An exploratory study of parents' approaches to health promotion in families of adolescents with physical disabilities.

BACKGROUND: The life expectancy of children with physical disabilities now extends into adulthood and has been accompanied by the transfer of rehabilitation services from institutions to the home. Thus, families must increasingly partner with health service providers to promote their child's health and prevent the development of secondary conditions that may contribute to heart disease, stroke, respiratory diseases, low endurance and emotional difficulties. AIM: To investigate within a family context the health promotion efforts of parents on behalf of a child with a physical disability. METHOD: The Long Interview Method was used to interview 15 families (11 two-parent and 4 single-parent) having a child 11-16 years of age with a physical disability including cerebral palsy (7), spina bifida (3), muscular dystrophy (3) and other conditions (2). RESULTS: Parents' health promotion efforts were characterized by three main themes. First, parents emphasized traditional lifestyle health behaviours including nutrition, physical activity, tobacco, alcohol and drug use, and personal hygiene. Second, parents tried to foster their adolescent's social life and friendships. They expressed particular concern about how, and if, their child would develop a sense of purpose and have a productive future. Third, parents invested a great deal of effort into observing daily routines, making arrangements for their child's social inclusion and supporting their child in a way that balanced independence with safety and energy conservation. CONCLUSIONS: Parents recognize that their child with a physical disability faces greater obstacles, and work hard at health promotion. Healthcare workers need to work with parents to: (1) provide information about specific lifestyle health behaviours including nutrition, physical activity and sexuality; (2) advocate for resources to foster social inclusion; and (3) discuss family strategies that balance parental involvement with their child's need for independence and energy conservation for daily activities.

Squamous cell carcinoma of the pyriform sinus.

At the Roswell Park Memorial Institute, 111 patients were treated for squamous cell carcinoma of the pyriform sinus over a 15-year period. Treatment modalities included surgery, radiation therapy, or a combination of both. A retrospective study was carried out to determine how these treatments, used singly or in combination, affected the cure rate. TNM clinical staging and recurrence patterns were studied, and a high tendency for distant metastases was documented. The five-year survival figure in this study was 29% (28/97).

Reconstruction of massive orbito-maxillary-cheek defects.

The problem of soft-tissue reconstruction in patients who must undergo radical resection of the maxilla, orbit, and cheek is discussed. This problem is greatly complicated by previous radiation therapy or by the need for postoperative radiation therapy. Restoration of oral competence is of primary importance and usually cannot be satisfactorily accomplished with prosthetic appliances when a stable support base is lacking. An orderly reconstructive plan with a high success rate is of the utmost help to the surgeon facing this problem. A multistaged procedure utilizing a deltopectoral flap that has been successful in 7 patients is presented.

Chemotherapy for advanced and recurrent squamous cell carcinoma of the head and neck with high and low dose cis-diamminedichloroplatinum.

Cis-diamminedichloroplatinum (cis-DDP) in both a high dose regimen of 120 mg/M2 every three weeks with pretherapy hydration and mannitol diuresis and a low dose regimen of 20 mg/M2 daily for five days and cycled every three weeks have effective antitumor activity in approximately one third of patients. Its toxicity in both regimens appears to limit the number of cycles of administration and the duration of response. Further trials with dose schedules intermediate between the present high and low dose schedules are needed to provide a suitable and effective one day regimen every three to four weeks that can be given on an outpatient basis and on a long-term basis.

Correlation between prognosis and degree of lymph node involvement in carcinoma of the oral cavity.

Accurate histologic determination of lymph node metastasis is most important in predicting prognosis in patients who undergo radical neck dissection. In this study of 340 determinate patients, the five year survival was 75 per cent when lymph nodes were histologically negative, 49 per cent when one lymph node was positive, 30 per cent when two lymph nodes were positive, and 13 per cent when three or more nodes were positive. Other factors useful in predicting prognosis are, to some extent, the level of lymph node metastasis in the neck, and the presence or absence of capsule penetration and soft tissue involvement. Those patients with metastasis to three or more lymph nodes had a five year survival of 13 per cent and belong to a high risk group. In this high risk group among those who died, the incidence of recurrence in the neck was 72 per cent, and the incidence of distant metastasis was 70 per cent. When autopsy was performed, more still were found to have distant metastasis, 75 to 80 per cent. Most of these high risk patients already have systemic dissemination of cancer at the time of their initial therapy; therefore, the addition of a systemic form of adjuvant therapy, such as chemotherapy and/or immunotherapy, is justified.

