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It is the aim of this review to provide a survey of research on Self-Help Groups (SHGs) in health care with a special focus on SHGs for women with chronic muscular pain. The aim is not only to describe this field of research, but also to consider how this research relates to gender research as such. A variety of themes are examined: history, external factors that influence SHGs, internal aspects of SHGs, and gender research on SHGs. It was found that the gender perspective was relatively neglected. Our suggestion for further research notes that group members can produce new ways to manage their lives with the help of the interaction/exchange in the SHGs, regarding gender construction, knowledge, legitimacy and adaptation or transformation, and the position of activities in SHGs among societal norms and attitudes. [ABSTRACT FROM AUTHOR]

This article details our findings from focus groups with social workers in Sweden and Canada illuminating similarities and differences in the process of social intervention in child maltreatment. We identified six categories that form the bases for hypothesizing different orientations of child welfare and child protection: Gate Keeping; Skills in Context; Client Identity; Decision Points; Compulsion; and Measures. We analysed participants' descriptions and uncovered how these descriptions of social intervention in child maltreatment connect to model orientations in both countries. In Swedish child welfare, there is a greater readiness to intervene with more resources and measures, intervention is assessment driven and focuses on family preservation. In Canadian child protection, only the most needy children are eligible for a limited range of services, intervention is structure driven and more narrowly focused on protection and permanency planning. The implications of these findings to social work are discussed. [ABSTRACT FROM AUTHOR]

In this appreciative comment on Michael Quinn Patton's article 'Two Decades of Developments in Qualitative Inquiry', two main issues are addressed. The first is whether the quantitative-qualitative conflict in social research really is over. There are signs that quantitative methods still are more accepted, especially in the intersection area between academic research and practice-based evaluations. The other issue is the risk, possibly attached to Patton's suggestions, of being too pragmatic in evaluation research. For the evaluator it is important to be able to account for the kind of knowledge that has been produced and on which grounds. [ABSTRACT FROM AUTHOR]

Empirical studies show that correlation between national stock markets increased and the benefits of global portfolio diversification decreased significantly after the global stock market crash of 1987. The 1987 and 2008 crashes are the two most important global stock market crashes since the 1929 Great depression. Although the effects of the 1987 crash on the comovements of national stock markets have been investigated extensively, the effects of the 2008 crash have not been studied sufficiently. In this paper we study this issue with a research sample that includes the U.S stock market and twenty European stock markets. We find that correlation between the twenty-one stock markets increased and the benefits of portfolio diversification decreased significantly after the 2008 stock market crash.

Abstract: This paper explores different orientations to child-centered social work as conveyed in the training materials and guidelines of Looking After Children and Assessment Framework in Australia, Canada and Sweden. ‘Child centered’ is shaped by contextual factors and influences social work practices. We found differences in these approaches as needs based and/or rights based and in relation to how each emphasizes the three P''s — Provision, Protection and Participation. Substantial differences were identified both in how references to a child-centered approach appear in theoretical frameworks, values, motives and use of concepts in training materials and guidelines, and in the instructions given as to how to apply these approaches. It appears that Australia balances needs and rights, while Canada is more needs-oriented and Sweden more rights-oriented. Swedish materials show a more explicit emphasis on participation than Australian and Canadian materials. Differences between the three countries indicate the importance of structural, contextual factors shaping orientations to child-centered practice. [Copyright &y& Elsevier]

This article details findings from social workers in Sweden and Canada, illuminating similarities and differences in gatekeeping in child welfare and child protection. Analysis revealed different patterns of inclusion and exclusion. Swedish child welfare includes a greater readiness to intervene with more resources and measures. Gatekeeping is assessment driven and focused on family preservation. In Canada, only the most needy children are eligible for a limited range of services. Gatekeeping is structure driven and narrowly focused on protection. Analyses of evidence-based research to improve outcomes for children and families must include comparisons of how different structural orientations influence management of referrals at intake. The authors discuss the implications of these findings. [ABSTRACT FROM AUTHOR]

