bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of an Interagency Home Visiting Program to Reduce Postneonatal Mortality in Disadvantaged Communities
Authors: Barnes‐Boyd Cynthia , Norr Kathleen F. , Nacion Karla W.
Published: May 2007

Abstract This paper describes an interagency home visiting program, Resources, Education and Care in the Home (REACH), designed to reduce preventable causes of morbidity among normal, socioeconomically disadvantaged infants at risk for adverse outcomes due to social factors. Home nursing visits by a trained nurse‐community worker team were made throughout the first year of life to 1,269 infants from predominantly African American families. Results demonstrate that repeated home visits with ongoing infant health monitoring plus individualized and culturally sensitive teaching helped mothers maintain good health practices and identify illnesses early. Infants' outcomes during the neonatal period and at 12 months showed consistent, though statistically nonsignificant, positive effects on physical health. The postneonatal mortality rate among REACH infants was 4.7 deaths per 1000 live births in communities where rates for nonpar ticipants ranged from 5.2 to 10.9 per 100. The evaluation demonstrates a need in this population for more intensive services with greater continuity of care. Specific areas where more education is needed include home safety, skin care, and early identification and treatment of upper respiratory infections. Infants from communities with high infant mortality rates present numerous preventable morbidities requiring interventions, even when they are not considered medically high‐risk at birth.
Effectiveness of Counseling in the Health Promotion of HIV‐Positive Clients in the Community
Authors: DiScenza Sally , Nies Mary , Jordan Cynthia
Published: May 2007

Abstract The purpose of this study was to examine the effects of a nurse's counseling intervention on high‐risk sexual behaviors of HIV‐positive patients and to explore the relationship of gender, race, age, and education to high‐risk sexual behaviors. A convenience sample of 20 adults who were newly diagnosed with HIV and were being treated at an inner‐city out‐patient clinic was used. Subjects were administered a questionnaire to determine their precounseling AIDS knowledge and precounseling sexual behaviors. A registered nurse then counseled them about safe‐sex practices. After 2‐3 months the questionnaire was readminis tered to determine the effects of counseling on AIDS knowledge and high‐risk sexual behaviors. Although statistical analysis indicated a significant main effect for change in high‐risk sexual behaviors after counseling, there were no significant relationships among change and the individual demographic variables of age, gender, race, and education. Pretest knowledge was not found to influence pretest behavior, nor was posttest knowledge found to affect posttest behavior. Paired t tests indicated a significant change in high‐risk sexual behavior scores after counseling but no significant change in knowledge scores.
Clients' Evaluation of Health Care Services in a Battered Women's Shelter
Authors: Attala Janice M. , Warmington Marva
Published: May 2007

Abstract There is a dearth of evaluation research regarding shelter health care. Health needs outweigh health services which are rarities within shelter settings (Gross & Rosenberg, 1987). The purposes of this article are to review the need for shelter health care, describe how shelter‐based advanced practice nurses (APNs) addressed health care needs and program goals in one shelter setting, and report findings from an impact evaluation study where APN services were rated by shelter clients (n= 69) for themselves and their children (n= 95). APNs have the ability to manage health care in shelter settings, but need to seek creative funding by documenting their worth. A 21‐item evaluation survey was designed to measure components of health assessment and education provided to clients by APNs. Content and construct validity were addressed by a statistician and nursing experts, and the internal consistency reliability coefficient (Cronbach's alpha) was measured at .91. Results showed that clients (96.1%) identified strongly positive responses to health services provided with some weak areas detected. Implications include the need to continue programs that serve vulnerable populations in times of cutbacks. Measuring program effects via impact evaluation is recommended for services in process to monitor quality and to give impetus to funding opportunities.
Empowerment Strategies in Nursing Education
Authors: Duncan Susan M.
Published: May 2007

Abstract Building on the already substantial body of literature on education for population‐focused practice, this article incorporates the teaching of empowerment strategies into this literature. These strategies provide a framework for teaching nursing students to promote the health of populations by shifting their focus of care to one that is compatible with principles of primary health care and health promotion within a context of health care reform. Since 1989, education for these shifts in practice has taken place within a clinical studies course on population‐focused practice and has continued to evolve within an innovative nursing curriculum developed by The University of Victoria and its collaborative partners in nursing education in British Columbia, Canada. Faculty have worked to develop innovative teaching strategies and practica that provide students with opportunities to practice empowerment strategies with populations. Examples of how students have learned and practiced these strategies in a baccalaureate nursing program at the University College of the Cariboo in Kamloops, British Columbia, Canada provide useful illustration of the shifts in nursing education that are needed to shape the next era of health care.
Girl Talk
Authors: Guthrie Barbara J. , Wallace John , Doerr Kay , Janz Nancy , Schottenfeld David , Selig Suzanne
Published: May 2007