Individualist and structuralist perspectives on nutrition education for Canadian children.

The controversy over the most efficacious approach to health education is presented as a debate between the individualist perspective which stresses lifestyle change and the structuralist perspective which emphasizes change in socio-political conditions. Within the context of nutrition education for Canadian children as a case study, the two perspectives are compared and contrasted with respect to their definitions of (1) the root causes of poor health, (2) the most appropriate strategies for health education programs and (3) the training and subsequent role of the health educator in health promotion. The authors discuss the conflict between the two perspectives and suggest that synthesis is needed for progressive health promotion for Canadian children to occur.

Adolescents with physical disabilities: some psychosocial aspects of health.

PURPOSE: To examine the psychosocial issues related to growing up with a physical disability. METHODS: Adolescents with physical disabilities aged 11-16 years were compared with a Canadian national sample of adolescents using the Health Behaviours in School-Aged Children (HBSC), a World Health Organization Cross-National Study survey. RESULTS: Adolescents with physical disabilities reported good self-esteem, strong family relationships, and as many close friends as adolescents in the national sample. However, adolescents with physical disabilities participated in fewer social activities and had less intimate relationships with their friends. They had more positive attitudes toward school, teachers, and their fellow classmates than the national sample, but fewer had plans for postsecondary education. The majority of adolescents with physical disabilities reported that they had not received information on parenthood, birth control, and sexually transmitted diseases. CONCLUSIONS: There are a number of critical areas of risk for adolescents with physical disabilities to which health promotion efforts should be directed. These include lower levels of peer integration, heightened adult orientation, low educational aspirations, and poor knowledge of sexuality.

Children in the context of "Achieving Health for All: a Framework for Health Promotion".

We analyze Achieving Health for All: A Framework for Health Promotion with respect to children. Although the document acknowledges the health needs of children, it depicts them as passive beneficiaries of health care efforts taken by others on their behalf. We believe that, like adults, children should become active participants in all of the health-promoting activities proposed in the framework and that they can do so if taught life skills for health which emphasize decision making, coping and community participation skills.

Outcomes of nurse (RN) refresher courses in a midwestern city.

Graduates of RN refresher courses offered by three hospitals in a midwestern city from 1981 to 1991 were surveyed (N = 179) to compare the nurses who returned to work (n = 148, 82.7%) with those who did not return to work (n = 26, 14.5%) on demographic and career characteristics, personal responsibilities, and attitudes toward professional nursing (5 nurses [2.8%] did not respond to this item). The non-returning group had fewer mean years of experience prior to leaving nursing, more mean years since last nursing position, and lower mean scores on the Professional Attitude scale used in this study, but the differences were not statistically significant.

Benefits of collaboration in continuing education: a partnership between a university provider and a nursing specialty organization.

During the past 2 years, a university provider of nursing continuing education and the local chapter of a specialty nursing organization have successfully collaborated in the delivery of continuing education. This collaborative approach has been effective for providing continuing education in oncology nursing that serves the needs of nurses in the geographic area and maximizes the effective use of the resources of both partners. This approach has also prevented overlaps in program planning dates and duplication of content within the geographical area. Additional benefits include a growth in membership for the specialty organization and a sustained level of interest and attendance in programs sponsored by the university provider.

Caring for the terminally ill: experiences of Latvian family caregivers.

AIM: To increase understanding of the experiences and needs of family caregivers of terminally ill persons in Latvia. BACKGROUND: Latvia has high death rates from cardiovascular disease and cancer, and families care for the terminally ill with little preparation and support. Health professionals also have little preparation in supporting these patients and families at the end of life. METHODS: A qualitative study was carried out in the summer of 2004 in Latvia. Data collection was by semi-structured interviews with caregivers (n=18) whose care recipients died at least 1 year previously. FINDINGS: The caregiver narratives addressed experiences that paralleled the trajectory of the patient's illness: the disruption of normal life patterns; taking on the caregiver role; establishing new patterns and learning role competencies; engaging in preparation for dying; and the gains and losses of the caregiving experience as seen in retrospect. CONCLUSIONS: The caregiver narratives suggested a need for more education in practical caregiving; access to patient care equipment and supplies; and a need for ongoing support and guidance by knowledgeable medical personnel during caregiving.

