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PubMed1991

[Health: a critical analysis and proposals for implementation in the city of Londrina and region].

Through this study, the authors make a capital a critical analysis about the national conjuncture within the field of health, and settle a relationship with the problems experienced by the municipality of Londrina. They analyse the responsibility of Federal Government and their various sectors, regarding the insufficiency of financial resources to be used in the area, and by the bad management of these resources. The structure health services in Londrina is described in detail, emphasizing the importance of this town as the regional center for the whole of northern Paraná. Emphasis is given to the excess os patients, at the moment, mainly in relation to general hospitals, because of lack of availability of beds. At the end of the study, considerations about the legislation of SUS (Sistema único de Saúde) are made and several suggestions are presented, aiming at regularizing the situation in the Municipality of Londrina.

Brazil↗
PubMedDate not supplied

[Census 2004 of the Italian Renal and Dialysis Units. Veneto, Friuli Venezia Giulia and Trentino Alto Adige].

The Italian Society of Nephrology (SIN) promoted a national survey of the Renal and Dialysis Units using an online questionnaire on some aspects of structural, technological and personnel resources, as well as organisation and activity. The major aim of this initiative was to obtain a reference benchmark on a national and regional basis. In this paper the data of the northestern regions of Italy (Veneto, Friuli-Venezia Giulia and Trentino-Alto Adige) are reported and compared with the recently published results of the northwestern regions (Piedmont, Liguria and Valle d'Aosta). From an epidemiologic point of view, the prevalence of dialysis patients was 534 pmp (per million population) in Veneto, 667 pmp in Friuli VG and 545 in Trentino AA, the prevalence of transplanted patients was 265, 294 and 404 pmp, respectively; the incidence of dialysis patients was 137, 182 and 130 pmp; gross mortality was 12.5, 14.3 and 16.5%; the distribution of vascular accesse in prevalently dialysis patients was: arteriovenous fistulas = 84.5, 70.4 and 80.9%, central venous catheters = 10.6, 20.0 and 10.2%, vascular graft = 4.9, 9.6 and 8.8%. Regarding structural resources, the distribution of hospital bed numbers was 38, 42 and 43 pmp; dialysis places were 137, 181 and 172 pmp. Human resources were given by renal physicians = 28.3, 38.2 and 23.6 pmp and renal nurses = 138, 200 and 172 pmp; each renal physician took care of 19, 17 and 23 dialysis patients and each renal nurse cared for 3.9, 3.3 and 3.2 dialysis patients. Activity data showed 1436, 1328 and 974 pmp hospital admissions, kidney biopsies were 106, 114 and 31 pmp. Overall, the Italian Northeast shows a significantly lower prevalence and incidence of end-stage renal disease patients than the Northwest; on the contrary, the incidence of patients with acute renal failure is significantly higher. In the Italian Northeast a significantly lower number of hospital beds devoted to renal patients is observed, while dialysis places are more frequent. In the Northeast fewer renal physicians are present than in the Northwest, whereas renal nurses are equivalent if related to the number of dialysis patients. Activity indexes, intended as amount of hospital admissions and renal biopsies standardised per population, are less significant in the Northeast. The results of the survey in Veneto, Friuli VG and Trentino AA show some discrepancies in the treatment of chronic kidney disease between the three regions and even more among different areas of Italy. Despite similar health care models, a relevant inequality in health care resources is evident.

Ambulatory Care Facilities↗
PubMed2000

Methods for identifying and assessing groups in health behavioral research.

Methods to study groups developed in other fields have much to contribute to the study of health behavior, including alcohol and substance use. This paper surveys group methods in order to demonstrate how attention to group levels of analysis can provide new insights about the context and causes of health behavior. The first major section of this paper focuses on the influences on health behavior associated with "naturally occurring groups" such as peer networks, families, workplaces, neighborhoods, churches, treatment groups and residential settings. Different aspects of group influence are discussed in terms of seven different features of social groups: history, structure, function, resources, process, norms and climate. The second major part of this paper is concerned with methods to identify meaningful subgroups in heterogeneous samples. Following an overview of taxonomic methods to identify and assign cases to groups, we highlight the potential for these methods to help address a number of fundamental theoretical problems in health behavioral research, including: describing cultural diversity, distinguishing response sets in survey research, controlling error in outcomes scores related to baseline differences, tracking trajectories of change, and revealing interactions among determinants of health behavior. The third and final section of the paper highlights specific applications of taxonomic and group-influence methodologies in intervention research, including design and analysis of randomized trials, studies of existing treatment settings and group-level variables involved in translational research.

Group Processes↗
PubMed1994

2058 expressed sequence tags (ESTs) from a human fetal lung cDNA library.

