Nursing patient education: a Canadian perspective

The health care system in Canada is gradually shifting towards greater emphasis on patient involvement, health promotion and management of chronic illness. Nurses can play a key role in shaping these changes. This article provides an overview of several facets of the nurse's role in patient education: national policy guidelines, standards of care, research and exemplary patient education programs.     

Perinatal transmission in developing countries: new developments,new challenges

In Africa, about 30% of all infants born to HIV-infected mothers become infected with HIV. About 4 million women of reproductive age in Africa are infected with HIV. Africa lacks HIV counseling and testing facilities. Family sizes are large. Asia has paid less attention to perinatal transmission than has Africa. Heterosexual transmission is also the predominant mode of HIV infection in Asia. Interventions that might prevent perinatal transmission have recently emerged. HIV/AIDS programs, maternal and child health (MCH) programs, and family planning providers must collaborate to reduce perinatal transmission. HIV/AIDS, MCH, and reproductive health specialists; women's health advocates; and pregnant women must discuss complex policy and ethics issues as they consider interventions. Women in developing countries familiar with their HIV status would arrive at more informed decisions about reproduction than those ignorant of their HIV status. Rapidly falling prices of HIV tests may mean access to testing for more women in developing countries. Availability of safe, effective contraception and abortion services would contribute to the success of counseling and testing to reduce the number of births at risk of perinatal transmission. In areas where infectious diseases and malnutrition cause most infant deaths, mothers should breast feed regardless of HIV status. In areas where this is not the case, mothers should use breast milk substitutes. Some evidence suggests that cesarean sections reduce the rate of perinatal transmission. Vaginal cleansing before and during labor may also reduce it. Since maternal vitamin A deficiency may facilitate perinatal transmission, vitamin A supplementation in pregnant women may reduce the risk of perinatal transmission. Administration of zidovudine to HIV-infected pregnant women reduced the risk of perinatal transmission by 67% in a recent clinical trial.     

Costimulatory pathways in transplantation: challenges and new developments

Summary:  T cells are central to graft rejection, and therefore preventing T cells from recognizing and destroying allografts remains an important area of transplant research. However, T cells are also required for transplant tolerance; a subset can enforce a state of tolerance by functioning as regulatory cells. As both rejection and regulation directed against alloantigens require T-cell activation, costimulatory molecules undoubtedly play an important role in regulating both processes and ultimately the fate of the allograft. However, costimulation involves an incredibly complex array of interactions that may act contemporaneously or at different times; these interactions can have additive or opposing effects on T-cell activation or differentiation. While some costimulatory molecules mediate activation of naive T cells or generation of memory T cells, others inhibit T-cell activation and promote anergy or apoptosis. Moreover, a given pathway can have diametrically different effects on T-effector cells and regulatory T cells (Tregs). Such a complexity presents both challenges and opportunities in targeting T-cell costimulatory pathways to promote transplant tolerance. In this review article, we provide a summary of recent advances in our understanding of T-cell costimulatory pathways in regulating different phases of the T-cell response in transplant models. We focus specifically on costimulatory molecules in the immunoglobulin (Ig) superfamily, tumor necrosis factor (TNF)/TNF receptor superfamily, and in the emerging T-cell Ig domain and mucin domain family (TIM), highlighting their unique and redundant roles in regulating the T-effector and Treg responses after transplantation. Finally, we summarize emerging approaches toward inducing tolerance by tipping the balance between cytopathic T-effector cells and protective Tregs by selectively targeting specific T-cell costimulatory pathways that are critically involved.     

Computers in clinical assessment: historical developments, present status, and future challenges

Computerized testing methods have long been regarded as a potentially powerful asset for providing psychological assessment services. Ever since computers were first introduced and adapted to the field of assessment psychology in the 1950s, they have been a valuable aid for scoring, data processing, and even interpretation of test results. The history and status of computer-based personality and neuropsychological tests are discussed in this article. Several pertinent issues involved in providing test interpretation by computer are highlighted. Advances in computer-based test use, such as computerized adaptive testing, are described and problems noted. Today, there is great interest in expanding the availability of psychological assessment applications on the Internet. Although these applications show great promise, there are a number of problems associated with providing psychological tests on the Internet that need to be addressed by psychologists before the Internet can become a major medium for psychological service delivery.     