Latvian community nurses practising in a time of turmoil: a thin line of defence for children at risk.

Recent World Health Organization (WHO) statistics rank Latvia below average on a number of health indicators, compared to other European Union (EU) candidate countries. Nurses who visit children in the home see a close-up view of the decline in health. This exploratory study was designed to understand the day-to-day experience of a representative sample of 17 Latvian nurses visiting infants and children in 1999, almost 10 years after the collapse of the Soviet Union. Analysis of practice reports from group and individual interviews, using interpretive phenomenologic methods, revealed three consistently emerging themes: the negative impact of societal change and dislocation on clients and nurses; clinical reasoning concerning degree of risk to children and priorities for intervention; and the physical and emotional burden of caring for increasingly vulnerable children. Risk assessment was expressed in the classification of families as 'good little family, a family that was 'simply poor, or a family that was a 'social risk.' With the first two types of families, concern about children was balanced with concern about the family as a whole. With 'social risk' families, the primary concern of the nurses was safeguarding the child. The findings cannot be generalized, but may imbue family health and welfare statistics with a human face, and suggest directions for education, practice and further research.

Sowing the seeds of public health nursing--1920-39.

The Florence Nightingale International Foundation and the Florence Nightingale International Courses played an important role in the development of public health nursing leadership in Europe and remain an outstanding example of international collaboration. Through the International Courses 203 nurses from 40 countries were prepared to organize and implement systems of public health nursing where none had previously existed; another 97 nurses were prepared for leadership as administrators and teachers. Below, how the courses started and their impact as viewed by nursing leaders of that era.

Starting from a blank page: discovering and creating community health nursing in post-Soviet Latvia.

Nurses discovering the practice and creating the tradition of community health nursing without mentors or forerunners have to learn from the practice itself and from each other. Data in the phenomenologic study of 17 Latvian community health nurses (CHNs) consisted of group and individual interviews and observation of practice with families. The focus of this article is the situated practice of nurses in the new role of primary care CHN, revealed through clinical stories that give voice to nurses in a particular historical and social context. The stories of the nurses in this article provide evidence of a growing ability to practice from a health promotion/prevention focus and engage with families and neighborhoods. The practice is still developing, and at this point nurses are not drawing on experience with families to identify and care for vulnerable populations.

Home health agency preferences for staff nurse qualifications, and practices in hiring and orientation.

The purpose of this study was to describe home health agency preferences with respect to staff nurse qualifications, and practices in hiring and orienting new staff. An 85-item home health staff nurse selection and orientation questionnaire was used to collect data from a random sample of 287 midwestern home health agencies in 12 states. Qualifications rated most highly were medical-surgical experience, venipuncture skills, completion of a physical assessment course, intravenous therapy skills, and patient-teaching skills. With agency sponsorship (traditional, proprietary, and hospital-based) as the independent variable, the three types of agencies were significantly different on ratings of six qualifications and six orientation topics. None of the agencies rated a BSN degree as very important or required, and the same was true for completion of a student experience in community health nursing. Preference for qualifications in this study is consistent with increasing acuteness of patients' illness and technologic complexity of home care.

Children's concepts of health and illness--and implications for health education: an overview.

Research on children's concepts of health and illness has been dominated by two theoretical approaches. The first has been concerned with the delineation of age-related qualitative changes in children's concepts of health and illness and the interpretation of these changes within a Piagetian framework. The second approach, based on expectancy theory from social psychology, has focused on children's perceptions of vulnerability to health problems and the relationship of these to potential health behavior. Both approaches have emphasized children's concepts of illness or of health problems. Thus, there is a dearth of literature on concepts of health per se.

Latvian nurses depart from Soviet ways.

As their country tries to break away from the Soviet political system, Latvian nurses try to break away from a Soviet health care system that has relegated their profession to one completely dominated by physicians. Two Latvian-born American nurses provide a glimpse of the early stages of this struggle.