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PubMed2004

Barriers to infectious disease care among lesbians.

Despite the considerable number of women in the United States who identify as lesbian, few data exist that address lesbians' health needs. The Institute of Medicine emphasized that data on sexually transmitted infections, Pap smear screening, and cervical dysplasia among lesbians were needed to guide clinical practice, policy development, and patient education. Use of surveillance data for this purpose is limited because risk classifications exclude same-gender sex among women or subsume it under behavior considered as higher risk. However, sexual transmission of human papillomavirus, HIV, Treponema pallidum, and Trichomonas vaginalis between women has been reported. Data indicate that lesbians receive routine Pap smear screening less frequently than is optimal. Moreover, lesbians commonly report previous pregnancy, induced abortion, and hormonal contraceptive use. Education of lesbians and their care providers should counter assumptions that sex between women confers no risk for transmission of sexually transmitted infections, and lesbians should receive Pap smears according to current guidelines.

Female↗
PubMed2005

Impact of statewide program to promote appropriate antimicrobial drug use.

The Wisconsin Antibiotic Resistance Network (WARN) was launched in 1999 to educate physicians and the public about judicious antimicrobial drug use. Public education included radio and television advertisements, posters, pamphlets, and presentations at childcare centers. Physician education included mailings, susceptibility reports, practice guidelines, satellite conferences, and presentations. We analyzed antimicrobial prescribing data for primary care physicians in Wisconsin and Minnesota (control state). Antimicrobial prescribing declined 19.8% in Minnesota and 20.4% in Wisconsin from 1998 to 2003. Prescribing by internists declined significantly more in Wisconsin than Minnesota, but the opposite was true for pediatricians. We conclude that the secular trend of declining antimicrobial drug use continued through 2003, but a large-scale educational program did not generate greater reductions in Wisconsin despite improved knowledge. State and local organizations should consider a balanced approach that includes limited statewide educational activities with increasing emphasis on local, provider-level interventions and policy development to promote careful antimicrobial drug use.

Anti-Bacterial Agents↗
PubMed1998

Sexually transmissible diseases surveillance in Australia: towards a coordinated national system.

Communicable diseases surveillance is essential for directing policy development. In most regards, sexually transmissible diseases (STD) surveillance is no different to surveillance for other communicable diseases. There are nevertheless several aspects of STDs that have to be taken into consideration in designing and managing surveillance activities. These include particular confidentiality concerns associated with STDs, the disproportionate morbidity STDs confer on marginalised or stigmatised populations, and clinical limitations due to the requirement of often uncomfortable genital examinations for the diagnosis of many STDs. Furthermore, interpretation of STD surveillance data requires information on sexual behaviour which is not routinely collected for other types of surveillance. In addressing new STD surveillance strategies the key public health questions that can be answered by surveillance need to be defined. These include the prevalence of individual STDs among the total population and specific population subgroups, the rates of symptomatic versus asymptomatic disease, treatment seeking levels, and antibiotic sensitivity patterns for some agents. This article describes possible STD surveillance methodologies to meet these demands.

Australia↗
PubMed2002

Synergism of frail rural elderly couples: influencing interdependent independence.

In this phenomenological study, a purposive sample of 19 frail rural elderly couples were interviewed as dyads to identify programs, services, and relationships perceived by the couples as beneficial to their ability to continue to live independently in the community. Communication between the partners, and roles and relationships were observed and discussed. Findings showed that mutually supportive dyads generated a synergism or energy that acted as a vital resource to couples. Research results led to the development of a continuum of spousal relationships and a trajectory of couple communication. Support to the couple as a unit, to the couple relationship, and to address the couple's needs may be strategic foci for nurses in their delivery of care and their involvement in planning programs and developing policy.

Activities of Daily Living↗
PubMed1990

The new non-traditional student in nursing.

Because different types of new, non-registered nurse students seek baccalaureate nursing education, this study was conducted comparing traditional undergraduate generic students with a group of non-traditional students to dispel myths and to develop policies and educational strategies. Traditional and non-traditional students were differentiated by age, sex, marital status, and experience in higher education. Traditional and non-traditional undergraduate students were compared on demographic variables, educational goals, sources of psychological and financial support, study habits, learning style, and clinical judgment skills. Non-traditional students were found to be an excellent risk for admission, having higher semester grade point averages and being more skilled in making professional judgments. Learning style differentiated traditional and non-traditional students, however, teaching methods were similar. Suggestions for educational planning and policies are made. Let the curriculum of the institution recognize that both educational content and process must be relevant to individual differences and that the curriculum is basically what different individuals do to learn what they need to learn, to fulfill the purposes that brought them to the college (Chickering, 1974).

