Involvement of leukotriene B4 and platelet-activating factor in cytokine priming of human polymorphonuclear leucocytes

Recombinant human (rh) tumour necrosis factor (TNF) alpha and rh granulocyte-macrophage colony-stimulating factor (GM-CSF) prime human polymorphonuclear leucocytes (PMN) for increased superoxide anion (O2-) generation and for increased platelet-activating factor (PAF) biosynthesis and leukotriene B4 (LTB4) release. Both PAF and LTB4 are candidate mediators for the enhanced O2- generation in cytokine-primed PMN, since exogenous PAF or LTB4 primes PMN. We measured the generation and release of these mediators and examined their potential roles in cytokine priming using the PAF receptor antagonist, WEB 2086, and the inhibitor of 5-lipo-oxygenase, CGS 8515.rhTNF-alpha or rhGM-CSF, alone, increased PAF levels in PMN, but did not cause PAF release or LTB4 synthesis. N-formylmethionyl-leucyl-phenylalanine (FMLP) stimulated the release of detectable and biologically active amounts of both LTB4 and PAF in primed, but not in non-primed PMN. However, neither blockade of PAF receptors, nor inhibition of LTB4 synthesis influenced the priming of O2- generation by rhTNF-alpha or rhGM-CSF. Simultaneous pretreatment of PMN with WEB 2086 and CGS 8515 also failed to inhibit priming. Our results do not exclude a role for cell-associated PAF in the priming response, but indicate that the release of PAF and LTB4 do not mediate this phenomenon. The ability of cytokines to amplify the production and release of lipids may represent a mechanism to attract and localize the pro-inflammatory actions of stimulated PMN to regions where cytokine levels are also elevated.

Beta-adrenergic receptors in lymphocyte subsets after exercise. Alterations in normal individuals and patients with congestive heart failure

Dynamic exercise increases the number of beta-adrenergic receptors in mixed lymphocytes by a mechanism that is incompletely understood. In a set of in vivo studies, we have investigated the effects of dynamic exercise on the subset distribution of circulating lymphocytes and on the number of beta-adrenergic receptors in each of these subsets in two groups of patients. In healthy subjects, exercise increased plasma norepinephrine and epinephrine and caused lymphocytosis. Whereas the number of Thelper cells increased only modestly, the number of Tsuppressor/cytotoxic and natural killer cells more than tripled. The number of beta-adrenergic receptors varied among subsets but was not significantly altered by dynamic exercise in any subset except natural killer cells (35% increase, p = 0.0302). In a group of patients with congestive heart failure, dynamic exercise increased plasma norepinephrine but did not alter plasma epinephrine and did not cause significant lymphocytosis. We did not detect any significant alterations of circulating leukocyte subsets or beta-adrenergic receptors in any of these subsets after exercise. A combined analysis of healthy patients and heart failure patients revealed a significant correlation between increases in plasma epinephrine and increases in circulating lymphocytes. We conclude that the exercise-induced increase in beta-adrenergic receptors of mixed lymphocytes is predominantly caused by a redistribution of circulating cell subsets that differ in their beta-adrenergic receptor number. This appears to be mediated by epinephrine rather than norepinephrine.

Assessing Decision-Making Skills

Psychiatric technicians are becoming increasingly important in the inpatient psychiatric setting, yet few educational programs properly prepare students for this demanding role. By structuring interviews around practical, real life dilemmas faced by technicians, the interviewer can establish which applicants are best suited for the job, thus helping to improve satisfaction and retention.

