NHS entrants. Great expectations

The plethora of tabloid newspaper stories slating penny-pinching managers and the glut of television soaps featuring over-worked nurses and exhausted junior doctors portray life in the NHS as far from glamorous. But it seems that once you have been bitten by the NHS bug nothing can put you off. The lure of large salaries, expense accounts and company cars apparently counts for nought when offered the prospect of a 72-hour working week and a significantly reduced income. The opportunity to 'do some good' and 'make a difference' is very obviously a strong motivating factor for many people considering a career in the NHS and there is no shortage of those who are keen to play their part. These are the stories of just some of those people.     

晕厥56例病因及临床特征分析

  目的  调查河南省郑州市中小学生不明原因晕厥发病率,并分析其危险因素,为预防不明原因晕厥提供有效建议。  方法  于2017年1月 — 2018年4月,采用分层整群抽样方法在郑州市随机抽取4 028名城乡中小学生,统计不明原因晕厥发病率、频次、诱发因素、晕厥先兆等,并分析影响晕厥发生的危险因素。  结果  郑州市中小学生有784例发生晕厥,占19.46 %,其中51例有家族晕厥史,占6.51 %,晕厥发生率随年龄增长呈逐步增高趋势;发生1次晕厥有427例,占54.46 %;女生晕厥发病率明显高于男生（P < 0.05）;诱发因素中排便排尿诱发男生晕厥率明显高于女生,而闷热环境、久站诱发女生晕厥率明显高于男生（P < 0.05）;晕厥先兆中恶心呕吐、大汗、胸闷、头晕女生发病率明显高于男生（P < 0.05）;在中小学生晕厥持续时间中,数秒所占比例最高（51.15 %）, > 10 min所占比例最低（9.69 %）;在体位中,晕厥时站立位所占比例最高（73.72 %）,坐位所占比例最低（7.27 %）;年龄、性别、焦虑程度是不明原因晕厥发生的危险因素（均P < 0.05）。  结论  郑州市中小学生不明原因晕厥发病率较高,随年龄增长呈上升趋势,年龄、性别、焦虑程度是其危险因素,对此应采取健康教育、减压、体育锻炼等措施预防晕厥发生。     

Great expectations: Challenges for women as mental health administrators

Although women have made many strides in the area of leadership, stereotypes still exist that limit their power. Traditional concepts of femininity have not typically been associated with strength and competence. This article describes an inpatient unit at San Francisco General Hospital, University of California, San Francisco, which is led by a group of women. The unit houses a women-focused treatment team specializing in treating women who have serious mental illness with histories of severe trauma, including poverty and violence. The article describes the challenges and rewards available to women leaders in this type of setting. Four areas of women’s leadership are explored: the stereotypes women have about each other as leaders, the expectations and biases of staff and trainees, the projections of patients onto women leaders, and women’s leadership in relation to department administration. Strategies for addressing biases in these areas and developing women’s leadership conclude the article.     

Great expectations: historical perspectives on genetic breast cancer testing.

Women who test positive for a genetic breast cancer marker may have more than a 50% chance of developing the disease. Although past screening technologies have sought to identify actual breast cancers, as opposed to predisposition, the history of screening may help predict the societal response to genetic testing. For decades, educational messages have encouraged women to find breast cancers as early as possible. Such messages have fostered the popular assumption that immediately discovered and treated breast cancers are necessarily more curable. Research, however, has shown that screening improves the prognosis of some--but not all--breast cancers, and also that it may lead to unnecessary interventions. The dichotomy between the advertised value of early detection and its actual utility has caused particular controversy in the United States, where the cultural climate emphasizes the importance of obtaining all possible medical information and acting on it. Early detection has probably helped to lower overall breast cancer mortality. But it has proven hard to praise aggressive screening without exaggerating its merits. Women considering genetic breast cancer testing should weight the benefits and limitations of early knowledge.     

Great expectations and hard times: developing community indicators in a healthy communities initiative in Canada

This paper reports on expectations for and community members' experience in the development of community indicators in a healthy communities initiative (HCI) in Alberta, Canada. The HCI process involved community visioning, the creation of action plans to further the vision by addressing key health priorities and/or community capacity building activities and the development of indicators to monitor and report on progress towards goals. Nineteen semi-structured interviews were conducted with community participants to discuss definitions of success in the HCI and participant experience in developing indicators. Three themes emerged: the formal indicators lacked relevance to community members; the community did not own the HCI indicators and participants instead drew upon measures of success which were largely experiential in nature. The study provides a critically reflective, candid account of on-the-ground work with communities. The findings reveal limitations in the process of developing community indicators in this HCI, which we attribute in part to skills and discontinuities on the staffing side of the health authority and in part to failure to recognize and fully appreciate 'different ways of knowing' between communities and agencies.     

Great expectations for the World Health Organization: a Framework Convention on Global Health to achieve universal health coverage

Establishing a reform agenda for the World Health Organization (WHO) requires understanding its role within the wider global health system and the purposes of that wider global health system. In this paper, the focus is on one particular purpose: achieving universal health coverage (UHC). The intention is to describe why achieving UHC requires something like a Framework Convention on Global Health (FCGH) that have been proposed elsewhere,¹ why WHO is in a unique position to usher in an FCGH, and what specific reforms would help enable WHO to assume this role.     

Patient expectations of dental services. Image affects expectations, and expectations affect perceived service quality

The authors construct a theoretical model of the antecedents of expectations for dental services by analyzing survey responses from 240 dental patients. The patients' image of the dentist, tangible cues, situational factors, and patient satisfaction with prior service encounters have the greatest influence on expectations of service, whereas marketing variables, such as price and advertising, appear to have no effect.