Dietitians' perceptions of communicating with preadolescent, overweight children in the consultation setting: the potential for e-resources.

BACKGROUND: There are calls to enhance existing child weight management interventions and to develop new treatment approaches. The potential for interactive electronic resources (e-resources) to support child-dietitian communication has yet to be explored. Towards developing such a tool, the present study aimed to understand dietetic attitudes and approaches to communicating with preadolescent overweight children in individual consultations to support behaviour change. METHODS: A purposive sample of 18 dietitians, providing weight management advice to overweight 7-11-year-old children, took part in the study. Individual semi-structured telephone interviews were conducted. Data were transcribed and then analysed using inductive thematic analysis. Content analysis was used to interpret dietetic attitude towards e-resources. RESULTS: Six overarching themes were identified describing dietitians' views: the complexity of treating childhood obesity, the strategic balance of dietetic communication focus between child and parent, the child's capacity to communicate affecting their contribution, dietetic approaches to verbal child communication and the features of resources that can support them, as well as dietetic expectations for resources. Independent inter-rater agreement for the themes was 76.9% and 73.1%, respectively. The majority of dietitians (n = 13) supported the concept of introducing an interactive multimedia e-resource into child weight management consultations. CONCLUSIONS: Most dietitians sought to engage the preadolescent child in the consultation, using dietetic visual aids to complement verbal strategies and to serve as scaffolding for the conversation. There is scope for interactive e-resources to enhance communication, provided that they are flexibly tailored to meet the needs of the dietitian and the overweight child.

Diabetes knowledge and glycemic control among Chinese people with type 2 diabetes.

BACKGROUND: Diabetes self-management education (DSME) is a key component of effective glycemic control and an important part of clinical diabetes management. The effects of DSME in China have not been investigated. OBJECTIVES: To identify factors that could enhance the quality of Chinese DSME programmes. The relationship between patients' diabetes knowledge and their glycemic control was explored. METHODS: A non-experimental cross-sectional study was undertaken in a large Shanghai hospital in China. Forty inpatients and 60 outpatients with type 2 diabetes mellitus were recruited. A Chinese version of the Diabetes Knowledge Scale was used to assess subjects' diabetes knowledge and collect demographic data and HbA1c levels. RESULTS: The mean diabetes knowledge scores among Chinese with type 2 diabetes was 22.1 +/- 3.76 out of a possible 30 marks. There was no difference in overall diabetes knowledge in people with HbA1c <7%, indicating good control and those with HbA1c >or=7%, indicating suboptimal glycemic control (t = -0.811, P = 0.419). However, there were differences in scores between the two groups for some specific questions on sick day management and food substitution. Moreover, sociodemographic characteristics such as age and occupation were significantly correlated with diabetes knowledge; age was negatively correlated with diabetes knowledge and white-collar workers had the highest mean knowledge score and housewives the lowest. CONCLUSION: Sociodemographic characteristics need to be considered when developing diabetes self-management programmes for Chinese people with type 2 diabetes.

A comparison of CAL with a conventional method of delivery of cell biology to undergraduate nursing students using an experimental design.

This paper describes the development and evaluation of a series of computer assisted learning (CAL) packages on cell biology produced for an undergraduate nursing course. The CAL packages were based on the material originally delivered in Kindermann's slide practical classes. The decision to convert this teaching material into CAL packages was taken for a number of reasons, but mainly in response to student evaluations and lack of equipment and staff resources needed to adequately deliver the sessions. Student feedback showed that CAL was preferred to the slide classes. Two studies were carried out to compare the CAL method of delivery with the conventional method using an experimental design. Students taught using CAL felt more confident that they would be able to use the material they had learnt if required as a basis for future work. The distributions rating 'how necessary was the contribution of a teacher in the session' were skewed towards the 'essential' end of the scale for the slide group but towards the 'unnecessary' end for the CAL group. Learning effectiveness was not compromised by the introduction of CAL, even though this meant that no lecturer was on hand to deal with questions.

The relationship between attendance at birth and maternal mortality rates: an exploration of United Nations' data sets including the ratios of physicians and nurses to population, GNP per capita and female literacy.