Platelet-activating factor may act as a second messenger in the release of icosanoids and superoxide anions from leukocytes and endothelial cells

Platelet-activating factor (PAF) is generated by endothelial cells, polymorphonuclear leukocytes, and macrophages after activation by appropriate receptor agonists, but much of the PAF remains intracellular. We have investigated whether PAF formation is important for the subsequent generation of icosanoids and superoxide anions by these cells. The generation of prostacyclin and leukotriene B4 were measured by radioimmunoassay, superoxide anion was measured by reduction of cytochrome c, and PAF was measured by bioassay. In each cell type, PAF formation preceded or accompanied icosanoid generation. Bradykinin-induced prostacyclin generation in endothelial cells was markedly reduced by the PAF receptor antagonists WEB 2086 or CV 6209. In guinea pig adherent macrophages in vitro, basal prostacyclin generation and that induced by endotoxin and fMet-Leu-Phe were inhibited by either WEB 2086 (1-100 microM) or CV 6209 (0.1-10 microM). In isolated rabbit polymorphonuclear leukocytes, fMet-Leu-Phe stimulated the generation of both leukotriene B4 and superoxide anion. WEB 2086 and CV 6209 caused concentration-dependent inhibition of both these markers of leukocyte activation. These observations lead us to suggest that PAF may be a second messenger in leukocytes and endothelial cells.

Two cases of autoantibodies that demonstrate mimicking specificity in the Duffy blood group system

Two transfused Caucasian patients presented with possible delayed transfusion reactions. Both patients demonstrated an anti-Fya (Fy1) plus anti-Fyb (Fy2) pattern of reactivity in their sera. The patients' red blood cells (RBCs) were Fy:1,-2,3. Both had positive direct antiglobulin tests (DAT) with anti-IgG and -C3d. The serum antibodies reacted with the patients' RBCs drawn when the DATs were negative Both patients' serum samples showed reactivity with Fy:1,-2 (1+), Fy:-1,2 (3+), Fy:1,2 (3+) RBCs at the antiglobulin phase (AGT) but were nonreactive with Fy: -1, -2 RBCs. The antibodies in both cases were nonreactive with papain- or ficin-treated RBCs and reacted with Rhnull RBCs, which ruled out anti-Fy3 and anti-Fy 5 respectively. These cases suggest mimicking autoantibody specificities in the Duffy system one case may indicate that the degree of reactivity is dependent on the Duffy phenotype of the RBCs tested( Fy:-1,2 > Fy:1,2 > Fy: 1,-2). An unusual characteristic seen in both of these cases was hemolysis in the EDTA cell samples but none In the clotted samples.

NHANES III for older persons: nutrition content and methodological considerations

The National Health and Nutrition Examination Surveys (NHANES) are important in the assessment of nutritional status of the population of the United States. The utility of these surveys for assessment of the nutritional status of older Americans has been limited because prior NHANES have not included persons aged greater than or equal to 75 y. This paper reviews the role of the NHANES for nutritional epidemiology, highlighting the unique opportunity NHANES III offers to expand the nutrition database for older persons. Data are presented on consequences of nonresponse in analytic work and mechanisms that have been devised to approach the potential problem of nonresponse within NHANES III.

The vacuolar ATPase of Neurospora crassa contains an F1-like structure

We have explored the structure and subunit composition of the vacuolar ATPase of Neurospora crassa by investigating the effects of nitrate. Inhibition of enzyme activity by nitrate was correlated with dissociation of a complex of peripheral polypeptides from the integral membrane part of the enzyme. Surprisingly, this nitrate-induced release of subunits occurred only when nucleotides such as ADP, ATP, or ITP were present. ATPase inhibitors that have been proposed to act at the active site prevented release of subunits. Six polypeptides, 67, 57, 51, 48, 30, and 16 kDa, were coordinately released from the vacuolar membrane. When analyzed by size exclusion chromatography or by centrifugation through glycerol gradients, the six polypeptides behaved as an aggregate of about 440,000 kDa. We also examined vacuolar membranes by electron microscopy, using negative staining. We observed a high density of "ball and stalk" structures on the membranes, similar in size but different in shape from the F0F1-ATPase of mitochondrial membranes. Treatment with nitrate removed the ball and stalk structures from vacuolar membranes but had no visible effect on mitochondrial membranes. We concluded that the overall structure of the vacuolar ATPase is similar to that of F0F1-ATPases; however, the sizes of the component polypeptides and the factors that can cause dissociation are different.

