Mobile telemetry for pre-hospital thrombolysis: problems and solutions

In the Angus region of Scotland, we have used mobile telemetry to facilitate pre-hospital thrombolysis by paramedic staff. An initial survey demonstrated that connection could be achieved in all but three locations. In the first year of operation, 229 contacts were received. Communication between the ambulance and the base station failed on four occasions (2%). Problems with transmission of an electrocardiogram (ECG) were encountered on 37 occasions (16%). The median time for acquisition and transmission of an ECG was 22 min. This compares with a median time of 59 min for first ECG in a control group from similar locations, who were assessed in hospital. Telemetry offers essential back-up to paramedics adopting a challenging and extended role. Strategies can be developed to deal with signal strength and equipment failure.     

Influences on general practitioners' use of pre-hospital thrombolysis: a qualitative study

BACKGROUND: The aim of the study was to determine factors influencing general practitioners' (GPs') decisions to provide pre-hospital thrombolysis for acute myocardial infarction. METHODS: Semi-structured, face-to-face interviews were carried out with 21 GPs in Grampian (10 rural; 11 urban). RESULTS: The GPs believed that thrombolysis has an important role in the management of acute myocardial infarction, but urban practitioners were not convinced that time savings could be made by GP provision. Practical issues such as taking an electrocardiogram, ascertaining contra-indications in patients, maintaining skills, equipment, and workload were barriers preventing the provision of pre-hospital thrombolysis. There was a sense that primary care needed to feel that it is initiating change rather than having change thrust upon it. CONCLUSION: Decision-making processes in primary care are complex, even when the evidence supporting change is strong. Health service planners wishing to implement successful change need to consider other issues such as practical matters, support structures, current morale and practitioner perceptions of control.     

Nutritional strategies to promote postexercise recovery

During postexercise recovery, optimal nutritional intake is important to replenish endogenous substrate stores and to facilitate muscle-damage repair and reconditioning. After exhaustive endurance-type exercise, muscle glycogen repletion forms the most important factor determining the time needed to recover. Postexercise carbohydrate (CHO) ingestion has been well established as the most important determinant of muscle glycogen synthesis. Coingestion of protein and/or amino acids does not seem to further increase muscle glycogensynthesis rates when CHO intake exceeds 1.2 g × kg?1 × hr?1. However, from a practical point of view it is not always feasible to ingest such large amounts of CHO. The combined ingestion of a small amount of protein (0.2-0.4 g × kg?1 × hr?1) with less CHO (0.8 g × kg?1 × hr?1) stimulates endogenous insulin release and results in similar muscle glycogen-repletion rates as the ingestion of 1.2 g × kg?1 × hr?1 CHO. Furthermore, postexercise protein and/or amino acid administration is warranted to stimulate muscle protein synthesis, inhibit protein breakdown, and allow net muscle protein accretion. The consumption of ~20 g intact protein, or an equivalent of ~9 g essential amino acids, has been reported to maximize muscle protein-synthesis rates during the first hours of postexercise recovery. Ingestion of such small amounts of dietary protein 5 or 6 times daily might support maximal muscle protein-synthesis rates throughout the day. Consuming CHO and protein during the early phases of recovery has been shown to positively affect subsequent exercise performance and could be of specific benefit for athletes involved in multiple training or competition sessions on the same or consecutive days.     

Developing people: teaching strategies to promote self-knowledge in nursing education

This is a study elaborated on the basis of the course Mental Health-I, about the nurse formation through self-knowledge motivation. The goals were, to reflect about self-knowledge as a tool in the nurse formation and to analyze didactic strategies to facilitate its development. The data was collected during the course using written registers, self-evaluation and course evaluation. Results showed that the student has the opportunity to develop her/his self-knowledge given that some teaching techniques stimulate the contact with personal issues, facilitating the discovery of potentiality for the professional practice. We concluded that the course has been playing a fundamental role in the nurse education.     

Ecological strategies to promote healthy body image among children

Background: Personal habits of children and adolescents related to healthy body image (BI) are influenced by various determinants in the micro‐ and macroenvironment. These include attitudes and behaviors about eating; exercise and physical appearance modeled by parents, teachers, and peers; as well as opportunities to learn new habits and social praise for healthy choices. The coordinated school health program (CSHP) is compatible with the 5 levels of an ecological approach to developing new health behaviors. Methods: Authors systematically applied the ecological model to all 8 components of coordinated school health. Next, strategies for each of the components were developed using the professional literature as well as author expertise in the areas of health education, exercise science, and dietetics. Results: For each strategy, applicable health and physical education standards, as well as goals for each strategy and additional Web resources, were provided to assist educators and administrators in supporting healthy BI among students. Conclusions: Educators may effectively use a coordinated approach to guide multiple intervention activities aimed at increasing healthy habits among adolescents and their families. The strength of the CSHP is its collaborative nature with active participation by students, faculty members, family caregivers, agency professionals, community residents, and health care providers.     

Community interdisciplinary education to promote partnerships in family violence prevention

Family violence is a major social and health problem in the United States. Educational approaches are needed that help professionals and communities develop more effective skills to work with families and communities. This article describes a statewide, interdisciplinary, community-based educational program for professionals and paraprofessionals and a 6-month post-evaluation. Participants reported knowledge and skill development in assessment and interventions, improved use of violence prevention data for planning and interventions, and increased community partnerships and collaborations. Recommendations address violence prevention leadership, funding, infrastructure, interdisciplinary professional education, greater community awareness, and policy development.     