Abstract The number of adolescent females between the ages of 13 and 19 who are contracting sexually transmitted diseases (STDs) is rising at an alarming rate. Although the issue of STDs has been overshadowed by continued public debate over adolescent pregnancy and childbearing, it demands attention. Particularly concerning is the fact that STDs increase the likelihood of transmitting HIV (N.E. MacDonald et al., 1990). To offset the growing incidences of STDs among female adolescents, gender‐specific interventions are needed. Following is a description of the theoretical underpinnings that informed and guided the development of a gender‐specific intervention titled Girl Talk. A two‐stage creation and review process was used to design this 2.5‐hr, four‐session intervention. An overview of the quasi‐experimental design that compared a nonequivalent comparison and two intervention groups (peer led and adult led) is presented. Baseline characteristics of the three groups are reported. Also described is how participant feedback and a design content analysis are used to evaluate the appropriateness of the intervention for adolescent females.
Enhancing the Role Public Health Nurses Play in Serving Children with Special Health Needs
Authors: Reiss John , Cameon Randi , Matthews Denise , Shenkman Elizabeth
Published: May 2007

Abstract Public Law 99‐457 Part H supports the development of systems to identify infants and toddlers with special health needs and provide these children the comprehensive care they need. Although public health nurses traditionally provide many of the mandated services, Part H, with its roots in education, presents new terminology, conceptual models, and challenges to public health nurses. An interactive videoconference entitled “Public Health Nurses and Part H: Putting the Pieces Together” was broadcast to 525 public health nurses in 11 states. The program goals were to increase knowledge of Part H among public health nurses and to enhance their role in its implementation. An evaluation was conducted to assess knowledge change and satisfaction with the program format. Results revealed a high degree of satisfaction with distance learning and no difference across sites in knowledge acquisition or participant satisfaction. A need identified through this project is increased interdisciplinary communication among those who serve infants and toddlers with special needs. In an era when financial resources are dwindling, interactive videoconferencing is an innovative and cost‐effective method for decreasing the isolation of many public health nurses by offering opportunities for education and networking from their local communities.
Access to Health Promotion, Protection, and Disease Prevention among Impoverished Individuals
Authors: Northam Sally
Published: May 2007

Abstract Health care access was surveyed in a sample of 182 northern Texas individuals (57% Hispanic) who provided information on 658 family members in northern Texas. Barriers were evaluated using the Institute of Medicine (Millman, 1993) and the L.A. Aday and R. M. Anderson (1981) conceptual framework and a survey research design. Eighty‐eight percent of the 182 respondents were 54 years old or younger, yet the majority reported fair health status with currently unmet needs and untreated health problems. Forty‐nine percent used an emergency room within the last year. Forty‐two percent of the respondents always worry about their future health and 40% perceived little or no influence over their family's future health status. Forty‐one percent of the variance in chronic health problems was accounted for by barriers, mental health needs, educational needs, and use of social services. Seventeen percent of the variance in health status was explained by mutable barriers to access. Unmet needs negatively affected physical and mental health. This study demonstrated that this relatively young sample (77% <44 years old) was experiencing health care access needs. These data aid evaluation of the Healthy People 2000 goal of reducing disparities that exist among Americans in health promotion, protection and prevention.
Perception of Risk by Home Health Care Administrators and Field Workers
Authors: Kendra Mary Agnes
Published: May 2007

Abstract The home health care industry has grown significantly over the past 15 years, primarily as the result of an increasing percentage of elderly needing services. Although personal risk has always been a contextual factor of home visiting, an additional challenge facing home health care administrators today is ensuring field worker safety, because visits are now made 24 hr a day, 7 days a week. The purpose of this study was to compare home health care administrators' with field workers' perceptions of risk involved in making home visits. The Home Health Care Perception of Risk Questionnaire (HHCPRQ), a self‐report measure, was administered to a national random sample of 93 home health care administrators and 705 field workers to determine perception of risk within the context of making home visits. Findings indicate significant differences between home health care administrators' and field workers' perceptions of risk in making home visits. Suggestions for enhancing communication among all agency personnel and developing in‐service education programs that are specifically for field workers are identified.
Health Patterns of Cardiac Surgery Clients Using Home Health Care Nursing Services
Authors: Redeker Nancy S. , Brassard Andrea Belanus
Published: May 2007

Abstract The purpose of this study was to examine the health patterns of cardiac surgical patients in the home health care population and their relationships to outcomes and duration of home health care using Gordon's Functional Health Pattern framework. Home health care records of 96 cardiac surgical clients were reviewed. Admission health pattern data, reasons for admission, duration and outcomes of home care services, characteristics of hospital experience, and demographic data were analyzed. Dysfunctional health patterns were primarily in the area of activity/exercise. The most common reasons for admission were monitoring of cardiopulmonary status, wound care, and instruction on diet, medications, and cardiac regimen. The mean duration of home care was 28.8 days. Thirty percent of the sample were readmitted to the hospital. Duration of home care was shorter for those who were married and for those who reported weakness, tiredness, or fatigue as a chief complaint. Readmission to the hospital was more likely for those who had complications during their initial hospital stay and those who required at least partial assistance with bathing, dressing, feeding, or toileting. Implications for practice and research are discussed.
Ethics in Public Health Practice: A Survey of Public Health Nurses in Southern Louisiana
Authors: Folmar Julie , Coughlin Steven S. , Bessinger Ruth , Sacknoff Donna
Published: May 2007

