Vertical equity in service provision: a model for the Irish public health nursing service

AIMS: This paper analyses the policy and conceptual basis of public health nursing service provision in the Republic of Ireland and situates it within an international context. It draws on the principles of horizontal and vertical equity in proposing a new model of public health nursing service provision. It gives the reader an understanding of a model of service delivery underpinned by the principle of vertical equity. BACKGROUND ISSUES: The Public Health Nurse in the Republic of Ireland has a wide remit encompassing primary, secondary and tertiary care at the level of the individual, family and community. The changing sociological and demographic nature of society in Ireland has impacted on a service that has largely remained unchanged since 1966. Since 1997 four review bodies have provided recommendations that are incompatible with each other. There remains a need to find a solution to the overwhelming demands placed on the public health nursing service in the Republic of Ireland. KEY ISSUES: The public health nursing service goes beyond the provision of a purely clinical nursing service. Communities differ in demography, epidemiology, environment, history, composition, support and most importantly needs. Using three exemplars a new model for the public health nursing service is explicated. This model has as its main focus the needs of the community it serves. CONCLUSIONS: A service underpinned by the principle of vertical equity can be used to deliver locally based, needs driven public health nursing services. The application of such a model would make the public health nursing service more flexible and responsive to local need. Public health nursing composition and provision must be determined using the principal of vertical equity determined by the needs of the community it serves.     

Fingerspelling, signed language, text and picture processing in deaf native signers: the role of the mid-fusiform gyrus

In fingerspelling, different hand configurations are used to represent the different letters of the alphabet. Signers use this method of representing written language to fill lexical gaps in a signed language. Using fMRI, we compared cortical networks supporting the perception of fingerspelled, signed, written, and pictorial stimuli in deaf native signers of British Sign Language (BSL). In order to examine the effects of linguistic knowledge, hearing participants who knew neither fingerspelling nor a signed language were also tested. All input forms activated a left fronto-temporal network, including portions of left inferior temporal and mid-fusiform gyri, in both groups. To examine the extent to which activation in this region was influenced by orthographic structure, two contrasts of orthographic and non-orthographic stimuli were made: one using static stimuli (text vs. pictures), the other using dynamic stimuli (fingerspelling vs. signed language). Greater activation in left and right inferior temporal and mid-fusiform gyri was found for pictures than text in both deaf and hearing groups. In the fingerspelling vs. signed language contrast, a significant interaction indicated locations within the left and right mid-fusiform gyri. This showed greater activation for fingerspelling than signed language in deaf but not hearing participants. These results are discussed in light of recent proposals that the mid-fusiform gyrus may act as an integration region, mediating between visual input and higher-order stimulus properties.     

Aerobic exercise improves hippocampal function and increases BDNF in the serum of young adult males

Physical activity has been reported to improve cognitive function in humans and rodents, possibly via a brain-derived neurotrophic factor (BDNF)-regulated mechanism. In this study of human subjects, we have assessed the effects of acute and chronic exercise on performance of a face-name matching task, which recruits the hippocampus and associated structures of the medial temporal lobe, and the Stroop word-colour task, which does not, and have assessed circulating concentrations of BDNF and IGF-1 in parallel. The results show that a short period of high-intensity cycling results in enhancements in performance of the face-name matching, but not the Stroop, task. These changes in cognitive function were paralleled by increased concentration of BDNF, but not IGF-1, in the serum of exercising subjects. 3 weeks of cycling training had no effect on cardiovascular fitness, as assessed by VO₂ scores, cognitive function, or serum BDNF concentration. Increases in fitness, cognitive function and serum BDNF response to acute exercise were observed following 5 weeks of aerobic training. These data indicate that both acute and chronic exercise improve medial temporal lobe function concomitant with increased concentrations of BDNF in the serum, suggesting a possible functional role for this neurotrophic factor in exercise-induced cognitive enhancement in humans.     

Basilar artery blood flow velocity changes in patients with panic disorder following 35% carbon dioxide challenge

