Innovation and restrictive conformity among hospital employees: individual outcomes and organizational considerations.

Two factors characterize innovative organizational climates as perceived by nonmanagerial hospital employees. The first, innovation, comprises perceptions about the consequences or contingencies (e.g., punished, ignored, rewarded) of such proactive activities as implementing new ideas, questioning established methods, and communicating with other departments and the supervisor. The second, restrictive conformity, comprises perceptions about the consequences of risk-aversive, conflict-avoidant activities that suggest dysfunctional conformity (e.g., "sticking to the rules no matter what"). Positive personal outcomes--greater role clarity, organizational involvement, and satisfaction, and lower role conflict and willingness to leave the organization--are associated with innovation; negative personal outcomes are associated with restrictive conformity. The dialectical tension between conformity and innovation is discussed in terms of loose coupling and a reward systems perspective.

Sustained improvements in hygiene behaviour amongst village women in Lombok, Indonesia.

Fifty-seven mothers in Indonesia were involved in a face-to-face health education programme which encouraged hand-washing with soap. The intervention spanned 4 months and comprised fortnightly visits by 2 community organizers, who supplied free soap. Two years after the intervention, 79% of mothers were still using hand soap, despite the fact that they now had to buy it themselves. The community seemed to be benefiting from a sustained reduction in diarrhoea episodes due to improved hygiene practices.

PIP: In early-mid 1990, in Balai Lua in Central Lombok, Indonesia, two community organizers distributed free hand soap and a plastic soap box to 65 mothers of children aged less than 11 years and encouraged them to wash their hands and those of their children after defecation and before contact with food. They also encouraged mothers to clear away immediately the feces of their children left near houses. They visited the same mothers every two weeks for 2-3 days to replenish soap, reinforce hygiene messages, and record morbidity information. Diarrheal prevalence decreased by 89%. Almost two years later, members of an Australian International Development Assistance Bureau mission to the village had the impression that the villagers had maintained the improved hygiene practices and the health benefits had been sustained. In August 1992, one of the community organizers returned to Balai Lua to determine if the hand-washing health education program was indeed able to sustain improved health benefits and hygiene practices. She was able to interview 57 mothers and collect data on 102 children aged less than 11 years. Before the intervention, no mother used soap to wash their hands or those of their children after defecation or before eating; 26% did before cooking. After the intervention, almost all (92-100) used soap after defecation or before eating; 60% did before cooking. At follow-up, 56% and 43% of mothers, respectively, reported always or sometimes using soap to wash their own or their children's hands after defecation. 94% claimed to always wash their hands with soap before eating, yet only 79% could show soap to the interviewer. 73% always had their children use soap when they washed their hands before a meal. The disease prevalence rate was lower than that before the intervention (1 vs. 3 episodes/100 children/week) but higher than that immediately after the intervention (0.33). Diarrhea rates appeared to be inversely related to reported soap use. 19% of the women understood the health reasons for hand-washing and why they should buy soap.

Hand-washing reduces diarrhoea episodes: a study in Lombok, Indonesia.

Sixty-five mothers from Balai Lua, Central Lombok, Indonesia were given soap and an explanation of the faecal-oral route of diarrhoea transmission. This very simple health message was repeated and reinforced fortnightly when mothers were also asked whether any members of their family had suffered from diarrhoea over the previous 2 weeks. Children of these mothers experienced an 89% reduction in diarrhoea episodes compared to a control period before the intervention.

Massive gastrointestinal bleeding in Crohn's disease: successful control by intra-arterial vasopressin infusion.

A case of massive lower gastrointestinal bleeding from Crohn's disease is reported. This is an uncommon complication of the disease and the literature is reviewed. Successful control of gastrointestinal bleeding by intra-arterial vasopressin infusion has not previously been reported in Crohn's disease. We suggest that this technique may be used in an attempt to avoid surgery.

Plasma zinc after myocardial infarction.

Plasma levels of zinc and albumin have been measured for eight consecutive days in patients suffering chest pain due to myocardial infarction or myocardial ischaemia. A substantial diurnal variation has been found in both controls and patients. Plasma zinc falls after myocardial infarction reaching the lowest level on day 2, thereafter returning to normal by day 8. The lowest plasma zinc levels occur within 48 h of a myocardial infarction and in some patients herald the development of a serious cardiac arrhythmia. Plasma albumin falls progressively after myocardial infarction, being lowest on day 8. The fall in plasma zinc is not totally explained by the fall in plasma albumin.