Background: Excessive worry is a common phenomenon. Our research group has previously developed an online intervention for excessive worry based on operant principles of extinction (IbET; internet-based extinction therapy) and tested it against a waiting-list. The aim of this study was to evaluate IbET against an active control comparator (CTRL)., Methods: A 10-week parallel participant blind randomised controlled trial with health-economical evaluation and mediation analyses. Participants ( N = 311) were randomised (ratio 4.5:4.5:1) to IbET, to CTRL (an internet-based stress-management training program) or to waiting-list. The nation-wide trial included self-referred adults with excessive worry. The primary outcome was change in worry assessed with the Penn State Worry Questionnaire from baseline to 10 weeks., Results: IbET had greater reductions in worry compared to CTRL [-3.6 point difference, (95% CI -2.4 to -4.9)] and also a significantly larger degree of treatment responders [63% v. 51%; risk ratio = 1.24 (95% CI 1.01-1.53)]. Both IbET and CTRL made large reductions in worry compared to waiting-list and effects were sustained up to 1 year. Treatment credibility, therapist attention, compliance and working alliance were equal between IbET and CTRL. Data attrition was 4% at the primary endpoint. The effects of IbET were mediated by the hypothesized causal mechanism (reduced thought suppression) but not by competing mediators. Health-economical evaluation indicated that IbET had a 99% chance of being cost-effective compared to CTRL given societal willingness to pay of 1000€., Conclusions: IbET is more effective than active comparator to treat excessive worry. Replication and extensions to real-world setting are warranted.

Mantle cell lymphoma (MCL), a malignancy of B-lymphocytes, has a poor prognosis. It is thus necessary to improve the understanding of the pathobiology of MCL and identify factors contributing to its aggressiveness. Our studies, based on Affymetrix data from 17 MCL biopsies, real-time quantitative polymerase chain reaction data from 18 sorted primary MCL cells and 108 MCL biopsies compared to non-malignant tissue, reveals that GNAZ expression predicts poor clinical outcome of MCL patients (Cox regression, P = 0·014) and lymphocytosis (Mann-Whitney, P = 0·011). We show that GNAZ translates to Gα z protein - a signalling molecule within the G-protein coupled receptor network. Our findings suggest that GNAZ/Gα z contribute to the MCL pathobiology., (© 2019 British Society for Haematology and John Wiley & Sons Ltd.)

This article explores how local politicians and care unit managers in Swedish eldercare experience and respond to state supervision (SSV). Twelve politicians and twelve managers in 15 previously inspected municipalities were interviewed about their experiences of and reactions to SSV in relation to their views of care quality and routines in eldercare practice. The findings indicate that local managers and political chairs perceived SSV in eldercare positively at a superficial level but were critical of and disappointed with specific aspects of it. In terms of (a) governance, chairs and managers said SSV strengthened implementation of national policies via local actors, but they were critical of SSV's narrow focus on control and flaws in eldercare practice. With regard to (b) accountability, SSV was seen as limited to accountability for finances and systemic performance, and regarding (c) organizational development, SSV was seen as limited to improving routines and compliance with legislation, while local definitions of quality are broader than that. In general, local actors regarded SSV as improving administrative aspects and routines in practice but ignoring the relational content of eldercare quality.

School health teams commonly address the needs of students with asthma, which requires specific knowledge and skills. To develop a skilled school health team, a competency-based framework for managing asthma in schools was developed. A modified Delphi with 31 panelists was completed. Consensus (≥80% agreement) was reached for all 148 items regarding the appropriateness as a minimum competency for asthma care in schools. The resultant Colorado Competency Framework for Asthma Care in Schools guided the development and pilot testing of a continuing education curriculum for school nurses. Pre- and postassessments demonstrated significant improvements in knowledge and self-confidence related to asthma care in schools and inhaler technique skills. This work is the first to use a consensus process to identify a framework of minimum competencies for providing asthma care in schools. This framework informed a continuing education curriculum that resulted in improved knowledge, confidence, and skills for school nurses.

