Celebrating 25 years of primary nursing.
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Biomedical subjects
Publications and source records attributed to B Vaughan.
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A 36-month double-blind clinical caries study was conducted to determine the comparative anticaries efficacy of sodium monofluorophosphate (MFP) and sodium fluoride (NaF) as incorporated in dentifrice formulations. The test dentifrices which were utilized are commercially available in the United States and all have been granted the American Dental Association Seal of Acceptance for anticaries efficacy. The study was conducted in accordance with the 1988 Guidelines of the American Dental Association Council on Dental Therapeutics. The two formulations used in the NaF versus MFP comparison were Colgate Winterfresh Gel with 0.76% sodium monofluorophosphate in a silica base and Crest Regular Flavor Toothpaste with 0.24% sodium fluoride in a silica base. A third commercially-available NaF dentifrice, Colgate Junior Toothpaste with 0.243% sodium fluoride in a silica base, was included in the study for further comparison. Schoolchildren residing in Maine, U.S.A. received a baseline caries clinical examination and then were randomly assigned to the twice-daily use of one of the three dentifrices which were purchased in the marketplace and repackaged in plain white tubes. Caries clinical examinations were subsequently conducted after 2 and 3 years' use of the dentifrices. A total of 2,222 children participated in both the 2 and 3-year caries clinical examinations. The 36-month DFS (decayed and filled surfaces) and the DFT (decayed and filled teeth) mean caries increments for the three dentifrice groups were virtually identical. The children using the MFP formulation experienced a DFS of 1.50 and a DFT of 1.08; those using the Crest NaF formulation experienced a DFS of 1.48 and a DFT of 1.07; subjects in the third group (Colgate Junior Toothpaste, 0.243% NaF) had a DFS of 1.49 and DFT of 1.06. The statistical evaluation of the data consisted of the calculation of 90% confidence bounds for the ratio of (true) mean increments, in accordance with the 1988 American Dental Association Guidelines. Expressed in the language of the Guidelines, the analyses indicated that, (1) the anticaries efficacy provided by the MFP formulation, (Colgate Winterfresh Gel with 0.76% MFP) is "as good as" that provided by the NaF formulation, (Crest Regular Flavor Toothpaste, with 0.243% NaF), and (2) the anticaries efficacy provided by the one NaF formulation (Colgate Junior Toothpaste, with 0.243% NaF) is "as good as" that provided by the other, (Crest Regular Flavor Toothpaste, with 0.243% NaF).
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Factors that will affect both contraceptive use and choice of method during the next 20 years are reviewed. Two factors are predictable: the changing age distribution of women and the revised upper-age limits for oral contraceptive use, with the effect of the latter as yet unknown. Less predictable factors include the number of women in each age group at risk for pregnancy, the effects of delayed childbearing and sterilization, and the impact of new contraceptive methods. Unpredictable factors include adverse publicity about oral contraceptives and breast cancer, concern about sexually transmitted diseases and acquired immunodeficiency syndrome, and changes in the availability of legal abortion. Numbers of women using oral contraception, other reversible methods, sterilization, and no method are projected from 1990 to 2010 under the assumption that use patterns in each age group resemble those observed in 1988. We conclude that discrepancies between projections of contraceptive use and fact are likely to occur because of the unpredictable nature of these few important variables.
This analysis uses data from Bangladesh and the Philippines to demonstrate that children who are born within 15 months of a preceding birth are 60 to 80% more likely than other children to die in the first two years of life, once the confounding effects of prematurity are removed. The risks associated with short conception intervals are confined to children who are also high birth order; they persist in the presence of controls for prior familial child mortality, breast-feeding, mother's age, and socioeconomic status. In Bangladesh but not in the Philippines, these effects are confined to the neonatal period.
It is argued in this paper that since practice is context bound, there can be no 'blueprint' offered through a formal educational programme for primary nursing. It is suggested that what may be needed is support on a much broader basis to help nurses to move from the relative safety of traditional approaches to work to the much riskier independent professional model of practice implicit in primary nursing. Three key areas have been identified which could be incorporated within an educational programme, namely development of self as an independent practitioner with the requisite skills of self-directed learning, the ability to accept responsibility discriminatingly and to account for practice through a well-established knowledge base; development of interpersonal skills required for the close personal nurse/client relationships required of primary nurses alongside appropriate support mechanisms; an understanding of the context in which practice occurs in order that the broad principles of primary nursing can be adapted to local needs. In this way, people may be helped to move from a dependency on central control and decision-making to become independent creative practitioners who are able to develop a local organisational model which suits their personal situation.
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The principles of Magnetic Resonance Imaging (MRI) evolved during the late 1970s and early years of the following decade. The author was fortunate in being able to visit many of the pioneer research projects in the U.K. and U.S.A. and attend two conferences. This paper briefly describes these projects and their role in the evolution of the present technology, illustrated by photographs obtained from colour slides taken during these visits.
Using data from the National Survey of Family Growth (NSFG), this study reports differentials in contraceptive use-failure and continuation among married women aged 15-44 years in the United States. Failure rates differed by contraceptive intention. Within categories of intention, these rates differed by method, age, race, and parity. Users of modern methods had higher continuation rates than users of traditional methods. These results indicate that a woman's motivation is an important factor in long-term successful use of available contraceptive methods and that more effective and easier to use methods need to be developed.
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