The interpersonal relationship in clinical practice. The Barrett-Lennard Relationship Inventory as an assessment instrument

The biomedical model that has long been central to medical practice is gradually being expanded to a broader biopsychosocial model. Relationship-building skills commensurate with the new paradigm need to be understood by educators and taught to medical practitioners. The person-centered, or humanistic, model of psychologist Carl Rogers provides a theoretical approach for the development of effective biopsychosocial relationships. The Barrett-Lennard Relationship Inventory (BLRI) was developed in 1962 as an assessment instrument for the person-centered model. In this article, the person-centered model and the use of the BLRI as an assessment instrument of this model are discussed. Current and potential uses of the BLRI are explored.     

Contraceptive introduction reconsidered: a new methodology for policy and program development

Although new contraceptive technology has the potential for providing women with expanded options for fertility control, the historical record of international family planning shows that, in practice, introduction of new methods has not always broadened reproductive choice. Using the example of introduction of intrauterine devices into the Indian family planning program in the 1960s, we show that an exclusive focus on the technology itself is problematic and argue that methodologies are needed that relate introduction of new methods to user needs and program capacities. We summarize key findings from the Indonesian experience with Norplant introduction. Although an effort was made to address problems with previous approaches, major deficiencies in both the technical and interpersonal dimensions of care arose when the implants were made broadly available within the program. We subsequently present a methodology for contraceptive introduction developed by the World Health Organization. This methodology emphasizes the social and institutional context in which technology is used and suggests a participatory and research-based approach to program and policy development. We illustrate results from this new approach in its implementation in Vietnam and suggest areas for further evaluation.     

When is research participatory? Reflections on a reproductive health project in Brazil

This article addresses women's participation in an organization development project designed to improve public sector family planning and reproductive health services in Brazil. Although community women collaborated in aspects of the intervention and research, the project nonetheless raises the basic question whether such involvement of community women does or does not correspond to what scientific writers consider to be the essence of participatory research. We review key project features in the context of recent literature and conclude that although the project is committed to the sharing of power and control, it does not fully correspond to the characteristics of participatory research. Moreover, we argue that given the project's central focus on reproductive health outcomes, complete adherence to the process-oriented, pure version of participatory research would have been inappropriate.     

Transforming Growth Factor-β2 mRNA Level in Unloaded Bone Analyzed by Quantitative In Situ Hybridization

The effects of tail suspension hypokinesia on the gene expression for TGF-β₂ at different sites within bone were evaluated. TGF-β₂ mRNA signal levels were determined quantitatively by an image analysis system. The osteopenia induced by tail suspension was verified by histomorphometry. In the periosteum of nonsuspended control rats, TGF-β₂ mRNA was highly expressed in the preosteoblasts and osteoblast-rich cambial layers; very little signal was present within the middle and outer fibroblastic layers. Gene expression was significantly reduced in suspended rats, and this was evident both in terms of the number of silver grains in unit area or length of tissue and in each osteoblast and preosteoblast. Hypokinesia also reduced the expression of TGF-β₂ mRNA level in cortical and trabecular bone osteocytes, but did not adversely affect the mRNA level in chondrocytes in growth plate. The results affirm the site-specific response of TGF-β₂ gene expression in rats, and suggest that the cortical and trabecular bone osteopenia associated with hypokinesia in rats may be associated with a deficit in osteoblastic and osteocytic TGF-β₂ level. Received: 6 February 1998 / Accepted: 10 November 1998     

Association of dialyzer reuse and hospitalization rates among hemodialysis patients in the US

OBJECTIVES: To determine if reuse of hemodialyzers is associated with higher rates of hospitalization and their resulting costs among end-stage renal disease (ESRD) patients. METHODS: Noncurrent cohort study of hospitalization rates among 27,264 ESRD patients beginning hemodialysis in the United States in 1986 and 1987. RESULTS: Dialysis in free-standing facilities reprocessing dialyzers was associated with a greater rate of hospitalization than in facilities not reprocessing (relative rate (RR) = 1.08, 95% confidence interval (CI), 1.02-1.14). This higher rate of hospitalization was observed with dialyzer reuse using peracetic/acetic acids (RR = 1.11, CI 1. 04-1.18) and formaldehyde (RR = 1.07, CI 1.00-1.14), but not glutaraldehyde (p = 0.97). There was no difference among hospitalization rates in hospital-based facilities reprocessing dialyzers with any sterilant and those not reprocessing. Hospitalization for causes other than vascular access morbidity in free-standing facilities reusing dialyzers with formaldehyde was not different from hospitalization in facilities not reusing. However, reuse with peracetic/acetic acids was associated with higher rates of hospitalization than formaldehyde (RR = 1.08, CI 1.03-1.15). CONCLUSIONS: Dialysis in free-standing facilities reprocessing dialyzers with peracetic/acetic acids or formaldehyde was associated with greater hospitalization than dialysis without dialyzer reprocessing. This greater hospitalization accounts for a large increment in inpatient stays in the USA. These findings raise important concerns about potentially avoidable morbidity among hemodialysis patients. Copyright Copyright 1999 S. Karger AG, Basel     

Incidents in obstetric anaesthesia and analgesia: an analysis of 5000 AIMS reports.

