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PubMedDate not supplied

Environmental nursing diagnoses: a proposal for further development of Taxonomy II.

PURPOSE: To propose further development of environmental diagnoses and to offer recommendations for expanding Taxonomy II to include more diagnostic labels that encompass the environmental domain. SOURCES: Literature in the disciplines of nursing, biology, toxicology, public health, sociology, and anthropology. DATA SYNTHESIS: Nurses need language to describe the human responses of individuals, families, communities, and global society to environmental health threats. CONCLUSIONS: New environmental diagnoses will lead to refinement of language that describes the contribution of nursing to an emerging international and community health priority. PRACTICE IMPLICATIONS: Environmental diagnostic labels will allow nurses to name responses and plan interventions that respond to instances or risks of exposure to threats from the physical and sociocultural environment.

Environmental Health↗
PubMed2002

HIV and AIDS risk behaviors among female jail detainees: implications for public health policy.

OBJECTIVES: We examined the sexual and injection drug use HIV and AIDS risk behaviors of female jail detainees. METHODS: The sample (n = 948) was stratified by charge type (felony vs misdemeanor) and race/ethnicity (African American, non-Hispanic White, Hispanic, other). RESULTS: Non-Hispanic White women, women arrested for less serious charges, women who had prior arrests, women arrested on drug charges, and women with severe mental disorders were at especially high risk for sexual and injection drug transmission of HIV and AIDS. CONCLUSIONS: Many women at risk for HIV and AIDS--women who use drugs, women who trade sex for money or drugs, homeless women, and women with mental disorders--eventually will cycle through jail. Because most jail detainees return to their communities within days, providing HIV and AIDS education in jail must become a public health priority.

Acquired Immunodeficiency Syndrome↗
PubMed1996

The National Women's Tobacco Control Plan.

Although many health organizations have acknowledged women's tobacco control as a public health priority, to date there has not been a national agenda, nor a coordinating mechanism in place, to ensure the reduction of women's tobacco use and exposure. The Women United Against Tobacco Workshop (the Workshop) was held to address these gaps. The consensus of the Workshop is represented by the National Women's Tobacco Control Plan (the Plan) which outlines goals, priorities, recommendations and implementation steps for reducing women's tobacco use and exposure. The development of a national organization dedicated to implementing the Plan is key to preserving the momentum gained at the Workshop.

Consumer Advocacy↗
PubMed2000

Emerging infectious diseases: a cause for concern.

As the twenty-first century begins it becomes increasingly apparent that the twentieth century, which opened with the promise of the eradication of most infectious diseases, closed with the specter of the reemergence of many deadly infectious diseases that have a rapidly increasing incidence and geographic range. Equally if not more alarming is the appearance of new infectious diseases that have become major sources of morbidity and mortality. Among recent examples are HIV/AIDS, hantavirus pulmonary syndrome, Lyme disease, hemolytic uremic syndrome (caused by a strain of Escherichia coli), Rift Valley fever, Dengue hemorrhagic fever, malaria, cryptosporidiosis, and schistosomiasis. The reasons for this situation are easily identified in some cases as associated with treatment modalities (permissive use of antibiotics), the industrial use of antibiotics, demographic changes, societal behavior patterns, changes in ecology, global warming, the inability to deliver minimal health care and the neglect of well-established public health priorities. In addition is the emergence of diseases of another type. We have begun to characterize the potential microbial etiology of what has historically been referred to as chronic diseases.

Bacterial Infections↗
PubMed1989

From the bench to the field: control of parasitic infections within primary health care.

During the last decade there has been a great increase in the number of countries that have endorsed the primary health care (PHC) policy at national level, set up national guidelines for it and launched its large-scale implementation. In addition, there have been many important developments with regard to appropriate, cost-effective technologies, training concepts and approaches to securing community participation. These achievements have produced numerous encouraging results. However, although the control of parasitic infections integrated into PHC systems has often been initially successful, these achievements could often not be sustained. Using case studies, mainly concerning schistosomiasis, as examples, control technologies and their applicability within PHC are discussed at three levels; the identification of public health priorities, the community-based implementation of control and the process of evaluation and monitoring. There is a great potential for the integration of a substantial part of control activities, particularly morbidity control, into PHC, provided that the aims and sequences of control activities are well matched with the felt needs of the communities concerned. This implies that the biomedical researcher, the epidemiologist and the health planner need to consider the indigenous health perspectives of the affected community. For example, recent progress in the laboratory in the development of vaccines against parasites needs to be complemented by field studies that continuously validate, standardize and assess the applicability of the proposed measures. This kind of interplay will form the basis for participatory approaches in health planning and make it possible for control activities to be integrated into existing PHC structures and to respond to the needs of the communities concerned.

