bluuebunny/crossref_metadata_2025 huggingface dataset:
An Examination of DSM-IV Borderline Personality Disorder Symptoms and Risk for Death by Suicide: A Psychological Autopsy Study
Authors: McGirr Alexander , Paris Joel , Lesage Alain , Renaud Johanne , Turecki Gustavo
Published: January 2017

Objective:

To clarify whether certain Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), borderline personality disorder (BPD) symptoms are more prevalent among people who die by suicide, and thereby better predict suicide risk.

Method:

A psychological autopsy method with best informants was used to investigate DSM-IV BPD symptoms and suicide risk among people who died by suicide and met criteria for BPD ( n = 62), and BPD control subjects ( n = 35).

Results:

BPD symptoms in people who died by suicide were less likely to include affective instability and paranoid ideation–dissociative symptoms. The negative association between paranoid ideation–dissociative symptoms and suicide was independent of all other BPD symptoms, Cluster B comorbidity, and alcohol dependence.

Conclusions:

We found that discrete DSM-IV BPD symptoms differentiate people with BPD who die by suicide and those who do not. People with BPD who go on to die by suicide appear to constitute a specific subgroup of those who meet criteria for BPD, characterized by different general clinical presentation, but also by different characteristics within BPD.
Psychiatric Complications of Dementia
Authors: Bhat Ravi , Rockwood Kenneth
Published: January 2017

Our paper describes the neuropsychiatric signs and symptoms of late-life disorders of cognitive impairment. Late-life cognitive disorders are associated with psychiatric symptoms in various ways—from apparent risk factors to pathognomonic features of particular dementias. They contribute greatly to the burden of illness, both in people with dementia, and in those who care for them. Here we consider specific dementia symptoms in relation to dementing illnesses and to the stages of dementia. Recognizing that no one drug is likely to successfully treat all dementia symptoms, we argue for a syndromic approach, which can lead to appropriately targeted therapy.
Factors Associated with Not Seeking Professional Help or Disclosing Intent Prior to Suicide: A Study of Medical Examiners' Records in Nova Scotia
Authors: Kisely Stephen , Campbell Leslie Anne , Cartwright Jennifer , Bowes Matthew J , Jackson Lois
Published: January 2017

Objective:

Individual-level data from clinical settings lack information on people who did not seek professional help prior to suicide. We used records of the Nova Scotia Medical Examiner Service (NSMES) to compare people who had contact with a health professional prior to suicide with those who did not.

Method:

We linked data from the NSMES to routine administrative data of the province.

Results:

The NSMES recorded 108 suicides in Nova Scotia from January 1, 2006, to December 31, 2006; there were 90 male and 18 female suicide deaths. Mean and median age at death were 44.73 (SD 13.33) and 44 years, respectively. Patients aged 40 to 49 years made up one-third of the cases ( n = 35) and this was the decade of life with the highest number of suicides. This was also the group least likely to have suicidal intent recorded in the NSMES files (χ2 = 3.86, df = 1, P = 0.05). Otherwise, there were no significant differences between people who sought help, or disclosed intent, prior to suicide and people who did not. The samples in all cases were predominately male and single.

Conclusions:

People aged 40 to 49 years were the age group with the highest absolute number of suicides, but were the least likely to have suicidal intent recorded in the NSMES files. This finding merits further investigation. Medical examiner or coroner data may provide additional information not obtained elsewhere for the surveillance of suicide.
Childhood Maltreatment and Aggressive Behaviour in Violent Offenders with Psychopathy
Authors: Kolla Nathan J , Malcolm Charlotte , Attard Stephen , Arenovich Tamara , Blackwood Nigel , Hodgins Sheilagh
Published: January 2017

Objective:

To document experiences of childhood maltreatment among violent offenders with antisocial personality disorder (ASPD) distinguishing between those with and without the syndrome of psychopathy (+P and -P), and to determine whether maltreatment is associated with proactive and reactive aggression.

Method:

The sample included 10 violent offenders with ASPD+P, 15 violent offenders with ASPD+P, and 15 nonoffenders. All participants completed interviews with the same forensic psychiatrist focusing on physical, sexual, and emotional abuse prior to age 18 using the Early Trauma Inventory. Aggression was assessed using the Reactive-Proactive Questionnaire.

Results:

Violent offenders with ASPD+P reported significantly more severe childhood physical abuse, but not more sexual or emotional abuse, than violent offenders with ASPD-P and nonoffenders. Psychopathy Checklist'Revised (PCL-R) scores, but not childhood physical abuse, were associated with proactive aggression. Childhood physical abuse was associated with reactive aggression, as was an interaction term indicating that when both PCL-R scores and childhood physical abuse were high, so was reactive aggression.

