Health literacy and behavioral health factors in adults.

OBJECTIVES: This study was to examine the relationship between health literacy (HL) and health behaviors in the South Bohemia Region in the Czech Republic (CR) and compare them to HL and health behaviors in the Visegrád group countries (Czech Republic, Hungary, Poland, and Slovakia). The paper reports the results from the research in the CR. STUDY DESIGN: A quantitative descriptive study. METHODS: The sample was stratified by sex and age and included a representative sample of 303 adults. The data were collected using the combination of a country-specific questionnaire with the HLS-EU-16 standardized questionnaire. RESULTS: Exercise was significantly associated with perceived health and HL; those with a lower level of HL did not exercise during the previous month. Based only on full answers (N = 251), inadequate HL was identified in 17.5% of the respondents (44), marginal HL in 31.5% (77), and adequate HL in 51% (128) of the respondents. Nearly 49% of the participants evaluated their health as 'good', 25.7% rated their health as 'very good' and 'satisfactory' by 25.7%. But 41.6% experienced one or more chronic diseases, 37.6% had some limitations to their health, and 20.5% smoked. For alcohol consumption, 26% drank weekly and 23% drank two to three times a month. Exercise varied from never (29.7%) to daily (7.9%). CONCLUSION: Based on our results, we conclude that health behavior risk factors are still present in the South Bohemia region of the CR regardless of levels of HL reported on the HLS-EU-16.

Mothers' explanatory models of lack of child growth.

This qualitative study elicited the explanatory models (EMs) of child growth held by mothers of growth-deficient children. EMs are culturally constructed explanations for a specific illness and its treatment (Kleinman, 1980). The EM concept was adapted for this study to focus on a child health condition instead of an illness. The sample comprised 22 mothers of growth deficient children who were interviewed 2 years after the conclusion of an intervention study to promote child growth. Growth deficiency was defined as below the 10th percentile for weight, height, or weight for height on the National Center for Health Statistics (NCHS) growth grids (Hamill, Drzid, Johnson, Reed, & Roche, 1976). Three major domains were identified in the EMs of growth held by mothers: (1) illness or heredity (etiology); (2) keeping track of growth (course); and (3) helping my child grow (treatment). The mothers in this study were concerned about their children's size and growth patterns and they monitored their children's growth with the methods available to them. They identified illnesses and allergies as environmental factors that negatively impact their children's growth. All mothers viewed size as a function of heredity. The findings from this study suggest that an emphasis on size will not encourage mothers to focus on their children's growth. The EMs for growth and size were different. Health care providers may be more effective in enhancing children's growth by teaching parents how to deal with the day-to-day problems of children who are picky eaters, stretching limited food money, creating mealtime schedules, and dealing with illnesses before they become severe.

Low-income mothers' perceptions of health in their children with growth delay.

ISSUES AND PURPOSE: Parental characteristics are the strongest predictor of poor health for children. This study examined how low-income mothers of children with growth delay define health for their children, and the behaviors they use to monitor their children's health. DESIGN AND METHODS: Naturalistic design using Kleinman's Explanatory Model approach and interviews with 22 mothers. RESULTS: Mothers consider nutritious food as a primary contributor to their children's health and consider healthy children to be chubby. Other indicators of health include children's energy levels, provision of nutritious food, and physical and mental activity balanced with rest. PRACTICE IMPLICATIONS: A mother's explanatory model of health for her child can guide health promotion targeted to the mother's beliefs.

Nutrition for the childbearing years.

OBJECTIVE: To review the literature on preconceptional nutrition and nutrition during pregnancy and lactation, focusing on recommendations from the Institute of Medicine. DATA SOURCES: Computerized searches on MEDLINE, CINAHL, National Institutes of Health and Institute of Medicine web sites. STUDY SELECTION: Articles from indexed journals and reports from government sources relevant to the topics of this review and published after 1990 (except for classic findings) were evaluated. DATA EXTRACTION: Data were analyzed under the headings of preconceptional nutrition, prenatal nutrition, nutrition during lactation, and nursing implications. DATA SYNTHESIS: The nutrition a woman receives before conception, during pregnancy, and during lactation affects her health and the health of her child. Information on the amount and timing of prenatal weight gain, recommended intakes of vitamins and minerals, and nutrition and activity during lactation have been revised in the last 10 years. CONCLUSIONS: The health, size, and growth of the infant are dependent on the timing and amount of weight gain during pregnancy and on maternal nutrition during lactation. Prenatal weight gain also affects a woman's future risk of obesity.

