Characteristics of child health care practitioners in overweight prevention of children.

OBJECTIVES: To identify behavioral and personal characteristics of child health care (CHC) practitioners that influences the effect of early overweight prevention in children. METHODS: In total 216 questionnaires were filled out by CHC practitioners from four organizations in the Netherlands. RESULTS: There is a gap between awareness of the problem overweight in early childhood and actually discussing this with parents, as well as a gap between the existing recommendations and the perceived importance of early overweight prevention. Despite the fact that nurses have a more central task in life-style support than physicians, they reported to have less knowledge and skills than physicians. CONCLUSIONS: While both CHC physicians and nurses need support in improving their knowledge and skills, it is the nurses who need more support. A more structured and tailored implementation strategy with more emphasis on the needs of the nurses and physicians may improve early overweight management.

A local consensus process making use of focus groups to enhance the implementation of a national integrated health care standard on obesity care.

BACKGROUND: Recent guidelines on obesity management promote integrated care. There is little knowledge about local opportunities and barriers, faced by health care professionals and patients, that affect implementation of an integrated national health care standard in a local setting. Our aim is to understand experiences and expectations of health care professionals and patients as part of the local implementation process. METHODS: Eight focus groups and two interviews have been conducted among 24 patients (60+) and 29 professionals from seven different care disciplines. RESULTS: Both patients and professionals have identified serious barriers to implement the national standard: older adults do not feel taken seriously and experience lacking support from professionals. Professionals give contradictory advice and recommendations do not match needs of older adults. Professionals actually feel reluctant to discuss weight-related topics due to several reasons: they do not consider obesity being a chronic disease, lack of qualifications to support self-management and perceived lack of awareness and motivation among patients. CONCLUSION: Focus groups have proven their value to ascertain the opportunities and barriers older adults and professionals foresee while improving obesity care in order to meet the standards as required in a national guideline. Our research provides an emerging picture of health care professionals and patients having contradictory views and expectations about 'the others' role and their notions on the capability to intervene on patient's weight problems. Without this emerging picture, we would have missed important information on barriers to overcome. The likelihood of successful implementation would then have been small.

Antagonism of meta-chlorophenylpiperazine-induced inhibition of exploratory activity in an emergence procedure, the open field test, in rats.

The effects of meta-chlorophenylpiperazine (mCPP) were studied on exploratory behaviour in the open field test, using a procedure designed to evaluate the emergence of rats into a novel environment. mCPP reduced the exploratory activity in a dose-related manner after subcutaneous (s.c.), intraperitoneal (i.p.) and intravenous (i.v.) administration. The inhibition was manifest in all the parameters used to quantify the exploration of the open field area. Additional neuroendocrine experiments in a parallel group of rats revealed a dose-related increase in plasma prolactin and ACTH levels after i.v. mCPP, pointing to a general state of arousal in these mCPP-treated animals. A number of 5-HT antagonists were tested for their ability to prevent or reverse the behavioural inhibition induced by an i.v. injection of 1.0 g/kg mCPP given 15 min before testing in the open field. The antagonists were injected s.c. or given orally at various time intervals before mCPP, or they were injected i.v. 10 min after mCPP. The lowest active doses for the attentuation of the mCPP-induced behavioural inhibition after s.c., oral and i.v. administration, respectively, were 0.04, 40 and 10 mg/kg for pizotifen; 0.16, 0.16 and 0.16 mg/kg for mianserin; 0.63, 0.16 and 0.16 mg/kg for methysergide, and 0.16, 2.5 and 2.5 mg/kg for ritanserin. The lowest active doses of mirtazapine after s.c. and i.v. treatment were 0.01 and 0.16 mg/kg. These data indicate that mixed 5-HT1/5-HT2 receptor antagonists such as pizotifen and methysergide, and mixed 5-HT and catecholamine antagonists such as mianserin and mirtazapine are more potent antagonists of mCPP-induced behavioural inhibition in rats than the more selective 5-HT2A/5-HT2C antagonist ritanserin.

Spinal sufentanil in rats: Part III: Effect of diluent volume on epidural sufentanil.

Male Wistar rats were injected epidurally with various doses of sufentanil in 3 different dilution volumes, in order to determine differences in the lowest ED50 values for analgesia and side-effects. The lowest ED50 for both a TWR latency greater than 6 and greater than or equal to 10 s was significantly lower in the 20-microliters group as compared to the 2-microliters group. With an injection of 5 microliters, intermediate values were obtained. With regard to the side-effects, there was a trend towards increased systemic resorption with larger diluent volumes in spite of a better and more selective spinal effect, as evidenced by increasing specificity ratios. In terms of duration of analgesia at fixed doses of sufentanil, different results were obtained. At low doses of sufentanil, a pronounced diluent volume effect was present and the duration of analgesia increased as a function of the volume. At higher doses of sufentanil, however, the volume effect faded away and no differences were observed as a function of the diluent.