Aim: To investigate different proxies of brain and cognitive reserve as potential mediators of the effect of cortical thinning on cognition in healthy middle-aged adults., Methods: Eighty-two middle-aged individuals were included (mean(SD) age=45.1(3.9)years). Cortical thickness was calculated for multiple brain regions using FreeSurfer. Cognitive measures sensitive to early cognitive decline were selected, including Block Design from the Wechsler Adult Intelligence Scale-III (WAIS-III), Judgment of Line Orientation Test (JLOT), Color Trails Test (CTT), and first learning trial of TAVEC (the Spanish version of the California Verbal Learning Test, CVLT). Brain reserve was operationalized as total intracranial volume (TIV); and cognitive reserve was estimated by means of Years of Education, WAIS-III Vocabulary subtest, WAIS-III Information subtest, and a Cognitive Reserve Questionnaire (CRQ). Mediation effects were investigated with multiple linear regression and bootstrapping analysis., Results: Information and Vocabulary showed the greatest mediation capacity. All the observed mediations were positive indicating that higher levels of reserve attenuate the effect of reduced cortical thickness on cognition. Information, Vocabulary and TIV buffered the effect of frontal thinning on Block Design; Vocabulary and Years of Education buffered the effect of frontal thinning on JLOT; and CRQ buffered the effect of temporal thinning on CTT., Conclusion: Higher reserve buffers the effect of cortical thinning on cognition in healthy middle-aged adults. The investigated proxies might be underpinned by slightly different neural networks. Advancing in the understanding of the influences of reserve in healthy middle-aged adults is crucial to facilitate early interventions., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Purpose: The purpose of this study was to investigate the impact of T-cell subsets on pathologic and clinical features including disease outcome in mantle cell lymphoma (MCL)., Experimental Design: Cell populations were investigated using flow cytometry in diagnostic MCL (n = 153) and reactive (n = 26) lymph node biopsies. Levels of tumor cells, T cells, T-cell subsets, and the CD4:CD8 ratio were assessed and related to pathologic and clinical parameters., Results: MCL cases with diffuse and nodular histologic subtypes showed lower levels of T cells, especially CD4(+) T cells, than those with mantle zone growth pattern. Both CD3 and CD4 levels were lower in the nodular subtype than in mantle zone (P = 0.007; P = 0.003) and in the diffuse compared with the nodular subtype (P = 0.022; P = 0.015). The CD4:CD8 ratios were inversely correlated to tumor cell proliferation (P = 0.003). Higher levels of CD3(+) and CD4(+) T cells and higher CD4:CD8 ratios were associated with indolent disease (P = 0.043, 0.021, and 0.003 respectively). In univariate analysis, a high CD4:CD8 ratio, but not the histologic subtype, was correlated to longer overall survival (OS). In multivariate analysis, the CD4:CD8 ratio correlated with OS independently of Mantle Cell Lymphoma International Prognostic Index (MIPI) and high p53 expression (P = 0.023)., Conclusion: CD3(+), CD8(+), and particularly CD4(+) T-cell levels are higher in indolent MCL and decrease with more aggressive histology as reflected by a diffuse growth pattern. High CD4:CD8 ratio correlated independently of other high-risk prognostic factors with longer OS, suggesting a prognostic role for T cells in MCL., (©2014 American Association for Cancer Research.)

