Vaginal delivery parameters and urinary incontinence: the Norwegian EPINCONT study

OBJECTIVE: The study was undertaken to investigate the effect of nine delivery parameters on urinary incontinence in later life. STUDY DESIGN: Incontinence data from the EPINCONT study were linked to the Medical Birth Registry of Norway. Effects of birth weight, gestational age, head circumference, breech delivery, injuries in the delivery channel, functional delivery disorders, forceps delivery, vacuum delivery, and epidural anesthesia were investigated. The study covered women younger than 65 years, who had had vaginal deliveries only (n=11,397). RESULTS: Statistically significant associations were observed between any incontinence and birth weight 4000 g or greater (odds ratio [OR] 1.1, 95% CI 1.0-1.2); moderate or severe incontinence and functional delivery disorders (OR 1.3, 95% CI 1.1-1.6); stress incontinence and high birth weight (OR 1.2, 95% CI 1.1-1.3) and epidural anesthesia (OR 1.2, 95% CI 1.0-1.5); and urge incontinence and head circumference 38 cm or larger (OR 1.8, 95% CI 1.0-3.3). CONCLUSION: The effects were too weak to explain a substantial part of the association between vaginal delivery and urinary incontinence, and statistically significant results may have incurred by chance.     

Vocational and social outcomes of adults with chronic aphasia

Vocational and social outcomes of rehabilitation, such as employment, Social Integration, and life satisfaction, are critical determinants of the usefulness of rehabilitation. The purpose of this study was to describe the employment status, Social Integration, and perceived life satisfaction of adults with chronic aphasia 2 years after discharge from an intensive treatment program. Among the 20 survey respondents, 62% of those who had been working prior to aphasia onset were also working at the time of follow-up. Those who were working before but not after onset had higher Home Integration scores. There was a relatively large perceived change in communication from clinic discharge to the 2-year follow-up. Eighty-five percent of the respondents indicated a positive life satisfaction rating. There was a significant positive relationship between Home Integration and life satisfaction ratings. The results are discussed in relation to other reports of employment and social outcomes for stroke and aphasia.

Learning outcomes

As a result of this activity, the participant will be able to: (1) identify factors that may contribute to the successful return to work for adults with chronic aphasia; (2) describe the vocational and social outcomes of a select group of adults with chronic aphasia after participation in an intensive treatment program; and (3) discuss future need areas in understanding vocational and social participation for adults with chronic aphasia after intervention.     

Comprehensive evaluation of a community coalition: a case study of environmental tobacco smoke reduction

Community coalitions have become an increasingly popular means for addressing community health issues, yet evaluating their effectiveness and performance has presented formidable challenges. To meet the community's need for health program evaluation, public health nurses will need to become better prepared to deal with the complexities of evaluating coalitions and their multifaceted organizational structures. This article presents the methodology and conceptual framework, Targeting Outcomes of Programs (TOP), used to evaluate the performance and impact of a local community coalition. The case study offered here focuses on a tobacco-prevention coalition composed of 15 public and private agencies and their 121 activities. The TOP evaluation model provided the coalition with formative evaluation, needed to improve the coalition's on-going program delivery, and summative evaluation, needed for annual reviews of the coalition's effectiveness and impact in the community. The methodological approach and instrument presented here provide the public health nurse with a solid conceptual framework for approaching such a task.     

A community-based approach to sexual assault

The community-based Athens-Clarke County Sexual Assault Nurse Examiners (ACC-SANE) program was developed to respond to the needs of sexual assault victims. Although this type of SANE model allows for a strong nurse-managed program, there are frustrations and pitfalls that differ from most hospital-based programs. At this time, the majority (71%) of SANE programs are based in hospitals, and few (15%) function in outpatient/community facilities. In the ACC-SANE program, many community agencies interact to provide a seamless approach to postassault health care, counseling, and criminal prosecution. SANE nurses are well equipped to provide forensic examinations in a caring, out-of-hospital environment. The program is housed in a remodeled cottage that rests on property owned by the Athens-Clarke County government and that is adjacent to the local police department. ACC-SANE is governed by a nonprofit board of directors. This management model has allowed the original organizing groups to remain active in the development of the program. As these agencies continue in the governance of the program, they remain committed to the success of ACC-SANE. The impact of program growth and published program guidelines is examined.     

The role of community staff in care home placement in Sweden

The role of community staff in placing a relative in a care home is a relatively unexplored area of practice. Interviews with a variety of community staff in Sweden suggest that they play a significant role in helping family carers, particularly spouses, research the decision about the need for placement. This role can include recognition that placement is required (seeing the need), initiating and sustaining discussions about placement (sowing the seed and nurturing the seed) and legitimating the decision. However, once the decision has been made relatively little attention is given to the emotional consequences of the move and attention is focused largely on instrumental aspects. Despite showing sensitivity in the decision-making phase, community staff could do more to help carers deal with the guilt they experience and to initiate contact with the care home.     

Care systematization in psychiatric nursing within the psychiatric reform context

The aim of this study was to approach care systematization in psychiatric nursing in two psychiatric disorder patients who attended ‘Nossa Casa’, São Lourenço do Sul, RS, Brazil. Nossa Casa services psychiatric patients in the community, focussing on: (i) permanence in their environment, allowing patients to remain close to their families and social spheres; (ii) integral attendance to meet individual needs; (iii) respecting individual differences; (iv) rehabilitation practices; and (v) social reinsertion. Concepts and assumptions of the psychiatric reform and the Irving’s nursing process were used as theoretical–methodological references to elaborate this systematization. A therapeutic project for the psychiatric patient was elaborated, in accordance with the interdisciplinary proposal accepted by Nossa Casa. Interdisciplinary team intervention, guided by a previously discussed common orientation and defined through an individualized therapeutic project, allowed for an effective process of psychosocial rehabilitation. The authors concluded that a therapeutic project based on the mentioned premises leads to consistent, comprehensive, dialectical and ethical assistance in mental health, thereby reinstating the citizenship of psychiatric patients.