Functional Health Pattern Assessment: A Seasonal Migrant Farmworker Community

A broad-based needs assessment of a migrant farmworker community was conducted using the community functional health pattern tool (Gikow & Kucharski, 1987) and Porter's (1987) factor-isolating theory of population group diagnosis. Data analysis revealed numerous health needs in all 10 functional health patterns and an urgent need for accessible primary prevention programs. A mobile outreach program to the migrant camps was seen as the most effective way to provide education, screening, and health care.     

对中国流动人口结核防治工作干预策略的循证评价

目的调查分析既往及正在执行的结核病控制项目在改善中国流动人口结核病服务获得和利用方面所采取的相关政策文件和干预措施,并评价其效果和影响,为进一步开展结核病防治工作提供依据和建议。方法计算机检索MEDLINE、PubMed、CNKI、CBM disc、万方学位论文全文数据库及VIP,纳入1988～2008年发表的关于流动人口结核防治工作的文献。同时采用非概率目的性抽样方法,在获得访谈对象知情同意后进行现场访谈、结果共检索到58篇文献,其中符合纳入标准的已发表文献8篇,未发表文献5篇,但其中仅有1篇为RCT,质量仅为B级。二次文献研究结果显示：我国目前对流动人口结核病防治采取的措施包括健康促进、提供激励机制、对病人实行督导管理等．且采取不同干预后病人知识知晓率、结核病治愈率均有所提高;但现场访谈结果显示,多数结核病人及疑似病例对于结核的防治知识及免费政策知晓不够,地区间结核病防治机构间没有有效的信息交流．致使流动人口追踪督导困难,结核病人的发现、治疗仍有待加强。结论现有针对流动人群的结核病防治研究中,缺乏高质量研究,因此难以对流动人口的结核病干预措施的效果做出客观、公正的评价;今后应开展专门针对流动人口结核病控制的大样本、多中心、高质量的RCT研究,为制定科学可行的干预设计方案提供依据。     

Tuberculosis screening in an at-risk immigrant Hispanic population in Baltimore city: an academic health center/local health department partnership

Tuberculosis (TB) is endemic and epidemic throughout the world. More people will die of TB this year then in any previous year in modern history. However, in the United States successful TB control programs have resulted in low morbidity and low mortality here. Globalization and immigration threatens this control potentially bringing the infection to a here-to-fore complacent United States. This article describes a unique partnership between a community health program of a School of Nursing and a local health department chest clinic to find, screen and treat a population of Hispanic immigrants otherwise difficult to reach because of legal, language, cultural and socioeconomic barriers. Working through community organizations and limiting, and/or eliminating cultural barriers accomplished a high level of screening and treatment in a population with a significant incidence of latent tuberculosis infection. The program was of great satisfaction to the students and faculty involved; the personnel of a seriously under-financed health department and the community participants involved.     

Violence against women in the context of migration

Since the eighties the percentage of migrant women is increasing continually in Switzerland and presents a new challenge for the public health system. The article will point out specific aspects of migration which are particularly associated with violence against women, besides domestic and sexual violence in their marriages. A successful communication serves as a basis for a reasonable diagnosis, therapy and counselling in health services. Beyond overcoming language barriers, it is essential to consider the physician-patient interaction influenced by the social status and cultural background of each. By using two vignettes specific difficulties in medical encounters with migrant women will be demonstrated and possible interventionsfor clinical practice will be offered complemented by references on existing services in Switzerland. By an interdisciplinary co-operation of physicians, social workers, mediators, lawyers and anthropologists a professional care in face of these complex issues will be guaranteed.     

The experiences of migrant health nurses employed in seasonal satellite nurse-managed centers: a qualitative study

This research study describes the unique experiences of nurses who are employed in migrant health seasonal satellite nurse-managed centers in the upper Midwest. Data were generated through semistructured interviews with 10 seasonal nurses. Phenomenology served as the research method. Four themes were identified including seeking seasonal employment, establishing migrant seasonal satellite nurse-managed centers, learning the culture of Hispanic migrant farmworkers, and referring Hispanic migrant farmworkers for medical care. During their seasonal employment, nurses learned to establish and operate satellite nurse-managed centers. Due to the migrant health nurses' daily contact with their clients, they were able to establish rapport that led to a trusting relationship. This enabled them to provide culturally sensitive and lifestyle appropriate care to the migrant farmworker population.     

