Nursing students' intentions to comply with standard precautions: an exploratory prospective cohort study.

BACKGROUND: Partial compliance of health care workers with standard precaution (SP) guidelines has been extensively documented. The aim of this study was to describe the development of nursing students' intentions to comply with SPs. METHODS: Prospective cohort study. Two consecutive classes of a 4-year bachelor of nursing program completed questionnaires 3 times. The transtheoretical model of change was used to describe the change in intentions to comply with SPs. Factor analysis displayed 2 behavioral categories: commonly used standard precautions (CUSPs) and less commonly used standard precautions (LUSPs). Knowledge, risk perception, sense of coherence (SOC), safety climate (SC), and emphasis given by educators were evaluated as associated factors. RESULTS: Of the 91 students, 85 (93%) completed the questionnaire during their second year, 57 of 88 students (65%) completed it during the third year, and 70 of 82 students (85%) completed it at the end of the fourth year. Of the 82 students, 45 (55%) completed 3 measurements. CUSPs exhibited a rise from the second to the third year, with a moderate decline from the third to the fourth year, whereas LUSPs continued ascending. CUSPs were positively associated with SC and SOC; LUSPs were commonly associated with risk perception. CONCLUSION: The different evolution of CUSPs and LUSPs and dissimilar associations may suggest that different strategies might encourage diverse SP behaviors. Improving the SC might be appropriate when aiming to encourage CUSPs, and highlighting risks may be appropriate to encourage LUSPs.

The dynamics of blood pressure and cognitive functioning: results from 6-year follow-up of an elderly cohort.

The association between blood pressure (BP) and cognitive functioning in the elderly is still under debate. Theoretically, high BP could either prevent or enhance cognitive impairment. The authors assessed the changes that took place in BP and cognitive functioning over 6 years. A total of 318 noninstitutional elderly (81% of the survivors) were re-evaluated. BP was measured and a cognitive test was performed. Elderly patients who had higher systolic BP (SBP) and scored lower on the Mini-Mental State Examination (MMSE) at baseline were less likely to survive. At follow-up, the proportion of patients with normal or normalized BP by treatment increased. Considerable changes in SBP were observed. Most cognitive functions declined during follow-up; however, decline in SBP was associated with better verbal fluency and memory. Both an increase and a decline in SBP were associated with better MMSE scores. Changes in diastolic BP (DBP) were less evident and DBP was not related to cognitive functioning. The current study demonstrates the importance of studying the dynamics of both BP and cognition over time. It appears that transition from hypertension to normotension improves cognitive functions. Survival processes may restrict the evaluation of the BP-cognition interaction over time.

Cognitive function and antihypertensive treatment in the elderly: a 6-year follow-up study.

Both antihypertensive treatment and statins were proved to reduce mortality and morbidity from cardiovascular disease in the elderly. Yet their effect on cognitive functions of the elderly is unclear. In this study, 518 elderly were interviewed at their home six years ago. BP was measured and antihypertensive drug treatment and cognitive functions were evaluated. 318 of the original sample were re-examined (81% of the survivors). We evaluated the selective survival in relation to changes in BP, the specific drug usage and cognitive functioning. Beta blocker treatment increased the odds of survival but also the odds of decline in MMSE and memory scores. ACE-I treatment was also associated with decline in memory. Subjects treated with CCB had improved MMSE scores, memory, and performed better on tasks requiring concentration. Statins treatment in this study did not show any affect on cognitive functions. Although most subjects were treated by more than one antihypertensive drug, less than half were normalized at baseline and only one quarter at follow-up. Despite the low normalization rate, antihypertensive treatment regimen had been hardly changed during the six years follow-up. The use of statins, however, increased dramatically: from 6% at baseline to almost half at follow-up. According to our findings CCB emerges as the best option for reducing BP in elderly patients. It appeared to improve cognitive functions without hampering survival.

Reshaping students' attitudes toward individuals with mental illness through a clinical nursing clerkship.

The purpose of this study was to evaluate the degree to which a psychiatric clinical clerkship alters nursing students' attitudes toward individuals with mental illness. The goal of the 4-week clerkship is to provide students with the knowledge, skills, and professional attitudes that will enable them to care for individuals with mental illness in different health care settings. A pencil-and-paper questionnaire was administered to 126 third-year students before and after the clerkship. Students were presented with four hypothetical patients with schizophrenia and were asked to what extent the patient was responsible for his condition, the emotions students felt, and whether students were willing to care for the patient or to segregate him in the hospital. After the clinical clerkship, students became more compassionate and less frightened by psychiatric patients, were more willing to care for individuals with mental illness, and expressed less need to segregate them from the community. In addition, in accord with professional attitudes, students became aware of their own attitudes (the responsibility attributed to patients) and their emotional responses, but these were no longer associated with reluctance to provide care.

