Identification and Management of Schizophrenia in Childhood

TOPIC: The identification and management of schizophrenia in childhood. PURPOSE: To provide an overview of what is currently known about childhood schizophrenia. SOURCES: Published literature and personal observations and experiences. CONCLUSIONS: Early identification and treatment of childhood schizophrenia are critical, and more research and education on the part of all mental health professionals are needed in order to identify, provide treatment, and/or make referrals for children with this serious mental disorder.     

Databases: Accuracy and readiness for use

Abstract Decisions for improving health care rely on data often contained in databases. A database is a compilation of information, often a group of variables, that is stored electronically in a computerized system. It can be specific to one organization, a group of several facilities, or a nationwide effort. Databases comprise elements specific to the endeavour. Types of databases include clinical, administrative, research, or combinations of these. The purpose of electronic storage of specific data and the uses for the results of database analyses need consideration regarding accuracy, validity, and reliability. All databases are accurate to the extent that each element and each point of data collection and entry are valid and reliable. The purposes of this paper are to explore methods for determining accuracy of the data in a database, reliability and validity of database elements, and to determine when a database is ready for use.     

A concept analysis of trust

Trust is an important and pervasive concept In nursing, it has been considered primarily from two perspectives Clinically, it is an important aspect of the nurse-patient relationship Organizationally, trust is associated with various outcomes and levels of effectiveness Much of the nursing literature that discusses trust relies upon vague conceptualizations or borrows from other disciplines The absence of a clear conceptualization of trust has been cited A core concept of trust is presented which is applicable to nursing in both clinical and organizational settings Established methods for concept analysis are supplemented by a sequential step model developed by the author The concept is developed as both process and outcome, and the relationships of the two states to measurement of the concept are identified The utilization of the core concept in context-specific instances is discussed, and suggestions are made for further research     

Transmission of HIV in the dental clinic and elsewhere

This review focuses on the risk of transmission of HIV in dental practice in developed and developing countries; and as a result of oral sex, perinatal transmission and breast feeding. Postexposure prophylaxis (PEP) and practical measures to control cross-infection with TB are also discussed. There are few data from resource-poor countries where prevalence of HIV and risk of infection are higher – issues that deserve priority. Available information indicates that the risk of HIV transmission in the dental office is very low. Transmission of HIV from three healthcare workers to patients has been confirmed, including a dentist who infected six patients. There are >300 reports (102 confirmed) of occupational transmission to healthcare workers, including nine dental workers (unconfirmed). Exposure to HIV has been reported by 0.5% dentists/year. The risk of HIV infection after percutaneous exposure (0.3%) can be reduced by 81% with zidovudine PEP. However, risk assessment is required to assess the need and appropriate regimen. The risk of HIV transmission associated with orogenital sex exists, but is considered extremely low: barrier protection is recommended. Conversely, the proportion of babies who acquire HIV from untreated HIV-seropositive mothers is 15–25% in developed countries and 25–45% in developing countries. The frequency of HIV transmission attributable to breastfeeding is 16%. Airborne transmission of TB can be avoided by the prompt referral of known/suspected cases of active TB for chemotherapy, deferral of elective procedures until patients are not infectious, and the use of appropriate standard/isolation precautions including adequate ventilation of treatment areas.     

The effect of foot reflexology on pain in patients with metastatic cancer

Thirty-six oncology inpatients participated in this third pilot study investigating the effects of foot reflexology in which equianalgesic dosing was calculated. Foot reflexology was found to have a positive immediate effect for patients with metastatic cancer who report pain, although there was no statistically significant effect at 3 hours after intervention or at 24 hours after intervention. Further study is suggested for foot reflexology delivered by family in the homes for management of cancer pain.     

Altered Thought Processes and Sensory / Perceptual Alterations: A Critique

Concerns about the clinical usefulness of altered thought processes and sensory/perceptual alterations— and the resulting avoidance of these two diagnoses—led to a study to determine how expert nurses differentiate between the diagnoses and how the diagnoses are used in practice. The authors developed a questionnaire and mailed it to 128 members of NANDA who had identified themselves as experts in the diagnoses; sixty-six (52%) responded. Conclusions were that the defining characteristics for altered thought processes were cognitively oriented and those for sensory/perceptual alterations were perceptually oriented. The overlap of defining characteristics, such as change in problem-solving ability, makes differential diagnosis a difficult task.     

