Obstacles to community health promotion

The health transition ushered into the world in this century calls for a reorientation of traditional health services to manage the new causes of morbidity and mortality, renewing interest in disease prevention and health promotion. Community-based health promotion emphasizes prevention and community participation with people's empowerment to overturn current inequities and increase control over their health. Encouraged worldwide by the World Health Organization for the last two decades, some community health promotion programs have been implemented and lessons learned. However, the shift in focus required means nothing less than a paradigm change demanding not only a reorientation of professional training, but also a reorganization of social structures in communities. This article discusses nine of the interrelated obstacles that must be overcome to further develop community health promotion.     

Community health promotion nursing practice

As social workers, we are educated about the values of client self-determination as well as the affirmation of uniqueness in how the client experiences life and death. In terms of choices at the end of life, assisted suicide has begun to come out of the closet, so to speak, and as a result, the National Association of Social Worker's adopted a policy in 1993 which addresses this end of life option. Oregon passed Ballot Measure 16 in November of 1994 which allows for a terminally ill person to request drugs to end life. As the legalities of assisted suicide are decided by judges and courts, some terminally ill people will think about and decide to take their own lives rather than wait for the disease process to come to its own ending. There are very few practice guidelines available to social workers who work with the suicidal terminally ill. A traditional mental health model for evaluation of lethality cannot be imposed onto this population. A three-part model for assessment and evaluation of a suicidal request from a terminally ill person is proposed in this article.     

The development of a community-based nursing practice: shifting the focus to health promotion

Developing guidelines for a community-based nursing group practice is a challenge for nursing professionals. Yet the benefits from the development of these guidelines can contribute to increased professionalism among nurses and accountability in nursing practice. In this article, the author describes the development of guidelines. The goal is for the development of guidelines based on health promotion.     

Using evidence in children''s nursing

In the 12-hour experiment with simulation of habituation factors in the cabin of one-seat aeroplane the individual dynamics of indices in 29 men (volunteers) has been studied. The reactive-situational anxiety, self-rating, heart rate, arterial pressure, blood glucose level, operator working capacity have been recorded. There have been revealed the twelve types of individual dynamics of the indices: linear increase or decrease, elevation or decline with stabilization of an indicator level, stable with a consequent elevation (decline), step-wise increase (decrease), P- and U-shaped wave-shaped dynamics and practically constant level have been recorded. The individual dynamics was depended on the expressivity and plasticity (responsiveness) of the prestart response to the effect of unfavourable factors resulting in the psychic and physiological stress and fatigue as well as in the internal variations of each test subject.     

Historic and future health promotion contexts for nursing

Lumbar artery aneurysms are uncommon lesions that usually present as pseudoaneurysms secondary to vessel injury. Despite their small size and retroperitoneal location, these lesions are potentially lethal once they rupture. This report describes a ruptured lumbar artery aneurysm which was successfully treated in a minimally invasive fashion. The diagnosis was suggested by computed tomography scan and confirmed with angiography. Successful treatment consisted of placing intravascular metallic coils into the lumbar artery. The literature contains only seven previous reports of ruptured lumbar artery aneurysms and these were managed either operatively or via an endovascular approach. Based upon the outcome of all reported cases, we believe that coil embolization of lumbar artery aneurysms following diagnostic angiography is an appropriate and effective mean of treating these lesions.     

Promoting collaboration in community health nursing

Malignant hyperthermia (MH) is a pharmacogenetic disorder. Susceptibility to MH (MHS) is presumed to be inherited in an autosomal dominant way. MH crises are triggered by halogenated inhalational anaesthetics and suxamethonium, and may be lethal if not treated early and adequately. Until now, eight mutations in the RYR1 gene have been described as causes of MHS phenotype in various MH families. The mutation RYR1 G1021A (Gly341Arg) has been reported to account for approximately 10% of Caucasian MHS cases. However, in our study this mutation was discovered in only 1 out of 89 Scandinavian families, indicating that this mutation may be the cause of MHS in only about 1% of MHS families in those populations. The mutation may have been brought to Scandinavia by an immigrant.     

