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Occupational exposures to carcinogens in developing countries.

There have been very few studies of exposure to occupational carcinogens in developing countries, and even fewer studies of the health consequences of such exposures. However, all industrial chemicals, occupations and industrial processes classified by the International Agency for Research on Cancer (IARC) as Group 1 or Group 2A (carcinogenic or possibly carcinogenic to humans) have been described in developing countries, and there is growing concern that the health impact of many chemicals used in the developing world has been underestimated. In all regions a very large workforce is employed in the construction industry, in which substantial exposure to asbestos may occur, and there has been a rapid increase in production in countries such as Brazil and India. There is, for instance, a similar pattern for tyre production with a large increase in production in developing countries in the 1980s. Thus, the number of workers in industries entailing a carcinogenic risk is increasing in developing countries, partly as a result of the transfer of hazardous industry from industrialized countries. There is much that could be achieved in the prevention of occupational cancer in developing countries, and there have been a number of successful initiatives. However, the greatest progress in the prevention of occupational cancer in developing countries is most likely to come from political and economic changes.

Carcinogens

Is elderly care research-based?

Nurses working with elderly people, and students considering the specialty as a career option, may develop negative attitudes about the value of the work they do. These often derive from the perception that their efforts do not improve patients' problems, and a misconception that what they do is intuitive rather than based in research. Such tensions can lead to the development of 'burnout' and the rapid demoralisation of the workforce. Roger Watson shows how nursing elderly people, particularly those with dementia who live in continuing care settings, calls on high degrees of technical and interpersonal skills, and demonstrates how the roots of the specialty are deeply entrenched in research.

Aged

Development management for nursing administration.

What are the needs of a nurse administrator in a developing country? For that matter, what are the requirements for a nurse administrator in areas of lesser developed delivery in this country (e.g., care of the homeless, care of indigent populations)? Heyden, Luyas, and Henry look at the educational needs of these nurse managers and compare the needs to the typical education received in nursing administration programs.

Administrative Personnel

Investing in Canada's nursing workforce: a comprehensive review to inform policy innovations and directions.

BACKGROUND: Health systems worldwide face persistent health workers challenges including nursing shortages, workforce strain, and inequities. In Canada, these challenges have prompted renewed national and provincial reforms to strengthen recruitment, retention, leadership, and sustainability. This paper compares nursing workforce policy directions across Canada, and international jurisdictions to inform policy and planning. METHODS: A cross-country comparative analysis of policies building on a comprehensive national funded review that included an umbrella review of 69 systematic reviews, a comparative policy review of nursing workforce strategies in five jurisdictions, and validation through national horizon-scanning and policy dialogues (n >100). Evidence was analyzed across system, organizational, and individual levels. RESULTS: At the system level, international jurisdictions demonstrate comprehensive, legislated approaches integrating data, governance, and multi-year funding have advanced key nursing strategies. In Canada, the advances show the importance of strategies to have national and provincial/territorial alignment emphasizing leadership, flexibility, and inclusion as key levers. Organizational and individual-level reforms such as mentorship, leadership development, and wellness initiatives are expanding but remain variably evaluated. Experts identified national workforce data strategies and policy integration with embedded evaluation as key enablers to inform scalability and sustainability of implemented strategies. CONCLUSIONS: Canada's nursing workforce reforms are advancing toward coordinated, equity-driven, and evidence-informed strategies. Continued investment in evaluation, leadership, and national integrated data systems along with integrating nursing workforce planning within broader intersectoral planning will consolidate these gains and position Canada as an international leader in sustainable nursing workforce policy.

Canada

An educational partnership to develop acute care nurse practitioners.

Hospitals currently are involved in a restructuring of the medical and nursing workforce as fiscal restraint and downsizing proceed. Changes in organizational structure, reductions in medical school enrollments and available resident positions, and the reconfiguration of nursing positions are common events. Noted gaps in the provision of care to patients are creating an opportunity to develop a new provider, an acute care nurse practitioner (ACNP). The need for ACNPs was identified in a series of consultations between the Faculty of Nursing at the University of Toronto and affiliated hospitals. In response to this need the Faculty of Nursing, with the assistance of the Max Bell Foundation, developed a three month post masters Fast Track Acute Care Nurse Practitioner Program in collaboration with 10 hospitals. Fifty-nine masters prepared nurses successfully completed one of four cycles of a concentrated program which included courses in Pharmacology, Advanced Assessment and Clinical Decision Making, Roles and Issues, and a four-week Clinical Practicum. Evaluation of graduates' competence to fulfil the nursing and medical role expectations included focus group discussions, an external review of case studies, and a questionnaire to hospital partners about their satisfaction with the program graduates.

