[Cholesterol determination at conscription. A method to identify persons with high risk of developing cardiovascular disease]. / Kolesterolbestemmelse ved sesjon. En måte å identifisere personer med høy risiko for å utvikle hjerte- og karsykdom.

In the adult population, serum cholesterol level and risk of cardiovascular disease are related to some extent to habits and lifestyle established at an early age. We have estimated serum total cholesterol levels by means of a dry chemical method and have collected information on established cardiovascular risk factors among 1,203 young Norwegian men at conscription. 30 of the recruits with the highest serum cholesterol levels were later examined in the hospital's out-patient clinic. A total of 30.8% of the recruits were daily smokers. Mean serum total cholesterol was 4.05 mmol/l with a 97.5 percentile value of 6.31 mmol/l. The prevalence of coronary heart disease among parents was significantly higher among recruits from the upper cholesterol quintile (4.2%) compared with those in the lowest quintile (0.8%) (p = 0.02). These findings show that cholesterol screening at conscription is feasible and can be used to identify a group of men at high risk of subsequently developing cardiovascular disease.

Pulmonary embolism and heart disease. An autopsy study.

The frequency of pulmonary embolism in patients with myocardial infarction (MI) and chronic rheumatic heart disease (RHE) has been investigated in an autopsy series. The series comprised 21530 hospital autopsies from 1960 to 1984. Altogether 5351 patients with MI and 289 patients with RHE as underlying death cause were selected for this study. Patients with RHE or old myocardial infarction (OMI) had a significantly higher frequency of pulmonary embolism than patients with acute myocardial infarction (AMI) or acute and old myocardial infarction combined (AOMI). This was true irrespective of duration of stay in the hospital during last admission. The frequency of pulmonary embolism decreased in patients with OMI or RHE from 1960 to 1984 suggestive of better therapy of chronic heart failure. A similar trend was seen in patients with AMI during a period with consistent anticoagulation treatment.

Can prediction of violence among psychiatric inpatients be improved?

In an effort to improve the prediction of violence among psychiatric inpatients, the authors retrospectively studied 25 patients who were violent and 34 who were not violent after admission to a psychiatric emergency ward in Norway. The only demographic variable that discriminated between the two groups was violence in the family of origin; the violent group had experienced significantly more. The best single predictor of violence was a history of previous violence by the patient, which correctly classified 80 percent of the patients. The combined information about patients' level of aggression rated at referral and level of anxiety rated at admission correctly classified 78 percent. In a subgrouping of violent patients who inflicted injuries and did not inflict injuries, a higher percentage of the injury-inflicting patients were found to have a diagnosis of schizophrenia. These patients also had a higher level of aggression at referral.

A case study approach to health care facility construction projects.

In this paper, the authors present a useful overview of the planning, design, and construction process, emphasizing the importance of the practical application of management skills to that process. They suggest that health administration students develop "real life" skills by participating in case studies and role playing, led by planning and health care professionals. Educators frequently look for ways to assist the student in transferring the didactic skills learned in the classroom to their practical application. Case studies and role playing have been used in the management curriculum for this purpose. In this article, the authors use the construction project management process as a model for exploring the many interactions which take place during this process and relate those interactions to specific management skills needed by the health care executive. The use of the construction project as a case study allows the student an opportunity to experience a multidisciplinary team effort and to relate the principles of such academic disciplines as economics, organizational behavior, financial management, and labor relations to a real life setting.

Medical students' experiences in medical emergency procedures upon qualification.

The experiences of eighty-five final-year medical students in twenty practical procedures identified as relevant to medical emergencies were registered. Notable differences between exposures to some of these procedures within and outside teaching situations were found. Instruction must be seen as inadequate prior to first performance in real-life situations. Experiences in cardiopulmonary resuscitation were acceptable, however, while exposures to procedures with special equipment, e.g. lumbar puncture or bladder catheterization, were variable. It is concluded that opportunities may be increased by expanding already existing scheduled activities and by spending more time on planning and organization. Examples or activities in order to increase students' experiences in practical procedures during medical school are given and discussed. The problem of assessment of practical competence is pointed out as is also the need for a clear definition of the teaching objectives.

The effect of a checklist on medical students' exposures to practical skills.

The effect is evaluated of a checklist exploring acquisition of practical skills by medical students during the first clinical course in internal medicine. A group of forty-five students using the checklist was compared with two reference groups doing their clerkship before and after the study group. The amount of exposure to practical procedures increased by about 30%. At the same time exposure to some simpler procedures was reduced, while there was an increase in exposures to more complicated procedures. The conclusion is that a checklist has potential value for increasing exposure to practical procedures, if given with advice about the procedures to be preferred and by demand for mastery of particular skills.

Activation of human monocytes by free muramyl dipeptide (MDP).

Activation of human monocytes with MDP (N-acetylmuramyl-L-alanyl-D-isoglutamine) 1-100 micrograms per ml for 48 h in vitro enhanced the cytostatic activity against the target cell line K-562, while cytolysis remained unchanged. Catalase, 600 SU per ml, had no inhibitory effect on the cytostasis mediated by MDP-activated monocytes. The optimal MDP concentration for activation was in the range 3-10 micrograms per ml. Supernatants from monocytes activated with MDP 1-30 micrograms per ml for 48 h exerted no cytostatic activity. MDP 1-100 micrograms per ml had no direct cytostatic or cytolytic effect on the target cells in a 24 h assay. When added to monocytes cultured in vitro for four days immediately prior to the chemiluminescence (CL)-assay, MDP 10-100 micrograms per ml enhanced both the zymosan and phorbol myristate acetate-triggered lucigenin-dependent CL. Monocytes pre-activated with MDP for 48 h did not demonstrate any enhanced CL-response. MDP-activation 30 micrograms per ml for 48 h increased the zymosan-triggered generation of H2O2 moderately. The enhanced cytostatic activity induced by MDP-activation is probably not mediated by hydrogen peroxidase or production of cytostatic factors.