Weight management practices among primary care providers.

This pilot study examined how primary care providers manage patients with weight problems, an important component of primary care. A convenience sample of 17 nurse practitioners and 15 physicians were surveyed about assessments and interventions used in practice for weight management along with perceived barriers to providing effective weight management. Practice patterns between gender, profession and practice setting of the nurse practitioners were compared.

Follow-up study of children with growth deficiency.

This follow-up study revealed that all the children with growth deficiency in the original study had slower growth velocity after termination of the study. Two years later, 56% of the sample was located and the measures were repeated. The experimental group had diets significantly higher in fat and zinc than did the control group. The amount of fat, calories, zinc, and protein intake in all the children's diets was significantly related to their percentile level for weight. The stress of all the mothers, both experimental and control, had increased, and there was a significant increase in stress in the experimental mothers. There was no difference in the children's home environments, but the parent-child interactions were significantly more positive between the experimental children and their mothers. This follow-up study demonstrates that children with growth deficiency benefited over time from the original intervention but need continued intervention for positive significant changes to persist.

Reversing growth deficiency in children: the effect of a community-based intervention.

INTRODUCTION: The effect of a community health nursing intervention on children with growth deficiency (also called nonorganic failure to thrive or growth failure) was examined in a pretest and post-test experimental study. This study evaluated the impact of the intervention on growth quotients, children's diets, parent-child interaction, home environment, and mothers' perceived stress. METHODS: The sample consisted of 39 children (ages 3 months to 3 years) with growth deficiency in weight or height for age, weight for height, or a decrease in growth across two percentiles. The children were enrolled in Special Supplemental Feeding Program for Women, Infants and Children (WIC) clinics in county health departments and were randomly assigned to experimental or control groups. After preliminary data were collected for the entire sample, a community-based intervention was administered to the experimental group during home visits. The intervention included education about nutrition and about parenting and community skills. RESULTS: Data collected after the intervention by a research assistant blind to group assignment indicated positive changes (P < or = .05) in the experimental group's growth quotients, home environments, and their mothers' perceived stress. DISCUSSION: This study supports the community health nursing practice of teaching nutrition and child care during home visits to families of children with growth deficiency.

Common adult infectious skin conditions.

Infectious skin conditions of the adult patient that primary care providers may often encounter in practice include those of viral (herpes simplex, herpes zoster, verruca and condylomata, molluscum), fungal (candidiasis, dermatophyte infections) and ectoparasitic (scabies, pediculosis) origin. Correct diagnosis and treatment of these conditions can provide relief to the patient and prevent spread to household and sexual contacts. This article discusses the epidemiology, etiology, history, appearance, diagnosis, and treatment of these commonly encountered infectious skin conditions. The primary care provider can differentiate these skin conditions by history, appearance, and laboratory tests, and should be able to diagnose and provide cost-effective therapy and secondary prevention for them. The primary care provider should also be able to recognize those lesions that are harbingers of systemic diseases and appropriately refer for further management.

Prenatal breastfeeding education: its effect on breastfeeding among WIC participants.

The effect of prenatal breastfeeding education on breastfeeding incidence and duration was determined among 31 prenatal WIC participants. The subjects, assigned to a control group (n = 17) or experimental group (n = 14), received prenatal nutrition education through the WIC program. The experimental group received at least one breastfeeding education class. There was no significant difference in breastfeeding incidence between the groups, however, there was a significant difference in breastfeeding incidence by parity (p < 0.05). There was a significantly higher percentage of women still breastfeeding at 3 and 4 months postpartum in the experimental versus the control group (p < 0.05). The control group breastfed for 29.5 +/- 43.6 days, while the experimental group breastfed for 76 days +/- 104.3 (p = .05). Multiparous women who had bottle-fed previous children breastfed for a shorter duration (18 +/- 22 days) than primiparous women (60 +/- 87 days) (p < .07).

