Health promotion versus disease and care: failure to establish "blissful clarity" in British nurse education and practice

An evaluation which involved documentary analysis, observation and interviews with teachers, students and nurses in four educational institutions, revealed that the interpretation and implementation of a philosophy of health in nursing in the UK has been variable. A small but influential group of teachers saw health as the basis for the curriculum and the way forward for nursing. The new Project 2000 health-based curriculum led some participants to reassess their conception of nursing, but disease and care of the sick remained uppermost. Trained hospital nurses in particular continued to view nursing as primarily concerned with disease treatment. The care model associated with 'New Nursing', rooted in communication and interpersonal relationships, was also apparent particularly among pre- and post-registration students. Health was operationalised as both health education and health promotion ranging from individualised information giving and disease prevention to more participatory forms based on equity and empowerment. Participants' responses to the introduction of health in the curriculum were categorised in one of four ways: pessimism, partisanship, fanschen (to turn over) or marketisation. Their response depended on whether they viewed health as the central nursing philosophy rather than disease or care. On the basis of our findings we propose that these responses give rise to four policy choices for nurses at an individual and group level.     

Income and health: what is the nature of the relationship?

The aim of this article is to examine the relationship between income and morbidity, both before and after controlling for other socio-economic variables. We use data from the Health and Lifestyle Survey (first wave), a national sample survey of adults, aged 18 upwards, in England, Wales and Scotland, conducted in 1984-1985. In total, 9003 interviews were achieved. We examine the shape of the relationship between household equivalised income and height, waist-hip ratio, respiratory function (FEV1), malaise, limiting longterm illness. These indices of morbidity, both self-reported and measured, are approximately linearly related to the logarithm of income, in all except very high and low incomes (this means that increasing income is associated with better health, but that there are diminishing returns at higher levels of income). A doubling of income is associated with a similar effect on health, regardless of the point at which this occurs, providing this is within the central portion (10-90%) of the income distribution. The effect of income on the health measures is comparable to that of the other socio-economic variables in combination. The shape of the relationship found between income and health is compatible with worse health in countries with greater income inequality, without the need to postulate any direct effect of income inequality itself.     

Bacterial expression of the major antigenic regions of porcine rotavirus VP7 induces a neutralizing immune response in mice.

The outer capsid protein of rotavirus, VP7, is a major neutralization antigen. A chimeric protein comprising Escherichia coli (E. coli) outer membrane protein A (OmpA) and part of porcine rotavirus VP7 containing all three antigenic regions (217 amino acids) was expressed in Salmonella and E. coli as an outer-membrane associated protein. Mice immunized intraperitoneally or orally, respectively, with live E. coli or Salmonella cells expressing this chimeric protein produced antibodies against native VP7 as determined by enzyme-linked immunosorbent assays and neutralization tests. This indicates that the VP7 fragment from a porcine rotavirus which is antigenically similar to human rotavirus serotype 3, when expressed in bacteria as a chimeric protein, can form a structure resembling its native form at least in some of the major neutralization domains. These results indicate that the use of a live bacterial vector expressing rotavirus VP7 may represent a strategy for the development of vaccines against rotavirus-induced diarrhoea in infants.     

Immunogenicity of peptides derived from a fibronectin-binding protein of S. aureus expressed on two different plant viruses

The D2 peptide derived from an S. aureus fibronectin-binding protein (FnBP) was expressed on the surface of the icosahedral cowpea mosaic virus (amino acids 1-30 of D2) or on the rod-shaped potato virus X (amino acids 1-38 of D2), termed CPMV-MAST1 and PVX-MAST8, respectively. Mice and rats were immunized subcutaneously with CPMV-MAST1 and mice with PVX-MAST8 in adjuvant and high titres of FnBP-specific antibody were obtained. The mouse IgG was predominantly of the IgG2a and IgG2b isotypes, which strongly bound complement component C1q, suggesting a TH1-bias in the peptide-specific responses. Sera from mice and rats immunized with CPMV-MAST1 and from mice immunized with PVX-MAST8 were shown to completely inhibit the binding of fibronectin to immobilised recombinant FnBP and rat sera against CPMV-MAST1 were able to block adherence of S. aureus to fibronectin. These studies demonstrate that the D2 peptide is highly immunogenic when expressed on 2 different plant viruses and highlight the potential of plant virus-based vaccines to protect against S. aureus infections.     

Lay beliefs about the preventability of major health conditions.

