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Parkinsonism can have many causes, among them cerebrovascular disease. Vascular parkinsonism can be caused by infarction or haemorrhage in the nigrostriatal pathway, resulting in hemiparkinsonism, or by widespread small vessel disease in the white matter, leading to the gradual development of bilateral symptoms in the lower extremities. Compared to patients with Parkinson's disease, individuals with vascular parkinsonism have earlier onset of gait disturbance, are more likely to have urinary incontinence and cognitive impairment, and have poorer treatment response and prognosis; however, they are less likely to have tremor. With its unclear pathophysiology, varying clinical picture and overlap with other diseases, vascular parkinsonism remains a little known and somewhat controversial diagnosis.

Background: Our picture of the neuronal pathology in schizophrenia remains fragmented. Many hypotheses emphasize neurotransmitter receptor dysfunction in the development of this condition. Additionally, receptors dominate most research on drug therapy in schizophrenia. The so-called membrane hypothesis focuses on the role of the neuronal cell membrane in the pathogenesis., Material and Methods: On the basis of literature studies, we briefly introduce the membrane hypothesis of schizophrenia. We then go on to present results from our own research group, which focuses on interactions between antipsychotic agents and cell membranes as opposed to drug-receptor interactions., Results and Interpretation: The membrane hypothesis offers an integral model for the neuropathology of schizophrenia. However, because of the relatively small number of scientific investigations based on the theory, it comes across as weakly documented. Our experiments, conducted on model membranes and living cells, point in the direction of direct drug-membrane interactions and thus the ability of drugs to influence membrane-related enzymes without the involvement of a neurotransmitter receptor. These results may contribute to an increased understanding of both the neuropathology in schizophrenia and the mechanisms of action of antipsychotic agents.

The postgraduate training of doctors depends on their self-directed learning activities. Traditional continuing medical education has a limited impact on their clinical behaviour. The authors review the most relevant models and concepts of adult learning for continuing medical education, and personal and environmental factors that influence the quality of the learning. Doctors learn best when they recognise the need to learn and perceive what is to be learned as relevant to their practice. Continuing medical education should meet the doctors' educational needs by presenting a variety of learning options to suit their personal learning styles.

Assured quality of medical education is a prerequisite for high quality medicine. Quality assurance of medical education implies a well-planned assessment of the structure, process and outcome of education based on defined standards and objectives, and draws heavily on a thorough knowledge of how people learn. Learning in medicine shares common features at all levels, from undergraduate to continuing education. Three core elements are the context of learning, availability of information, and opportunities for elaboration (educational counselling, mentorship, interaction with peers) as a basis for linking practice and theory. A quality assurance programme must examine all these factors and suggest remedies when appropriate. The upgrading of educational research in medicine, and valuing and recognition of teaching within the profession, are important factors in promoting continuous improvement of the quality of medical education.

50 Norwegian doctors selected at random from the population of general practitioners who were neither recognized specialists nor enrolled in the specialist training programme, were interviewed by telephone about the need for postgraduate hospital training and the obstacles involved. Most of the doctors expressed a strong need for the education provided by such training. The most important obstacles to hospital training were personal domestic reasons, concern for the functioning of the practice and concern for the emotional problems the hospital work might cause. Strategies are suggested to make it easier, in practice and emotionally, to do hospital training.

A Norwegian programme for treatment of hypercholesterolemia in adults was published in 1988. In 1990 the Norwegian Medical Association appointed a group to modify this programme in the light of current knowledge, and taking into consideration the recommendations of the Consensus Conference on Cholesterol of October 1989. The present article presents this modified programme. When evaluating the risk of developing coronary heart disease a combined risk score should be calculated which also takes into account important risk factors other than cholesterol, such as family history, sex, age, smoking, hypertension, presence of diabetes etc. For those considered to be at high risk of developing coronary heart disease, the programme gives guidelines on how to intervene. With regard to treatment, special emphasis is placed on changing the diet.

In 1988 a group of Norwegian experts published a programme for treatment of patients with increased cholesterol. The programme recommended dietary counselling when plasma cholesterol exceeded 5 mmol/l. In the autumn 1988 the Norwegian National Health Association started a campaign on cholesterol for health personnel. In order to find out to what extent general practitioners adhered to the recommendations of the programme, a random sample of 100 general practitioners were sent a questionnaire before and after the campaign. The results showed no significant differences in the doctors' attitudes towards diagnosis and treatment of patients with increased plasma cholesterol. Both before and after the campaign the plasma cholesterol levels at which they would initiate follow-up, dietary counselling or drug therapy were 1-2 mmol/l above the levels recommended by the expert group. The attitude of the general practitioners was more conservative than the recommendations of the programme. The interval between the information meeting and the post study was only six months. It is a complicated process to change attitudes and practice routines, and the time required may be longer than six months. Furthermore, the recommendations of the programme were questioned by other doctors, which reduced its impact.