"Areas of Worklife scale" (AWS) short version (Spanish): a confirmatory factor analysis based on a secondary school teacher sample.

BACKGROUND: This study examines the construct validity of the Areas of Worklife Short Scale, a practical instrument to measure employees' perceptions of their work environments in the sample of secondary obligatory education teachers in Spain. METHODS: Conducted in 33 centers of secondary obligatory education in Spain (N = 677). Confirmatory Factor analysis for 3 different models for the 29-items version and 1 model for the 18-items version was tested. RESULTS: Results confirmed that the short AWS short version had the best fit to the data than any other model proposed (GFI-Satorra-Bentler scaled chi-squared = 320.19, × 2/df = 2.337) and good fit indices (CFI = 0.911; RMSEA = 0.046). CONCLUSIONS: This analysis ultimately supports the appropriateness of AWS short version to explore areas of worklife and therefore can indicate the factors that contribute to burnout in the sample of secondary obligatory education teachers in Spain. Therefore it has been confirmed that this tool is able to assess the 6 domains of work environment of secondary schools teachers.

Hyperventilation and amplified blood pressure response: is there a link?

Based on prior studies, the hypothesis that hyperventilation (HV) may have a pressor effect and play a causal role in hypertension has been suggested. The objective of this study was to correlate HV with blood pressure (BP)-change during a postural challenge. Consecutive subjects referred for evaluation of syncope, dizziness, chronic fatigue syndrome (CFS), fibromyalgia, or non-CFS fatigue were assessed with a 10-min supine 30-min head-up tilt test combined with capnography. We selected for analysis the records of patients aged 17-70 years, not taking vasoactive medications, having sitting systolic BP (SBP) < 140 mmHg, sitting diastolic BP (DBP) < 90 mmHg, and who completed 30 min of tilt. HV was diagnosed when end-tidal pressure of CO2 < 30 mmHg was recorded consecutively for > or = 10 min. Postural hypertension (PHT) was diagnosed when DBP on tilt > or = 90 mmHg was recorded consecutively for > or = 10 min. DBP-change was computed as (median DBP on tilt) -(median DBP supine). PHT and DBP-change were correlated with HV. A total of 320 patient charts were reviewed. PHT was present in 30 cases. The mean DBP-change in patients with PHT was +9.9 mmHg (s.d. 5.8), with three patients manifesting HV. Of the remaining 290 patients, 56 had HV, their mean DBP-change was -0.3 mmHg (s.d. 7.2). The other 234 patients without HV had a mean DBP-change +0.95 mmHg (s.d. 5.7), comparable to the DBP-change in patients with HV. In, conclusion, posturally induced HV was not associated with an increase in BP, nor was PHT associated with HV, except in a small minority of cases.

Public-private partnerships in healthcare: the managers' perspective.

The role of the private sector in the provision of publicly funded healthcare services has become the subject of increasing debate and discussion at the heart of the New Labour Government. The present paper reports the findings from an empirical study regarding the attitude of public-sector managers towards public-private partnerships in the healthcare arena. It reveals a growing awareness amongst managers of both the positive and negative consequences of stepping into the market place to purchase services. However, in the context of the ongoing ideological debate within the Government regarding the role of both the private sector and markets within healthcare, public sector managers are unlikely to receive the practical advice that will enable them to reap the benefits of working with the private sector and avoid the pitfalls.

Staff morale in the merger of mental health and social care organizations in England.

Following the closure of the last Victorian asylum in Somerset, the health authority and county council undertook a review of mental health services. A major outcome of this review was the creation of an integrated mental health and social care provider. The current paper explores the impact of this integration on the morale of staff members involved, using a conceptual model derived from the literature on organizational behaviour. During the year immediately following integration, the average ratings on all measures of role clarity and job satisfaction reduced. For staff members involved in the integration, by far the largest group of whom were mental health nurses, job satisfaction was related to team role clarity, team identification, emotional exhaustion and gender. These effects of the integration on staff morale are discussed in light of the wider research into the determinants of job satisfaction and the conditions for success in merging organizations. The study has significant implications for managerial and professional leadership during organizational change.

The meanings of 'culture' in health and social care: a case study of the combined Trust in Somerset.

