High Level Of Continuity Research Articles

The appearance and disappearance of cognitive impairment in elderly patients during treatment for hip fracture.

We studied the natural course of cognitive state in 256 consecutive hip fracture patients who were admitted from an independent living situation. We employed a treatment programme that focused on preventing postoperative cognitive impairment. Cognitive function was assessed with the SPSMQ screening test. The incidence of postoperative cognitive impairment among those lucid on admission was 13%, which generally was reversed before discharge. Thirty-seven percent were cognitively impaired on admission; of those, 51% reached normal test scores while in hospital. Those who recovered within the first week had as good a prognosis during the first year as those who remained lucid throughout the hospital stay. Cognitive impairment was associated with an increased complication rate, e.g. a three-fold increase of early fracture displacement and a four-fold increase of wound infection. This increased risk was present even in patients with mild/moderate cognitive impairment and could not entirely be explained by age. Our results suggest that it is possible to decrease postoperative cognitive impairment by routine monitoring of cognitive status, a high level of continuity and a reorientation programme. The routine assessment of the cognitive function is recommended in geriatric patients who are admitted for surgery.

Continuity or Change? Civil-Military Relations in Democratic Argentina, Chile, and Peru

Have the armed forces maintained their influence in Latin America's new democracies? Or has the reinstallation of free political competition diminished their political clout? Have overbearing militaries tightly constrained popular sovereignty? Or have democratic responsiveness and accountability extended into wider spheres of political life and reduced military influence? These questions are of crucial importance for the future of the fledgling civilian regimes in the region.1 Scholars adhering to a modes-of-transition perspective expect a high level of continuity in military clout. Following Alfred Stepan, they focus on the fact that Latin American militaries usually maintained control over the democratization process and therefore managed to extract from resurgent democratic forces important institutional prerogatives, such as extensive representation on national security councils and other decision-making bodies with broad political responsibilities, to shield themselves from civilian control, to keep watch over civilian forces, and to interfere in many arenas of democratic politics.2 The modes-of-transition argument thus expects persistent military influence based on institutional structures that are frozen into place during the regime transition.

MEMBERSHIP OF THE ‘NEW STYLE’ HEALTH AUTHORITIES: CONTINUITY OR CHANGE?

The 1989 White Paper ‘Working for Patients’ continued the process begun by Griffiths of managerial reform and the introduction of private sector concepts into the NHS. One of the new proposals was to change the composition and constitution of health authorities, both to avoid the assumed weaknesses of the existing format and to emulate the pattern found in the private sector.The essence of the change was the removal of the representational elements on authorities, both of medical professionals and nominees from the local authority. The health authorities were reduced in size to just eleven members and for the first time executives were included. Previous attempts at reform within the NHS have been judged to have resulted in more continuity than change. This article examines in detail who the new members are and assesses the balance between continuity and change.Despite a high level of continuity of membership, there are signs of more fundamental change. There is a significant increase in the proportion of non‐executive members from the private sector and with the inclusion of executives, a stronger managerial role is emerging. The article concludes by assessing what the implications of these changes maybe.

Immunosuppressive levels of glucocorticoid block extrauterine luteolysins in the rat.

Leukocytes, normal constituents of the corpus luteum, release prostaglandins (PGs), superoxide, and hydrogen peroxide (H2O2) upon activation. These products appear to mediate luteolysis, and it has been postulated that activated leukocytes serve a role in corpus luteum regression. Glucocorticoids prevent leukocyte infiltration and activation by inhibiting cytokine production, secretion, and action, and also inhibit eicosanoid synthesis. The objective of the present studies was therefore to assess whether glucocorticoid would influence luteal regression in the rat. Ovulation and pseudopregnancy were synchronized in prepubertal rats by gonadotropin treatment. In uterine-intact rats, functional luteal regression, assessed from serum progesterone levels, began on Day 10 and was complete by Day 14. Dexamethasone blocked luteal regression in uterine-intact animals when administered daily from early in pseudopregnancy for as long as treatment was continued (up to Day 17). Immunosuppressive effects of dexamethasone were evident in the inhibition of estrogen-induced infiltration of eosinophils, as shown by abrogation of estrogen-induced uterine peroxidase activity, and high continuous levels of dexamethasone were necessary to block luteolysis. Hysterectomy extended luteal function by several days, with maintenance of maximal serum progesterone levels up to Day 12; but serum progesterone levels were reduced about 50% by Day 16 and completely depressed by Day 19. Dexamethasone treatment of hysterectomized rats from Day 12 until Day 15 or 18 blocked the decline in serum progesterone levels. Dexamethasone treatment did not block the decrease in serum progesterone levels induced within 24 h by PGF2 alpha in uterine-intact animals on Day 9 or in hysterectomized animals on Day 19.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Spatial Organization of a Desert Rodent Community in Bolson de Mapimi, Mexico

We studied the distribution of niches in resource space and niche patterns of a 12-species community of desert rodents by use of canonical-variate and principal-component analyses. Fourteen characters of the environment, measured at 475 sample plots within 19 1-ha grid areas (474 captures of rodents on plots), and eight morphological indicators of niches were used. The first three canonical axes of resource space accounted for 81% of the variance; each of the axes is identified by one of the characteristics of the substrate and one to two characteristics of the vegetation. There was a high level of continuity in distribution of species in the resource space. The lowest values of coefficients of variation of niche overlap and of distances between niche centers characterize a group of the nearest-neighbor species. There was a marked negative correlation of morphological distances to the nearest neighbor with the distances between the same species in the resource space. This evidence indicates certain limitations of ecological similarity of cohabitating species. Negative correlations between niche breadth and the position of the niche in resource space, and between the maximal density of population and niche breadth, are demonstrated.

Le mariage en Chine [Marriage in China]. By Jean Luc Domenach and Hua Chang-Ming. Paris: Presses de la Fondation Nationale des Sciences Politiques, 1987. 187 pp. Fr 98 (paper).

Marriage in contemporary China is analyzed using data from Chinese sources primarily the press. The authors show that marriage in China is an institution which reflects individual aspirations the rules of society and the objectives of those in power. The impact of bureaucracy and political cadres on marriage and the family is noted. The high level of continuity in the characteristics of marriage from pre-revolutionary times is then discussed and the continuing influence of traditional cultural factors as well as new economic factors described. (ANNOTATION)

Psychiatric and social work collaboration in pediatric chronic illness hospital.

Recently pediatric literature has noted that pediatric facilities often function as mental health facilities for their patients. There is little acknowledgment of the role of the pediatric social worker in such care. This paper reviews one year of child psychiatry consultations in a pediatric chronic illness hospital, with particular attention paid to quality of social work, pediatric and psychiatric collaboration. In the study year, 72 psychiatric consultations were requested for medical patients, the majority of which were requested by the social worker assigned to the medical service. Organizational and theoretical issues of the psychiatric consultation-liaison and social work service are discussed as well as disposition of consultations. From the data presented, close collaboration between pediatricians, social workers and child psychiatrists can be efficient, effective and offer a high level of continuity for mental health care of children with chronic illness.