Capturing metal-support interactions in situ during the reduction of a Re promoted Co/γ-Al2O3 catalyst.

The reduction of a Re promoted Co/γ-Al2O3 catalyst was monitored in situ by synchrotron X-ray powder diffraction (XRPD) under H2 environment. Whole powder pattern analysis revealed a non-linear expansion of the unit cell of γ-Al2O3 during the reduction process, suggesting the diffusion of Co cations into the structure of the support. The non-linear cell expansion coincided with the formation of a CoO phase. In addition, space resolved diffraction at the inlet and the outlet of the reactor evidenced a negative effect of the partial pressure of indigenous H2O(g) on the reduction process.

[Gabapentin--a new antiepileptic agent]. / Gabapentin--et nytt antiepileptikum.

Gabapentin is a new antiepileptic drug. Its mechanism of action is not clearly understood, but it seems to differ from that of other antiepileptic drugs. The favourable pharmacokinetic properties of gabapentin make it simple to use. Our preliminary clinical observations with gabapentin at the National Center for Epilepsy are presented. 58 adult patients (mean age 28.9 years), mainly with refractory partial seizures, had gabapentin added to their existing medication. The follow-up period was 6.9 months on average. Only one patient experienced a reduction in seizures of more than 50%, while 25 patients experienced a moderate reduction in seizures (10-50%). The clinical effect was most favourable in patients with secondary generalized tonic-clonic seizures. Gabapentin was well tolerated, and no clinically significant interactions were encountered. Recent observations show that the doses of gabapentin used in our study may have been too low.

[Returned medicines as quality indicator for pharmacotherapy--what is left?]. / Medisinretur som kvalitetsindikator for farmakoterapien--hva blir til overs?

Unused medication accumulating in the homes of patients represents a medical, professional, financial and ecological challenge. Drugs returned to pharmacies show what kinds of medication are not being used. In our survey. 14 pharmacies registered all the medication returned during a three-month period. A total of 641 persons handed in 4,860 containers of medication during this period. A third of the containers were unopened and another third had more than half the contents left. The returned drugs were valued at approx. 450,000 NOK. Drugs used in cardiovascular and respiratory diseases constituted the largest part of the medication returned, both with respect to value and to volume. Drugs returned to pharmacies give an indication of the efficacy of pharmacotherapy. The results should prove suitable for reflection in multi-professional quality groups.

["To be used as directed by your physician"--reasons why patients do not use prescribed medicines]. / "Brukes etter avtale med legen"--årsaker til at pasienten får medisin til overs.

Research and practice indicate that a substantial amount of drugs prescribed for patients are never used. However, we do not know much as to why around 10% of the drugs paid for by the National Insurance are not used. The object of our survey was to identify and illustrate different reasons for this waste. On a questionnaire, 462 persons, who returned unused medication to 14 Norwegian pharmacies during a three-month period in 1994, indicated their reasons for not using the drugs. About half of these persons were also willing to participate in an in-depth interview. Using qualitative methodology, we grouped the reasons for having surplus medication into four main categories: Altered drug requirements--because of changes in the state of the patient's health or because of a new treatment regime. How the patients handled the prescribed drugs--influenced by the patient's knowledge, attitude and physical ability. Illness, social network and the complexity of the treatment were also contributing factors in this category. Coordination of the health services--related to how closely the various sections within the health care service worked together. Prescribing and distribution of drugs--related to rules and regulations, politics, technology, availability and the degree of economic consciousness among doctors and pharmacists. Both the professional and the socioeconomic aspects cited in this study call for reflection and may be used as a basis for further general discussion on the prescribing and handling of drugs, as well as the economic aspect of drug issue. They may also serve as an inspiration for local quality assurance measures and collaboration, especially between the various groups involved in the primary health care service.

Changes in plasma insulin, enterostatin, and lipoprotein levels during an energy-restricted dietary regimen including a new oat-based liquid food.

The changes in plasma insulin, enterostatin, lipid, and glucose levels during weight reduction were studied in 32 subjects having a body mass index of 25-35. The 31 subjects who completed the study followed for 23 weeks an energy-restricted dietary regimen which included a new oat-based soup as the main meal once or twice daily. The intake of energy decreased from 8.9 to 6.2 MJ/day from 0 to 22 weeks, the energy percentage from fat decreased from 35 to 30%, and the intake of dietary fiber increased from 21 to 25 g/10 MJ. The body weight decreased from 83 to 78 kg after 6 weeks and to 77 kg after 23 weeks. Plasma glucose had decreased significantly from 5.4 to 5.2 mmol/l, and plasma insulin from 122 to 98 pmol/l after 23 weeks. In contrast, the plasma enterostatin concentration did not vary significantly over five sampling times, the mean values ranging from 25 to 30 nmol/l. Plasma cholesterol declined from 5.6 to 5.2 mmol/l, low-density lipoprotein cholesterol from 3.8 to 3.3, and plasma triglycerides from 1.5 to 1.3 mmol/l from 0 to 23 weeks. High-density lipoprotein cholesterol increased from 1.1 to 1.3 mmol/l. It is concluded that an energy-restricted regimen leading to lower plasma insulin, triglyceride, and low-density lipoprotein cholesterol levels did not significantly affect the plasma enterostatin concentration in overweight subjects. A new oat-based liquid food as a part of the dietary regimen was well tolerated.

