Group-based comprehensive behavioral intervention for tics (CBIT) for adults with Tourette syndrome or chronic tic disorders: A pilot study

Comprehensive behavioral intervention for tics (CBIT) administered individually is an effective treatment for tics. However, the effectiveness of CBIT administered in groups for adults with Tourette syndrome and chronic tic disorders has not been investigated yet. This pilot study examined the effectiveness of group-based CBIT with respect to reduction of tic severity and tic-related impairment, as well as improvement of tic-related quality of life. Data from 26 patients were included in the intention-to-treat analyses. The Yale Global Tic Severity Scale was used to assess total tic severity and tic-related impairment. The Gilles de la Tourette - Quality of Life Scale was used to assess tic-related quality of life. These measures were administered at three points in time: at pretreatment, posttreatment, and 1-year follow-up. The results showed a significant reduction of total tic severity from pretreatment to 1-year follow-up, with larges effect sizes. Tic-related impairment and tic-related quality of life also improved significantly, although the effect sizes were smaller. Motor tics showed a stronger reduction than vocal tics. Additional analysis revealed that all change was achieved during treatment and that this effect was maintained from posttreatment to 1-year follow-up. The results of this study indicate that group-based CBIT is a promising treatment for tics.

Pricing and reimbursement of pharmaceuticals. A new culture for the community pharmacist

Pricing and reimbursement of pharmaceuticals are of concern for pharmacists. Different countries have different ways of organising their health care systems. The place for pharmaceuticals within these systems also differ. This article looks into the price- and reimbursement systems for medicinal products in Germany, Sweden, the UK and Norway. Various ways of organising the pharmaceutical market emerge. Some existing measures have been in place for a long time while others have been introduced more recently. A common goal for the four countries seems to be the drive to cut costs, and attempts to do this can be directed through various reimbursement systems, by focusing on prices or by influencing the physicians' prescribing behaviour, either through the use of advice or through the use of budgets. It is important for the pharmacists to have in-depth knowledge of the price- and reimbursement system they have to work within in order to be of full service to their customers.

[Changes among residents in homes for the aged in Bergen between 1985-96]

Homes for the aged are intended for elderly people who, by and large, are able to perform basic activities of daily living (ADL) on their own, but who, in spite of this, need or wish to live in an institutional setting, where only minor nursing facilities are available. The present study focuses on the changes in mental capacity and in the altered need for nursing assistance with ADL functions which developed among residents at 13 homes for the aged in the city of Bergen, between 1985 and 1996. In 1985, the average age for residents was 84 years; and in 1996 it was 87 years. The average duration of stay was 30 and 38 months, respectively. There was a significant increase in the proportion of mentally impaired residents (28% and 35%). There was also an increase in the percentage in need of intensive nursing care (34% and 41%). The changes in residents living in the homes were not caused by dementia. It is concluded that homes for the aged are used increasingly for elderly in need of nursing care. There is an obvious mismatch between tasks and resources.

Intestinal morphology and cytokinetics in pancreatic insufficiency. An experimental study in the rat

Intraluminal pancreatic enzymes influence intestinal function, adaptation, and susceptibility to injury. These effects may be mediated partly through changes in the rate of epithelial cell turnover. We assessed intestinal morphology and cytokinetics in a rat model of exocrine pancreatic insufficiency that does not alter anatomic relationships or animal growth. Pancreatic duct occlusion was performed by applying metal clips on both sides along the common bile duct. Control animals underwent sham-operation with exposure and manipulation of the pancreas without duct occlusion. Twelve days later, pulse labeling with tritiated thymidine was performed, and mitotic arrest was induced with colcemid. Groups of animals were sacrificed at 0 and 2 hr after colcemid injection. Specimens for histopathology, morphometry, and autoradiography were obtained from duodenum, proximal jejunum, distal jejunum, and ileum. Labeling index, grain counts, mitoses per crypt, cells per crypt, cells per villus, crypt depth, villus height, and number of goblet cells per villus were used as end points. Pancreatic duct occlusion resulted in increased labeling index across intestinal segments relative to sham-operated controls (P < 0.01) and increased labeling index and mitotic rate in distal compared to proximal intestine (P < 0.05). Grain-count histograms were similar in the two experimental groups. There were no significant morphologic differences between pancreatic duct-occluded animals and controls. Exocrine pancreatic insufficiency increases crypt cell proliferation in distal small intestine but does not alter the duration of S phase. These changes are most likely due to an increase in the size of the proliferative compartment and may be partly responsible for changes in small bowel function and response to injury.

Chitosan cross-linked with Mo(VI) polyoxyanions: a new gelling system

A procedure for preparing homogeneous chitosan gels by in situ molybdate cross-linking is described. The gels are obtained by dispersing solid MoO3 in a buffered chitosan solution and the polymer is cross-linked by formation of heavily negatively charged molybdate polyoxyanions. The resulting ionic gels are very transparent, thermoirreversible and can be made at low polymer concentrations. Depending on the ionic strength, these gels are able to swell several times their original size in aqueous solutions. Estimates of the degree of cross-linking reveal a very open pore structure which is confirmed by electron micrographs of the gel.

Evidence of mouse epidermal subpopulations with different cell cycle times

In order to obtain information on the distribution of total cell cycle times in hairless mouse epidermis, basal cells were isolated and prepared for DNA flow cytometry at intervals after a pulse labeling with 50 microCi of thymidine. The DNA distributions were recorded, and cells were sorted from windows in the S, G2, and G1 phases of the cell cycle, collected on glass slides, and subjected to autoradiography. The proportions of labeled cells were scored in each fraction, and the percentage of labeled mitoses was determined in histologic sections from the same animals. Grain count distributions were recorded at selected time points over labeled cells in sorted fractions and over labeled mitoses. The movement of the labeled S-phase cohort was thus followed through all cell cycle phases. Peaks in labeled cells were observed at about 36 h in S phase, G2 phase, and mitosis, and high levels of labeled G2 cells and mitoses were seen at about 80 h. These results indicate the existence of one rapidly cycling subpopulation of keratinocytes with a cell cycle time slightly less than 30 h, in addition to keratinocytes with considerably longer cell cycle times. The first peak of labeled G2 cells reached only about 30%. This is consistent with earlier findings of about 30% G2 cells with a rapid traverse, and 70% with a considerably delayed traverse through G2 phase. The proportion of labeled G1 cells reached a value corresponding to twice the initial labeling index at 8 h after pulse labeling. This is consistent with previously obtained phase durations, indicating an unperturbed cell cycle traverse of labeled cells from S phase through G2 and mitosis.