ESTs (expressed sequence tags) provide complementary resources for structural and functional analyses of the human genome. We have performed single-pass sequencing of 2058 randomly selected, directionally cloned cDNAs isolated from a fetal-lung cDNA library constructed with oligo(dT) primers. Computer analyses of the 5'-end sequences revealed that 60.4% of the clones were considered to be identical to previously reported human genes or ESTs; 9.0% of them showed significant homology to known genes in human, other mammals, or lower organisms; 30.6% showed no homology to any genes or DNA sequences in the public database. These data and reagents will be useful for future investigations of gene expression during prenatal development of human lung.

Amino Acid Sequence↗
PubMed1994

Towards an optimal teaching programme for supportive care.

The changes occurring in medical education have led to important principles being identified that are relevant to teaching in supportive care. Many of these principles are already an integral part of the Newcastle, NSW, Medical Faculty undergraduate course and are being applied to the teaching of oncology and supportive care. The same principles can be applied to curriculum development and implementation in other settings. A curriculum is proposed that builds on a general background of oncology knowledge. Factual knowledge is limited to the precarious clinical problems requiring optimal supportive care, the priority oncology syndromes, palliative care and principles of psychosocial and behavioural science interventions. The curriculum also includes critical reasoning, special skills including counselling, communication, self-directed learning, team management, health-service resources and structure, and relevant management skills. To implement the curriculum, consideration must be given to teaching methods (teaching in context and in small groups, problem-based learning and problem solving). The needs of students, quality of the teachers, when and where the teaching and learning will occur and methods of assessment should also be considered to ensure the curriculum can be used optimally.

Clinical Competence↗
PubMed2003

Service sector and perceived social support at work in Norwegian nurses' aides.

OBJECTIVES: Social support at work is associated with reduced risk of illness and sickness absence. Identifying determinants of social support at work is, hence, important. The objective of this study was to determine the relationship between service sector and level of social support at work in nurses' aides. METHODS: A random sample of nurses' aides, organised by the Norwegian Union of Health-and Social Workers, was mailed a questionnaire in 1999. Of 12,000 recipients, 7,478 (62.3%) completed the questionnaire. The 6,234 vocationally active, female respondents comprised the sample of this study. Perceived social support at work was assessed by scales in the standardised questionnaire, the General Nordic Questionnaire for Psychological and Social Factors at Work (QPSNordic). Each service sector was compared with all other sectors. Because of multiple comparisons, the significance level was set at 0.01, and 99% confidence intervals were used. RESULTS: The following associations were found, after adjustments for age and work schedule: high levels of support from the immediate superior were reported more often by aides in the psychiatric sector [odds ratio (OR) 1.72; 99% confidence interval (CI) 1.29-2.29] and community-nurse service (OR 1.22; CI 1.01-1.48), and less often by aides in nursing homes (OR 0.67; CI 0.58-0.77). Encouraging and supportive culture in the work unit was reported more often by aides in the psychiatric sector (OR 1.55; CI 1.13-2.13), and less often by aides in nursing homes (OR 0.79; CI 0.69-0.92). CONCLUSIONS: In nurses' aides, perceived level of social support at work varies with service sector. Differences in organisational structure, personnel resources, and work tasks could explain the results. It is essential that managers in nursing homes put more emphasis on creating a supportive culture in their work units. Reorganisation and training of personnel could be elements of this effort. Higher grants may also be needed.

Adult↗
PubMed1985

Economic evaluation of a Swedish medical care program for hypertension.

A Hypertension Care Program, developed in cooperation between physicians and nurses in both primary care and at the hospitals in the area, was implemented in the Skaraborg County, Sweden in 1977. The Program, which provided for the establishment of hypertensive clinics at outpatient units and referral to medical clinics, was clearly aimed towards giving nurses increased responsibility for hypertensive care. The Skaraborg Program has been evaluated from several important perspectives. A terminal population study showed better blood pressure control among the hypertensive patients within the program area than within the control area. The economic evaluation indicates that hypertensive care according to the Program is somewhat less resource demanding than conventional hypertensive care. Since the medical effects of hypertensive care were improved without increased demand for resources, the structured Care Program was more cost-effective than conventional care.

Cost-Benefit Analysis↗
PubMed1989

A QSAR model for the estimation of carcinogenicity: example application to an azo-dye.

Since carcinogenicity bioassays are time-consuming, costly, and use animal resources, structure-activity relationship equations which model toxicological end-points have been developed to make available alternative methods which approximate the results that could be obtained from bioassays but which are less expensive and time-consuming and use fewer, if any, animals. These equations are based on sets of bioassay results and explain the end-point under consideration in terms of substructural and other parameters which describe the chemical entities. The resulting equations--or models--can then be used to estimate--or predict--the end-point for new structures. The estimation is followed by validation procedures.