Counseling↗
PubMed1993

A longitudinal study of the relationships between overload, social support, and burnout among nursing educators.

The major purpose of this study was to examine the causal relationships between role overload, social support, and burnout among nursing educators over a period of time. Eighty-four nursing educators from eight campuses of a state university system completed a questionnaire twice, within a two-year interval. Data analyses consistently revealed the following: 1) Emotional exhaustion correlated significantly and positively with a demanding job, time pressure, and feelings of job inadequacy; 2) Burnout (i.e., emotional exhaustion, depersonalization of students, and a sense of decreased accomplishment) correlated significantly and negatively with social support from one's chairperson and peers. Predictor variables from the initial data set were regressed on the burnout data of two years later. The variable--job demands--was the strongest predictor of emotional exhaustion. Chairperson support was the strongest predictor of both depersonalization toward students and a person's sense of accomplishment two years later. The reported chronic exhaustion among educators in this study should be of concern. An awareness of the role of social support and overload as associated with burnout can help educators develop policies to assure peak performance on the job.

Achievement↗
PubMed2005

Childhood sexual abuse, teenage pregnancy, and partnering with adult men: exploring the relationship.

Although the mechanism by which early victimization, specifically sexual abuse, increases the risk of adolescent pregnancy is unclear, a relationship between previous victimization and adolescent pregnancy has been demonstrated. While partnering with an older man may initially offer the means necessary to escape a neglectful or violent family of origin, this protection be accompanied by an imbalance of power and control. Both adolescent mothers partnered with adult men and adolescent mothers partnered with male peers reported sexual abuse perpetrated by family members, family friends, strangers, and peers. Policies developed to protect young people from victimization, including mandatory reporting and statutory rape laws, should be evaluated for their consistent application to all children, regardless of age, race, gender, or pregnancy status.

Adolescent↗
PubMed2005

Molecular strategies for the detection, identification, and differentiation between enteroinvasive Escherichia coli and Shigella spp.

A strategy for the detection, identification, and differentiation of enteroinvasive Escherichia coli (EIEC) and Shigella spp. has been developed. The strategy includes (i) a multiplex PCR for the amplification of two virulence genes, i.e., iuc (222 bp) and ipaH (629 bp); (ii) amplification of the ial gene (a 1,038-bp amplicon) located within a large plasmid; and (iii) restriction fragment length polymorphism (RFLP) of the ial gene amplicon. The multiplex PCR provided three patterns. Pattern 1 (iuc-/ ipaH+) was found in 10 (67%) of 15 EIEC strains tested, pattern 2 (iuc+/ipaH-) in only 2 (4.4%) of 46 non-EIEC isolates, whereas pattern 3 (iuc+/ipaH+) was observed in all Shigella spp. and also in 5 (33%) of 15 EIEC strains tested. The pattern 3 EIEC strains were all positive for the ial gene. The PCR-RFLP of the ial gene amplicon using the endonuclease AclI was used to differentiate Shigella spp. from the EIEC strains that belonged to pattern 3. The ial gene was present in 21 (38%) of 56 and 6 (40%) of 15 Shigella spp. and EIEC strains tested, respectively. The PCR-RFLP of the ial gene amplicon divided the strains in two types. Type 1 did not contain the restriction enzyme site and was found in 6 (100%) of 6 EIEC strains, 4 (80%) of 5 Shigella boydii, and 4 (100%) of 4 Shigella dysenteriae strains tested. Type 2, which gave two fragments of 286 and 752 bp, was observed in 5 (83%) of 6 Shigella fiexneri strains and 6 (100%) of 6 Shigella sonnei strains. Detection, identification, and differentiation of Shigella spp. and EIEC were achieved by analyses of the PCR patterns and RFLP types. To our knowledge, this is the first study to demonstrate a simple and rapid method for detecting, identifying, and differentiating, at the molecular level, Shigella spp. and EIEC strains. This method will have tremendous utility as an epidemiological tool and in helping to develop policies, risk assessments, and national and international methods for Shigella spp.

