Interviewing and counseling skills. Techniques for their evaluation.

Assessment of knowledge and cognitive skills has been traditionally included in examinations for certification and licensure of health professionals. Evaluation techniques for assessing complex cognitive and interpersonal skills, however, have not been as widely developed or incorporated in national examination programs. Specifically, the evaluation of interviewing and counseling skills has been complicated by difficulties in: (a) defining what consititutes skillful interviewing and counseling and in specifying criteria against which performance can be assessed; (b) developing evaluation procedures to permit accurate and reliable observations of these activities; (c) solving logistic problems of standardizing the content and format of these evaluation procedures; and (d) establishing standards for identifying individuals who have not yet achieved acceptable levels of proficiency. Progress has been made in defining the criteria for evaluating the interviewing and counseling skills of several categories of health professionals. Definitions can be developed to identify specific behaviors associated with acceptable and unacceptable skills in this area of professional competence. On the basis of these definitions, interaction analysis techniques have been developed for accurate and reliable recording of behavior as it occurs in an interviewing and counseling session. Moreover, the use of actors programmed to portray the roles of patients has enabled the standardization of this evaluation procedure so that examinees can be assessed on the basis of equivalent testing conditions. A number of research studies are under way to determine whether paper-and-pencil, as well as audiovisual, simulations can be substituted for evaluation in a live, interactive setting. However, little has yet been done to identify appropriate procedures for establishing standards of proficiency. Perhaps such efforts will be more feasible when appropriate evaluation techniques are more fully developed. Of relevance in determining whether the evaluation of counseling and interviewing skills is pertinent to dietetics are questions such as: How frequently do dietitians interact with patients? In what settings and for what purposes do these interactions take place? What impact do dietitian-patient interactions have on the quality of the health care provided?     

Nosocomial colonization of premature babies with Klebsiella oxytoca: probable role of enteral feeding procedure in transmission and control of the outbreak with the use of gloves.

OBJECTIVE: To investigate the persistence of colonization of premature babies by Klebsiella oxytoca, with special emphasis on the mode of transmission of the bacterium and evaluation of Standard Precautions to stop the epidemic. DESIGN: Retrospective analysis of cases and prospective study of systematic bacteriological samples (stools and throat) from babies, healthcare workers (HCWs), and environment, with genotyping of strains by arbitrarily primed polymerase chain reaction. SETTING: A premature baby unit (PBU) and a neonatal intensive care unit in the university hospital of Saint-Etienne, France. RESULTS: An outbreak of K oxytoca was suspected in two pediatric wards after the occurrence of a fatal bacteremia in a newborn hospitalized in the PBU and the colonization of other babies 2 months later. Retrospective analysis showed that 24 babies' digestive tract had been colonized. No environmental reservoir was recovered in the units nor in enteral feeding. No K oxytoca was isolated from HCW samples. Genotyping confirmed the presence of epidemic strains, although independent clones were responsible for infections or colonizations in each of the two units. The chronology and the site of babies' colonization (isolation of K oxytoca in stools before throat) were determined during a prospective study and suggested that enteral feeding procedures could be the source of contamination. Therefore, use of gloves during this practice by HCWs was recommended and, after readjustment of Standard Precautions, stopped the outbreak. CONCLUSION: To prevent cross-contamination among high-risk babies, careful attention must be paid to Standard Precautions. Bacteriological surveillance of the digestive tract of neonates could help to check compliance with these guidelines     

A qualitative study of vaccination behaviour amongst female Polish migrants in Edinburgh,Scotland

