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PubMed2005

Cross-cultural analysis for conceptual understanding: English and Spanish perspectives.

Culture and primary language provides the context for understanding between the patient and the nurse and therefore is part of the foundation for nursing care. Knowledge development in nursing is predicated on mutual understanding and interpretation of language. Concept development has been identified as one of the approaches to the development of nursing knowledge. Since the process of concept analysis is based on understanding a phenomenon through language and experiences, this process is culture-bound and language-specific. The purpose of this column is to discuss the value of interviews with people from two different cultures resulting in an attempt to develop nursing knowledge with international relevance. An example of an analysis of a concept, worry, is provided, and the effects of culture and language on this nursing concept are discussed. The analysis was the result of collaboration among nurses from Mexico and the United States of America.

Cross-Cultural Comparison↗
PubMed2007

Prevalence and risk factors of overweight and obesity in China.

OBJECTIVE: To examine the prevalence and risk factors of overweight and obesity in China. RESEARCH METHODS AND PROCEDURES: A cross-sectional survey was conducted in a nationally representative sample of 15,540 Chinese adults in 2000-2001. Body weight, height, and waist circumference were measured by trained observers. Overweight and obesity were defined according to the World Health Organization classification. Central obesity was defined according to guidelines of the International Diabetes Federation. RESULTS: Mean BMI and waist circumference were 23.1 kg/m2 and 79.6 cm, respectively, for men and 23.5 kg/m2 and 77.2 cm, respectively, for women. The prevalences of overweight and obesity were 24.1% and 2.8% in men and 26.1% and 5.0% in women, respectively. The prevalence of central obesity was 16.1% in men and 37.6% in women. The prevalences of overweight, obesity, and central obesity were higher among residents in northern China compared with their counterparts in southern China and among those in urban areas compared with those in rural areas. Lifestyle factors were the most important risk factors to explain the differences in overweight and central obesity between northern and southern residents. Among women, lifestyle and diet were the most important risk factors to explain the differences between urban and rural residents, whereas socioeconomic status, lifestyle, and diet were all important among men. DISCUSSION: Our study indicates that overweight and obesity have become important public health problems in China. Environmental risk factors may be the main reason for regional differences in the prevalence of overweight and obesity in China.

Adult↗
PubMed1989

Exercise physiology: health indicators and cardiovascular risk factors during childhood and adolescence.

Low risk strategies use favourable levels of different behavioural and physiological parameters, which may be accepted as health indicators. High risk strategies are oriented to protect people from the potential risk levels of the same behavioural and physiological parameters. Both strategies are first applied to adults; but the established levels of risk in adults cannot be explained only by their living conditions, these factors must have some genetic and educational roots in childhood and adolescence. Based on several cross-sectional and longitudinal studies of 1652 subjects it was shown that trained and untrained adolescents did not differ in family history of CHD but clearly had different behavioural risk factors. The early identification of children and adolescents with a high risk of developing CHD should be intensified using integrated risk indicators. Thus collaboration between exercise physiology and preventive cardiology should be centered more on studies of children and adolescents.

Adolescent↗
PubMed1996

Advance directives in the emergency department: too few, too late.

OBJECTIVE: To determine: 1) the number of patients arriving at the ED who had executed an advance directive (AD), 2) how many of the patients who had an AD brought the AD with them, and 3) whether those patients who did not have an AD had ever discussed ADs with their primary care providers (PCPs) or had ever heard of an AD. METHODS: A cross-sectional, observational survey of a convenience sample of high-risk patients presenting to the ED of a university hospital was performed. Patients presenting to the ED for acute complaints who were elderly or had an underlying disease that suggested a risk of death in the near future were considered high risk. RESULTS: Of the 238 patients surveyed, 90% had PCPs. However, only 22% had ADs. Of these, only 23% brought the AD to the ED. Of the patients who did not have ADs, 95% had never discussed ADs with their PCPs, and 42% did not know what an AD was. Blacks were less likely than whites to have ADs (p < 0.0002) or to know about them (p < 0.004). CONCLUSION: The majority of high-risk patients presenting to this ED do not have ADs. Among those high-risk patients who did have ADs, fewer than 25% brought the ADs with them. The development of ADs for high-risk patients and the availability of ADs in the ED are woefully inadequate. Emergency physicians need to collaborate with PCPs to remedy these deficiencies.