Animals↗
PubMed2002

Psychiatric health in a sexually transmitted infections clinic: effect on reattendance.

BACKGROUND AND OBJECTIVES: Sexually transmitted infections (STIs) remain a public health priority, but associated psychological morbidity has recently been ignored. One aspect of STI control is test of cure and further treatment at follow-up clinic appointments. We chose reattendance rates as a measure of compliance and assessed whether reattendance was related to psychological morbidity. METHODS: 938 STI clinic patients were offered the Hospital Anxiety and Depression Scale (HAD) and staff rated each patient's psychological health. Predictors of attendance, caseness and staff recognition were assessed by logistic regression. RESULTS: 401/774 [51.9%; 95% confidence interval (CI): 48.3-55.4%] patients, who completed the HAD, scored above threshold. Staff rated 151/743 (20.4%) patients as having "psychological problems." HAD caseness was not associated with attending arranged follow-up [adjusted odds ratio (adj. OR): 0.83 (0.49-2.05)]. Patients rated with psychological problems by staff were more likely to attend [adj. OR: 1.91 (1.02-3.60)]. CONCLUSIONS: Half of our sample had significant anxiety and staff should be more aware of this suffering. Our work suggests that such awareness might improve subsequent attendance.

Adolescent↗
PubMed2005

Medicines and vaccines for the world's poorest: is there any prospect for public-private cooperation?

This paper reviews the current status of the global pharmaceutical industry and its research and development focus in the context of the health care needs of the developing world. It will consider the attempts to improve access to critical drugs and vaccines, and increase the research effort directed at key public health priorities in the developing world. In particular, it will consider prospects for public-private collaboration. The challenges and opportunities in such public-private partnerships will be discussed briefly along with a look at factors that may be key to success. Much of the focus is on HIV/AIDS where the debate on the optimal balance between intellectual property rights (IPR) and human rights to life and health has been very public and emotive.

Journal Article↗
PubMedDate not supplied

[The goals and tasks of the Roll Back Malaria WHO Cabinet Project].

WHO's Roll Back Malaria Cabinet Project (RBM) has been initiated by WHO Director-General Dr. G. Brundtland in 1998. The World Health Organization, The United Nation's Children's Fund, the United Nation's Development Programme and World Bank have joined forces to fight malaria, which kills more than one million people a year. RBM is being launched at time of growing and investment in malaria, which still remains grossly underfunded. RBM is different from previous efforts to fight malaria. The project is working not only through new tools for controlling the disease but also by involving and strengthening the health services to affected population. This pattern of activities is close to Russian version of malaria eradication programme that had been carried out with the success in the former Soviet Union in the 1950s. RBM seeks to reduce substantially the human suffering and economic losses due one of the most costly diseases. Malaria causes an estimated 300 to 500 million acute cases per year. Malaria is a disease of young and the poor, many of them children who live with no easy access to health service. RBM goal is a significant reduction--ideally halving within ten years--in the global burden of disease associated with malaria. RBM purpose is to create an environment that helps countries develop policies and implement relevant elements of RBM strategy. There are six elements to roll back malaria. They are: early detection of malaria illness; rapid treatment of those who are ill; multiple means for preventing infection; strengthening of health sector and intersectoral activities; a powerful sustained social involvement and movement; focused research for new tools and better implementation. New tools are available to combat malaria. They include among others: rapid diagnostics; new drugs (artesunates) and new means for delivery; impregnated bednets; new means for predicting epidemics (satellite mapping). WHO will be coordinating the RBM project. Endemic countries and affected populations have identified malaria as a priority health issue. Activities will cut across WHO programmes and regions to support government, to improve technical efficiency and capacity, to optimize resource allocation, utilization and mobilization.

Disease Outbreaks↗
PubMed2004

The role of routine polio immunization in the post-certification era.

The role of routine vaccination against poliomyelitis for the post-certification era remains an important area for policy decision-making. Two critical decisions need to be taken: first, to continue or discontinue vaccination with the live attenuated oral poliovirus vaccine (OPV); and second, if OPV is to be discontinued, whether vaccination with inactivated poliovirus vaccine (IPV) is needed. Four potential vaccination scenarios can be constructed: stop all polio vaccination; continue with current vaccination policies (OPV, IPV, or sequential schedule); discontinue OPV, but continue IPV universally; or discontinue OPV, but continue IPV in selected countries. All possible scenarios require continued investments in a surveillance and response strategy, including a stockpile of polio vaccine. Continuing vaccination would limit the savings that could be applied to the control of other health priorities. This report reviews the key issues associated with each scenario, highlights the advantages and disadvantages of each scenario, and outlines the major challenges for policy decision-making.

