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PubMed1995

The role of the Zairian Health Services in the Rwandan refugee crisis.

In July 1994, a stream of Rwandan refugees entered the southern part of North Kivu Region, Zaire. The public health consequences of this crisis for the host population and health services have not been analysed up to now. The lack of human and financial resources did not prevent Zairian health structures and personnel from taking care of the many refugees settled outside the camps, following their arrival. The public health consequences of the crisis for the local population should be considered an integral part of the disaster.

Child, Preschool↗
PubMed2000

Nursing and health policy.

PURPOSE: To describe ways nurses are and are not effective in the development of health policy in the United States today, and to provide useful information for those interested in making nursing a more vital part of the policy arena. DESIGN: Qualitative examination of the career experiences and observations of a purposive sample of 27 American nurses currently active in health policy at the national, state, local, or organizational level. METHOD: Semi-structured interviews regarding career path, contributing resources improvement of resources available to nurses, and the strengths and weaknesses of currently available information for policy work. FINDINGS: For nurse participants, policy involvement meant speaking for patients in arenas where those need of care have limited voice. Participation occurred after assessment, diagnosis, and planning revealed the need for change in the way resources were allocated. Strong belief in the capacity and importance of people caring for themselves distinguished nurses in their policy roles. Policy makers responded to the experiences and determinants of health and illness as presented by nurses. CONCLUSION: Once engaged, nurses seldom turned their backs on the world of policy-making. However, they did not report significant use of nursing research or information in policy making. Further investigation and testing of systems to connect nurse policymakers with nurse scholars are recommended.

Career Choice↗
PubMed2000

Connectivity of marine populations: open or closed?

Most marine populations are thought to be well connected via long-distance dispersal of larval stages. Eulerian and Lagrangian flow models, coupled with linear mortality estimates, were used to examine this assumption. The findings show that when simple advection models are used, larval exchange rates may be overestimated; such simplistic models fail to account for a decrease of up to nine orders of magnitude in larval concentrations resulting from diffusion and mortality. The alternative process of larval retention near local populations is shown to exist and may be of great importance in the maintenance of marine population structure and management of coastal marine resources.

Animals↗
PubMed2002

Self perceived work related stress and the relation with salivary IgA and lysozyme among emergency department nurses.

AIMS: To assess and compare the self perceived work related stress among emergency department (ED) and general ward (GW) nurses, and to investigate its relation with salivary IgA and lysozyme. METHODS: One hundred and thirty two of 208 (63.5%) registered female ED and GW nurses participated in the study. A modified mental health professional stress scale (PSS) was used to measure self perceived stress. ELISA methods were used to determine the salivary IgA and lysozyme levels. RESULTS: On PSS, ED nurses had higher scores (mean 1.51) than GW nurses (1.30). The scores of PSS subscales such as organisational structure and processes (OS), lack of resources (RES), and conflict with other professionals (COF) were higher in ED than in GW nurses. ED nurses had lower secretion rates of IgA (geometric mean (GM) 49.1 micro g/min) and lysozyme (GM 20.0 micro g/min) than GW nurses (68.2 micro g/min, 30.5 micro g/min). Significant correlations were observed between PSS and log IgA and lysozyme secretion rates. OS, RES, and COF were correlated with log IgA and lysozyme levels. CONCLUSION: ED nurses, who reported a higher level of professional stress, showed significantly lower secretion rates of salivary IgA and lysozyme compared to GW nurses. Salivary IgA and lysozyme were inversely correlated with self perceived work related stress. As these salivary biomarkers are reflective of the mucosal immunity, results support the inverse relation between stress and mucosal immunity.

Adult↗
PubMed2004

Clinical issues and research in respiratory failure from severe acute respiratory syndrome.