Coexpression of sialosyl-Tn (NeuAc alpha 2----6GalNAc alpha 1----O-Ser/Thr) and Tn (GalNAc alpha 1----O-Ser/Thr) blood group antigens on Tn erythrocytes

Polyagglutinable erythrocytes expressing the rare human blood group phenotype Tn were tested for expression of both Tn (GalNAc alpha 1----O-Ser/Thr) and sialosyl-Tn (NeuAc alpha 2----6GalNAc alpha 1----O-Ser/Thr) antigens by agglutination with a panel of well-characterized monoclonal antibodies specifically directed to Tn and sialosyl-Tn antigens, respectively. Tn erythrocytes from 4 patients were strongly agglutinated by both sialosyl-Tn and Tn-specific monoclonal antibodies, indicating coexpression of sialosyl-Tn and Tn antigens on the cell membrane surface of Tn polyagglutinable erythrocytes. Human polyclonal anti-Tn antisera were found to express weak and variable anti-sialosyl-Tn antibodies in conjunction with the anti-Tn antibodies. The Tn phenotype thus involves not only the classically known Tn antigens but also sialosyl-Tn antigens. However, the human anti-Tn antibodies may be directed mainly toward the Tn antigen (GalNAc alpha 1----O-Ser/Thr).

Longitudinal study of physical ability in the oldest-old

Based on 1984 data from the Longitudinal Study on Aging, one-third of White persons aged 80 or older living in the community (N = 1,791) were defined as having no difficulty in walking 1/4 of a mile, in lifting 10 pounds, in climbing 10 steps without resting, or in stooping, crouching or kneeling. Physical ability was associated with lower risk of death over two years mean follow-up; Relative odds (RO) = .4 (95 percent confidence interval = .4, .6) and in survivors, lower utilization of hospitals RO = .4 (CI = .3, .7), physicians RO = .6 (CI = .5, .8) and nursing homes RO = .3 (CI = .2, .5) compared with those having difficulty on any of the four functional measures included in the definition of physical ability. Fifty percent of the women and 42 percent of the men physically able at the time of the baseline survey in 1984 remained physically able at follow-up. Continued physical ability in this group was associated with never having had cardiovascular disease RO = 2.1, (CI = 1.2, 3.7), never having had arthritic complaints RO = 1.9 (CI = 1.2, 2.7), a body mass index less than the 75th percentile RO = 1.8 (CI = 1.2, 2.9), younger age (for each decade of age, RO = 2.0 (CI = 1.1, 3.6), and higher level of education (greater than 13 years versus 0-6 years) RO = 2.4 (CI = 1.2, 4.7). These correlates include factors amenable to preventive measures and highlight the need to consider the heterogeneity of the oldest-old in formulating programs aimed at prevention and postponement of disability.

Antihypertensive drug therapy and survival by treatment status in a national survey

The National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study, an investigation of a cohort originally examined during the period 1971-1975, provided an opportunity to assess the frequency of antihypertensive drug therapy in the United States during the period 1982-1984. For most age-sex-race subgroups, the frequency of medication use during 1982-1984 was higher than that observed during 1976-1980 based on the NHANES II. In the interval 1982-1984, diuretic agents were the most frequent medications prescribed (47% of drugs prescribed), and beta-blockers were second (17%). At the time of the initial survey in 1971-1975, participants had their blood pressures measured and a history of diagnosis and treatment of hypertension ascertained. Follow-up for vital status was 93% complete by 1984 (average length of follow-up, 9 years). In white men and women aged 50 years and older, the relative risk of death increased steadily, from those with elevated blood pressure (systolic blood pressure greater than or equal to 160 mm Hg or diastolic blood pressure greater than or equal to 95 mm Hg) but no history of hypertension to those treated for hypertension but whose blood pressure was still elevated. Regardless of history or treatment, those with an elevated blood pressure had about a 25-30% excess risk of death. Evidence from these national studies shows a high frequency of antihypertensive drug therapy in 1982-1984 and suggests the importance of adequate blood pressure control for optimal survival.

