To market! To market! A new dawn for community care?

The public sector in Britain has been subjected to over a decade of major reform aimed at breaking up public service monopolies, at containing costs while at the same time opening services up to greater consumer choice. Health and social services have not been exempt from this revolution in the organization and management of public sector services. The long-standing policy of care in the community is being subjected to market principles and the introduction of a ‘contract culture’ very similar to the NHS reforms introduced in 1991. This paper reviews the origins of these developments in the doctrines of ‘new public management’, a movement which has proved attractive to policy-makers in many countries. Local authority social services departments have been identified as the lead agency for the development of a mixed economy of care following a review of community care policy by the government's health adviser, Sir Roy Griffiths, and a subsequent white paper. This paper examines the limited empirical evidence available on how managers and providers are meeting the challenge bestowed upon them, and concludes that most authorities are moving ahead cautiously if at all. Only a handful of authorities studied have embraced the reforms with any degree of enthusiasm. The paper concludes with an assessment of the reforms from two perspectives: a pessimistic one and an optimistic one. There are many worrying features of the reforms, not least among these being a lack of clarity over their intended purpose. Tensions and contradictions are plentiful, which places in jeopardy the certainty of the reforms in becoming user led rather than provider driven. A more optimistic scenario is that the changes are leading to a loosening up of services and practices which have often suffered from sclerotic tendencies, paternalism and sometimes complacency. If the reform process is skilfully handled and not rushed and if the ends are clearly established and communicated then users and carers could prove to be the principal beneficiaries.     

Needs assessment for persons with severe mental illness: What services are needed for successful community living?

The development and implementation of effective community support systems are goals of many public mental health authorities who are attempting to shift the focus and dollars for mental health services from inpatient to community care. This article presents the results of a survey which asked 90 community mental health agency case managers to assess the community support and residential needs of over 1400 of their clients. Medication monitoring and therapy were rated high priority needs. Psychosocial treatment, day and vocational activities also ranked high. Survey responses regarding residential services indicated a need for more supported and supervised options.The study reported was a collaborative effort by county and agency staff.     

Cognitive behaviour therapy approach to disputing automatic thoughts: a two-stage model

Research shows that clients with automatic thoughts (dysfunctional thinking) often do not think of alternative explanations in relation to negative events. Furthermore, these automatic thoughts are characterized by a broad global, self-evaluative and ambiguous nature that could make disputing (or changing the ways they think) the most difficult part of the therapeutic process. This paper proposes a two-stage practise-based disputing model, guided by research, that aims to 'bring' an automatic thought to a specific, objective, quantifiable and concrete level at which not only is the particular aspect(s) of the automatic thought that causes emotional disturbances finely focused, but the disputing is also likely to be effective and manageable. Furthermore, it will also generate alternative explanations that are helpful in reducing emotional disturbances and in facilitating problem solving approach. In this paper, the authors use a case example to discuss the rationale that underpins the conceptualization of the model and to illustrate the process in which the strategies of the model are effectively used.     

骨质疏松症的治疗和预防概述

原发性骨质疏松症 (Op)是骨构建和骨重建中 ,骨形成和骨吸收恒常调节失衡引发的一种缓慢的、渐进的骨吸收亢进症 ,是一类综合征。多种病因可以引起 ,现今一般认为和机体遗传、个体生活习惯、生理状态与生存环境等多种因素综合影响有关。因Op病因的多源性和发病机理的复杂性 ,现今尚在不断阐明中 ,多主张综合治疗处理。凡是骨密度(BMD)有明显减低或骨吸收生化标志有明显上升者 ,无论伴有或不伴有非暴力性骨折 ,均应给予治疗处理。一、Op的治疗原则和许多慢性非传染性流行性疾病类似 :(1 )去除病因 ,阻止骨量减少和骨质量劣化进程。 (2 )增…     

Activation of guinea pig eosinophil respiratory burst by leukotriene B4: role of protein kinase C

Leukotriene B4 (LTB4) and the protein kinase C activator, 4-beta-phorbol dibutyrate (PDBu), both induced a pronounced and concentration-dependent stimulation of hydrogen peroxide (H2O2) generation by purified guinea pig peritoneal eosinophils in the concentration range 1 nM-1 microM. The LTB4 response was inhibited competitively by the specific LTB4 receptor antagonist, U-75302, with a KB of 25 nM, while the concentration-response curves for both stimuli were shifted rightwards (3.8-fold and 2.8-fold for LTB4 and PDBu, respectively) by the competitive protein kinase C inhibitor, 1-O-hexadecyl-2-O-methylglycerol at a concentration of 300 microM. LTB4 appears, therefore, to induce respiratory burst in eosinophils via a receptor-mediated mechanism involving protein kinase C.     

硫酸镁联合亚低温治疗对大鼠局灶性脑缺血的保护作用

目的　探讨硫酸镁对SD大鼠局灶性脑缺血损伤的保护作用。方法　将 4 0只大鼠随机分成模型对照组、硫酸镁治疗组、亚低温治疗组、硫酸镁联合亚低温治疗组。采用线栓法建立大鼠局灶性脑缺血模型。通过计算大鼠神经功能缺陷评分 ,测量脑梗死体积 ,观察神经元超微结构改变 ,评定硫酸镁联合亚低温治疗作用。结果各治疗组大鼠神经功能评分及脑梗死体积均显著低于对照组 (P <0 0 5 ) ,联合治疗组大鼠明显低于对照组 (P<0 0 1) ;联合治疗组神经元超微结构改变轻微。结论　硫酸镁联合亚低温治疗对大鼠局灶脑缺血有明显保护作用     

Becoming a mother — an analysis of women's experience of early motherhood

This paper presents the results of a qualitative study conducted by midwife researchers into women's experience of new motherhood. Data were collected using focus groups involving 55 first-time mothers and analysed using grounded theory method. The analysis produced six categories: 'realizing', 'unready', 'drained', 'aloneness', 'loss' and 'working it out'. The core category, 'becoming a mother', integrates all other categories and encapsulates the process of change experienced by women. Also explained are factors mediating the often distressing experience of becoming a mother. The analysis provides a conceptualization of early motherhood enabling the development of strategies for midwives, nurses and others helping women negotiate this challenge.     

Antenatal education – where next?

The history of antenatal education throws light on why contemporary class attenders represent only a particular section of the childbearing population. Since Victorian times, the non-availability of the women's network to middle class women has forced them to seek knowledge of their own bodies, confidence in their childbearing capacities and the support of other women through formal educational opportunities. Research suggests that antenatal classes often fail to provide women with a realistic account of birth and parenting to replace the lived experience of earlier decades and may not be facilitated in such a way as to create the support groups which class attenders critically need. Teaching approaches often promote dependency amongst clients rather than nurturing the decision-making skills required by a consumer-driven maternity service.