The role played by informal carers in the care of people with chronic disabilities is well known. Given its importance, it is essential to consider the evaluation methodology applied in economic appraisals of different care options. Few studies attempt any evaluation and those that do use varied, inconsistent and controversial methodologies. This paper aims to elicit the major issues and methodological problems related to economic appraisal of informal care. The main concern over the present methods utilized is the lack of explicit exploration of the benefits, as perceived by carers. Carers, through their decision to care it is argued, will consider both costs and benefits. Although concepts encompassed by benefits tend to be less tangible they may considerably outweigh any financial burdens. Various methods have been utilized in the past. Financial outlays are fairly straightforwardly costed, personal effort on the part of carers causes more problems. Methods applied include: the cost of substitute services; state benefits; and travel time values. The most useful is probably the latter, although it is not problem-free. Assessing benefits relating to concepts of direct and indirect utility and welfare is more complex and difficult to measure. Despite considerable literature on carers' attitudes, often these concepts are not applied (especially to residential care options) or if they are, negative aspects are emphasized (with domiciliary care). A useful application of economic appraisal would elicit optimal solutions to care dilemmas. Producing economic burden information about informal care may not be particularly constructive. Brief assessment of eight scenarios of care, considering cost differences for the public sector and the preferences of patient and carer gives insight to the problem. It emphasizes the complexity of the issue and the essential role likely to be placed on care managers in helping carers to maximize the net benefit of their efforts.

Caregivers↗

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Botulinum a toxin for spasmodic torticollis: multiple vs single injection points per muscle.

Eighty-six injections in 49 patients with adult onset spasmodic torticollis were evaluated for efficacy with respect to single point per muscle versus multiple point per muscle injection techniques. Parameters of the syndrome assessed were pain, posture deformity, range of cervical motion, disfigurement, cervical muscle hypertrophy, activity limitation, and degree of involuntary movement. The multiple point per muscle injection strategy appeared superior to the single injection per muscle technique with respect to pain (p less than 0.002, chi-square), posture deformity (p less than 0.001), range of motion (p less than 0.001), and improvement in activity endurance (p less than 0.001). No significant differences were noted with respect to cervical muscle hypertrophy or degree of involuntary movements, although the injections were considered beneficial in both groups to these syndrome components.

Adult↗

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Training physicians to conduct physical activity counseling.

BACKGROUND: In accordance with the U.S. Preventive Services Task Force recommendations, the current pilot study tests the feasibility and efficacy of a physician-delivered physical activity counseling intervention. METHODS: A sequential comparison group design was used to examine change in self-reported physical activity between experimental (counseling and self-help materials) and control (usual care) patients at base-line and 6 weeks after the initial office visit. Patients in both groups were contacted by telephone 2 weeks after their office visit and asked about the physical activity counseling at their most recent physician visit. Experimental patients also received a follow-up appointment to discuss physical activity with their physician 4 weeks after their initial visit. RESULTS: Counseling was feasible for physicians to do and produced short-term increases in physical activity levels. Both groups increased their physical activity, but the increase in physical activity was greater for patients who reported receiving a greater number of counseling messages. CONCLUSIONS: Physician-delivered physical activity interventions may be an effective way to achieve wide-spread improvements in the physical activity of middle-aged and older adults.

Aged↗

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Use of a new integrational vector to investigate compartment-specific expression of the Bacillus subtilis spoIIM gene.

The product of the spoIIM gene of Bacillus subtilis is required for complete septum migration and forespore engulfment during sporulation. To investigate whether expression of spoIIM is required in the forespore compartment of the sporangium, we have constructed a new integrational vector, pKSV7, which contains temperature-sensitive replication functions derived from pE194ts. The presence of the conditionally defective replication origin greatly stimulates plasmid excision when sporulation occurs at the permissive temperature. This facilitates the use of a genetic technique employed by Illing et al to distinguish genes whose expression must occur in the forespore from genes that may be expressed exclusively in the mother cell compartment. The results of the integration/excision experiments using pKSV7 support the conclusion that spoIIM must be expressed in the forespore. Biochemical analysis of forespore and mother cell fractions suggests that spoIIM is also expressed in the mother cell. The conditional integrational vector pKSV7 replicates at high copy number in E coli and allows the identification of inserts in the polylinker cluster by disruption of alpha-complementation and thus should be useful for other kinds of genetic manipulations in B subtilis.

Bacillus subtilis↗

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Anticipatory guidance for the employed breast-feeding mother.

A significant number of women are combining childrearing and career. Mothers who opt to breast-feed while employed may demonstrate increased breast-feeding success when supported by knowledgeable counseling. This article discusses specific techniques for maintaining maternal fluid intake; pumping, storing and preparing breast milk; wardrobe planning; and personal hygiene. Knowledge of these measures will provide the basis for anticipatory guidance for mothers who wish to balance the demands of breast-feeding and employment.

Breast Feeding↗

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Observations on staphylococcal strains with reference to impedin and mastitis.

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Animals↗

PubMedDate not supplied

The role of the pediatric nurse practitioner in educating teens with mental retardation about sex.

Adolescents with mental retardation have sexual needs that are often overlooked, underestimated, or considered problematic by parents, teachers, or other caregivers. This article describes ways in which the pediatric nurse practitioner can help these special teens develop responsible social and sexual relationships through assessment, education, coordination of services, appropriate referrals, and regular follow-up.

Adolescent↗

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Leucofiltration, retention/generation of soluble prion and annexin V and storage of blood components.

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Annexin A5↗

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Fibre mapping--a case study.

Fibre mapping, more commonly known as one-to-one taping, was developed in Germany approximately twenty years ago. The technique facilitates the distribution of fibres on a surface to be recorded. The impact of this technique on the investigation of serious crime has been reported in the European Fibre Group on several occasions. This paper represents a case study of the application of the technique. It is believed to be the first time that this technique has been successfully applied in the United Kingdom.

Journal Article↗

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A study of the cellular response to orientated fibronectin material in healing extensor rat tendon.

3D orientated fibronectin (Fn) mats have been used as biocompatible and biodegradeable scaffolds to provide orientated cues using contact guidance for cell migration/adhesion and deposition of extracellular matrix. We have implanted Fn scaffolds in an established rat tendon(partial tenotomy) injury model to test its efficacy and monitor the early cellular and inflammatory response. Tendons were harvested at 0, 6 h, 1, 3, 5, 7 and 14 days for H&E, immunohistochemistry and TEM. Total cell counts within the window increased progressively with time with no significant differences between the Fn scaffolds and controls. CD45 (pan leukocyte) positive cell numbers peaked at 6 h and when expressed as a percentage of total cell counts as determined by H&E staining constituted 20% of the total cell number at 6 h but decreased to 5% of total number by 72 h. There were no significant differences in the inflammatory response between the control and implanted groups. Few CD44 (mesenchymal stem cell) positive cells identified had a surface location. A novel cell with long exaggerated cytoplasmic processes was identified by TEM. Our results show that the Fn scaffold did not degrade or elicit any untoward inflammatory response at the time points tested and has potential use in guiding the repair process.

Journal Article↗

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Theoretical mechanisms in targeted and random integration of transgene DNA.

The genetic manipulation of mammalian cells and animals would be greatly expedited if gene targeting could be reliably achieved in the widest possible range of host cell types. This paper considers empirical evidence and theoretical considerations associated with transgene integration, and concludes that utilisation of gene targeting in non-selective systems awaits further progress in modelling homologous recombination.

Animals↗