Some influences on public participation in a genetic screening program

To identify the psychosocial factors associated with voluntary cooperation in mass genetic testing, stratified random samples of 500 participants and 500 nonparticipants were drawn from an identified at-risk population for Tay-Sachs disease. Participants were relatively younger and better educated, reported higher levels of perceived susceptibility to being a carrier, and also stated more often that the impact of learning of being a carrier would be low. Participants were also more likely to indicate they would not alter plans for future progeny. Recommendations are made for enhancing participation in future genetic screening programs of this type.Dr. Becker is Associate Professor, Departments of Pediatrics (School of Medicine) and Behavioral Sciences (School of Hygiene and Public Health), The Johns Hopkins University, Edwards A. Park Building, Room B172, The Johns Hopkins Hospital, 601 North Broadway, Baltimore, Maryland 21205. Dr. Kaback is Associate Professor, Departments of Pediatrics and Medicine, and Associate Chief, Division of Medical Genetics, School of Medicine, University of California at Los Angeles. Dr. Rosenstock is Professor and Chairman, Department of Health Behavior, School of Public Health, University of Michigan. Ms. Ruth is Chairman, Department of Community Health Nursing, School of Nursing, University of Maryland.     

Student nurse opinions about the importance of health promotion practices

Senior nursing students (N=505) attending 13 schools in the NY metropolitan area were administered a questionnaire to assess their beliefs about the importance of health promotion behaviors to the average person. Respondents rated 23 health promotion practices on a Likert scale. The five most important items concerned: knowledge of drug contents and their side effects; the elimination of cigarette and cigar smoking; eating a balanced diet; and using a seat belt. The least important item concerned having an annual exercise test. These results were similar to those found for other health care providers, including physicians, dieticians, and pharmacists. Further, the results were similar to those found in an earlier survey of student nurses. Nurses' attitudes and beliefs seem supportive of health promotion and disease prevention. These attitudes also seem associated with the nurse's role as health promoter. Positive nurse attitudes/beliefs toward health promotion are posited as precursors to the alteration of patient behaviors, although further exploration in this area is needed.Sherri Sheinfeld Gorin, Ph.D. is Associate Professor, School of Social Work, Adelphi University, Garden City, New York.This research was supported by National Cancer Institute Grant No. CA41621 and No. CA16713. The author thanks all participating Nursing Schools: Adelphi Marion A. Buckley School of Nursing; The City College-The City University of New York College of Nursing; Columbia University College of Nursing; State University of New York College of Technology at Farmingdale; Hunter College Bellevue School of Nursing; County College of Morris Nursing Department; College of New Rochelle School of Nursing; New York Technical College Nursing Department; The State University of New Jersey-Rutgers College of Nursing; Wagner College Department of Nursing; Westchester Community College Nursing Department; Mt. Vernon Hospital School of Nursing; and St. Vincent's School of Nursing.The author wishes to thank the following who contributed to the study: Drs. Jacqueline Royce and Mario Orlandi of the American Health Foundation, New York, N.Y.     

Carbohydrate moieties as vaccine candidates: targeting the sweet spot in the immune response

Advances in the use of carbohydrates as vaccine candidates for the prevention of infectious and malignant diseases was the topic for a meeting in Rockville, MD, sponsored by the National Institute of Allergy and Infectious Diseases involving a diverse group of scientists. Participants included research scientists and clinicians from academia and industry, and representatives from the National Institutes of Health and US Food and Drug Administration. This workshop was the third in a series of meetings designed to address issues relating to the immune response to carbohydrate antigens and how this information is used in the development of vaccines. Participants also identified roadblocks, research opportunities and resource needs. The meeting was organized into sessions that focused on recent advances in the immune response to microbial and cancer carbohydrate antigens, glycomics, novel vaccine approaches, novel adjuvants and delivery systems.     

Discharge planning in nursing homes.

OBJECTIVE. The purpose of this study is to identify nursing home residents who vary in their discharge planning needs. DATA SOURCES AND STUDY SETTING. Administrative records from a database maintained by the National Health Corporation were the primary data source. The 3,883 persons studied were admitted in 1982 to one of 48 nursing homes located in Tennessee, other southern states, and Missouri. STUDY DESIGN. Residents were followed until discharge or for one year, whichever occurred first. A multinomial logistic regression model was used to identify the characteristics at the time of admission of persons likely to go home and the characteristics of those who may be able to be discharged to other residential care facilities. DATA EXTRACTION METHODS. A data tape with resident information was supplied by the National Health Corporation, which also provided data on the 48 nursing homes. Market data were obtained from the Area Resource File. PRINCIPAL FINDINGS. Health status measures are important predictors of discharge status. Financial status (i.e., primary payer) also had a large effect on discharge status; a measure of potential informal care in the community did not. CONCLUSIONS. It is possible to identify at admission nursing home residents likely to have very different discharge planning needs. Nursing home staff can use the results to focus their discharge planning efforts. Regulators can use them to assess how well nursing homes are meeting the discharge planning needs of their residents.     