Age Factors↗
PubMed2004

Health status among REACH 2010 communities, 2001-2002.

The REACH 2010 Risk Factor Survey was conducted in 21 minority communities in the United States during June 2001-August 2002. The survey included 10,953 Blacks/African Americans, 4,257 Hispanics/Latinos, 4,204 Asians, and 1,791 American Indians. Data demonstrate that residents in the minority communities bear a greater socioeconomic, risk factor, and disease burden than do members of the general US population. However, substantial variations in the prevalence of risk factors and chronic conditions also indicated that public health priorities should vary among different racial/ethnic groups, and even among communities within each group, and that culturally sensitive primary and secondary prevention strategies should be tailored to meet community-specific needs.

Adolescent↗
PubMed1999

The American Stop Smoking Intervention Study. Conceptual framework and evaluation design.

Reducing tobacco use, especially cigarette smoking, is a public health priority. The American Stop Smoking Intervention Study (ASSIST) was initiated in 1991 to prevent and reduce tobacco use primarily through policy-based approaches to alter the social-political environment. This article describes the conceptual design, research framework, evaluation components, and analytic strategies that are guiding the evaluation of this demonstration research endeavor. The ASSIST evaluation is a unique analysis of the complex relationships between the social context, public health activity at the state level, tobacco use, and individual behavior. The measures of tobacco control activity developed for this evaluation may be useful in ongoing national cancer control surveillance efforts, and the lessons learned will enhance the development of tobacco control programs.

Humans↗
PubMed2003

Universal influenza immunization. Were Ontario family physicians prepared?

OBJECTIVE: To explore family physicians' experiences during the first year of Ontario's universal influenza immunization program. DESIGN: Qualitative study using in-depth interviews. SETTING: Thames Valley region of southwestern Ontario. PARTICIPANTS: A maximum variation sample of nine family physicians selected by snowball sampling after initial consultation with a local family physician advisory committee. METHOD: Interviews were audiotaped and transcribed verbatim. Analysis was sequential, using a combination of editing, immersion, and crystallization. Interview transcripts were read by individual members of the team who met to compare findings at several stages during data collection. MAIN FINDINGS: The program affected family physicians because immunization strategies designed for immunizing high-risk patients needed to be modified to deal with greater numbers of patients. While generally supportive of the program, physicians found it difficult to implement. Responses reflected ongoing conflict between individual and public health priorities, particularly regarding children and pregnant women. CONCLUSION: The program could have been more effective if the culture and climate of Ontario family practice had been considered during its development and implementation.

Attitude of Health Personnel↗
PubMedDate not supplied

Physical activity and osteoporosis: disparities between knowledge and practice.

Osteoporosis and osteoporosis-related conditions are national health priorities, and physical activity has been associated with a reduction of osteoporosis risk factors (i.e., increased bone mineral density and decreased falls). Our study examined the disparity between awareness of physical activity as an osteoporosis prevention strategy and the quantity and quality of physical activity performed. Results indicate that most individuals view physical activity as an important prevention strategy. However, few participants are engaged in physical activity which meets current public health recommendations despite their awareness of physical activity health benefits. Barriers to regular exercise are discussed as well as promising approaches to reducing barriers through alterations to physical and social environments.

Adult↗
PubMed2006

Suicide in schizophrenia: findings from a national clinical survey.

BACKGROUND: A reduction in suicide among individuals with mental illness is an international public-health priority. Approximately 10% of patients with schizophrenia will die by suicide. OBJECTIVE: The goal of this study was to describe social and clinical characteristics of people with schizophrenia who completed suicide, including aspects of the clinical care they received. METHOD: A national clinical survey was conducted based on a 4-year (1996-2000) sample of people in England and Wales who had died by suicide and had been in contact with mental health services in the previous 12 months. RESULTS: Of 20,927 individuals who committed suicide, 5,099 (24%) were known to have been in contact with mental health services in the year prior to death. Completed questionnaires were returned on 4,859 cases of suicide. Of these, 960 (20%) were diagnosed with schizophrenia. These suicides were characterized by more violent modes of death, with over a quarter (27%) jumping from a height or in front of a moving vehicle compared to 10% of the remaining sample. They were more likely than the other individuals in the sample to be young, male, unmarried, and from an ethnic minority with high rates of unemployment. Rates of previous violence and drug abuse were high and they were proportionally more likely to be inpatients at the time of death and to have been noncompliant with medication. Patients with schizophrenia and comorbid substance abuse showed particularly complex social and clinical morbidity. CONCLUSIONS: Measures that may prevent suicide among patients with schizophrenia include improved ward safety, closer supervision in both inpatient and community settings, particularly for those with poor medication compliance, and effective treatment of substance abuse.