We aimed to explore the first 5000 incidents reported to the Australian Incident Monitoring Study (AIMS) involving anaesthesia for obstetric patients and found 203 such incidents. Analysis and classification identified seven main incident groups; regional anaesthetic techniques (33%), anaesthetic equipment problems (13%), "wrong drug" errors (10%), other drug-related problems (16%), difficult/failed intubation (9%), problems with the endotracheal tube (9%) and other problems (10%). When compared to the incidents in the main database, obstetric cases were found to be over-represented with respect to accidental dural puncture, post dural puncture headache, failed intubation in emergency situations and the incidence of certain types of "wrong drug" error. The implications of these reports regarding safe practice of obstetric anaesthesia are discussed.     

Diabetes in New Zealand--better information needed.

AIMS: To review the availability and quality of data on the epidemiology of diabetes in New Zealand. METHODS: A search was undertaken for all Medline-indexed publications on diabetes in New Zealand. Hospitalisation and mortality data (ICD9 code 250) from the New Zealand Health Information Service (NZHIS) were examined. RESULTS: Information on diabetes in New Zealand has come from community surveys, national surveys, diabetes registers, hospitalisation data and mortality data. Much of this information has been valuable, but there is still inadequate national information on diabetes prevalence, incidence and time trends. CONCLUSION: Information technology provides an opportunity to couple the surveillance of diabetes with improved diabetes care. Medical practitioners need to support the development of their own practice-based registers/recall systems and to contribute to the development of district-based diabetes registers where these have a central focus on improving diabetes care.     

Prevalence of known diabetes in different ethnic groups in inner urban South Auckland.

AIM: To describe the prevalence of known diabetes in different ethnic groups in inner urban South Auckland. METHOD: Cross-sectional household survey of 27,419 residences in the multi-ethnic community of inner urban South Auckland 1992-1995. RESULTS: Responses from 91.3% of households included 90,477 residents, 1862 (2.1%) of whom had diabetes. The all-age adjusted prevalence of known diabetes was 1.9 (1.7-2.0)% in Europeans, 5.2 (4.9-5.5)% among Maori, 4.0 (3.8-4.2)% among Pacific Islands people and 4.3 (3.8-4.9) 2% among other ethnic groups. There was heterogeneity within the Pacific Islands and "other" groups with the highest prevalence present in South Asians, Niueans and those from the Middle East. A non-significantly lower prevalence of diabetes was found among Chinese respondents. These data predicted 85,581 people with known diabetes in New Zealand in 1996. The greatest growth, due to demographic changes alone (i.e. without taking account of the known increased incidence of diabetes), was predicted among non-European, non-Polynesian groups, with a 181% increase in numbers with diabetes since 1991. CONCLUSION: Demographic pressures have been sufficient to increase the number with known diabetes by 13.9% in five years. This would have underestimated the epidemic in view of the observed growth in the age-adjusted incidence of diabetes in overseas studies.     

Children's perceptions of parental drinking: the eye of the beholder

OBJECTIVE: Children learn about alcohol and about how to drink through modeling experience, in part. Modeling is typically studied by asking parents to describe their drinking behavior. However, children's perception of parents' drinking may differ from the way parents describe it. This study examined the degree to which children's perceptions and parents' reports agreed. METHOD: A sample of 177 grade-school children and their parents was drawn from a public school in Kentucky. Children completed questionnaires inquiring about their perceptions of the quantity, frequency and the positive and negative consequences of their parents' drinking. Their parents completed similar questionnaires describing their own drinking and its consequences. RESULTS: As hypothesized, first and second grade children's perceptions of parents' drinking were unrelated to parents' self-reports: Most of these children perceived their parents as nondrinkers even though parents reported drinking. Also as hypothesized, children's perceptions and parents' reports were significantly correlated for third through sixth grade students. However, there was a great deal of reliable, but unshared variance between these older children's perceptions and parents' reports. Children's perceptions and parents' reports were consistently quite different, even when both child and parent described the parent as a drinker. CONCLUSIONS: Studies of modeling influences on children regarding drinking should assess children's perceptions of their parents' behavior rather than parents' self-reports.