Adolescent↗
PubMed2006

Evaluation and development of potentially better practices for perinatal and neonatal communication and collaboration.

OBJECTIVE: The obstetric and neonatal exploratory focus group of the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative 2002 set out to improve collaboration, communication, and coordination between maternal and neonatal caregivers in 3 areas: the pregnancy at 22 to 26 weeks, measurement of maternal outcomes that are linked with neonatal outcomes, and team performance during high-risk delivery. Antepartum and intrapartum maternal attributes and interventions also were considered important measurements to identify practice variations and their relationship to neonatal outcomes for ongoing obstetric and neonatal collaboration. METHODS: Potentially better practices were developed on the basis of evidence in the literature, expert opinion, and internal analysis at the participating perinatal centers. The potentially better practices include development of local guidelines at each center for the care and counseling of pregnant women who are at risk for delivering at the margin of viability; communication strategies for obstetric and neonatology providers relating to high-risk pregnancy treatment plans; team communication and performance at high-risk deliveries; design of organizational structures and processes that facilitate obstetric and neonatal collaboration; and development of perinatal data to evaluate effects of perinatal practices on maternal, fetal, and neonatal outcomes. RESULTS: As a result of the project, participating centers developed local guidelines for pregnancies between 22 and 26 weeks, created a cross-center maternal database that currently is being linked to neonatal outcomes, and completed a pilot study on video simulation of neonatal-perinatal team communication. CONCLUSIONS: Increased understanding of practice variation in the management of care for infants who are at the margins of viability, locally developed guidelines, and a focus on improved team communication during delivery can be accomplished with a multicenter collaborative approach.

Communication↗
PubMedDate not supplied

How much time do patients with diabetes spend on self-care?

INTRODUCTION: Little is reported about how much time patients spend on self-management, a cornerstone of diabetes care. METHODS: We studied a cross-section of 1482 diabetic patients enrolled in 3 northeastern United States managed care plans. Patients were surveyed about how much time they spent on foot care, exercise, and food shopping/preparation (7/00 to 9/01). Logistic regressions modeled which types of patients were likely to spend time, and linear regressions modeled characteristics associated with spending more/less time. RESULTS: Patients (57.9% > or = 55 years; 51.6% women; 36.2% African American; 31.1% on insulin) spent 58 (mean) minutes/day on self-care (interquartile range 19, 84). Many patients skipped individual self-care elements: 37.9% reported no foot care, 37.7% no exercise, and 54.4% no time on food shopping/preparation. One fourth of patients with severe foot neuropathy symptoms spent no time on foot care. Never self-testers were less likely than others to engage in foot care (odds ratio (OR) 0.4 (95% CI 0.3, 0.6), exercise (OR 0.4 (95% CI 0.3, 0.6)), and food shopping/preparation (OR 0.7 (95% CI 0.5, 1.0)), and were likely to spend 30 minutes less total self-care time than frequent self-testers (P <.01). DISCUSSION: Most people spent considerable time engaged in self-care, but many skipped individual tasks, offering clinicians opportunities for collaborative decision making.

Adult↗
PubMed2006

Post-acute service utilisation and parental satisfaction with health care services after mild traumatic brain injury in children and adolescents.

The objectives of this study were to describe and analyse the current aftercare practise following define TBI in four German cities. A retrospective, cross-sectional design was chosen in order to investigate the research questions. Methods and procedures included a questionnaire mailed to parents whose children were admitted with TBI to one of seven collaborating hospitals. A total of 564 parents participated in the study. The results indicate that aftercare services were rarely utilised. Furthermore, it was found that the behaviour of the physician in charge had a great impact on parental satisfaction with healthcare services. In conclusion, the findings described in this article underline the need to improve communication between acute and post-acute services.

Adolescent↗
PubMed2000

Elective high frequency jet ventilation versus conventional ventilation for respiratory distress syndrome in preterm infants.