Conclusions:

Among violent offenders, PCL-R scores were positively associated with proactive aggression, while experiences of childhood maltreatment were not. This finding concurs with previous studies of children and adults and suggests that proactive aggression may be a behavioural marker of psychopathic traits. By contrast, childhood physical abuse was associated with reactive aggression, even among violent offenders with high PCL-R scores. This latter finding suggests a strong influence of childhood physical abuse on the development of reactive aggression that persists over the lifespan.
Neuroimaging-Based Biomarkers in Psychiatry: Clinical Opportunities of a Paradigm Shift
Authors: Fu Cynthia H Y , Costafreda Sergi G
Published: January 2017

Neuroimaging research has substantiated the functional and structural abnormalities underlying psychiatric disorders but has, thus far, failed to have a significant impact on clinical practice. Recently, neuroimaging-based diagnoses and clinical predictions derived from machine learning analysis have shown significant potential for clinical translation. This review introduces the key concepts of this approach, including how the multivariate integration of patterns of brain abnormalities is a crucial component. We survey recent findings that have potential application for diagnosis, in particular early and differential diagnoses in Alzheimer disease and schizophrenia, and the prediction of clinical response to treatment in depression. We discuss the specific clinical opportunities and the challenges for developing biomarkers for psychiatry in the absence of a diagnostic gold standard. We propose that longitudinal outcomes, such as early diagnosis and prediction of treatment response, offer definite opportunities for progress. We propose that efforts should be directed toward clinically challenging predictions in which neuroimaging may have added value, compared with the existing standard assessment. We conclude that diagnostic and prognostic biomarkers will be developed through the joint application of expert psychiatric knowledge in addition to advanced methods of analysis.
Psychostimulant Prescriptions by Psychiatrists Higher Than Expected: A Self-Report Survey
Authors: Beck Charles , Silverstone Peter , Glor Kathleen , Dunn Joshua
Published: January 2017

Objective:

To survey Alberta psychiatrists on their prescribing of psychostimulants to adults.

Method:

A questionnaire was mailed to all 245 registered psychiatrists in Alberta. The respondents were requested to anonymously report, for the previous year, the number of adult patients to whom they prescribed pemoline, methylphenidate, amphetamines, or other psychostimulants for the treatment of adult attention-deficit hyperactivity disorder (ADHD), narcolepsy, unipolar depression, bipolar disorder, dementia, and other disorders.

Results:

The response rate was 93.9%; 88.7% treated adults. Of these, 46.6% prescribed psychostimulants to 1238 patients. The greatest proportion of prescriptions of psychostimulants was for adult ADHD, depression, and narcolepsy.

Conclusions:

Psychostimulants are more widely prescribed by psychiatrists than indicated in earlier studies and in recommendations for treatment.
Attributional Style and Depression in Schizophrenia
Authors: Addington Donald , Addington Jean , Robinson Geraldine
Published: January 2017

Objectives:

The literature implies that negative attributional style is a psychological correlate of depression. Recent evidence suggests that negative attributional style may be specific to depression. This study examines the association between level of depression and negative attributional style in a sample of individuals with schizophrenia.

Method:

One hundred and thirteen inpatients with schizophrenia were assessed with the Calgary Depression Scale for Schizophrenia and the Attributional Style Questionnaire.

Results:

Attributions of negative events to internal and to global causes were significantly associated with depressive symptoms. Only the global dimension was significantly associated with positive symptoms. No attributional dimensions were significantly associated with negative symptoms.

Conclusions:

These results are consistent with the idea that negative attributional style may be specific to depression and not a general characteristic of psychopathology.
Families, Alzheimer's Disease, and Nursing Homes
Authors: Linsk Nathan L. , Miller Baila , Pflaum Roberta , Ortigara-Vicik Anna
Published: January 2017

The Alzheimer's Disease Family Care Center program was established within an intermediate care teaching nursing home as a demonstration program to investigate ways to involve families in care of their relatives. In total, 45 family members participated in a program including an orientation session; a preliminary family involvement interview; contracts with family members, in which they chose specific tasks to engage in during visits; a five-session course on Alzheimer's disease and how families may be partners in care within the facility; and an ongoing family support group. Evaluation data sources include a baseline and 9-month follow-up questionnaire completed by families, preliminary and follow-up family interviews conducted by project codirectors, records of family visits, and family choices on contracts. Findings from the 23 family members who contracted for tasks during their visits and from the follow-up questionnaire completed by 25 family members showed that most sought social and emotional interactions with relatives, some maintained direct personal care activities, and only a few identified interest in extensive involvement with staff and facility. At follow-up, family members involved in the program reported they continued to feel close to their relatives. Many felt that their relatives were generally stable or improved with regard to cognitive function, but over a third noted difficulties in communicating. Participating family members reported that the program of staff supports helped them to feel more integral to the unit. They expressed a need for more education and support for their involvement in the nursing home setting. Project findings confirm previous studies recommending that programming at nursing homes needs to include specific institutional and staff supports to maintain and enhance family contributions to the long-term nursing home care of their relatives.
Hispanic Geriatric Residents in a Long-Term Care Setting
Authors: Jette Carmen C. Brenes , Remien Robert
Published: January 2017