Spinal sufentanil in rats: Part II: Effect of adding bupivacaine to epidural sufentanil.

Male Wistar rats were injected epidurally with various doses of sufentanil, bupivacaine or sufentanil combined with bupivacaine either 40 or 80 micrograms. Addition of 80 micrograms bupivacaine to sufentanil produced a 2.2- to 3-fold decrease of the lowest ED50 for a tail withdrawal reaction latency greater than 6 and greater than or equal to 10 s. The potentiation was already present at low doses. Whereas both 0.16 microgram sufentanil and 80 micrograms bupivacaine were inactive, the combination of the two drugs resulted in a deep analgesia in all animals. Because the addition of low doses of bupivacaine to sufentanil did not increase the ED50's for side-effects, higher specificity ratios were obtained as compared to sufentanil given alone. These results were discussed with regard to the potentiation of the analgesic properties of epidurally administered lipophilic opioids by local anaesthetics.

Interactions between epidurally and intrathecally administered sufentanil and bupivacaine in hydroxypropyl-beta-cyclodextrin in the rat.

The interaction between inactive doses of the opioid sufentanil and the local anesthetic bupivacaine after complexation in various concentrations of hydroxypropyl-beta-cyclodextrin (HP-B-CD) were studied after epidural and intrathecal administration in the rat. Whereas 0.125 microgram sufentanil and 80 micrograms bupivacaine produced only limited effects, a combination of the two compounds resulted in a profound surgical analgesia in all rats tested after epidural administration. Also intrathecally, a clear potentiation was present. The complexation of the same doses of sufentanil plus bupivacaine in HP-B-CD increased the duration of analgesia. Epidurally, a maximal potentiation of analgesia was present at 0.125 microgram sufentanil plus 80 micrograms bupivacaine in 20% HP-B-CD. Intrathecally, maximal potentiation of the analgesic activity was present starting from a complexation of both drugs in 10% hydroxypropyl-beta-cyclodextrin. Higher concentrations of hydroxypropyl-beta-cyclodextrin did not significantly further increase the duration of analgesia. These results indicate that for both routes of spinal administration, the complexation of sufentanil plus bupivacaine in HP-B-CD can produce a longer analgesia than either plain sufentanil, sufentanil combined with bupivacaine or sufentanil alone in HP-B-CD. The complexation of sufentanil plus bupivacaine in HP-B-CD did not diminish the increased safety observed to occur after complexation of sufentanil in HP-B-CD and after combination of sufentanil plus bupivacaine.

Entrapment of a Swan-Ganz-catheter in tricuspidal valve.

Unsuccessful pulmonary artery catheter removal is a rare but potential life-threatening complication. This was observed in a dog during investigations on cerebrovascular reactivity. Postmortem examination showed entrappment of the pulmonary artery catheter in tricuspidal valve. "Clinical" symptoms are described and therapeutic measures in the case of suspected entrappment are discussed.

Long-term neurological assessment of the post-resuscitative effects of flunarizine, verapamil and nimodipine in a new model of global complete ischaemia.

In anesthetized rats, global complete ischaemia lasting for 9 min was induced by controlled hydraulic compression of the chest. A neurological score, based on cranial and spinal reflexes, postural tone, gait, movement and limb placement, was determined at 2 hr and 1, 2, 3, 7, 14, 21 and 28 days after resuscitation. Three doses of three calcium antagonists, flunarizine, verapamil and nimodipine and their respective solvents, were given intravenously during the resuscitation. The total neurological score was significantly better than solvent with 0.16 and 0.63 mg/kg of flunarizine and 0.04 and 0.16 mg/kg of verapamil; it was significantly better with solvent (10% ethanol) than with 0.04 and 0.16 mg/kg of nimodipine. The deficiency in tactile placing reactions of the hindpaws was the most resistant to therapy. This non-invasive model of global ischaemia in rats seems useful for the evaluation of drugs, since it requires minimal anesthesia and allows assessment of neurological recovery over an extended period of time.

Relationships between quantitative EEG measures and pharmacodynamics of alfentanil in dogs.