UNLABELLED: The relationship between attendance at birth and maternal mortality rates: an exploration of United Nations' data sets including the ratios of physicians and nurses to population, GNP per capita and female literacy. BACKGROUND: This is the third and final paper drawing on data taken from United Nations (UN) data sets. The first paper examined the global distribution of health professionals (as measured by ratios of physicians and nurses to population), and its relationship to gross national product per capita (GNP) (Wharrad & Robinson 1999). The second paper explored the relationships between the global distribution of physicians and nurses, GNP, female literacy and the health outcome indicators of infant and under five mortality rates (IMR and u5MR) (Robinson & Wharrad 2000). In the present paper, the global distribution of health professionals is explored in relation to maternal mortality rates (MMRs). The proportion of births attended by medical and nonmedical staff defined as "attendance at birth by trained personnel" (physicians, nurses, midwives or primary health care workers trained in midwifery skills), is included as an additional independent variable in the regression analyses, together with the ratio of physicians and nurses to population, female literacy and GNP. AIM: To extend our earlier analyses by considering the relationships between the global distribution of health professionals (ratios of physicians and nurses to population, and the proportion of births attended by trained health personnel), GNP, female literacy and MMR.

Invisible nursing: exploring health outcomes at a global level. Relationships between infant and under-5 mortality rates and the distribution of health professionals, GNP per capita, and female literacy.

AIMS: To explore the relationship between the global distribution of health professionals (physicians and nurses), gross national product per capita (GNP), female literacy and the health outcome indicators of infant, and under-5 mortality rates using available data from United Nations' (UN) sources. To consider the reliability and validity of the variables included, and the implications of the findings for health policy and practice, and for further research. DESIGN: Using a database on 155 countries, regression analyses were performed using GNP, female literacy, numbers of physicians per 1000 population and numbers of nurses per 1000 population as independent variables, and infant mortality (IMR) and under-5 mortality rates (u5MR) as dependent variables. RESULTS: Linear regression analyses give R2 values for the two mortality indicators (IMR and u5MR) of 63% and 66% for physicians and 51% and 52% for nurses. Multiple linear regression analyses reveal a more complex picture. Countries with high ratios of physicians and nurses to population relative to their GNP also tend to show low IMRs and u5MRs. However, when female literacy is included in the model, the majority of these outlying countries move back towards the regression line. Nurses disappear from the model altogether when regressed with physicians, GNP per capita and female literacy for both outcome indicators. CONCLUSIONS: Despite the acknowledged need for caution in the validity and reliability of the UN data sources used in the analyses, interesting positive relationships are identified between the input variables and mortality outputs. The implications for future health policy, practice and research are considered. These include the need for more reliable, comprehensive and up-to-date data sets.

The global distribution of physicians and nurses.

AIM: To explore the global distribution of physicians and nurses and the influence of gross national product per capita on this distribution, using available United Nations' (UN) sources. OBJECTIVES: to compare the international distribution of physicians and nurses by country; to examine the influence of gross national product per capita (GNP) on the global distribution of physicians and nurses; to explore the assumptions underlying the recommendations of The World Development Report 1993 Investing in Health for health workforce substitution; and to consider the implications for future studies of global health labour distribution. DESIGN: A database was compiled from various UN sources on 147 countries. Using some of the variables from this database, a general linear regression model for log GNP per capita on each of the two dependent variables (log nurses and log physicians per 1000 population) was produced. Standardized residuals obtained from these bivariate regressions were calculated and plotted against each other to determine the relationship between the global distribution of physicians to population and that of nurses. From this analysis outlying countries could also be identified. RESULTS: Ratios of physicians to population by country varied from 0. 02 to 4.4 per 1000 population (or from 1 to 227 and 1-50,000 population), and nurses from 0.03 to 16.4 (or from 1 to 61 and 1-33, 000 population). There was a positive correlation (r = 0.84, P < 0. 001) between the number of physicians per 1000 population and the number of nurses per 1000 population. GNP explained 49% of the variation in physicians and 40% in nurses. Ranking of countries according to their standardized deviation from mean regression lines for GNP against health personnel in countries with both the lowest incomes and lowest numbers of health personnel, resulted in little change from the original rankings of ratios of physicians and nurses relative to population. For some of the wealthiest countries, there was a marked fall in global ranking and for some middle income countries a marked improvement in ranking. CONCLUSION: 70% of the distribution of nurses globally can be explained by the distribution of physicians, and the influence of GNP per capita on the global distribution of physicians and nurses appears to be substantial. In only a minority of the world's very poorest countries is there evidence to suggest that higher numbers of nurses substitute for low numbers of physicians. Standardization of the distributions by GNP demonstrates that many countries (but not the poorest) regress to within one standard deviation of the mean expected distribution. This suggests that countries could set optimum levels of physicians and nurses within the limits of their GNP. More realistically, the findings suggest that recommendations for modification of the structure of countries' health labour forces as a component of health care reform may be more difficult to achieve than at first appears. The potential unreliability of the data sources used, and the implications for the accuracy of the findings, are discussed.