Bacterial Typing Techniques↗
PubMed2006

Detection and enumeration of Salmonella enteritidis in homemade ice cream associated with an outbreak: comparison of conventional and real-time PCR methods.

Salmonellosis caused by Salmonella Enteritidis (SE) is a significant cause of foodborne illnesses in the United States. Consumption of undercooked eggs and egg-containing products has been the primary risk factor for the disease. The importance of the bacterial enumeration technique has been enormously stressed because of the quantitative risk analysis of SE in shell eggs. Traditional enumeration methods mainly depend on slow and tedious most-probable-number (MPN) methods. Therefore, specific, sensitive, and rapid methods for SE quantitation are needed to collect sufficient data for risk assessment and food safety policy development. We previously developed a real-time quantitative PCR assay for the direct detection and enumeration of SE and, in this study, applied it to naturally contaminated ice cream samples with and without enrichment. The detection limit of the real-time PCR assay was determined with artificially inoculated ice cream. When applied to the direct detection and quantification of SE in ice cream, the real-time PCR assay was as sensitive as the conventional plate count method in frequency of detection. However, populations of SE derived from real-time quantitative PCR were approximately 1 log higher than provided by MPN and CFU values obtained by conventional culture methods. The detection and enumeration of SE in naturally contaminated ice cream can be completed in 3 h by this real-time PCR method, whereas the cultural enrichment method requires 5 to 7 days. A commercial immunoassay for the specific detection of SE was also included in the study. The real-time PCR assay proved to be a valuable tool that may be useful to the food industry in monitoring its processes to improve product quality and safety.

Colony Count, Microbial↗
PubMed2006

Outbreak of multidrug-resistant Salmonella typhimurium associated with ground beef served at a school potluck.

An outbreak of gastroenteritis occurred among at least 47 persons attending a school potluck. Illness was associated with consumption of ground beef (estimated odds ratio, 16.3; 95% confidence interval, 2.2 to 338.3). Salmonella Typhimurium isolated from infected individuals and the implicated ground beef revealed identical pulsed-field gel electrophoresis patterns and was multidrug resistant. The implicated ground beef was improperly handled during the cooking process and stored above the U.S. Food and Drug Administration cooling temperature standard for >15 h before being served. This outbreak demonstrates the limitations of food safety regulations in settings where foods are prepared in the home environment for communal potlucks, bake sales, or other such gatherings held at schools, churches, or other institutions. Public health authorities should encourage school and other institutional administrators to develop policies that require dissemination of safe food preparation guidelines to prospective food handlers when such events are scheduled.

Adolescent↗
PubMed1987

Occupational therapy in mental health: crisis or opportunity?

For at least a decade, concern has been expressed about the status of occupational therapy in mental health. Increases in the number of new jobs and clinicians have not kept pace with growth in other practice areas. Although growing criticism of the practice of deinstitutionalization and an increased focus on cost-effectiveness have recently become major public policy trends in mental health practice, the psychological and nursing professions have responded creatively in order to expand their influence and practice. This paper relates changes in the delivery of mental health services to the systematic study of policy development and careful planning needed to help occupational therapy accomplish the same goals.

Humans↗
PubMed1998

Complementary therapies: research, education and practice in nursing.

There has been an increase in interest in complementary therapies amongst the general public and health care practitioners in recent years. Nurses integrating complementary therapies into their practice are not always adequately prepared due to the diversity of the therapies and the duration of the courses. Guidelines are broad and general, and there is no set standard nor minimum educational requirements related to the therapies in which nurses can integrate in their practice. This paper aims to raise awareness of nurses practising complementary therapies the need for research into practice and efficacy, education and policy development.

Complementary Therapies↗
PubMed2006

Health care safety and quality: where have we been and where are we going?

Health care will always be associated with risk, but the Australian Council for Safety and Quality in Health Care has achieved much in bringing health care safety and quality into public consciousness and beginning systemic change for improvement. Work is underway to develop safety and quality standards, and infrastructure and systems for measurement and evaluation; to increase workforce understanding of how to improve health care delivery; to increase consumer engagement in health care management; and to develop policy and understanding of the barriers to progress. With this foundation of reform, the future of the new Australian Commission on Safety and Quality in Health Care is promising, but it is up to us as health professionals and managers, with the help of the community, to improve the safety and quality of health care.

Advisory Committees↗
PubMed2004

Ocular laser exposure incident reporting.