Intravenous alfentanil was administered as a constant 1 h infusion to 6 dogs. Before, during and up to 3 h after infusion, the effects of 3 doses (0.001, 0.004 and 0.016 mg/kg/min) on 6 quantitative EEG measures (zero-crossing frequency, root mean square (rms) amplitude, spectral edge, relative delta, alpha and beta power) were assessed in relation to plasma concentrations of alfentanil. All EEG measures, except zero-crossing frequency and rms amplitude, showed statistically significant dose-dependent changes in peak effect and duration. In addition, times-to-peak effect and return-to-baseline were sensitive to dose. The EEG effects of the low dose were smaller than those of the middle and high doses, whose peak effects did not statistically differ; but the high dose produced more persistent effects, which outlasted the infusion period for a longer time. Alfentanil-induced changes in rms amplitude and relative delta power showed the widest dynamic ranges. Measurable EEG changes occurred at low plasma concentrations, but EEG responses saturated at the middle dose. Significant correlations between plasma concentration and EEG effect were obtained for only the subperiod ranging from onset of infusion to peak EEG effect, indicating very short concentration-effect equilibration delays. On the other hand, clockwise concentration-effect loops were suggestive of acute tolerance: EEG responses peaked before peak plasma levels and they returned to baseline at dose-dependently higher plasma concentrations of alfentanil.

Measurement of ischemic changes in cerebral blood flow by the hydrogen clearance technique and brain cortical temperature. Influence of flunarizine.

In dogs global cerebral ischemia was produced by clamping reversibly the left subclavian and brachiocephalic arteries, supplying the head. The intercostal arteries were ligated permanently. Cerebral blood flow (CBF) was measured discontinuously using a hydrogen saturation-desaturation technique. Clamping of the former two vessels caused an increase in systemic blood pressure. When this increase was not blunted by previous splenectomy and blood withdrawal a still important CBF remained during the clamp. However, if this rise in blood pressure was impaired, CBF decreased to 9 +/- 8% (mean +/- S.D., n = 14) of the pre-ischemic value. Flunarizine is known to have anti-hypoxic/ischemic properties. The influence of this drug (0.1 mg/kg i.v.), injected 10 min after the beginning of a 30-min ischemia period, on the post-ischemic CBF was investigated. Two-three hour after ischemia CBF was significantly lower in the solvent-treated animals than in the flunarizine-treated group, in which CBF approached the preischemic values. Changes in CBF were also followed continuously by measurement of the variations of brain versus aortic temperature. It was analyzed what information this can provide on CBF.

Improved short-term neurological recovery with flunarizine in a canine model of cardiac arrest.

A 10-minute cardiac arrest was produced in dogs by electrical fibrillation of the heart. Recovery of cerebral function was monitored by estimating the cerebral metabolic rate of oxygen consumption (CMRO2), cerebral blood flow (CBF), electroencephalograph (EEG) and extent of neurological deficit. The study group received flunarizine (0.1 mg/kg intravenously) at the beginning of resuscitation, while control animals were given the drug vehicle. By four hours after resuscitation, CMRO2 in flunarizine-treated dogs was 121 +/- 43% of pre-arrest baseline, as compared with 37 +/- 9% in control animals (P less than 0.02). In the flunarizine group, CBF was 83 +/- 21% of baseline, while it was only 31 +/- 8% in controls (P less than 0.01). As compared with the control group, no other significant changes were detected in electrocardiographic, hemodynamic, or biochemical parameters in the flunarizine-treated dogs. A significant improvement in the visual EEG score (P less than 0.001) and neurological deficit (P less than 0.05) was seen in flunarizine-treated dogs six hours after ischemic insult.

Effects of flunarizine on recovery of cerebral function following cardiac arrest.

A 10-min cardiac arrest was produced in alfentanil-anesthetised dogs by electrical fibrillation of the heart. Recovery of cerebral function was monitored by 3 separate EEG techniques and visual assessment of neurologic deficit. The EEG techniques were visual scoring, broad-band power spectral analysis and period-amplitude analysis. The treatment group (n = 8) received flunarizine (0.1 mg/kg i.v.) at the beginning of resuscitation, while control animals (n = 8) were given the drug vehicle. A significant improvement in the visual EEG score and neurologic deficit 6 h after insult was noted in flunarizine-treated dogs. The extent of neurologic recovery was significantly correlated with the visual EEG score, with the relative power in the alpha frequency band (7.5-13.5 c/s) and with the percentage of zero-cross frequency.

A putative multipartite model of haloperidol interaction in apomorphine-disturbed behavior of the dog.

The interaction between various doses of apomorphine and haloperidol on intracranial self-stimulation in the dog was studied using a pradigm in which reinforcing brain-stimulation was controlled by a discriminative auditory stimulus. Reinforced lever-pressing was decreased by low doses of apomorphine and completely suppressed by stereotypogenic doses. At various doses of apomorphine, low doses of haloperidol either increased response inhibition by enhancing stereotypy, or increased lever pressing by reducing stereotypy while concomitantly increasing the number of nonreinforced responses. Intermediate to relatively high doses of haloperidol antagonized stereotypy and the response inhibition produced by apomorphine. High doses of haloperidol antagonized stereotypy but also suppressed self-stimulation. Thus, haloperidol is not only able to restore performance capability, but also disturbed reinforcing and discriminative stimulus control.