While admission to long-term care facilities is often a stressful and disruptive experience for elders and their families, it can be particularly traumatic for Hispanics. In addition to common losses experienced in the process of institutionalization (e.g., loss of home, social network, and autonomy). Hispanic older adults lose the social context for the expression and reinforcement of cultural values such as “ respeto,” “ personalismo,” and “ confianza.” Because of cultural and language differences, some Hispanics face unique obstacles in adjusting to institutional living. We propose that the special circumstances aged Hispanics face in long-term care adversely affect quality of life and place them at risk for psychological disturbances (e.g., anxiety, depression, acting-out behaviors). After a discussion of issues in the context of the relevant literature, we propose some preventive and interventive strategies, discuss case studies that illustrate salient issues to adjustment, and generate a series of testable hypotheses.
Social Presence and Transactional Distance as an Antecedent to Knowledge Sharing in Virtual Learning Communities
Authors: Karaoglan Yilmaz Fatma Gizem
Published: January 2017

Today, the use of social network-based virtual learning communities is increasing rapidly in terms of knowledge management. An important dynamic of knowledge management processes is the knowledge sharing behaviors (KSB) in community. The purpose of this study is to examine the KSB of the students in a Facebook-based virtual community created within the scope of a class in terms of their social presence (SP) and transactional distance (TD) perceptions. Both SP and TD are important factors in the creation of a community feeling and in the interaction of the participants, and it is believed that these two factors will effect KSB in virtual communities. Data were gathered from 217 university students by using three scales: the KSB scale, the SP scale (subdimensions: interaction, ownership, and affective statements) and the TD scale (subdimensions: student–student [S–S] interaction, student–teacher [S–T] interaction, student–content [S–C] interaction, student–interface [S–I] interaction, and student–environment [S–E] interaction). The structural equation modeling showed that students’ KSB were related to their SP and TD perceptions in the process of utilizing virtual learning communities. The results of the study indicate that each subdimension of SP and TD scales are significant predictors on KSB. Further researches and implications are explained and discussed.
Radiologic Evaluation of Renal Trauma: Part 2
Authors: Goodacre Brian , vanSonnenberg Eric
Published: January 2017

Imaging of the kidneys and upper urinary tract has traditionally relied upon the administration of intravascular, iodine-based radiographic contrast agents. These contrast agents are not without drawbacks, however, and may cause renal damage, cardiopulmonary dysfunction, and allergic-type reactions. Computed tomography (CT) has largely replaced the “single shot” intravenous urogram (IVU), except in unstable patients, because of the ability to accurately and rapidly delineate the majority of significant renal injuries. Renal contusions, intra- and extrarenal hematomas, renal lacerations and fractures, and urinary extravasation all can be reliably depicted with CT. The extent of parenchymal injury, minor laceration versus “shattered” kidney, as well as the size of a hematoma or collecting system injury are critical in determining whether urgent intervention is required or expectant management can be instituted. Extravasation of intravascular contrast on CT is an important clue to significant, ongoing bleeding. Further evaluation with angiography is usually indicated in this case, with the additional benefit that transcatheter embolization may be curative. Other imaging modalities such as ultrasonography, magnetic resonance imaging, and nuclear medicine can be considered for patients with a history of intravenous contrast allergy or preexisting renal dysfunction. These latter modalities also assume more important roles in the follow-up of patients with posttraumatic renal tissue loss or hypertension.
Rapid and Definitive Diagnosis of Infectious Diseases Using Peripheral Blood Smears
Authors: Lehmann Lisa Soleymani , Spivak Jerry L.
Published: January 2017

A timely diagnosis is essential in the management of septicemia and septic shock. Three patients are described, all of whom presented with fever and one of whom was hypotensive at the time of admission. In each patient, rapid diagnosis of the cause of fever was possible because microorganisms were identified on a peripheral blood smear obtained at the time of admission. This identification permitted prompt initiation of appropriate antimicrobial therapy. In addition, a literature review of use of peripheral blood smears in the diagnosis of bacterial, fungal, and parasitic infections is provided.
Creating a Screening Measure of Health Literacy for the Health Information National Trends Survey
Authors: Champlin Sara , Mackert Michael
Published: January 2017

Purpose:

Create a screening measure of health literacy for use with the Health Information National Trends Survey (HINTS).

Design:

Participants completed a paper-based survey. Items from the survey were used to construct a health literacy screening measure.

Setting:

A population-based survey conducted in geographic areas of high and low minority frequency and in Central Appalachia.

Subjects:

Two thousand nine hundred four English-speaking participants were included in this study: 66% white, 93% completed high school, mean age = 52.53 years (SD = 16.24).

