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In an initial study, 18 VDT operators were found to have a higher muscle load in the neck/ shoulder region when using progressive lenses compared with single-vision lenses, while working on a VDT unit. For single-vision lenses, a higher flexion angle in the neck was also discovered. The present study investigates whether this higher muscle load is reduced when a progressive correction is worn for a three-month period. Adaptation in terms of reduced muscle load measured by electromyography (EMG) was not discovered. Head flexion angle was smaller when using progressive correction as compared with single-vision lenses. Some practical implications for occupational optometry are discussed.

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A sample of 80 direct and 36 telephone encounters for fever was established in 1988 as part of a Norwegian study on fever as a clinical problem in general practice. Reasons for encounter (ICPC) and clinical examinations were recorded along with clinical laboratory tests, treatment, management and follow up (IC-Process-PC). The doctors assessed the diagnostic process by means of visual analogue scale. Duration of the fever conditions was estimated through a postal questionnaire. Patients with direct encounters presented a wide range of reasons for the encounters. Fever was the most frequent single presenting complaint (31%). The general practitioners put major emphasis on the clinical examinations. They prescribed drugs in 68% of the direct encounters. Seventy per cent of the prescriptions were general systemic anti-infectives. Penicillin accounted for 58% of antibiotics. Six (8%) patients were hospitalized, and three (4%) were referred to a specialist. The mean time until complete recovery was 15 days for direct and 19 days for telephone encounters. Fever may be a sign even when it is not a presenting complaint. Major emphasis is probably put on the clinical examination of febrile patients because of the complexity of symptoms and the wide range of diagnoses associated with fever.

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Although fever is a common symptom, few studies have broadly addressed this as a clinical problem in general practice. The aims of this study were to determine the frequency of fever among general practice patients in two rural municipalities in Norway, the diagnoses (according to ICHPPC-2-def.) of conditions causing fever, and the receptionist's role in the management of these problems. All the general practitioners and their receptionists within the study area participated. During 4 weeks throughout 1988 all individuals attending their general practitioner had their body temperature measured with an electronic thermometer (orally > or = 7 years, rectally < 7 years). Fever was defined as an oral body temperature > or = 37.5 degrees C (rectally > or = 38.0 degrees C in those < 7 years). All telephone applications, including telephone encounters for fever, were recorded. Fever was detected in 80 (5%) of a total of 1610 direct encounters: 36% of those below 7 years of age (n = 70) were febrile. One-third of the total encounters for fever were telephone encounters (n = 36), of which 30% were managed by the receptionists. A wide range of diagnoses were made, most of which were associated with infectious diseases. The distribution of the diagnoses of primary care patients with fever is different from those admitted to hospital for fever of unknown origin. General practitioners and their receptionists should consider fever a diagnostic challenge, especially when the patient is handled over the telephone.

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Magnesium deficiency is common but difficult to diagnose and to assess in clinical practice. The use of a magnesium loading test was therefore evaluated to diagnose magnesium deficiency in 661 hospitalized patients with medical conditions assumed to interfere with magnesium uptake and excretion. Thirty millimoles of magnesium sulphate were administered intravenously during 8 h as a loading test and related to the urinary excretion in the following 24 h. A group of 30 patients without any known predisposition for magnesium deficiency and a group of 27 healthy volunteers served as controls. The mean (with 95% confidence interval) magnesium retention was 4 (-2-10)% in the control group of patients and 3 (-2-8)% in healthy subjects. A significantly higher retention was observed in all the groups of the patients: atrial fibrillation 18 (11-25)%, other arrhythmias 18 (11-24)%, hypertension 27 (20-33)%, coronary artery disease 25 (20-30)%, congestive heart failure 31 (26-37)%, cerebrovascular events 38 (24-51)%, gastrointestinal disorders 22 (14-29)%, diabetes mellitus 16 (9-22)%, and alcoholics 33 (29-36)%. The percentage of patients with a retention greater than mean + 2 SD of the two control groups varied between 22% and 54% among the different patient groups. The mean serum magnesium among the patient groups was similar to the control group of patients, except for the alcoholics, hypertensives and young healthy controls, who had significantly reduced levels. Magnesium retention was significantly correlated to age and renal function, and among the alcoholics negatively correlated to serum magnesium.(ABSTRACT TRUNCATED AT 250 WORDS)