Blood pressure treatment and cognition in the elderly.

While the health and longevity benefits of antihypertensive treatment have been established in past research, the cognitive consequences of blood pressure control in the elderly are still under debate. In this paper, the authors review the current evidence and the different ways in which cognition is measured. Since research on the cognitive consequences of blood pressure control in the elderly population is characterized by a variety of research questions, designs, and cognitive measurements, the authors conclude that a large-scale study that compares the cognitive benefits of different methods of blood pressure reduction is urgently needed.

Students' reactions to three typical examinations in health sciences.

OBJECTIVE: A search for universal and particular changes in emotional, behavioral and cognitive assessments in relation to three types of examinations: an oral presentation, an objective structured clinical examination (OSCE) and a pencil and paper examination. METHODS: One hundred and two students of health professions completed the Profile of Mood States (POMS) questionnaire before (t1) and after (t2) each type of examination. Data regarding stress-related symptoms, attitudes, and preparation behavior were collected at (t2). RESULTS: POMS six subscales scores at (t1) did not differ by examination type and five of them were statistically significant higher at (t1) than (t2) regardless of examination type. "Preparing behavior" also emerged as a universal feature. As for the particular aspects of each examination, OSCE students felt more depression-dejection and fatigue at (t2) than at (t1). Oral presentation was perceived as the most difficult by students, who also reported more symptoms. For this type of examination, the students regained their confidence towards the end of the presentation and perceived classmates as most supportive and least disturbing. The pencil and paper examination was evaluated as the easiest by students, produced fewest symptoms and no excitement during the examination. CONCLUSIONS: Three types of examinations, frequently used in health sciences, appeared to initiate different physical, emotional, and social reactions.

Hypertension and cognitive functioning among the elderly: an overview.

This paper reviews the longitudinal studies in which the association between hypertension and cognitive functioning has been explored. The findings of these studies are far from being consistent: positive, adverse, or no relationships between cognitive performance and blood pressure have been reported. In some studies, cognitive functioning was related only to systolic blood pressure, whereas in others, it was related to diastolic blood pressure alone. Most probably, the inconsistency is due to the variability in research design, the measures employed, and data management. Some of the main methodological issues are the wide range in the age of the subjects and the variability in hypertension at baseline. Length of exposure to hypertension was rarely considered, and the search for the possible effects of the different antihypertensive treatments on cognitive ability is in its infancy. Many studies seek to identify cognitively impaired elderly and do not distinguish between the different types of dementia or the different cognitive domains. Thus, the possibility that hypertension affects specific cognitive functions has not been explored. The use of subdivisions of blood pressure values may have obscured nonlinear relationship. Nevertheless, the pattern that emerges is that midlife hypertension enhances cognitive impairment later in life, but at old age, mild hypertension may increase cognitive performance. Directions for future research to further elucidate the complex relationship between age, blood pressure, and cognition are discussed.

Israeli men in nursing: social and personal motives.

AIM: This paper intends to explore what leads Israeli men to choose nursing as their profession. BACKGROUND: In the early years of nursing education in Israel, like in other western societies, men were excluded from the profession. Shortage in nursing personnel and urgent needs led to recruitment of men into the profession for a short period of time. Only since the early 1990s the nursing profession is experiencing a gradual but steady influx of men. Yet, nursing is generally perceived as women's work, and men have to cope with the stereotypes attributed to them as a prominent minority in a profession primarily occupied by women. Currently, no study had examined who are the Israeli men who are willing to enter the profession and why. METHODS: A 52-item questionnaire was distributed among all registered female and male nurses in three general and three psychiatric hospitals during 1997-98. The questionnaire covered sociodemographic characteristics, exposure to the profession and reasons for choosing the profession. The response rate of 74% included 123 male and 137 female registered nurses. CONCLUSIONS: Early exposure to the profession and the fact that the majority of male nurses belong to ethnic minorities and recent immigrants to the Israeli society were the most prominent factors in the selection of the nursing profession by these men. Surprisingly, economic considerations did not constitute a compelling motive in this population.

Academic stress, immunological reaction, and academic performance among students of nursing and physiotherapy.

