local inflammation of a hindpaw produced by injection of 0.25% carrageenan (1 microl/g). Examinations of paw withdrawal responses to thermal and mechanical stimulations in adult animals, which as neonates were subjected to this insult, showed that the previously-reported long-term hypoalgesia and hyperalgesia are not mutually exclusive outcomes of early noxious experience. Long-term hypoalgesia was apparent at the basal conditions and was equally strong in the previously injured and uninjured paws, which suggests a globally-driven deficit. In contrast, long-term excessive hyperalgesia had the strongest manifestation in the neonatally-injured paw after re-inflammation, indicating significant segmental involvement in its generation. The differences between mechanisms underlying the observed hypoalgesia and hyperalgesia are further underscored by the finding that, while the former is detectable only after animals reach the second month of life, the latter is elicitable immediately upon cessation of the initial neonatal inflammation. Nevertheless, we detected a significant overlap in the neonatal sensitive periods for generation of these effects (both occurring within the first postnatal week). Also, neither the basal hypoalgesia nor excessive re-inflammation-associated hyperalgesia subsided with age and were detectable in 120-125-day-old rats. These finding provide a framework within which the entire complex of long-term effects of early noxious experience can be understood and examined.

The job satisfaction of health visitors, district nurses and practice nurses working in areas served by four trusts: year 1.

This paper reports the results of the first of three annual surveys of the job satisfaction of health visitors, district nurses and practice nurses working in communities served by four trusts. Analysis of variance illustrates differences in the level of Personal Satisfaction, Satisfaction with Workload, Satisfaction with Professional Support, Satisfaction with Training and Satisfaction with Pay and Prospects. Practice nurses appear to be the most satisfied group; the level of satisfaction for health visitors is significantly lower. Qualitative analysis of the additional comments made by approximately one-third of respondents illustrates the gulf in perceived values between staff and management and the feelings of uncertainty experienced by community nurses in the wake of major legislative change. Possible reasons for differences in level of staff satisfaction between the four trusts are discussed.

Colostomy patients: psychological adjustment at 10 weeks and 1 year after surgery in districts which employed stoma-care nurses and districts which did not.

Two hundred and fifteen colostomy patients were interviewed at 10 weeks after surgery from a stratified random sample of 12 health districts in which stoma-care nurses were employed and eight other districts: 85 survivors who did not have restorative surgery were reinterviewed 1 year later. The Present State Examination (PSE) was used to assess the prevalence of affective disorder on both occasions. Analysis of covariance of the 10-week PSE scores revealed that age was unrelated to psychological adjustment after controlling for the extent and severity of patients' symptoms and that patients in districts which employed stoma-care nurses had significantly lower PSE scores. Single and widowed males appeared to enjoy better emotional health than married men and than women. Analysis of covariance of PSE scores obtained 1 year later also revealed that age was unrelated to psychological adjustment after controlling for the patients' physical state. No difference was found between patients who had access to a National Health Service stoma-care nurse and patients in other districts, many of whom had seen a representative from one of the appliance companies. The finding that single and widowed males appeared to fare better than married men was repeated. Ten per cent of patients who felt completely well were anxious or depressed. Psychiatric referral may be inappropriate for the majority of depressed patients who may instead benefit from medical treatment or from nursing intervention to deal with physical symptoms such as pain or urinary incontinence.

Patterns of neuroleptic use among the institutionalised elderly.

A survey was conducted of neuroleptic use amongst the residents of Local Authority homes for the elderly, and elderly patients in geriatric, psychogeriatric and general hospital wards in one of the London boroughs. Some 13% of the residents and patients surveyed were found to have received neuroleptics in the 24 h preceding the survey. Marked variation between homes and between wards and hospitals was observed, although for the sample overall associations were observed between disturbed behaviour and mood and the likelihood of receiving neuroleptics. Issues regarding the use of neuroleptics in the non-psychotic elderly are discussed.