Resource management in community residential facilities for adults with learning disabilities.

The trend towards community living for people with learning disabilities puts pressure on traditional hierarchical lines of resource management. A sample of 150 community residential facilities is surveyed in order to describe the systems used to manage resources in the community and to assess the impact they have on the quality of service provided. There are marked differences amongst provider agencies in the degree to which responsibility for resource management is devolved to facility managers and this has a direct effect on the quality of care. Residential homes which operate under centralised management systems are more institutional in their care practices and less responsive to individual clients' needs. In contrast, homes in which responsibility is delegated to the facility manager provide a service more in keeping with current philosophies of care. The results of this survey suggest that more responsibility for resource management can be delegated to facility managers without losing control of expenditure and with improvements in the efficiency and effectiveness of care.     

Acute-phase protein synthesis in human hepatoma cells: differential regulation of serum amyloid A (SAA) and haptoglobin by interleukin-1 and interleukin-6.

Interleukin-6 (IL-6, BSF-2 or IFN-beta 2) is thought to be the major regulator of the acute-phase protein response that follows tissue injury and inflammation, with interleukin-1 (IL-1), tumour necrosis factor and more recently, LIF or HSF III, slightly stimulatory on only certain acute phase proteins. The synthesis of the major acute-phase protein SAA, originally described as being synthesized in response to IL-1, has been claimed recently to be mainly under IL-6 regulation. Our results show that in the human hepatoma cell line HuH-7, IL-1 is the major stimulating cytokine increasing SAA synthesis by a factor in excess of 100-fold. We also show that under most conditions interleukin-6 and tumour necrosis factor stimulate additively in combination with IL-1. Isoelectric focusing has demonstrated that SAA1 and SAA2 alpha are expressed but not SAA2 beta. The HuH-7 cell line is IL-6 responsive since haptoglobin is stimulated mainly by IL-6.     

Diagnosis of Streptococcus pneumoniae pneumonia by quantitative enzyme linked immunosorbent assay of C-polysaccharide antigen.

AIMS--To evaluate the use of a quantitative enzyme linked immunosorbent assay (ELISA) detecting C-polysaccharide (PnC) antigen in sputum for the diagnosis of Streptococcus pneumoniae infection. METHODS--Specimens of sputum from 60 patients with acute community and hospital acquired pneumonia and infective exacerbations of obstructive airways disease were examined by semiquantitative culture and antigen ELISA. RESULTS--Using a cutoff value of 1 microgram/ml PnC antigen for a positive result, the sensitivity of this assay was 90.3%, specificity 93.1%, predictive value of a positive result was 93.5%, and the predictive value of a negative result 89.6%. CONCLUSIONS--Quantitation of C-polysaccharide antigen in sputum by ELISA distinguishes between carriage of oral bacteria which express PnC-like antigen and infection with S pneumoniae and compares favourably with other diagnostic methods.     

Acute-phase proteins and the serological evaluation of experimental contact sensitivity in the mouse

The evaluation of contact reactions in previously sensitized mice is assessed conventionally by measurement of increases in ear thickness following challenge. In an attempt to develop a serological method for the investigation of contact sensitization in mice, we have examined whether analysis of changes in the concentration of acute-phase proteins in response to challenge provides a reliable alternative means of evaluating elicitation reactions. Measurement of either the relative serum haptoglobin concentration, using radial immunodiffusion, or the absolute concentration of serum amyloid A, by an enzyme-linked immunosorbent assay, has been found to correlate well with induced increases in ear thickness following challenge. Changes in the concentration of acute-phase proteins proved to be of sufficient sensitivity to reflect the specificity of contact sensitization and its inhibition by antigenic competition.     

Prioritising home care needs: research with older people from three ethnic minority community groups

This paper draws on research with three minority ethnic community groups in Manchester. The aim of the study was to examine and prioritise social care needs. Focus groups were chosen as a way of beginning discussion about these issues. The findings suggest that some quality issues are relevant to all communities of older people. However, some were specific to the community groups. This paper describes some of the lessons learned about running focus groups with people whose first language is not English and suggests some considerations for future research.     

Sulphatide-binding properties are shared by serum amyloid P component and a polyreactive germ-line IgM autoantibody,the TH3 idiotype

Serum amyloid P component (SAP) concentration was elevated in sera from leprosy patients, significantly so above endemic controls in lepromatous cases. In the sera of lepromatous leprosy (LL) patients who experienced an erythema nodosum leprosum (ENL) episode the SAP fell at the onset of ENL and remained low throughout, in two of three cases. Changes in SAP concentration parallel anti-sulphatide IgM concentrations. TH3, a monoclonal IgM germ-line antibody derived from a LL patient, and SAP share similar binding patterns. In this study we demonstrate binding to heparin and sulphatide. Moreover, SAP inhibited the binding of TH3 to sulphatide, as well as anti-sulphatide IgM found in a range of sera, and anti-sulphatide IgG in the only sera sample in which it was found. The observation that anti-TH3 idiotype monoclonal and polyclonal anti-SAP antibodies both inhibited the binding of TH3 and IgM in sera (but not IgG) to sulphatide without binding to sulphatide themselves further demonstrated similar binding specificities. The observations of similarity in binding reinforce ideas that SAP may function as a primitive opsonin, but the clear ability to inhibit binding of autoantibodies suggests that SAP may play a role in ameliorating tissue and particularly nerve damage in leprosy patients.     

Attitudes to clients with mental handicap

The increase in community care provision for people with a mental handicap makes an understanding of the attitudes and motivations of staff caring for them an urgent priority. Norma Raynes and colleagues describe a Department of Health-sponsored study which investigated the quality of care delivered in four key sectors of community residential care. Their findings reveal the positive attitudes of staff in all four settings and suggest that local authorities have a potential source of highly motivated recruits among those working in the health, voluntary and private sectors.