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PubMed2000

Evaluation of the AIDS Prevention Street Nurse Program: one step at a time.

The AIDS Prevention Street Nurse Program uses specially prepared community health nurses to focus on HIV and STD prevention with marginalized, hard-to-reach and high-risk clients within a broader context of harm reduction and health promotion. Street nurses (n = 17), service providers (n = 30), representatives of other HIV/STD programs in the province of British Columbia, Canada (N = 5), and clients (n = 32) were interviewed during an evaluation for the purpose of describing the nurses' work, the challenges the nurses' face, the fit of the program with other services, and the impact of the nurses' work. This article describes the impact of the nurses' work on clients. Impact/outcome changes reflected a progression from knowledge to behavioural levels and to major indicators of health/illness. Impact on clients included: knowing more about HIV/AIDS, their own situation, and options; receiving essential supplies to reduce harm and promote health; changing behaviour to reduce disease transmission, improve resistance, and promote health; connecting with help; feeling better about themselves and others; feeling supported; influencing others; receiving earlier attention for problems; being healthier with or without HIV; making major changes in drug use; and likely decreasing morbidity and mortality. The Program was found to be clearly effective in making a positive impact on clients.

Acquired Immunodeficiency Syndrome↗
PubMed2006

How can a beta-sheet peptide be both a potent antimicrobial and harmfully toxic? Molecular dynamics simulations of protegrin-1 in micelles.

In this work, the naturally occurring beta-hairpin antimicrobial peptide protegrin-1 (PG-1) is studied by molecular dynamics simulation in all-atom sodium dodecylsulfate and dodecylphosphocholine micelles. These simulations provide a high-resolution picture of the interactions between the peptide and simple models of bacterial and mammalian membranes. Both micelles show significant disruption, as is expected for a peptide that is both active against bacteria and toxic to host cells. There is, however, clear differentiation between the behavior in SDS versus DPC, which suggests different mechanisms of interaction for PG-1 with mammalian and bacterial membranes. Specifically, the equilibrium orientation of the peptide relative to SDS is a mirror image of its position relative to DPC. In both systems, the arginine residues of PG-1 strongly interact with the head groups of the micelles. In DPC, the peptide prefers a location closer to the core of the micelle with Phe12, Val14, and Val16 imbedded in the core and the other side of the hairpin, which includes Leu5 and Tyr7, located closer to the surface of the micelle. In SDS, the peptide prefers a location at the micelle-water interface. The peptide position is reversed, with Leu5 and Cys6 imbedded furthest in the micelle core and Phe12, Val14, and Val16 on the surface of the micelle. We discuss the implications of these results with respect to activity and toxicity.

Amino Acid Sequence↗
PubMed2006

Population screening for Chlamydia trachomatis infection in the UK: a qualitative study of the experiences of those screened.

BACKGROUND: Screening for Chlamydia trachomatis in selected health care settings is underway in the UK despite insufficient evidence about the personal impact of screening. OBJECTIVES: To describe men and women's experiences of being screened for chlamydia as part of the Chlamydia Screening Studies (ClaSS) project, a population-based UK study of postal screening for chlamydia. METHODS: We conducted in-depth interviews with 45 purposively sampled participants in the ClaSS project using a checklist of topics relating to their experiences of the screening process. Interviews were audio-tape recorded, transcribed verbatim and analysed using the constant comparison method. RESULTS: Four main themes emerged: initial discomfort with screening arising from an unease with sexual health issues; anxiety, especially after receiving a positive test result, due to the fear of informing sexual partners, the risk of infertility and the possibility of having other undetected infections; women's concern about being stigmatised for having been infected with chlamydia, which affected how they felt about themselves and how they thought others would perceive them; and recognising the need to balance the harms of screening with the benefits. Despite some reported adverse effects, no one regretted their decision to be screened. CONCLUSIONS: Public education and discussion of sexually transmitted infections should help to increase the acceptability of chlamydia screening and destigmatise a diagnosis of chlamydia. Those working in primary care settings are likely to become increasingly involved in chlamydia screening and so must be suitably trained to inform individuals of the potential adverse effects and to deal with their consequences.

Attitude to Health↗
PubMed2006

Role of medical students in preventing patient harm and enhancing patient safety.