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367 patients with mild-moderate hypertension were included in a multicentre study for the purpose of examining the antihypertensive effect of six weeks of treatment with the ACE-inhibitor lisinopril 10 and 20 mg once daily. Both low-dose and high-dose lisinopril significantly reduced sitting and standing blood pressure values. The fall in blood pressure in the sitting position was slightly but significantly greater among the high-dose group compared with the low-dose group (a 3 mm Hg fall difference in systolic values and a 1 mm Hg fall in diastolic values). No such differences were found in the standing position. Heart rate remained unchanged during lisinopril treatment. Episodes of possible first dose hypotension were reported in six patients. Approximately 90% of the patients in both groups were classified as responders according to defined criteria. The frequency of side-effects was low, and was equal in both treatment groups. An evaluation of reduction in blood pressure, and of response rate and side-effects suggests that an initial dose of 10 mg lisinopril once daily is sufficient, and that this dosage will control blood pressure in the majority of patients.

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Different parameters of antiepileptic drug (AED) treatment have been shown to affect cognitive function. The drug, dose, and duration of treatment have been studied. The present study assessed cognitive function in relation to time-of-day variation in serum carbamazepine (CBZ) concentration in epileptic patients treated with monotherapy. We studied 10 males and 12 females with a mean age of 36 years and a mean duration of CBZ-therapy of 4.4 years. Patients had been seizure-free for at least 1 month and took two daily CBZ doses. The test battery included tests of motor speed, reaction time, attention, and memory. In the experimental design, the subjects were tested twice at times close to expected daily maximum and minimum serum CBZ concentration. They were studied in two balanced blocks (block 1 tested at 8 a.m. and noon, block 2 tested at noon and 8 p.m.). Blood samples were collected every 2 hr from 8 a.m. to 8 p.m. The subjects showed significant differences in serum CBZ concentration between testing times, with suggested maximum concentration between 10 a.m. and noon. The test battery showed no consistent differences between performance at times of high versus low serum concentration. A supplementary analysis of correlations between mean performance level on cognitive tests and variables related to CBZ treatment did not show consistent trends.

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Ninety-seven mildly obese females (BMI = 27.4 kg/m2) were in a randomized, double-blind, placebo-controlled trial treated for 52 weeks. The treatment consisted of a hypocaloric diet providing 5000 kJ/day (1200 kcal) and a dietary fibre supplement of 7 g/day for 11 weeks, (part I), followed by a diet providing 6720 kJ/day (1600 kcal) and a dietary fibre supplement of 6 g/day for 16 weeks (part II). Finally placebo was withdrawn and all still adhering subjects were given a dietary fibre supplement of 6 g/day and an ad libitum diet for the rest of the period (part III). Initial body weights were comparable, 76.9 +/- 0.8 kg in the fibre group versus 77.7 +/- 1.3 kg in the placebo group. During part I the weight reduction in the fibre group of 4.9 kg was significantly higher compared to that of 3.3 kg in the placebo group (P = 0.05). Accumulated weight reduction during part II was still significantly higher in the fibre group, 3.8 kg, compared to 2.8 kg in the placebo group (P less than 0.05). Total weight loss in the fibre group after 52 weeks was 6.7 kg. Probability of adherence to the treatment regimen was significantly higher in the fibre group from week 13 and onwards (P less than 0.01). Initial blood pressures were comparable. A significant reduction of systolic blood pressure occurred in both groups. A significant reduction of diastolic blood pressure occurred in the fibre group only, from 85.4 +/- 1.2 mmHg to 81.7 +/- 1.1 mmHg (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

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