Lead in inner-city soil and its possible contribution to children''s blood lead

The heterologous expression of a cloned endoglucanase gene (endA) from the ruminal bacterium Ruminococcus flavefaciens 17 was demonstrated in the Streptococcus species S. bovis JB1 and S. sanguis DL1. The endA gene was introduced into S. bovis and S. sanguis using the Escherichia coli/Streptococcus shuttle vector pVA838. Expression of the gene was detected by clearing zones around the recombinant colonies on agar plates containing carboxymethylcellulose stained with Congo red. S. bovis JB1 containing the endA gene was capable of utilizing cellotetraose at a faster rate than the parent strain. This is the first demonstration that Streptococcus species can express a gene from a Ruminococcus flavefaciens strain.     

Assessing community violence: the children''s report of exposure to violence

Optical imaging methods are being explored as a potential means of screening for breast cancer. Previous investigations of time-resolved imaging techniques have suggested that due to the lack of photons with sufficiently small pathlengths, the spatial resolution achievable through a human breast would be unlikely to be better than a centimeter. Experimental results presented here indicate, however, that higher resolution may be achieved by extrapolating the measured temporal distribution of transmitted photons. This is performed using a least-squares fit between data and an analytic model of photon transport. The spatial resolution of a time-resolved imaging system was evaluated by measuring the edge response produced by an opaque mask embedded in the center of a 51-mm-thick, very highly scattering medium. The limiting spatial resolution was improved from about 13 mm to about 5 mm.     

The new paradigm: concepts and application in community health nursing

The central role of community health nursing in future health care delivery systems is undisputed. The abilities and characteristics of nurses who will practice in those systems depends to a large extent on their learning experiences in basic nursing programs. Educators are being asked to prepare skilled, compassionate scholar-clinicians to provide care for the complex needs of clients, despite already packed curricula. The curricular changes cannot be additive; learning must be designed to empower students to become nurses who are both skilled and compassionate. Certain faculty attitudes and behaviors are essential to this new educational paradigm and student activities and assignments must foster confident effective practice.     

The contribution of non-insulin-dependent diabetes to lower-extremity amputation in the community

BACKGROUND: Despite the significant public health burden of lower-extremity amputations in diabetes mellitus, few data are available on the epidemiology of lower-extremity amputations in diabetes mellitus in the community setting. METHODS: A retrospective incidence cohort study based in Rochester, Minn, was conducted. RESULTS: Among the 2015 diabetic individuals free of lower-extremity amputation at the diagnosis of diabetes mellitus, 57 individuals underwent 79 lower-extremity amputations (incidence, 375 per 100,000 person-years; 95% confidence interval, 297 to 467). Among the 1826 patients with non-insulin-dependent diabetes mellitus, 52 underwent 73 lower-extremity amputations, and the subsequent incidence of lower-extremity amputation among these residents was 388 per 100,000 person-years (95% confidence interval, 304 to 487). Of the 137 insulin-dependent diabetic patients, four subsequently underwent five lower-extremity amputations (incidence, 283 per 100,000 person-years; 95% confidence interval, 92 to 659). Twenty-five years after the diagnosis of diabetes mellitus, the cumulative risk of one lower-extremity amputation was 11.2% in insulin-dependent diabetes mellitus and 11.0% in non-insulin-dependent diabetes mellitus. When compared with lower-extremity amputation rates for Rochester residents without diabetes, patients with non-insulin-dependent diabetes mellitus were nearly 400 times more likely to undergo an initial transphalangeal amputation (rate ratio, 378.8) and had almost a 12-fold increased risk of a below-knee amputation (rate ratio, 11.8). In this community, more than 60% of lower-extremity amputations were attributable to non-insulin-dependent diabetes mellitus. CONCLUSIONS: These population-based data document the magnitude of the elevated risk of lower-extremity amputation among diabetic individuals. Efforts should be made to identify more precisely risk factors for amputation in diabetes and to intervene in the processes leading to amputation.     

Relevance of NANDA and health promotion diagnoses to school nursing. National Association of School Nurses

This is a report of a national survey of 490 members of the National Association of School Nurses which described the relevance of 109 nursing diagnoses approved by NANDA (1992) and 29 health promotion (wellness) diagnoses developed by the authors. The relevance of these 138 nursing diagnoses for school nursing was determined by the percent of participants who checked "Yes" for the diagnostic categories they observed in their practice and for which they provided one or more interventions. More than half of the sample checked "Yes" for 67 NANDA diagnoses; health promotion diagnoses were checked "Yes" by 45% to 89% of the sample. The implications are that NANDA and health promotion diagnoses are relevant to school nursing and could readily be incorporated into practice to facilitate data collection that supports both the funding of school nurses and program development for children, families, and school staff.     

