Community Health Workers and Primary Health Care in Honduras

Community participation and utilization of community health workers (CHWs) are essential components of the primary health care model. The success of CHWs is dependent on their training and subsequent community support. Community-prepared nurses are ideal CHW educators. A training program for CHWs was implemented in Honduras emphasizing the principles of adult learning and problem-based learning. Following a 4-month program of training a primary health care clinic was opened and managed by CHWs for a population over 10,000. Approximately 80% of local health problems were managed by the CHWs proving that well-trained CHWs can have a significant impact on the delivery of health care.     

Comparison of three preverbal scales for postoperative pain assessment in a diverse pediatric sample

The purposes of this study were to compare the reliability and validity of three pain measurement scales for assessing pain in preverbal and nonverbal children and to determine which of the scales was mos tappropriate in a clinical setting to evaluate pain for infants and young children regardless of developmental stage or cognitive or physical disability. Pain scales tested were revised versions of the Riley Infant Pain Scale (RIPS), the Nursing Assessment of Pain Intensity (NAPI), and the Postoperative Pain Score (POPS). Purposive sampling of 391 postoperative infants and children was used for evaluation of pain in a midwestern children's hospital. Four assessments with each scale were done 1 hr apart by trained observers blinded to pain medications. Data analyses supported high inter-rater reliability, satisfactory discrimination between pain and no-pain observations, and suggested acceptability for all three scales with lower caregiver burden for RIPS and NAPI.     

Health, mortality, and wellness issues in adults with cerebral palsy

For many years, children with cerebral palsy (CP) and their parents have been told that health and functional status stabilize by early adulthood. However, adults with CP report ongoing health conditions and aging and secondary conditions that are not always recognized or managed by their healthcare providers. There is a growing body of literature to better define the health, mortality, and wellness of those aging with CP. In general, adults with CP report good health, although health outcomes appear to be linked to the severity of CP and to increasing age. Studies reporting on lifespan warrant caution in interpretation because of biases in the survey and surveillance systems. It appears that lifespan of persons with CP is at or close to that of the typical population. The most commonly reported age-related changes and secondary conditions involve pain/fatigue, physical performance, and the musculoskeletal system. Not all adults have serious health problems, and many now recognize the aging process as a natural course of events. Few adults with CP engage in typical screening and health promotion activities due to a variety of barriers. There continues to be much to be learned and disseminated, in order to improve the care of adults with CP.     

Alcoholism and the Patterning of Outcome: a multivariate analysis

This study takes a particular data set deriving from 10-year follow-up information on 68 male alcoholics as basis for exploring patterns of outcome in multivariate terms. A Principal Components Analysis demonstrates that degree of dependence is intrinsic to the patterning of outcome. The overall relationship between dependence and holistic outcome is a ‘Janus’ effect: high dependence may be related either to good or to bad outcome in different circumstances. When there is good outcome in terms simply of abstinence, dependence then further predicts within abstinent patients the overall quality of outcome which will be achieved. The need for a multivariate model is underlined.     

Pacifier Use: A Systematic Review of Selected Parenting Web Sites

INTRODUCTION: The purpose of this study was to explore and describe content related to pacifier use on parenting Web sites. METHODS: Sixteen parenting Web sites met the inclusion criteria of the study. Two checklists were used to evaluate and describe different aspects of the Web sites. The first checklist provided a quality assessment of the Web sites. The second checklist was constructed to identify content categories of pacifier use. RESULTS: The majority of sites met quality assessment criteria. Eleven content categories regarding pacifier use were identified. Nine of the 16 sites contained eight or more of the 11 content areas. The most common types of Web pages containing pacifier information included pacifier specific (articles), questions and answer pages, and related content pages. DISCUSSION: Most of the parenting Web sites met the quality measures for online information. The content categories reflected the current controversies and information regarding pacifier use found in the expert literature. The findings of this study suggest the need to establish pacifier recommendations in the United States to guide parents and health care providers with decision making.