后勤生活服务对职业院校学生心理健康的影响

目的:评价职业院校学生的心理健康状况,分析后勤生活服务对其的影响。方法:①于2006-04采取整群分层随机抽样方法抽取湖南、广西两所医科职业院校1￣4年级(2002/2005)在校学生900名为测试对象,平均年龄(18±1)岁。②采用症状自评量表和自编后勤生活服务条目进行团体测评和比较分析。就餐方式包括4种:学生食堂大锅菜、学生食堂小炒、校外排档、自家吃饭或亲戚家搭餐;住宿去处包括4种:带公厕普通宿舍、带卫生间的公寓、校外租房、走读住家。后勤生活服务态度包括5种:很差、较差、一般、较好、很好。症状自评量表90个条目,采用从1￣5的5级计分。包括10个因子即躯体化、强迫症状、人际关系、抑郁、焦虑、敌对、恐怖、偏执、精神病性、其他,总分,阳性项目数(90个条目中≥2之条目数),分数越高表示心理状况越差。症状自评量表因子分≥2表示阳性分,≥3表示有明显的心理问题。③两组间比较采用独立样本t检验,多组间比较采用单因素方差检验。结果:发放问卷900份,其中湘环职院468份,南宁卫校432份,全部回收合格,有效率100%。①就餐方式间差异:校外排档就餐学生各因子分和总分及阳性项目数均比其他就餐方式高,食堂小炒学生和自家吃饭学生相对较低。不同就餐方式学生症状自评量表中人际关系、偏执2个因子和阳性项目数评分比较,差异明显(F=3.5,3.7,2.65,P≤0.05)。②住宿去处间差异:校外租房学生各因子分和总分均比其他住宿去处学生高,不同住宿去处学生症状自评量表中躯体化、焦虑和精神病性评分差异明显(F=3.32,2.77,2.91,P<0.05)。③后勤生活服务态度间差异:后勤生活服务态度从差到好,所有因子分和总分及阳性项目数基本上依次降低,除其他因子外的其余9个因子分比较,差异明显(F=2.60￣5.78,P<0.05￣0.01)。④后勤服务对职业院校学生心理健康状况的影响因素分析:后勤服务态度、住宿条件为对心理健康有影响的主要因素(t=-4.358,2.552,P<0.01,0.05)。⑤心理健康问题检出率:2所院校900名抽样学生中,有548人(60.9%)症状自评量表因子分≥2,存在各种轻度的不良心理反应;126人(14.0%)因子分≥3,存在比较明显的心理健康问题;196人(21.8%)总均分≥2,整体心理健康出现不良,强迫症状、抑郁和人际关系因子人数最多;16人(1.8%)总均分≥3,整体心理健康有着明显的不良倾向,人际关系、强迫症状和敌对因子为检出率的前3位。结论:①医科职业院校学生的心理健康状况总体较差,校外排档、校外租房、遭遇后勤生活服务态度很差的学生心理健康状况最差。②后勤生活服务特别是服务态度和住宿条件对学生心理健康的影响最大。     

What Maintains the Myth of the Wicked Stepmother?

TOPIC. A critical analysis of the myth of the wicked stepmother, its origins and social purposes, as well as factors that influence the myth and contribute to its maintenance.
PURPOSE. To explore the myth of the wicked stepmother as represented in literature for professionals, parents, and children regarding the dynamics of relationships between children and stop-parents.
SOURCES. Published literature and clinical observations.
CONCLUSIONS. •A cyclical process can be identified by reviewing the influence of myth on relationships between stepchildren and stepmothers as well as the influence of stepfamily relationships on the maintenance of myth.
• Solutions for stepfamily relationships require broader possibilities than the dichotomous answers provided by myth.
• Answers to many of the questions raised concerning the complexities of stepfamily life require an increased focus on clinical research.