The associations among health status, health behavior, and changes in human cytomegalovirus (HCMV) specific salivary antibodies during academic stress were investigated in relation to academic achievement among nursing and physiotherapy students. Fifty-four first year students donated saliva samples and completed a pencil and paper questionnaire before (t1), during two term examinations (t2 and t3), and after grades were posted (t4). An increase in the level of specific salivary HCMV IgG and IgA antibodies from t1 to t2, and a decrease from t2 to t4 were related to academic success. Health status and health behavior remained fairly stable during the stress period. The results are congruent with the inverted U-shape model of stress and learning suggested by Yerkes & Dodson (1908).

Utilization of maternal care in rural HeBei Province, the People's Republic of China: individual and structural characteristics.

PURPOSE: To study the effect of individual's socio-economic characteristics and the structure of the health services in the village on utilization of maternal care in rural HeBei, the People's Republic of China (PRC). DATA: Data were collected from 4273 women who gave birth to one child at least, living in a stratified sample of 288 villages in HeBei Province. FINDINGS: 54.8% of the women had at least one pre-natal care visit, 27.5% gave birth in a health care facility, and 18.1% had post-natal check-up. Utilization was inversely related to age and parity and positively to education. Occupation was related to use of pre- and post-natal services, but not to home birth. Per-capita income and living arrangement are not related to utilization. MCH worker in the village promote pre- and post-natal care, but also home delivery. Village doctors promote pre-natal care and hospital delivery but do not promote post-natal check-up. Women tend to avoid the maternal services in the township health centers but some are ready to travel to city hospitals for delivery and post-natal care. CONCLUSIONS: Health education programs regarding the importance of all three maternal care services are clearly needed. These programs should address not only women of child bearing age but also care providers, MCH workers in particular. Township health center should reach-out and motivate women to use their accessible services.

Health inequalities in rural China: evidence from HeBei Province.

The purpose of this study was to examine the degree to which commonly used social class indicators-education, income, and occupation-are associated with health in the context of rural China. Data were collected from 10,226 individuals of working age (16-60) living in HeBei Province, the PRC. The association between education and income observed resembles the patterns documented in industrial societies, but the health status of farmers is quite similar to that of white collar employees. Persons in other than mainstream occupations report the poorest health status. Social selection and the costs of relative deprivation appear to be useful to the understanding of health inequality in rural China, though in a manner shaped by the particular social context.

Blood pressure and cognitive functioning among independent elderly.

BACKGROUND: The morbidity and mortality benefits of blood pressure (BP) control for the elderly is well documented. The cognitive consequences of hypertension control in this population, however, are still under debate. We aim to study the association between BP and cognitive performance in the elderly. Specifically, we explore 1) the possibility that BP is differentially associated with various cognitive domains; and 2) the utility of analyzing both BP and cognitive scores as continuous variables to unravel possible nonlinear associations. METHODS: Four hundred ninety-five community living 70 to 85 year olds completed eight cognitive tests that measured memory, concentration, visual retention, verbal fluency, and the mini-mental state examination (MMSE). The performance of each test was analyzed first by comparing four groups (normotensives, normalized hypertensives, untreated hypertensives, and treated but uncontrolled hypertensives). Then, using BP values as continuous variables, linear, U-curve, and J-curve associations were estimated. RESULTS: On all cognitive tests, except for verbal fluency, normotensives performed poorest, treated but uncontrolled hypertensives achieved the highest scores. The MMSE scores and the lighter concentration task were linearly related to BP; J-curve association was observed between memory and visual retention; prolonged concentration was related to pulse pressure alone. CONCLUSIONS: Low BP, as observed among the normotensive subjects, was associated with poor cognitive performance. Mild hypertension appeared to enhance cognitive functioning among the subjects of this study. Moreover, we found support for the hypothesis that the association between BP and different dimensions of cognition take on different patterns.

Gender and health in rural China: evidence from Hebei Province.

Gender differences in health and health behavior are well established in Western societies, but little is known about gender health inequalities in rural China. We examine patterns of age-sex differences in health and health behavior of men and women in rural HeBei, People's Republic of China, and consider the extent to which these patterns resemble gender health inequalities observed in North America and Western Europe. The data analyzed were collected from 14,895 individuals residing in 288 villages in the HeBei Province. The results show that gender differences emerged at a later age than generally reported in Western societies. Poorer health among women, as compared with men, becomes observable during young adulthood (25-44) rather than at adolescence, and reached its peak among older adults (45-59) rather than during the productive and reproductive stage of the life course. Among the elderly, the differences between the health and the health behavior of men and women narrowed, similar to many reports in North America and Western Europe. Most importantly, no gender differences in mental health were observed. These findings suggest that the older adult age group (45-59) may be appropriate for interdisciplinary efforts to advance the understanding regarding the relative contributions of nature and nurture to gender differences in health.