“十三五”期间贵州省利福平耐药结核病发现情况分析

目的 通过分析2016—2020年“十三五”结核病防治规划实施期间贵州省利福平耐药结核病（rifampicin-resistant tuberculosis,RR-TB）患者的发现情况,探讨影响贵州省RR-TB患者发现的主要原因,为进一步完善贵州省耐药结核病防控政策提供参考依据。方法 收集中国结核信息管理系统中2016—2020年贵州省肺结核患者耐药筛查数据,分析不同年份的RR-TB患者的估算数和实际发现数、药敏诊断时间和检测方法、病原学诊断结果。采用Kruskal-Wallis检验比较各年间耐药诊断时间的差异。结果 2016—2020年共发现RR-TB患者3 588例,RR-TB患者发现数和发现率从2016年的280例和7.65%增至2020年的1 038例和32.05%,这与病原学阳性率和耐药筛查率从2016年的30.19%和12.01%上升到2020年的56.82%和67.59%密切相关,但贵州省9个市（州）病原学阳性率和耐药筛查率差异仍较大。另外,RR-TB患者开展氟喹诺酮（fuoroquinolones,FQs）药敏检测比例较低,从2016年起逐年下降至2020年的8.07%...     

Testing for HIV among patients with tuberculosis in Montreal.

OBJECTIVE: To determine the rate of HIV testing among patients with tuberculosis (TB) in Montreal, and to identify patient characteristics associated with physician screening patterns. Knowledge of local patterns of HIV testing among patients with TB could be used to facilitate the development of strategies to improve compliance with recommendations that all patients with TB be screened for HIV. DESIGN: Retrospective chart review. PATIENTS: All patients with TB reported to the Montreal Public Health Unit from 1992 to 1994 (ages 19 to 50) and from 1992 to 1995 (ages 18 and under) and for whom a chart could be reviewed. OUTCOME MEASURES: Patients with TB screened versus not screened for HIV infection, analyzed to determine which variables independently predict the likelihood of screening for HIV infection. RESULTS: Of the 376 patients with TB for whom data were available, 192 (51%) were screened for HIV. Of those, 33 (17%) had been tested before having received the diagnosis of TB. Multivariate analysis revealed that patients with TB who were male, aged 30 to 39, had a positive sputum smear, displayed at least 1 clinical symptom, received the TB diagnosis from a microbiologist or infectious disease specialist, or reported 1 or more HIV risk factors were more likely to be screened for HIV. CONCLUSIONS: HIV screening of patients with TB is selective, depending on both patient and physician characteristics. Physicians' awareness of recommendations needs to be increased to improve the diagnosis and treatment of TB/HIV co-infection.     

Evidence-based management of perinatal depression

Perinatal depression, which may occur from pregnancy to one year after childbirth, is recognized by the World Health Organization as a significant health issue affecting women. Depression during the perinatal period can have enormous consequences, not only affecting the health of the woman herself but also influencing her interaction with her children and other family members. This article introduces several depression screening tools and evidence-based nonpharmacological managements of perinatal depression. There are some fairly valid and feasible screening methods, among which routinely screening perinatal women with EPDS (Edinburgh Perinatal Depression Scale) or BDI (Beck Depression Inventory) in the primary care setting is practicable. A survey of the limited literature available reveals that interpersonal psychotherapy, cognitive behavior therapy and listening to music provide quantifiable depression amelioration effects for perinatal women. More scientific research moderated by women's life experiences and preferences should be conducted, however, and applied to improve women's health.     

A Critical Caring Theory of Protection for Migrants and Seasonal Farmworkers

Pesticide exposures represent inequities among a vulnerable population of migrant and seasonal farmworkers. A social justice theory synthesized from an environmental health research framework, a middle range theory of critical caring, and literature on pesticide exposure is presented as a situation‐specific public health practice theory. Concepts from the physiological, epistemological, vulnerability, and health protection domains are related to concepts of critical caring revealing protective strategies for vulnerable populations exposed to pesticides. The key concepts are risk exposure, community assessment, transpersonal health promotion, community competence, and controllability. Protection from exposure involves raising awareness, critically assessing communities, educating for empowerment, building capacity, and advocating to ensure social justice. Critical caring protection is provided in a mutually respectful relationship that promotes responsibility at the individual and population levels.     

Tuberculosis screening in a dialysis program.

Patients with end stage renal disease (ESRD) are at high risk for contracting tuberculosis (TB), therefore, routine screening of these patients is recommended This article describes the steps used to design and implement a TB screening protocol in a new regional dialysis program. The results showed a high rate of skin test positivity and, therefore, of infection. Over half of the patients tested were found to be anergic, necessitating a chest x-ray for 70% of the patients. In light of these findings, the annual skin testing of all patients, which was originally planned, has been changed to testing upon admission to the program, providing a baseline with which to compare subsequent skin tests.     