[Do we need new guidelines on iron supplementation during pregnancy?]. / Trenger vi nye retningslinjer for bruk av jerntilskudd i svangerskapet?

Studies have shown that the present official Norwegian recommendations on iron supplementation during pregnancy are not followed. A meeting was arranged in February 1993 to discuss the need to change the recommendations. The article describes the conclusions of the panel. It was proposed that the iron status of the pregnant woman, determined as serum ferritin concentration, should be measured early (before the 15th week of gestation) and iron supplement should be given as selective prophylaxis based on the serum ferritin level. The Directorate of Public Health has been asked to issue new recommendations.

[Pregnancy and iron supplementation--are the official guidelines followed?]. / Graviditet og jerntilskudd--blir de offisielle retningslinjene fulgt?

In the present study we have examined to what extent the national recommendations concerning iron supplements during pregnancy are being followed. 222 women in childbed were interviewed within one week after delivery concerning their intake of iron and other dietary supplements. We found that no more than 1/4 of the women were using iron supplements according to the national recommendations and that the advice given by doctors, midwives or public health nurses varied considerably. 70% of the women were recommended to take iron supplement, but no more than 66% of them were given specific advice as to which iron preparation they should take, or in what doses. The specific advice that was given varied. 93% of the women who were advised to take iron supplement followed this advice. More women took low-dose iron preparations, while more doctors recommended high-dose preparations. Only 30% of the women thought that iron supplement is vital for all pregnant women. We also found that many of the women (59%) took one or more dietary supplements, alone or in addition to iron.

[Emergency services in Norway. A questionnaire study]. / Legevakt i Norge. En spørreskjemaundersøkelse.

A questionnaire survey of primary health care emergency services in Norway (1991) covered 71 municipalities organized into 43 regions containing about 15% of the Norwegian population. The large cities are excluded. Long distances to travel and frequent duty periods cause some problems, but not for the majority of the population or doctors who participated in the survey. In several regions, a significant part of the service is covered by locums. Written directives for the services are rare. The availability of the doctor on duty falls short several places, owing to lack of satisfactory routines and the occasional need to accompany a patient to hospital. In more than half the regions communication systems are unsatisfactory and will have to be upgraded. In almost half the regions emergency telephone calls are sometimes answered by staff without a medical background. A code of practice or central regulation are suggested as possible ways of improving the services.

[Emergency medical services in a city. 1 year's data from a physician in Oslo]. / Legevakt i en storby. Ett års materiale fra en legevaktlege i Oslo.

After 297 contacts with patients through visits to the home in 1988 when doing emergency service in Oslo, 16% of the patients were referred to hospital. 26% were given new prescriptions or were advised to continue the drug prescribed for the acute illness by another doctor. 38% were given advice, a prescription-free drug, or no treatment. Only 4% of the patients under ten years of age were referred to hospital, 22% in this age group were given prescriptions and 73% were given advice and/or prescription-free drugs only. 8% of the patients were given prescriptions for group B drugs (mainly diazepam, diazepam-related drugs and combinations of paracetamol and codeine), or single or a few doses of group B or group A drugs (opiates). 11% of the patients were given antibiotics. 16 out of 32 prescriptions of antibiotics were phenoxymetylpenicillin. The average time spent on each patient was about 40 minutes, including travelling time. A warning is given against speedy consultations when carrying out emergency service, since most patients are unknown to the doctor. Other doctors taking part in emergency services in large towns and cities are advised to evaluate their medical practice.

Misuse of statistical methods: critical assessment of articles in BMJ from January to March 1976.

Sixty-two reports that appeared as Papers and Originals (excluding short reports) in 13 consecutive issues of the British Medical journal included statistical analysis. Thirty-two had statistical errors of one kind or another; in 18 fairly serious faults were discovered. The summaries of five reports made some claim that was unsupportable on re-examination of the data. Medical investigators should consult with people who have a real understanding of statistical methods throughout their projects.