Abstract The present study was designed to help learn more about the ethical interests and concerns of public health nurses employed in state and local health departments. Self‐administered postal questionnaires were mailed to 41 public health nurses employed at health units in Region I of the Louisiana Office of Public Health. Basic demographic information was obtained along with information about the workers' previous instruction or training in ethics and the nature of ethical conflicts encountered in their public health practice. Only 38% (15 of 39) of the surveyed nurses had had formal instruction in ethics. Even fewer (7.3%) had received continuing education on ethics. Most of the nurses felt confident in their ability to recognize an ethical conflict or dilemma in the workplace; fewer felt confident in their ability to resolve an ethical conflict or dilemma. A high proportion of the nurses agreed that there is a need for continuing education courses on ethics for public health workers. Nurses who had received formal ethics instruction were more likely to feel confident in their ability to recognize an ethical conflict in their public health practice. Continuing education programs on ethics are needed that are designed to meet the specific needs of frontline public health workers.
More Does Not Mean Better: Prenatal Visits and Pregnancy Outcome in the Hispanic Population
Authors: Goss Gay L. , Lee Kathryn , Koshar Jeanette , Heilemann Mary Sue , Stinson Janice
Published: May 2007

Abstract Early and consistent prenatal care (PNC) is thought to play an important role in the reduction of low birthweight (LBW) in the United States. It has been reported that LBW and delayed PNC are common to the Hispanic woman. In California, this cultural group comprises approximately 26% of the population, and much debate concerning health care reform has been targeted at this problem. A comparative study was conducted in California to examine the number of prenatal visits and the outcomes of Mexico‐born Hispanics and U.S.‐born Hispanics. Obstetric and medical record review for 783 women was done. The results show that more prenatal visits did not improve the outcome during pregnancy, labor, or the postpartum period. Because a large portion of PNC is now delivered by the advanced practice nurse, implications for practice include exploring alternatives for the delivery of culturally relevant care, addressing the barriers to caring for this population, and finding alternative models of care that have the potential to produce positive outcomes.
What Do Public Health Nurses Really Do During Prenatal Home Appointments?
Authors: Twohy Kathleen M. , Reif LuAnn
Published: May 2007

Abstract This study describes the nursing interventions and activities utilized by public health nurses in home‐based delivery of care to high‐risk prenatal clients. Fourteen home appointments by nine public health nurses were audiotaped, transcribed, and coded using the Nursing Interventions Classification (NIC) as the coding frame. Seven interventions accounted for approximately 83% of the nursing care during these appointments. Weak relationships were found between the interventions projected in the client's written nursing care plan, the interventions identified in the coded transcriptions, and the chart documentation of the events of the home appointment. Practice, education, and research implications are discussed.
Designing a Care Pathway for a Maternity Support Service Program in a Rural Health Department
Authors: Olds Shelly
Published: May 2007

Abstract Today's heath care system in the United States faces many financial dilemmas related to the country's current economic status. Despite dwindling resources, the health care system must continue to provide high quality care to meet ever‐increasing demands (Ferguson, 1993). Care pathways are an example of case management tools which provide care coordination. With an interdisciplinary approach, pathways increase communication and continuity of care between service disciplines, as well as improve efficient resource utilization. The purpose of this paper was to review: (1) the literature related to the benefits of using care pathways to enhance client care: (2) the benefits of public health nurse home visitation to pregnant and postpartum women; and (3) to describe the process to design a care pathway for the Maternity Support Service (MSS) program at a rural health department. This health department provides MSS to a county with a population of 65,000, with over 900 births per year. The county is 100 miles wide and 28 miles long. Thus, the MSS staff cover a large area, and needed a method to maximize efficient use of staff time. Care pathways have tremendous appeal because they accomodate interdisciplinary teams of care, focus on process, reduce unnecessary variation in care, and attend to quality and client outcomes (Pearson, Goulart‐Fisher, & Lee, 1995).
Community Health and Pediatric Nurses' Knowledge, Attitudes, and Behaviors Regarding Child Sexual Abuse
Authors: Blakeley Judith , Ribeiro Violeta
Published: May 2007

Abstract Community health and other child care nurses can play a major role in the prevention, early detection, referral, treatment, and rehabilitation of victims of child sexual abuse (CSA) and their families. It is not known, however, whether these health care professionals are well prepared or feel sufficiently confident to address these challenges. The present study provides some information on this matter by examining their knowledge, attitudes, practices, and degree of confidence concerning CSA. The total population of community health and pediatric nurses of a Canadian province were surveyed using a mail out questionnaire. The results revealed that these nurses need and want to improve their knowledge and skills regarding the identification, referral, and treatment of victims of CSA. Small but significant differences were noted between the nurses and other professional and non‐professional workers who had been surveyed in a previous study regarding their applied knowledge of CSA, attitudes toward victim credibility and culpability, and punishment for offenders.
Environmental Health Hazards: The Impact on a Southern Community
Authors: Carruth Ann K. , Gilbert Kellen , Lewis Bonnie
Published: May 2007