BACKGROUND: Substantial efforts are focused on the high prevalence of patient harm due to medical errors and the mechanisms to prevent them. The potential role of the medical student as a valuable member of the team in preventing patient harm has, however, often been overlooked. METHODS: Four cases are presented from two US academic health centers in which medical students prevented or were in a position to prevent patient harm from occurring. The authors directly participated in each case. RESULTS: The types of harm prevented included averting non-sterile conditions, missing medications, mitigating exposure to highly contagious patients, and respecting patients' "do not resuscitate" requests. CONCLUSION: Medical students are often overlooked as valuable participants in ensuring patient safety. These cases show that medical students may be an untapped resource for medical error prevention. Medical students should be trained to recognize errors and to speak up when errors occur. Those supervising students should welcome and encourage students to actively communicate observed errors and near misses and should work to eliminate all intimidation by medical hierarchy that can prevent students from being safety advocates.

Clinical Clerkship↗
PubMed1990

An epidemiologic study of thyroid cancer in Hawaii.

A population-based case-control interview study was designed to test the hypothesis that dietary iodine or the consumption of goitrogenic vegetables increases the risk of thyroid cancer. A total of 191 histologically confirmed cases (64 percent female) and 441 matched controls from five ethnic groups in Hawaii were available for analysis. Among women, intake of seafood (especially shellfish), harm ha (a fermented fish sauce), and dietary iodine were associated with an increased risk of cancer, whereas consumption of goitrogenic (primarily cruciferous) vegetables was associated with a decreased risk. Non-dietary risk factors included miscarriage (especially at first pregnancy), use of fertility drugs, family history of thyroid disease, obesity, and work as a farm laborer. The odds ratio for the combined effect of a high iodine intake and a first-pregnancy miscarriage was 4.8 (95 percent confidence interval [CI] = 1.2-19.2); and for high iodine intake and use of fertility drugs 7.3 (95 percent CI = 1.5-34.5). Among men, positive associations were found for obesity, work as a farm laborer, and a past history of benign thyroid disease. Although this study identified several dietary and non-dietary risk factors for thyroid cancer, it could not fully explain the exceptionally high incidence rates among Filipino women in Hawaii.

Adult↗
PubMed2006

Reflections on the process of change on acute psychiatric wards during the City Nurse Project.

The intention of this paper is to discuss the process of therapeutic change on two acute psychiatric wards during a research project that aimed to reduce conflict and containment. Analysis of fieldwork notes, reflection, team discussion and supervision. The City Nurse Project successfully reduced patient aggression, self-harm and absconding. This paper reports on the reflections made over the course of the year as changes and developments to acute wards took place. Specifically discussed are the beneficial effects of an action research approach, the role of the City Nurse, support for ward managers, education and training, clinical supervision as well as difficulties and barriers to the overall process of change. At an interim stage of the project, the staff have shown a willingness to engage in efforts to change and improve two acute wards. This paper shows the potential to improve acute wards and produce positive outcomes using a working model.

Behavior Control↗
PubMed1993

Hoists for locomotor disability--Properties of the person-carrying section and biomechanics of sitting positions.

The purpose of this study was to make an inventory of the slings available for person hoists, to describe them and to carry out biomechanical analyses of the sitting positions in different slings. On the Swedish market 18 different slings were available. Nine were photographed with a subject sitting in them. The sagittal lengths of the supporting parts of the slings varied between 0.10 m and 1.0 m. The risk of falling through was considered largest in divided slings, but even in one-piece slings with divided leg supports, the person lifted can most probably slip through inadvertently. Almost all the slings gave a backward-inclined sitting position. However, in one of the slings the trunk inclination was small and the seat was slightly forward-downward inclined, giving a risk of falling/sliding forwards. Some of the slings entailed a trunk thigh angle smaller than 90 degrees, perhaps a problem for patients with hip pain and reduced hip flexion. Given the great variety of slings available, it seems important to work for relevant instructions and information about their use.

Accidental Falls↗
PubMed2002

How physicians feel about assisting female victims of intimate-partner violence.