Measures:

A health literacy screening measure was created using four items included in the HINTS survey. Scores could range from 0 (no questions affirmative/correct) to 4 (all questions answered affirmatively/correctly).

Analysis:

Multiple regression analysis was used to determine whether demographic variables known to predict health literacy were indeed associated with the constructed health literacy screening measure.

Results:

The weighted average health literacy score was 2.63 (SD = 1.00). Those who were nonwhite ( p = .0005), were older ( p < .0005), or had not completed high school ( p < .0001) tended to have lower health literacy screening measure scores.

Conclusion:

This study highlights the need to assess health literacy in national surveys, but also serves as evidence that screening measures can be created within existing datasets to give researchers the ability to consider the impact of health literacy.
Multilevel Analysis of Municipal Officials’ Participation in Land Use Policies Supportive of Active Living
Authors: Zwald Marissa , Eyler Amy , Goins Karin Valentine , Lemon Stephenie C.
Published: January 2017

Purpose:

To investigate individual- and city-level factors associated with municipal officials’ participation in a local land use policy that supports active living.

Design:

Cross-sectional study.

Setting:

Eighty-three cities in eight states.

Subjects:

Four hundred thirteen elected and appointed officials with various job functions including mayors, city councilors, aldermen, selectmen, city or town managers, and heads of departments of planning, community development, public works, transportation, engineering, parks and recreation, neighborhood services, and public health.

Measures:

A Web-based survey assessed perceived importance of physical activity and livability issues to job responsibilities; perceived resident support of local government action to address physical activity and livability issues; and residence. City-level factors obtained from Census data included percentage of commuters by walking, bicycling, and public transit. The dependent variable was self-reported participation in developing, adopting, or implementing a local land use policy supportive of active living.

Analysis:

Hierarchical (two-level: municipal official–city) logistic regression model, using R.

Results:

Municipal officials living in the city where they worked were significantly more likely to be involved in a land use policy. Higher perceived importance of livability issues was associated with participation. Perceived importance of physical activity was inversely associated with land use policy involvement. Higher city-level bicycling rates resulted in increased odds of participation in a land use policy. City-level walking rates were inversely associated with land use policy participation.

Conclusion:

Municipal officials who worked in cities with a higher proportion of bicycle commuters, who prioritized livability issues, and who resided in the city where they worked were more likely to engage in land use policies supportive of active living.
Pragmatic, Randomized Controlled Trials of the Girls on the Go! Program to Improve Self-Esteem in Girls
Authors: Tirlea Loredana , Truby Helen , Haines Terry P.
Published: January 2017

Purpose:

To test the effectiveness of an intervention delivered by health professionals outside the school environment to girls identified with issues such as poor body image, low self-esteem, low self-confidence, nonparticipation in sports, or being overweight or underweight.

Design:

The study’s design was a stepped-wedge randomized controlled trial to test the efficacy of an intervention on self-esteem, impairment induced by eating disorders, self-efficacy, body satisfaction, and dieting behaviors.

Setting:

The study took place at the community health center located in a culturally diverse area of Melbourne, Victoria, Australia.

Subjects:

Participants were 122 primary and secondary school girls between 10 and 16 years of age.

Intervention:

Girls on the Go! is a 10-week program designed to improve self-esteem, body image, and confidence, using an empowerment model that involved interactive and experiential learning approaches. Weekly themes included body image and self-esteem, safety and assertiveness, a healthy mind, physical activity, healthy eating, trust and confidence, and connections.

Measures:

Measurements were made using Rosenberg Self-Esteem Scale, clinical interview assessment, health self-efficacy (included mental health and physical health self-efficacy scales), body esteem scale, and the Dutch Eating Behavior Questionnaire for Children.

Analysis:

A linear mixed model was used.

Results:

The intervention led to a significant increase ( p < .05) in self-esteem and self-efficacy (mental and physical health self-efficacy subscales), for both primary and secondary school-aged participants and reduced dieting behaviors (secondary school participants). These gains were retained after 6 months of follow-up.

Conclusion:

This group-based, low-dose intervention, which, although targeting girls with a range of psychological issues and including both overweight and underweight participants, is a successful means of improving self-esteem among girls from diverse cultural backgrounds.
Parental Involvement: Developing a Partnership and a Policy
Authors: Harding JO
Published: January 2017

Effective parental involvement stems from good management of the process
Clinical Pharmacy Nephrology Practice in the Outpatient Dialysis Center
Authors: Norwood Cynthia E. , Pahre Steven N.
Published: January 2017