PURPOSE: We compared the mean basilar artery blood flow velocity (BABFV) between patients with panic disorder and healthy subjects both at rest and immediately following carbon dioxide (CO(2)) challenge, and examined the effects of treatment on BABFV. METHODS: Twenty four patients with panic disorder with or without agoraphobia and 12 healthy comparison subjects were studied. Visual Analog Anxiety Scale was used to evaluate the anxiogenic effect of 35% CO(2) inhalation. Mean BABFV was monitored using transcranial Doppler ultrasonography at rest and 10, 20, 30, 60, 90, 120 s after 35% CO(2) challenge both before and after four weeks treatment with paroxetine. RESULTS: The hemodynamic response pattern of basilar artery to CO(2) inhalation was significantly different between two groups. CO(2) rapidly triggered blood flow velocity in basilar artery amongst panic patients but not in healthy comparisons. The mean time to normalization of BABFV was significantly longer in panic patients. Four weeks of treatment with paroxetine led to a significantly reduced mean BABFV after 35% CO(2) inhalation in comparison with pretreatment. CONCLUSIONS: Patients with panic disorder had impaired cerebral regulatory mechanisms observed as a change in response characteristics in BABFV in response to CO(2) inhalation. Treatment with paroxetine reduced the increase of BABFV seen in patients after the CO(2) challenge.     

Placement of External Ventricular Drains and Intracranial Pressure Monitors by Neurointensivists

Introduction  External ventricular drains (EVDs) and intracranial pressure (ICP) monitors are widely used in the Neurological Critical Care Unit (NCCU) to measure ICP and divert cerebrospinal fluid (CSF). EVDs and ICP monitors have historically been placed by neurosurgeons; however, with recent staffing of NCCUs by neurointensivists, a growing number of EVDs and ICP monitors are being placed by these specialists. Results  Limited data are available concerning the safety or feasibility of such placements by neurointensivists. We present our experience with EVD and ICP monitor placement by a neurointensivist in the NCCU. A retrospective chart review of 29 patients with EVD placement and 7 patients with ICP monitors—all placed by a single neurointensivist—was conducted for patients admitted to the NCCU from August 2005 to January 2008. Discussion  These findings were compared to published outcomes from neurosurgeon placements. All 29 patients with EVDs remained infection-free, with CSF pleocytosis occurring in one patient (3.4%). All 7 patients receiving ICP monitors remained free from infection. Complications after drain placement occurred in 20.7% (n = 6) of patients, with all six complications being EVD tract hematoma measuring less than 5 cm³. Conclusion  Patients receiving ICP monitors had no complications. These complication rates are comparable to published rates, which suggest that placement of EVDs and ICP monitors by neurointensivists may be safe and effective. However, small sample size (n = 36) prohibits definitive safety and efficacy conclusions. For this reason, further research analyzing a larger patient sample is warranted.     

Epstein-Barr virus encephalitis: findings of MRI, MRS, diffusion and perfusion

Epstein-Barr virus is an infection that is known as infectious mononucleosis. Even though the central nervous system is not a primary region of involvement of this disease, neurological complications are reported rarely. In this case report, we evaluated a 15-month-old male who presented to the pediatric neurology clinic due to high fever and a neurologic attack. His serological tests and radiological examinations (magnetic resonance imaging (MRI), MR spectroscopy (MRS), diffusion-weighted imaging (DWI) and MR perfusion) were consistent with Epstein-Barr virus encephalitis, which is a very rare complication of infectious mononucleosis. Additionally, we discuss the MRI, MRS, DWI and MR perfusion findings of our case, which were different from other cases reported in the literature.     

Electrophysiological evidence for the effect of interactive imagery on episodic memory: encouraging familiarity for non-unitized stimuli during associative recognition

Episodic memory depends upon multiple processes, including familiarity and recollection. Although associative recognition tasks are traditionally viewed as requiring recollection, recent research suggests a role for familiarity if to-be-remembered stimuli are perceived as unitized. Here we use event-related potentials (ERPs) to examine the relationship between stimulus properties and encoding strategy on the engagement of familiarity during associative recognition. Participants studied word pairs containing an association (e.g. traffic-jam) or an unassociated semantic relationship (e.g. violin-guitar), using either item or interactive imagery. At test, participants were required to recognize if word pairs were presented in the same pairing as study, were rearranged, or new. We hypothesized that adopting a strategy of interactive imagery during encoding (i.e. encouraging unitization) would enhance familiarity for unassociated word pairs but would have no effect on association pairs because they are already perceived as unitized. As expected, overall recognition performance was better for word pairs encoded with interactive imagery, and for association than semantic word pairs. ERPs recorded at test revealed an interaction between encoding strategy and stimulus properties. Association word pairs elicited similar bilateral frontal (familiarity) and left parietal (recollection) old/new effects following item and interactive imagery. By contrast, for semantic word pairs, the left parietal effect was equivalent across conditions, but the bilateral frontal effect was enhanced for the interactive imagery condition. The ERP results suggest that an encoding strategy of interactive imagery can enhance familiarity during associative recognition, but this effect is ultimately dependent on the properties of the stimuli to-be-remembered and the nature of the representations that underlie them.