PURPOSE: To assess the feelings of physicians about assisting female victims of intimate-partner violence (IPV), and to examine factors related to positive and negative feelings about assisting victims of IPV. METHOD: In 1998, a total site sample of 150 physicians practicing in a large general hospital in the area of Virginia Beach, Virginia, was surveyed by questionnaire via the mail. Four specialties were represented: emergency medicine, family practice, obstetrics-gynecology, and psychiatry. The questionnaire asked about medical training and training in assisting victims of IPV. The physicians' feelings about working with victims of IPV were measured on a nine-item, five-point semantic differential scale. RESULTS: A total of 76 physicians responded to the questionnaire (response rate = 51%). Only a minority (11%) had overall positive feeling scores about assisting victims of IPV. While most physicians reported that it was "significant work," the great majority also felt that it was difficult, low-paying, and stressful. Training in assisting victims of IPV, in medical school or afterwards, did not appear to influence feelings about assisting victims of IPV. However, physicians who were white and who were married (the majority of the respondents) were significantly more likely than the other respondents to feel negatively about providing services to victims of IPV. CONCLUSION: Graduate medical education and training programs need to address the association of negative feelings with helping women harmed by IPV, because these feelings may interfere with the appropriate screening, referral, and treatment of these victims.

Adult↗
PubMedDate not supplied

Child labor and health: problems and perspectives.

Child labor remains a widespread problem. Although it can have positive effects, in some situations it has negative effects on health and development of the children. Although mainly a problem in developing countries, it is also possible to find child workers, some working in hazardous activities, in developed countries. The authors describe the child labor profiles in developed and developing countries, the principal occupations of children, and their concomitant hazards. They summarize the epidemiologic evidence for a greater impact of some occupational exposures on the health of children as compared with adults, and the theoretical concerns about the impact of child labor on health, and suggest policies that can be used to combat harmful child labor.

Adolescent↗
PubMed1986

Transamniotic fetal feeding. III. The effect of nutrient infusion on fetal growth retardation.

The small-for-gestational age (SGA) infant resulting from intrauterine growth retardation (IUGR) is at high risk for perinatal complications and chronic morbidity. Most IUGR is the result of inadequate transfer of nutrients and/or oxygen from mother to fetus. Transamniotic fetal feeding (TAFF) has been proposed as a method of treating IUGR in which nutrients infused into the amniotic fluid would be swallowed, absorbed, and used by the growth retarded fetus. To study the efficacy of TAFF in the treatment of IUGR, we have previously described a rabbit model for TAFF that takes advantage of the relationship between "natural runting" (IUGR) and position on the uterine horn. We report on a controlled study of the effects of specific nutrient infusion on fetal growth retardation in this model. The infusion of dextrose, a dextrose-amino acid mixture, or lipid did not reverse or ameliorate fetal IUGR compared with controls. In addition, the infusion of lipid emulsion resulted in chronic lipid aspiration and further growth retardation. This work does not support the use of TAFF as a prenatal treatment for IUGR and suggests that oxygen may be the growth-limiting factor in most substrate deficiency IUGR. In addition, the infusion of solutions containing lipid may be harmful to the developing fetus.

Amino Acids↗
PubMed2005

Respiratory effects of exposure to dust from herbs.

A group of 150 people occupationally exposed to dust from herbs were examined. As a reference group, 50 urban dwellers, not exposed to any kind of organic dust were examined. People were subjected to routine physical examination and to lung function examinations with the LUNGTEST 500 spirometer (MES, Kraków, Poland). The spirometric values of the forced expiratory volume in one second (FEV (1)), vital capacity (VC) and FEV(1)/VC were recorded before and after work. Physical chest examination revealed pathological crepitations in 10 people (6.7 %). The mean baseline spirometric values in the study and reference groups did not show significant differences compared to the normal values. In the herb workers exposed to organic dust the post-shift decrease of all analysed spirometric values was noted. The post-shift decrease of some spirometric values (VC, VC % of normal values) was highly significant (p < 0.01). There was evidenced of a significant positive correlation between the age of examined people and decrease of VC and FEV(1) values. In 12 exposed workers the decrease of FEV(1) or FEV(1) % of normal values higher than 15 % was noted. 50 % of these workers cultivated thyme (Thymus vulgaris L.). This may suggest that dust from herbs, especially thyme dust, may cause acute airway obstruction. In the group showing significant decrease of FEV(1)/FEV(1) % of normal values ( > 15 %) the frequency of reported respiratory work-related symptoms (83.3 %) was higher than in the rest of exposed group (61.5 %). In conclusion, occupational exposure to dust from herbs may cause harmful effects on the respiratory system among herb processing workers. This indicates the need for use of prophylactic measures in this professional group, the more so as number of people occupationally exposed to dust from herbs is growing.

Adolescent↗
PubMedDate not supplied

Vaginal or cesarean birth? Application of an advocacy organization-driven research translation model.

