Ancient wheat and health: a legend or the reality? A review on KAMUT khorasan wheat

After WWII, the industrialized agriculture selected modern varieties of Triticum turgidum spp. durum and spp. aestivum (durum wheat and common wheat) based on higher yields and technological characteristics. Nowadays, the use of whole ancient grains and pseudo cereals is considered nutritionally important. How ancient grains have positive effects is not entirely known, the fragmentation of the scientific knowledge being also related to the fact that ancient grains are not a homogeneous category. The KAMUT^® trademark indicates a specific and ancient variety of grain (Triticum turgidum ssp. turanicum, commonly khorasan wheat), and guarantees certain attributes making studies sufficiently comparable. In this work, studies on KAMUT^® khorasan wheat have been systematically reviewed, evidencing different aspects supporting its benefits. Although it is not possible to establish whether all ancient grains share these positive characteristics, in total or in part, this review provides further evidences supporting the consumption of ancient grains.     

Uncertainty in health care environments: myth or reality?

Health care leaders and analysts typically describe the health care environment as dynamic, complex, and highly uncertain. This study conceptualizes environmental uncertainty as an individual perception that blends subjective and objective realities derived from the complexity and dynamism of the organizational task environment. Exploratory judgments of the complexity and dynamism of the environment of health care organizations are included.     

Empowerment: A goal or a means for health promotion?

Empowerment is a concept that has been much used and discussed for a number of years. However, it is not always explicitly clarified what its central meaning is. The present paper intends to clarify what empowerment means, and relate it to the goals of health promotion. The paper starts with the claim that health-related quality of life is the ultimate general goal for health promotion, and continues by briefly presenting definitions of some central concepts: “welfare”, “health” and “quality of life”. Several suggestions as to what empowerment is are then discussed: autonomy, freedom, knowledge, self-esteem, self-confidence, and control over health or life. One conclusion of this discussion is that empowerment can be seen as a complex goal which includes aspects of the three central concepts welfare, health and quality of life. To the extent that the empowerment goals aimed at are health-related, it is concluded that empowerment is a legitimate goal for health promotion. But empowerment is not only a goal, it can also be described as a process or as an approach. This process, or approach, in a fundamental way involves the participants in problem formulation, decision making and action, which means that the experts have to relinquish some of their control and power.     

Will PSOs be a disaster or a dream?

The healthcare landscape is littered with failed attempts by hospitals and physicians to manage insurance risk. This year's survey of managed-care plans shows 12 of 30 provider-owned HMOs lost money in 1997. And Modern Healthcare's news pages have chronicled recent losses at more than 20 provider-owned plans. With provider-sponsored organizations in the pipeline, the question is: Will they be a dream or are they a disaster in the making?     

Yellow fever vaccine safety: a reality or a myth?

The 17D-derived yellow fever (YF) vaccines have had an excellent record of their safety among millions of recipients. Recently, extensive viral dissemination in seven vaccinees, aged 5-79 years, with just one survivor posed a serious challenge for vaccine manufacturers. Prospective evaluations of yellow fever vaccine bulk suspensions for their viscerotropism and neurovirulence in primates or an alternate animal should minimize identical viral dissemination among prospective recipients of YF vaccines.     

The objective assessment of the quality of hospital care: dream or reality?

One of the hottest topics of the international journals is the question: what is the effect of the public indicator-based quality assessment on the quality of care and on the decision of stakeholders, and which criteria should be applied for development of public quality assessment system. According to the international literature the paper discusses 6 topics: (1) the ability of indicators to distinguish providers from the point of view of quality; (2) the appropriateness of outcome indicators to assess providers; (3) the ability of league tables to rank providers; (4) the people's behaviour during choosing providers; (5) the impact of indicator-based public report; (6) recommendations for developing quality assessment system. Based on the literature review, the ability of indicators in distinguishing providers from the point of view of quality is doubtful primarily because of risk-adjustment problems. Other reasons are: the outcomes of care do not definitely refer to the quality of care process; the rankings of providers (league tables) based on more indicators are not reliable; people take into account mainly distance and the opinions of acquaintance when they choose providers; as a result of public reports the overall quality of care is declining. The publication of the results of measurement to assess providers has to be considered as a tool. For the purpose of helping people in choosing providers, the publication of patient satisfaction survey designed according to their preferences could achieve the desired effect. The quality improvement aims are definitely helped by the direct feedback to providers about the indicator values. Furthermore, much finer picture can be made if the standardized audits of care and organisational processes are inserted into external assessment procedures.     

Probiotics--industry myth or a practical reality?

Probiotics are "bacteria that are good for you' evolving out of the food industry, without quality data or a framework in which to function. This review asks three questions, the answers to which dictate the level of success that probiotics have had in moving into the medical model. How do they work? Evidence is summarised to show that (at least) certain bacteria activate Peyer's patch T cells to drive the common mucosal system via toll-like receptors on antigen presenting cells. They influence distant mucosal sites, promoting Th1 cytokine responses while downregulating Th2 responses. New data is included. Are all probiotics the same? They clearly are not - variation occurs between different isolates and importantly within isolates due to variable production/storage and poor quality control. These latter issues, together with poor clinical trials lacking surrogate markers of activation, have made clinical assessment very difficult. Do they have a role in man? Yes they do, but whether that is now or in the future largely depends on the quality of studies done. There is clear evidence in man that mucosal INF-gamma secretion is stimulated, indicating promotion of immune protection, downregulation of hypersensitivity disease and (yet to be demonstrated) enhanced apoptosis to reduce cancer risk. Preliminary evidence suggests that certain probiotics may regulate cytokine secretion around a mean, ensuring optimal protection without non-specific damage. Thus probiotics appear to restore defective immunity rather than stimulate, an observation relevant to restoration of Th1 immunity in infants.     

Recovery in mental health policy: good strategy or bad rhetoric?

This article explores current positions on ‘recovery’ in Scottish mental health policy and the practical limitations of these positions from a rhetorical perspective. It is not our intention to conduct a formal policy analysis but rather to open up an argumentative space for thinking critically about recovery. In adopting a rhetorical perspective, we are concerned not with the quality of evidence in support of recovery per se, but with the quality of the arguments and the manner in which these have been produced, reproduced and promulgated to support recovery in terms of its adoption in policy and practice within the Scottish context. We sketch the background to the ‘case for’ recovery in Scotland by drawing upon key policy documents, referring to the public mental health focus in Scotland's mental health policy, and indicate how policy and practice on recovery have been evaluated in that context. We then explore the value of critical dialogue by exploring the potential limitations of the case for recovery by considering hope and the medical model as examples of themes in recovery policy and practice. In light of this analysis, we argue that while the policy and its implementation might be understood as a good strategy for addressing major issues in mental health, it is bad rhetoric to the extent that it limits argument, and therefore practical deliberation, about recovery. In conclusion, we discuss the implications of our argument for mental health practitioners, for whom a critical stance on health policy is a necessary resource.