Vaccine hesitancy is increasing and failure to vaccinate is well-recognised in Europe as a contributing factor to outbreaks of infectious diseases. In Lothian and Scotland, low vaccine uptake has been seen in migrants – notably in the Polish group who have arrived since 2004. The recent Vaccine Confidence in European Union report highlights a concerning recent decline in vaccine confidence in Poland.We held three focus groups containing 13 Polish women about the childhood vaccination programme in Lothian, with specific focus on influenza and Human Papillomavirus vaccinations. Key emergent themes were: trust in the national vaccination policy, trust in the vaccination providers (health professionals), trust in the individual vaccines, balancing the risk of disease, and language and communication.Polish norms, beliefs and behaviours shape how Polish migrants navigate the UK health system and its vaccination programme. While not confident in the Scottish primary care model and its generalist practitioners, the participants liked the ethos of informed consent in Scotland and compared this favourably with the compulsory vaccination policy in Poland. There was a belief that vaccines in Scotland were of higher quality than Poland and with fewer adverse effects.Respondents reported returning to Poland for specialist clinical appointments and diagnostic testing. They regularly access Polish clinical expertise and their opinions about health are influenced by Polish friends and family. They say they have difficulty finding official UK Government and health authority vaccination material and often access Polish media, online resources and information. They are familiar with anti-vaccination activities in Poland.Consequently, there are important unmet information needs for this group of parents who may not be making truly informed choices about vaccination. This requires further investigation especially as migration continues and declining immunisation uptake is reported in many countries across Europe.     

Organoleptic analysis of food packaging

The basic rules for the organoleptic analysis of food contact materials and food packaging and the criteria of their assessment was presented. According to the EU legislation food contact materials can not release their constituents into the food in quantities that can be harmful for the consumers and/or can change the organoleptic characteristics of food. Conformity of food contact materials and food packaging with the regulation for overall and specific migration and organoleptic characteristics should be shown by their performance in relevant tests. The standardised method for the organoleptic analysis of the food contact materials does not exist in the UE. Member States use the own methods published as national standards. For sensory analysis of foreign taste and odour Poland uses the triangle method according to Polish Standard PN-87/O-79114. Some countries use Robinson test according to German Standard DIN 10955. These two tests are basing on the same principle. Food contact materials and food packaging, which give negative results in sensory analysis can not be used in direct contact with food, even though all testing parameters in overall and specific migration were fulfil the requirements for the permissible limits.     

Validity and reliability of Short Form General Health Survey (SF-20) in population of elderly people

Aim of this study was assessing validity and reliability of Short Form General Health Survey (SF-20) and it's usefulness in evaluation of health status of elderly people in Polish conditions. Study group consisted of 529 randomly chosen elderly (household residents) living in Krakow. Theoretical validity of the test was evaluated using exploratory factor analysis (principal components method). Reliability was calculated by Cronbach's alpha index and by checking if questions forming each sub scale fulfill Kline's criterion. Analysis showed some faults in theoretical validity of scales concerning mental and physical health, which decrease their reliability. Nevertheless, scales constituting this Survey fulfill Kline's and Nunnaly's criterias, which means that they have high internal consistency. Results confirm satisfactory value of SF-20 test as an instrument for evaluation of health of elderly people in Polish conditions.     

Standard setting in occupational health: "philosophical" issues

This paper discusses various "philosophical" issues in standard setting in occupational and environmental health, i.e., general principles, actual procedures for standard setting, inter- and intra-agency discrepancies in procedures and criteria, and choices and decisions in the preparation of criteria documents and in the evaluation of the toxicology databases. Unpublished, possibly confidential information should be made available to expert committees, workers, and the general public. There is an urgent need to improve the validity of the toxicology databases that have to underpin occupational and environmental exposure limits. Standard setting requires various ethically loaded choices and decisions by experts, employees, managers, government officials, and politicians.     

A Health Promotion Program for School Personnel

Though public schools traditionally have been concerned about the mental and physical health of children, programs that provide support for the health and well-being of school employees are rare. A health promotion program that focused on self-help in the areas of self-management, coping and adapting, exercise and fitness, and nutrition and well-being was designed for school employees. Before the program began, surveys of teachers and school administrators were conducted to document general well-being, health protective behaviors, and perceived occupational stress. A prevention-oriented educational program was implemented that provided for trained facilitators to influence small groups of employees to work together to maintain or improve their health. Results indicate that school employees who meet specified criteria can be trained to facilitate a health promotion program within the public school environment. Also, as a result of the facilitator training program, knowledge levels, attitudes, and certain health behaviors of participants are significantly influenced. However, feasibility will depend on a social process during which stakeholders are given opportunity to make decisions concerning implementation. An algorithm is useful to communicate the social process for decision making as it translates abstract principles of formative evaluation into concrete procedures that will assist planners in determining the feasibility of implementing the program in a school.     