BACKGROUND: Research translation models are needed to demonstrate a process for identifying and communicating high-quality scientific evidence that enables informed involvement of relevant stakeholders, including informed consumer participation in healthcare decision making. PURPOSE: To describe the rationale for, and elements of, a research translation model, as it is being applied to inform and support diverse end users with respect to decisions relating to vaginal versus cesarean birth. METHODS: The Maternity Center Association (MCA), the oldest national United States organization advocating on behalf of mothers and babies, identified the need to clarify and translate into practice best evidence about relative harms of cesarean and vaginal birth. MCA developed a model that included engaging leading stakeholder groups, conducting a systematic review to fill research gaps, and initiating an education and advocacy campaign to reach consumers, health professionals, and the general public with review results and related information and guidance. International standards for systematic reviews and evidence about effective professional practice, use of decision aids, and risk communication were used. RESULTS: Dozens of harms that differ by mode of delivery, with nearly all favoring vaginal birth, were found during review. Without clear, compelling, and well-supported justification for cesarean section, vaginal birth is the safest way for women to give birth and babies to be born. Despite modest resource expenditure, the implemented model is bringing review results to many individuals and organizations, incorporating elements that have been shown to be effective. The next step is to formally evaluate the decision aid in clinical settings. DISCUSSION: Advocacy organizations are uniquely positioned to carry out research translation. Given the importance of research translation and the challenges of carrying out this work, programs and policies should be established to support and evaluate advocacy organizations in this role.

Cesarean Section↗
PubMed1986

Nutritional aspects of preconceptional period as related to pregnancy and early infancy.

The maternal nutritional status is considered as one of the most important factors influencing the pregnancy and the state of the offspring. There are limited data available on inadequate intake, especially before conception. A variety of nutritional and non-nutritional factors can act during the preconceptional period. Prepregnancy body weight and gestational weight gain have an independent but cumulative influence on the birth weight. The vitamin deficiency in preconceptional period, especially of folates, seems to be associated with neural tube defects. The infants of women with total gestational weight gain below 9 kg have the mean birth weight always lower than those of women with weight gain more than 9 kg in all three categories of preconceptional relative weight (i.e. less than 95%, from 95% to 105% and greater than 105%). Also the proportion of infants with birth-weight greater than 2500 g is higher in average (6.2%) and under-weight (4.4%) groups than in those over-weight (1.8%). Several other maternal nutritional as well as non nutritional variables are related with the pregnancy outcome. Among those with harmful effect on pregnancy outcome since preconceptional period, are alcohol drinking and smoking. Work outside the home can be associated with preterm deliveries and low-birth-weight infants, but the results are not consistent. Nutritional intervention, energy and/or protein supplementation also contribute to an increase of the birth-weight. As far as the antenatal care is concerned, only few studies investigated, with a scientific rigour the relation if any between prenatal care and pregnancy outcome. We concluded that the available evidence confirms a significant impact of preconceptional nutrition on pregnancy outcome. A sensitive evaluation of nutritional status in preconceptional period seems to be a positive strategy for prevention of at risk pregnancies. There is a clear need of prospective human studies with aim to relate the nutrient status of future mother to the evolution of her pregnancy.

Adolescent↗
PubMed2007

Role development and career stages in addiction nursing: an exploratory study.

AIM: This paper reports a study to explore factors influencing recruitment and retention in addiction nursing, and the stages and features of role acquisition and personal qualities important to that role. BACKGROUND: Specialist addiction nurses engage in a number of roles in the care of individuals with problematic use of psychoactive substances. These include assessment, outreach, prescribing, counselling, and harm reduction. In a climate of increasing demand for specialist substance misuse workers, and a trend to identify key occupational competencies, there is a need for a framework in which career progression can be supported. Studies exploring the roles of addiction nurses are minimal, and there is less comment on how these roles are developed in the context of career stages. METHOD: A qualitative study using focus groups was undertaken with specialist addiction nurses between March and June 2004. The data were transcribed verbatim and analysed using Burnard's six content analysis stages. FINDINGS: Positive factors identified as influencing recruitment and retention included: prior knowledge of the working environment (as a nursing student), opportunities for autonomous practice, the client profile, and associated treatment philosophy and care approach. There was consensus that nurses choosing to work in the field of addiction needed, in addition to being non-judgmental, personal qualities including hardiness, patience and tolerance. Five role development stages, with a set of descriptors, were identified: encounter, engagement, stabilization, competency and mastery. CONCLUSION: Identification of these five role development stages for addiction nurses offers employers, nurse managers, educators and addiction nurses a starting point from which specific occupational competencies can be further explored. In addition, continuing professional development needs can be mapped to specific role development stages. Employers and nurse managers may wish to offer increased learning opportunities to student nurses to gain work experience within specialist addiction units.

