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Occupational cancer in the European part of the Commonwealth of Independent States.

Precise information on the number of workers currently exposed to carcinogens in the Commonwealth of Independent States (CIS) is lacking. However, the large number of workers employed in high-risk industries such as the chemical and metal industries suggests that the number of workers potentially exposed to carcinogens may be large. In the CIS, women account for almost 50% of the industrial work force. Although no precise data are available on the number of cancers caused by occupational exposures, indirect evidence suggests that the magnitude of the problem is comparable to that observed in Western Europe, representing some 20,000 cases per year. The large number of women employed in the past and at present in industries that create potential exposure to carcinogens is a special characteristic of the CIS. In recent years an increasing amount of high-quality research has been conducted on occupational cancer in the CIS; there is, however, room for further improvement. International training programs should be established, and funds from international research and development programs should be devoted to this area. In recent years, following privatization of many large-scale industries, access to employment and exposure data is becoming increasingly difficult.

Carcinogens↗

Understanding older women's health care concerns: a qualitative study.

BACKGROUND: Older women often have different physical and psychological health priorities compared to men, and health systems must strive to extend and improve health care delivery to meet older women's specific health care needs. The goal of this study was to obtain information from older women on how to improve health care services to best support their efforts to age successfully and receive optimal quality health care in later life. METHODS: Focus groups were conducted among women aged 65 or older recruited from the community in the Montreal, Quebec area. A total of 36 women participated. The focus group sessions were audiotaped, and the transcripts of each session were analyzed for issues and themes emerging from the text. Content analysis using the framework approach was used to explore and understand the experience of the focus group participants. The data from the text were then coded according to the relevant and emergent ideas and concepts. RESULTS: Participants felt that their physical health care needs were being met, but that a number of issues relating to psychological health were inadequately addressed by health care professionals. The importance of feeling validated as active participants in a health care relationship, recognition of fears and anxieties associated with aging, and the need for information-sharing and education were all viewed as important health care priorities for older women. Time and accessibility were identified as the most significant barriers towards receiving optimal health care in later life. INTERPRETATION: The current health care system does not meet the global health care needs of older women. Health care leaders must recognize that success in program development and delivery for older women will require designing clinical programs that address both the physiological and psychosocial requirements of women. Only when women feel that they are being cared for in a comprehensive manner, one that includes attention to physical, psychological and emotional health, are we likely to be delivering health care that optimally promotes successful aging.

Age Factors↗

Understanding older women's health care concerns: a qualitative study.

BACKGROUND: Older women often have different physical and psychological health priorities compared to men, and health systems must strive to extend and improve health care delivery to meet older women's specific health care needs. The goal of this study was to obtain information from older women on how to improve health care services to best support their efforts to age successfully and receive optimal quality health care in later life. METHODS: Focus groups were conducted among women aged 65 or older recruited from the community in the Montreal, Quebec, area. A total of 36 women participated. The focus group sessions were audiotaped, and the transcripts of each session were analyzed for issues and themes emerging from the text. Content analysis using the framework approach was used to explore and understand the experience of the focus group participants. The data from the text were then coded according to the relevant and emergent ideas and concepts. RESULTS: Participants felt that their physical health care needs were being met, but that a number of issues relating to psychological health were inadequately addressed by health care professionals. The importance of feeling validated as active participants in a health care relationship, recognition of fears and anxieties associated with aging, and the need for information-sharing and education were all viewed as important health care priorities for older women. Time and accessibility were identified as the most significant barriers towards receiving optimal health care in later life. INTERPRETATION: The current health care system does not meet the global health care needs of older women. Health care leaders must recognize that success in program development and delivery for older women will require designing clinical programs that address both the physiological and psychosocial requirements of women. Only when women feel that they are being cared for in a comprehensive manner, one that includes attention to physical, psychological and emotional health, are we likely to be delivering health care that optimally promotes successful aging.

Age Factors↗

Building community-based service systems for children with special needs: the Michigan Locally Based Services program.

The philosophy of the Michigan Department of Public Health, Division of Children's Special Health Care Services (DCSHCS) program holds that children with special health care needs have a right to every opportunity for self-support and self-fulfillment. To assist families, the program historically has provided support with medical care and treatment payments. Likewise, local health departments have shared in the process of supporting families of children with special health care needs. A growing awareness that these families experience a variety of other needs not directly attended to by these mechanisms led the Division to respond further to those needs. The response was aimed toward increasing the capacity to locate clients and provide family assessments, and, where necessary, case management services at the local community level. The implementation, on-going program development, stabilization, and future trends of the Locally Based Services program are described from the varying perspectives of the state and a local health department.