BACKGROUND: This section is under preparation and will be included in the next issue. OBJECTIVES: The objective of this review was to determine whether the elective (commencing soon after initiation of mechanical ventilation) use of high frequency jet ventilation (HFJV), as compared to conventional ventilation (CV) in preterm infants with respiratory distress syndrome (RDS), would decrease the incidence of chronic lung disease (CLD) without adverse effects. SEARCH STRATEGY: Randomized trials from MEDLINE were identified by means of MeSH and text words 'high frequency ventilation', 'high frequency jet ventilation', 'jet ventilation' from the years 1980 to 1997. The EMBASE database, the Oxford Database of Perinatal Trials, the Neonatal Trials Register of the Neonatal Review Group of the Cochrane Collaboration and the Cochrane library were also accessed. Proceedings of recent SPR/APS meetings were hand searched. Information was obtained from experts in the field, and cross references were checked. SELECTION CRITERIA: All randomized controlled trials of elective high frequency jet ventilation versus conventional ventilation in preterm infants born at less than 35 weeks GA or with a birth weight less than 2000 gms with respiratory distress were included in the systematic review. Trials which used HFJV to 'rescue' preterm infants due to severe respiratory distress usually beyond 24 hours, and trials that used HFJV for a mandatory time period and then switched back to CV, were not included in this review. DATA COLLECTION AND ANALYSIS: The standard methods of the Neonatal Cochrane Review Group were used, including independent trial assessment and data extraction. Data were analysed using relative risk (RR) and risk difference (RD). From 1/RD the number needed to treat (NNT) for benefits and number needed to harm (NNH) for adverse outcomes were calculated. MAIN RESULTS: Overall analysis of the three trials showed that HFJV is associated with a reduction in CLD at 36 weeks postmenstrual age in survivors [RR 0.58 (0.34, 0. 98), RD -0.138 (-0.268, -0.007), NNT 7 (4, 90)]. The use of home oxygen therapy was evaluated in only one study (Keszler 1997) and a lower rate was found in the HFJV group [RR 0.24 (0.07, 0.79), RD -0. 176 (-0.306, -0.047), NNT 5 (3, 21)]. Overall there was a trend towards an increase in the risk of PVL in the HFJV group, which was not significant. Subgroup analyses shows a significant increase in risk of PVL in the trial by Wiswell 1996 [RR 5.0 (1.19, 21.04), RD 0.250 (0.069, 0.431), NNH 4.0 (2.3,14.5)] where a 'low volume strategy' was the standard protocol for HFJV. In the other trial by Keszler 1997, where the intention was to use a 'high volume strategy', there was no significant difference in the incidence of PVL, RR 0.42 (0.14, 1.30). In the overall analysis, there were no significant differences in the incidence of neonatal mortality, IVH all grades or in grades 3 or 4 IVH. In the subgroup where 'low volume strategy' was used there was a non-significant trend toward an increase in risk of IVH all grades and grades 3 or 4 IVH. REVIEWER'S CONCLUSIONS: The overall analysis shows a benefit in pulmonary outcomes in the group electively ventilated with HFJV. Of concern is the significant increase in acute brain injury in one trial which used lower mean airway pressures when ventilating with HFJV. There are as yet no long term pulmonary or neurodevelopmental outcomes from any of the trials. Until further studies ascertain the most appropriate strategy to routinely ventilate premature infants with HFJV safely, ventilation with HFJV cannot be recommended for preterm infants with RDS.

High-Frequency Ventilation↗
PubMed2000

Examining the psychological consequences of surviving childhood cancer: systematic review as a research method in pediatric psychology.

OBJECTIVE: To report the results of a systematic review to determine the psychological consequences of surviving childhood cancer. METHODS: Searches were conducted using Psyclit, Medline, Cinahl, and Bids and articles selected on the basis of predefined criteria. Key information was extracted to data sheets and these were rated by two coders. RESULTS: Twenty studies were identified, seventeen from the United States. Survivors did not show deficits in measures of anxiety, depression, or self-esteem when compared with population norms or matched controls. Survivors of some cancers (bone tumors) have poorer outcomes. CONCLUSIONS: The results of this review support findings of previous descriptive reviews. Methodological problems include poorly reported medical information (for example, time since diagnosis), heterogeneous samples, self-selection of participants, poorly chosen/lack of suitable measures, and a lack of longitudinal work. Findings are discussed in terms of the need for cross-cultural work on adjustment to childhood cancer, the need for studies to take on a more developmental approach, and for greater national and international collaboration.

