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This article is designed to explore and examine the key components of communication that emerged during the interactional analysis of a role play that took place in the classroom. The 'actors' were nurses who perceived the interaction to reflect an everyday encounter in a hospital ward. Permission to tape the interaction was sought and given by all persons involved. The principal 'players' in the scenario were: the patient, a 70-year-old-woman who had been admitted with dementia, her son and daughter, and the nurse in charge of the ward. The fundamental dynamics of the use of power and restriction, truth telling, family stress, interpersonal conflict, ageism, sexism, empathy and humanism surfaced during the analysis. The findings show that therapeutic communication should be the foundation on which nursing should stand. The article continues with an exploration of the theoretical frameworks that guided the analysis of interaction and concludes by suggesting tentatively some meaningful implications for nursing practice. It plans to furnish provocative new insights into the sometimes covert communication dynamics occurring within the nurse-patient relationship. Finally, it aims to generate discussion on this little-charted realm of human social interaction.

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OBJECTIVE: To ascertain whether constant body mass index (BMI) standards are appropriate in genetically similar populations. DESIGN: Data are taken from the International Collaborative Study of Hypertension in Blacks (ICSHIB), an observational study. SUBJECTS: Individuals of African descent who were included in ICSHIB. Subjects lived in eight different sites: Barbados; Cameroon (urban and rural); Jamaica; Manchester, UK; Maywood, IL; urban Nigeria; and St Lucia. MEASUREMENTS: Weight and height. RESULTS: Constant BMI standards effectively argue for the constancy of slope of the linear regression equations of In(weight) on In(height) across populations. Linear regression results indicate that the height/weight relationship implied by the use of constant BMI standards, is not found in these populations and that there is much variation across groups. CONCLUSION: The use of constant BMI standards in classifying individuals prognostically may be unwise, even in genetically similar populations.

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The role of leptin in humans remains controversial. Leptin concentrations are highly correlated with body fat stores. We tested whether or not this relation was consistent across the range of body composition encompassing the lean as well as the obese. Individuals participating in community-based comparative research in Nigeria (n = 363), Jamaica (n = 372), and the United States (Maywood, IL; n = 699) had their plasma leptin concentrations and body compositions (with bioelectrical impedance analysis) measured. All participants identified themselves as being black. Body mass index (in kg/m2) ranged from 14 to 62. Large differences in mean plasma leptin were noted across populations for both men and women in Nigeria, Jamaica, and the United States, respectively (men: 2.8, 3.9, and 6.8 microg/L; women: 10.3, 18.6, and 27.7 microg/L). An exponential function fit the relation between percentage body fat or total fat mass and leptin for men and women at each site. For women and men the exponential function with either percentage body fat or total fat mass was of the same shape, but increased by a constant in women, yielding higher leptin concentrations than in men at every level of body fat. On the basis of this broad distribution of body composition, the data suggest an exponential response of leptin to increases in body fat stores, consistent with the development of leptin resistance in individuals developing obesity. These findings likewise confirm that men and women exhibit different set points in terms of leptin production.

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This article is designed to focus on the provision of nursing care in general medical wards following the admission of persons who have attempted suicide or who have a previous history of attempting suicide. The authors explore, analyse and synthesize how nurses, as key players in the health care team, may begin by recognizing the uniqueness of the individual, and by cotravelling therapeutically with the person on part of his or her journey towards recovery and healing. Efforts are made to demonstrate how nurses can influence the health gain of this group of people and their families. Professional attitudes and related ethical aspects, such as autonomy, respect for autonomy and paternalism, are also examined within the context of the nursing care of people who have attempted suicide. The need to enhance sensitive and caring communication skills for nurses who work with this group of people is tentatively considered. Some reasoning about why there may be difficulties in specific areas of communication such as empathy are contested and explored.

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Associations between body mass index (BMI) and blood pressure (BP) have been consistently observed, but remain poorly understood. One unresolved question is whether there is a linear relationship across the entire BMI range. We investigated this question among 11,235 adult men and women from seven low-BMI populations in Africa and the Caribbean. We used kernel smoothing and multivariate linear and spline regression modeling to examine gender differences in the relationship and to test for a threshold. Age-adjusted slopes of BP on BMI were uniformly higher in men than women, with pooled slope ratios of 2.00 and 2.20 for systolic and diastolic BPs, respectively. Men displayed no evidence of age modification or nonlinearity in the relationship, and the age-adjusted slope of systolic BP on BMI was 0.90 (95% confidence interval [CI], 0.76 to 1.04). Women demonstrated both age modification and nonlinearity. For both younger (<45 years) and older (45+ years) women, the optimal change point for a single threshold model was found to be 21 kg/m2. Slopes of systolic BP on BMI above this threshold were positive and significant: 0.68 (95% CI, 0.54 to 0.81) and 0.53 (95% CI, 0.29 to 0.76) for younger and older women, respectively. Slopes below the threshold were essentially zero for both groups of women, and the difference between the slopes above and below the threshold was significant for younger women (P=.019). In summary, we observed a threshold at 21 kg/m2 in the relationship between BMI and BP for women but not for men. This contributes to the effort to identify the mechanisms that underlie this relationship and how they differ by gender.

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This article explores and examines the fundamental need for nurses to include the promotion of the spiritual dimension of the health of human beings as well as the physical, mental and social facets if they truly wish to engage in holistic care. The author attempts to define the phenomenon of spirituality, aware of the dilemma that many individuals face when thinking and reflecting on this very personal and intangible issue. To be spiritual is to become fully human, the article argues, and the reverse is also true. Spirituality in health is inextricable in each person's search for the discovery of the truth about self and the meaning and purpose of life. Healthy communities are the product of healthy individuals who sow spiritual seeds such as unconditional positive regard, acceptance, respect and dignity for the benefit and advancement of individuals and humankind as a whole. The global nature of the phenomenon of spirituality is also shown by using examples of people who demonstrate compassion and communion with other human beings, in other countries in times of suffering, war and disaster. Compassion and empathy is expressed and experienced for victims of earthquakes that happen miles from home and far removed from personal or religious beliefs. Yet at such times we are all connected in the tapestry of life by our own human spirituality and earthiness. Abstract themes like compassion and justice are treated in the text within the context of spirituality. The author argues that being just and fair means that all patients have the right to achieve spiritual healing regardless of their belief systems, culture or creed. The works of some spiritual philosophers are used to reflect on this integral aspect of human caregiving. Historical symbols of spirituality are examined. The need for nurses to explore and reflect on the paradoxical concepts involved in their own spirituality is highlighted. Nurses are the essential providers of care and, therefore, the paper argues, guardians of that essential humanity that ensures that patients never become less than full human beings, whatever their condition, faith, culture or belief, or whoever they may be. The author contends that this responsibility is uniquely essential to being a nurse.

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This paper examines the organizational and financial changes experienced by the Chilean Health System in the last 20 years. The succession of widely different political and philosophical views sponsored by the governments of Frei, Allende and Pinochet and the marked economic fluctuations experienced in the last decade have affected the organization of health care financing and the allocation of resources among the population. The trend towards a completely state financed health care system was reversed in 1973. Pinochet's government explicitely included the private sector in the provision of public health services and assigned the State a subsidiary role. Several financing mechanisms created to coopt private capital into the health system are described as well as the evolution of private and public health care expenditures. The political and economic context that shapes the allocation of limited health care resources among a population with a highly unequal income distribution may endanger the access and the quality of health care services in the country.

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