Child↗

Catholic identity in a changing church. The 1989 Flanagan lecture examines coping strategies.

Change abounds in our lives. The Catholic Church needs to stop being fearful of changes and start benefiting from them. We have absorbed and become accustomed to a variety of social changes. In addition, significant changes in our religious behavior and attitudes need to be incorporated into our self-understanding. One problem is that we have no road map for the new territory marked by these unavoidable changes. In a previous era, our healthcare institutions were easily identifiable as Catholic because the people who ran them dressed in religious garb. Now laypeople are taking on more and more administrative roles in all our institutions. Where will future Catholic leaders come from? Parishes are still the core of the local Church experience in this country, and it is from this core that our future leaders emerge. Today, we need to regenerate this source of leadership. We have the opportunity to break new ground in community healthcare by building even closer connections with parishes. In addition, we can use parishes as resources for trained volunteers and professionals. Our healthcare operations can develop programs of consumer education through local communities. Finally, we can develop "centers of critical study" by combining some of our university resources with our healthcare resources.

Catholicism↗

Use of a clinical audit to promote the quality use of medicines to rural and remote general practitioners.

Very few methods have been shown to change prescribing behaviour. Queensland Rural Medical Support Agency's Quality Use of Medicines (QUM) Program aims to engage rural general practitioners (GPs) in the development of strategies to improve health outcomes in relation to the quality use of medicines. The present paper describes the development of a tool to audit the management of heart failure in rural general practice and to encourage rural GPs to undertake such an audit as a method of continuing medical education. A self-administered retrospective clinical audit of heart failure patients was undertaken by rural and remote GPs. Fourteen doctors undertook the audit, providing data on 270 patient cases. Patient data collected include 30% not receiving adequate angiotensin-converting enzyme inhibitor doses, 45% of patients who may benefit from a beta-blocker and 14% of patients taking a drug known to aggravate heart failure. The majority of participants would review a patient following the audit and 93% confirmed that the audit assisted them in identifying patients whose heart failure management could be enhanced. The clinical audit provided results and a commentary to allow GPs reflective educational opportunities through the dissemination of results and engagement with appropriate educational organisations (e.g. Australian College of Rural and Remote Medicine) to inform the development of educational standards for personal development programs in QUM. Audits must be relevant and practical to meet the learning needs of GPs.

Adrenergic beta-Antagonists↗

Advances in the clinical development of antiepileptic drugs.

In this paper we describe advances in the clinical development of antiepileptic drugs as a function of the Antiepileptic Drug Development Program of the National Institute of Neurological and Communicative Disorders and Stroke. This program encompasses both the preclinical and clinical elements of drug development through the Anticonvulsant Screening Project, the Toxicology Project, and the support of controlled clinical trials of potential new drugs that emerge from these projects and promise to be more effective and less toxic than those currently available for the treatment of epilepsy.

Animals↗

[Computerized analysis of activity profiles of beta-lactams].

This study was designed to compare the in vitro activities of recent cephalosporins and other beta-lactams. One of our objectives was to determine whether the microbiologist could use a single cephalosporin for routine antibiotic sensitivity testing. All the strains studied were recovered from outpatients. Sensitivity and/or resistance were evaluated by MIC determination, according to a program developed in our laboratory, using a personal computer. Using special programs, patterns of activities of beta-lactams were determined quantitatively and graphically for each bacterial strain tested. For most strains ceftriaxone, and to a lesser extent moxalactam and cefoperazone, exhibited greater antibacterial activity than the other beta-lactams, except against group D streptococci. For Enterobacteriaceae, cefadroxil is satisfactory in screening for in vitro activity of cephalosporins.

Anti-Bacterial Agents↗

A workplace stretching program. Physiologic and perception measurements before and after participation.