Novel strategies to promote children's physical activities and reduce sedentary behavior

Physical activity and sedentary behavior (performed primarily while sitting) play a key role in the current and future health of young people. Most health evidence and intervention strategies targeting reductions in children's sedentary behavior have focused on television viewing, with mixed evidence as to the effectiveness of these strategies and of the importance of television viewing for children's health. Evidence from studies with adults using objective measures of sedentary behavior suggests that accumulated sedentary time is independently associated with metabolic health; importantly, emerging evidence suggests that the manner in which the sedentary behavior is accrued (ie, frequency of interruptions to time spent sedentary) may also have independent effects on health. Potential novel intervention approaches to reduce children's sedentary time include activity breaks during class time at school, delivery of active lessons and homework, and changes to the classroom environment. Further evidence of the importance of sedentary time (both total accumulation and frequency of interruptions) on children's health is required. Future studies should assess the effectiveness of interventions targeting organizational and pedagogical changes in schools as well as using homework to engage with families in more active ways.     

The physical examination in cosmetic surgery: communication strategies to promote the desirability of surgery

Cosmetic surgery is a controversial medical practice that is rapidly expanding in the United States. In 2004 alone, 9.2 million procedures were performed. From breast augmentation to tummy tuck, Americans are taking surgical/medical/health risks to alter their bodily appearance. Although many scholars have criticized the practice, few have looked closely at how plastic surgeons interact with prospective surgical candidates. This essay explores videotaped data of naturally occurring interactions between plastic surgeons and patients seeking to transform their physical appearance. Drawing on action-implicative discourse analysis (Tracy, 2005), the article describes plastic surgeons' embodied and discursive activities during a typical physical examination. The core analysis shows how the patient's body and its aesthetic features can be used by plastic surgeons as interpretive resources to promote the desirability of surgery. By touching excess tissue, pinching it, moving it, or applying tools and artifacts (e.g., tape measurer) on and around the body, plastic surgeons literally bring to life patients' bodily "flaws." Through their multimodal performance, I argue, plastic surgeons mark the desirability of surgical transformation. As medicine meets consumerism, medical activities turn persuasive, incrementally constructing the patient's body as a territory of surgical need.     

Community strategies to address cancer disparities in Appalachian Kentucky

Central Appalachian residents suffer disproportionate health disparities, including an all-cancer mortality rate 17% higher than the general population. During 10 focus groups and 19 key informant interviews, 91 Appalachian residents identified cancer screening challenges and strategies. Challenges included (1) inadequate awareness of screening need, (2) insufficient access to screening, and (3) lack of privacy. Strategies included (1) witnessing/storytelling, (2) capitalizing on family history, (3) improving publicity about screening resources, (4) relying on lay health advisors, and (5) bundling preventive services. These insights shaped our community-based participatory research intervention and offered strategies to others working in Appalachia, rural locales, and other traditionally underserved communities.     

Community organization to promote breast cancer screening ordering by primary care physicians

Community organization has been viewed as a promising approach to changing preventive behaviors. We evaluated the impact of community organization strategies to promote breast cancer screening ordering by primary care physicians in Washington State. Physicians practicing in two intervention and two control communities were surveyed by mail pre-intervention (1989) and post-intervention (1993). Intervention activities targeting the health care sector included the formation of local physician planning groups, a series of informational mailings, medical office staff training sessions, and reminder system support. There were no significant post-intervention differences in the self-reported mammography ordering of physicians practicing in the intervention and control areas. Over the four-year study period, the proportions of physicians who ordered regular mammography increased by 36%. By 1993, over 80% of the respondents routinely used mammographie screening. Concerns about the high price of mammograms and inadequate insurance coverage were significantly reduced over time in both community pairs. Also, use of patient reminder systems increased significantly between 1989 and 1993. Secular trends resulting from diffusion of strategies to promote mammography were responsible for increases in physician ordering of the procedure. Year 2000 goals for breast cancer screening use by physicians may already have been met in some communities.Funded by grant CA34847 from the National Cancer Institute.     

Community readiness to promote Latinas' participation in breast cancer prevention clinical trials

The high breast cancer (BC) mortality rates that exist among Hispanic women (Latinas) are a health disparity burden that needs to be addressed. Prevention clinical trials are a burgeoning area of cancer prevention efforts and may serve to promote parity. Unfortunately, Latinas, along with other ethnic minority women, continue to be under-represented in this form of research. Previous studies have examined individual barriers to ethnic minorities' participation, but none have assessed community factors contributing to Latinas' under-representation in these studies. The present study addressed these limitations from a community perspective by exploring which factors might inhibit Latinas' participation in clinical trials, specifically BC prevention trials. Using the Community Readiness Model (CRM), 19 key informants were interviewed in four communities, two rural and two urban, in Colorado, USA. The key informant assessment involved a semistructured interview that measured the level of community readiness to encourage participation in BC prevention activities. The results reflected a community climate that did not recognise BC as a health problem that affected Latinas in participating communities. Compared to other healthcare priorities, participation in BC prevention clinical trials was considered a low priority in these communities. Overall, leadership and community resources were not identified or allocated to encourage the participation of Latinas. The results highlight the lack of awareness regarding clinical trials among both community members and leaders. According to the CRM, strategies to enhance awareness at multiple levels in the community are necessary. This study demonstrates how the CRM can be used to better understand a community's perspective on BC, and specifically, the under-representation of Latinas in clinical trials.