Beliefs about the extent to which health problems can be prevented reflect an understanding that preventive measures can reduce adverse health events and the level of control individuals perceive that they hold over the factors that affect their health. A population survey of 1659 people conducted in 1995 in south western Sydney, Australia, found that only child drownings, tooth decay, skin cancer, and burns and scalds were considered all or mostly preventable by more than 50% of the sample. The majority of respondents did not believe that heart attacks, cervical cancer, high blood pressure, serious road injury, lung cancer and asthma deaths were all or mostly preventable. Logistic regression analysis showed that people born in an English speaking country, those with more than 10 years of education and men were significantly more likely to recognize a number of key conditions as highly preventable. The findings suggest that, in spite of the range of prevention efforts in Australia to date, these are not matched by strong beliefs within the community that prevention is possible. Communication of the opportunities and methods for prevention needs to be improved, particularly among certain population groups. The findings also indicate a need to examine social and environmental factors which are potentially reducing confidence, and subsequently and adoption of preventive behaviours.     

A brief motivational intervention to improve dietary adherence in adolescents. The Dietary Intervention Study in Children (DISC) Research Group.

Motivational interviewing offers health care professionals a potentially effective strategy for increasing a patient's readiness to change health behaviors. Recently, elements of motivational interviewing and the stages of change model have been simplified and adapted for use with patients in brief clinical encounters. This paper describes in detail a brief motivational intervention model to improve and renew dietary adherence with adolescents in the Dietary Intervention Study in Children (DISC). DISC is a randomized, multi-center clinical trial assessing the efficacy and safety of lowering dietary fat to decrease low-density lipoprotein cholesterol in high-risk children. In the first 3 years of follow-up covering ages 8-13, intervention participants (n = 334) were exposed to a family-based group intervention approach to change dietary choices. To address adherence and retention obstacles as participants moved into adolescence (age 13-17), an individual-level motivational intervention was implemented. The DISC motivational intervention integrates several intervention models: stages of change, motivational interviewing, brief negotiation and behavioral self-management. A preliminary test of the intervention model suggests that it was acceptable to the participants, popular with interventionists and appeared to be an age-appropriate shift from a family-based intervention model.     

Indiana Children's Special Health Care Services Program: Impact of Administrative Changes on Health Care Utilization, Access to Care, and Unmet Needs

In this study we assessed the impact of administrative changes occurring in 1993 on the Indiana Children's Special Health Care Services program. Responses from a 1994-1995 survey were compared with a 199 1 survey. Unmet needs declined in 6 categories: primary medical care, hospital services, home nursing care, physical therapy, occupational therapy, and special equipment. Unmet needs remained the same in 6 categories: specialty care, speech therapy, respite care, parent support, child support, and sibling support. Unmet needs increased in 5 categories: dental care, mental health, transportation, housing modifications, and child and day care. Although program changes improved the health care needs of clients in many areas, additional efforts are still needed.     

Worldwide trends in DDT levels in human breast milk.

BACKGROUND: Concern over human breast milk contamination with the pesticide DDT (1,1,1-trichloro-2,2-bis(chlorodiphenyl)ethane) has prompted numerous studies around the world during the last five decades. This article examines trends in reported DDT levels, and the apparent effect of restrictions on DDT use. METHODS: More than 130 published values for DDT in human milk since 1951 were compiled, and trend lines were fit for regions of the world. RESULTS: Population means have declined in much of the world, from 5000-10000 microg DDT/kg milk fat to around 1000 today in many areas. Although different regions have different means, the decline seen in various countries corresponds to their restricting DDT use. DISCUSSION: DDT concentrations in human milk have declined in most areas of the world, consistent with restrictions on its use. Nevertheless, levels can be high in areas still using DDT, even higher than the World Health Organization's recommended limit for infants. These results indicate that population averages can be reduced by a predictable amount as DDT use is restricted.     

A stimulus control intervention in the gynecological exam with sexual abuse survivors

The effectiveness of a new examination gown, as a stimulus control intervention designed to reduce distress during the pelvic exam, was investigated in a sample of sexual abuse survivors and women without abuse histories. Sixty-nine participants from a women's health ambulatory center and a private practice in gynecology were randomly assigned to the experimental gown condition or the paper drape control group. One-third of the sample reported a history of childhood sexual abuse. Survivors reported higher anxiety during exams than did women without abuse histories. Women who wore the experimental gown reported more positive emotional and physical experiences of the exam. Further research is required to examine the trend showing that survivors who wore the experimental gown reported less anxiety during the examination than survivors who wore the control drape.