A new direction for cognitive development in nursing to prepare the practitioners of the future

The quest to improve metacognitive control of critical thinking abilities has gained increasing importance throughout the world during the past thirty years. Self-regulated learning, a concept within the construct of critical thinking, is currently receiving much attention from educational theorists. A self-regulated individual requires a dependable experiential knowledge base, uses cognitive critical thinking strategies in a reflective manner, and is affected by social and cultural influences. One purpose of this article is to review the significant legacy of cognitive research in nursing. The research is categorized according to the concepts of the self-regulation learning model; metacognitive self-regulation (critical thinking, information processing), behavioral self-regulation (reflective practice) and environmental self-regulation (social interaction, clinical context). Another purpose of the article is to explore some self-regulated learning techniques that could be used to improve metacognitive control of critical thinking abilities in practice situations. Nursing leaders in service and education should consider a new approach for cognitive development in practice, since the result could be outcomes that are more closely aligned with mandates of governing bodies, growth of the discipline and patient welfare.     

Meeting the Health Care Needs of Migrant Farmworkers: The Experience of the Niagara County Migrant Clinic

The Niagara County Migrant and Rural Ministry Clinic (Migrant Clinic) in northwestern New York State is an example of how the health care needs of migrant farmworkers can be met with limited assistance and funding from federal, state, or local agencies. This article relates the history of the Migrant Clinic and describes how various sources of funding and personnel are utilized to operate the clinic. In addition, several case examples from the clinic are presented to illustrate how nurses and outreach workers are able to overcome some of the obstacles that migrant farmworkers face in obtaining health care services. By relating the experiences of this clinic, we hope to provide others who offer health care to migrant farmworkers with ideas about establishing and managing a clinic to serve this population.     

The impact of tuberculosis on Zambia and the Zambian nursing workforce

In Zambia, the incidence of tuberculosis (TB) has greatly increased in the last 10 years. This article describes Zambia and highlights the country's use of the United Nations Millennium Development Goals as a framework to guide TB treatment programmes. An overview of TB in Zambia is provided. Data related to TB cases at the county's main referral hospital, the University Teaching Hospital (UTH), is discussed. Treatment policies and barriers are described. Zambian nurses have been greatly affected by the rise in the morbidity and mortality of nurses with TB. This article explains the impact of TB on the Zambian nursing workforce. Review of Zambian government programmes designed to address this health crisis and targeted interventions to reduce TB among nurses are offered.     

Community-based participatory research (CBPR) approach to study children's health in China: experiences and reflections

Background

Community-based participatory research principles have been successfully applied to public health research in U.S. settings. While there is a long history of collaboration between government and communities in China, to date, community-based participatory research has not been used in children's environmental health studies.

Method

This article describes how community-based participatory research principles were applied by an international research group to the China Jintan Child Cohort Study, a longitudinal study of malnutrition and lead exposure on cognitive and neurobehavioral development. Challenges emerged and lessons learned from implementing the study were discussed and recommendations were presented.

Conclusion

We conclude that the community-based participatory research model can be applied in conducting and promoting environmental health research in China and researchers should be prepared for special challenges and cultural constraints in the implementation of the research in regards to human subject regulations, information dissemination, and culture.     

Tuberculosis: laboratory diagnosis

Delay in laboratory diagnosis of tuberculosis (TB) is a major obstacle in TB control programs. There is an imperative need for scale-up of peripheral health care laboratories with conventional and molecular technologies for rapid and reliable diagnosis of TB. A cost-effective diagnostic algorithm for rapid diagnosis of TB should be implemented and followed, thereby reducing cost burden on patients.     

浙江省衢州市农村老年人肺结核主动筛查效果分析

目的 分析浙江省衢州市开展农村老年人群肺结核主动筛查效果。方法 2020年通过对浙江省衢州市6个县（市、区）89个乡镇持续居住6个月及以上且满65周岁本市常住人口开展居民健康体检时利用胸部数字影像（DR）检查，胸片诊断为疑似肺结核病例转诊定点医院进行确诊，并追踪落实诊断结果的主动筛查方法，收集其筛查的统计报表和病例个案调查表，获取老年人群肺结核筛查情况与检出率情况。结果 2020年符合要求的体检对象共计311 385人，接受居民健康体检187 065人，完成居民健康体检和胸部DR检查者共186 096人，筛查率为59.76%(186 096/311 385)，女性筛查率（64.22%,98 652/153 606）高于男性（55.42%,87 444/157 779），差异有统计学意义（χ2=2 507.786,P=0.001）;70～岁年龄组筛查率最高（82.82%），≥85岁年龄组最低（37.95%），随年龄增长呈下降趋势，差异有统计学意义（趋势χ2=6 510.086,P=0.001）；不同地区筛查率常山县最高（80.75%,30 199/37 396），柯城区最低（35.47%...     

