Hormonal treatments of sexual unresponsiveness in postmenopausal women: a comparative study

Summary. Forty postmenopausal women, referred for hormone replacement therapy and all of whom reported a significant concern about a decline in their sexual interest, were randomly allocated to one of two hormone implant treatment groups: either oestradiol (50 mg) alone, or oestradiol (50 mg) and testosterone (l00mg). Comparison between the two groups as a whole revealed no significant differences on any measure, both treatments being associated with a significant reduction in the severity of psychological, somatic and vasomotor symptoms, and with a significant improvement in sexual interest and responsiveness. Similar effects were also observed in patients who denied, pretreatment, any concurrent dyspareunia. Although it is not possible to identify the reasons for change, the results indicate no advantages of supplementary testosterone administration over oestradiol alone for sexually unresponsive postmenopausal women.     

Interpersonal support amongst nurses at work

The needs for support of staff in human services work are often stated, but less often is the nature of such support clearly specified. This study attempts to clarify the nature of effective support from a superior, as perceived by qualified nursing staff working in psychiatric, mental handicap and medical settings. 'Personal respect', 'empathic attention' and 'absence of interpersonal defensiveness' appeared to be important components to such support. Staff on the same ward showed a high degree of agreement in judgements of their superior's personal respect and empathic attention, but perceived interpersonal defensiveness appeared more specific to perceptions or interactions between particular staff. Greater degrees of 'personal respect' experienced by staff were associated with reduced role ambiguity and reduced emotional exhaustion ('burnout'). The empathic attention reported as given by ward charge nurses was highly correlated with the personal respect they reported receiving from their own superior. These results support approaches which see respect, empathy and genuineness as important ingredients in helping relationships.     

Assessing reported adherence to pharmacological treatment recommendations. Translation and evaluation of the Medication Adherence Report Scale (MARS) in Germany

Objectives Patients' self‐report of medicine taking is a feasible method of assessing their adherence to prescribed pharmacological treatment. Aim of this study was to assess whether the German version of the Medication Adherence Report Scale (MARS‐D) is an appropriate instrument for measuring patient adherence. Methods After translation into German, the questionnaire was sent to 1488 patients with chronic diseases and patients with risk factors of cardiovascular disease. Reliability and validity of the MARS‐D were assessed and compared with the psychometric properties of the original English version. The relationship between patients' characteristics and adherent behaviour was estimated using bivariate correlation and a linear regression model. Results The MARS‐D was analysed if patients were taking medicines and the MARS‐D was complete leaving 523 (35.1%) analysable questionnaires. Internal consistency of the MARS‐D (Cronbach's α 0.60–0.69) was satisfactory and comparable to the English original (Cronbach's α 0.69–0.90). Test–retest reliability was satisfactory (Pearson's r 0.61–0.63), however, lower than in the English sample (r = 0.97). Convergent validity was low but showed statistical significance. Patient socio‐demographic characteristics had weak influence on MARS‐D score indicating high reported adherence for older patients (P < 0.05), patients with German mother tongue (P < 0.05) and high number of medicines (P < 0.01). Conclusions Preliminary psychometric evaluation of the MARS‐D is encouraging. MARS‐D is an appropriate measure to detect patients at risk of non‐adherence. The MARS‐D could be used in routine care to support communication about the medication taking behaviour, as self‐report of non‐adherent behaviour corresponds to the facts.     

关于“药品集中采购”的研究报告

目的为药品集中采购工作的健康发展及有关部门的相关决策提供参考。方法分析了当前药品集中采购中存在的突出问题、根源及其危害性,提出了解决问题的方案。结果与结论自2000年开始进行药品招标采购试点,至今已经走过了10的历程。改革取得的成效是不容质疑的,存在的问题也是实实在在的。只有正视问题进一步实施改革才是出路。     

Cognitive and educational outcome of very-low-birthweight children in early adolescence

A cohort of 138 very-low-birthweight (VLBW) 12-year-old children and matched control children were assessed on objective cognitive and educational measures. School performance was rated by teachers and by the children themselves. VLBW children were shown to have lower IQ scores, and poorer scores on all objective educational measures compared with control children. Controlling for IQ differences, mathematics and reading-comprehension scores remained significantly lower for VLBW children. Teachers rated VLBW children lower in all curriculum areas. Significantly more VLBW children were found to be 'failing' in one or more subject and an increased proportion compared with the control children had received remedial education. The VLBW group showed no evidence of 'catch up' between 6 and 12 years of age. Multiple regression analyses were used to identify predictors of cognitive and educational outcome. The duration of mechanical ventilation in the neonatal period was inversely related to outcome. Full-Scale IQ at 6 years, motor-skills score at 6 years, and head circumference at 12 years all predicted outcome at 12 years, as did maternal education, family income and size. Individually, many VLBW children perform satisfactorily, but as a group VLBW children appear to be at a long-term disadvantage to peers in the areas of cognitive and educational performance.     

Children whose mothers had second trimester amniocentesis: follow up at school age

Objective To explore potential long term consequences of second trimester amniocentesis.
Design Children exposed to second trimester amniocentesis have been followed prospectively from birth to school age and compared with children whose mothers declined the test.
Setting The Hospital for Sick Children, Toronto.
Sample Eighty-six children exposed to amniocentesis and 44 children whose mothers declined the test.
Interventions Second trimester amniocentesis for the late maternal age indication.
Main outcome measures Standardised tests of intelligence, academic achievement, speech articulation, visual-perceptual-motor ability and fine motor coordination were administered. Parents reported on child behaviour using standardised measures of behaviour problems, social competence, hyperactivity and temperament. Physical growth was also measured, and parents reported on child health.
Results Group differences were not observed.
Conclusions Second trimester amniocentesis does not appear to compromise child development, behaviour, growth or health.     

An evaluation of two systems of in-patient care in a general hospital psychiatric unit I: staff and patient perceptions and attitudes

This study reports a comparison of a single ward versus a two-ward system of acute in-patient care in a general hospital psychiatric unit. It focuses on staff and patient perceptions and attitudes towards the two types of ward. A continuous care ward system was preferred by the majority of staff who described an improvement in 'ward atmosphere'. Patients who had experienced both ward systems also preferred the continuous care system. Both patients and staff felt that the continuous care system still needed to place greater emphasis on 'ward atmosphere' dimensions of involvement, support and spontaneity. The implications of these findings for improving the functioning of the preferred ward are discussed.     

Outcome of extremely-low-birthweight infants

Summary. The overall 1-year survival rate of 261 infants born at 500 g–999 g over a 7-year period was 46%. The survival rate of the 220 inborn infants, corrected for birth defects, would have increased from 47% to 57% if delivery room deaths were excluded and to 62% if postneonatal deaths had also been ignored. Survival improved progressively with increasing 100 g weight groups. The disability rate in the 108 survivors who were at least 2 years old corrected for prematurity was 28% with little variation between the 100 g weight groups. There were no significant trends in annual perinatal mortality, 1-year survival and disability rate in survivors over the study period for the inborn population. The male infants had significantly lower normal-survival rate than the female infants. Small-for-gestational-age infants, comprising 11% of the inborn group, had significantly better survival but a higher disability rate. Multiple births had significantly lower survival and normal-survival rates than had singleton births. Infants whose mothers were transferred for delivery at the perinatal centre before onset of labour had a significantly better survival rate than those whose mothers had 'booked' and those who were transferred in labour.