The cannabinoid receptors are upregulated in many types of cancers, including mantle cell lymphoma (MCL) and have been suggested to constitute novel therapeutic targets. The expression pattern of the key members of the endocannabinoid system was analyzed in a well-characterized MCL patient cohort and correlated to biological features. 107 tumor tissues were analyzed for the mRNA levels of cannabinoid receptors 1 and 2 (CNR1 and CNR2) and the two main enzymes regulating the endocannabinoid anandamide levels in tissue: NAPEPLD and FAAH (participating in synthesis and degradation, respectively). NAPEPLD, CNR1 and CNR2 were overexpressed while FAAH expression was reduced in MCL compared to non-malignant B-cells. Both low CNR1 and high FAAH levels correlated with lymphocytosis (p=0.016 and p=0.022, respectively) and with leukocytosis (p=0.0018 and p=0.047). Weak to moderate CNR1 levels were a feature of SOX11 negative MCL (p=0.006). Both high CNR2 and high FAAH levels correlated to anemia (p=0.0006 and p=0.038, respectively). In conclusion, the relative expression of the anandamide synthesizing and metabolizing enzymes in MCL is heavily perturbed. This finding, together with high expression of cannabinoid receptors, could favor enhanced anandamide signaling and suggest that targeting the endocannabinoid system might be considered as part of lymphoma therapy.

The aim of the study was to examine school-related determinants of self-reported health among adolescents. Questionnaire survey data comprising 4,972 students, Grades 7 through 9, from 20 schools in northern Sweden were used. Also, complimentary data about each school were collected from the Swedish National Agency for Education. Using multilevel logistic regression analyses, results showed that most variation in self-reported health was explained by individual-level differences. Truancy, bullying, and poor relations with teachers significantly increased the odds ratio of reporting poor general health, for boys and for girls. Most variables at the school level, for example, school size and student-teacher ratio, did not render significant associations with students' self-reported health. In conclusion, this study indicates that health promotion at school, including school health services, may benefit from focusing primarily on individual-level determinants of health, that is, students' relations to peers and teachers, without ignoring that bullying and weak student-teacher relationships also may induce school-level interventions.

Background: Within the prosthetics profession, there is a lack of evidence to support many clinical practices. It is therefore important that clinicians systematically document and evaluate their daily practices., Objectives: To record preoperative characteristics and functional outcomes for patients with a lower limb amputation and to investigate variations between prosthetic users and non-prosthetic users., Study Design: Prospective cohort study., Methods: A total of 23 patients (mean age = 80 years, standard deviation = 7.3) who underwent a major lower limb amputation were assessed within 2 weeks of admission and 6 months post-operatively. Locomotor Capabilities Index-5, the Timed-Up-and-Go Test and prosthetic use were used to evaluate functional outcomes., Results: A total of 13 participants (57%) received a prosthesis within 6 months of amputation. Mean time to prosthetic fitting was 48 days (range = 28-97). No statistically significant difference was found between prosthetic users and non-prosthetic users regarding age, time to rehabilitation and Locomotor Capabilities Index-5 (p > 0.05). Locomotor Capabilities Index-5 basic was significantly lower at 6 months than prior to amputation (p = 0.039)., Conclusion: The functional outcome at 6 months indicates a sizable restriction in mobility among lower limb amputees. No variation in preoperative characteristics between prosthetic users and non-prosthetic users could be confirmed in this study., Clinical Relevance: This study highlights the need for prosthetists to better incorporate research findings into their daily practice and presents an example of how to implement a procedure for assessment and documentation of patients' functional outcomes in a clinical setting. Results confirm difficulties in identifying amputees who will become prosthetic users based on preoperative characteristics.

The aim of this study was to investigate associations of birth weight with sociodemographic variables, domestic violence, ways of coping, social support, and general mental health of Iranian mothers. Six hundred mothers aged 15 to 29 years participated between June 2009 and November 2010. t-Test, analysis of variance, Spearman's correlation, and multiple regression were used. The results showed that there was no significant association between birth weight and general mental health of the mothers. Prenatal care visits, the mothers' history of having children with low birth weight (LBW), and weight gain during pregnancy were significantly associated with birth weight. The women who reported physical abuse during pregnancy had infants with lower birth weight. Satisfaction with social support and use of positive reappraisal were significantly associated with higher birth weight. In conclusion, a high quality of prenatal care and screening of pregnant women are recommended. Social environments good enough during pregnancy have protective effects against LBW.