BACKGROUND: Advances in laser technology are providing opportunities for new laser applications. Once the nearly exclusive province of scientists and the military, lasers are finding increasingly widespread applications in modern life. Along with this increase in applications, it is reasonable to expect a concomitant increase in the number of accidents and occasions of purposeful misuse, resulting in excessive ocular exposures to laser radiation. METHODS: A survey was conducted of databases currently collecting laser exposure and injury information. Those found were then evaluated for content, organization, and ease of use. RESULTS: A number of laser injury databases, privately and publicly funded, were found Overall, information on laser-associated injuries was quite fragmented, showing significant variability in format and content. CONCLUSIONS: Public health policy development and clinical management of eye injuries would benefit from a single, comprehensive, and easily accessible database/information tool such as the U.S. Army's Laser Accident and Incident Registry.

Databases as Topic↗
PubMed1995

Misrepresentation of academic accomplishments by applicants for gastroenterology fellowships.

OBJECTIVE: To determine whether two applicants who misrepresented their accomplishments in applications for gastroenterology fellowships reflected isolated incidents or whether misrepresentation was more wide-spread. DESIGN: Retrospective review of all 236 applications submitted for fellowship in a recent year for confirmation of research experience and cited publications. RESULTS: 138 applicants (58.5%) reported research experience during residency in a U.S. training program. Research activity could not be confirmed for 47 of 138 applicants (34.1%). Fifty-three applicants (22.4%) reported published articles, and 16 of these applicants (30.2%) misrepresented articles. Misrepresentation included citations of nonexistent articles in actual journals, articles in nonexistent journals, or articles noted as "in press." CONCLUSIONS: Misrepresentation on applications for gastroenterology fellowships was common. The following steps are recommended: 1) Fellowship programs should require that copies of all publications and letters of acceptance for manuscripts in press be submitted with fellowship applications; 2) applications should contain a statement to be signed by the applicant that the information provided is accurate; 3) persons writing letters of recommendation should verify the information being submitted by applicants; 4) medical students and residents should be taught that embellishment of curricula vitae constitutes misconduct; and 5) institutions and professional organizations should develop policies to deal with this problem.

Fellowships and Scholarships↗
PubMed1999

Elevated asthma morbidity in Puerto Rican children: a review of possible risk and prognostic factors.

Latino children represent a significant proportion of all US children, and asthma is the most common chronic illness affecting them. Previous research has revealed surprising differences in health among Latino children with asthma of varying countries of family origin. For instance, Puerto Rican children have a higher prevalence of asthma than Mexican American or Cuban American children. In addition, there are important differences in family structure and socioeconomic status among these Latino populations: Cuban Americans have higher levels of education and family income than Mexican-Americans and Puerto Ricans; mainland Puerto Rican children have the highest proportion of households led by a single mother. Our review of past research documents differences in asthma outcomes among Latino children and identifies the possible genetic, environmental, and health care factors associated with these differences. Based on this review, we propose research studies designed to differentiate between mutable and immutable risk and prognostic factors. We also propose that the sociocultural milieus of Latino subgroups of different ethnic and geographic origin are associated with varying patterns of risk factors that in turn lead to different morbidity patterns. Our analysis provides a blue-print for future research, policy development, and the evaluation of multifactorial interventions involving the collaboration of multiple social sectors, such as health care, public health, education, and public and private agencies.

Asthma↗
PubMed1990

AIDS, ethics and hospitals.

The issue of AIDS has raised a number of concerns for the health professions and for hospital administrators. An outline of some of the fundamental facts about HIV infection and AIDS and of the human rights obligations is provided. A number of issues for both practitioners and patients are raised. Administrators and practitioners are asked to develop policies through a careful consideration of the facts and issues and to set in place safeguards that recognise the rights and needs of all concerned.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Managed care: practice, pitfalls, and potential.

The results of coordinating and changing patterns of health care using managed care activities and organizations are reviewed in this article. Although utilization review and high-cost case management programs reduce the use of expensive services, incentives for providers of care, placing them at risk, are important for managing the intensity of health care. Managed care appears capable of reducing health care costs substantially. However, this increased efficiency has not translated to lower insurance premiums or modulated total health care expenditures because either purchasers are not aware or are not concerned about securing care at the least cost. To correct these deficiencies and deliver the potential of managed care, the author suggests the need to separate insurance into its three components parts (financing, risk spreading, and program management) and developed policies for each.

Cost Control↗