Outpatient dialysis centers are a prime environment for clinical pharmacy intervention. Opportunity abounds for patient outcome-focused intervention such as intensive compliance counseling, drug-interaction screening, evaluation and interpretation of drug level assays, teaching (staff, physicians, patients), and enhanced overall medication management. Nephrology pharmacy is a relatively underdeveloped specialty practice, with clinical pharmacy practice in outpatient dialysis centers comprising a very small segment of that practice. There are many topics of concern that show a need for further evolution of this practice: polypharmacy, patient compliance, expensive medications (ie, recombinant human erythropoietin [rHuE-PO]), and Medicare End Stage Renal Disease (ESRD) program reimbursement constraints. In this report the origin and current status of the pharmacy nephrology service at St. Joseph Hospital and Health Care Center in Tacoma, WA is described.
Horizontal Mergers in the United States Health Field: Some Practical Realities
Authors: Weil T. P.
Published: January 2017

During the past decade, ‘merger mania’ has been a striking trend in the US health field as a strategy to improve the integration of services, to reduce expenses, and to increase the ability of providers to manage risk-based payment. However, during the past quarter of a century limited operational and fiscal evidence has been published in both the health and general management literature that strongly supports the efficacy of horizontal mergers. This article further argues that a likely scenario over the next decade, in spite of disappointments among these mergers in effecting significant cost reductions, is for the US health networks to continue acquiring additional providers and insurers. After these alliances gain significant market penetration, they are expected to behave as oligopolists. For these mergers to eventually achieve their earlier projected savings, the health field's leadership will be forced to implement cost-cutting measures such as: more vigorously coordinating the network's key clinical services to reduce competition for revenues among the partners within an alliance, closing superfluous hospitals and centralizing expensive tertiary services, encouraging surplus physicians to relocate to under-served areas, and providing direction to carefully integrate the best elements of what the competitive and regulatory strategies are able to offer to improve access, social equity, quality of care, and to reduce total health expenditures.
What is a ‘Learning Organization’ in General Practice? A Case Study
Authors: Cantle Florence
Published: January 2017

The focus of the research herein was to examine the main characteristics of a learning organization in a general practice. An ethnographic approach was taken. Blockage instrument, structured interviews and documentary evidence were used to establish the validity and the reliability of the research. Data were collected and analysed systematically. It is shown that the case study practice contains the characteristics of a learning organization and key management and organizational issues, such as policy making, practice management and performance management, are identified. Management strategies are offered and recommendations made both for the case study practice and generally for primary and secondary healthcare services. We hope that our research will guide further strategic planning in the case study practice, and that it will help other general practices and the NHS as a whole in the development of a learning organization.
Strategic Choices for a Primary Care Advantage: Re-Engineering Osteopathic Medicine for the 21st Century
Authors: Glover Saundra H. , Rivers Patrick Asubonteng
Published: January 2017

The rapidly growing area of osteopathic medicine takes us beyond high technology, life-saving equipment, or at least the most accurate diagnostic test. Whether it is called ‘alternative’, ‘complementary’ or ‘holistic’ medicine, it cannot be ignored as a legitimate healthcare choice, with well-defined benefits for healthcare consumers. This paper examines the history, development, philosophy of practice and challenges facing the viability of osteopathic medicine. More specifically, we address the following key questions: What is osteopathy medicine? What role does osteopathic medicine play in the provision of health services? What challenges face this professional group? And is osteopathic medicine an alternative approach to healthcare?
Privatizing Indigent Health Services in Los Angeles County: Understanding the Effects on Community-Based Providers
Authors: Grazman David N. , Cousineau Michael R.
Published: January 2017

Faced with imminent financial collapse of its public healthcare system, the Los Angeles County Department of Health Services solicited community-based providers to supply primary care health services to the medically indigent. This study highlights the effects that participation in the programme has had on these community providers. While strongly committed to the programme's objectives, community providers tended to overextend themselves financially, putting their organizations at substantial risk of failure should contractual expectations or patient demand forecasts not be met. Because of this risk, policymakers involved in public—private partnerships with community-based providers must exercise extreme caution owing to the unique status many of these providers hold as centrally positioned actors in their communities. On the positive side, we found evidence of increased levels of co-operation and innovation between community providers outside their formal roles in the county-sponsored public—private partnership programme.
On Taking Chances with the Law of Large Numbers
Authors: Stuart Bruce , Yesalis Charles
Published: January 2017

An increasing number of major purchasers of health services now consider capitation to be the preferred method of payment for individual physicians and small group practices. This paper is a primer on capitation payment plans for small risk pools. It describes some of the basic economic issues that purchasers and providers face when negotiating small-panel capitation contracts, including sources of risk, techniques of risk reduction and risk sharing. An empirical section analyses the experience of a plan that took a chance with the law (law of large numbers) and lost.
Physician Use of Hospitals: Effects of Physician, Patient, and Hospital Characteristics
Authors: Burns Lawton R. , Wholey Douglas R. , Huonker John
Published: January 2017