Primary medical care for elderly patients part II: Results of a survey of office based clinicians

Evidence of the degree of fit between the special needs of the elderly and the service mix and payment level of ambulatory services offered under the Medicare program is presented in this second part of a two-part study of geriatric office care. Results from interviews with a focus group of 60 practicing clinicians, incorporating diversity of geography and practice setting, are described and compared with the view of geriatricians. Between 30 and 57% of the clinicians are aware of negative effects of Medicare's benefit structure on specific aspects of their practice.Marianne C. Fahs, Ph.D., M.P.H., is Assistant Professor of Health Economics, Department of Community Medicine, Mount Sinai School of Medicine.Charlotte Muller, Ph.D., is Professor of Economics and Sociology, City University of New York Graduate School, and Professor of Health Economics, Department of Community Medicine, Mount Sinai School of Medicine.Malvin Schechter, M.S., is Assistant Professor of Geriatrics Ritter Department of Geriatrics and Adult Medicine, Mount Sinai School of Medicine.Supported by a conference grant from the National Center for Health Services Research, Herbert C. Traxler, Ph.D., project director.A briefer version of this paper was presented at the annual meeting of the Association for the Social Sciences in Health, Las Vegas, Nevada, 1986.The research assistance of Helen Hooke is gratefully acknowledged.     

The influence of training level and practice setting on patterns of primary care provided by nursing personnel

The influence that the level of training and practice setting have on the patterns of primary care provided by nurses at the Frontier Nursing Service (FNS) is assessed. The Frontier Nursing Service is the only available source the residents of Leslie County, Kentucky have for primary care; it utilizes nurses for the management of approximately 80% of its primary care patients.Patterns of care given by family nurse practitioners and registered nurses at FNS during 1974 were analyzed according to two tracer conditions, otitis media and urinary tract infection. Data were obtained from the encounter forms that are filled out for all primary care visits to FNS. Computerized routines were developed to group the relevant encounters into episodes of care for the two tracer conditions.Results indicate that the practice setting, rather than the level of training, has the strongest effect on the patterns of primary care rendered by nurses in a rural environment such as FNS.Dr. Moscovice is Assistant Professor of the Center for Health Services Research, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195. Support for this research was provided by a traineeship of the National Center for Health Services Research, HS 0090-05, while the author was a trainee for the Center for the Study of Health Services at Yale University. Additional support was provided by grant SOC 75-1602 from the National Science Foundation.     

Primary medical care for elderly patients part I: Service mix as seen by an expert panel

A survey of six geriatric experts concerning the normative role content of physicians providing primary care for the elderly emphasizes the importance of distinguishing reversible and irreversible components of a patient's problems and of conducting multidimensional functional assessments. Appreciation of the role of the environment in maintaining functional capacity should be inculcated in practitioners treating the elderly. Medicare payment methods should recognize that the elderly require more professional time for adequate care, and should address transportation needs.Charlotte Muller, PhD, is Professor of Economics and Sociology, City University of New York Graduate School, and Professor of Health Economics, Department of Community Medicine, Mount Sinai School of Medicine.Marianne C. Fahs, PhD, MPH, is Assistant Proffessor in Community Medicine, Mount Sinai School of Medicine.Malvin Schechter, MS, is an Assistant Professor, Ritter Department of Geriatrics and Adult Medicine, Mount Sinai School of Medicine.Supported by a conference grant from the National Center for Health Services Research, Herbert C. Traxler, PhD, project director.A briefer version of this paper was presented at the annual meeting of the Association for the Social Sciences in Health, Las Vegas, Nevada, 1986.The research assistance of Helen Hooke is gratefully acknowledged.     

Psychiatric nursing production in Brazil, 1932-1993

The present research aims at studying the psychiatric nursing bibliographical production in Brazil, from 1932 to 1993. Therefore, the authors searched national journals, annals of the Brazilian Nursing Congresses, Annals of the National Seminars on Nursing Research and Catalogues of the Brazilian Nursing Association--Center of Nursing Studies and Research. In addition, the authors selected publications of the following events: III Meeting of Researchs on Mental Health, II Meeting of Specialists on Psychiatric Nursing, Nursing Undergraduation Golden Jubilee and National Meeting of University Hospitals. After the conclusion of this study, discussions were based on the central themes of the texts as well as on historical development of Psychiatric Nursing in Brazil.     