Electromagnetic hazards from electrosurgery--assessment of occupational exposure to electromagnetic field and currents induceed in the body

The investigation of the occupational exposure to electromagnetic fields from electrosurgery devices were done (according to the requirements of Polish Standard PN-T-06580:2002). The exposure was evaluated following the criteria established by occupational safety and health regulations. The measurements and evaluation of the currents flowing through the exposed workers body were also conducted following the method and criteria published by IEEE standard and European Directive 2004/40/EC. It was found that in the vicinity of electrosurgical devices, the area of electromagnetic fields to which only workers operating the source of field should be exposed can exist up to the distance of 70 cm from the active electrode and supplying cables. In the case when the cables are placed directly on the surgeon body or long duration of the daily exposure the overexposure of workers can appear (referring to Polish regulations). The current flowing through the arm of surgeon keeping the electrode with electric field of the maximum strength (app. 1000 V/m or higher) can exceed permissible value of 40 mA established by the Directive 2004/40/EC for contact current. The reduction of the surgeon exposure can be reached by the proper positioning of the cables supplying monopolar electrode or by the use of bipolar electrode.     

Comparative review of the test design Tentative Final Monograph (TFM) and EN 12791 for surgical hand disinfectants

Preoperative antiseptic treatment of the hands of the surgical team is a standard procedure used worldwide in order to reduce the risk of surgical site infection. Two different types of antiseptics are available: alcohol-based hand rubs and antimicrobial liquid detergents ("soaps"). Standards have been developed to determine the antimicrobial efficacy of such preparations: the European norm EN 12971, finally issued in 2005, and the Tentative Final Monograph (TFM) for health care antiseptic products from 1994, which is the corresponding document in the USA. Although both methods use the reduction of resident hand flora as a quantitative parameter for antimicrobial efficacy, there are major differences concerning the test design. Whereas the European method is carried out following a randomized, reference-controlled crossover design, the US method can be characterized as a randomized, blinded parallel arm design. While both standards aim at immediate as well as sustained efficacy of the procedure, according to the EN the test product must not be significantly less effective than the reference procedure, whereas the TFM requires absolute reduction of > or = 1, > or = 2, and > or = 3 log10 per hand on days 1, 2, and 5, respectively. Results from various studies demonstrated that meeting the criteria defined by both standards may happen, but meeting the specifications of one standard does not necessarily mean that the same product will pass the requirements of the other. Missing accordance may be due to a number of considerable differences between both test methods. For a number of reasons the European method seems to be closer to clinical practice and to provide higher patient safety than the US method. However, available study data do neither allow for evaluation of the clinical impact of surgical hand disinfection as such nor of the effect of a particular product on postoperative wound infection rates.     

Substance migration and health quality of packaged food

According to legislation the producer is responsible for the product. Products placed on the market must be safe and the relevant documentation confirming the conformity of the product with the accepted limits of global and specific migration must be available from the producer. The provisions concerning acceptable migration limits (global and specific), stimulants and testing methods are set by the relevant regulations. Distilled water, 3% acetic acid, 10% ethanol and olive oil are used as stimulants of foodstuffs. The choice of an appropriate stimulant and testing conditions depends on the type of food expected to come in contact with packaging. According to provisions testing should be performed in the conditions, which possibly closely reflect actual or expected use of the packaging material, taking into account storage of the product as well as possible thermal processing. Test methods for global migration into stimulants using the cell, pouch, by immerse or by article filling are recommended. The criteria used to choose an appropriate testing method are set in European Standards EN 1186. A product meets the quality criteria as set by the legislation if the global migration from the packaging into stimulants does not exceed value of 10 mg/dm2 or 60 mg/kg and if the specific migration limit (SML), set for given substance is not exceeded.     

