Community-based research for promoting the new public health

The rhetoric of the new public health urges a focus on healthpromotion achieved through policy and structural change, andplaces emphasis on primary health care services based on communityinvolvement. Research should contribute to the implementationof such policies at the local level. Methods for community-basedresearch, however, are not well developed. This article, drawingon the experiences of a South Australian community health researchunit, describes approaches that can make research (especiallyneeds assessment and evaluative research) more relevant anduseful. The factors discussed include the relationship betweenresearchers, service providers and service consumers, and appropriateresearch methodologies for community research.     

Do Electrode and Lead Design Differences for Permanent Cardiac Pacing Translate into Clinically Demonstrable Differences? (Comparison of Sintered Platinum and Activated Vitreous and Porous Carbon Electrodes)

A randomized prospective study was undertaken to compare the electrical performances of three permanent, endocardial, tined pacing leads with different electrode designs--sintered platinum, vitreous carbon, and porous carbon. Ninety-nine patients received one of the leads (S80 31; 423S 32; S100 36). Acute R wave amplitude and ST elevation of the native endocardial electrogram, voltage threshold, impedance, and current flow at four pulse durations (0.25-1.0 msec) were measured. Voltage thresholds were measured noninvasively at each of four pulse durations at 2 days and 1, 3, and 6 months after implantation. No significant differences were found in sensing properties, or current flow at threshold at 0.5 msec pulse duration. The 423S lead had a significantly higher impedance at threshold and both a higher impedance and lower current flow at 5 V. No significant differences in threshold voltages were found between the three leads at any pulse duration, at any of the assessed times after implantation. Six-month thresholds for the S80, 423S, and S100 leads were 1.18 +/- 0.35, 1.17 +/- 0.29, and 1.06 +/- 0.38 V respectively at 0.5 msec pulse duration. Differences between 'high performance' pacing leads need to be of a greater order of magnitude before they can be exploited to give any real clinical advantage to patients.     

Community attitudes towards people with mental health problems: a discourse analytic approach

This paper addresses some methodological issues related to the generation of knowledge for mental health practice. It is suggested that a knowledge and understanding of attitudes towards the mentally ill has the potential to inform policy and practice regarding the establishment of community mental health facilities in order to encourage their acceptance by the public. Traditional approaches to attitude research are outlined followed by the proposal of an alternative approach: discourse analysis. The utility of each approach is assessed with regard to the potential relevance and applicability of research findings to practice. Traditional approaches are criticized on the grounds that they fail to take into consideration the social contexts within which attitudes are naturally expressed. As a result, information which is of potential interest to mental health practitioners is lost and it is unclear how the findings of such research might relate to or be translated into practice. It is argued, that since this information is to be found in the language used to describe people with mental health problems and to express attitudes towards them, that discourse analysis is ideally suited to the study of attitudes towards the mentally ill. The potential utility of the approach is demonstrated by an empirical example. Implications for practice are considered.     

Ultrasound study of the cranial venous system in the human new-born infant and the adult

A pulsed doppler ultrasound technique has been used to measure changes in blood velocities in the superior sagittal sinus, the jugular veins and intracranial and extracranial arteries in 13 neonates, and in the jugular veins and an extracranial artery in 13 adults, during unilateral and bilateral jugular venous compressions. The results have enabled us to determine how the subject under examination functionally uses his cranial venous drainage system in the resting state, and whether or not he can shunt obstructed venous flow through other cranial venous channels. We have found great variability between the subjects. In the resting situation the range of possibilities from total dependence on one jugular vein alone to usage of both jugular veins and the vertebral veins exists. Shunting of blood on jugular compression from either or both jugular veins to the vertebral veins may occur, and contralateral shunting between the jugular veins may be possible in both directions, in one direction or not at all.     

EFFECTS OF CATECHOLAMINES ON PREGNANT RAT UTERUS

• 1 The effects of noradrenaline (NA), adrenaline (Adr) and isoprenaline (Iso) have been studied on pregnant rat uterus, at various stages of gestation - on the 10th and 20th days of pregnancy and on the first day post-partum.
• 2 The three catecholamines were inhibitory in all stages of gestation, with the same order of potency as observed in non-pregnant uteri (ie Iso > Adr > NA). However, mean pD₂ values for the catecholamines tended to decrease as gestation progressed.
• 3 In 20 day pregnant and 1 day post-partum uteri, in the presence of propranolol, NA and Adr produced consistent α-adrenoreceptor mediated motor responses.
• 4 It is concluded that in the rat uterus, a form of pregnancy reversal occurs, in that there is a decrease in β-adrenoreceptor responsiveness, and an increase in α-adrenoreceptor responsiveness towards the end of gestation, and immediately post-partum.

     

Juvenile Erythrodermic Dermatomyositis

Letters to the Editor are welcomed for publication (subject to editing). Letters must be signed by all authors, and must not exceed two pages of text including references. Letters should not duplicate material submitted or published in other journals. Prepublication proofs will not be provided.     

A comparison of the effects of maternally administered meptazinol and pethidine on neonatal acid-base status

Summary. A randomized double-blind study compared the effects of equi-analgesic doses of maternally administered meptazinol (1.5 mg/kg) and pethidine (1.5 mg/kg) on neonatal acid-base status. Heel-prick samples were taken for assessment of acid-base status at 10 and 60 min after delivery. Maternal antenatal history, details of labour and neonatal status at delivery were also recorded. Meptazinol produced less neonatal respiratory depression than pethidine: the mean 10 min acid-base data from 16 infants whose mothers received pethidine were indicative of a respiratory acidosis (pH 7.13, SD 0.08, P co₂,9.11, SD 2.2 kPa; standard bicarbonate 22.3, SD 3.1 mmol/1). This was not evident in the mean acid-base data from 16 infants whose mothers received meptazinol (pH 7.23, SD 0.07; P co₂ 6.83, SD 1.6 kPa; standard bicarbonate 20.9, SD 4.2 mmol/1). The mean pH and P co₂ in the two treatment groups were significantly different (P<0.002) at 10 min but not at 60 min after delivery.     

Harlequin fetus successfully treated with etretinate

A harlequin fetus seen at birth was treated with etretinate and more general measures, including careful attention to fluid balance, calorie intake and temperature control. She improved, continued to develop, and had survived to 5 months at the time of this report.