More than the sum of its parts? Nutrition in Alzheimer's disease

The aim of this article is to emphasize the importance of malnutrition and micronutrient deficiencies in Alzheimer's disease and discuss recent supplementation trials. Alzheimer's disease (AD) is a devastating neurodegenerative disease with increasing socio-economic impact. It leads to cognitive decline over the years, finally resulting in brain atrophy and gradually destroying a person's ability to learn, reason, make judgments, and communicate. Most of the cases are sporadic and risk factors evolve. There is evidence that malnutrition, oxidative stress, and homocysteine-related vitamins play a role in the pathogenesis of AD. A plethora of epidemiologic studies have explored the associations between nutrients and AD. In addition, more and more data from recent trials are evolving to analyze the impact of micronutrient supplementation in AD and incipient AD concerning B vitamin status and antioxidants. Available data do not support definitive conclusions regarding specific recommendations on micronutrient supplementation for the prevention or treatment of AD; however, more data from prospective trials are needed. Approaches with multiple nutritional components might be promising.     

Management theory. More art than science?

Evidence-based medicine can draw on more clear-cut research than that available for management. But it is still desirable to practise evidence-based management. Managers should encourage a research culture and a questioning approach. Developing a research culture requires at least one senior manager to act as a role model.     

The impact of diabetes mellitus and other chronic medical conditions on health-related Quality of Life: Is the whole greater than the sum of its parts?

Background  

Diabetes mellitus (DM) is an important public health concern, the impact of which is increased by the high prevalence of co-existing chronic medical conditions among subjects with DM. The aims of this study were therefore to (1) evaluate the impact of DM and co-existing chronic medical conditions on health-related quality of life (HRQoL) (which could be additive, synergistic or subtractive); (2) to determine the extent to which the SF-6D (a single-index preference measure) captures the multidimensional information provided by the SF-36 (a profile measure).     

Does the whole equal the sum of the parts? Patient‐assigned utility scores for IBS‐related health states and profiles

The quality-adjusted life year (QALY) assumes that the value of a health state is linearly related to the time spent in it, which implies that the value of a health state is independent of the states which precede or follow it. Irritable bowel syndrome (IBS) is a suitable condition to test this assumption since it is subject to considerable fluctuations over time. Forty-nine IBS patients were asked to rate their own health using generic measures of health and a condition specific classification. They were then asked to value five IBS states and four profiles using a self-completed version of the standard gamble technique. The implied value of each profile was estimated using the QALY assumption of linearity over time and compared with the direct profile valuations. The directly elicited profile values suggest that reductions in the duration of IBS symptoms has less of an impact on the value of quality of life than would be implied by the QALY assumption of linearity over time, though the differences were small. There are a number of competing explanations for this finding, including possible sequence effects, quantity effects or time preference, or it might be due to gestalt effects resulting in a neglect of time spent in symptomatic states of health.     

More than preparing a meal? Concerning the meanings of home cooking

Cooking is one of the basic activities in our lives. However, people frequently feel they fall short of time to cook when facing problems with the temporal organization of daily life. How people think about home cooking is considered to be important for the time they spend on preparing meals. It is assumed that the meaning of cooking differs for different people, depending on the temporal and social context. This contribution allows us to clarify how the meaning of cooking varies according to individual and household characteristics and the cooking occasion. By using the pooled time-diary data from the Flemish time-use surveys from 1999 and 2004 we can examine people's views on cooking in order to understand how people use time for food preparation. Although the results suggest that people consider cooking primarily as a household chore, preparing food can also be a way to please others, as well as themselves. It seems that feelings of time pressure and the family situation are clearly related to men's and women's cooking experiences. Furthermore, the meaning of cooking also tends to be clearly influenced by the meal situation and (the moment of) the day.     

Is a family equal to the sum of its parts? Estimating family-level well-being for cost-effectiveness analysis

Cost-effectiveness (CEA) analysis of health interventions focuses primarily on individual-level costs and benefits. However, health interventions intended for individuals often have implications for other members of an individuals family and the overall functioning of the family. While researchers have assessed the effects of health interventions on multiple family members, CEA has not routinely incorporated measures of effectiveness or costs from multiple family members. We could imagine, however, that CEA might over- or under-estimate the effects of health interventions if they are limited to individuals targeted by the intervention. Family-level CEA would consider the well-being of and costs borne by multiple family members in response to an individual-level intervention, and potentially lead to more appropriate resource allocation. Using the health plan as a working frame of reference, we explore conceptual issues related to estimating effectiveness at the level of the family for use in CEA.     

More aspiration than achievement? Children's complaints and advocacy in health services in Wales

The present paper reports on key results from a government-funded survey of all National Health Service trusts, local health boards and community health councils in Wales, which was conducted in 2004-2005 to identify the characteristics of complaints involving children, and the use of professional advocacy services in these complaints and their role in supporting children in relation to health service matters more generally. Findings from the survey are presented which reveal the marginal take-up of professional advocacy services in health complaints, and the slender resource in professional advocacy for children commissioned by a small number of health bodies. Advocacy support for users of health services typically focuses upon adult-related issues. The needs of children, particularly those who may have special requirements because of disability, being looked after, or having language or cultural needs are not well met according to the present survey. This raises the question of whether recent policy and guidance on advocacy (particularly for children and vulnerable groups) is seen by health bodies as warranting decisive action and dedicated investment, or whether rhetoric and modest change is the more likely outcome in the face of other pressing demands on health budgets.     

Global Ratings of Student Performance in a Standardized Patient Examination: Is the Whole More than the Sum of the Parts?

Standardized patient examinations (SPE)are widely used in medical education to assess skillsthat cannot be measured with written examinations.Trained actors termed standardized patients (SPs) areused to simulate patients with specific medicalproblems. SPs typically use behaviorally specificchecklists and rating scales to evaluate examinees. This study explored the use of faculty and SP globalratings of students' clinical and interpersonal skillsin an SPE. The reliability of global ratings wasfound to on par with more specific behaviorallyanchored ratings. Global ratings were also found tobe predictive of written tests of clinical knowledgeand ratings of actual clinical performance aftercontrolling for behaviorally anchored ratings. Facultyglobal ratings were more reliable and more predictiveof other performance than SP global ratings. Theseresults suggest global ratings by faculty observersand possibly SPs can provide unique and usefulinformation in these performance-based examinations. This revised version was published online in June 2006 with corrections to the Cover Date.