Current practice and adaptations being made for people with autism admitted to in-patient psychiatric services across the UK.

Background: A significant number of people with autism require in-patient psychiatric care. Although the requirement to adequately meet the needs of people with autism in these settings is enshrined in UK law and supported by national guidelines, little information is available on current practice.

Aims: To describe characteristics of UK in-patient psychiatric settings admitting people with autism.

Exposure of children with developmental delay to social determinants of poor health: cross-sectional case record review study.

Background: Research on child development in general has highlighted the importance that the family environment plays in mediating the pathway between exposure to low socio-economic position (SEP) and child well-being. While child developmental models in intellectual disability have highlighted the interplay between social context, family environment and child development, little empirical work has attempted to formally evaluate the evidence in support of specific mediating pathways between low SEP and child outcomes.

Methods: Secondary analysis of cross-sectional confidentialized needs analysis data collected in three Primary Care Trusts in England covering a total population of 1.

The developmental health of children of parents with intellectual disabilities: cross sectional study.

In a representative population-based sample of 46,025 families caring for a young child, parental intellectual disability (identified in 588 families) was associated with increased risk of child developmental delay, child speech and language problems, child behaviour problems and frequent child accidents and injuries. Parental intellectual disability was also associated with increased risk of exposure to a wide range of environmental adversities such as poverty, poor housing and social isolation. Adjusting for between-group differences in exposure to low socio-economic position reduced the risk of adverse child outcomes by over 50% on each of the four measures of child developmental health.

Health behaviours and mental health status of parents with intellectual disabilities: cross sectional study.

Objectives: The authors sought to: (1) estimate the prevalence of health behaviours, mental health and exposure to social determinants of poorer health among parents with and without intellectual disability; and (2) determine the extent to which between-group differences in health behaviours/status may be attributable to differential exposure to social determinants of poorer health.

Study Design: Cross sectional survey.

Methods: Secondary analysis of confidentialized needs analysis data collected in three Primary Care Trusts in England on 46,023 households with young children.

The evolution of burn care facilities in the United States.

This historical review documents the establishment and current status of specialized burn care facilities opened in the United States since 1947, describes trends in their physical configuration and burn bed availability and discusses the terms used to classify those facilities. Lists of active burn care facilities were reviewed, including primarily the Burn Care Resource directories of the American Burn Association, which date back to 1976, along with the results of special surveys carried out by the authors in 1992 and 2006. Of the burn facilities at 175 US hospitals which had reported the presence of specialized burn beds since 1947, 25 had closed before 1992, 153 have been active as recently as 1992, and 125 were active as of early 2007.

The demographic and social class basis of inequality in self reported morbidity: an exploration using the Health Survey for England.

Study Objectives: To assess the relative contribution of age and social class to variations in the prevalence of a selection of self reported health problems. To examine the implications of observed variations for research on health inequalities.

Design: Secondary analysis of the Health Survey for England (1991-1997) using morbidities that are particularly prone to class effects.

The pursuit of equity in NHS resource allocation: should morbidity replace utilisation as the basis for setting health care capitations?

Although the English NHS has been described as a world leader in pioneering methods of distributing expenditure in relation to population needs, concerns about the legitimacy of using the current utilisation-based model to allocate health service resources are mounting. In this paper, we present a critical review of NHS resource allocation in England and demonstrate the feasibility and impact of using direct health estimates as a basis for setting health care capitations. Comparing target allocations for the inpatient treatment of coronary heart disease in a sample of 34 primary care trusts in contrasting locations in England, we find that a morbidity-based model would result in a significant shift in hospital resources away from deprived areas, towards areas with older demographic profiles and towards rural areas.

Allocating resources for health and social care: the significance of rurality.

Whilst an allowance is made for sparsity in the allocation of resources for social care services in England, rurality is not a significant factor in health resource allocation. This lack of consistency in resource allocation criteria has become increasingly visible as health and social services departments are required to work in partnership across a range of areas. Differences in funding mechanisms also raise the question of why it is legitimate to make adjustments for rurality in the distribution of some public services, but not for others.

Geographies of need and the new NHS: methodological issues in the definition and measurement of the health needs of local populations.

For a variety of purposes it is increasingly necessary to establish the health needs of local populations. Following a critique of existing proxies of need, this paper presents and evaluates an alternative which draws upon epidemiological evidence concerning the age, sex and social class distribution of morbidity in order to estimate the prevalence of specific conditions in designated populations. By way of demonstrating the insights to be gained through the use of these indicative prevalence rates, the paper considers the treatment of ischaemic heart disease in a sample of 539 practices and presents evidence regarding the significance of deprivation and rurality in determining health service use relative to needs.

