Care of very low birth weight infants by neonatal nurse clinicians.

In 1980, the medical facility at the authors' hospital developed a program to train neonatal critical care nurses for primary care provider roles in the intensive care nursery. The neonatal nurse clinician (NNC) program consists of a didactic portion that emphasizes physiology and pathophysiology of sick newborns, and an internship that focuses on the medical needs of very low birth weight (VLBW) neonates. At the completion of the internship, the NNC is assigned to be the primary care provider for infants with birth weights less than or equal to 1,250 g. This report discusses the NNC training program and the five-year experience with the NNC caring for VLBW infants.

The environmental profile of a community's health: a cross-sectional study on tobacco marketing in 16 countries

To examine and compare tobacco marketing in 16 countries while the Framework Convention on Tobacco Control requires parties to implement a comprehensive ban on such marketing.METHODS:Between 2009 and 2012, a kilometre-long walk was completed by trained investigators in 462 communities across 16 countries to collect data on tobacco marketing. We interviewed community members about their exposure to traditional and non-traditional marketing in the previous six months. To examine differences in marketing between urban and rural communities and between high-, middle- and low-income countries, we used multilevel regression models controlling for potential confounders.FINDINGS:Compared with high-income countries, the number of tobacco advertisements observed was 81 times higher in low-income countries (incidence rate ratio, IRR: 80.98; 95% confidence interval, CI: 4.15-1578.42) and the number of tobacco outlets was 2.5 times higher in both low- and lower-middle-income countries (IRR: 2.58; 95% CI: 1.17-5.67 and IRR: 2.52; CI: 1.23-5.17, respectively). Of the 11,842 interviewees, 1184 (10%) reported seeing at least five types of tobacco marketing. Self-reported exposure to at least one type of traditional marketing was 10 times higher in low-income countries than in high-income countries (odds ratio, OR: 9.77; 95% CI: 1.24-76.77). For almost all measures, marketing exposure was significantly lower in the rural communities than in the urban communities.CONCLUSION:Despite global legislation to limit tobacco marketing, it appears ubiquitous. The frequency and type of tobacco marketing varies on the national level by income group and by community type, appearing to be greatest in low-income countries and urban communities.

Family practitioners and the prescription of psychoactive drugs.

Sixty-eight family physicians in Toronto were personally interviewed and reported the drugs they prescribed for a list of functional ailments, estimated extent of their per-patient prescribing of psychoactive drugs, also their attitudes toward emotionally disturbed or neurotic patients. Numerous variables were explored, but the only important correlation with lower prescribing rates was the period of graduation (1955 or later), irrespective of the patient population composition. Attitudes toward neurotics had no connection with per-patient prescribing, older graduates holding as favorable attitudes as more recent ones. An unfavorable attitude did, however, correlate with a greater number of patients seen on an average day. Background characteristics, professional associations and types of practices are described. Some irrational elements in prescribing are discussed.