Adult↗
PubMed2004

The use of CDA best management practices and amalgam separators to improve the management of dental wastewater.

Concerns over the persistence and effects of mercury in the environment, particularly in wastewater, have increased significantly over the past decade. Because mercury is a component of dental amalgam, comprising about 50 percent of amalgam among other metals, in recent years the concern has affected dental practices and even educational curricula in the dental schools. While numbers vary widely from area to area, on average, it is estimated dentistry contributes less than 1 percent of the mercury generated from human activity to the environment. Despite dentistry's low contribution to the environmental mercury load, organized dentistry's position is that dentistry's role as a public health profession includes environmental stewardship, as well as patient safety, and that dental professionals must act responsibly by taking steps to prevent amalgam waste or any potentially harmful materials from entering the environment, no matter how small the amount. In support of this belief, both the California Dental Association and the American Dental Association have developed recommendations for best practice that dental offices should follow when handling dental amalgam waste. Many dental schools and auxiliary programs have shown their commitment to minimizing detrimental effects to the environment, evidenced by the fact that most, if not all, have incorporated safe work practices including mercury hygiene procedures as part of clinical coursework. Some local jurisdictions hardest hit by the effects of mercury in wastewater have gone even further to recommend, or even require, the installation of amalgam separators in dental offices. This article will describe the history of BMPs and amalgam separators usage in California, and examine the practical aspects of their usage in reducing the discharge of dental amalgam into waste streams.

California↗
PubMed2004

Children's views of microbes: current beliefs about bacteria in Italian grade school children.

INTRODUCTION: The misuse of antibacterials and the consequent emergence of resistance indicate that enhanced awareness is required among clinicians, patients and the general population of the collaborative roles of the bacterial ecosystem in health preservation. The objective of this work is to assess school students' knowledge and perception of microbes. METHODS: In preparation for a meeting of health professionals concerning antimicrobial policies, a questionnaire for administration to children from fourth to eighth school grades was developed, exploring their understanding of bacteria, use of antibiotics and hygiene. SETTING: Twenty-eight classrooms in north-central Italy, 7 from fourth to fifth grade and 21 from sixth to eighth grade. RESULTS: Four hundred ninety-nine students with a mean age of 12 years participated in the study. For 60% of the children, the notion of bacteria centered on their harmfulness; only 25% of the interviewees acknowledged a positive role. Antibiotics were perceived as the absolute weapon against both viruses and bacteria by 56% of respondents and most cases of domestic health impairment by 46% of respondents. The proportions of children being treated at the time once or more than once with an antibiotic were 23 and 24%, respectively. Little difference emerged between the notion of cleansing as opposed to disinfecting. CONCLUSION: Children's confused understanding of bacteria and the lack of a specific contribution from schools suggest that health professionals should engage further in educational activities in the community to overcome this problem. Relevant policies may benefit from being targeted at children directly because they are more open to new ideas and can spread in their milieu the idea of a "reconciliation" with the microbial world.

Adolescent↗
PubMed1983

Influence of knee flexion on isometric hip extensor strength.

The maximum isometric extensor muscle strength was measured in 10 healthy subjects of different combinations of hip and knee angles. An ordinary exercise device was used for the measurements and the method could be useful in clinical work. The results revealed that the knee angle does not affect the hip extensor strength. The highest extensor muscular moments occurred at 90 degrees hip flexion, decreasing with decreasing hip angle. The distribution of the strength over the motion sector differed between male and female. The weight of the body segments was found to utilize 10-24% of the maximum strength at hip angles 60 degrees-0 degrees with subjects in a prone position.

Adult↗
PubMed1992

Drug exposed infants and their mothers: facts, myths, and needs.

There is much interest in the use and abuse of chemicals by pregnant women. Although maternal chemical use is believed to be harmful to the fetus and has become the basis for criminal prosecution of mothers, obtaining accurate information about the incidence and consequences of prenatal exposure is difficult. This article critically examines the research on incidence and consequences of chemical use and offers suggestions for providing services to this vulnerable population for health care social workers in policy and practice positions.

Combined Modality Therapy↗