Establishing a Research Agenda for School Nursing

ABSTRACT: During 1996, representatives from two professional organizations — American School Health Association and National Association of School Nurses — met collaboratively to identify and rank order key questions regarding contemporary research needs in school nursing services. This article summarizes existing literature and proposes areas for research. Recommendations are offered for nurses, school health program administrators, educators of school nurses, professional organizations, and others who plan and provide health care for school-aged youth.     

Balancing statistical data and clinician judgments in the diagnosis of patient educational needs

Survey content is necessarily limited by the investigators' foresight and by prior research on their subject of inquiry. Clinical data must supplement statistical data whenever the prior research is insufficient to delineate exactly what problems to expect. The differing perspectives on needs of patients sometimes set up competing demands. This calls for strategies based on a programmatic or population perspective that identifies the commonalities in patient educational needs from the statistical profiles, while at the same time allowing for the development of interventions that provide for as much tailoring of the educational experience based on clinical judgments as possible. By combining the community health education perspective with a clinical perspective, we were able to design interventions that responded to the educational needs of a population of low-income, black hypertensive patients. A needs assessment process that combined these perspectives began with a historical and community assessment of the problem in its most general terms. A second phase focused on the most important behavioral and organizational points for intervention. A third phase required formal assessment of predisposing, enabling, and reinforcing factors that may be determining the priority behaviors of health care organizational problems. Finally, clinical and administrative judgment sharpened and supplemented the educational interventions that were suggested by statistical data from formal surveys. Behavioral science theory was applied usefully in all these phases.At the time this study was conducted, the authors were all with the Health Services Research and Development Center and Division of Health Education, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21205. Dr. Green is now Director of the Office of Health Promotion, DHEW. Dr. Lewis is currently with the Department of Community Health Care Systems, School of Nursing, University of Washington, Seattle. Correspondence and reprint requests should be addressed to Lawrence W. Green, Office of Health Promotion, Office of the Assistant Secretary for Health, U.S. Department of Health, Education, and Welfare, Room 721B, Hubert Humphrey Building, 300 Independence Avenue, S.W., Washington, D.C. 20201.Parts of this paper were presented at the Second Annual Needs Assessment Conference, March 28–31, 1978, in Louisville, Kentucky; the National Conference on High Blood Pressure Control, Los Angeles, April 3, 1978; and Endocrinology Rounds at the Indiana University Diabetes Research and Training Institute, Indianapolis, January 29, 1979. This research was supported by Grant Nos. 1R25 HL 17016-03 and IT32-H10710 from the National Heart, Lung, and Blood Institute. The authors would like to acknowledge the support and consultation of Drs. Carol Johns and R. Patterson Russell of the Johns Hopkins Hospital and of Robert Bertera, Michael Bowler, A. Judith Chwalow, Sigrid Deeds, Marion Field Fass, Brian Flynn, Michael Gross, Donald Morisky, Patricia Mullen, and Sam Shapiro of the Health Services Research and Development Center and the School of Hygiene and Public Health, Johns Hopkins University.     

Ethical issues in public health: a qualitative study of public health practice in Scotland

STUDY OBJECTIVE: To identify ethical issues encountered by staff in the development and implementation of public health activities at two sites in Scotland. DESIGN: Qualitative research study involving face to face semi-structured interviews with participants. SETTING: A public health directorate in a National Health Service Trust, and a public health demonstration project in child health. PARTICIPANTS: Health promotion specialists, managers, nurses, public health consultants and specialists, researchers, trainees, and other public health staff. MAIN RESULTS: Three main categories of ethical issues were identified: paternalism, responsibilities, and ethical decision making. Consulting with the community and sharing information raised issues of paternalism and honesty. Participants identified multiple and sometimes conflicting responsibilities. Barriers to fulfilling responsibilities included meeting targets, working with partners, and political influences. Defining the limits of responsibilities posed challenges. Participants identified values for ideal decision making, but lack of time often led to a more pragmatic approach. CONCLUSION: These empirical findings complement and extend existing discussions of public health ethics, emphasising the complex nature of ethical issues in public health. The implications for public health policy and future research are discussed.     