Barrett's esophagus: diagnostic challenges and recent developments

Inclusion of histologic classification into the risk assessment of adenocarcinoma arising from Barrett's esophagus (BE) has placed surgical pathologist in the center of clinical care and research endeavors. Recent advances in endoscopic diagnostic and therapeutic modalities demand additional proficiency in diagnosis and grading of dysplasia. The objectives of this study are as follows: (1) Discuss the definition of BE and features differentiating BE vs intestinal metaplasia involving cardia. (2) Describe the morphological approach of diagnosing and grading of dysplasia and differentiation of high-grade dysplasia from intramucosal carcinoma. (3) Role of special stains in diagnosis of BE and dysplasia. (4) Brief review the literature on histologic and endoscopic factors associated with progression of BE to adenocarcinoma. (5) Discuss the biomarkers in progression of BE to adenocarcinoma. The following conclusions from this review are important and should be applied in routine practice. Because of the controversy in defining BE, the histologic type of columnar mucosa and presence or absence of intestinal metaplasia should be specified in pathology report. The major limitations of appropriately diagnosing and grading dysplasia include technical problems related to biopsy processing and staining, presence of acute inflammation, and high interobserver variations among pathologists. The extent of high-grade dysplasia, high-grade dysplasia with certain endoscopic abnormalities, and low-grade dysplasia, when diagnosed with consensus by 2 or 3 gastrointestinal pathologists, has higher risk of progression to adenocarcinoma. All nonhistologic markers are still in the investigational phase and have not yet been validated in phase 3/4 prospective trials.     

A developmental perspective on the challenges of diabetes education and care during the young adult period

There is increasing recognition that the patient education and care provided to young adults with chronic physical illnesses, including type 1 diabetes, is inattentive to the complex developmental issues facing the older adolescent transitioning into the young adult period [Pediatrics 110 (2002) 1307]. In this paper, we present a clinical perspective on the challenge of improving diabetes education and care during the young adult period focusing on the importance of the developmental changes-cognitive, social, emotional, educational, and familial-that occur during this transitional stage of life. This developmental perspective on young adulthood provides a conceptual framework to better understand the young adult's "readiness" for engagement in intensive medical therapy. We review factors such as the timing and context of diabetes care and education that may be important determinants of young adults' ultimate success in becoming independent managers of their health care during this difficult transition. Developmentally-based practice principles for the young adult period are presented which include: assessing the patient's expectation at transition, building the relationship, working with families, assessing barriers to care, and formulating treatment plans and goals.     

How does patient engagement work in a real-world setting? Recommendations,caveats, and challenges from a psychosocial perspective

ObjectiveTo propose a possible taxonomy for diverse stakeholders outside the healthcare communication field and to promote meaningful patient engagement in healthcare settings. Moreover, to support them in making more coherent policy, strategy, and practice decisions to enhance patient participation in their healthcare systems.DiscussionThis paper is part of the pEACH Position Papers Series and provides a critical and experience-based reflection on patient engagement in different healthcare-related settings. We propose a framework that operationalises actionable patient engagement at the micro-meso-macro levels. Finally, the authors will highlight some “points of attention” that need to be addressed to support patient engagement implementation in healthcare organisations.Conclusion and practice implicationsUnderstanding and systematising the established meanings of patient engagement through a psychosocial lens is critical to addressing the following questions: "how can various health care organisations ensure that authentic patient engagement informs decision-making and strategies", "how can these organisations build authentic connections with their patients", and importantly, "how can patients gain valuable and reliable insights through patient engagement"? Answering these questions can enable key stakeholders to make informed decisions that ensure the quality and effectiveness of patient engagement initiatives in different healthcare settings.     

Amyloid and amyloidoses: differences, common themes, and practical considerations

Amyloidosis is not one entity but a grouping of disorders in all of which there is a tissue protein deposit with similar morphological, structural, and staining properties despite involving fundamentally different proteins or peptides. Each protein is involved in its own specific pathogenetic mechanism. These mechanisms determine, in a manner as yet unknown, which protein will be present in an amyloid deposit. The role of proteolysis in the pathogenesis is questioned. Proteolysis may well be a postfibrillogenic event. Local tissue factors, such as the basement membrane form of heparan sulfate proteoglycan, in addition to perhaps other basement membrane components, may play an important role in the genesis of amyloid. Differences, common themes, and various unanswered questions related to the pathogenesis of the amyloids are presented as are practical diagnostic considerations.     

Need for change in patient education: a Finnish survey from the patient's perspective

This study aims to find out how hospital patients in Finland perceive and evaluate the education they receive. It represents the first part of a patient education project at one university hospital in which the ultimate goal is to support patients' decision-making and self-care and in this way to facilitate the independent empowerment with health problems. The survey comprised of 754 patients from 63 of the hospital's 100 wards during a randomly selected week in spring 2001. The results show that most patients described the patient education they had received as sufficient, although some did indicate they had not learned enough about the possible side effects of care, problems of care and future care. Patients were not content with the education they received in support of social, experiential, ethical and financial aspects. The methods used in patient education should also be more diversified and patient-centred.     