This paper examines the determinants of hospital utilisation in one county. In contrast to previous studies, the paper examines the physician rather than the patient as the key decision-maker. Specifically, the paper assesses the impact of several physician, patient, and hospital characteristics on the probability of admitting to a hospital, the volume of the physician's admissions at the hospital, and the concentration of the physician's admissions at the hospital. Distance from the physician's office to the hospital exerts the strongest and most consistent effects. The results are interpreted in light of several theoretical and research perspectives on physician behaviour.
Graduate Recruitment in the Future
Authors: Key Peter
Published: January 2017

Many organizations face increasing difficulty, not to mention direct competition, in recruiting the appropriate quality and number of graduates. This paper examines the basic demographic position and then records the approaches organizations are taking to overcome the shortfall in graduate recruitment. Finally, some options and alternatives are considered.
Relative Performance Evaluation of Non-Profit Hospitals
Authors: Pink George H.
Published: January 2017

In this paper, we use the relative performance evaluation model of Gibbons and Murphy (1990) to examine the relationship between management compensation and the absolute and relative financial performance of 223 non-profit hospitals in Ontario, Canada for the year 1985–86. We find support for the hypothesis of a positive relationship between absolute hospital performance and management compensation and a negative relationship between relative hospital performance and management compensation. Management compensation is also influenced by the size, teaching status, and religious affiliation of the hospital.
Changing Cultures—Determining Domains in the NHS
Authors: Mark Annabelle , Scott Hilary
Published: January 2017

This article explores changes in the National Health Service (NHS) as an organisation, in the context of the emerging managerial culture. This new culture is also seeking to influence the other forms of organisational culture which have co-existed until now in the NHS; its success in doing so is limited by the lack of a shared value system within the new management culture. The issue is explored with reference to domain theory as suggested by Kouze and Mico (1979), and subsequently amended by others, to fit the developments occurring in the NHS. Consideration is given to the following issues with reference to the three domains of politics, management and professions.

Can we establish:

Can we establish: the continued existence of each domain the changing location of groups between each domain the interrelationship between the domains the location of issues within or between the domains

The theory is then located within the broader discipline of organisational behaviour to provide a revised model for thinking about and acting upon the cultural change in the new NHS; the organisational learning now required is shown to require the following activities by each domain; identification, interpretation and communication.
Undergraduate Medical Education towards Health for All: Progress, Pitfalls, Perspectives
Authors: Carvalho Antonio C. M.
Published: January 2017

I discuss aspects of undergraduate medical education related to primary health care and analyse innovative programmes, with emphasis on problem-based methods and community-based education. Assessing the impact of these programmes shows problem-based learning is an interesting didactic exercise but not a necessary or sufficient condition for the adequacy of programmes to the Health for All (HFA) policy. Community-based education is pressed by several obstacles inside and outside educational institutions that put at risk its effectiveness as a real agent of change. Amongst these obstacles are political difficulties in building linkages amongst teaching institutions, services, and community; logistical problems in facilitating faculty and student work in the community; reactions from faculties; poor research opportunities in primary health care; pressures for more socially, professionally, and economically rewarding careers; biases in training the present generation of teachers; attempts to fulfil the social, behavioural, epidemiological, and preventive knowledge requirements for medical education by adding to an already overloaded information base; and shortage of relevant and significant sources of information for the medical students.

Building corporations representing ‘innovative’ programmes, on one side, and ‘conservative’, ‘traditional’ ones, on the other, is not helpful and probably false. Each Programme should be assessed in its strength and weaknesses in the light of political decisions committed to change in unequal, poor-quality health systems.
Effects of Nitrite Use on Lymphocyte Mitogenesis in Homosexual Men
Authors: Ross Michael W , Drew Paul A
Published: January 2017

Immune function in 97 homosexually active men (none of whom had HIV infection) was assessed. Data revealed that mitogenesis in those who used volatile nitrites compared to those who did not was higher at 72 h but that there was no difference between the groups at 96 h. In those who had high as compared to low nitrite use, mitogenesis was higher at 72 h but decreased significantly by 96 h. These data support previous suggestions that immunosuppressive effects of nitrites alone cannot account for the development of Kaposi's sarcoma in homosexual men with HIV infection.
The Role of Maternal Syphilis, Gonorrhoea and HIV-1 Infections in Spontaneous Abortion
Authors: Temmerman M , Lopita M I , Sanghvi H C G , Sinei S K F , Plummer F A , Piot P
Published: January 2017