Evidence for an intracellular action of platelet-activating factor in bovine cultured aortic endothelial cells

Bovine culture endothelial cells (BAECs) generate platelet-activating factor (Paf) following activation by bradykinin (Bk 0.1 nM), the ionophore, A23187 (3 microM), and ATP (10 microM), but Paf is not released from the cells. These stimuli also elicit generation of prostacyclin (PGI2). The specific and competitive Paf receptor antagonists, WEB 2086 (0.1-1.0 microM) and CV 6209 (0.01-0.1 microM), inhibited Bk-, A23187- and, to a lesser extent, ATP-induced PGI2 generation but had no effect on basal PGI2 generation. These data suggest a role for intracellular Paf in signal transduction.

Anthropometric indicators and hip fracture. The NHANES I epidemiologic follow-up study

A cohort of 3,595 white women aged 40-77 years was followed for an average of 10 years during which 84 new cases of hip fracture were identified. Triceps skinfold thickness and arm muscle area measured at baseline were examined as possible risk factors for hip fracture controlling for physical activity, height, menopausal status, calcium consumption, and smoking. Of these variables only arm muscle area, triceps skinfold thickness, and activity in recreation were independent predictors of hip fracture incidence using the Cox proportional hazards model. After adjustment, the estimated relative risk of hip fracture was approximately two for an increment of each anthropometric indicator (adjusted for the other) equivalent to comparing those at the 25th percentile to those at the 75th percentile (maximum width of 95% confidence intervals, 1.2-2.9). Risk of hip fracture was approximately two-fold for persons who reported little recreational exercise compared to persons who reported much recreational exercise (95% confidence interval, 1.2-3.2). Our findings are the first evidence from a prospective study that anthropometric indicators besides body mass index may have an independent relationship to risk of hip fracture.

Severely threatening events and marked life difficulties preceding onset or exacerbation of multiple sclerosis

Information was obtained on stressful life circumstances, using the Life Events and Difficulties Schedule (LEDS) from 39 patients with early multiple sclerosis and 40 matched nonpatient volunteers. The proportion of multiple sclerosis patients who experienced marked life adversity in the year prior to onset of symptoms was significantly higher than for nonpatients in the year before interview (77% vs. 35%). The excess in marked life stress was most evident in the 6 months before onset. Such stressors might explain the timing of symptom exacerbation for some patients with multiple sclerosis, perhaps by perturbing an already unstable neuroimmunological system.

Proportional hazards analysis of risk factors for coronary heart disease in individuals aged 65 or older. The Framingham Heart Study

Risk factors for coronary heart disease were examined in 2,501 individuals in the Framingham Heart Study who survived to the age of 65 without evidence of coronary artery disease. We used a proportional hazards (Cox) analysis that examined risk factors over time and included events through the 16th biennial examination. The independently significant multivariate correlates of the development of coronary heart disease after the age of 65 were sex (incidence rate ratio [RR] for males of 1.7 [95% confidence interval of 1.4,2.0]), left ventricular hypertrophy (RR = 2.4 [1.7,3.5]), systolic blood pressure (RR = 2.2 [1.4,3.3] for systolic blood pressure of 160 mmHg or higher as compared with less than 120 mmHg), casual blood glucose (RR = 2.2 [1.5,3.4] for 175 mg/dL or more as compared with less than 90 mg/dL), Metropolitan relative weight from examination 1 (RR = 1.3 [1.0,1.6] for those 130% or more of ideal weight compared with those less than 110% of ideal), and total serum cholesterol (RR = 1.8 [1.3,2.5] for cholesterol in the 90th percentile or higher compared with less than 200 mg/dL). Controlling for all these risk factors, those smoking 20 cigarettes a day or more were at slightly increased risk of coronary heart disease (RR = 1.2 [.9,1.6]) compared with nonsmokers. These analyses suggest that older persons share the same risk factors for coronary artery disease that are significant in younger populations.