The National Heart, Lung, and Blood Institute, along with the Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases, convened a panel to develop recommendations for treatment, prevention, and research for respiratory failure from severe acute respiratory syndrome (SARS) and other newly emerging infections. The clinical and pathological features of acute lung injury (ALI) from SARS appear indistinguishable from ALI from other causes. The mainstay of treatments for ALI remains supportive. Patients with ALI from SARS who require mechanical ventilation should receive a lung protective, low tidal volume strategy. Adjuvant treatments recommended include prevention of venous thromboembolism, stress ulcer prophylaxis, and semirecumbent positioning during ventilation. Based on previous experience in Canada, infection control resources and protocols were recommended. Leadership structure, communication, training, and morale are an essential aspect of SARS management. A multicenter, placebo-controlled trial of corticosteroids for late SARS is justified because of widespread clinical use and uncertainties about relative risks and benefits. Studies of combined pathophysiologic endpoints were recommended, with mortality as a secondary endpoint. The group recommended preparation for studies, including protocols, ethical considerations, Web-based registries, and data entry systems.

Adrenal Cortex Hormones↗
PubMed1990

Culture and chronic mental illness.

The relationship of culture to chronic mental illness is reviewed in a cross-national and cross-ethnic perspective. The author critically examines the argument, based on differential prognosis for serious mental illness in developing and industrial countries, that chronicity is a cultural artifact. Key questions include whether cultural beliefs and practices that minimize social stigma, self-devaluation, and patients' assumption of the sick role are linked to better prognosis. World view, religion, alternative healing resources, values of interdependence, extended kinship structure, family support, and professionals' willingness to work collaboratively with families are viewed as cultural strengths that may help to mediate the course of mental illness. Issues that are relevant to treatment of long-term psychiatric disability in ethnic patients in the United States include interethnic differences in the distribution of cases and service utilization patterns, diagnostic and medication issues, and development of culturally relevant treatment modalities.

Attitude to Health↗
PubMed1981

Developmental stages of health education in HMOs.

With no standards for comparison, expectations for health education programs and judgments of their success are subjective. Regardless of initial differences in variables such as starting point of the program, resource allotment, and organizational characteristics and structures, all health education programs have some similar goals and development processes. The goals are: the need to establish long-term relationships, gain visibility, and appeal to the dominant domains within the organization in order to survive. An empirical three-stage model is proposed as a generic development process. The stages, formation, action, and stabilization, propose more sophisticated and complex programmatic content evolving as the initial strategic organizational issues are resolved.

Health Education↗
PubMedDate not supplied

Who shall lead: is there a future for population health?

Despite renewed interest in population health concerns, elevation of this field in policy considerations faces many challenges. At present there is much concern about disparities and meeting improved population health objectives, but interest waxes and wanes with scientific developments and especially with dominant political alignments and ideologies. If the field of population health is to have sustained policy influence, it requires a persistent constituency, a strong organizational base both within and outside of government, and academic respectability. Population health faces many issues in seeking to become legitimized as both a unique field of study and as a significant force in public policy. Among these are a clear definition of the boundaries of the field, a continuing flow of resources for development, and attractive career structures for new recruits and future leaders.

Delivery of Health Care↗
PubMed2004

Let regionalization continue to evolve.

This commentary provides a practical perspective on the benefits of regionalization within the context of the lead paper by Lewis and Kouri. Discussion of the best structure of health systems needs to take into account the reality that constitutional and funding responsibility--and therefore accountability--for our healthcare system lies with provincial governments. Accountability at the provincial government level is simply a part of regionalization and should be expected by health system managers. Regionalization of healthcare is in its infancy. Systems necessary to support regionalization, which can only be established under a regionalized structure (e.g., information technology, procurement, human resources and service planning), are evolving. Given the size and complexity of the healthcare system, as we gain more experience with regionalization the systems we need to support it will attain their potential, as will the managers of the system. Regionalization was the most appropriate option for healthcare in the 1990s given the objectives of provincial governments to achieve efficiencies, better utilize resources and improve patient care. We must allow regionalization to evolve in order to see long-term improvements in the healthcare system.

Canada↗
PubMed2005

The Veterans Health Administration: quality, value, accountability, and information as transforming strategies for patient-centered care.

The Veterans Health Administration is the United States' largest integrated health system. Once disparaged as a bureaucracy providing mediocre care, the Department of Veterans Affairs (VA) reinvented itself during the past decade through a policy shift mandating structural and organizational change, rationalization of resource allocation, explicit measurement and accountability for quality and value, and development of an information infrastructure supporting the needs of patients, clinicians, and administrators. Today, the VA is recognized for leadership in clinical informatics and performance improvement, cares for more patients with proportionally fewer resources, and sets national benchmarks in patient satisfaction and for 18 indicators of quality in disease prevention and treatment.