Ten Years after the Creation of the Portuguese National Network for Long-Term Care in 2006: Achievements and Challenges

The Portuguese National Network for Long-term Integrated Care (Rede Nacional de Cuidados Continuados, RNCCI) was created in 2006 as a partnership between the Ministry of Health and the Ministry of Labour and Social Solidarity. The formal provision of care within the RNCCI is made up of non-profit and non-public institutions called Private Institutions of Social Solidarity, public institutions belonging to the National Health Service and for-profit-institutions. These institutions are organized by type of care in two main settings: (i) Home and Community-Based Services and (ii) four types of Nursing Homes to account for different care needs. This is the first study that assess the RNCCI reform in Portugal since 2006 and takes into account several core dimensions: coordination, ownership, organizational structure, financing system and main features, as well as the challenges ahead. Evidence suggests that despite providing universal access, Portuguese policy-makers face the following challenges: multiple sources of financing, the existence of several care settings and the sustained increase of admissions at the RNCCI, the dominance of institutionalization, the existence of waiting lists, regional asymmetries, the absence of a financing model based on dependence levels, or the difficulty to use the instrument of needs assessment for international comparison.     

Prevention and control of viral hepatitis through adolescent health programmes in Europe

The Viral Hepatitis Prevention Board jointly organized with the European Union for School and University Health and Medicine a meeting on the prevention and control of viral hepatitis through adolescent health programmes in Europe, held in Ljubljana, Slovenia, 15–16 March 2007. Participants from some 16 countries in Europe as well as the United States of America emphasized the importance of reaching adolescents mainly through school health programmes, provided an overview of currently existing youth health systems and reviewed their experiences with childhood and adolescent immunization programmes. The meeting concluded with a discussion of issues, lessons learnt, opportunities and action points for the future.     

Status and goals of local school wellness policies in Virginia: a response to the child nutrition and WIC Reauthorization Act of 2004

By fall 2006 each school division participating in the National School Lunch Program was mandated to establish a local wellness policy. The study objective was to assess schools' plans for the policy, including goals for food, nutrition education, and physical activity and evaluation. Surveys were administered to 132 School Health Advisory Board coordinators in Virginia in early 2006; 92 (69.7%) responded. The findings highlight gaps toward meeting minimum requirements for the policy and give guidance on how nutrition educators and researchers can provide expertise to optimize the policy and document progress and impacts on children's health related to the policy.     

Training of public health workforce at the National School of Public Health: meeting Africa's needs

PROBLEM: The inadequate number of trained public health personnel in Africa remains a challenge. In sub-Saharan Africa, the estimated workforce of public health practitioners is 1.3% of the world's health workforce addressing 25% of the world's burden of disease. APPROACH: To address this gap, the National School of Public Health at the then Medical University of Southern Africa created an innovative approach using distance learning components to deliver its public health programmes. Compulsory classroom teaching is limited to four two-week blocks. RELEVABT CHANGES: Combining mainly online components with traditional classroom curricula reduced limitations caused by geographical distances. At the same time, the curriculum was structured to contextualize continental health issues in both course work and research specific to students' needs. LESSONS LEARNED: The approach used by the National School of Public Health allows for a steady increase in the number of public health personnel in Africa. Because of the flexible e-learning components and African-specific research projects, graduates from 16 African countries could avail of this programme. An evaluation showed that such programmes need to constantly motivate participants to reduce student dropout rates and computer literacy needs to be a pre-requisite for entry into the programme. Short certificate courses in relevant public health areas would be beneficial in the African context. This programme could be replicated in other regions of the continent.     

REVIEWS OF BOOKS AND REPORTS

Book reviewed in this article:
National Center for Health Statistics. Vital and Health Statistics. "A Study of the Achievement Test Used in the Health Examination Survey of Persons Aged 6–17 Years"
Pediatric Nursing . Helen C. Latham, R.N., M.S., Augusta, Ga., Robert V. Heckel, Ph.D., New Orleans, Louisiana and Margaret C. Moore, M.S., New Orleans, Louisiana.
Bucher, Charles A. Administration of School and College Health and Physical Education Programs
Committee on School Health of the American Academy of Pediatrics, Report of the Committee on School Health     

The Management Academy for Public Health: program design and critical success factors.

The Management Academy for Public Health is a team-based training program jointly offered by the School of Public Health and the Kenan-Flagler Business School at the University of North Carolina at Chapel Hill. This 9-month program teaches public health managers how to better manage people, information, and finances. Participants learn how to work in teams with community partners, and how to think and behave as social entrepreneurs. To practice and blend their new skills, teams develop a business plan that addresses a local public health issue. This article describes the program and explains the findings of the process evaluation, which has examined how best to structure and deploy a team-based method to create more effective, more entrepreneurial public health managers. Findings indicate that recruitment and retention are strong, program elements are relevant to learners' needs, and learners are satisfied with and value the program. Several specific benefits of the program model are identified, as well as several elements that support business plan success and skills' application on the job. On the basis of these findings, four success factors critical for developing similar programs are identified.