Adolescent↗
PubMed2002

Enrico Pieragnoli and the prevention of tuberculosis: Florence 1906.

Tuberculosis (TBC) is today a health priority in Asia, Africa, and South America and a re-emerging social disease in the Western World. While the pharmacological therapy of TBC is nowadays well established, preventive measures are still under-powered and under-estimated. Current failures in the prevention of tuberculosis are even more surprising considering that, already a century ago a comprehensive preventive of defence against TBC had been designed by clinicians and ante-litteram 'health care managers' such as Enrico Pieragnoli. Pieragnoli was an Italian physician who lived in Florence between the XIX and XX century, and who, after many years of accurate planning, succeeded in 1906 in opening the first Italian tuberculosis preventive centre. Pieragnoli considered it his mission to 'fight' against TBC, a public enemy that was to be defeated using the weapons of global prevention; Pieragnoli had crystal clear concepts of prevention, of the predisposing factors to the disease, and of the need for aggressive treatment. He established his preventive institute with two main aims: the modification of the individual substratum in which the germs grew and the removal of contagion. The prophylactic and diagnostic accuracy of his preventive institute are shown in a number of clinical documents containing objective body measurements (height, weight, thoracic circumference), quantitative clinical comparisons (intra-and inter-subjects) and field epidemiology. We may therefore conclude that the cornerstone of 'evidence-based' prevention of tuberculosis was present in Italy almost a century ago.

Academies and Institutes↗
PubMed2004

[Control of tuberculosis as seen "in the field": popular perceptions of the disease and access to care in Conakry, Guinea].

Tuberculosis is a public health priority especially in developing countries. A variety of control programs have been implemented. The purpose of this survey was to study the perceptions and practices of the victims of this disease "in the field". The findings of this survey carried out in a cohort of 65 patients and their families in Conakry, Guinea underline the importance of popular perceptions of the disease in care-seeking behavior. This survey also shows that health care workers share the same perceptions as the general population, which constitutes a major impediment for screening and treatment.

Adult↗
PubMed2000

Engaging women's interest in colorectal cancer screening: a public health strategy.

Screening rates for colorectal cancer are unacceptably low. New guidelines, public education campaigns, and expanded coverage of screening costs by healthcare insurance are expected to increase screening rates, but interventions targeting women may accelerate this change. Most American women already participate in regular cancer screening, in the form of Papanicolaou (Pap) tests and mammography, so they may be receptive to tailored messages about the need to add regular colorectal cancer screening to their preventive health regimen. In addition, their role in promoting the health of family members may position women to influence screening behavior in family and friends. Women may be particularly valuable change agents in populations where screening rates are traditionally low, such as medically underserved populations, the elderly or low socioeconomic status groups with competing health priorities, and populations with cultural values or practices inconsistent with the adoption of a new screening behavior. To serve as agents of change in their family and social networks, women must understand that colorectal cancer is not solely a man's disease and that the benefits of colorectal screening are similar to those of Pap testing and mammography. Colorectal cancer screening should also be promoted within a framework of a lifelong strategy for health maintenance for both men and women. The message to women should emphasize the value of colorectal cancer screening rather than the disagreement among experts over preferred screening strategies and should emphasize the value of shared decision making between the patient and her healthcare provider.

Colorectal Neoplasms↗
PubMedDate not supplied

What do pregnant women know about preventing preterm birth?

Approximately 75% of all perinatal mortality is attributable to preterm birth and its sequelae; therefore, the prevention of preterm birth is a major public health priority. In an effort to determine what pregnant women need to be taught about this subject, 211 pregnant women in an inner-city clinic were given a questionnaire to ascertain their basic knowledge about the subject. Among the results were that almost one-half of the women surveyed did not know how many weeks constituted a normal pregnancy and one-third did not know that neonates born preterm could have health problems. The importance of teaching these and other basic facts (which nurses might think are already known by pregnant women) is a notable finding of this research. If perinatal nurses are to effectively teach pregnant women about the prevention of preterm birth, they must target the appropriate facts and build their patients' knowledge base.

Adolescent↗