High glucose mediates prooxidant and antioxidant enzyme activities in coronary endothelial cells

Objective: Excess levels of free radicals such as nitric oxide (NO) and superoxide anion (O2-)are associated with the pathogenesis of endothelial cell dysfunction in diabetes mellitus. This study was designed to investigate the underlying causes of oxidative stress in coronary microvascular endothelial cells (CMEC) exposed to hyperglycaemia. Methods: CMEC were cultured under normal (5.5 mmol/L) or high glucose (22 mmol/L)concentrations for 7 days. The activity and expression (protein level) of eNOS, iNOS, NAD(P)H oxidase and antioxidant enzymes, namely, superoxide dismutase (SOD), catalase and glutahione peroxidase (GPx) were investigated by specific activity assays and Western analyses,respectively while the effects of hyperglycaemia on nitrite and O2 - generation were investigated by Griess reaction and cytochrome C reduction assay, respectively. Results: Hyperglycaemia did not alter eNOS or iNOS protein expressions and overall nitrite generation, an index of NO production. However, it significantly reduced the levels of intracellular antioxidant glutathione by 50% (p<0.05) and increased the protein expressions and/or activities of p22-phox, a membrane-bound component of pro-oxidant NAD(P)H oxidase and antioxidant enzymes (p<0.05). Free radical-scavengers, namely, Tiron and MPG (0.1-1 mol/L) reduced hyperglycaemia-induced antioxidant enzyme activity and increased glutathione and nitrite generation to the levels observed in CMEC cultured in normoglycaemic medium (p<0.01). The differences in enzyme activity and expressions were independent of the increased osmolarity generated by high glucose levels as investigated by using equimolar concentrations of mannitol in parallel experiments. Conclusions: These results suggest that hyperglycaemia-induced oxidative stress may arise in CMEC as a result of enhanced prooxidant enzyme activity and diminished generation of 3 antioxidant glutathione. By increasing the antioxidant enzyme capacity CMEC may protect themselves against free radical-induced cell damage in diabetic conditions. The definitive version is available at http://www.blackwell-synergy.com

Diversity in intermediate care

This paper discusses the evolution of intermediate care and presents some interim observations from a survey of providers in England being conducted as part of a national evaluation of intermediate care. Telephone interviews covering various issues concerning the level of provision and style of delivery of intermediate care have been conducted with 70 services to date. Data from these are used to discuss the progress, range and nature of intermediate care in relation to clinician viewpoints and academic and official literature on the subject. Intermediate care ‘on the ground’ is a multiplicitous entity, with provision apparently evolving in accordance with the particularities of local need. Whilst protocols for medical involvement in intermediate care generally appear to be well established, there are some tensions concerning integration of services in a locality, care management processes and questions of flexibility and inclusiveness in relation to eligibility criteria. The definitive version is available at www.blackwell-synergy.com

Human motivation and professional practice: of knights, knaves and social workers

Efforts to improve the efficiency and responsiveness of public services by harnessing the self-interest of professionals in state agencies have been widely debated in the recent literature on welfare state reform. In the context of social services, one way in which British policy-makers have sought to effect such changes has been through the "new community care" of the 1990 NHS and Community Care Act. Key to this is the concept of care management, in which the identification of needs and the provision of services are separated, purportedly with a view to improving advocacy, choice and quality for service users. This paper uses data from a wide-ranging qualitative study of access to social care for older people to examine the success of the policy in these terms, with specific reference to its attempts to harness the rational self-interest of professionals. While care management removes one potential conflict of interests by separating commissioning and provision, the responsibility of social care professionals to comply with organizational priorities conflicts with their role of advocacy for their clients, a tension rendered all the more problematic by the perceived inadequacy of funding. Moreover, the bureaucracy of the care management process itself further negates the approach's supposedly client-centred ethos. The definitive version is available at www.blackwell-synergy.com

Narratives great and small: neighbourhood change, place and identity in Notting Hill

The area of Notting Hill in west London has been subject to much media coverage in recent years, which, along with substantial gentrification, has given rise to an image of the area as the epitome of fashionable London. This study investigates the views of those marginal to gentrification and mediated representation on their feelings about the local area, its image and their changing neighbourhoods. Many participants in the research resented some of the more recent changes in Notting Hill and the area's representation in the media. However, in contrast to expectations, most of the more working-class respondents involved in the research did not articulate much emotional attachment to the area. They were more concerned with what might be termed the material aspects of life in Notting Hill: convenience, facilities, safety and so on. In contrast, the more middle-class respondents frequently spoke of their regret of the changes to the area, such as the loss of independent shops, and the reduction in diversity. Paradoxically, the loss of working-class landscapes seems a relatively middle-class worry. The symbolically important landscapes described by working-class respondents were related to more immediate, material issues, in which gentrification was only a relatively minor concern. The definitive version is available at www.blackwell-synergy.com