Body mass index and mortality among nonsmoking older persons. The Framingham Heart Study

The relationship of weight at age 65 years and subsequent mortality was examined in a population of 1723 nonsmokers who were followed up from one to 23 years (mean, 9.5 years) during the Framingham Heart Study. In sex-specific proportional hazards analyses, risks of mortality were increased for men and women at the high and low extremes of body mass index, even when accounting for potential effects of excess weight on serum cholesterol level, blood glucose level, and systolic blood pressure. For those at the lower extreme of body mass index, the relative risk of death was almost twice as high in the years immediately after age 65 years as in later follow-up, suggesting that the increased early death rate was due to disease that was already present. At the upper extreme, risk of death was twofold over the entire follow-up period for persons with body mass indexes at or above the 70th percentile at both 55 and 65 years of age. We conclude that, even when accounting for cardiovascular risk factors, being overweight is a serious health problem for older people, especially for those with long-standing weight problems.

Health statistics on older persons United States, 1986

The National Center for Health Statistics (NCHS) collects data on the health of older persons through numerous data systems. The Vital Statistics Program and the National Health and Nutrition Examination Survey (NHANES) are examples. This report contains statistics from the data systems covering four general areas-mortality, other measures of health status and determinants of health, use of health care, and health costs . The structure of this report is patterned after the annual publication Health, United States, with detailed tables and accompanying text. Where data permit, the tables contain age, sex, and race categorizations including the age group 85 years and over as well as aggregated data for persons aged 65 years and over and 75 years and over. For comparison purposes, the tables also include data concerning the transition age group 55-64 years of age.

Loss of parent in childhood and adult psychiatric disorder: the role of social class position and premarital pregnancy

This paper addresses the critique which maintains that loss of parent in a sample of female adults plays no role in determining current depression over and above that of low social class position with which such loss is associated. It examines a series of variables which combine to determine current social class position and which seem to stem from lack of adequate replacement care following loss of mother. The experience of a premarital pregnancy and the way in which women cope with it emerge as critical in this process. The relationship of low social class to the onset of depression is discussed in the light of better-known vulnerability factors such as low confiding in, and undependability of, marital partner, employment outside the home and number of children. It is concluded that a current low social class position, far from explaining away the association between loss of mother and current depression, may itself be brought about by a chain of circumstances stemming from the loss. Once again, the quality of replacement care is shown to play a critical role.

Social support, self-esteem and depression

A prospective study of 400 largely working-class women with children living at home has used measures of self-esteem and 'social support' to predict the risk of depression in the following year once a stressor had occurred. Actual support received at the time of any crisis in the follow-up year was also measured. Self-esteem was correlated quite highly with some of the measures of support. A core tie was defined as a husband, lover or someone named as very close at first contact. Negative evaluation of self (i.e. low self-esteem), and various indices of lack of support from a core tie at the first interview, were associated with a greatly increased risk of subsequent depression once a stressor occurred. Lack of support from a core tie at the time of the crisis was particularly highly associated with an increased risk. There was also a high risk among those who were 'let down' - that is, for those who did not receive the support which they might have expected in terms of the first interview material. It is concluded that it is essential for prospective enquiries to take account of the actual mobilization of support in the follow-up period.