Abstract The impact of environment on health is a growing area of concern for nurses. The purpose of this study is to describe and characterize residents living near an abandoned hazardous waste site, assess their past and present exposure risk, and describe health concerns and psychosocial effects. Data were obtained by a door‐to‐door outreach effort. Networking was also used to identify residents with health concerns. Extensive field notes were taken to record the responses of residents. A preliminary windshield survey was conducted to approximate the number of residents living in the geographic area, assess the residential community, analyze drainage pathways away from the site, and observe outdoor activity patterns. Community concerns from the residential population were collected and analyzed for recurrent themes. Significant off‐site activity patterns included use of drainage ditches as play areas for children. Foraging on‐site activities included picking berries, crawfishing, geophagy (clay eating), and rabbit hunting. Common health problems described by residents included skin rashes, respiratory‐related complaints, reproductive difficulties, and headaches. The majority of residents were concerned about the incidence of cancer in the area. Identifying the concerns of residents and indicators of health problems helps nurses begin to understand the relationship between the environment and health.
Tried, True, and New: Public Health Nursing in a County Substance Abuse Treatment System
Authors: Littman Patricia S. , Ritterbusch Jill
Published: May 2007

Abstract The Milwaukee Target Cities (MTC) project was the only site within 19 federally funded Target Cities programs to feature a public health nursing model as its sole means of providing comprehensive health‐related services to indigent substance abuse clients. We first describe MTC's implementation process, focusing on the public health nursing component, and then present a program evaluation section with selected findings from the ongoing qualitative evaluation. Initially, misunderstandings about the nurses' community‐based, family‐centered strategy of assuring access to health care through cross‐system service linkage dogged the nurses' efforts to explain their roles and mission to federal funders, project management, coworkers. and treatment providers. In the end, after federal funding ended, public health nursing left an enduring legacy of partnerships in the county substance abuse treatment system: education about public health nursing, networking, referral processes, and resources to meet the complex health‐related needs of indigent substance abusers. Despite the project's many changes, the nurses (a) became specialists in substance abuse, gaining expertise and recognition in a new community, particularly with isolated subpopulations; (b) assured substance abuse clients and their families access to health‐related resources through core public health nursing skills; and (c) educated project staff, administrators, providers, and clients about public health nursing.
Measuring the Need for Nursing Care in Older Adults Living at Home
Authors: Hays Bevely J. , Willborn Elizabeth Hazen , Lopez Pat
Published: May 2007

Abstract The Community Health Intensity Rating Scale (CHIRS) has been found to significantly explain variation in resources consumed by both home health care clients and high‐risk public health nurse clients. Secondary analysis of CHIRS scores from two earlier retrospective studies provided insights into basic similarities and differences between older adults served by a home care program (n= 208) and those served by a public health nursing program for frail elderly (n= 47). CHIRS scores for both client groups demonstrated a substantial need for care, with a greater range of CHIRS global scores for home health care clients but significantly higher CHIRS total scores for the public health nurse clients (t= ‐5.24,p < .001). These findings suggest that the public health nurse clients experienced needs across multiple areas whereas the home health care clients' needs were more narrowly focused and episodic. Representation of needs by an intensity rating such as CHIRS can foster more focused visit planning and more specific outcome assessment, assist in planning staffing and in‐service education, and focus nursing education regarding care of older adults.
Impact of Marital Quality and Parent‐Infant Interaction on Preschool Behavior Problems
Authors: Benzies Karen M. , Harrison Margaret J. , Magill‐Evans Joyce
Published: May 2007

Abstract This study examined the relationships between parent interactions with healthy term and preterm infants at 12 months of age, marital quality, family socioeconomic status, and preschool behavior problems. Eighty mothers and 74 fathers were observed in the home during an interaction with their child (Nursing Child Assessment Teaching Scale). and this group of parents completed the Dyadic Adjustment Scale questionnaire (marital quality) 12 months after the child was discharged from the hospital. Each parent completed the Eyberg Child Behavior Inventory when their child was four years of age. The parent and infant interaction scores were not predictive of later child behavior problems. Maternal perceptions of marital quality at 12 months predicted the frequency (Eyberg Intensity score) and impact (Eyberg Problem score) of the child's problematic behaviors reported by mothers. Marital quality and family socioeconomic status predicted the impact of behavior problems for fathers. There were no significant differences between preterm and term children or between boys and girls in the frequency or impact of problematic behaviors. Mothers reported a significantly greater frequency of behavior problems than fathers of the same children. The implications of these findings for nurses who work with families and young children are discussed.
Using a Nursing Framework to Measure Client Satisfaction at a Nurse‐Managed Clinic
Authors: Bear Mary , Bowers Clint
Published: May 2007

