Biomedical subjects
Publications and source records attributed to L Kendall.
The NHS's most significant contribution to reducing inequalities will be through partnerships with other organisations. Many health authorities have set targets and these vary greatly. HAs need to consider how susceptible any target is to local action.
This article focuses on methods of resolving conflict either within or between health care organizations using an alternative dispute resolution (ADR) strategy. After identifying the principal sources of contemporary disagreements within health services settings, the authors describe the basis of ADR. This is followed by a discussion of some common obstacles to settling a dispute. The principal communication guidelines and stages of a mediation session are presented. An alternative dispute resolution framework is proposed that includes an Office of Dispute Resolution (ODR). Also provided is a series of attributes that together comprise the core of mediation as a discipline.
The effects of DL-homocysteine, and DL-homocysteate, on extracellular levels of amino acids in the rat hippocampus have been studied using brain microdialysis. Hippocampal electroencephalogram activity was monitored simultaneously using an electrode attached to the dialysis probe. DL-Homocysteine (1200 mg/kg; i.p. injection) produced epileptic activity in hippocampus in an inconsistent manner. Alterations in electroencephalogram activity were not observed in urethane anaesthetized animals, whereas 50% of Hypnorm anaesthetized animals exhibited epileptic activity. DL-Homocysteate (2 mu mol; i.c.v.) induced epileptic activity in a majority of animals anaesthetized using urethane. Dialysate levels of aspartate were significantly elevated by homocysteine in both groups of animals. Conversely, dialysis levels of GABA were reduced. Dialysate levels of other amino acids measured (glutamate, glutamine, taurine, alanine and valine) were not affected significantly. Dialysate levels of taurine were increased significantly in animals injected with homocysteate. These data suggest that the imbalance in excitatory:inhibitory neurotransmission in the hippocampus caused by these alterations in extracellular levels of neuroexcitatory (i.e. aspartate) and neuroinhibitory (i.e. GABA) transmitters could underly the epileptic effect of homocysteine.
An animal model of perinatal asphyxia, in which near-term fetal rats are subjected to-short periods of hypoxia, has been investigated by 31P-NMR spectroscopy. Changes in the high-energy phosphates and intracellular pH of the fetal rat brain were measured in utero following ligation of the placental blood vessels, and during reperfusion after a 20-min period of occlusion. The hypoxia-induced changes observed in the fetal brain were substantially slower than in the adult, and were completely reversible after 20 min of hypoxia.
A group of 28 children attending a unit for children with developmental language disorders was assessed on a battery of cognitive and language tests. No relationship was found between verbal IQ and scores on other language measures. However, although correlations between the specialist language tests used were highly significant, the mean age scores obtained on the different tests were found to vary by as much as 2 years. The implications of these findings for clinical and experimental studies of children with language impairments are discussed.
The excitatory neurotransmitters glutamate and aspartate are an important factor in the causation of ischemic brain damage. The concentration of glutamate and aspartate was serially measured in extracellular fluid using in vivo microdialysis after induction of a subdural hematoma or after a sham operation in the rat. Measurements were made in the cortex underlying the hematoma and in the ipsilateral hippocampus, and these findings were correlated with regional cerebral blood flow (CBF), measured autoradiographically 2 hours after hematoma induction. In the severely ischemic cortex underlying the hematoma (mean CBF less than 25 ml/100 gm/min), glutamate and aspartate content increased more than 750% over basal levels. In individual animals the magnitude of glutamate release correlated with the extent of the focal ischemic zone under the hematoma (r = 0.907). Hippocampal glutamate levels rose 339%, yet regional CBF was preserved (114 ml/100 gm/min). This accords with focal hypermetabolism in this model, and may imply a glutamate-mediated "excitotoxic" process after subdural hematoma.
The efficacy of a controversial treatment, using colored filters to remediate reading disabilities, was measured empirically, with colored overlays placed over reading material on white paper. Irlen's (1983) method is to prescribe specific tinted filters as lenses that she claims filter specific light frequencies and remove a range of perceptual disorders that adversely affect reading and related learning performance. Irlen calls this condition "scotopic sensitivity" and claims it is a significant factor in a high percentage of people with learning disabilities. Ninety-two children with significant reading disabilities were classified as either scotopic or nonscotopic using the Irlen Differential Perceptual Schedule, and were randomly assigned to one of six treatment groups using colored or clear overlays. Reading performance (rate, accuracy, and comprehension) as measured by the Neale Analysis of Reading Ability (Neale, 1987) and the Formal Reading Inventory (Wiederholt, 1986) improved significantly when the scotopic children read with the preferred colored overlay filter compared to clear or different-colored overlay filters. Nonscotopic children showed no change.