Loss of parent in childhood and adult psychiatric disorder: the role of lack of adequate parental care

The inconclusiveness of the literature on the role of loss of parent in influencing psychiatric disorder in adulthood is well known. A number of reasons involving sampling, location and other methodological features, are given to account for these contradictory findings. A study specially designed to cope with these features is then described and basic results are reported. These indicate that, in a sample of women aged 18-65, loss of mother before the age of 17, either by death or by separation of one year or more, was associated with clinical depression in the year of interview. Loss of father by death was in no way associated with current depression, but separation from father showed a trend which, however, did not reach statistical significance. Control for other possible confounding factors did not change this patterning of results; these were further supported when psychiatric episodes earlier in adulthood were examined. Examination of the caregiving arrangements in childhood suggests that it is 'lack of care', defined in terms of neglect rather than simply hostile parental behaviour, which accounts for the raised rate of depression. Such 'lack of care' is more frequent after loss of mother than after loss of father.

Life stress, chronic subclinical symptoms and vulnerability to clinical depression

Prospective enquiries of the role of social factors in the aetiology of depression are faced with the problem of who to exclude from the enquiry in terms of psychiatric symptomatology present at first contact. With this problem in mind the role of subclinical symptoms among women not cases of depression has been examined in terms of their relation with a subsequent onset of caseness depression. Psychosocial factors of particular importance in the development of such depression were low self-esteem, marked long-term difficulties and severe life events arising out of (or 'matching') these difficulties. These psychosocial factors were also correlated with the presence of subclinical symptoms. It is concluded that although subclinical symptoms relate to a raised risk of subsequent depression at a caseness level there is no evidence that there is inherent vulnerability stemming from such subclinical symptoms over and above that explained by the psychosocial correlates.

Dopaminergic and noradrenergic sympathetic nerves of the dog have different DOPA decarboxylase activities

We have compared the pattern of neural catecholamine fluorescence with that of immunoreactivity for the catecholamine-synthesizing enzymes tyrosine hydroxylase (TH) and DOPA decarboxylase (DDC) in dog atrium, which is innervated by noradrenergic nerves, and in dog kidney, which is thought to be supplied by dopaminergic nerves as well. In both tissues the distribution of nerves containing catecholamine fluorescence was similar to that of nerves exhibiting TH-like immunoreactivity. By contrast, DDC-like immunoreactivity was present in some (but not all) of the nerves associated with the intrarenal blood vessels, but was not detectable in any atrial nerves. High DDC activity provides further confirmation of the existence of sympathetic dopaminergic neurons supplying the kidney.

Interpreting data in aetiological studies of affective disorder: some pitfalls and ambiguities

Although recent research in social psychiatry has produced an encouraging congruence of findings and conclusions, puzzling inconsistencies continue to be reported. One explanation which is often overlooked is that subtle differences in the way seemingly identical variables are grouped can produce sizeable, and sometimes dramatic, differences in the patterning of the same data. Re-examination of existing results can therefore often better clarify confusing inconsistencies than collection of new data. This is illustrated by examples from recent studies of affective disorder where the grouping of variables is discussed in three broad areas: parental loss in childhood, precipitating stress, and social support. Until the aetiology of affective disorder is more fully understood, it will often be clearer if data are analysed more than once, so that several combinations of variables are systematically examined.

Alexander's disease

This is the first pathologic report of an infant at 37 weeks' gestation with Alexander's disease. The findings demonstrate that the disease can arise in utero and be extensive at birth before myelination begins.

Blood pressure experience and risk of cardiovascular disease in the elderly

For the 1254 persons in the Framingham Heart Study who survived to age 65 without prior cardiovascular disease or prior use of antihypertensive medications, significant univariate correlates of the development of cardiovascular disease after age 65 included (1) the systolic blood pressure at age 65, (2) the average systolic blood pressure before age 65, and (3) the slope of blood pressure change up to age 65. After controlling for the systolic blood pressure at age 65, average pre-age 65 blood pressure remained significant (p less than 0.05) and the slope of the pre-age 65 blood pressure was marginally significant (p = 0.06). Even after controlling for the mean of up to three blood pressure measurements at age 65, an average systolic blood pressure of 160 mm Hg or greater before age 65 was an independently significant predictor of the post-age 65 development of cardiovascular disease (rate ratio = 1.79; 95% confidence interval = 1.04, 3.07). These data suggest that even after performing multiple measurements at a single examination, knowledge of past systolic blood pressure history, especially if it averages 160 mm Hg or greater, adds a small but statistically significant increment in predicting future cardiovascular disease in the elderly.