On the horizon: new options for contraception.

Future contraceptives include refinements of existing contraceptives and totally new methods. New formulations of oral contraceptives, subdermal hormonal implants, injectable hormones, vaginal spermicides, and intrauterine devices (IUDs) are being tested around the world. New methods that are not yet available include the use of vaginal preparations containing sperm-immobilizing agents, gonadotrophin releasing hormone agonists and antagonists, vaccines against ova and sperm, and endogenous hormones. Male contraceptive methods use hormones to suppress testosterone and vaccines to immobilize sperm. The availability of all future contraceptives is dependent on ample funds for research, development, and testing, and such funds are in jeopardy.

PIP: Insufficient government funds for the extensive clinical trials required for product approval threaten to impede the future availability in the US of innovative new contraceptive technologies. Funding cutbacks place the burden for contraceptive research on the pharmaceutical and biotechnology industries; however, concerns about product liability have led many of these companies to drop their contraceptive research programs. New formulations of oral contraceptives, subdermal hormonal implants, and IUDs are being tested around the world. New methods on the horizon include vaginal preparations containing sperm-immobilizing agents, gonadotropin-releasing hormone agonists and antagonists, vaccines against ova and sperm, and endogenous hormones. Also under review are male methods that use hormones to suppress testosterone and vaccines to immobilize sperm, polyurethane condoms, and new vasectomy techniques. Because many future methods will be targeted to men, family planning programs will have to be redirected to address the contraceptive needs of both genders. Moreover, as contraceptive technologies become more diverse, primary care of men and women will assume increasing importance. The only new products likely to be available by the year 2000 are contraceptive vaginal rings and one or two rod implant systems.

Background contrast modulates kinetics and lateral spread of responses to superimposed stimuli in outer retina.

Surround enhancement (sensitization) is a poorly understood form of network adaptation in which the kinetics of the responses of retinal neurons to test stimuli become faster, and absolute sensitivity of the responses increases with increasing level of steady, surrounding light. Surround enhancement has been observed in all classes of retinal neurons in lower vertebrates except cones, in some primate retinal ganglion cells, and in human psychophysical studies. In theory, surround enhancement could be mediated by two broad classes of mechanisms, which are not mutually exclusive: one in which the kinetics of the transduction linking cone voltage to postsynaptic current in second-order neurons is modulated, and another in which the transformation of postsynaptic current to membrane voltage is modulated. We report here that both classes of mechanism play a role in surround enhancement measured in turtle horizontal cells (HCs). We stimulated the retina by modulating sinusoidally the illuminance of a bar placed at various positions in the HC receptive field. The bar was surrounded by either equally luminant or dim, steady light. Interpretation of responses in the context of a model for the cone-HC network led to the conclusion that the speeding up of response kinetics--due to selective increase in response gain at high temporal frequencies--by surround illuminance is almost completely accounted for by the change in the kinetics of the transduction linking cone membrane potential to HC postsynaptic current. However, surround illuminance also had an additional, surprising effect on the transformation between postsynaptic current and voltage: the space constant for signal spread in the HC network for the dim-surround condition was roughly twice as large as that for the bright-surround condition. Thus, increasing surround illuminance had analogous effects in the spatial and temporal domains: it restricted the time course and the spatial spread of signal. Both effects were dependent on the contrast between the mean bar illuminance and that of the surround, rather than on overall light level. When the stimulus with the bright surround was dimmed uniformly by a neutral density filter, the space constant did not increase, and response gain at high temporal frequencies did not decrease. Pharmacological experiments performed with dopamine and various agonists and antagonists indicated that, although exogenous dopamine can influence surround enhancement, endogenous dopamine does not play an important role in surround enhancement. We conclude that contrast in background light modulates the spatiotemporal properties of signal processing in the outer retina, and does so by a non-dopaminergic mechanism.

The use of human ecology and epidemiology in nonorganic failure to thrive.