The organization, form and function of intermediate care services and systems in England: results from a national survey

This paper reports the results of a postal survey of intermediate care co-ordinators (ICCs) on the organization and delivery of intermediate care services for older people in England, conducted between November 2003 and May 2004. Questionnaires, which covered a range of issues with a variety of quantitative, ‘tick-box’ and open-ended questions, were returned by 106 respondents, representing just over 35% of primary care trusts (PCTs). We discuss the role of ICCs, the integration of local systems of intermediate care provision, and the form, function and model of delivery of services described by respondents. Using descriptive and statistical analysis of the responses, we highlight in particular the relationship between provision of admission avoidance and supported discharge, the availability of 24-hour care, and the locations in which care is provided, and relate our findings to the emerging evidence base for intermediate care, guidance on implementation from central government, and debate in the literature. Whilst the expansion and integration of intermediate care appear to be continuing apace, much provision seems concentrated in supported discharge services rather than acute admission avoidance, and particularly in residential forms of post-acute intermediate care. Supported discharge services tend to be found in residential settings, while admission avoidance provision tends to be non-residential in nature. Twenty-four hour care in non-residential settings is not available in several responding PCTs. These findings raise questions about the relationship between the implementation of intermediate care and the evidence for and aims of the policy as part of NHS modernization, and the extent to which intermediate care represents a genuinely novel approach to the care and rehabilitation of older people.

Adaptive regulation or governmentality: patient safety and the changing regulation of medicine

Studies from across the world have shown that clinical mistakes are a major threat to the safety of patient care (World Health Organisation 2004). For the National Health Service (NHS) of England and Wales it is estimated that one in ten hospital patients experience some form of error, and each year these cost the service over £2billion in remedial care (Department of Health 2000). Unsurprisingly, ‘patient safety’ is now a major international health policy priority, questioning the efficacy of existing regulatory practices and proposing a new ethos of learning. Within England and Wales, the National Patient Safety Agency (NPSA) has been created to lead policy development and champion service-wide learning, whilst throughout the NHS the National Reporting and Learning System (NRLS) has been introduced to enable this learning (NPSA 2003). This paper investigates the extent to which, in seeking to better manage the threats to patient safety, this policy agenda represents a transition in medical regulation.

Foster Fathers: their experiences and contributions to fostering

The paper reports some of the findings of an exploratory study which looks at foster fathers’ experiences of fostering and discusses their routes into foster care and their perspectives on their roles and tasks. The study collected quantitative and qualitative data by approaching all foster fathers registered with a single independent fostering agency based in southeast England. They were asked about their personal and professional attributes, and their experiences of and views concerning the role of foster father. The study discusses the foster fathers’ motivation to foster, and argues that what they see as its positives and drawbacks, and how it fits into their own family lives, are all relevant to improving service recruitment, delivery and retention. The study produced some evidence about the distinctive and positive contribution which foster fathers see themselves making to the lives of the children they foster. Further research is needed to refine our knowledge of what this contribution may be. Such knowledge could potentially develop our understanding of the roles of fathers in child development more generally as well as fine-tuning practice in matching what particular placements have to offer to the needs of individual children.

Expertise and forms of knowledge in the government of families

This paper examines the relationship between the state and the individual in relation to an aspect of mundane family life – the feeding of babies and young children. The nutritional status of children has long been a matter of national concern and infant feeding is an aspect of family life that has been subjected to substantial state intervention. It exemplifies the imposition upon women the ‘biologico-moral responsibility’ for the welfare of children (Foucault 1991b). The state’s attempts to influence mothers’ feeding practices operate largely through education and persuasion. Through an elaborate state-sponsored apparatus, a strongly medicalised expert discourse is disseminated to mothers. This discourse warns mothers of the risks of certain feeding practices and the benefits of others. It constrains mothers through a series of ‘quiet coercions’ (Foucault 1991c) which seek to render them self-regulating subjects. Using data from a longitudinal interview study, this paper explores how mothers who are made responsible in these medical discourses around child nutrition, engage with, resist and refuse expert advice. It examines, in particular, the rhetorical strategies which mothers use to defend themselves against the charges of maternal irresponsibility that arise when their practices do not conform to expert medical recommendations.