Accounts of shamans' lives have typically emphasized the shaman's experience of a divine 'calling' and subsequent initiation as the key incidents around which other biographical, psychological, and cultural information may be organized and appreciated. Scholars have thus emphasized those aspects of the shaman's experience which set the shaman apart from other members of her or his society and at the same time, render the shaman comparable to other shamans in other places far removed in time and space. This paper takes a different approach, describing a series of ordinary misfortunes that befell a Korean mansin several years after her initiation, the interpretations she and her colleagues placed upon these events, the advice she received, and the healing strategies she subsequently followed. This discussion reveals those aspects of the shaman's experience that render her more, rather than less, like those she treats and suggests a process whereby the shared reality of shaman and client is realized in lived experiences, rituals, and conversations.
The Pawtucket (Rhode Island) Heart Health Program is designed to effect a community-wide change in heart disease morbidity and mortality by reducing smoking prevalence and other behavioral risks for this disease. The initial emphasis of the Pawtucket Heart Health Program was on the development of risk factor programs within specific churches, work sites, and other organizations in the community. At the end of 9 months of programming, however, only one organization had elected to begin a stop-smoking program. Given the community smoking prevalence of 43.4%, it was decided that larger-scale interventions would be required if a significant public health impact was to be realized. Therefore, a community-wide campaign was mounted to recruit as many participants as possible into the "Up in Smoke" cessation program. A lottery was attached to this program, with the contingency based on program attendance rather than cessation per se. One hundred three participants, including residents of neighboring communities, enrolled in three Up in Smoke lottery groups. At a 3-month follow-up, only 11 (7%) of smokers from the Up in Smoke lottery reported that they were not smoking (10% of those actually contacted). For a variety of reasons, the "Quit and Win" approach was later adopted by the Pawtucket Heart Health Program as the primary smoking intervention. One month after the end of the contest, 20% of those contacted reported not smoking. The percentage of quitters for the Up in Smoke program increased while the Quit and Win rate decreased over longer periods of follow-up. These and other data were compared with those of participants of a screening program conducted concurrently. Lotteries in general and face-to-face recruitment in large crowds were shown to be effective recruiting methods for large-scale smoking cessation programs.
Koreans attribute a wide variety of complaints to naeng, literally 'chill'. For women, a cold imbalance of the womb brings on a heavy vaginal discharge (also called naeng), can lead to sterility, and may precipitate other kinds of discomfort. Working in Korea, Dorothea Sich and her colleagues have described the folk etiology of naeng and some subtle transformations of the concept in cosmopolitan medical settings. I am less interested in describing the concept of naeng than in appreciating the complex interlayering of information and experience that shapes a Korean woman's sense of illness or well-being when she describes an intimate condition as naeng, and that may be lost in translation when she presents her condition to an American clinician. My informants were socialized as Korean women, they were veterans of a plural medical system in Korea, they were novices at seeking health care in Honolulu, and they were individuals, carrying the baggage of their own lives. These various dimensions emerge through interview data and, especially, through three detailed case studies. It is argued that a cookbook definition of cold wombs as folk illness would not explain the particular anxieties that naeng sufferers bring to a clinic; the vocabulary they use is vested with nuances that are personal as well as Korean, humoral as well as cosmopolitan.
Sufficient data exist to support approaches to lowering cardiovascular disease risk which target population-wide reductions in elevated blood cholesterol levels. Within the context of a multifactorial cardiovascular disease prevention program, a 2-month cholesterol education campaign was launched to encourage citizens to "Know Your Cholesterol" by attending screening, counseling, and referral events (SCOREs) held throughout the community. These events featured assessment of dietary fat and cholesterol, rapid blood cholesterol analyses with a fingerstick procedure and the Kodak Ektachem DT60, and immediate dietary counseling by trained volunteers. A total of 1439 persons attended 39 SCOREs: nearly 60% were found to have blood cholesterol levels that exceeded recommended goal levels. At a 2-month follow-up of 1040 of these same individuals, 600 had lowered their blood cholesterol level by an average of 29.1 mg/dl. This experience suggests that similarly modeled campaigns may have a significant impact on the distribution of blood cholesterol levels in the entire U.S. population.
The interexperimental variation often observed following the repeated monitoring of immune phenomenon was analysed using the alloimmune cellular response that developed in the spleens of B6AF mice following a challenge with Mastocytoma P815-X2 and intervention with BCG. The response, mediated solely by T cells, could be defined in terms of the involvement of nylon-wool adherent and nonadherent T cells. The relative contribution of each cell type to the response was found to vary considerably and could be use to define the interexperimental variation. Hence when a given treatment resulted in a poor response, the major contributors were nonadherent to nylon-wool, while when the same treatment yielded a good response, adherent cells became the predominant contributors. It was concluded that the inter-experiment variations observed here were a biological event, rather than an experimental artefact, being a function of the relative contribution of different T-cell subpopulations.
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The government's green paper sets specific targets for a reduction in the incidence of stroke. Carol Williams and Lynne Kendall look at the nurse's role in prevention and recovery.