The purpose of this study was to implement a primary prevention program in the workplace targeted to prevent muscle strains. Physiologic and perception measurements were taken before and after participation in a stretching program developed to improve flexibility through conditioning. A one group pre-test post-test design was used with 60 employees enrolled in a 36 session stretching program in the workplace. Flexibility was measured by a flexibility profile including the sit and reach test, bilateral body rotation measurements, and shoulder rotation measurements. A statistically significant increase was found in all flexibility measurements at the conclusion of the study for the participants as a total group. Perception, as measured by the Fox Physical Self Perception Profile, was statistically significant in relation to participants' perceptions of their body attractiveness, physical conditioning, and overall self worth at the program's conclusion. In addition, participants who completed the program had zero occurrences of musculoskeletal injuries during the 2 month period. The results of this study suggest that continued development and implementation of stretching programs in the workplace may benefit employees by increasing flexibility and potentially preventing injuries due to muscle strains. Stretching programs in the workplace also may improve components of employees' perceptions of their physical bodies.

Adult↗

An international physician education program to support the recent introduction of family medicine in Egypt.

BACKGROUND AND OBJECTIVES: There are few reports of systematic international physician development programs to create family medicine as a new specialty in a developing nation. This paper describes the process and outcomes of a large-scale effort to initiate new family medicine training through the Egyptian Ministry of Health and Population (MOHP) using a 12-week US-based program at the University of California, Irvine (UCI). METHODS: Generalist physicians (n=134) with 1 year of internship training, currently working under the MOHP in Egypt, were competitively selected to participate in a training program at UCI between 1998 and 2002. Participants were assessed before, during, and after the program using multiple measures of competencies in family medicine topics, practice, and teaching. Aggregate participant data, post-program quality surveys, and follow-up surveys of the program's influence on practice behaviors comprised the main measures used for program evaluation. RESULTS: Participants showed improvement in knowledge and skills for family medicine practice and teaching for topics covered in the program. After returning to Egypt, 98% reported continued use of their newly acquired skills and knowledge. Participants reported that the program advanced their careers, they taught family medicine to other physicians, and they were likely to pursue certification under a newly established Family Medicine Board of Egypt. Self-reported practice in family medicine increased to 69% after the program versus 16% before. CONCLUSIONS: Overseas training programs are a viable method of introducing family medicine as a new clinical specialty. Ingredients for successful implementation and barriers are discussed.

Clinical Competence↗

Attributes of an ideal continuing medical education institution identified through nominal group technique.

INTRODUCTION: Continuing medical education (CME) is an important resource physicians use to maintain their clinical competence. While many options for CME programs are available, there are few measures of their impact and few measures for physicians to use to systematically gauge their efforts in maintaining competence. This study initiates a process designed to identify key attributes of an ideal CME institution, defined as one that facilitates ways for individual physicians to maintain their competence. METHOD: Using a nominal group technique (NGT), two sessions were conducted with panels of experts in the field. The NGT systematically elicits and prioritizes panelists' responses to a specific question. A larger review panel then rated the importance of each attribute. RESULTS: Panel I: Highest priority attributes: Develops programs based on gaps in healthcare outcomes (8 votes); Has ready access to performance data (6 votes); Has measurement capability that enables tracking individual practice and program performance (6 votes). Panel II: Highest priority attributes: Has adequate resources to accomplish objectives (5 votes); Conducts outcomes assessments (5 votes); Links CME and continuous improvement (5 votes); Employs staff that is able and willing to "think out of the box" (5 votes). The highest rated attributes of the larger panel were: links CME and continuous improvement; develops and promotes programs based on gaps in healthcare outcomes and evidence-based content; and has access to needs data. DISCUSSION: Using an expert panel to define the key attributes of an ideal CME institution creates a roadmap for excellence. An ideal CME institution is one that provides CME that demonstrates effectiveness in supporting physicians' efforts to maintain competence.

Education, Medical, Continuing↗

Developing a reciprocal program between student nurse organizations and hospitals.

Student nurse organizations can develop reciprocal programs with hospitals which can be mutually beneficial to both organizations. Hospitals need to recruit and retain qualified nurses through cost-effective methods. NSAs need to develop financial support for their group's activities. Both the hospital and the NSA need to expose students to various nursing roles in an effort to reduce reality shock. Developing a reciprocal relationship between an NSA and a hospital is one method of meeting the complementary objectives of both organizations.

Hospital Administration↗

Critical factors for successful hospital-based case management.

Six hospitals were funded to develop programs for long-term case management. Factors that should be considered when developing hospital-based case management are discussed within three areas: organizational placement, program management, and financial viability.

Arizona↗

Maternal coping strategies and emotional distress: results of an early intervention program for low birth weight young children.

