"I know now that it's something that you can do something about": Deductive thematic analysis of experiences at an arts-based dementia risk reduction exhibit.

Dementia is one of the leading global health crises. Despite the devastating impacts of the illness, general population knowledge pertaining to risk reduction is still limited. Previous research on the impact of dementia risk reduction campaigns has largely focused on awareness rather than behaviour change. Our research introduced an arts-based exhibit to address dementia modifiability, aiming to enhance effectiveness by providing an immersive experience for altering adults' perceptions of risk reduction and lifestyle behaviours. Interviews were conducted with adults (n = 38 [13 male, 25 female]) who attended an interactive dementia awareness and risk reduction exhibit. Data was analysed using deductive thematic analysis within the Health Belief Model framework to determine key mechanisms of behaviour change. Four key themes encompassing exhibit significance and factors underlying behaviour change were identified. Participants recounted positive experiences, particularly being engaged by the artistic aspects of the exhibit, and recorded heightened engagement in behaviours supporting dementia risk reduction post-exhibit. Areas for improvement included the need for a take-home summary and variation in formats. Participants described prior encounters with dementia and their age as factors which influenced their engagement with dementia risk reduction behaviour, with younger participants reporting lesser engagement with risk reduction information. Our research found that arts-based educational initiatives have the potential to advance public understanding and promote behavioural changes for dementia risk reduction. Our study recommends enhancing the impact of future interventions by employing innovative formats and tailoring them to varied audiences, with a specific emphasis on engaging younger individuals.

Translational mini-review series on Th17 cells: CD4 T helper cells: functional plasticity and differential sensitivity to regulatory T cell-mediated regulation.

CD4(+) T cells display considerable flexibility in their effector functions, allowing them to tackle most effectively the range of pathogenic infections with which we are challenged. The classical T helper (Th) 1 and Th2 subsets have been joined recently by the Th17 lineage. If not controlled, the potent effector functions (chiefly cytokine production) of which these different cells are capable can lead to (sometimes fatal) autoimmune and allergic inflammation. The primary cell population tasked with providing this control appears to be CD4(+) regulatory T (T(reg)) cells expressing the forkhead box P3 (FoxP3) transcription factor. Here we consider the comparative capacity of FoxP3(+) T(regs) to influence the polarization, expansion and effector function of Th1, Th2 and Th17 cells in vitro and in vivo as well as in relation to human disease. This remains a particularly challenging series of interactions to understand, especially given our evolving understanding of T(reg) and T effector interrelationships, as well as recent insights into functional plasticity that cast doubt upon the wisdom of a strict categorization of T effector cells based on cytokine production.

Spotlight on teenage pregnancy--defining the demographics and the family planning requirements.

This study aims to provide a demographic analysis of teenage pregnancy and a needs-assessment for teenage family planning. A questionnaire was sent to all teenage mothers delivered in 2000 in Waterford Regional Hospital (WRH), and demographic analysis was performed. There were 118 teenage pregnancies, only 88% were primigravid, and 24% were aged <17 years. The response rate was 43%. The uptake of contraception before pregnancy was 74%, (42% using barrier methods only), and post-partum, the uptake was 98%, (12% barrier methods). The majority of teenagers (72%) prefer to attend the General Practitioner, preferably with an out-of-hours, weekday service. Teenage family planning is an area of need, particularly in the younger teen-years and following a pregnancy. We have shown how this can be addressed.

Medical residencies and increased admissions in rural hospitals with fewer than 200 beds.

Medical education programs in general, and rural residency programs in particular, can be beneficial for rural hospitals. This study of 1,792 non-metropolitan statistical area, acute general hospitals with fewer than 200 beds from 1993 to 1996 was designed to help rural hospitals and communities to quantify the likely effects of rural residency programs on hospital admissions. Data came from the hospital Prospective Payment System minimum data set. The results show that additional residents at rural hospitals with fewer than 200 beds generally result in an increase of approximately 100 to 200 admissions per resident--more for smaller hospitals and fewer for larger hospitals. Because increased admissions generally improve the financial health and continued operation of rural hospitals, this study confirms the importance of education-based strategies in ensuring access to care in rural communities.

NO contributes to proliferative suppression in a murine model of filariasis.

Infection of BALB/c mice with microfilariae (mf) of Brugia pahangi leads to the suppression of antigen (Ag)-specific proliferative responses in the spleen. The proliferative defect is dependent on inducible nitric oxide synthase (iNOS) activity, since inhibition of iNOS with either L-N-monomethyl arginine (L-NMMA) or aminoguanidine reversed defective proliferation. Splenocytes from mf-infected animals produce high levels of gamma interferon (IFN-gamma) upon in vitro restimulation with Ag, and experiments in IFN-gamma receptor-deficient (IFN-gamma R(-/-)) mice demonstrated that signaling via the IFN-gamma R is essential in the induction of NO production and subsequent proliferative suppression. Restimulation of splenocytes from mf-infected animals with an extract of Acanthocheilonema viteae, a related filarial worm which lacks endosymbiotic bacteria, also resulted in NO production and proliferative suppression, demonstrating that lipopolysaccharide of bacterial origin is not essential to the induction of iNOS activity. These results extend previous observations that infection with different life cycle stages of Brugia leads to the development of differentially polarized immune responses and demonstrate one method by which these differences may exert their effects on the proliferative potential of cells from infected animals.

Movement toward individual health benefit accounts.