Effect of human monocyte-released cytostatic factors on target cell DNA synthesis, protein synthesis, and ATP content.

Cultured human monocytes activated in vitro with lymphokines and lipopolysaccharide release cytostatic protein factors that may be separated by ion-exchange chromatography into two populations, termed cytostatic factors I and II (CF I and II). The effect of CF I and II on target cell DNA synthesis, protein synthesis, and ATP content and the possible presence of a CF-associated protease activity were investigated. Inhibition of DNA synthesis was detected 4 h after addition of either CF I or CF II, whereas inhibition of protein synthesis was first detected after 10-15 h. Moreover, 20 h after addition of either CF I or CF II the average DNA synthesis per cell was inhibited by 25-35%, as compared with 10-15% inhibition of protein synthesis. No significant alteration in cellular ATP content was observed in cells culture up to 25 h with either CF I or CF II. Thus, neither protein synthesis nor generation of ATP appeared to be primary targets of either CF I or CF II, but the factors may act more directly on DNA synthesis. Protease activity was not associated with either CF I or CF II, and the factors thus differed from a previously reported cytolytic protease released from activated murine macrophages.

Assessment of students' experiences in technical procedures in a medical clerkship.

This study was designed to provide some insight into the manner and degree of students' acquisition of practical skills. One hundred and fifty-two of a total of 166 students in a medical clerkship during the first clinical year answered a questionnaire. The questionnaire contained fifty-eight different laboratory tests and technical procedures. The study revealed deficiencies in the teaching programme. On the average the students had been exposed to 19.4 procedures during their 13-week clerkship. We found no differences according to sex or age. Fourteen skills were considered mandatory. The mean result was 62% for these procedures. Urine analysis and participating in evening rounds gained best scores, while test for blood in faeces and discussing insulin dosage had the lowest scores, 14% and 10% respectively. In order to increase the amount of exposure to practical skills, some improvements in the teaching programme are suggested.

Toxic oxygen species in monocyte-mediated antibody-dependent cytotoxicity.

The role of toxic oxygen species in monocyte-mediated ADCC against the myelogenous cell line K-562 was investigated. Freshly isolated human monocytes caused 40% specific lysis of antibody-coated K-562 cells (Ab-K-562). Monocytes challenged with Ab-K-562 gave a small but definite luminol-dependent chemiluminescence response, indicating that a respiratory burst with generation of toxic oxygen species had been elicited. Generation of hydrogen peroxide in areas of close apposition between the monocyte and the Ab-K-562 plasma membranes was demonstrated by electron microscopy using precipitation of cerium ions as a cytochemical stain for hydrogen peroxide. Catalase inhibited the formation of cerium precipitates in the interaction zone between monocytes and Ab-K-562 cells. Despite evidence that toxic oxygen species were generated, the monocytes' cytolytic activity against Ab-K-562 was not inhibited by superoxide dismutase, catalase, or azide. Enzymatically generated fluxes of superoxide anion or hydrogen peroxide were not cytolytic to K-562 cells but did have a cytostatic effect. We conclude that toxic oxygen species are generated when human monocytes are challenged with Ab-K-562. However, these toxic oxygen species do not appear to be the major mediators of the monocytes' cytolytic activity in this experimental system.

Role of myeloperoxidase in the luminol-dependent chemiluminescence response of phagocytosing human monocytes.

The luminol-dependent chemiluminescence (CL)-response of phagocytosing declined steadily during in vitro differentiation and was approximately 10% of the initial value by the fourth day of culture. A parallel decline in myeloperoxidase (MPO)-activity of monocyte cell lysates was observed during the same period, and a close correlation was found between peak luminol-dependent CL-response and MPO-activity. The lucigenin-dependent CL-response of phagocytosing monocytes in parallel cultures declined to about 85% of the initial value during four days of in vitro culture. Chemiluminescence was determined in solutions of luminol or lucigenin subjected to fixed amounts of H2O2 or enzymatically generated fluxes of H2O2. Horseradish peroxidase (HRPO) markedly enhanced the luminol-dependent CL but not the lucigenin-dependent CL of this cell-free system. Similar results were obtained when a crude MPO extract was substituted for the HRPO. Despite this evidence that luminol-dependent CL is enhanced by peroxidases, addition of HRPO to the assay medium did not increase the luminol-dependent CL-response of four days old, phagocytosing monocytes.

Production of reactive oxygen species and chemiluminescence by human monocytes during differentiation and lymphokine activation in vitro.

The zymosan-induced respiratory burst of human monocytes was studied, measuring the generation of reactive oxygen species (ROS) and luminol-dependent chemiluminescence (CL). The monocytes' ability to generate ROS declined markedly during the first 24 hours of culture, but regained the original level during the following three days. In contrast, the CL-response declined steadily during the same period. In vitro activation by lymphokines from lymphocytes stimulated with bacillus Calmette-Guérin gave a significant increase in ROS-generation; the CL-response was only marginally increased, but activated cells consistently displayed an altered kinetics of the CL-response with a more rapid decline from peak CL-values. These findings indicate that the production of ROS is not the limiting factor for the magnitude of the CL-response in the present experimental system and that the CL-assay may be an uncertain way of quantitating ROS.