Abstract There is considerable literature on nurse‐managed clinics and client satisfaction with nurse practitioner care. However, the methodological weaknesses of satisfaction measures which are often used limits confidence in the study findings. Satisfaction measures typically lack reliability analysis and/or have limited validity testing. This descriptive, correlational study investigates the validity and reliability of a new measure, the Client Satisfaction Tool (CST) and determines the degree of satisfaction that clients at a newly established senior health clinic had with the primary care services they were receiving. The CST is based upon Cox's Interactional Model of Client Health Behavior and thus was explicitly developed to measure client satisfaction with a nurse practitioner model of care. A convenience sample of 38 clients completed the CST. Responses to the CST indicated that users of the senior health clinic were satisfied with the care they received. Reliability testing showed that the tool has high internal consistency (Chronbach's alpha was 0.956) and high stability (r= 0.974). Construct validity testing with measures of perceived health changes showed that the tool has both convergent (r= 0.599, P≤ 0.01) and divergent (r= 0.194, P > 0.10) validity. Thus, the CST is a methodologically sound measure of client satisfaction that can be used in future research that examines client satisfaction with nurse practitioner care.
The Importance of the Health Education Program Environment for Pregnant and Parenting Teens
Authors: Alpers Rojann R.
Published: May 2007

Abstract Teenage Pregnancy is recognized as one of this country's most critical social issues. Each year, one out of ten females aged 15 to 19 becomes pregnant. In addition, there are a number of documented complications and consequences for the pregnant teenagers, their children, families and society. In response a number of health education programs have been developed to meet the myriad needs of this aggregate. Unfortunately, most of this cohort do not participate in these health education programs. This study, a part of a larger study, was conducted to identify the health education program elements most important to attract and sustain the participation of pregnant and parenting teens in a health education program. The sociodemographics of the pregnant and parenting teens were identified and linked to program elements. Since sociodemographics are often the first information known about a target group, linking these demographics to health education program elements has implications for program development and marketing. An exploratory survey methodology was used in this study and data were analyzed by measures of central tendency, dispersion, and analysis of variance to understand better the relationship between sociodemographic characteristics and importance of the health education program environment for pregnant and parenting teens.
Collaboration Between Schools of Nursing and Local Education Agencies to Provide Health Care Services to Pre‐Kindergarten through Twelfth Grade Students: Elements of Cooperative Agreements
Authors: DeLellis Anthony J. , Henry JoAnne , Decker Larry E.
Published: May 2007

Abstract Establishing cooperative relationships between schools of nursing and local education agencies for the delivery of health care services to children from pre‐school through the twelfth grade is a process all too often characterized by numerous legal, insurance, and administrative roadblocks. While nursing faculty and their students may wish to cooperate with professional educators and their students to enhance the health care of the children, there are obstacles. Both institutions are represented by attorneys, insurance companies and others who must attend to aspects of the process other than direct health care delivery. A model for joint planning and a list of elements of effective agreements are offered as a way of engaging all parties in a constructive and useful process of collaboration.
Nursing Research on the Health of Low‐Income Women
Authors: Reutter Linda , Neufeld Anne , Harrison Margaret J.
Published: May 2007

Abstract The purpose of this paper is to describe the scope of published nursing research on the health of low‐income women. Williams' (1990) model of the relationship between socioeconomic status and health was used as a framework for the analysis. This model includes three major components: Medical Care, Psychosocial Factors, and Health Outcomes. There is a body of published nursing research that addresses a range of health issues of low‐income women. Our search of English language literature published between 1989 and 1995 retrieved 49 articles that met the inclusion criteria. Most of the nursing studies examined a portion of Williams' model but did not address multiple components. The most frequently addressed component was Psychosocial Factors, particularly health practices, stress and coping, and social ties. Williams' model was an effective framework to classify nursing research. Results of our analysis suggest that further research is needed on the pathways by which low income influences health and on the effectiveness of nursing interventions.
Depressive Disorders Among the Chinese Elderly in a Suburban Community
Authors: Lu Chwen‐Hwa , Liu Chia‐Yih , Yu Shu
Published: May 2007

Abstract A community survey of depression among the Chinese ≤ 65 years in age was performed in a suburban setting. One hundred and eighty‐seven individuals comprised the survey group. Among them, 65 (34.8%) were scored ≤ 11 on the Chinese version of the Geriatric Depression Scale. Compared with nondepressed individuals, those with depressive disorders were more likely to be older and with poor family support. Forward stepwise logistic regression analysis identified only age as significantly correlating with geriatric depression scores.
Comox Valley Nursing Centre: From Collaboration to Empowerment
Authors: Clarke Heather F. , Mass Heather
Published: May 2007