Social workers are considered a professional group at high risk of burnout. Noticing the insufficient human resource management and understaffed social work centers, Iranian social workers are faced with a considerable level of physical and mental stress, which can lead to burnout. A national study on 390 social workers was conducted. Among social workers, 10.9% had experienced burnout and 17.4% are at risk of developing burnout. Social workers scored higher in burnout if they were dissatisfied with their income, had experienced violence, or had lower self-esteem. Findings are discussed with regard to Iranian context and recommendations for authorities of Iranian state welfare organizations are made.

The purpose of this study was to compare the toxicity profiles of docetaxel administered on a weekly schedule and the standard three-week schedule in the treatment of advanced primary ovarian carcinoma. Eligible patients were treated with intravenous docetaxel (30 mg/m 2 ) on days 1, 8 and 15, and carboplatin (AUC 5) on day 1 or with docetaxel (75 mg/m 2 ) and carboplatin (AUC 5) on day 1; Q21 days for 6 cycles. This study was a pooled study of two primary phase II studies. A total of 108 patients received the weekly schedule and 59 patients received the three-week schedule. All patients were evaluated for toxicity. The overall response rate was 79% and the biochemical response 93% for the weekly schedule. The median overall survival rate was 35.3 months. Neutropenia was significantly more common (ANOVA; p<0.0001) in the three-week group than in the weekly group during all six courses of chemotherapy. Fever and infections were also more common in this group. Thrombocytopenia and anemia were slightly more common in the weekly group. Fatigue, epiphora, nail changes and taste disturbances were specific side-effects following weekly docetaxel. Peripheral sensory neuropathy (grade 1-2) increased with every cycle of treatment, but in a similar manner in the two groups. Grade 3-4 neuropathy was not recorded. Oral mucositis and myalgia were two side-effects associated with the three-week schedule. Nausea and vomiting, diarrhea and dyspnea were a limited problem in both groups. Cardiac toxicity was rare and did not differ between the two docetaxel schedules. The weekly administration was favored due to the lower rates of neutropenia, fever, infections, oral mucositis and myalgia. However, epiphora and nail changes were specific side-effects of the weekly treatment. Both regimens appeared to be rather well tolerated with similar compliance (66 and 70%) with regard to completion of the planned six courses of chemotherapy.

The aim of the study was to explore whether parent-adolescent relations are associated to self-reported health of adolescents. Logistic regression analyses were performed on a cross-sectional data set consisting of 5060 adolescents, grades 7-9, from six municipalities in the northern part of Sweden. The study was approved by the Regional Ethical Review Board in Umeå, Sweden. Results showed that, in both boys and girls, experiencing low parental demands as well as perceiving the relationship quality and the communication with parents as poor were significantly associated with having poor general health, somatic complaints and feelings of stress. In general, girls scored lower on self-reported health than boys, but our findings indicate that these gender differences could not be explained by relations to parents. In conclusion, relations to parents play an important role for self-reported health of adolescents. Although no causal-effect statements can be determined in this study, it is implied that there is a need for health professionals, such as school nurses, school welfare officers, etc., to pay special attention to parent-adolescent relations in their work with adolescents., (© 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.)

The prognostic role of the transcription factor SOX11 in mantle cell lymphoma (MCL) is controversial. We investigated prognostic markers in a population-based cohort of 186 MCL cases. Seventeen patients (9%) did not require any therapy within the first 2 years after diagnosis and were retrospectively defined as having an indolent disease. As expected, indolent MCL had less frequent B symptoms and extensive nodal involvement and 88% of these cases expressed SOX11. In our cohort 13 cases (7.5%) lacked nuclear SOX11 at diagnosis. SOX11(-) MCL had a higher frequency of lymphocytosis, elevated level of lactate dehydrogenase (LDH), and p53 positivity. The overall survival in the whole cohort, excluding 37 patients receiving autologous stem cell transplantation, was 3.1 year and in patients with indolent or nonindolent disease, 5.9 and 2.8 years, respectively (P = .004). SOX11(-) cases had a shorter overall survival, compared with SOX11(+) cases, 1.5 and 3.2 years, respectively (P = .014). In multivariate analysis of overall survival, age > 65 (P = .001), Eastern Cooperative Oncology Group score ≥ 2 (P = .022), elevated LDH level (P = .001), and p53 expression (P = .001) remained significant, and SOX11 lost significance. We conclude that most indolent MCLs are SOX11(+) and that SOX11 cannot be used for predicting an indolent disease course.