Several questions were examined with Infant Health and Development Program (IHDP) data (N = 843). Are effects of intervention services found for maternal emotional distress and coping strategies, and are these effects different for different groups of mothers? Do maternal distress, coping, and life events moderate (or mediate) the intervention effects reported earlier for children's test scores and behavior problems (IHDP, 1990)? The intervention reduced maternal distress, especially for women with less than a high school education. Maternal distress did not moderate or mediate the influence of the intervention on child outcomes. Maternal coping was not influenced by the intervention and did not moderate the influence of the intervention on child outcomes. Life events moderated the influence of the intervention on children's test scores; the intervention was more effective for children whose mothers had fewer life events.

Adaptation, Psychological↗

Re-engineering: an opportunity to advance clinical practice in a community hospital.

A hospital pharmacy's efforts to advance clinical pharmacy practice and reduce pharmacy costs as part of a hospitalwide re-engineering program are described. In 1995, a 321-bed community hospital in Wisconsin undertook a three-year re-engineering program aimed at reducing operating expenses, primarily labor costs. The pharmacy department focused its efforts within the program on improving the efficiency of product-related functions, mainly through automation, and redeploying staff to value-added clinical functions. This involved installation of a hospitalwide pneumatic-tube system, use of unit-based automated medication dispensing devices, and implementation of a dedicated clinical pharmacy services program. Implementation of this program was to occur incrementally, with the first 12 months to be used primarily in developing a service model, initiating a staff-development program, and hiring additional clinical staff. Services added under the program included i.v. to oral conversion, dosage adjustments for patients with renal impairment, advanced patient counseling, development of care plans, and rounds in all areas of the hospital. After the first full year of implementation of the program, a cost-benefit analysis was undertaken; costs were composed primarily of pharmacists' salaries and benefits, and benefits were composed primarily of drug cost savings. A benefit to cost ratio of 2.61:1 and a net saving of $217,551 were calculated. The introduction of clinical pharmacy services as part of a hospitalwide re-engineering program was associated with a positive benefit to cost ratio and a substantial net cost saving.

Cost-Benefit Analysis↗

Strategies for teaching clinical decision-making.

Nursing today requires clinicians who are autonomous decision-makers. It is therefore essential that nurses develop effective problem-solving and decision-making skills. The authors have found, both in practice and in searches of the literature, that registered nurses (RNs) appear to lack the skills necessary to make effective decisions. RNs demonstrate a propensity to stereotype, to be influenced by cultural bias and a desire to make rapid decisions. The literature abounds with research into and discussion on clinical decision-making. It fails however, to specify the skills required and to delineate the educational strategies that may be employed to improve the process of making decisions. An educational program developed by the authors indicates that it is possible to facilitate the development of cognitive skills in clinical decision-making. This paper explores views expressed in the literature, as well as examining the skills developed within the program that have been found to enhance decision-making. Finally, educational strategies designed to improve these skills are discussed.

Clinical Competence↗

Hitting the mark in community health outreach: what counts?

This article describes a nurse-managed community health outreach project, at the Health Promotion Center (HPC) of Fairfield University School of Nursing, to prevent cardiovascular disease in an inner-city community. Flexibility in the project's grant funding has enabled the HPC to use a customer-oriented approach to develop programs. The article details the application of community health nursing and quality management practices to the development of HPC's cardiovascular-disease-screening program.

Cardiovascular Diseases↗

The farm family perception of occupational health: a multistate survey of knowledge, attitudes, behaviors, and ideas.

It is vitally important to integrate the views and concerns of the farm family into the process of policy development. If the input is not there, policy planners could implement programs that are philosophically separated from the farm families' concerns and attitudes. This would destroy credibility and future farmer support of any new program development. From May of 1988 to April of 1989, a phone and mail survey of approximately 1,500 farmers and spouses was conducted to assess knowledge, attitudes, and behaviors regarding agricultural safety and health. The survey was conducted in Iowa, New York, South Carolina, and Washington state. Preliminary results from Iowa and New York indicated that: 1) farmers value highly, and are concerned with, occupational health and safety issues; 2) farmers report that their major concerns include stress, trauma and respiratory problems; 3) farmers would like access to an occupational health and safety service; and 4) any new farm health and safety programs must include farmer input to ensure practicality, applicability, and acceptance.

Agriculture↗