Feasibility of an Emergency Department-based Tuberculosis Counseling and Screening Program

OBJECTIVE: To assess the feasibility and effectiveness of an ED-based tuberculosis (TB) screening program. METHODS: A TB screening program of adult ED patients was conducted at a university hospital ED with 46,000 annual visits that serves a poor urban community. Patients were screened on weekdays during business hours. ED patients were counseled about the disease and the screening procedure and, after consent, purified protein derivative (PPD) tests were placed. Patients returned in 48-72 hours for reaction reading and post-test counseling. PPD-positive patients received a physical examination, chest x-ray, and HIV testing and were referred to a city TB clinic for possible treatment. RESULTS: Overall, 873 patients were counseled, 630 were eligible for screening, and 374 (59.4%) consented to PPD testing. Of the 203 (54.1%) who returned, 32 (15.8%) were PPD-positive. No active case was detected, but 26 patients were referred to the health department. Eighteen kept their appointments and all 13 who were started on therapy completed treatment. Targeted screening of groups aged 55 years or more, nonwhite groups, and those with other high-risk factors would detect 84% of PPD-positive cases while testing only 48% of eligible patients. CONCLUSION: An ED-based TB screening program is feasible and can identify many patients requiring treatment. Targeted screening of high-risk groups could reduce the program cost, but would miss some cases.     

Annual Cognitive Assessment for Older Adults: Update for Nurses

Alzheimer’s disease is predicted to bankrupt Medicare by 2050 if current trends in disease prevalence do not change (Alzheimer’s Association, 2012). Earlier diagnosis and access to health care for Alzheimer’s disease result in decreased health care costs (Brosch & Matthews, 2014). Consequently, in January 2011 screening for cognitive impairment became a component of the annual wellness visit (AWV) outlined in the Patient Protection and Affordable Care Act. Many community health nurses are unaware of this benefit. This article includes a review of the updated 2011 definition of Alzheimer’s disease, the components of the AWV, and tools for conducting cognitive assessment.     

老年缺血性脑卒中患者社会网络与认知功能的相关性研究

目的探讨老年脑卒中患者社会网络与认知功能及其各领域的相关性。方法采用简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、记忆与执行筛查量表(分为MES-M和MES-E)、语言功能量表(LAST)、社会网络量表(LSWS-6)对2018年8月-2019年5月复旦大学附属上海市第五人民医院收治的141例老年脑卒中患者进行评估;采用Pearson和Spearman相关对认知功能的影响因素进行单因素分析,基于社会网络影响健康结局的理论和单因素分析结果建立结构方程模型。结果研究对象中认知障碍与轻度认知障碍发生率分别为33.3%和94.3%。路径分析显示:年龄、婚姻状况、文化程度、有氧运动、抑郁状态、神经功能缺损评分(NIHSS)等直接和(或)间接影响老年患者认知功能,社会网络在文化程度与MMSE、MoCA、MES-M之间起中介作用,中介效应值分别为0.047、0.065、0.092,社会网络在抑郁状态与MMSE之间的中介效应值为-0.105。结论脑卒中后认知障碍在老年缺血性脑卒中患者中十分常见,受多种因素影响,抑郁状态和社会网络均对认知功能有显著影响,社会网络在抑郁状态与认知功能...     

Estimating resources for setting up an HV service for postnatal depression

Postnatal depression (PND) presents a significant health burden for mothers and their offspring. Research has indicated that screening for PND increases detection (Holden et al, 1989) and also that counselling by health visitors (HVs) is an effective intervention. This article describes a pilot PND screening and treatment project which aimed to assess the resource and organizational implications of introducing new health visiting services modelled on research findings compared with existing practice. The pilot project included approximately 400 new mothers in an inner city multicultural area and confirmed previous findings regarding prevalence of PND (19%) and the effectiveness of brief counselling interventions. It resulted in significantly reduced estimates of the HV resources that would be required to introduce screening as part of the core health-visiting programme. The project also revised expected training requirements and challenged existing concerns about its appropriateness for minority cultural groups.