Behavioural and autonomic responses to sound in pre-term and full-term babies.

The pattern of motor (body movement) and autonomic (heart rate and respiration) responses to no sound and sound trials were compared in 20 pre-term and 22 full-term neonates. Sound levels were calibrated using neonatal ear-sized couplers to produce, in the neonatal ear, sound levels of 80, 90 and 100 dB SPL. Accelerations in heart rate (> or = beats per minute for pre-terms; > or = 7 beats per minute for full-terms) were found to be the best criterion for establishing a possible response using bandpass noise at 80, 90 or 100 dB SPL. Respiration rate decreased in response to sound stimuli, this being significant for the pre-term group for the 100 dB SPL stimulus when comparing the 5 s period post-stimulus with the stimulus period. The number of movements detected during the sound trials was higher than for the control trials, being statistically significant for the pre-term group. These changes were elicited in response to stimuli presented at levels some 20-40 dB lower than for other studies and for behavioural screening because sounds were calibrated in an appropriately sized coupler. It is concluded that the response to sound is different in the pre-term group compared with the full-term group.

The use of posters in the teaching of biological sciences on an undergraduate nursing course.

Posters are commonly used at research conferences for communicating information and in education as an alternative way of teaching and assessing students. We report the use of posters as a means of teaching and assessing part of the biological sciences component of an undergraduate nursing course. Tutors felt it was a valuable exercise enabling students to develop a number of skills, alongside the learning and revision of knowledge, including working as a team, condensing information and word and graphic processing. Students evaluated the exercise as being challenging but rewarding and preferred to be assessed by this method than by oral presentations or examinations. Lecturers and guided study/tutorials were preferred to posters as teaching methods.

A survey of the teaching and learning of biological sciences on undergraduate nursing courses.

Curriculum planners developing degree courses in nursing have to decide how much time to allocate to each of the academic disciplines including biological sciences. There is no research-based evidence to suggest what depth and detail of knowledge of biological sciences is required to support nursing practice. There is also some debate about the teaching methods used and who should teach the biological sciences. This paper reports the results of a small survey investigating the teaching of biological sciences on 16 nursing degree courses in the UK. The survey uncovered great variation in the number of hours spent on biological sciences in the different universities and in the science entry requirements of the different universities. Most teachers of biological sciences had a first degree in the subject but few were nurses. The possible implications of these findings are discussed. Problems associated with shared learning and didactic teaching methods are also highlighted. Although the biological sciences input will largely be a matter of institutional preferences, nursing needs to develop a research-based framework to aid curriculum planning.

Interpretation of pressure-sore prevalence.

Pressure sores result in patient morbidity and mortality as well as commanding considerable resources within the British National Health Service. To assess the impact of preventive measures, accurate and reliable rates of prevalence and incidence are required. This information is likely to be used as a measure of quality of care as well being included in future purchaser/provider contracting. A number of prevalence studies have been carried out in the United Kingdom using a variety of populations and different methods. The methods employed in these studies need to be considered before any meaningful comparisons can be drawn. In particular, there are variations in the reported rates possibly related to the under-reporting of pressure sore prevalence. This paper describes a recent point prevalence study which suggested that this may be the case. The need for caution when comparing crude rates is highlighted and the importance of standardizing the methods used for determining prevalence rates is discussed.

