The role of the nurse in health promotion

This paper describes and discusses issues concerned with therole of the nurse in health promotion work. It represents thefirst phase of a research project designed to explore this role,and presents the evolving philosophical framework for the study.The study is taking place currently in the United Kingdom andhas been made possible by the (first) award of a Post DoctoralNursing Research Fellowship to the project director. Against the backdrop of the World Health Organization's ‘Healthfor All by the year 2000’ (WHO HFA 2000) movement therehave been repeated calls for nurses to be the leaders in healthpromotion. Policy makers and educators have responded to thesecalls by claiming a central role for nursing and putting healthpromotion high on policy and training agendas. Very little attention,however, has been devoted to exploring the legitimacy and developmentof this role in nursing. Generally, nurses seem enthusiasticabout health promotion, and sure that they have a role to play.What is less certain is what this role is. The study seeks toclarify this by exploring policy, behaviour, and attitudes.Policy provides the framework for practice, and operates ata number of levels. In this early paper we review the literatureto explore policy and practice from international to grassrootslevels. We also make some initial observation derived from ourpilot work.     

The regulation of pulmonary vascular tone

1 The ability to manipulate pharmacologically pulmonary vascular tone independent of effects on systemic blood vessels is a desirable objective. Elucidation of the biochemical mechanisms underlying hypoxia-induced pulmonary vasoconstriction (HPV) may permit preferential targeting of the pulmonary circulation.
2 Here we review our studies of the role of locally synthesized candidate vasoactive factors in HPV. In addition, we present data demonstrating an attenuated pressor response to hypoxia in the pulmonary circulation of Fischer 344 rats compared with the Wistar-Kyoto (WKY) rat strain.
3 We propose that a systematic genome-wide search using the HPV phenotype and a panel of highly informative microsatellite markers will elucidate the genetic loci underlying the difference in susceptibility to HPV in these two rat strains and provide a valuable and novel insight into the factors that determine the HPV response.     

MATERNAL USE OF ALCOHOL AND OTHER DRUGS DURING PREGNANCY AND BIRTH ABNORMALITIES: FURTHER RESULTS FROM A PROSPECTIVE STUDY

This paper presents an extended analysis of data produced duringa prospective study of the possible association between maternalalcohol use during pregnancy and fetal harm. This new analysisexamines the possible links between not only maternal alcoholconsumption, but also the use of tobacco, prescribed and illicitdrugs and birth abnormalities. There was no general associationbetween birth abnormalities and maternal psychoactive drug useand misuse. Even so, women who neither smoked nor consumed alcoholduring the first trimester produced offspring with significantlyfewer birth abnormalities than did those who drank heavily andsmoked cigarettes.     

The Inhalation Toxicology, Genetic Toxicology, and Metabolism of Difluoromethane in the Rat

Difluoromethane (HFC32) is under development as a replacementfor chlorofluorocarbons (CFCs) in some refrigeration applications.It has been evaluated by standard studies of toxicity, developmentaltoxicity, and genotoxicity. In addition, the metabolism anddisposition of HFC32 was investigated and a physiologicallybased pharmacokinetic (PB-PK) model constructed. Inhalationof HFC32 (up to 50,000 ppm) caused no organ-specific effects,but resulted in slight maternal toxicity to the pregnant ratand rabbit and some fetotoxicity to the rat. HFC32 did not sensitizethe heart to adrenaline. The pharmacokinetics of [¹⁴C]difluoromethane(10,000 to 50,000 ppm/6 hr) revealed that about 2.1% of theinhaled HFC32 was absorbed and that steady state blood levelswere achieved within 2 hr and were proportional to dose. Carbondioxide was the major metabolite of HFC32 at all exposure levels.Carbon monoxide was not detected. The in vivo data were usedto validate a PB-PK model to describe the uptake and metabolismof HFC32. Absorption and distribution are adequately describedusing rat blood:air and tissue:air partition coefficients. Metabolism,which was linear across the dose range, was described by a firstorder rate constant (K_f=8.98 hr^–1). Of the absorbed HFC32,about 63% was metabolized at all doses; however, when metabolismwas expressed as a percentage of the inhaled dose it was muchlower, being about 1.4% of the HFC32 entering the airways. Overall,the results indicate that HFC32 is of very low toxicity andshould be an acceptable alternative to CFCs.