Ethnic and gender differences in patient education about heart disease risk and prevention

Objective

To investigate whether there are gender and ethnic disparities in the patient education provided by primary healthcare providers about heart disease (HD) risk and prevention.

Methods

A telephone survey, conducted in four languages, was completed by 976 people, 40+ years of age, in Metro Vancouver, Canada. Questions assessing communication with healthcare providers’ provision of HD risk and management education were the focus.

Results

Statistically significant gender and ethnic differences were found. Women were less likely to report discussing HD risk and management with their healthcare providers. Chinese-Canadian participants had less likelihood of receiving HD education compared with participants of other ethnic origins. These differences persisted after multivariate adjustment with income, highest level of education attained, age, and other factors.

Conclusion

Primary healthcare providers should make improved efforts towards education about HD and its risk factors for women in general, and for postmenopausal women especially.

Practice implications

Healthcare providers should be aware that some ethnic populations may not be receiving patient education similar to that received by people of other communities, as found for Chinese-Canadian members of this study community. Further understanding of the barriers faced by ethnic groups must be gained to develop solutions.     

Continuing medical education in Turkey: Recent developments

Background  

The Turkish Association of Medicine founded a Continuing Medical Education Accreditation Committee in 1993 to evaluate and accredit scientific meetings and publications. The aims of this project were to raise the standards of meetings and to introduce compulsory revalidation and re-certification for physicians in Turkey.     

A developmental psychopathology perspective on emotional availability research: current trends and challenges

Studies using the Emotional Availability Scales have burgeoned in the past decade. The collection of papers included in this Special Section represents the latest innovations in research with this paradigm. Consistent with a developmental psychopathology perspective, these papers evaluate emotional availability in a variety of typical, at-risk, international, and intergenerational samples of children and caregivers, with many utilizing longitudinal designs or employing measures from multiple levels of analysis. One study begins to translate findings from this body of research into a promising intervention program. Although further growth and refinement in research with this paradigm is needed, the results to date begin to place the construct of emotional availability into a complex, dynamic biopsychosocial context, and promise to inspire a new generation of studies. In this commentary, some of the key contributions and challenges of this collection of studies are highlighted using a developmental psychopathology framework.     

A public health perspective on HIV/AIDS in Africa: Victories and unmet challenges

More than three decades after the first cases of HIV were recognized in the United States and worldwide, Africa remains a remarkable example of both public health successes and remaining challenges. Although many African countries initially lacked the resources and sociopolitical will to advance HIV treatment and prevention strategies, world governments, a committed scientific community, and activists have made tremendous advances. We present a public health perspective on the history of the HIV epidemic in Africa, combining summaries of the epidemiology of HIV infection rates and risk factors for horizontal and vertical HIV transmission, along with a historic perspective on programmatic and funding initiatives that have strongly reduced levels of HIV infection across the continent. In our preparation of this review two clear themes emerged: that (1) the HIV epidemic in Africa remains geographically and culturally heterogeneous, so that treatment and prevention strategies need to be thoughtfully tailored for maximal effectiveness; and (2) a lack of openness to recognize and discuss infection disparities in high risk groups, disseminate prevention information, and enact policies to partner with these highly stigmatized risk groups. This is especially true of female sex workers, people who inject drugs, and men who have sex with men, communities that are often not recognized or typically undercounted when HIV testing and prevention policies are developed by many African governments. Without changes to recognize and de-stigmatize these high-risk groups, a lack of sociopolitical will to alter public health perspectives will likely hinder advances to further curb the HIV epidemic.     

Socioeconomic status,education, and reproduction in modern women: An evolutionary perspective

Although associations between status or resources and reproduction are positive in premodern societies and also in men in modern societies, in modern women the associations are typically negative. We investigated how the association between socioeconomic status and reproductive output varies with the source of status and resources, the woman's education, and her age at reproductive onset (proxied by age at marriage). By using a large sample of US women, we examined the association between a woman's reproductive output and her own and her husband's income and education. Education, income, and age at marriage are negatively associated with a woman's number of children and increase her chances of childlessness. Among the most highly educated two‐thirds of the sample of women, husband's income predicts the number of children. The association between a woman's number of children and her husband's income turns from positive to negative when her education and age at marriage is low (even though her mean offspring number rises at the same time). The association between a woman's own income and her number of children is negative, regardless of education. Rather than maximizing the offspring number, these modern women seem to adjust investment in children based on their family size and resource availability. Striving for resources seems to be part of a modern female reproductive strategy—but, owing to costs of resource acquisition, especially higher education, it may lead to lower birthrates: a possible evolutionary explanation of the demographic transition, and a complement to the human capital theory of net reproductive output. Am. J. Hum. Biol. 22:578–587, 2010. © 2010 Wiley‐Liss, Inc.