Acute Disease

Balancing skill mix--future paediatric health care provision.

Issues of "cost vs quality" and the needs for "pairs of hands" rather than "pair of eyes" has meant that nursing service managers are having to look closely at the skill mix of the staff they employ. This paper outlines the need to define the role of the nurse and the function of skill mix review. Arguments are discussed surrounding the issues of an all qualified nursing staff in a traditional hospital or the use of a generic "multiskilled" workforce within a "patient-focused" environment. The reasons for developing the role of the National Vocational Qualification (NVQ) Support Worker are examined and how they, and the Project 2000 trained staff nurse compare, against each other when looking for staff to employ. This paper looks at the paediatric field of health care in the light of the recommendations made by the 1991 Clothier Report to increase the number of specialist trained staff within that environment and what the future role of the children's nurse may be

Clinical Competence

Measurement of exposure to mouse urinary proteins in an epidemiological study.

OBJECTIVES: To develop an assay to measure airborne mouse urinary protein (MUP) and to assess the occupational exposure to MUP in the workforce of three establishments as part of an epidemiological study examining the influence of aeroallergen exposure on the development of allergic respiratory disease. METHODS: Personal air samples were collected from nine exposure groups during a workshift. A sensitive and reproducible competitive inhibition assay, which used rabbit antisera specific for MUP, was developed and used to measure the occupational exposure to MUP. RESULTS: The personal measurements of MUP showed that people with direct contact with mice (animal technicians) had the highest exposure followed in decreasing order by those working with anaesthetised animals or their tissue (postmortem workers and scientists) and those with indirect contact with mice (supervisors, office workers, and slide production workers). The only difference in concentrations of MUP between the three establishments were found for cage cleaners, which reflected differences in working practises for this exposure category. Air samples collected during the performance of specific tasks showed that high exposures to MUP were associated with handling mice, indirect contact with mice, and washing floors. CONCLUSIONS: Exposure to mouse urinary proteins has been measured in the occupational environment. This information can be used to determine the relation between exposure to MUP and the development of allergic and respiratory disease.

Air Pollutants, Occupational

Physical medicine and rehabilitation workforce study: the supply of and demand for physiatrists.

OBJECTIVE: Analysis, results, and implications of a supply and demand workforce model for physical medicine and rehabilitation. Explicit issues addressed include: (1) the supply implications of maintaining current (1994-1995) output of physiatrists from residency programs; (2) the implications of continued growth in managed care on the demand for the services of physiatrists; (3) likely future supply and demand conditions; and (4) strategies to adapt to future conditions. DESIGN: A workforce model of the supply and demand for physiatrists was developed. Parameters of the model are estimated using econometric models and by applying the judgments of a consensus panel. The model evaluated several different scenarios regarding managed care growth, competition from other providers and other factors. RESULTS: Based on the analysis, physiatrists will continue to be in excess demand through the year 2000. More aggressive growth in managed care can affect this result. CONCLUSIONS: Based on an overall assessment of supply and demand conditions, and under the assumption that the supply of new entrants each year remains in the range of 1994-1995 levels, demand for physiatrists will continue to exceed supply, on average, through the year 2000. Excess supply has, and will, emerge in selected geographic areas. If the profession is successful in informing the market regarding the advantages of physiatry, the profession can continue to grow without experiencing excess supply, in the aggregate, for the foreseeable future.

Forecasting

Development and experience of a university-based, freestanding birthing center.

OBJECTIVE: To describe our experience with a freestanding birthing center established in conjunction with a university medical center, and to determine the safety and effectiveness of such a program. METHODS: The University of California Irvine Medical Center opened a freestanding birthing center 2 miles from the hospital. The unit provides prenatal, labor, delivery, postpartum and well-baby care 24 hours/day. All direct patient care is provided by certified nurse-midwives. Data were collected prospectively to provide a descriptive account and to evaluate maternal and perinatal morbidity and mortality to determine the safety and efficacy of this approach. RESULTS: During the first 20 months of operation, the University of California Irvine Birthing Center cared for 1830 patients. Approximately 90% were indigent, 85% were Hispanic, and 35% were nulliparas. Of the total patients, 12% were transferred antenatally for high-risk conditions and 19% were transferred intrapartum. The cesarean rate for all patients was 10% (6.5% for those whose intrapartum care began at the birthing center). The perinatal mortality rate was six per 1000. Neonatal morbidity rates, neonatal intensive care unit admissions, and maternal complications were not greater than expected. CONCLUSION: The first 20 months of experience with a university-based, freestanding birthing center suggests that this alternative is safe for delivering obstetric and newborn care to low-risk patients.

Adolescent