Bachelor of nursing students' experiences of learning biological sciences alongside medical students.

One of the features of the Bachelor of Nursing (BN) course at Nottingham University is that the students study some biological sciences alongside their medical counterparts. Formative evaluation of the processes of teaching and learning, with a view to monitoring and improving the process of education taking place, is an integral part of the BN curriculum. The findings obtained to date suggest that, whilst the students value some aspects of learning biological sciences with medical students, they are anxious about the effectiveness of the teaching methods being employed; the difficulty of what they are learning and the depth and level of knowledge required in order to deliver safe competent nursing care. They are also concerned about the medical bias of the content that they are being taught and its relevance for them as nurses. This paper will set the biological sciences component of the course in context within both the BN and the medical curriculum. The methods being used to evaluate the teaching and learning processes and the results of these evaluations will be discussed and the implications of the students' experiences will be explored.

Early detection of hearing impairment: what role is there for behavioural methods in the neonatal period?

A survey of the use of behavioural methods for neonatal hearing screening in 1985 (1) concluded that the future for automated methods was quite promising. Since then several studies have assessed the two main automated behavioural tests: the Auditory Response Cradle (ARC) and the Crib-o-Gram (COG). As a screen targeted at neonatal intensive care unit (NICU) babies and other high risk groups (at present the most cost-effective form of neonatal hearing screening), the ARC is shown to have low sensitivity, even for severe hearing impairments, and the COG has an unacceptably low specificity. Any future for behavioural testing during this period must therefore rely on new implementations flowing out of a fundamental understanding of (a) the way in which neonates respond to sound and (b) the ways in which a behavioural test might complement screening with Auditory Brainstem Responses (ABR) or Evoked Oto-acoustic Emissions (EOAE). A clearer understanding of the relative benefits of detecting different degrees of hearing impairment at birth in both the NICU population and the unrestricted population is urgently needed. To determine what role should be played by specific screening programmes such benefits need to be balanced against the total costs of screening assessment and rehabilitation, in which false positives (low specificity) play a large part.

High-dose inhaled albuterol in severe chronic airflow limitation.

Higher doses of inhaled albuterol have been shown to cause slightly more bronchodilatation than standard doses from a metered-dose inhaler in patients with severe chronic airflow limitation. Higher doses, however, carry an increased risk of side effects, and the optimum dose balancing benefit and adverse effects have yet to be established. We have therefore looked at objective and subjective evidence of beneficial and adverse effects after 4 doses of albuterol in 30 patients with chronic bronchitis, severe airflow limitation, and less than 200 ml increase in FEV1 after 200 micrograms inhaled albuterol. Subjects were given placebo, 400 micrograms, 1 mg, 2 mg, and 4 mg albuterol by dry powder inhaler in random order on separate days in a double-blind study, and FEV1, relaxed VC, PEFR, 12-min walk distance, finger tremor, oxygen saturation, heart rate, and arrhythmias were measured at intervals over 6 h. With increasing doses of albuterol, there was a significant dose-related increase in FEV1, VC, and PEFR, the maximal mean changes being 196 ml, 480 ml, and 50 L/min, respectively. The duration of effect was longer with the higher doses. There was a dose-related increase in heart rate, tremor amplitude, and supraventricular ectopic beats and a dose-related fall in oxygen saturation. There was no drug-related effect on the frequency of ventricular ectopic beats either at rest or during the walk tests. The largest increases in walk distance occurred after the 1 and 2 mg doses and the least after the 4 mg dose.(ABSTRACT TRUNCATED AT 250 WORDS)

The comparative effects of ICI 118551 and propranolol on essential tremor.