Animals↗
PubMed2006

Influences of the season and the habitat structure on the foraging ecology of two coua species in the western dry forest of Madagascar.

I studied the foraging ecology of Coquerel's Coua (Coua coquereli) and Giant Coua (Coua gigas), which occur in the dry forest in west Madagascar. This kind of forest is characterised by an alternating of a dry and a rainy season. The foraging behaviour was described in several dimensions: i.e. height and proportion of perching, rate of capture (estimating the food availability), foraging techniques, substrates used, type and size of the captured prey. Their foraging behaviour was different according to the season and to the proximity of water. Habitat structure was important to take in consideration to study their foraging behaviour. They tended to use the same pattern of techniques and substrates, but differed by the proportions they used these variables and also by the possibility to climb into the dense understorey vegetation. Seasonal variation has probably an important effect on the prey availability and the nature of prey captured. The diet of both species is also discussed. I suggest that change in habitat structure and resources levels could be important to take in consideration for the conservation of these forest birds.

Animals↗
PubMed2005

The Health Promoting Prison (HPP) and its imperative for nursing.

The World Health Organisation's (WHO) Ottawa Charter for Health Promotion in 1986 provided the catalyst from which the Health Promoting Prison (HPP) movement emerged. Here, an extensive review of the available prison-related health literature provides the basis for critical discussion and recommendations for nursing services and prison-related health care. The findings suggest that current prison-based nursing services are seriously neglected and woefully lacking in structure and resources. This article recommends strategies for reform that includes nurses who practice in all settings, and not just prison-based nurses. If nurses wish to be at the forefront of future HPP strategies, they must first embrace the radical health promotion reforms that are emerging from the current literature. Building sustainable group capacity into prison-based health care, through developing social interaction, cohesion, participation and political action can only benefit the community at large and further emphasise the health promotion role of nursing.

Clinical Competence↗
PubMedDate not supplied

Experiences and benefits of volunteering in a community AIDS organization.

This qualitative study examines the AIDS service organization-volunteer relationship from the volunteer's point of view. Factors that led to a relationship with an AIDS service organization included personal values and individual characteristics and needs. Volunteers reported many rewards from the work itself and the responses of others. Volunteers also encountered challenges that included role demands, role-ability fit, and stress/burnout concerns as well as limited organizational resources and structural obstacles. These results suggest that care must be taken to ensure that the volunteer role meets the needs, skills, and abilities of the individual volunteering. The need to ameliorate challenges is clear for AIDS service organizations seeking to retain volunteers. Some of the preventive strategies include goal-setting and feedback, individual-sensitive role redesign, opportunity to participate in decisions, and increased communication.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Finding functional sites in structural genomics proteins.

Assigning function to structures is an important aspect of structural genomics projects, since they frequently provide structures for uncharacterized proteins. Similarities uncovered by structure alignment can suggest a similar function, even in the absence of sequence similarity. For proteins adopting novel folds or those with many functions, this strategy can fail, but functional clues can still come from comparison of local functional sites involving a few key residues. Here we assess the general applicability of functional site comparison through the study of 157 proteins solved by structural genomics initiatives. For 17, the method bolsters confidence in predictions made based on overall fold similarity. For another 12 with new folds, it suggests functions, including a putative phosphotyrosine binding site in the Archaeal protein Mth1187 and an active site for a ribose isomerase. The approach is applied weekly to all new structures, providing a resource for those interested in using structure to infer function.

Algorithms↗
PubMed1998

Internet integrated in the daily medical practice within an electronic patient record.

Healthcare enters the information age and professionals are finding an ever-growing role for computers in the daily practice of medicine. However, a number of problematic issues are associated with electronic publications, especially through Internet. Whilst access to any information has been improved, access to specific information has become more and more difficult [1], due to the lack of a general meta-knowledge allowing to structure Internet resources. Physicians have to learn and adapt themselves to computers and Internet, but Internet has to meet the specific requirements of Healthcare. Important issues must therefore be addressed to allow a real and daily use of Internet in the medical practice. The paper discusses most of these issues and proposes a solution developed at the University Hospital of Geneva that integrates an Electronic Patient Record with Internet, without compromises on security or on performances and that runs on standard PCs'.

Computer Security↗
PubMed1997

Ways forward for shared learning between nursing and social work students.