Abstract The Comox Valley Nursing Centre was initiated as a two year demonstration project by the Registered Nurses Association of British Columbia (RNABC) and funded by the Ministry of Health. The purpose of the project was to demonstrate innovative nursing practice in a primary health care context. Findings from the project were expected to inform provincial health care planning, nursing scope of practice, and health and nursing policy development. A free standing nursing center was planned and implemented through a collaborative effort by RNABC, nurses and community residents. An external team of researchers evaluated the project using a variety of methods, including participatory action research. During the project an innovative nursing practice, based on principles of collaboration, developed and has continued during the extended provincial and regional funding of the Centre. Drawing from the evaluation findings, case studies and using Henneman, Lee and Cohen's (1995) concept analysis of collaboration, this paper describes how the principles of collaboration were actualized or suppressed. The paper examines how collaboration impacted empowerment for nurses, clients and the community. Lessons learned about the reciprocal relationships between collaboration and empowerment, implications for nursing practice, and how the approach can contribute to a better understanding of the impact of collaborative practice approaches on health care delivery are discussed.
Home Intervention for In Utero Drug‐Exposed Infants
Authors: Butz Arlene M. , Lears Mary Kathleen , O'Neil Siobhan , Lukk Peter
Published: May 2007

ABSTRACT Each year in the United States, around 5.5% (or 230,000) infants are born to mothers who used illicit drugs during pregnancy. The untoward effects of in utero drug exposure (IUDE) include significant decreases in birthweight and length and head circumference, prematurity, and developmental problems. Intensive early intervention, including home‐based interventions, is recognized as an effective method to improve cognitive development and reduce health problems in these high risk infants and children. Examination of home visit records of 20 IUDE infants during their first year of life revealed frequent health and social problems. Infectious disease symptoms were the most frequent problem encountered in the home during the physical assessment of the infants. Of note was the mothers' lack of basic parenting information (understanding signs of illness, basic nutrition, and infant development) which was then provided by the nurse during each home visit. Of concern was the lack of drug treatment sought by these mothers. Findings support the view that home visiting should be incorporated into the discharge planning of any IUDE infant in order to maintain these infants in the health care system and monitor their safety.
Adolescent Pregnancy and Loneliness
Authors: Klein Toni M.
Published: May 2007

ABSTRACT The number of adolescent pregnancies in the United States has reached epidemic proportions. Loneliness and adolescent sexuality, however, have not been previously studied. This descriptive study investigated the relationships of characterological and situational loneliness in childbearing adolescents. Related variables of shyness, self‐esteem, perceived maternal and paternal expressiveness, and social support also were studied. The data were collected at multiple sites in Northern California using a convenience sample of adolescents ranging in age from 12 to 21 years: early (n= 11), middle (n= 22), and late (n= 24). Results of the analysis of variance and the Tukey‐HSD indicated situational variables were more significant than characterological variables in understanding loneliness in early and middle adolescence. The characterological variables were not statistically significant. Using Pearson's correlation coefficient, significant relationships were found among and between variables. The findings suggest parental relationships were powerful in influencing the existence of loneliness as well as self‐esteem, shyness, and social support.
Influence and Leadership in Community‐Based Nursing in Norway
Authors: Ellefsen Bodil
Published: May 2007

ABSTRACT This study investigated the perception of influence and decision making among mid‐level community‐based nurses. Respondents were nurses and nurse leaders in public health nursing, home nursing, and nursing in nursing homes in the municipality. Nurses in three nursing services located within each municipality's Community Health Service in 72 municipalities were surveyed or interviewed. The results show that the leaders of the nursing service and nurses in the three services are regarded as having influence, and in fact, possess more influence on the decision process than the administrative leaders and political management. There are great differences in the perception of decision making among the leaders of the nursing service and nurses in the three services. The leader of the health visiting service has less influence on decision making than the leader of the nursing home, while the health visitor has more influence on decision making and autonomy in professional work than the nurse in the nursing home. These differences might be explained by contextual factors such as tradition, gender, and work process.
Vagus Nerve Stimulation Therapy Induces Changes in Heart Rate of Children during Sleep
Authors: Zaaimi Boubker , Grebe Reinhard , Berquin Patrick , Wallois Fabrice
Published: May 2007

Summary:  Purpose: This study analyzed changes in the heart rates of children receiving vagus nerve stimulation (VNS) therapy for pharmacoresistant epilepsy.

Methods: Changes in the heart rates of ten children receiving VNS therapy for pharmacoresistant epilepsy were evaluated with polysomnographic recordings, including electrocardiogram (ECG), EEG, thoraco‐abdominal distension, nasal airflow, and VNS artifacts. Measurements during stimulation were compared with those at baseline for each patient.

Result: While the VNS therapy pulse generator was delivering stimulation, the heart rates of four children increased significantly (p < 0.01), decreased for one child, and increased at the end of the stimulation for one child. The heart rates of four children did not change. Changes in heart rate varied during VNS, within stimulation cycles for individual children and from one child to another. Changes in heart rate differed between rapid eye movement (REM) and non‐REM (NREM) sleep states. Respiratory changes (increases in frequency and decreases in amplitude) were concomitant with the changes in heart rate.

