ß-Blockade in the perioperative management of the patient with cardiac disease undergoing non-cardiac surgery.

The cardiology literature has suggested for decades that ß-blockade protects patients with ischaemic heart disease. Extending this concept to perioperative patients initially produced promising results, with reductions in perioperative myocardial ischaemia and longer-term cardiovascular complications observed in several small randomized trials. However, subsequent larger trials have either shown no benefit or greater morbidity (especially stroke), despite reductions in cardiovascular events. Retrospective database analyses have confirmed or disputed these findings. Speciality societies, most importantly, the American Heart Association/American College of Cardiology Foundation, have promulgated guidelines for perioperative ß-blockade, which have been revised, as the evidence has changed. While the European guidelines continue to emphasize perioperative ß-blockade in high-risk patients, the American guidelines have reduced the strength and breadth of recommendations, focusing on haemodynamic titration. Future work will need to focus on identifying populations most likely to benefit or to be harmed, including pharmacogenetic analyses and distinctions between individual ß-blockers.

Utilization and satisfaction with prenatal care services.

This study was conducted in St. Petersburg, Russia, under the auspices of the World Health Organization, Healthy Cities Project, and the St. Petersburg Healthy City Project. The purpose of this study was to investigate the predict use of prenatal care services (utilization) and satisfaction with the services. A high maternal mortality rate and low attendance at prenatal clinics brought this health care issue to the forefront of the St. Petersburg Healthy City Project agenda. Aday and Andersen's conceptual model was used to investigate use of and satisfaction with prenatal care services. Several characteristics of pregnant women were found to influence early use of prenatal care services and women's level of satisfaction. Need had no influence in explaining when women started prenatal care or satisfaction with the services. Lastly, there was no relationship between early use of prenatal care services and women's level of satisfaction with the services.

Creating violence-free healthy cities for our youth.

Communities are seeking ways to improve health by reducing violence. The Social Ecology Model of Adolescent Interpersonal Violence Prevention is presented as a tool for communities to use in identifying and addressing the multiple factors impacting engagement in or avoidance of violent behaviors. The CityNet Healthy Cities model is presented as a process for communities to use in developing broad-based actions groups capable of having an impact on violence. Together these models can be used by health professionals as they work with communities. Suggestions for community assessment, evaluation of available programs, committee development, and implementation are provided using the two models.

Communicating with the public: community-based nursing research and practice.

This paper presents examples of community-based nursing research in relation to selected health care trends that affect practice and considers ways the media can help community health nurses be more effective communicators with the public. Research provides evidence that community-based nursing practice includes quality services that can control costs; a focus on disease prevention and health promotion; the organization of services where people live, work, and learn; partnerships and coalitions; service to people across the life span; services to culturally diverse populations; access to services for at-risk populations; development of the community's capacity for health; work with policy makers for policy change; and efforts to make the environment healthier. Two approaches to communication with the public through the media, social marketing and media advocacy, are compared. It is recognized that community health nurses are well prepared and suited for media advocacy. Media advocacy can be used to not only communicate the effectiveness of community-based nursing practice but also to support the community's voice for public health.

Detection of soft X-rays and a sensitive search for noble gases in comet Hale-Bopp.

An image of comet Hale-Bopp (C/1995 O1) in soft x-rays reveals a central emission offset from the nucleus, as well as an extended emission feature that does not correlate with the dust jets seen at optical wavelengths. Neon was found to be depleted in the cometary ice by more than a factor of 25 relative to solar abundance, which suggests that ices in Hale-Bopp formed at (or later experienced) temperatures higher than 25 kelvin. A helium line emission at a wavelength of 584 angstroms was detected and may be attributable to charge transfer of solar wind alpha particles in the cometary coma. Ionized oxygen and another helium line contribute to an emission observed at 538 angstroms.

Partnerships in healthy cities and communities: a social commitment for advanced practice nurses.

People, recognizing that health is influenced by factors affecting the broader environment, are building healthier communities locally. The principles of the Ottawa Charter for Health Promotion gave direction for the development of the Healthy Cities movement globally. Community-oriented advanced practice nurses (APNs) have skills and expertise to support community leaders in their efforts to build healthier communities. Examples of partnerships involving Healthy Cities and Communities and APNs include: community leadership development, community assessment, nurse managed services, research, and policy advocacy. Based on APN experiences in community health promotion, future challenges are suggested.

Healthy Cities: toward worldwide health promotion.