This paper is based on the work of Connor (1995) which examined the potential for shared learning on qualifying programmes of social work and nurse education in Wales. The research was carried out mainly by interviewing 44 providers of social work and nurse education in the 13 colleges delivering qualifying courses throughout Wales. The main findings indicate that: nursing and social work educators have a positive attitude to shared learning, provided that the focus is on sharing appropriate areas of learning and not on joint training; there are considerable areas of commonality between social work and nurse education that could be shared; obstacles to shared learning mainly concern structural and resource issues which would require the appropriate political will to implement shared learning programmes; and there are a wide variety of models that could be used to implement future shared learning. The management of this project with its commitment to collaboration between the two professional groups throughout the process of enquiry is offered as a model for further research projects.

Curriculum↗
PubMed2002

Being deaf and being other things: young Asian people negotiating identities.

This paper explores how Asian deaf young people negotiate identity claims against the backdrop of deaf politics, ethnicity, religion, gender and age. The paper is based on a qualitative study of Asian (mainly Pakistani Muslim) deaf young people and their parents in the UK. The findings provide little support for notions of singular or primary identities (as, for example, 'Deaf' people or 'Muslims') which may make other identity claims irrelevant. Instead, young people's identifications were multiple, complex and contingent. However, resources and structures remained important for identifications to be cultivated and gaining legitimisation.

Adolescent↗
PubMed2004

Living with conflicts-ethical dilemmas and moral distress in the health care system.

During the last decade, the Swedish health care system has undergone fundamental changes. The changes have made health care more complex and ethics has increasingly become a required component of clinical practice. Considering this, it is not surprising that many health care professionals suffer from stress-related disorders. Stress due to ethical dilemmas is usually referred to as "moral distress". The present article derives from Andrew Jameton's development of the concept of moral distress and presents the results of a study that, using focus group method, identifies situations of ethical dilemmas and moral distress among health care providers of different categories. The study includes both hospital clinics and pharmacies. The results show that all categories of staff interviewed express experiences of moral distress; prior research has mostly focused on moral distress experienced by nurses. Second, it was made clear that moral distress does not occur only as a consequence of institutional constraints preventing the health care giver from acting on his/her moral considerations, which is the traditional definition of moral distress. There are situations when the staff members do follow their moral decisions, but in doing so they clash with, e.g. legal regulations. In these cases too, moral distress occurs. Hitherto research on moral distress has focused on the individual health care provider and her subjective moral convictions. Our results show that the study of moral distress must focus more on the context of the ethical dilemmas. Finally, the conclusion of the study is that the work organization must provide better support resources and structures to decrease moral distress. The results point to the need for further education in ethics and a forum for discussing ethically troubling situations experienced in the daily care practice for both hospital and pharmacy staff.

Conflict, Psychological↗
PubMed2002

The administration of school-based mental health services.

Challenges and proposed solutions in the administration of school-based mental health services have been addressed. Differences depend on whether the services are provided by the mental health component of an SBHC or by an ISBMHP. Seven common elements relevant in developing and administering school-based mental health services, whether in an SBHC or ISBMHP, have been identified: funding, assessment and resources, program structure, staffing and training, partnership and collaboration, quality assurance, and evaluation. How these elements are addressed varies from school district to indivdual school to individual principal to agencies providing services to specific clinicians. One of the most important lessons learned is that the ecosystem of each school is different; one size does not fit all. When external agencies enter a school, they are in the best case guests, in the worst case foreigners or invaders. Agencies and their clinicians must be respectful, adaptable, flexible, and competent professionals. With such attributes, the chance for an effective collaboration is enhanced. Contributions of school-based mental health services to the child and adolescent mental health delivery system include (1) access to services for disadvantaged and underserved youth, (2) system-wide collaboration, (3) prevention of acute psychiatric intervention, (4) gate-keeper role for more acute or specialized care, (5) systematic program evaluation in a "naturalistic" setting, (6) professional training in working with a range of systems and cultures, and (7) outreach and community-based care. With the emphasis on partnership and collaboration, school-based programs have the potential to benefit the children and families, schools, communities, and managed care organizations. The provision of access and early intervention is cost effective in the long run, and findings indicate that school-based mental health service is as effective as that of a central clinic. With the emphasis on collaboration, partnership, and bridging systems and cultures, the provision of school-based mental health care may be able to offer tools and experience to create integrated systems of care. This is a reciprocal process and an ongoing dialectic, however. Providers and planners of a school-based mental health programs, schools, and managed-care leaders can learn from one another, and all have major contributions to make to the overall delivery system. Schools and mental health service providers contribute knowledge and skills in working with this population; managed care organizations bring administrative and fiscal expertise and a focus on and mandate for quality and cost-effective care. For-profit and not-for-profit agencies must enter into a dialogue to educate and understand each other so that they may become collaborators in the underutilized service for children and youth.

Adolescent↗