Children with nonorganic failure to thrive (NOFTT) comprise a population at risk for small stature, poor growth, slower development, and lower intellectual outcomes. These children are often seen in the Women, Infants, and Children Supplemental Nutrition Program (WIC) and child health clinics and in caseloads of high-risk families. Public health nurses may not be sure how to intervene in the problem of NOFTT because of its multifactorial etiology. A model of nursing care that addresses the many factors that affect the development of NOFTT can enable the public health nurse to appropriately care for the child with NOFTT. The Eco-Epi model, a combination of human ecology and epidemiology, is a conceptual model that can provide a framework for the public health nurse to plan interventions. Even though children with NOFTT are the target population for this model, it can be applied to other public health nursing populations at risk for multifactorial problems. In the Eco-Epi model, the epidemiological concepts of agent (food), host (child), and environment (home) are examined in the context of the microsystem (parent-child interaction, daily activities of the family), the mesosystem (interactions between different environments), and the exosystem (the child's community). The concepts of microsystem, mesosystem, and exosystem are from the theory of human ecology. Examples of how the model works to assess a family and design interventions are provided.

Modulation of synaptic transfer between retinal cones and horizontal cells by spatial contrast.

We studied the influence of steady annular light on the kinetics and sensitivity of horizontal cell (HC) responses to modulation of the intensity of small concentric spots in the turtle retina. As shown by previous investigators, when the intensity of the annulus was equal to the mean spot intensity, spot response kinetics were the same as those for the modulation of spatially uniform light. Turning off the annulus attenuated dramatically high-frequency flicker sensitivity and enhanced somewhat low-frequency sensitivity. This phenomenon reflects a modulation of synaptic transfer between cones and second-order neurons that is mediated by cones, and it will be referred to as cone-mediated surround enhancement (CMSE). Our main results are as follows: (a) The change in test-spot response sensitivity and kinetics upon dimming a steady surrounding annulus is a consequence of the change in spatial contrast rather than change in overall light level. (b) Introduction of moderate contrast between the mean spot intensity and steady surrounding light intensity causes a marked change in spot response kinetics. (c) The dependence of spot response kinetics on surrounding light can be described by a phenomenological model in which the steady state gain and the time constant of one or two single-stage, low-pass filters increase with decreasing annular light intensity (d) The effect of surrounding light on spot responses of a given HC is not determined by change in the steady component of the membrane potential of that cell. (e) Light outside the receptive field of an HC can affect that cell's spot response kinetics. (f) In an expanding annulus experiment, the distance over which steady annular light affects spot response kinetics varies among HCs and can be quite different even between two cells with closely matched receptive field sizes. (g) The degree of CMSE is correlated with HC receptive field size. This correlation suggests that part of the enhancement mechanism is located in the HC. Taken together, our results suggest the involvement of the inner retina in CMSE.

Restructuring the American health care system: an analysis of Nursing's Agenda for Health Care Reform.

Equal access to health care for all citizens is a hotly debated issue of the American health care system. Different plans for reform that would allow equal access to health care have been proposed, but few include nurses as key health care providers. To correct this oversight, a coalition of more than 60 national nursing and health care organizations has created Nursing's Agenda for Health Care Reform, a blueprint for restructuring the health care system. This article reviews the agenda within the framework of the ethical theory of distributive justice. Distributive justice allows for the allocation of health care resources in a manner that is fair but not necessarily equal for all. The agenda addresses the basic level of health care needed by all Americans and supports the provision of primary care by nurse practitioners. Nurse practitioners need to be aware of plans to reform the health care system and should be supportive of those plans that enhance nurse participation in the health care system. Nursing's Agenda for Health Care Reform is a plan that encourages the health care consumer's participation and promotes nursing care as the link between the consumer and the health care system.

Educating women about benign breast disease.

The occupational health nurse can be a valuable resource for women by teaching how their bodies work and how female hormones affect their breasts. Nurses who work in primary care should view their role as one of education and advocacy on behalf of the client. Nurses can model a healthy attitude about breast self examination, encouraging women to perform it and to discuss openly their questions and concerns. Women should be encouraged to have mammograms, following ACS guidelines: a baseline mammogram between the ages of 35 and 40, a mammogram every 1 to 2 years between the ages of 40 and 49, and a yearly mammogram after age 50.