The purpose of this study was to assess the response rate, toxicity, progression-free survival (PFS) and overall survival (OS) in a series of advanced stage ovarian carcinoma patients treated with a first-line weekly docetaxel and three weekly carboplatin regimens. All eligible patients were treated with intravenous docetaxel (30 mg/m2) on Days 1, 8 and 15, and carboplatin (area under the curve, 5) on Day 1; Q21 days for at least 6 cycles. Neurological tests, questionnaires, and the EORTC QLQ-C30 and OV28 were used for quality-of-life assessments. One hundred and six patients received at least one cycle of primary chemotherapy (median 6.0; range, 1-9) and they were evaluable for toxicity assessment. Eighty-five patients had evaluable disease and received at least 3 courses of chemotherapy and were evaluable for clinical response rate. The overall response rate was 78.8% (95% CI 70.1-87.5%) and the biochemical response was 92.8% (95% CI 87.2-98.4%). The median PFS was 12.0 months and the median OS was 35.3 months. Thirty-six patients (34.0%) experienced grades 3 and 4 neutropenia, which resulted in the removal of 3 patients. Six patients (5.7%) experienced grades 3 or 4 thrombocytopenia. No patients experienced grade 3-4 sensory neuropathy. Epiphora, nail changes and fatigue were frequently recorded non-hematological side effects. The tolerable hematological toxicity (no need for colony-stimulating factors) and the low rate of severe neurotoxicity (only grade 1-2) and response rates in line with the standard 3-week paclitaxel-carboplatin regimen for advanced primary ovarian carcinoma after suboptimal cytoreductive surgery make this regimen an interesting alternative in selected patients.

Aims: This study examines the relationship between norm compliance and self-reported health in adolescents, and how this differs between genders. Our specific aim was to investigate if extremely high norm compliance revealed any particular health patterns., Methods: This empirical study used a web-based survey from 2005, which was distributed to all students (n = 5,066) in years 7-9 of compulsory school within six municipalities in northern Sweden. The respondents answered questions about their general health as well as specific health problems such as headaches, stomach ache, sleeping difficulties and stress. Compliance was measured according to different norm-related behaviour, such as truancy, crime and use of tobacco, alcohol and narcotics., Results: The majority of respondents reported good health and norm-compliant behaviour. Girls reported more health problems than boys, a difference that increased with age. Those who were more norm compliant reported better health, fewer somatic complaints and less stress, which goes against our initial hypothesis that extremely high norm compliance and self-reported ill-health are related. There seemed to be a stronger relationship between self-reported health and norm compliance for girls than boys, in absolute terms., Conclusions: The results clearly show a relationship between norm compliance and health, and suggest inequalities between genders.

During the 1990s priority discussions were actualized in Sweden due to increased demands on health care and limited resources. In the county of Västerbotten in northern Sweden, with large rural areas, the decision makers faced special challenges due to distances and cost. Despite discussions striving for fairness in priorities, decision makers are still dealing with limited resources and difficult priority decisions regarding different diseases and treatments. In this study we aimed at describing views on priorities in public psoriasis care and visions of a future care among politicians, administrators and professionals in the county of Västerbottten in northern Sweden. Qualitative research interviews were performed with 23 key-persons. The findings revealed priority dilemmas about issues on organization, accessibility and ethics. Visions of a future care appeared as ambitions of a more effective care with good accessibility, continued research, information and a holistic approach in priorities. We conclude that dilemmas revealed in this study were a reflection of a gap between intentions and practice. In efforts to reduce these dilemmas we suggest methods with fairness in economic planning and priority setting, with concrete, official statements about the dominating views on which the priorities are based, and public information about these statements.

