The Scottish Brain Health Service Model: Rationale and Scientific Basis for a National Care Pathway of Brain Health Services in Scotland.

In order to address the oft-cited societal, economic, and health and social care impacts of neurodegenerative diseases, such as Alzheimer's disease, we must move decisively from reactive to proactive clinical practice and to embed evidence-based brain health education throughout society. Most disease processes can be at least partially prevented, slowed, or reversed. We have long neglected to intervene in neurodegenerative disease processes, largely due to a misconception that their predominant symptom - cognitive decline - is a normal, age-related process, but also due to a lack of multi-disciplinary collaboration. We now understand that there are modifiable risk factors for neurodegenerative diseases, that successful management of common comorbidities (such as diabetes and hypertension) can reduce the incidence of neurodegenerative disease, and that disease processes begin (and, crucially, can be detected, reduced, and delayed, prevented, or treated) decades earlier in life than had previously been appreciated. Brain Health Scotland, established by Scottish Government and working in partnership with Alzheimer Scotland, propose far-reaching public health and clinical practice approaches to reduce neurodegenerative disease incidence. Focusing here on Brain Health Scotland's clinical offerings, we present the Scottish Model for Brain Health Services. To our knowledge, the Scottish Model for Brain Health, built on foundations of personalised risk profiling, targeted risk reduction and prevention, early disease detection, equity of access, and harnessing comprehensive data to assist in clinical decision-making, marks the first example of a nationwide approach to overhauling clinical, societal, and political approaches to the prevention, assessment, and treatment of neurodegenerative disease.

Functional coma.

Functional coma - here defined as a prolonged motionless dissociative attack with absent or reduced response to external stimuli - is a relatively rare presentation. In this chapter we examine a wide range of terms used to describe states of unresponsiveness in which psychologic factors are relevant to etiology, such as depressive stupor, catatonia, nonepileptic "pseudostatus," and factitious disorders, and discuss the place of functional or psychogenic coma among these. Historically, diagnosis of functional coma has sometimes been reached after prolonged investigation and exclusion of other diagnoses. However, as is the case with other functional disorders, diagnosis should preferably be made on the basis of positive findings that provide evidence of inconsistency between an apparent comatose state and normal waking nervous system functioning. In our review of physical signs, we find some evidence for the presence of firm resistance to eye opening as reasonably sensitive and specific for functional coma, as well as the eye gaze sign, in which patients tend to look to the ground when turned on to one side. Noxious stimuli such as Harvey's sign (application of high-frequency vibrating tuning fork to the nasal mucosa) can also be helpful, although patients with this disorder are often remarkably unresponsive to usually painful stimuli, particularly as more commonly applied using sternal or nail bed pressure. The use of repeated painful stimuli is therefore not recommended. We also discuss the role of general anesthesia and other physiologic triggers to functional coma.

Belfast children's awareness of violent death.

Although violent deaths due to the Northern Ireland civil strife receive wide publicity, up to three times as many people are killed in road accidents, and death-rate statistics reveal that natural causes predominate. Against this backdrop the study explores development of the death concept in Belfast children (n = 200). A disguised test technique was supplemented by more probing questions. Subject variables were age (five groups from 3 years 8 months to 15 years 8 months), sex, verbal ability, religious denomination, and place of residence. Vocabulary scores were significantly related to conceptual level for the 7- and 13-year-olds only. More advanced definitions were given by the 4-year-olds living in the 'troubled' areas, by both groups of 13-year-old Protestants and by the 15-year-old Protestants living in the 'less troubled' areas. Overall, the children attributed death more often to sickness than to accidents or to violence; just as frequently to heart disease and to old age as to explosions and shootings and more often to road accidents and to cancer than to specific local violence. These attributions quite accurately reflect the total objective situation, and suggest that violence is not a salient dimension for the children of the area.

Mental illness in Northern Ireland. A comparison with Scotland and England.

First and all admissions to psychiatric hospitals and units during 1981 were obtained from the DHSS in England, Scotland and Northern Ireland. Age and sex standardized rates were calculated for each country. Possible reasons for observed rate differences are discussed. Whilst overall high rates of admissions in Northern Ireland are most likely attributable to provision and use of beds, these factors may not entirely account for high rates of admissions for neurotic disorder, particularly among males.

The development of psychological well-being in late adolescence.

Studies following adolescents from school to work indicate a sharp decrease in psychological symptoms over the 16-17-year period compared to a more gentle decrease subsequently. This could be a genuine developmental phenomenon, related to school leaving, or because anxiety levels are higher at age 16 years due to approaching examinations. The present study examined these hypotheses. GHQ scores for those at school were related to examination candidacy. Eighteen months later such differences had disappeared among those young people now in full-time employment. Similarly, a group who remained in full-time education also showed a significant decline in GHQ scores.

The role of nursing partnership interventions in improving the health of disadvantaged women.