Healthy Cities is a community problem-solving process for health promotion that began in Canada and Europe in the mid-1980s. Although Healthy Cities have expanded worldwide, there is limited scientific literature that documents the effects of these efforts. This review describes the dynamic status of Healthy Cities globally and summarizes what is known about these efforts. It is difficult to draw generalizations or clear differences between Healthy Cities and other efforts with similar objectives in the United States. There appears to be less variation among Healthy Cities in Europe, most likely because of the extensive technical support provided by the WHO European Regional Office to the Healthy Cities Project. Case descriptions present the diversity and types of activities of Healthy Cities. It is concluded that community participation and broad involvement from different sectors of the community are promising approaches to addressing urban problems.

Characteristics of pregnant women, utilization, and satisfaction with prenatal services in St. Petersburg, Russia.

A descriptive study with a convenience sample of 47 subjects drawn from two birthing houses was conducted in St. Petersburg, Russia, under the auspices of the World Health Organization Healthy Cities Project. Data were collected with a self-administered questionnaire given to women in birthing houses after delivery and prior to discharge. Subjects ranged in age from 16 to 38 years. Sixty-one percent of women began prenatal care within the 1st trimester, 35% within the 2nd trimester, and 2% received no prenatal care. Younger women were more likely than older women to start prenatal care in the 1st trimester, but received less teaching by health care providers. Younger women also expressed more stress and need for counseling. In addition, 83% of low-birthweight babies were born to younger women. These findings indicate a focus by health care personnel on older pregnant women, although younger pregnant women were at higher risk for poor pregnancy outcome. The strongest statistically significant correlations were found among the patient satisfaction variables, indicating that satisfaction with prenatal services may influence when women begin prenatal care services.

A cost analysis of a nurse-managed, voluntary community health clinic.

Nurse-managed, voluntary community health centers are thought to represent cost-effective means of providing healthcare to the medically indigent. A cost analysis of a community healthcare clinic indicates that the cost of a clinic visit may be more expensive than the cost of a community physician visit when all costs (real and donated) are included. Increasing the number of patients seen per hour may be necessary to achieve more cost-effective delivery.

Empowering communities: action research through healthy cities.

The Healthy Cities process uses action research to empower communities to take action for health. Five concepts that link community empowerment and action research are: focus on community, citizen participation, information and problem solving, sharing of power, and quality of life. Two city examples from Healthy Cities Indiana, a pilot program of CITYNET Healthy Cities, provide illustrations of these concepts. The dynamics of community participation in action research and the successes and barriers to community participation are presented. Outcomes that empowered the community are suggested: the extent to which Healthy City projects are initiated, their progress monitored, continued action in health supported, resources obtained, and policies promoted that contribute equity in health.

Healthy cities: the Indiana model of community development in public health.

While the Institute of Medicine's Report on The Future of Public Health provokes debate on public health issues in the United States, the Healthy Cities movement is one approach to addressing many of these issues. Healthy Cities Indiana began in 1988 and adapts the European and Canadian healthy cities experience within the sociopolitical context of Indiana and the United States. Six Indiana cities are collaborating with Indiana University School of Nursing and the Indiana Public Health Association in a process of urban health promotion. The overall healthy cities process is presented including: city commitment, formation of healthy city committee, community leadership development, city action, provision of data-based information to policy makers, and action research and evaluation. Each step in the healthy cities process is described, highlighting examples from the Indiana experience, including an analysis of selected data describing the cities. The facilitators of a healthy city provide support to city leaders in other cities interested in becoming involved in the healthy cities process. Implications of healthy cities for health educators and other health professionals are suggested.

Preparation of community health nursing leaders for social action.

Indiana University School of Nursing graduate Department of Community Health Nursing has been preparing community health nurses for primary health care practice, as defined by the World Health Organization since 1978. The faculty are committed to preparing community health nursing leaders for social action aimed at improving the health of the community in both the Department's major in the master's programme and its new major in the doctoral programme. The core curricula for these majors in both programmes are presented. The master's curricula is based on integrating public health principles with those of community development. The doctoral major builds on this base of primary health care practice with a curriculum focused on the contribution of community health nursing to public and health policy. The graduates of the master's programme are prepared to work with community groups as a social force in promoting the health of the community. The graduates of the new doctoral major entitled "Health Policy and the Health of the Community" are being prepared as community health nursing leaders with expertise in health care policy and the legislative process with a focus on issues related to nursing and community health. These graduates will be able to function within the broader community, including national and international settings. Based on experiences in graduate education in community health nursing recommendations are made for the response graduate nursing education must make in order to prepare appropriate leaders who can work toward the goal of improving the community's health.