There are strong pressures for employers to pursue defined contribution health benefits with individual health benefit accounts such as Medical Savings Accounts (MSAs), Health Care Reimbursement Accounts (HCRAs), and Comprehensive Individual Medical Accounts (CIMAs). Health care consumers are becoming more assertive. The political backlash against managed care is eroding provider-based cost control mechanisms. Health insurance premium inflation is intensifying. Advocates of the movement toward individual health benefit accounts view them as a means of restoring autonomy to the physician-patient relationship and controlling costs. Opponents are concerned that individual health benefit accounts of any type will segment insurance markets, benefiting the healthy and wealthy at the expense of the chronically ill and the poor. Can these accounts be designed so as to achieve their positive effects and minimize negative effects?

Enhancement of chemotherapeutic drug toxicity to human tumour cells in vitro by a subset of non-steroidal anti-inflammatory drugs (NSAIDs).

The effect on cytotoxicity of combining a range of clinically important non-steroidal anti-inflammatory drugs (NSAIDs) with a variety of chemotherapeutic drugs was examined in the human lung cancer cell lines DLKP, A549, COR L23P and COR L23R and in a human leukaemia line HL60/ADR. A specific group of NSAIDs (indomethacin, sulindac, tolmetin, acemetacin, zomepirac and mefenamic acid) all at non-toxic levels, significantly increased the cytotoxicity of the anthracyclines (doxorubicin, daunorubicin and epirubicin), as well as teniposide, VP-16 and vincristine, but not the other vinca alkaloids vinblastine and vinorelbine. A substantial number of other anticancer drugs, including methotrexate, 5-fluorouracil, cytarabine, hydroxyurea, chlorambucil, cyclophosphamide, cisplatin, carboplatin, mitoxantrone, actinomycin D, bleomycin, paclitaxel and camptothecin, were also tested, but displayed no synergy in combination with the NSAIDs. The synergistic effect was concentration dependent. The effect appears to be independent of the cyclo-oxygenase inhibitory ability of the NSAIDs, as (i) the synergistic combination could not be reversed by the addition of prostaglandins D2 or E2; (ii) sulindac sulphone, a metabolite of sulindac that does not inhibit the cyclooxygenase enzyme, was positive in the combination assay: and (iii) many NSAIDs known to be cyclo-oxygenase inhibitors, e.g. meclofenamic acid, diclofenac, naproxen, fenoprofen, phenylbutazone, flufenamic acid, flurbiprofen, ibuprofen and ketoprofen, were inactive in the combination assay. The enhancement of cytotoxicity was observed in a range of drug sensitive tumour cell lines, but did not occur in P-170-overexpressing multidrug resistant cell lines. However, in the HL60/ADR and COR L23R cell lines, in which multidrug resistance is due to overexpression of the multidrug resistance-associated protein MRP, a significant increase in cytotoxicity was observed in the presence of the active NSAIDs. Subsequent Western blot analysis of the drug sensitive parental cell lines, DLKP and A549, revealed that they also expressed MRP and reverse-transcription-polymerase chain reaction studies demonstrated that mRNA for MRP was present in both cell lines. It was found that the positive NSAIDs were among the more potent inhibitors of [3H]-LTC4 transport into inside-out plasma membrane vesicles prepared from MRP-expressing cells, of doxorubicin efflux from preloaded cells and of glutathione-S-transferase activity. The NSAIDs did not enhance cellular sensitivity to radiation. The combination of specific NSAIDs with anticancer drugs reported here may have potential clinical applications, especially in the circumvention of MRP-mediated multidrug resistance.

Which types of hospital mergers save consumers money?

This study analyzes the changes in costs and prices from 1986 to 1994 for more than 3,500 U.S. short-term general hospitals, including 122 horizontal mergers. These mergers were generally financially beneficial to consumers, providing average price reductions of approximately 7 percent. Merger-related price reductions were considerably less in market areas with higher market concentration levels. Merger-related price reductions in areas with higher penetration by health maintenance organizations (HMOs) were approximately twice those in areas with lower HMO penetration. Merger-related price reductions were greater for low-occupancy hospitals, nonteaching hospitals, nonsystem hospitals, similar-size hospitals, and hospitals with greater premerger service duplication.

Competition, professional synergism, and the geographic distribution of rural physicians.

This study provides a theoretical and empirical investigation of competition and synergism among physicians in rural areas. The results show that rural primary care physicians cluster together rather than distribute themselves evenly. This suggests that public policy makers and rural communities must take an active role to ensure provider availability in all rural areas. There is less clustering among subspecialists. The results also reveal a disturbing negative relationship between young children and physician availability in rural areas. Finally, the results provide strong evidence that the relationship between rural physicians and hospitals is synergistic.

An analysis of physician recruitment strategies in rural hospitals.

This article analyzes the importance and effectiveness of several physician recruitment strategies in 60 short-term general hospitals in rural Minnesota. The results suggest that rural hospitals should continue to attract physicians with quality facilities and services, increase efforts to facilitate group practice opportunities, and rely less on direct financial incentives.

U.S. hospital workforce-to-population ratios by service area.

Traditionally, hospital productivity has been measured in terms of episodic patient services such as days or admissions. However, the delivery of health care is shifting toward a greater focus on the health of a covered population. Thus, population-based indicators of hospital productivity are needed. This work analyzes hospital FTEs per 10,000 served population across the United States as a function of regional demographic, socioeconomic, and geographic factors. For managers of integrated service networks, it provides benchmarks for hospital FTEs per service population for several personnel categories. Important findings for public policy include an 11 percent increase in FTEs per 1 percent increase in interns and residents and a 2 percent increase in FTEs per 1 percent increase in the elderly.

Induction of labour--not how but why?

Induction of labour is one of the most frequently employed interventions in obstetric practice. Despite this, controversy exists over its role in many clinical situations.