Characterization of chromaffin-like cells in the canine sympathetic chain by enzyme immunohistochemistry and quantitation of their distribution

Some of the paravertebral sympathetic ganglia of the dog contain relatively large amounts of dopamine, which we have suggested previously is localized in dopaminergic neurones. However, the possibility exists that intraganglionic chromaffin-like cells may also be a source of dopamine. In order to resolve this question, we have examined the distribution of chromaffin-like cells in dog paravertebral ganglia (T7-S2) using formaldehyde-induced fluorescence of catecholamines and immunohistochemical localization of dopa decarboxylase, dopamine beta-hydroxylase and phenylethanolamine N-methyltransferase. The results have been compared with levels of the different endogenous catecholamines in equivalent ganglia. Clusters of between 20 and several thousand chromaffin-like cells were randomly present in ganglia at all levels of the chain, and were most common in the more caudal segments (L4 or below); but many ganglia contained no cells. About 24,000 chromaffin-like cells were found in 18 ganglia from six animals which were stained for dopa decarboxylase and dopamine beta-hydroxylase. In 16 of these ganglia, all of the 17,000 cells present contained both enzymes, indicating that they could synthesize noradrenaline. In the remaining two ganglia, 500 out of 7000 cells contained dopa decarboxylase, and therefore were capable of synthesizing dopamine, but appeared to lack the dopamine beta-hydroxylase necessary to convert this to noradrenaline. Five ganglia from three other dogs were stained for dopamine beta-hydroxylase and phenylethanolamine N-methyltransferase. A further 2600 cells were found in these ganglia and both enzymes were present in all of the cells, indicating that they could all synthesize adrenaline. Biochemical estimates of the various catecholamines showed that ganglia containing appreciable amounts of adrenaline had similar distributions to those containing chromaffin-like cells in the same animals. High concentrations of adrenaline were often correlated with high concentrations of noradrenaline but were not correlated with high concentrations of dopamine. It is concluded that paravertebral chromaffin-like cells in the dog store adrenaline, and also perhaps noradrenaline, but not dopamine. The high concentrations of dopamine found in certain ganglia cannot therefore be attributed to the presence of these cells. The erratic distribution of chromaffin-like cells suggests that they are unlikely to fulfil any general role in modulation of ganglionic transmission.

Psychiatric disorder in a rural and an urban population: 3. Social integration and the morphology of affective disorder

This paper focuses on the morphology of affective disorder. We set out to confirm on the island of Lewis a cross-over result originally found on the island of North Uist, whereby in those sections of the population where the rates of depression were lowest the rates of anxiety were highest. These sections of the population varied in the degree to which their members were integrated into the traditional way of life. 'Integration' was characterized in terms of churchgoing and crofting (the word for farming in the Hebrides). It is predicted here that the churchgoing rather than the crofting component of the integration measure would account for any cross-over result found concerning the morphology of symptoms. This hypothesis, derived from a theoretical concern with links between repression and anxiety, is not confirmed. Instead, crofting is found to be the component of the integration index which predicts anxiety/phobia without depression. In seeking to explain this unexpected finding further significant associations between crofting, pure anxiety/phobia and the style of personal relationships are revealed. It is also confirmed that types of severe events among women are also found to vary with the degree of integration into traditional society. A perspective is then developed which might explain how the interaction between style of personal attachments and types of provoking event could produce variations in the morphology of affective disorder.