Adaptation, Psychological↗
PubMed2002

Emergency/Adjunct services and attrition prevention for randomized clinical trials in children: the MTA manual-based solution.

Treatment studies in child and adolescent psychiatry are increasingly characterized by long-term, multisite, randomized clinical trials (RCTs). During the course of these RCTs it is common for clinical exigencies to emerge that require rapid, direct intervention. The challenge is to provide clinically appropriate responses that do not contaminate the delivery, distinctness, and interpretation of the treatments under investigation. In multisite studies, the problem is compounded by the need to minimize cross-site differences in the delivery of adjunct treatments. Such minimization requires fully operationalized and manual-based procedures for clinically mandated intervention. The NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (ADHD)--"the MTA"--is a long-term multisite collaborative study in which children with ADHD were randomly assigned to either medication management, behavioral treatment, the combination, or community-comparison assessment and referral. In designing its study, the MTA developed a manual-based set of procedures (the MTA Adjunct Services and Attrition Prevention [ASAP] Manual) for situations not covered by the protocol treatments. The majority of cases requiring adjunct services fell into two major categories: (1) crisis/emergent situations and (2) imminent risk of attrition. This report describes the ASAP guidelines for dealing with cases that required adjunct services that the MTA Steering Committee adopted before initiating the trial. Although the manual-based guidelines are especially applicable to multisite RCTs, many of the procedures in the ASAP Manual can apply to any treatment study in children.

Attention Deficit Disorder with Hyperactivity↗
PubMed2002

Precise determination of electroweak parameters in neutrino-nucleon scattering.

The NuTeV Collaboration has extracted the electroweak parameter sin(2)theta(W) from the measurement of the ratios of neutral current to charged current nu and (-)nu cross sections. Our value, sin(2)theta((on-shell))(W) = 0.2277 +/- 0.0013(stat) +/- 0.0009(syst), is 3 standard deviations above the standard model prediction. We also present a model independent analysis of the same data in terms of neutral-current quark couplings.

Journal Article↗
PubMed1987

Male unemployment and cause-specific mortality in postwar Scotland.

This article reports a time-series analysis of male unemployment and mortality in postwar Scotland. The results provide little evidence to support the hypothesis that unemployment exerts a significant and consistent positive impact on mortality from all causes, lung cancer, ischemic heart disease, and cerebrovascular disease. Although significant positive associations between unemployment and mortality from lung cancer and ischemic heart disease were detected for older males in the short term, the long-term association between unemployment and mortality tends to be negative. Further progress on establishing possible causal relationships between unemployment and health requires both the collaboration of medical and social scientists and a well designed prospective study that avoids many of the problems associated with time-series and cross-sectional analyses.

Adolescent↗
PubMed2006

The Yapunyah project: embedding Aboriginal and Torres Strait Islander perspectives in the nursing curriculum.

The Yapunyah Project is an initiative of the Faculty of Health at Queensland University of Technology. It was instigated to further improve the development of cultural competence in health graduates with respect to Aboriginal and Torres Strait Islander perspectives. The project was informed by the cultural competence in healthcare delivery models of Campinha-Bacote (1998a) and Cross, Bazron, Dennis and Isaacs (1989) and by the cultural safety reforms to nursing curricula in New Zealand. The Yapunyah Project involved extensive consultation and collaboration with Indigenous staff and health experts in the local Aboriginal and Torres Strait Islander community. A core curriculum, and associated graduate transcultural competencies, were informed by these discussions and earlier reforms in health curricula by the Committee of Deans of Australian Medical Schools and the Royal Australian College of General Practitioners. Although the overall project involved four separate schools within the faculty, this paper details the experience of embedding Indigenous perspectives within the undergraduate nursing curriculum. The experience has been a challenging and positive one, and the reforms have been supported by a sustainable framework. This paper outlines how one university faculty is endeavouring to educationally prepare nursing students to practice with evidence-based transcultural nursing knowledge based on culture care values, beliefs, and traditional lifeways of Indigenous people of Australia. As such, the project aims to contribute to the improvement and promotion of the health and well-being of Indigenous Australians in culturally and ethnohistorically meaningful ways.