In this study, the authors aimed at a sociological approach to the individual's everyday life with psoriasis and to this end conducted qualitative interviews with 18 persons from a county in northern Sweden. The most difficult aspects of living with psoriasis were being marked by the visibility of psoriasis, especially in the younger ages, and the visibility of joint changes. Therefore, those with both rashes and joint changes felt marked and discredited in a twofold way. Commonly used coping strategies were routinization of both the treatment and the adjustment to the marking process, and acceptance, and these strategies developed with age. Most participants experienced a good quality of life but still could find nothing positive about psoriasis. The authors suggest efforts toward increased awareness among health care professionals of the marking process and future qualitative studies about experiences of psoriasis during adolescence.

The aim was to analyse use of psoriasis care and expectations from a gender perspective in a psoriasis population. The study is based on questionnaire data from 1,060 subjects. The response rate was 74%. The relation between care consumption and studied variables was measured using regression and chi-square analysis. Care consumption was strongly influenced by age, quality of life, income and joint symptoms. Men visited a dermatologist more often, while women visited a general practitioner and treated themselves topically more frequently. Important expectations among both women and men concerned the receiving of professional care and amelioration, while more women wanted to be treated politely. Expectations were fulfilled, except those regarding amelioration, especially among men. Awareness of gender differences is important among professionals. In order to decrease such differences decision-makers should provide for a maintained specialized care as well as a local health care system of high standard.

The aim of this study was to assess possible determinants of quality of life in psoriasis patients in northern Sweden, and to analyse the association between these determinants and quality of life. A questionnaire was mailed to 1,707 subjects, resulting in a response rate of 74%. The study is therefore based on 1,060 subjects, since 195 denied having psoriasis. Quality of life was measured using a version of the Dermatology Life Quality Index. The extent of the disease was estimated using the patients' sketches. The association between determinants and quality of life was calculated in a risk analysis using logistic regression. Large disease extent and joint symptoms were the strongest indicators for impaired quality of life. Other indicators were withdrawal from medical treatment due to distance to treatment facilities, which strongly influenced the quality of life and choice of treatment.

A system is described for recording psoas muscle contractions in response to stimuli delivered to the sole of the foot of the acute spinalized unanaesthetized rat. Clonidine, an alpha adrenergic receptor agonist, caused a major increase in this flexor reflex amplitude. The increase was blocked by phenoxybenzamine at a dosage level of 20 mg/kg which did not, of itself, reduce flexor reflex amplitude. Older, larger rats responded significantly more forcefully to clonidine than did younger, smaller rats. However, these differences between rats of different size tended to disappear when the data were expressed in terms of 0/0 of original baseline amplitude. L-dopa, 75 mg/kg, increased the flexor reflex amplitude more so than did L(+)erythro dihydroxyphenylserine (DOPS) at twice the disage in rats pretreated with reserpine and nialamide. Other DOPS isomers were less effective, and L(-)threo DOPS was toxic. These results support the view that spinal noradrenaline receptors exist that increase the psoas flexor reflex. The advantages of the present system are twofold: first, the results may be quantitated; second, small amounts of potential central noradrenaline receptor agonists and antagonists may be tested for their effect on the flexor reflex using relatively few unanaesthetized rats.

Almost all catecholamine (CA)-containing nerve terminals in the ventral column, intermediate grey and ventral half of the dorsal column disappeared after bilateral stereotaxic lesions of nucleus locus coeruleus, as revealed by fluorescence histochemistry. Some of the CA nerve terminals in the dorsal half of the column seemed to be unaffected by the lesions, as well as the CA terminals innervating the thoracic sympathetic lateral column and the band of nerve terminals crossing the midline and innervating the central grey. This coeruleo-spinal pathway in the rat is located in the anterior funiculus and the ventral parts of the lateral funiculus. A schematic map of the different CA projections to the spinal cord is presented. It was concluded that locus coeruleus innervates almost all parts of the central nervous system.