Provider arrangements for mental health services in 'The New NHS'

Mental health services in England, in common with many other European countries, have been the subject of sustained government attention during the 1990s. Since the election of the Labour administration in Britain in May 1997, mental health services have been discussed in most Department of Health documents on health and social care policy, and mental health services in England have a new national strategy. At the same time, the local provision of mental health services within NHS Trusts has been undergoing organisational change. This paper sets out the policy context and evidence base for the reorganisation of provider arrangements for mental health services. In addition, the results of a documentary analysis of unpublished reviews of provider arrangements in 10 localities are presented. The review identified three major themes: firstly, the reconfiguration of NHS Trusts is based around Specialist Mental Health Trusts and Community and Mental Health Trusts; secondly, the joint provision of services and/or the integration of services between health and social services is starting to appear and; thirdly, the delegation of responsibility to localities based on Primary Care Group/Social Services boundaries is being discussed. The paper discerns a number of trends and points to the need for further research, in particular into the relationship between organisational arrangements and effective service delivery.     

Magnetic resonance angiography findings in the early post-carotid endarterectomy period

This preliminary study was designed to investigate the ability of multiple axial volume three-dimensional fourier transform (3DFT) time-of-flight (TOF) magnetic resonance angiography (MRA) to depict the carotid bifurcation in the early post-carotid endarterectomy period. Five patients underwent intra-operative digital subtraction angiography (DSA) and carotid MRA within 5 days of carotid endarterectomy. An axial volume fast imaging in steady-state precession (FISP) gradient-echo 3DFT TOF carotid MRA technique in this limited series appeared to display accurately the surgically significant abnormalities at the carotid bifurcation after endarterectomy. However, in normal or near-normal intra-operative DSA studies, overestimation of internal carotid artery stenoses was encountered. Postoperative MRA demonstrates potential as a useful non-invasive investigation after carotid endarterectomy but should be interpreted with caution until larger studies become available.     

Setting trouble-free policies for parental and sick leave

Parental and sick leave are medical staff benefits that can lead to all kinds of problems. This article offers specific guidance for heading off the most common and difficult problems, focusing particularly on ways to provide fair benefits to employees who need them without inviting unnecessary absences and policy abuse. It reviews typical medical practice sick leave policies as well as four creative strategies for encouraging and rewarding excellent attendance and deterring abuse. In addition, this article suggests ways to structure a parental leave policy that will not only be fair to employees but also help the practice fulfill its legal obligations.     

A comparison of self-reported and measured height,weight and BMI in Australian adolescents

OBJECTIVE: To explore the relationship between self-reported weight and height to actual weight and height in older Australian adolescents. METHOD: Weights and heights of 572 adolescents aged 15-19 years who participated in the 1995 Australian National Health Survey (NHS) and National Nutrition Survey (NNS) were examined. RESULTS: Self-reported heights were significantly higher than measured heights in participants. There were no differences in the accuracy of self-reported heights among the adolescents by gender. Self-reported weights were significantly lower than measured weights among both boys and girls (p < 0.01). There were no differences in the accuracy of self-reported weights among the boys and girls. Differences between actual weight and self-reported weight were significantly greater for overweight or obese adolescents compared with normal/underweight adolescents (p < 0.01). The use of self-reported weight and height resulted in the correct classification of overweight or obesity in 69% boys and 70% of girls. CONCLUSIONS: There was no significant gender difference in reporting weight and height in older adolescents. Bias in reporting weight and height was much higher in overweight or obese adolescents than normal/underweight adolescents. IMPLICATIONS: The percentage of misclassification of overweight or obesity from self-reported data in this study was 31% for boys and 30% for girls, respectively. Therefore, the self-reported weight and height of older adolescents needs to be more cautiously utilised. Efforts to improve the accuracy of self-reporting in older adolescents are needed if this measure is to be reliable.     

New Zealand community attitudes toward people with epilepsy

PURPOSE: International surveys on knowledge and attitudes toward people with epilepsy suggest that public opinion is improving in many countries. This study aimed to discover how New Zealand compared with other countries, and how subgroups within the New Zealand population compared with each other, by conducting a survey of community knowledge and attitudes toward epilepsy. METHODS: Telephone interviews were conducted on a random sample of 400 persons older than 17 years, drawn from a mid-sized provincial town and its hinterland. RESULTS: Ninety-five percent of respondents had heard or read about epilepsy; 73% knew someone with epilepsy; and 67% had seen an epileptic seizure. Somewhat less knowledgeable were young people, the less educated, lower socioeconomic status (SES), and those of Maori or non-European ethnicity. Attitudes toward people with epilepsy were favorable, with only 5% objecting to their child marrying a person who sometimes had seizures. Less-positive attitudes were found among some older people. CONCLUSIONS: Compared with those in other Western countries, New Zealanders are well informed about epilepsy, and their attitudes toward it are mainly positive. Continuing public education about epilepsy is still necessary, especially among the young, the non-European, and older people.     

Structure of the inhibitory region of troponin by site directed spin labeling electron paramagnetic resonance

Site-directed spin labeling EPR (SDSL-EPR) was used to determine the structure of the inhibitory region of TnI in the intact cardiac troponin ternary complex. Maeda and collaborators have modeled the inhibitory region of TnI (skeletal 96-112: the structural motif that communicates the Ca(2+) signal to actin) as a kinked alpha-helix [Vassylyev, D., Takeda, S., Wakatsuki, S., Maeda, K. & Maeda, Y. (1998) Proc. Natl. Acad. Sci. USA 95, 4847-4852), whereas Trewhella and collaborators have proposed the same region to be a flexible beta-hairpin [Tung, C. S., Wall, M. E., Gallagher, S. C. & Trewhella, J. (2000) Protein Sci. 9, 1312-1326]. To distinguish between the two models, residues 129-145 of cardiac TnI were mutated sequentially to cysteines and labeled with the extrinsic spin probe, MTSSL. Sequence-dependent solvent accessibility was measured as a change in power saturation of the spin probe in the presence of the relaxation agent. In the ternary complex, the 129-137 region followed a pattern characteristic of a regular 3.6 residues/turn alpha-helix. The following region, residues 138-145, showed no regular pattern in solvent accessibility. Measurements of 4 intradomain distances within the inhibitory sequence, using dipolar EPR, were consistent with an alpha-helical structure. The difference in side-chain mobility between the ternary (C.I.T) and binary (C.I) complexes revealed a region of interaction of TnT located at the N-terminal end of the inhibitory sequence, residues 130-135. The above findings for the troponin complex in solution do not support either of the computational models of the binary complex; however, they are in very good agreement with a preliminary report of the x-ray structure of the cardiac ternary complex [Takeda, S. Yamashita, A., Maeda, K. & Maeda, Y. (2002) Biophys. J. 82, 832].     

反应停治疗难治性多发性骨髓瘤25例

1临床资料我院2001-02/2004-01接受2个疗程卡氮芥 环磷酰胺 马法兰 泼尼松 长春新碱或2个疗程长春新碱 阿霉素 地塞米松方案化疗无效或复发的难治性多发性骨髓瘤患者25(男16,女9)例,年龄42～80(中位年龄57.2)岁.单用反应停口服治疗,起始剂量200 mg/d,如无不良反应,每周增加100 mg,根据患者耐受情况,最高剂量为600 mg/d,3 mo为1疗程.服药期间禁止使用糖皮质激素类药物及细胞毒药物.