Cooperative Behavior↗
PubMed2005

Social support and depressive symptomatology among HIV-positive women: the mediating role of self-esteem and mastery.

Women constitute an increasing proportion of individuals contracting HIV in the United States and, once diagnosed, are living longer lives since the advent of combination antiretroviral therapies. HIV-positive women, who are disproportionately ethnic minority, face unique challenges to their psychosocial adaptation. Findings from a survey of 373 mainly indigent African-American and Puerto Rican women living with HIV/AIDS in the New York City area indicated high levels of depressive symptomatology, which were inversely related to HIV-related social support from friends, relatives, partner, and groups/ organizations. In line with the Cognitive Adaptation Model, structural equation modeling indicated that psychological resourcefulness (i.e., self-esteem and mastery) mediated the effects of social support on depressive symptomatology. Findings suggest the need to assess HIV-positive women for social isolation and depression and to provide them with interventions such as support groups that capitalize on their existing strengths, including their psychological resourcefulness.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Haptic interaction with highly detailed objects.

Haptic exploration of detailed models from patient specific anatomical structures places high demands on computational resources. Constant collision detection and correct calculation of forces fed back to the operator quickly exceed available processing power with increasing level of detail of the represented objects. To alleviate the strain on computational resources optimisation schemes are employed to speed up processing and guarantee glitch-free operation as well as smooth haptic feedback. Among these are the generation of a local haptic model, a look-ahead strategy to increase its range of validity, small world-shift operations and force extrapolation algorithms for smooth feedback.

Algorithms↗
PubMed2004

Effects of organizational scheme and labeling on task performance in product-centered and user-centered retail Web sites.

As companies increase the quantity of information they provide through their Web sites, it is critical that content is structured with an appropriate architecture. However, resource constraints often limit the ability of companies to apply all Web design principles completely. This study quantifies the effects of two major information architecture principles in a controlled study that isolates the incremental effects of organizational scheme and labeling on user performance and satisfaction. Sixty participants with a wide range of Internet and on-line shopping experience were recruited to complete a series of shopping tasks on a prototype retail shopping Web site. User-centered labels provided a significant benefit in performance and satisfaction over labels obtained through company-centered methods. User-centered organization did not result in improved performance except when the label quality was poor. Significant interactions suggest specific guidelines for allocating resources in Web site design. Applications of this research include the design of Web sites for any commercial application, particularly E-commerce.

Adolescent↗
PubMed2004

A chromosome bin map of 16,000 expressed sequence tag loci and distribution of genes among the three genomes of polyploid wheat.

Because of the huge size of the common wheat (Triticum aestivum L., 2n = 6x = 42, AABBDD) genome of 17,300 Mb, sequencing and mapping of the expressed portion is a logical first step for gene discovery. Here we report mapping of 7104 expressed sequence tag (EST) unigenes by Southern hybridization into a chromosome bin map using a set of wheat aneuploids and deletion stocks. Each EST detected a mean of 4.8 restriction fragments and 2.8 loci. More loci were mapped in the B genome (5774) than in the A (5173) or D (5146) genomes. The EST density was significantly higher for the D genome than for the A or B. In general, EST density increased relative to the physical distance from the centromere. The majority of EST-dense regions are in the distal parts of chromosomes. Most of the agronomically important genes are located in EST-dense regions. The chromosome bin map of ESTs is a unique resource for SNP analysis, comparative mapping, structural and functional analysis, and polyploid evolution, as well as providing a framework for constructing a sequence-ready, BAC-contig map of the wheat genome.

Chromosome Mapping↗
PubMed1997

[Quality of life from the viewpoint of patients with spinal cord lesions].