The role of the human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) as risk factor for spontaneous abortion was investigated in a case-control study in Nairobi, Kenya. Cases ( n = 195) were women admitted with clinical signs and symptoms of spontaneous abortion, before 20 weeks of gestation. Patients with induced or clinically septic abortion were excluded. Controls were unselected pregnant women in their second or third trimester ( n = 195). Spontaneous abortion was independently associated with maternal HIV-1 antibody (14.4% versus 6.2%; adjusted odds ratio, 2.3; 95% confidence interval, 1.1–4.8), with maternal syphilis seroreactivity (6.8% vs 2.1%, adjusted odds ratio, 4.3; 95% confidence interval 1.2–15.6), and with vaginal colonization with group B streptococci (15.6% vs 5.2%; adjusted odds ratio, 3.2; 95% confidence interval, 1.5–6.7). No significant association was found between maternal infections with gonococci and genital mycoplasmas, and spontaneous abortion.
The Impact of HIV Disease on an Irish Prison Population
Authors: Murphy M , Gaffney K , Carey O , Dooley E , Mulcahy F
Published: January 2017

Between January 1987 and January 1991, 168 known HIV-infected prisoners have been incarcerated in Dublin's Mountjoy prison. This figure constitutes 16.6% of the total HIV-infected population in the Republic of Ireland over the same period. One hundred and forty-one (84%) of these prisoners have attended the Department of Genitourinary Medicine, St James's Hospital, Dublin. This group displayed considerable morbidity from HIV-related disease. Respiratory tract infection was the most frequent complication seen. Much additional morbidity was directly attributable to intravenous drug use. A survey of a representative group of inmates revealed that 64.7% were diagnosed HIV-positive in prison. The mean length of time spent incarcerated since the diagnosis of HIV infection was 38.9 months. Twenty-nine of 34 individuals who answered a questionnaire were imprisoned for drug-related crimes and 32 of 34 prisoners admitted to parenteral drug use within the prison. As the HIV epidemic unfolds in Dublin, increasing numbers of prisoners with symptomatic HIV disease will spend time incarcerated in Mountjoy prison. This will pose a considerable burden on prison and hospital medical services alike.
The First Woman Doctor from Aberystwyth: Mary Angharad Guy (née Hughes) (1905–1994)
Authors: Owen Buddug
Published: January 2017

Mary Angharad Guy was born one of three daughters of an affluent seafaring family. After preclinical education in Cardiff she proceeded to Charing Cross Hospital, London, for her clinical studies and on qualification worked with eminent men. She married John Guy, who became county medical officer for Westmorland, and they had three children. She gave up her career after marriage and it was another 15 years before she returned to work, to undertake school and baby clinics. She was a woman of outstanding promise and gifted artistically, but she was caught in a social trap between the wars, when women were expected to give up professional careers on marriage.
John Bell (1763–1820), the ‘Father’ of Surgical Anatomy
Authors: Kaufman M H
Published: January 2017

John was one of four very talented sons of the Reverend William Bell. Two qualified as advocates and both became professors. John and his younger brother Charles (later Sir Charles) entered medicine. John qualified with the Edinburgh MD degree in 1779, then obtained the FRCS Edin diploma in 1786. As a student, initially he studied anatomy under Professor Alexander Monro secundus, and it was soon evident to him that his teacher did not have any first-hand knowledge of the problems encountered by surgeons. He then decided to teach anatomy, while practising as a surgeon, and was among the first to emphasize the relevance of anatomy to surgical practice. During this period he lectured and wrote on anatomy and surgical anatomy. After 1800 he, like many of his surgical colleagues, was excluded from the Edinburgh Royal Infirmary as a consequence of the activities of Professor James Gregory, one of the most influential of the managers of that institution. When he stopped lecturing, he continued practising as a surgeon and wrote several influential textbooks but he never forgave Gregory for exclusion from the Infirmary. He was soon recognized as one of the foremost surgeons in Scotland. He spent the last few years of his life on the Continent attending to the surgical needs of the numerous expatriate Britons who lived there.
Professor Sir William Liley (1929–83): New Zealand Perinatal Physiologist
Authors: Hawgood Barbara J
Published: January 2017

William (Bill) Liley received his MB ChB from Otago University, Dunedin (New Zealand), in 1954. Under the guidance of the neurophysiologist Professor J C Eccles (1903–97), he carried out major research on neuromuscular transmission, both as an undergraduate at Otago University and as a postgraduate at the Australian National University at Canberra. In 1957 Bill Liley switched to research in obstetrics at the Women's National Hospital at Auckland in New Zealand. He refined the diagnostic procedure for rhesus haemolytic disease of the newborn and was able to predict its severity. Liley developed the technique of intrauterine transfusion of rhesus-negative blood for severely affected fetuses and led the team that carried out the first successful fetal transfusions in the world. He was a passionate advocate of the medical and societal rights of the unborn child.
Sir Ernest Graham-Little, MP, MD FRCP (1867–1950): Dermatologist and Politician
Authors: Monk B E
Published: January 2017