Child health and chemical safety

Recently concern over the hazards posed by chemicals to children has become more active. Many chemicals have been introduced into the market within the past several decades. These chemicals are used widely in consumer products and dispersed in the environment. Children are at risk of exposure to such chemicals. Scientific understanding has also improved about the vulnerability of children to chemical hazards. As children represent the future of our societies, protecting their health is an important issue. Thus, many actions are being undertaken by international organizations, e.g., the World Health Organization and the United Nations, and regulatory bodies in Japan, the US and the EU, based on the probable vulnerability of infants and children to chemicals. In this paper, these efforts and state measures are summarized, the characteristics of children at risk assessed, and the list of chemicals concerning child health as well as future actions in Japan are presented.     

Assessment of health status at two years of very low birthweight infants--clinical governance

Aims to establish a mechanism to determine prospectively the health status at two years of babies who weighed less than 1.5 kg at birth, born and receiving neonatal intensive care in North Wales. Maternal and neonatal data on all babies discharged from each of the three units in North Wales meeting this criteria were collated by the study coordinator. A mechanism for review of the health status at two years, corrected for gestational age, was established using the data set recommended by a working group convened by the National Perinatal Epidemiology Unit and Oxford Regional Health Authority. The procedures developed and the outcome data, for a two year cohort of babies born in 1995 and 1996, are reported. Concludes that prevalence of severe disability was similar to that found in other studies, with a considerable number exhibiting impaired growth and delay in speech development.     

The estimation of intake of selected and permissible preservatives used in food industry among people from Podlaskie voivodeship

The work aimed at estimating intake of food containing permissible preservatives. The data was comprised of food samples from 14 poviats of Podlaskie voivodeship taken to detect presence of preservatives (sodium nitrate, nitrite, benzoic acid and its salt, sorbic acid and its salt). The samples were collected between 2004 and 2007 by food inspection agency. Data concerning consumption of food provided results for an average consumption of some foodstuffs in households in which consumption of given foodstuff has been recorded by Polish Central Statistical Office, whereas data concerning consumption of soft drinks was provided by the report from March, 2008 (soft drinks market in Poland). It was stated that an average intake of the considered preservatives with an average diet is not a threat to people. Taking into account the fact data concerning consumption of foodstuffs in households is limited, it is advised to create databases comprising consumption of foodstuffs which would help in more precise evaluation of the intake.     

The Mediterranean diet for Polish infants: a losing struggle or a battle still worth fighting?

The Mediterranean diet is well known for its health-promoting effects. Among its key ingredients, olive oil is the most characteristic. Processing industries have been successfully manufacturing and marketing jarred baby foods with the use of vegetable oils, including olive oil, as well as other sources of visible fat. We aimed to survey manufacturer claims concerning added fat in jarred infant foods supplied to the Polish market. A total of 124 kinds of infant foods from six suppliers were analyzed. Corn, canola, and soybean oil occupied the first three positions, respectively, in rank order of vegetable oils used in jarred baby foods. In our sample, only one type of ready-to-eat jars with vegetables contained olive oil. 11% of products contained cow milk butter or cream. 61% of jarred “dinners” contained poultry or fish, which are typical sources of animal protein in the Mediterranean diet. Given that commercial baby foods currently available in the Polish market contain no olive oil, we advocate considering home preparation of infant foods with the use of visible fat. Medical professionals should encourage food manufacturers to return to the concepts of the Mediterranean diet for young consumers, aimed at long-term health.     

The Istituto Superiore di Sanità, the organization responsible for the evaluation and accreditation of food product testing laboratories

Laboratories in charge of food control play a pivotal role within the actions planned for the safety of food products, the latter identified as a fundamental strategic priority in the European Union Food safety white paper 2000. They are demanded to comply with specific criteria to demonstrate the use of an appropriate quality system, technical competence and production of technically reliable and valid results. Precise guidance is set forth in the Italian law DL. vo 156/97 which requires that official test laboratories should comply with European Standard UNI CEI EN 45001, currently replaced by UNI CEI EN ISO/IEC 17025. and with some of the OECD principles of good laboratory practice. The Istituto Superiore di Sanità, the Italian National Health Institute, was designated by the Ministerial Decree of 12 May 1999 as the organism responsible for evaluation and accreditation of official food product control laboratories.     