Australia↗
PubMed1991

Increasing productivity by developing alliances.

Collaborative alliances among nurses may provide a feasible and satisfying opportunity to increase the productivity of nurses. Inherent in successful alliances are the development of trust, compatibility, commitment, and mutality of benefits. The development of collaborative relationships among clinical research nurses, a research methodologist, and a nurse educator resulted in several federally funded grants and publications. The alliances described here cross disciplines and institutions and demonstrate the enhanced productivity that can result from such efforts.

Education, Nursing↗
PubMed2000

European Consultation-Liaison Psychiatric Services: the ECLW Collaborative Study.

OBJECTIVE: To describe the patterns of organization of consultation-liaison (C-L) services in 11 European countries in relation to hospital characteristics and national approaches to C-L psychiatry. METHOD: Cross-sectional survey. RESULTS: Services can best be described in terms of their size and seniority of their staff and whether or not they are multidisciplinary. Single-discipline services are based upon the standard medical consultant model, whereas those with multidisciplinary teams work in a way that is comparable with community mental health teams. German psychosomatic C-L services belonged to either model. National differences were found. CONCLUSION: This first international study provides empirical evidence for the wide variation in the organization of C-L services. In view of the increasing numbers of patients with psychiatric disorder who are being treated in general hospitals and the changing patterns of medical care there are important implications for clarification and improvement of the role of C-L services.

Cluster Analysis↗
PubMed2004

Material deprivation and self-rated health: a multilevel study of adolescents from 22 European and North American countries.

This cross-sectional study examined the combined and interactive effects of material deprivation and area deprivation on adolescent self-rated health, using data from the World Health Organization collaborative study 'Health Behaviour in School-aged Children 1997/1998'. Included in the present study were 94,915 11-15-year-old students from a total of 22 European and North American countries. Multilevel logistic regression analyses revealed significant additive main effects of individual material deprivation and area deprivation, but not interactive effects. The most deprived students had an odds ratio for self-rated poor health almost three times higher than the least deprived students. Area deprivation effects were stronger at the country level than at the school level, and stronger among 11-year-olds than among 13- and 15-year-olds. A combined 'individual and area deprivation' model predicted that the most disadvantaged 11-year-old students were eight times more likely to have poor self-rated health compared to the least disadvantaged student (OR (95% CI) = 7.96 (3.38, 18.75)). The findings highlight the multilevel effects of deprivation at the individual, local, and national level.

Adolescent↗
PubMed2002

Collaborative signaling by mixed chemoreceptor teams in Escherichia coli.

Chemoreceptors of the methyl-accepting chemotaxis protein family form clusters, typically at the cell pole(s), in both Bacteria and Archaea. To elucidate the architecture and signaling role of receptor clusters, we investigated interactions between the serine (Tsr) and aspartate (Tar) chemoreceptors in Escherichia coli by constructing Tsr mutations at the six hydrophobic and five polar residues implicated in "trimer of dimers" formation. Tsr mutants with proline replacements could not mediate serine chemotaxis, receptor clustering, or clockwise flagellar rotation. Alanine and tryptophan mutants, although also nonchemotactic, formed receptor clusters, and some produced clockwise flagellar rotation, indicating receptor-coupled activation of the signaling CheA kinase. The alanine and tryptophan mutants evidently assemble defective receptor complexes that cannot modulate CheA activity in response to serine stimuli. In cells containing wild-type Tar receptors, tryptophan replacements in Tsr interfered with Tar function, whereas four Tsr mutants with alanine replacements regained Tsr function. These epistatic and rescuable phenotypes imply interactions between Tsr and Tar dimers in higher-order signaling teams. The bulky side chain in tryptophan mutants may prevent stimulus-induced conformational changes in the team, whereas the small side chain in alanine mutants may permit signaling control when teamed with functional receptor molecules. Direct physical interactions between Tsr and Tar molecules were observed by in vivo chemical crosslinking. Wild-type Tsr crosslinked to Tar, whereas a clustering-defective proline replacement mutant did not. These findings indicate that bacterial chemoreceptor clusters are comprised of signaling teams, seemingly based on trimers of dimers, that can contain different receptor types acting collaboratively.

Bacterial Proteins↗