Sir Ernest Graham-Little was not only one of the foremost British dermatologists of the first half of the 20th century but he also served from 1924 to 1950 as an Independent Member of Parliament. As a dermatologist he played a leading role in medical education, wrote a vast number of clinical papers, was the President of both the British Association of Dermatology (as it then was) and the Section of Dermatology of the Royal Society of Medicine, and he described a form of scarring alopecia that has become known as Graham-Little syndrome. He was the first to describe the syndrome later named after Waterhouse and Friedrichsen. In Parliament he expressed his opinions on a vast array of subjects, often advancing views well ahead of his time. Perhaps most remarkably, for much of his time in Parliament he was still an active dermatologist. Notwithstanding the formidable achievements in his twin careers, his name is not well known.
Toxic Honey and the March Up-Country
Authors: Daugherty C G
Published: January 2017

This article gives an account of the Greek warrior-historian Xenophon and his Anabasis ( The March Up-Country), one of the most famous events in military history. It includes a description of how the Greek soldiers, after reaching apparent safety near the south-eastern Black Sea, were felled by a strange honey that rendered them as if dead for a day. Modern understanding of the toxicology of this honey is given, then an epilogue summarizing the rest of Xenophon's life.
False-Positive Result and Reattendance in the Ontario Breast Screening Program
Authors: Chiarelli A M , Mai V , Moravan V , Halapy E , Majpruz V , Tatla R K
Published: January 2017

Objective:

To determine the association between initial screen result and returning for a second screen in an organised breast screening programme for women with a biennial screening recommendation.

Setting:

Women who attended the Ontario Breast Screening Program (OBSP).

Methods:

A retrospective cohort study was conducted of 140,723 Ontario women aged 50 years ond older who had an initial screen at the OBSP between 1 July 1990 and 31 December 1995 and were followed until 30 June 1998. Rescreening rates at 36 months and risk ratio estimates were calculated using survival methods. Age of women, year of screen, region (within Ontario) and initial screen result were compared. For initial screen results, returning for a second screen was examined by integration of screening centre with an assessment programme and by modality of referral.

Results:

Women with a false-positive result were less likely to return for a second screen as were women aged 70 and older and those living in regions of Ontario with fewer OBSP screening centres. However, there were minimal differences in reattendance behaviour by initial screen result for women screened at the OBSP centre with an assessment programme.

Conclusions:

Integration of breast screening and assessment services improved reattendance of women with false-positive screen results within an organised screening programme.
Screening for Non-Insulin-Dependent Diabetes Mellitus (NIDDM): How Often Should it Be Performed?
Authors: Davies Melanie , Day John
Published: January 2017

Objectives—

To examine whether a screening programme for diabetes repeated after an interval of 30 months is worthwhile both in terms of yield of new cases and continued high response rate.

Methods—

Self testing for postprandial glycosuria was used as it has been shown to have a good response rate, a good yield of cases of diabetes, and a sensitivity and specificity which compares favourably with more expensive and invasive screening methods. A total of 3231 subjects aged 45–70 years in one practice were screened on two occasions 30 months apart. Eighty seven subjects known to have diabetes were excluded. This number included five new patients who had presented since the initial screen; two of whom had moved into the practice, one who screened positive at the initial screen but failed to attend for the oral glucose tolerance test (OGTT), and two subjects who had screened negative, the first presenting 24 months after screening.

Results—

At repeat screening the return rate was lower than at the first screening (72·5% v 79·2%, P < 0·0001). Glycosuria was detected in 52 subjects (2·3%), at the repeat screening, similar to that at the initial screen. Attendance for the OGTT after a positive screening test was 93·2%. Only six subjects of the 24 with Glycosuria but normal glucose at initial screen were found to have glycosuria again; repeat OGTTs were all normal. Of the remaining 46 subjects, 10 had non-insulin-dependent diabetes mellitus (NIDDM) and five impaired glucose tolerance (IGT). The number of subjects with diabetes was not significantly different from that at the initial screening (0·44% v 0·72%, P = 0·2).

Conclusions—

Repeat screening after 30 months has a high response rate, similar rate of detection of glycosuria, and a further yield of 0·44% of newly diagnosed cases of diabetes. A screening programme detecting postprandial glycosuria identifies additional diabetic subjects 30 months after a previous screening programme.
Presentation of Screen Negative Results on Serum Screening for Down's Syndrome: Variations across Britain
Authors: Allanson Abi , Michie Susan , Marteau Theresa M
Published: January 2017

Objectives—

To document current practice of communicating screen negative results to pregnant women undergoing a test for Down's syndrome.

Setting—

169 British NHS hospital antenatal clinics currently offering multiple marker serum screening for Down's syndrome and giving results directly to women.

Methods—

All 169 clinics were sent a letter asking about the method and form of communicating screen negative results.

Results—

In only 29% of programmes were specific arrangements made to inform women of screen negative results, and in 5% these results were not given at all. Screen negative results were given as a verbal phrase in 44% of programmes, as a risk figure in 16% of programmes and as both in 40% of programmes.

Conclusions—

These results highlight a gap between screening policy guidelines and practice in the case of Down's syndrome serum screening.