Asthma Knowledge, Roles, Functions, and Educational Needs of School Nurses

In October 1997, 790 school nurses in Maryland and the District of Columbia were surveyed to determine their attitudes, knowledge, and beliefs about asthma. Results for 550 (70%) nurses indicated school nurses possess a generally appropriate level of knowledge concerning asthma, and most asthma myths have been replaced with knowledge. However, school nurses also have varied responsibilities that affect their ability to provide health education and support services to children with asthma at school. Little time is available for a proactive role. Concerns about the criteria and follow-up for delegating medication administration within the school setting were reported. A lack of communication existed with parents about the child's asthma. Open communication between school nurses and the family is recommended to establish a partnership and improve asthma management outcomes. In addition, school policies and procedures should be updated to meet the demands of children with asthma.     

A tiered approach for assessing children's exposure

Recently, intense attention has been given to children's health issues, particularly in the use of consumer products. Because of this attention, researchers have been planning and initiating studies specifically aimed at developing both toxicology data and exposure data directed to improve our understanding of industrial and consumer product chemical impacts on children's health. To ensure that this research is focused on the highest priority chemicals, we present a methodology for determining and prioritizing the higher hazard chemicals and scenarios for which children could be disproportionately or highly exposed. This tiered approach includes a screening step for initial chemical selection, a hazard assessment based on no- or lowest-observed-adverse-effect levels, and a margin of exposure (MOE) calculation. The initial chemical screen focuses on the chemical presence in specific media that are special to children, such as foods children regularly eat and drink, residential or school air, products children use, and soil and dust in and around residences. Data from the literature or from models serve as the initial exposure estimate. This methodology would allow us to focus on those chemicals to which children are most exposed that are also associated with, potentially, the highest risk. Use of the MOE calculation allows for comparison among chemicals, prioritization of chemicals for evaluation and testing, and identification of significant data gaps.     

Development in harmonisation of proficiency testing (for vapours, gasses, and dusts) in the European Union.

A network has been established of the 11 major proficiency schemes in the European Union concerned with the occupational hygiene and environmental analyses of chemicals and dusts in the air. A comparison of all the schemes was carried out and a compendium is being produced. This will allow users of the schemes such as testing laboratories, customers, and regulatory bodies to choose the scheme that is most suited to their purpose. All schemes have been compared with the revised ISO Guide 43, published in 1997. The performance statistics in most schemes conform to the criteria in European Standard EN 482 that define the acceptability limits for overall uncertainty in measurement. However, the performance statistics and assessment strategies of the different schemes vary. While many of the schemes supply similar sample material such as lead on filters and benzene on charcoal, there are a number of sample types that many schemes would like to introduce. However, it would be uneconomic to do this on a national basis and the network is developing procedures to introduce them throughout the member countries. Additionally, there are countries that have no schemes at present and may wish to introduce them. The network will provide a framework to help set up schemes in these areas.     

Ecotoxicological characterization of hazardous wastes

In Europe hazardous wastes are classified by 14 criteria including ecotoxicity (H 14). Standardized methods originally developed for chemical and soil testing were adapted for the ecotoxicological characterization of wastes including leachate and solid phase tests. A consensus on which tests should be recommended as mandatory is still missing. Up to now, only a guidance on how to proceed with the preparation of waste materials has been standardized by CEN as EN 14735. In this study, tests including higher plants, earthworms, collembolans, microorganisms, duckweed and luminescent bacteria were selected to characterize the ecotoxicological potential of a boiler slag, a dried sewage sludge, a thin sludge and a waste petrol. In general, the instructions given in EN 14735 were suitable for all wastes used. The evaluation of the different test systems by determining the LC/EC₅₀ or NOEC-values revealed that the collembolan reproduction and the duckweed frond numbers were the most sensitive endpoints. For a final classification and ranking of wastes the Toxicity Classification System (TCS) using EC/LC₅₀ values seems to be appropriate.