动脉粥样硬化患者血浆内皮素和一氧化氮水平的观察

目的研究血浆内皮素(ET)和一氧化氮(NO)在颈动脉粥样硬化(AS)中的作用.方法用颈动脉超声检测患者顼AS情况,同时测定血浆ET和NO水平.结果颈AS阳性患者血浆ET水平明显升高,NO水平较阴性患者明显降低.结论AS病变可引起血管内皮依赖性舒张功能障碍,NO降低,ET增高是导致或加重AS的重要因素之一.     

Pain Impacts Sexual Functioning among Interstitial Cystitis Patients

Ethnographic methods were used to gather illness narratives on 11 men and 38 women diagnosed with interstitial cystitis (IC). Content analysis using the Spradley ethnographic method reveals that patients directly link IC pain to diminished sexual functioning. We conclude: (1) Patients with IC are deeply concerned about diminished sexual function. Physicians and rehabilitation specialists should actively investigate and treat this problem. (2) Management of IC pain is inadequate and leads to disability and changes in sexual practices. (3) Linking treatments for sexual dysfunction with appropriate pain management strategies could substantially improve the quality of life for patients with IC. Structural factors in medical delivery along with health insurance policies reduce patient access to a comprehensive and interdisciplinary set of needed health interventions that could make a difference in the treatment of persistent pelvic pain and sexual dysfunction. Recognition of these structural issues is the key to improved health service delivery.     

An ethnographic study of three mental health triage programs

Triage processes are commonly used to manage the interface between demand for, and supply of, health services. This dimension of service provision is particularly pertinent for mental health services in Australia, where demand outweighs services available. This paper draws on the experiences of using participant observation to explore mental health triage processes. Findings highlight the complexities of the researcher role and benefits of using an ethnographic approach to explore mental health triage patterns. Insider participant observation brings many challenges but also, in this study, enabled the researcher to uncover some roles and processes underpinning triage decisions in mental health services.     

Arguments for 'British Pluralism' in qualitative health research

AIMS OF THE STUDY: This paper examines the argument that certain qualitative research methods can be used in 'pure' forms. Whilst rigid adherence to particular published procedures might be possible, we argue that in many cases this is neither necessary nor more likely to increase the validity of the research outcome. METHODOLOGICAL PURITY: In examining the works of well-known claimants to particular research approaches such as grounded theory and phenomenology we show that purity of method is uncommon. In particular it is possible to demonstrate that all published qualitative methods are subject to their own underlying relativist philosophy. The implication of this is that all are social constructions and that their execution will necessarily be negotiated in time and context. CONCLUSION: We conclude that analysis of varied examples of qualitative research shows methods to be more flexible than is often admitted. What we describe as 'British Pluralism' is an attempt to accept this reality whilst maintaining rigour through integrity, clear accounts, reflexivity and constructive critique of one's own work and that of others.     

'Patient satisfaction': knowledge for ruling hospital reform--an institutional ethnography

Driven by funding restraint, Canadian health-care has undergone over a decade of significant reform. Hospitals are being restructured, as text-based practices of accountability bring a new business-orientation into hospital and clinical management. New forms of knowledge, generated through records of various sorts, are a necessary resource for managing care in the new environment. This paper's research uses Canadian sociologist Dorothy E. Smith's institutional ethnographic methodology to critically analyse one instance of text-based management. I analyse information about 'patient satisfaction' as it is generated through a patient survey (in which I was implicated through my involvement with a hospitalized family member). Subsequently, I have studied the management environment into which that information would be entered. I argue that in the instance analysed, the information becomes part of a dominant consumer oriented healthcare discourse that subordinates concerns about 'what actually happened' as a professional caregiver would have known it. On this basis, I contend that this sort of taken-for-granted approach to making decisions about quality care in hospitals may be seriously, even dangerously, flawed.     

Qualitative Methodologies and Community Participation in Examining Reproductive Experiences: The Harlem Birth Right Project

Objectives: Racial disparities in health present a challenge to public health because of the complexity of interacting social forces. The Harlem Birth Right Project sought to improve understanding of these forces by using qualitative and community participatory methods. In this paper we 1) describe the process of qualitative inquiry and community involvement, 2) evaluate the impact of community participation, and 3) present a brief summary of the findings on social context as it relates to pregnancy outcomes of women in Harlem. Methods: We operationalized the qualitative method by combining participant observation, longitudinal case studies, and focus groups. An ethnographic survey was used to verify and triangulate findings across methods of data collection. We involved the community in the design, implementation, and analysis by collaborating with community-based organizations, setting up a community advisory board, and the use of dialogue groups and community meetings. Results: The use of qualitative methods and community partnership uncovered important aspects of the social context of women's lives that may not have emerged through traditional epidemiologic research. We found that pregnancy may serve as a catalyst to increase perception of the magnitude of preexisting social stressors. Several stressors and chronic strains associated with structural forces were identified. For example, the high percentage of households headed by women is seen as one consequence of larger structural forces. While social support networks serve as an important coping mechanism to buffer against the stress caused by these structural forces, the types of support women seek differs by social strata, and some strategies were identified as being substantially more effective than others. Conclusions: Qualitative and community participatory research can be successfully conducted to support public health goals and can derive important new information on the social context of women's lives.     

A journey to becoming: the student nurse in transition

The study reported in this paper explored the nature of the transition experienced by student nurses in their journey to becoming qualified nurses. In keeping with the developing relationship between the disciplines of anthropology and nursing, the methodology of choice was ethnography. Data were collected by open-ended questionnaires and interviews with key informants from one English College of Nursing undertaking Diploma level Project 2000 Adult Branch Studies. Thematic analysis of the data revealed an ill-defined transition for the student nurse and this lack of clarity was being perpetuated for many by their dual role as both student nurse and worker. This was also creating a potential role conflict and a blurring of the boundaries between professional nursing and skilled health care work. The data also revealed two 'in limbo' states, a ritualized transition phase, and that the rationale for 'learning to become a nurse' retains the idealized and vocational imagery of nursing as helping and caring for sick people.