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.

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.

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.

Baccalaureate nursing education development in 2 Baltic countries: Outcomes 10 years after initiation.

BACKGROUND: Baccalaureate nursing education began in the Baltic countries of Latvia and Lithuania ten years ago to prepare nursing teachers and leaders. PURPOSE: The purpose of the study was to assess the outcomes of the initial baccalaureate programs for nurses in Latvia and Lithuania from the perspective of program graduates. METHOD: The method was an alumni survey developed by the authors in English and translated into the respective languages. DISCUSSION: Most of the Latvian and Lithuanian alumni respondents were staff nurses on entering the baccalaureate programs, but after graduation were making a contribution as nursing leaders and teachers. CONCLUSIONS: The initial baccalaureate programs for nurses have been followed by increasing opportunities for nurses to pursue graduate study and careers in and outside of nursing. The infusion of prepared local nursing faculty to replace physician faculty and foreign short-term guest faculty promises continued development of nursing education.

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.

Glomus vagale presenting as a supraclavicular mass: magnetic resonance imaging findings.

Glomus vagale are rare vascular tumours of the paraganglion cells of the vagus nerve, and they usually occur in the carotid space. Tumours can be familial, multicentric, malignant but rarely hormonally active. A rare case is reported of glomus vagale presenting as a supraclavicular mass.

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.

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.

Society of Pediatric Psychology Task Force Report: pediatric psychology and injury control.

Injuries are the major causes of death for children. Pediatric psychology offers significant contributions to the multidisciplinary efforts necessary to prevent injuries and reduce harm to children. This Task Force Report reviews epidemiological data, characteristics of children's injuries, passive and active interventions for reducing injuries, and research, policy, and evaluation issues for individual and community injury control efforts. Directions for future pediatric psychology efforts are identified and placed in a context of collaborative efforts required to advance the control of children's injuries.

Locally advanced (stage III and IV) head and neck cancer: Westmead Hospital experience.

Two hundred and fifty-one patients with Stage III and IV (UICC staging system) squamous cell cancers of the oral cavity, oropharynx, hypopharynx and larynx were assessed between January 1980 and December 1988 at Westmead Hospital. Of these, 50 patients received palliative treatment or were not treated and the remaining 201 patients received treatment with curative intent by various combinations of radiotherapy, surgery and chemotherapy. Thirty-nine operable cases were entered into a multimodality protocol initiated in April 1985, which consisted of induction chemotherapy (cisplatin 100 mg/m2 i.v. day 1, 5-fluorouracil 1000 mg/m2 per 24 h i.v. days 1-5, q3w x 2) followed by surgery and postoperative radiotherapy. The median follow-up for all 251 patients was 57 months. Actuarial 3-year survival rate for all 201 patients receiving radical treatment was 48% (Stage III 66%, Stage IV 36%; P less than 0.001). Overall actuarial local and nodal control rates at 3 years were 67% and 69%. Thirty-two of 201 patients (16%) developed distant metastases at a median time of 11 months. Twenty-one patients (10%) had a previous or subsequent second primary cancer. In the group of 39 protocol patients, overall actuarial survival, local and nodal control rates are 68%, 77% and 73% at 3 years. A group of 22 'protocol' patients was compared with a group of 22 patients treated prior to commencement of the protocol, matched as closely as possible on the basis of site, stage, age, sex and ECOG status.(ABSTRACT TRUNCATED AT 250 WORDS)

Frey's syndrome following parotid surgery.

Twenty-one patients were followed up with a home visit after having parotid surgery at the Westmead Centre between January 1988 and October 1989. Nine of these patients (42.8%) had objective gustatory sweating as proven by Minor's Starch Iodine Test, with three of these (14.3%) having symptoms of Frey's syndrome. Symptoms started an average of 4.3 months after surgery. None of the three were anxious enough about their symptoms to seek medical treatment. Those patients with objective gustatory sweating were more likely to be women. No statistical significance was found in regard to the presence or absence of greater auricular nerve section, facial nerve paresis, age or type of operation (superficial parotidectomy or otherwise). Frey's syndrome is a benign condition and explanation and reassurance are usually adequate therapy.

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.

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.

Cancer of distant primary site relapsing in the nasopharynx: a report of two cases and review of the literature.

Cancers metastatic to the nasopharynx are rarities. We present here two more such tumors. Although the clinical features of primary and secondary tumors in the nasopharynx are indistinguishable, a past history of treatment for malignant disease is an obvious clue to the correct diagnosis.