Conclusion: In this case series of children with pharmacoresistant epilepsy, cardiorespiratory variations occurred while the VNS therapy pulse generator was delivering stimulation. Understanding these variations may allow further optimization of VNS parameters.
Epilepsy and Toxocariasis: A Case‐Control Study in Burundi
Authors: Nicoletti Alessandra , Bartoloni Alessandro , Sofia Vito , Mantella Antonia , Nsengiyumva Georges , Frescaline Guilhem , Preux Pierre‐Marie
Published: May 2007

Summary:  Purpose: A case‐control study to assess the relationship between epilepsy and toxocariasis was carried out in the Kiremba population, Burundi.

Methods: People with epilepsy (PWE) were diagnosed according to the definition proposed by the International League Against Epilepsy (ILAE). Seizures were classified according to the classification proposed by ILAE in 1981. One control per case was selected matched by age (±5 years). Control subjects also lived in Kiremba, had neither neurological disorders nor kinship with the PWE. Cases and controls were assessed serologically for antibodies against Toxocara canis by an immunoblotting assay. Odds ratios (ORs) and 95% CI were determined using conditional regression analysis for matched case‐control study.

Results: One hundred ninety‐one PWE (99 men and 92 women) and 191 age‐matched controls (72 men and 112 women) were enrolled in the study. Of the 191 PWE, 113 presented partial seizures while 73 generalized seizures and five were unclassifiable. Antibodies anti T. canis were found in 114 PWE (59.7%) and in 97 controls (50.8%). Multivariate analysis (conditional logistic regression) showed a significant association between positivity for T canis and epilepsy with an adjusted OR of 2.13 (95% CI 1.18–3.83; p‐value 0.01).

Conclusions: We found a significant association between toxocariasis and epilepsy. In agreement with a previous study, our finding suggests that toxocariasis may increase the risk of developing epilepsy in endemic areas and could participate to the high burden of epilepsy in tropical areas.
Effects of Alpha Adrenergic Stimulation and Blockade on Early Afterdepolarizations Induced by Cesium in Canine Cardiac Purkinje Fibers
Authors: KASEDA SHUNICHI , ZIPES DOUGLAS P.
Published: May 2007

Alpha Adrenergic Stimulation and EADs. The effects of alpha adrenergic stimulation and three alpha adrenoceptor blockers on early afterdepolarizations (EADs) were examined in canine card diac Purkinje fibers. In the first group of 18 preparations, EADs were induced by superfusion with 7.5 mM cesium (Cs) dissolved in low potassium (2.7 mM KCl) Tyrode's solution. During alpha adrenoceptor stimulation (norepinephrine 1 μM and propranolol 1 μM) to enhance EADs, the effects of phentotamine and two new alpha 1 adrenoceptor antagonists, benoxathian and WB 4101 (1, 3, and 10 μM), were examined. WB 4101 (1 μM) suppressed EADs in all six preparations. Benoxathian required 3 μM in five preparations and 10 μM in one to suppress EADs. Phentolamine (10 μM) suppressed EADs in two of six preparations. In the second group of 21 preparations, the effects on cesium‐induced EADs of the three alpha adrenoceptor hlockers (10 μM) were examined without alpha adrenoceptor stimulation. WB 4101 (10 μM) suppressed EADs in seven of seven preparations, while benoxathian (10 μM) suppressed EADs in five of seven. Phentolamine (10 μM) enhanced EADs in six of seven preparations. In the third group of 24 Purkinje fibers, the direct effects (without alpha adrenoceptor stimulation) of these three antagonists on the characteristics of normal Purkinje fiber action potentials superfused with normal Tyrode's solution were examined. Phentolamine (1, 3, and 10 μM, n = 8) prolonged action potential duration at 90% repolarization (APD90) by 5.3%± 1.3%, 10.0%± 1.8%, and 14.3%± 2.7%, respectively. Benoxathian (n = 8) and WB 4101 (n = 8) shortened APD90 equally: 6.8%± 1.1% vs 7.7%± 1.3% at 1 μM, 13.6%± 1.0% vs 14.5%± 1.6% at 3 μM, and 21.1%± 1.2% vs 20.8%± 2.1% at 10 μM, respectively. We conclude that in cesium treated Purkinje fibers: (1) Alpha adrenoceptor stimulation enhanced EADs; (2) Phentolamine was least effective in suppressing EADs, probably because of a direct effect that prolonged MM)90,: and (3) Although benoxathian and WB 4101 had similar etTects on APD90, WB 4101 was more effective in suppressing EADs at lower concentrations than henoxathian.
Transcoronary Chemical Ablation of Incessant Atrial Tachycardia
Authors: SOSA EDUARDO M. , ARIE SIGUEMITUZU , SCANAVACCA MAURICIO I. , VANZINI PALMIRA , BELLOTTI GIOVANNI , PILEGGI FULVIO
Published: May 2007

