Co-ordination, collaboration and health promotion: lessons and issues from an alcohol education programme

This article draws upon the evaluation of an alcohol educationprogramme in South West England to develop a discussion abouthow to improve co-ordination and collaboration in health promotionbetween different professionals. The importance of collaborationis frequently recognized but research evidence suggests thatit is very hard to achieve. Three main issues are addressed.First, the article considers how the national funders of regionalprogrammes can improve their relationship with local agencies.Second, the district co-ordination model of the South West programmeis assessed as a possible model for co-ordination across a rangeof health topics. Third, the tactics of professional networkdevelopment at the local level are explored.     

Is Chronic Atrial Stimulation a Reliable Method for Single Chamber Pacing in Sick Sinus Syndrome?

To evaluate the feasibility of chronic atrial pacing (AAI) in sick sinus syndrome (SSS), 22 patients (pts) with bradytachycardia syndrome (BTS) and 17 patients with only bradyarrhythmias (BA) were studied on the incidence of supraventricular tachycardias (SVT) and occurring AV block. A scoring system based on symptoms of SVT was developed (grade 0–5). All patients had proven normal AV conduction before PM implantation. In the BTS-group, nine patients (41%) had symptomatic SVT at the end of follow-up (mean 53 months), despite drug therapy. These patients had a high SVT score on entry (mean 3.2). High degree AV block occurred in three patients. Although in the BA-group SVT arose in six patients (35%), there was only one symptomatic patient at the end of follow-up (mean 36 months). In this group, only one patient developed high degree AV block. Atrial stimulation should be considered as a reliable therapy in patients with SSS and low SVT score before PM implantation when normal AV conduction is present.     

Minimal Breastfeeding

Current advice to breastfeeding mothers is that breasts must be emptied regularly and frequently to help maintain lactation. A method of maintaining lactation, minimal breastfeeding, in which mothers nurse once or twice a day without expressing the breast between breastfeedings was investigated. A convenience sample of 30 mothers using minimal breastfeeding was interviewed monthly until weaning. These mothers used minimal breastfeeding as a method of slow weaning, a way to combine breastfeeding and work, and a means of comfort-nursing older infants. In all cases, weaning occurred because the mother or the infant chose to wean, not because of insufficient milk. The authors conclude that for working mothers who cannot express between feeds, breastfeeding can still be maintained, and that minimal breastfeeding is an important alternative to weaning.     

An in vitro investigation into the wear effects of selected restorative materials on dentine

SUMMARY Wear testing of five restorative materials was carried out against plates of human dentine using a wear machine specifically designed to simulate the masticatory cycle. The results showed that dentine is substantially less wear resistant than enamel when compared to previous findings. Amalgam produced no measurable wear of dentine, conventional composite produced extreme destruction and porcelain produced the greatest amount of wear. Great care should be taken with the choice of restorative material when opposing dentine.     

Carbon monoxide within circle systems

After reports of carbon monoxide toxicity from the United States, the Medicines Control Agency issued a warning which recommended that soda lime used in circle breathing systems should not be allowed to dry out. We have measured carbon monoxide levels within a circle system in vitro (under a variety of conditions) and in vivo. Carbon monoxide was detected only when a patient was connected to the circle system. As levels in the expiratory limb of the circle system were significantly higher than those in the inspiratory limb, we conclude that the patient acts as the source of carbon monoxide.     

Changes in work performances in obstructive sleep apnea patients after dental appliance therapy

Abstract The effects of dental appliances on work performances of obstructive sleep apnea syndrome (OSAS) is not well examined. This study evaluated the polysomnographic and psychological findings before and after therapy. Nine patients were diagnosed OSAS by nocturnal polysomnography. The psychological battery was performed from 13:00 to 14:00, which consisted of Uchida-Kraepelin psychodiagnostic test (U-K's test) and Bourdon's cancellation test (Bourdon's test). Approximately 3 months after the treatment, the examinations were performed. Apnea and desaturation index decreased significantly after the therapy. In addition, sleep architecture improved after the therapy compared with that before the therapy. Dysfunction of task performances, such as mean level of work amounts in U-K's test, mean error, mean performance time and mean deviation in Bourdon's test improved after therapy. We conclude that dental appliances therapy is effective not only to apnea but also to work performance in OSAS.