Socioeconomic determinants of health. The contribution of nutrition to inequalities in health

Social class differences in health are seen at all ages, with lower socioeconomic groups having greater incidence of premature and low birthweight babies, heart disease, stroke, and some cancers in adults. Risk factors including lack of breast feeding, smoking, physical inactivity, obesity, hypertension, and poor diet are clustered in the lower socioeconomic groups. The diet of the lower socioeconomic groups provides cheap energy from foods such as meat products, full cream milk, fats, sugars, preserves, potatoes, and cereals but has little intake of vegetables, fruit, and wholewheat bread. This type of diet is lower in essential nutrients such as calcium, iron, magnesium, folate, and vitamin C than that of the higher socioeconomic groups. New nutritional knowledge on the protective role of antioxidants and other dietary factors suggests that there is scope for enormous health gain if a diet rich in vegetables, fruit, unrefined cereal, fish, and small quantities of quality vegetable oils could be more accessible to poor people.     

Application of the planning compass to the nursing curriculum: a tool for health promotion practice

Holoprosencephaly (HPE) is a common developmental defect involving the brain and face. HPE is extremely heterogeneous, some cases being associated with structural anomalies of the short arm of chromosome 3. For a detailed characterization of a t(3;19)(p14.1;p13.1) breakpoint associated with HPE, we performed fluorescence in situ hybridization (FISH) analysis using yeast artificial chromosomes (YACs) mapped to the short arm of chromosome 3 from the Le Centre d'Etude du Polymorphisme Humain (CEPH) library. Three YACs mapped proximal, and one was located distal to the described breakpoint on chromosome 3. One of the chromosome 3 'Mega-YACs' spanned the translocation breakpoint. From this chimeric YAC we generated a site specific probe of about 370 kb by digestion of the YAC-DNA, which will be assessed for gene alterations that could underlie HPE in this patient.     

Qualitative approach: a contribution to nursing

This paper focus on some characteristics of the qualitative methodology. Some of these methods are explored such as: participatory research, phenomenology, grounded theory and ethnography critical theory Perspectives of their utilization in nursing research are examined.     

Community-based nursing versus community health nursing: what does it all mean?

These are exciting times in nursing, with great possibilities for reforming nursing as we now know it. The desired outcome is to improve any nurse's ability to care for individuals, families, and communities wherever they are. We believe that articulating CBN and CHN practice is a necessary first step in achieving this outcome; however, it now becomes our challenge to advance this vision. We ask you to join us in this endeavor.     

The indoor air and children''s health study: methods and incidence rates

The effect of chronic alcohol (33 mM ethanol) on Ca2+ signals elicited by glutamate receptor agonists (quisqualate and NMDA) was examined in developing cerebellar Purkinje and granule neurons in culture. The neurons were exposed to alcohol during the second week in culture, the main period of morphological and physiological development. The Ca2+ signals were measured with fura-2 based microscopic video imaging. Chronic exposure to alcohol during development significantly reduced the peak amplitude of the Ca2+ signals to quisqualate (1 microM; Quis) in both the somatic and dendritic regions of the Purkinje neurons. The dendritic region was affected to a greater extent than the somatic region. Granule neurons also showed a reduced somatic Ca2+ signal to Quis (dendrites not measured) in the alcohol-treated cultures, indicating that the effect was not limited to Purkinje neurons. In addition to the effects on in the response to Quis, the peak amplitude of the Ca2+ signals to NMDA (100 microM) was reduced by chronic alcohol exposure during development in both the cultured Purkinje and granule neurons. Resting Ca2+ levels were not consistently affected by alcohol treatment in either neuronal type. These results indicate that Ca2+ signaling linked to glutamate receptor activation is an important target of alcohol in the developing nervous system and could be a contributing factor in the altered CNS function and development observed in animal models of fetal alcohol syndrome.     

Community psychiatric nursing: promoting health in a community setting

With the development of care in the community, some mental health nurses have adopted approaches focused on health. This article explores one model of this approach which is aimed at secondary and tertiary health promotion in a community setting.