The fire-safe cigarette: a burn prevention tool.

Cigarettes are the most common ignition source for fatal house fires, which cause approximately 29% of the fire deaths in the United States. A common scenario is the delayed ignition of a sofa, chair, or mattress by a lit cigarette that is forgotten or dropped by a smoker whose alertness is impaired by alcohol or medication. Cigarettes are designed to continue burning when left unattended.

GP fundholding and prescribing in UK general practice: evidence from two rural, English Family Health Services Authorities.

Background: Two separate prescribing budget regimes (part of GP fundholding and the indicative prescribing scheme) were introduced into UK general practice in April 1991 in an attempt to contain the growth in NHS expenditure on prescribed drugs.

Objectives: The aims of this study are (i) to examine whether the fundholding scheme has been more effective at containing prescribing cost growth than the indicative prescribing scheme and (ii) to ascertain whether its implementation, at a practice level, has been affected by local circumstances and conditions.

Methods: Prescribing cost data were collected from two rural, English Family Health Services Authorities for the financial years 1990/1991 to 1993/1994.

Burn incidence and medical care use in the United States: estimates, trends, and data sources.

Recent estimates related to annual burn incidence and medical care use in the United States include 5500 deaths from fire and burns (1991), 51,000 acute hospital admissions for burn injury (1991 to 1993 average), and 1.25 million total burn injuries (1992). Time trends from 1971 to 1991 reveal significant declines in each estimate.

Progress towards a fire-safe cigarette.

About 1,000 deaths, 3,000 serious injuries, and several billion dollars in costs of property loss, health care and pain and suffering, result each year in the U.S. from fires started by dropped cigarettes.

The development of burn centers in North America.

Burn center development in North America began in the mid 1940s, surged in the 1970s, and had reached virtually every distinct medical market by 1985. The authors present chronologies of the establishment of 137 currently active burn centers in the United States and 27 burn facilities in Canada, discuss public policy and other influences on burn center development, and review burn admissions trends. Another 46 U.

Object relations and regression in groups.

This article uses a psychoanalytic ego-psychological framework to examine the regression experienced by an individual group member and the defenses mobilized to counter it, focusing in particular on the defensive functions of constituting leadership somewhere in the group. The leader, regarded as an internal object in the member's object world, is hypothesized to be a combination of projected and personified part-objects and at the same time an integrating whole object. Various phenomena of group life are discussed from this viewpoint, notably the lability of the relationship with the leader, the externalization of various endopsychic regulations, and the conditions supporting the defensive utility of the leader for the group member.

Classifying patients with burns for hospital reimbursement: diagnosis-related groups and modifications for severity.

This study was designed to evaluate the relative severity and resource consumption of hospitalized patients with burns in a national cross section of hospitals, both with and without burn centers. We investigated to determine whether clinical variables or severity of illness measures not recorded in the Uniform Hospital Discharge Data Set are significant in explaining variation in length of stay, total cost, and mortality for patients with burns. The ability of the six burn diagnosis-related groups (DRGs) to explain variation in patients' length of stay was 20% and their ability to predict total costs was 24%.

Action of topical minoxidil in the bald stump-tailed macaque.

The effect of topical minoxidil (5% and 2% solutions) on hair regrowth was studied in the frontal bald scalp of 18 adolescent and adult stump-tailed macaques (Macaca arctoides). Gross observation of the hairiness and folliculogram analysis of the skin biopsy specimens have shown that minoxidil induces the enlargement of vellus follicles to the size of middle to terminal follicles (regrowth of hair effect), minoxidil maintains the terminal follicles in the prebald scalp of periadolescent animals (prevention of baldness effect), enlarged follicles regress after minoxidil is withdrawn, and hair follicular growth is once again stimulated when treatment with minoxidil is reinstituted. Hair regrowth was more prominent in the early stage of baldness among younger macaques than in baldness of longer duration in older animals.

Role of alpha-2 adrenergic affinity in the action of a non-sedative antispasticity agent.

Muscle hypertonus of central origin can be effectively reversed by either dopamine agonists or alpha-adrenergic antagonists. Because of its efficacy in reversing reserpine rigidity (a syndrome resembling Parkinsonism), SKF-7265 was examined to determine whether its action was mediated through alpha-adrenergic or dopaminergic receptors. The pharmacologic blocking activity of SKF-7265 was assessed by measuring blockade of the cardiovascular agonist responses induced by norepinephrine, epinephrine, isoproterenol, acetylcholine and histamine.