1. The effects of the selective beta 2-adrenoceptor antagonist ICI 118551 on essential tremor, heart rate and blood pressure were compared with those of propranolol. 2. ICI 118551 (150 mg daily for 7 days) and propranolol (120 mg daily for 7 days) were about equally effective in reducing essential tremor (by about 40%) and were more effective than placebo. 3. When compared with the effect of placebo, propranolol reduced blood pressure and exercise heart rate whereas ICI 118551 had no significant effect on blood pressure and produced a small but significant reduction in exercise-induced tachycardia. 4. ICI 118551 may be useful in the management of essential tremor while having fewer cardiovascular side-effects than non-selective beta-adrenoceptor antagonists.

Low plasma concentrations of adrenaline and physiological tremor in man.

Finger tremor was measured in six normal subjects during intravenous infusions of adrenaline (10 ngkg-1min-1 and 50 ngkg-1min-1) resulting in venous plasma adrenaline concentrations within the physiological range (0.77 +/- 0.08 and 2.28 +/- 0.18 nmoll-1). Tremor amplitude significantly increased after 15 and 25 minutes infusion at the higher dose of adrenaline. The lower dose of adrenaline increased tremor in three of the six subjects.

The variation of finger tremor with age in man.

The variation of the amplitude and frequency of finger tremor was studied in 190 subjects ranging in age from 7 to 77 years. Tremor was measured in various postures with an accelerometer and a transduced signal was analysed by Fourier analysis. The variation of tremor frequency and amplitude with age depended upon the posture adopted for measurement and in certain postures some of the variation was related to changes in stature with age.

The effect of a week's beta-adrenoceptor antagonism on daytime heart-rates, subjective responses to exercise, and physical activity in normal subjects.

The effects on heart rate (HR) and physical activity of 1 week's treatment with three different beta-adrenoceptor antagonists (20 mg betaxolol (Lorex); 160 mg propranolol LA; or 100 mg atenolol daily) have been compared with placebo in a double-blind study of 12 normal men. On the fifth day of each treatment a body-borne tape-recorder was worn during waking hours for recording of ECG and footfall signals. Each record was calibrated in terms of the subject's response to laboratory ergometer exercise, and a computer analysis provided objective indices of physical activity. While on beta-adrenoceptor antagonists the subjects perceived standard exercise as significantly harder than on placebo and reported more side-effects (albeit mild and transient). Ambulatory monitoring of HR showed that subjects spent 13% of their waking day at heart rates below 50 beats min-1 while on propranolol, compared with 1% on placebo and 20% on atenolol and betaxolol. On these latter drugs, the group spent as much as 10% of their waking time with HR below 45 beats min-1. The lowest individual heart-rates recorded were below 35 beats min-1. Objective indices of physical activity, such as the duration of periods spent with heart rates above the HR found at 100 W in the ergometer test, showed no differences between the treatments. This negative finding was confirmed by pedometer step counts over the whole week.

The influence of fasting and of caffeine intake on finger tremor.

The effect of finger tremor of the administration of 150 mg of caffeine three times daily for two days was measured using an accelerometer in 7 healthy subjects taking their normal diet (excluding caffeine-containing beverages). The effect on finger tremor of a short period of fasting with and without the 450 mg daily dose of caffeine was also studied in the same 7 subjects. Fasting increased finger tremor significantly when caffeine was administered. In doses comparable to the likely adult daily intake in this country, caffeine did not increase finger tremor whilst subjects were taking their normal diet.

Effect on finger tremor of withdrawal of long-term treatment with propranolol or atenolol.

The effect of the withdrawal of long-term beta-adrenoceptor blockade on pulse rate and finger tremor was studied in 27 patients who had been treated for 2 years following an uncomplicated myocardial infarction with either atenolol, propranolol or placebo. During treatment, pulse rate was significantly lower in patients treated with propranolol or atenolol compared with placebo. Compared with the response in the placebo group the mean increase in tremor on withdrawal of propranolol was statistically significant for postural and for work tremor in both hands. A significant increase in tremor on withdrawal of atenolol occurred only in the postural position and in a narrow frequency band (left hand, 7-11 Hz; right hand, 7-9 Hz). The differences in the effect on tremor of withdrawal of treatment with propranolol or atenolol in doses which produced similar reductions in heart rate, emphasise the beta 2 classification of peripheral receptors associated with normal muscle tremor but do not exclude the involvement of beta 1-adrenoceptors.