Distribution of neurones containing DOPA decarboxylase and dopamine-beta-hydroxylase in some sympathetic ganglia of the dog: a quantitative study

Using a technique by which binding sites for two antibodies can be visualized in single tissue sections, we have studied the distribution of neurones containing DOPA decarboxylase-like and dopamine beta-hydroxylase-like immunoreactivity in ganglia of dog sympathetic chain. Three types of neurones could be distinguished: those that contained both enzymes, and were presumably noradrenergic; those that contained neither enzyme, and were presumably not catecholaminergic; and a group that contained DOPA decarboxylase but lacked dopamine beta-hydroxylase. The numbers of cells of each type were counted in serially-sectioned ganglia from regions of the sympathetic chain thought to contain dopaminergic neurones (T12-L1 and L7-S2). The percentages of total cell numbers contributed by the DOPA decarboxylase-positive, dopamine beta-hydroxylase-negative cells in these regions were similar to the estimates of dopaminergic neurone numbers that can be made from previously obtained biochemical data. Our results are consistent with the presence of dopaminergic neurons in regions of the paravertebral chain supplying the kidney and the distal hindlimb.

Liquid Chromatographic Assay for Dalapon Grasskiller Products: Collaborative Study

As a replacement for the present mercury reagent titration assay for dalapon grasskiller products, a liquid chromatographic method has been developed and collaboratively studied. The method separates the active ingredient, 2,2-dichloropropionic acid, from its related products by paired ion chromatography with UV detection at 214 nm. Statistical analysis of the data indicates that a single assay from one laboratory should not differ by more than 2.2% from the average assay of many laboratories, at the 95% confidence level, for products containing about 75% 2,2-dichloropropionic acid equivalent as the magnesium and/or sodium salt. The method has been adopted official first action.

Disease, distress and depression. A comment

Bebbington et al. (1981) in their paper in the present number of this Journal suggest that psychiatric disorders in the community are likely to be cases of distress and base this assertion on the fact that very few out-patients have a significant life event preceding onset. A review of 7 recent studies of depressive patients, using a broadly comparable life-event instrument, gives a quite different picture: an average of 56% had an important life event before onset, compared with 18% in the general population. It is concluded that the authors arrive at their conclusion because they have failed in a number of critical respects to replicate previous analyses. The distinction between disease and distress is discussed in the light of these results.

Overweight and obesity in preschool children in New York City

In an effort to ascertain the prevalence of obesity in young children, 48 nursery schools in Manhattan and Queens, New York City were surveyed. The weights and heights of 2606 children, ages 3 to 6 yr, were obtained. Three-hundred seventeen children (12.2%) were above 120% of ideal body weight and 122 (4.7%) were above 130% of ideal weight. Twenty percent of the children from schools attended by youngsters from low income families, 12% from schools attended by pupils from middle income families, and 5% from schools with pupils from families with a high income were classified as obese. Of the obese children's actual body weights 90% were at or greater than the 75th percentile for age while mean higher percentiles of the obese and nonobese children were not significantly different. Sex specific prevalence rates were similar for boys and girls. These data indicate that obesity is already prevalent in the nursery school population and that such obese children can be easily identified from weight and height measurements at a time when programs for successful permanent weight reduction and maintenance may be feasible.

Psychiatric disorder in a rural and an urban population: 2. Sensitivity to loss

In an earlier paper we found that a model of depression developed on a sample of women in a London population was confirmed in a female population in the Outer Hebrides. Differences in the rates of onset and chronic cases between the two populations, however, suggested that the Scottish women might be more likely to become depressed after the death or intimation of death of close relatives; furthermore, it seemed that such depressions were more likely to remain chronic in the Scottish islands than in London, and to contain a strong anxiety component. This difference is discussed in the light of socio-cultural differences between the two populations, particularly in terms which relate family structure, marital position and contact with relatives to affective disorder in terms of theories of attachment.

Depression and anxiety in the community: replicating the diagnosis of a case

The diagnoses were reviewed of 866 women interviewed in 5 community surveys carried out by the Bedford College team. The diagnoses matched commonly held conceptions of who is a case in terms of both severity and type of syndrome. Two methods of replicating the diagnoses are prevented, one based on discriminant function analysis and the other based on a simple checklist.