Before the existence is negotiating of individuals that present lesion medular, we came across the problem involved in the daily of those people after a situation of sudden and unexpected trauma. With the intention of rendering effective cares to these people worried, in this study, in identifying the situation for the which they are passing, there were been changes and which were them, so much in psychic level as physicist and social. For so much, he/she/it opted for the accomplishment of a semi-structured individual interview, being used the resource of the recording, the instrument of collection of data consists of identification data and data regarding the interviewee's life. The speech free with recording and posterior transcription characterizes a study of case of nature, above all, exploratory. The obtained data received a thematic analysis using conceptions about life quality according to FORATTINI (1991). In this study they were identified a physical deficiency and a series of inabilities. The deambulação is the first loss noticed by the patient after the lesion and its first subject to the professional closer of him, it is that settles down a communication channel that allows this expression. But we should remember the possible process of rehabilitation that doesn't approach only the search for the locomoção, permeating the re-learning in this new life situation. We verified modifications in all the spheres (physics, social, psychological), and the most affected. according to the picked data, went the psychological and to social due to the physical alterations. The main loss sensation refers to the social paper, and this is characterized, mainly, for the impossibility of coming back to the work. The changes in the solemnity-image conceptions and self-esteem were also identified, in smaller degree, for the sensation of inability. The more important and comprehensibly told physical loss refers the sensibility loss and motive capacity of the members.

Adult↗
PubMed2006

Consumer-resource body-size relationships in natural food webs.

It has been suggested that differences in body size between consumer and resource species may have important implications for interaction strengths, population dynamics, and eventually food web structure, function, and evolution. Still, the general distribution of consumer-'resource body-size ratios in real ecosystems, and whether they vary systematically among habitats or broad taxonomic groups, is poorly understood. Using a unique global database on consumer and resource body sizes, we show that the mean body-size ratios of aquatic herbivorous and detritivorous consumers are several orders of magnitude larger than those of carnivorous predators. Carnivorous predator-prey body-size ratios vary across different habitats and predator and prey types (invertebrates, ectotherm, and endotherm vertebrates). Predator-prey body-size ratios are on average significantly higher (1) in freshwater habitats than in marine or terrestrial habitats, (2) for vertebrate than for invertebrate predators, and (3) for invertebrate than for ectotherm vertebrate prey. If recent studies that relate body-size ratios to interaction strengths are general, our results suggest that mean consumer-resource interaction strengths may vary systematically across different habitat categories and consumer types.

Animals↗
PubMedDate not supplied

A framework for the integration of distributed autonomous healthcare information systems.

This paper presents a domain-specific framework for the integration of geographically distributed heterogeneous autonomous healthcare information systems. Integration is seen and understood in terms of access to information resources, and in terms of content, structure, and visualization of patient record segments, with the goal of creating a virtual patient record at the medical workstations. The proposed approach covers integration aspects related to presentation, control, data, and function. The architecture and the components of the framework are based on the newly introduced Patient Meta-Record (PMR) concept, but also make use of existing or emerging standards for distributed object-oriented computing and information presentation. At the application and middle-ware layers of the presented healthcare information systems architecture, the PMR concept enhances or enables services for data mediation, distributed directory access, and workflow management. At the bitways layer, high performance networks provide a fast medium, which is indispensable for medical image distribution, collaborative work, hypermedia library applications, and teleconsultation.

Computer Communication Networks↗
PubMed1998

Creating a team approach to hospital and college of pharmacy relationships: a strategy to integrate missions to enhance education and patient care.

Academic medical centers continue to bear the burden of the additional costs of professional education. Such institutions and their affiliated colleges of pharmacy are challenged to sustain the degree of professional staffing required to deliver quality education and patient care services. Historically, these relationships have not always proven to be cooperative and mutually beneficial. As managers and deans attempt to maximize the productivity of their financial and human resources, they will need to creatively structure relationships that effectively meet those diverse professional missions that sometimes seem to exist in conflict or that each seem to be successful only at the expense of the other. Pharmacists who act as both faculty, delivering experiential education, and clinical staff providing patient care, are significantly stressed in their attempts to meet the sometimes conflicting objectives of these multiple missions. The survival of precepted experiential education in pharmacy and of pharmaceutical care in academic medical center hospitals will likely depend upon a model of cooperative relationship, such as the venture described by Jorgenson, et al.

Academic Medical Centers↗