On the 1st of April 1999 Somerset Health Authority and Somerset County Council established a Joint Commissioning Board (JCB) to commission mental health services. Simultaneously, the Somerset Partnerships Health and Social Care NHS Trust was set-up as a combined health and social care services provider; for the first time in England, the majority of social services mental health staff transferred their employment to this Trust. The JCB commissioned an evaluation of the impact of these innovations on users and carers, staff and senior officers and members in the organisations concerned. In the course of the research, one concept frequently recurred as a source of both optimism and concern: 'culture'. However, the meanings attributed to this term varied significantly between stakeholders. After summarising the methodology and the results to date of the evaluation, this paper briefly reviews the conceptions of culture in the literature on organisations, and introduces a taxonomy for discussing culture. That taxonomy is then deployed to explore the ways in which the notion of 'culture' is being applied to and within the combined Trust in Somerset, and the implications of those applications for local practice and national policy around partnership.

Characterization of NA+/H+ exchanger isoform (NHE1, NH32 and NHE3) expression in prairie dog gallbladder.

Gallbladder Na+ absorption is linked to gallstone formation in prairie dogs. Na+/H+ exchange (NHE) is one of the major Na+ absorptive pathways in gallbladder. In this study, we measured gallbladder Na+/H+ exchange and characterized the NHE isoforms expressed in prairie dogs. Na+/H+ exchange activity was assessed by measuring amiloride-inhibitable transepithelial Na+ flux and apical 22Na+ uptake using dimethylamiloride (DMA). HOE-694 was used to determine NHE2 and NHE3 contributions. Basal JNams was higher than JNasm with JNanet absorption. Mucosal DMA inhibited transepithelial Na+ flux in a dose-dependent fashion, causing JNams equal to JNasm and blocking JNanet absorption at 100 microm. Basal 22Na+ uptake rate was 10.9 +/- 1.0 micromol. cm-2. hr-1 which was inhibited by approximately 43% by mucosal DMA and approximately 30% by mucosal HOE-694 at 100 microm. RT-PCR and Northern blot analysis demonstrated expression of mRNAs encoding NHE1, NHE2 and NHE3 in the gallbladder. Expression of NHE1, NHE2 and NHE3 polypeptides was confirmed using isoform-specific anti-NHE antibodies. These data suggest that Na+/H+ exchange accounts for a substantial fraction of gallbladder apical Na+ entry and most of net Na+ absorption in prairie dogs. The NHE2 and NHE3 isoforms, but not NHE1, are involved in gallbladder apical Na+ uptake and transepithelial Na+ absorption.

Mental health. Doing the hurdles.

A survey of senior mental health managers in London found that less than half thought they would stay in their job more than a year. The resulting turnover could create significant instability. Respondents considered the development of community mental health teams as the top priority for implementation. Financial restrictions were seen as the major obstacle to service development. Most respondents welcomed the national service framework for mental health.

Laparoscopic tubal sterilization under spinal anesthesia in the Third World.

Adequate family planning options are extremely limited in the third world. Sterilization is desired by many and often unavailable. Quality of life for women and their families in the third world can be greatly improved by making additional family planning options available. This article describes a program to make sterilization available to women of southeastern Dominican Republic.

Pharmacologically induced preconditioning with diazoxide: a novel approach to brain protection.

BACKGROUND: Ischemic preconditioning is an endogenous mechanism whereby brief periods of ischemia render neurons resistant to subsequent lethal insults. This protection appears to alter cellular apoptosis and can be induced by potassium channel openers acting on the inner membrane of the mitochondria (mitoK(ATP)). To test the hypothesis that pharmacologic preconditioning could provide neuroprotection, the mitoK(ATP) opener diazoxide was used in a canine model of brain injury induced by hypothermic circulatory arrest (HCA). METHODS: Seventeen dogs were placed on cardiopulmonary bypass (CPB) and cooled to 18 degrees C. After 2 hours of HCA, animals were rewarmed and weaned from CPB. Six dogs received intravenous diazoxide (2.5 mg/kg bolus 15 minutes prior to CPB, then 0.5 mg/min until circulatory arrest, then restarted for the first hour of rewarming). Six animals received vehicle only. Five received diazoxide and the mitoK(ATP) blocker 5-hydroxydecanoate (5-HD). Using a modified Pittsburgh Canine Neurological Scoring System (0 = normal, 500 = brain death), animals were evaluated every 24 hours for 3 days. The brains were removed and histologic sections of four regions characteristically injured in this model were scored (0 = no injury, 4 = infarction) by a neuropathologist in a blinded fashion. RESULTS: Clinical scoring showed marked improvement in the diazoxide group at 48 hours (101 +/- 10.5 vs 165 +/- 14.8, p < 0.01) and 72 hours (54 +/- 9.3 vs 137 +/- 12.1, p < 0.01). This neuroprotection was attenuated when 5-HD was concomitantly administered. Three of four brain regions typically injured in this model (cortex, hippocampus, and entorhinal cortex) had significant neuron preservation in the diazoxide group. Likewise, combined region scores were significantly improved in the treatment group (1.18 +/- 0.2 vs 2.46 +/- 0.2, p < 0.01). CONCLUSIONS: Pretreatment with diazoxide resulted in significant improvement in both clinical neurologic scores and histopathology in our model of HCA. This suggests that pharmacologic preconditioning with the mitoK(ATP) channel opener diazoxide may offer effective neuroprotection during HCA.

