Behaviour rating scales for older people with dementia: which is the best for use by nurses?

There is increasing awareness of the importance of disruptive behaviour in people with dementia and the need for rating scales to accurately and reliably measure this behaviour. When rating scales are to be administered by nurses, scale characteristics must take into account the limitations of the nursing role and the nature of the environment in which nurses work. This paper reviews thirty-one rating scales that have been used to measure behaviour in dementia. From this analysis, five scales were identified as suitable for use by nurses when measuring disruptive behaviour in older people with dementia.

International childcare practices study: Infant sleeping environment

Background: The International Child Care Practices Study (ICCPS) has collected descriptive data from 21 centres in 17 countries. In this report, data are presented on the infant sleeping environment with the main focus being sudden infant death syndrome (SIDS) risk factors (bedsharing and infant using a pillow) and protective factors (infant sharing a room with adult) that are not yet well established in the literature. Methods: Using a standardised protocol, parents of infants were surveyed at birth by interview and at 3 months of age mainly by postal questionnaire. Centres were grouped according to geographic location. Also indicated was the level of SIDS awareness in the community, i.e. whether any campaigns or messages to “reduce the risks of SIDS” were available at the time of the survey. Results: Birth interview data were available for 5488 individual families and 4656 (85%) returned questionnaires at 3 months. Rates of bedsharing varied considerably (2–88%) and it appeared to be more common in the samples with a lower awareness of SIDS, but not necessarily a high SIDS rate. Countries with higher rates of bedsharing appeared to have a greater proportion of infants bedsharing for a longer duration (>5 h). Rates of room sharing varied (58–100%) with some of the lowest rates noted in centres with a higher awareness of SIDS. Rates of pillow use ranged from 4% to 95%. Conclusions: It is likely that methods of bedsharing differ cross-culturally, and although further details were sought on different bedsharing practices, it was not possible to build up a composite picture of “typical” bedsharing practices in these different communities. These data highlight interesting patterns in child care in these diverse populations. Although these results should not be used to imply that any particular child care practice either increases or decreases the risk of SIDS, these findings should help to inject caution into the process of developing SIDS prevention campaigns for non-Western cultures.

Is bucindolol BEST? (A Key Paper Evaluation)

Carvedilol, a non-selective β-adrenoceptor blocker with ancillary properties, and metoprolol and bisoprolol, selective β1-blockers without ancillary properties, have been shown to reduce mortality and morbidity in heart failure. In the Beta-blocker Evaluation of Survival Trial (BEST), bucindolol, a non-selective β-adrenoceptor blocker with different ancillary properties to carvedilol, did not reduce overall survival in heart failure. Possible explanations for this include: more Blacks being included in the trial, bucindolol being more ‘sympatholytic’ than the other β-blockers and more advanced heart failure in BEST. Another possible explanation is that bucindolol is stimulating cardiac β2-adrenoceptors to counter the effects of inhibiting cardiac β1-adrenoceptors. Bucindolol is not the best treatment and carvedilol, metoprolol and bisoprolol should be preferred in heart failure.

Trade and environment: Evidence from China's manufacturing sector

This paper focusing on the Chinese manufacturing sector assesses the environmental impact of trade liberalization in China. The results show that China's experience with the trade liberalization-environment nexus is consistent with international evidence. On one hand, trade liberalization has had various positive effects on the environment. Firstly, it promoted specialization in areas of comparative advantage, which, in general, included industries that contributed less to environmental degradation. Secondly, it allowed China to access and adopt the best international practices in pollution abatement technology. Thirdly, it enabled China to transfer environmental costs to other countries by importing intermediate products whose production contributed to environmental degradation. On the other hand, these positive effects were overwhelmed by a negative scale effect, which was the result of a huge increase in the demand for Chinese exports. The paper concludes that if China is to prevent pollution from reaching a critical threshold, environmental regulations need to be tightened. Copyright (C) 2002 John Wiley & Sons, Ltd and ERP Environment.

The socio-religious beliefs and nature of the contemporary Vampire Subculture

The contemporary Vampire Subculture can be defined as a multi-faceted, socio-religious movement with its own distinct collective community and network of participants who share a similar belief system and customary lifestyle that reflect their concept of the vampire. The Vampire Subculture consists of individuals who profess to be 'real vampires', vampire communities of like-minded persons, 'blood-donors' who willingly allow vampires to partake of them, occult-based and mystical-orientated groups that appeal to their spirituality, the blood fetishists, and the live-action vampire role-players. In response, a Christian counter-movement of self-proclaimed 'vampire-slayers' has emerged that actively opposes the vampire subculture and its beliefs and practices. The socio-religious nature of the Vampire Subculture can be best described as a Segmented, Polycentric and Integrated Network of participants.

Attitudes and practices of general practitioners in the diagnosis and management of attention-deficit/hyperactivity disorder

Objective: To assess understanding of, and actual and potential roles in management of attention-deficit/hyperactivity disorder (ADHD) among GPs. Methods: A cross-sectional questionnaire survey of Queensland GPs selected randomly from the Royal Australian College of General Practitioners directory of members was carried out. Main outcome measures were knowledge levels of ADHD, current management practices, referral patterns and self-perceived information and training needs. Results: Three hundred and ninety-nine GPs returned a completed questionnaire (response rate 76%). Roles identified by GPs were: the provisional diagnosis of ADHD and referral to specialist services for confirmation of the diagnosis and initiation of management; assistance with monitoring progress once a management plan was in place; education of the child and their family regarding the disorder; and liaison with the school where necessary. Perceived barriers to increased involvement of GPs were: time and resource constraints of general practice; concerns regarding abuse and addiction liability of prescription stimulants; complex diagnostic issues associated with childhood behavioural problems; and lack of training and education regarding ADHD. Conclusions: General practitioners identify a role for themselves in ADHD care that is largely supportive in nature and involves close liaison with specialist services.

Amphitheater staging: In-the-round or to the front (and what about asides)?

When the existence in Utrecht of the DeWitt/Van Buchel drawing of the Swan Theater became known in 1888, William Poel was already seven years into his inquiries into the best means of staging the public amphitheater and great hall plays of the English Renaissance.1 I mention this to emphasize that the discourse came before the fact: the belief that Shakespeare's plays are best staged as it was then imprecisely imagined they had once been staged-simply, without elaborate settings or time-consuming scene changes, with direct actor-audience address, "in-the-round"-had as much to do with reactions against the late nineteenth-century stage's pictorialism, with its set-changing interruptions and cut-and-paste revisions to Shakespeare's texts, as it had to do with presenting the Bard "authentically." Some of the confusion caused by the uneasy mixing of historical scholarship and the assumptions and practices of our own contemporary theater profession can be glimpsed in the phenomenon of modern in-the-round staging, often claimed as a more "authentic" approach to Shakespeare in performance, but one which is then modified to make possible post-Stanislavsky acting methods and to satisfy modern audience expectations.