This paper describes a project which assessed the contribution that nursing professionals are making to improving the health of deprived women living in Northern Ireland. The study is set within the context of the Targeting Health and Social Need (THSN) Initiative an important theme within the Northern Ireland Regional Strategy entitled Health and Well-being into the Next Millennium - A Regional Strategy for Health and Social Well-being 1997-2002 which is concerned with addressing inequalities in health status and social well-being. The paper describes the results of a survey (n=1,000, response rate 39%) and the criteria used to select 22 interventions to provide evidence of 'effective practice' within THSN. The study highlights the work of previous reviews in the area and provides evidence concerning effective interventions in practice. Although the interventions described may be lacking in 'pure scientific' method and may not meet the rigorous inclusion criteria of systematic review methodologies, there is evidence to suggest that nurses are using well-designed more qualitative evaluation methods and demonstrating improvements in health and social need for women in the lowest socio-economic groups. In terms of equity the case studies show that community nursing may be a powerful vehicle for researching people previously neglected by the formal health care system. Health policies such as THSN can now articulate the methods needed for reform or change, setting directions and articulating the barriers to implementation and achievement.

Children's perceptions of negative events in Northern Ireland: a ten year study.

This study examines changes in Northern Irish children's perceptions of negative events over ten years. Ten year old children's perceptions of potentially distressing situations were obtained from two groups of children in 1983 and 1994 using a 25 item self-report measure. The children's perceptions of the events are contrasted across time and also comparisons between socioeconomic and religious groups are made. The comparison shows that the children's perceptions of the events remains relatively constant across time, with certain events being consistently viewed as the most stressful and least stressful across time and between groups. Comparison of religious and socioeconomic groups suggests that working class and Roman Catholic children in Northern Ireland frequently rate negative events as more stressful than others in their cohort.

Tackling inequalities in health and social wellbeing: evidence of 'good practice' by nurses, midwives and health visitors.

This paper details a project which assessed the contribution made by nurses, midwives and health visitors to Targeting Health and Social Need (THSN). Targeting Health and Social Need is an important theme within the Northern Ireland Regional Strategy entitled Health and Wellbeing into the Next Millennium: A Regional Strategy for Health and Social Wellbeing 1997-2002 which is concerned with addressing inequalities in health status and social wellbeing. While there is a considerable body of research and information on variations in health and social wellbeing there is a paucity of corresponding research on those interventions which may improve the health of disadvantaged groups. Health professionals are addressing such inequalities so it is appropriate that their efforts should be recorded and assessed. The project was conducted jointly by the departments of nursing at The Queen's University of Belfast and the University of Ulster, funded by the Department of Health and Social Services and had a timetable that covered three phases. Phase 1 entailed the distribution of a survey questionnaire to all nurses, including those professionals working with community and voluntary groups, to assess their contribution to THSN. The paper describes the results from the 392 questionnaires identified (a response rate of almost 40%) and the work in phase 2 of analysing the responses by selection criteria devised by the Project Advisory Board to allow further investigation. The resulting interventions were reduced to 22 and in an overview of each of these a number of characteristics kept recurring that could serve to define aspects of 'good practice'. These 22 case studies demonstrate the efforts made by nurses and health professionals to change behaviour, practice, the community and the environment. Also highlighted are the nursing competencies gained through working, the lessons learnt and the problems and difficulties encountered. The paper concludes that the use of qualitative research opens the door to measures of social position that reflect the ways in which people define themselves and the relationships that sustain them. Although there is still some way to go in understanding the different approaches to evaluation, an environment that fosters the monitoring and assessment of practice might be created in the future within the nursing community.

Platelet-surface glycoproteins in healthy and preeclamptic mothers and their newborn infants.

Preeclampsia, a common complication of pregnancy, contributes significantly to maternal and fetal morbidity and mortality. It may lead to both quantitative and qualitative defects of maternal and neonatal platelets. In this prospective study, flow cytometry has been used to study expression of platelet-surface glycoproteins (GPs) on maternal and neonatal platelets of both healthy and preeclamptic subjects. We studied 15 preeclamptic women, 20-44 y of age, and their newborns (median gestational age, 32 wk; range, 26-38) and seven healthy women (aged 26-41 y) and their healthy newborns (median gestational age, 38 wk; range, 38-42). Compared with their healthy and preeclamptic mothers, resting platelets from neonates expressed significantly less CD41 and CD9. Thrombin activation resulted in significant increases in platelet-surface expression of CD62P, CD63, CD41, CD9, and CD36 in neonates and their healthy mothers. Compared with neonates of healthy mothers, platelets from neonates of preeclamptic mothers expressed lower levels of CD62P, CD63, CD9, and CD36 on activated platelets. These findings suggest that preeclampsia influences the expression of platelet-surface GPs on neonatal and maternal platelets, which may affect platelet function, leading to an additional risk for bleeding in thrombocytopenic neonates of mothers with preeclampsia.