Transcoronary Ablation of Incessant Atrial Tachycardia. Incessant atrial tachycardia, of at least 10 years duration and not controllable by antiarrhythmic drugs, was ablated by means of transcoronary administration of ethanol in a 24–year‐old female. The arrhythmia was suppressed completely without recurrences during 8 months of follow‐up. (J Cardiovasc Electrophysiol, Vol. 1, pp. 116–120, 1990)
Profibrillatory Effects of Multiple Extrastimuli
Authors: AVITALL BOAZ , BUMP THOMAS E.
Published: May 2007

Profibrillatory Effects of Extrastimuli. Multiple extrastimuli are known to cause ventricular Hhrillation in normal hearts. The mechanisms by which multiple extrastimuli facilitate induction of ventricular fibrillation were studied in 10 normal, anesthetized, open chest dogs. Strength‐interval curves and latency‐interval curves were measured following basic drive (S1S1) and following captured single and double extrastimuli (S2and S3). The zone of relative refractoriness was widened by closely coupled extrastimuli: 44 ± 8 msec after basic drive. 81 ± 19 msec after S2 and 92 ± 15 msec after S2S3 (P <0.001 compared to basic drive). The maximum latency between a test stimulus and its propagated response was prolonged by extrastimuli: 95 ± 6 msec after basic drive, 144 ± 11 msec after S2, and 162 ± 12 msec after S3 (P <0.001). Extrastimuli that were not closely coupled (i.e., that were delivered 30 or 50 msec following the effective refractory period of the previous beat) had little effect on the zone of relative refractoriness or maximum latency of subsequent stimuli. Catbodal, anodal, and bipolar extrastimuli had similar effects on effective refractory period, zone of relative refractoriness, and latency. Extrastimuli did not cause decreases in threshold for capture and did not exaggerate early diastolic dips in strength‐interval curves. Forty episodes of ventricular fibrillation were induced in eight of ten dogs. Latency‐interval curves that induced VF had longer maximum latency (P <0.001) and wider zones of relative refractoriness (P <0.001) than did latency interval curves that did not result in ventricular fibrillation. Prolongation of the relative refractory period resulted in corresponding prolongation of latency with correlation coefficient of 0.97, however, both of these parameters correlated poorly with the coupling interval of The premature stimuli (R = 044 and 043). In conclusion, premature extrastimuli may facilitate induction of ventricular fibrillation by widening the relative refractory period and prolonging latency. However, premature stimuli initiated at coupling intervals of over 30 msec above the ERP of the previous propagated beat eliminate much of the relative refractory period and latency increase, and were not associated with ventricular flbrillation. (J Cardiovasc Electrophysiol, Vol. I, No. 3, pp 197–208, June 1990)
Mechanism of the Vulnerable Period in a Model of Cardiac Fibrillation
Authors: ABILDSKOV J. A.
Published: May 2007

Vulnerable Period. The mechanism of the vulnerable period for induction of fibrillation was investigated with a computer model of propagated excitation. The model included nonuniform cycle length dependent refractoriness and slow propagation during incomplete recovery. Recovery properties that permitted induction of fibrillation by a single stimulus were identified, and fibrillation usually occurred after stimuli later than the earliest stimulus resulting in propagation. The responsible mechanism was slow propagation near the stimulus site during excitation from the earliest effective stimulus. The time required for That propagation permitted sufficient recovery in surrounding regions that excitation propagated without reentry. Later stimulation was associated with more rapid propagation near The stimulus site, so surrounding regions were invaded while recovery was markedly nonuniform. This resulted in nonuniform propagation and self sustained reentrant excitation simulating fibrillation. Nonuniformity of premature propagation was quantitated and increased with increasing stimulus cycle length before progressively decreasing. The time of maximal increase of nonuniformity became later with increasing mean value of disparate recovery, but was not affected by The range of disparity. Findings provide a possible explanation for failure of The earliest propagated premature response to initiate fibrillation and suggest That prolonged recovery is associated with vulnerability to late premature responses. (J Cardiovasc Electrophysiol, Vol. l, pp. 303–308, June 1990)
Overdrive Suppression of Antegrade Conduction Over A Kent Bundle Induced by Disopyramide
Authors: INOUE HIROSHI , SAIHARA SHINICHIRO , USUI MASAHIRO , TODA IKU , NOZAKI AKIRA , SUGIMOTO TSUNEAKI
Published: May 2007

Overdrive Suppression of Kent Conduction. A patient with Wolff‐Parkinson‐White syndrome was described in whom antegrade conduction over the Kent hundle was suppressed after termination of orthodromic tachycardia. A phenomenon indicative of overdrive suppression of conduction occurred after intravenous disopyramide, and tended to be rate and lime dependent. (J Cardiovasc Electrophysiol, Vol. 1, No. 6, pp. 512–516 December 1990)