Research lessons from implementing a national nursing workforce study.

BACKGROUND: National nursing workforce studies are important for evidence-based policymaking to improve nursing human resources globally. Survey instrument translation and contextual adaptation along with level of experience of the research team are key factors that will influence study implementation and results in countries new to health workforce studies. AIM: This study's aim was to describe the pre-data collection instrument adaptation challenges when designing the first national nursing workforce study in Poland while participating in the Nurse Forecasting: Human Resources Planning in Nursing project. METHODS: A descriptive analysis of the pre-data collection phase of the study. Instrument adaptation was conducted through a two-phase content validity indexing process and pilot testing from 2009 to September 2010 in preparation for primary study implementation in December 2010. Means of both content validation phases were compared with pilot study results to assess for significant patterns in the data. RESULTS: The initial review demonstrated that the instrument had poor level of cross-cultural relevance and multiple translation issues. After revising the translation and re-evaluating using the same process, instrument scores improved significantly. Pilot study results showed floor and ceiling effects on relevance score correlations in each phase of the study. LIMITATIONS: The cross-cultural adaptation process was developed specifically for this study and is, therefore, new. It may require additional replication to further enhance the method. CONCLUSIONS: The approach used by the Polish team helped identify potential problems early in the study. The critical step improved the rigour of the results and improved comparability for between countries analyses, conserving both money and resources. This approach is advised for cross-cultural adaptation of instruments to be used in national nursing workforce studies. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Countries seeking to conduct national nursing workforce surveys to improve nursing human resources policies may find the insights provided by this paper useful to guide national level nursing workforce study implementation.

Serum tryptase level is a better predictor of systemic side effects than prostaglandin D2 metabolites during venom immunotherapy in children.

OBJECTIVES: We performed a prospective study to analyze mast cell mediators as predictors of systemic adverse reactions during rush venom-specific immunotherapy (VIT) in children. PATIENTS AND METHODS: Nineteen children aged 5-17 years received VIT with Venomenhal (HALAllergy). We analyzed serum tryptase (CAP, Phadia), plasma prostaglandin (PG) D2 metabolites (9alpha, 11beta-PGF2), and urine PGD2 metabolites (9alpha, 11beta-PGF2, tetranor-PGD-M) using gas chromatography mass spectrometry before and after the rush protocol. RESULTS: Three boys with high baseline serum tryptase values (>7.76 g/L) (P < .001) and low 9alpha, 11beta-PGF2 concentrations developed grade III systemic adverse reactions during VIT. Baseline serum tryptase was lowest in children who had a Mueller grade II reaction (1.93 [0.36]) before VIT and highest in children with a Mueller grade III reaction (6.31 [4.80]) (P = .029). Repeated measures analysis of variance confirmed that, in children who developed systemic adverse reactions during VIT, serum tryptase was higher both before and after desensitization and increased significantly following the procedure. Analysis of PGD2 metabolites in the prediction of systemic adverse reactions during VIT was inadequate (sensitivity 67% and specificity 0.53%), whilst prediction based on serum tryptase was accurate. CONCLUSIONS: In children with severe systemic adverse reactions to Hymenoptera sting, the evaluation of baseline tryptase levels should be a standard procedure. Children with Apis mellifera venom allergy and baseline tryptase levels higher than 7.75 g/L are at risk of anaphylaxis during buildup. Lower baseline values of plasma and urinary PGD2 metabolite concentration in patients with systemic adverse reaction during VIT suggest that prostaglandin catabolism is altered.

Factors determining changes in self-rated health in the Polish community-dwelling elderly.

Changes in self-rated health and its determinants have been analyzed in the group of 551 community-dwelling older age citizens of Krakow during the 12-year interval observation. Multidimensional model showed that changes in self-rated health between the studies have been significantly determined by such variables like age and self-evaluation of health status in the Ist study. Self-rated health was also less markedly decreased in men, who continued professional activity in the Ist study. Among variables analyzed in the IInd study it was age-related functional disability reported by men and reported chronic conditions that deteriorated self-rated health significantly. Changes in self-rated health between the Ist and the IInd study among women were determined by the same variables as in men (except for the continuation of professional activities in the Ist study). Significantly diminished scores were found in women with higher level of functional activity in the Ist study and greater independence in performing daily activities in the IInd study. Analysis of the summary effect of chronic diseases on self-rated health has shown significantly greater deterioration of self-rated health between the first and the second study related to the number of diseases reported in the Ist study.

Gender-related differences in self-rating of health and functional status of elderly people with ischaemic heart disease. Comparative study in 12-year period.

PURPOSE OF THE STUDY: The study aim is to present changes in the self-rating of health and functional status in performing activities of daily living, reported by the elderly persons with ischaemic heart disease (IHD), at the time interval of 12 years. Gender-related differences as well as socio-medical characteristics have been involved in the analysis changes. DESIGN AND METHODS: The study was carried out in 607 elderly respondents who participated in two surveys at the time interval of 12 years. The analysis of the functional ability in performing daily activities in both surveys was based on the ADL and IADL scales, self-rated health was based on the scale ranging from very poor to excellent health. RESULTS: It has been observed in the baseline survey that the respondents with IHD reported lower mobility, functional activity and scored their health lower than other respondents. Though females with IHD scored higher their functional ability than males with the same disease, decrease of their functional ability at the time interval between both surveys was three-fold higher compared to males with the same disease. The results of the second study demonstrated age-related level of self-coping with the activities of daily living (ADL scale) in females with IHD, while none of the factors from the baseline survey had influence on their functional independence (irrespective of IHD). Functional status in the second study of males with IHD has been influenced by age and presented in baseline study willingness to life, while in males who have not reported IHD, any factor coming from the 1st survey have not determined the level of independence in activities of ADL in survey II. Functional ability in males with IHD was affected in the IInd study, besides age, by the attitude denying weariness of life demonstrated in the baseline survey. None of the factors from the baseline survey determined self-coping with daily activities by the males without IHD as it was observed in the IInd study.