Evaluation of community mental health services: comparison of a primary care mental health team and an extended day hospital service.

Alongside mental health policies emphasising the need to focus on people experiencing serious, long-term problems, recent general healthcare policy is leading to the development in the UK of a primary care-led National Health Service. While most primary care-led mental health initiatives have focused on supporting general practitioners (GPs) in managing milder depression and anxiety, this article describes an evaluation comparing primary care-based and secondary care-based services for people with serious long-term problems. A survey of service users was carried out at three points in time using three measures: the Camberwell Assessment of Need, the Verona Satisfaction with Services Scales and the Lancashire Quality of Life Profile. Staff views were sought at two time intervals and carers' views were obtained towards the end of the 2-year study period. The results indicate that both services reduced overall needs and the users' need for information. The primary care service also reduced the need for help with psychotic symptoms whereas the secondary care service reduced users' need for help with benefits and occupation. There were no major differences in terms of satisfaction or quality of life. Primary care-based services therefore appear to have the potential to be as effective as more traditional secondary care services. However, a more comprehensive range of services is required to address the whole spectrum of needs, a conclusion supported by the views of staff and carers.

Integrity, ambiguity or duplicity? NHS consultation with the public.

Recent guidance from the Department of Health and National Health Services (NHS) Executive has stressed the importance of public involvement in the NHS. This paper places this guidance in the historical context of public consultation in the NHS and explores, through a detailed case study, the traditional approach to consultation that the guidance is seeking to change. The paper concludes with some reflections on the challenges that will need to be addressed in order for the guidance to be put into practice.

A fatal case of intrathoracic cuterebriasis in a cat.

A seven-year-old, castrated male domestic shorthair was presented with lethargy, fever, and sneezing. In spite of intensive therapy, the cat's condition progressively worsened to severe dyspnea and death. At necropsy, a single, second instar larval stage of Cuterebra sp. was found in the trachea. This represents an unusual site for Cuterebra migration in an aberrant host. The cause of death was attributed to a combination of local tissue damage and anaphylaxis. Veterinarians should include Cuterebra migration in their differential diagnosis list for dyspnea.

Second exon of Tat of HIV-2 is required for optimal trans-activation of HIV-1 and HIV-2 LTRs.

To determine conditions for optimal trans-activation by Tat of HIV-2, genomic DNAs and cDNAs encoding Tat of HIV-2 were tested on their homologous (HIV-2) and heterologous (HIV-1) long terminal repeats (LTRs). It has been previously reported that Tat of HIV-2 could efficiently trans-activate only its own LTR but not that of HIV-1. The inefficient trans-activation of HIV-1 is due, in part, to an acidic residue in the basic, RNA-binding domain of Tat of HIV-2. Here we demonstrate that inefficient trans-activation of HIV-1 LTR is observed only with plasmids that express exon 1 and genomic forms of tat of HIV-2. Expression of both exons of Tat of HIV-2 from cDNA results in trans-activation of HIV-1 that is equivalent to the effect of Tat of HIV-1. In addition, the cDNA form of tat of HIV-2 trans-activates the HIV-2 LTR more efficiently than exon 1 and genomic forms of tat of HIV-2. We conclude that exon 2 of Tat of HIV-2 is important for optimal interactions with the trans-acting responsive regions (TARs) of HIV-1 and HIV-2 and that differential expression of short and full-length Tats of HIV-2 during the viral life cycle might affect viral latency, levels of viral replication, and cellular cytopathology.

Power in the National Health Service: a case study of a unit considering NHS Trust status.

There are a number of theoretical frameworks which aim to provide a language for understanding and discussing the nature of power and influence in organisational decision making. One of the most recent and comprehensive frameworks is that developed by Mintzberg. Following a resumé of the most pertinent sections of Mintzberg's framework, this paper uses it to investigate the power relationships in an NHS Mental Health Unit (MHU) considering NHS Trust status. This investigation reveals some important conclusions about the nature of power in the NHS but also explores some of the limitations of the framework as a descriptive and predictive tool.