Aplicabilidade da auriculoterapia para reduzir estresse e como estratégia de coping em profissionais de enfermagem

OBJETIVOS: trata-se de ensaio clínico randomizado com o objetivo de avaliar a auriculoterapia, para diminuição de níveis de estresse, em 75 profissionais de enfermagem de um hospital e analisar os principais domínios de coping que se modificaram após o tratamento. METODOLOGIA: os sujeitos foram divididos em grupos (controle, agulhas, sementes), receberam 8 sessões nos pontos Shenmen, rim e tronco cerebral. O grupo controle não recebeu nenhuma intervenção. RESULTADOS: constataram-se diferenças significativas pela ANOVA, para níveis de estresse entre o grupo agulha/controle na terceira e quarta avaliações, segundo escores de estresse da Lista de Sintoma de Stress de Vasconcelos. Para o Inventário de Folkman e Lazarus, obteve-se diferença estatística para o domínio afastamento entre os grupos agulha/controle, após tratamento; e, na análise dentro do mesmo grupo, obtiveram-se diferenças significativas para o domínio confronto, na quarta avaliação entre grupos agulha/controle e para suporte social, na terceira avaliação para os grupos agulha/semente. CONCLUSÕES: a auriculoterapia com agulhas diminuiu os níveis de estresse significativamente e houve diminuição da utilização dos domínios afastamento, confronto e suporte social para os grupos de intervenção, após o tratamento, sugerindo que a auriculoterapia tanto com agulhas quanto com sementes pode produzir impacto positivo para melhorar a estratégia de coping na equipe de enfermagem. Mais estudos, porém, fazem-se necessários para que se possa conhecer o alcance da técnica.

Noninvasive ventilation immediately after extubation improves weaning outcome after acute respiratory failure: a randomized controlled trial

Abstract Introduction Noninvasive ventilation (NIV), as a weaning-facilitating strategy in predominantly chronic obstructive pulmonary disease (COPD) mechanically ventilated patients, is associated with reduced ventilator-associated pneumonia, total duration of mechanical ventilation, length of intensive care unit (ICU) and hospital stay, and mortality. However, this benefit after planned extubation in patients with acute respiratory failure of various etiologies remains to be elucidated. The aim of this study was to determine the efficacy of NIV applied immediately after planned extubation in contrast to oxygen mask (OM) in patients with acute respiratory failure (ARF). Methods A randomized, prospective, controlled, unblinded clinical study in a single center of a 24-bed adult general ICU in a university hospital was carried out in a 12-month period. Included patients met extubation criteria with at least 72 hours of mechanical ventilation due to acute respiratory failure, after following the ICU weaning protocol. Patients were randomized immediately before elective extubation, being randomly allocated to one of the study groups: NIV or OM. We compared both groups regarding gas exchange 15 minutes, 2 hours, and 24 hours after extubation, reintubation rate after 48 hours, duration of mechanical ventilation, ICU length of stay, and hospital mortality. Results Forty patients were randomized to receive NIV (20 patients) or OM (20 patients) after the following extubation criteria were met: pressure support (PSV) of 7 cm H2O, positive end-expiratory pressure (PEEP) of 5 cm H2O, oxygen inspiratory fraction (FiO2) ≤ 40%, arterial oxygen saturation (SaO2) ≥ 90%, and ratio of respiratory rate and tidal volume in liters (f/TV) < 105. Comparing the 20 patients (NIV) with the 18 patients (OM) that finished the study 48 hours after extubation, the rate of reintubation in NIV group was 5% and 39% in OM group (P = 0.016). Relative risk for reintubation was 0.13 (CI = 0.017 to 0.946). Absolute risk reduction for reintubation showed a decrease of 33.9%, and analysis of the number needed to treat was three. No difference was found in the length of ICU stay (P = 0.681). Hospital mortality was zero in NIV group and 22.2% in OM group (P = 0.041). Conclusions In this study population, NIV prevented 48 hours reintubation if applied immediately after elective extubation in patients with more than 3 days of ARF when compared with the OM group. Trial Registration number ISRCTN: 41524441.

Norm and difference : Stone Age dietary practice in the Baltic region

Stone Age research on Northern Europe frequently makes gross generalizations about the Mesolithic and Neolithic, although we still lack much basic knowledge on how the people lived. The transition from the Mesolithic to the Neolithic in Europe has been described as a radical shift from an economy dominated by marine resources to one solely dependent on farming. Both the occurrence and the geographical extent of such a drastic shift can be questioned, however. It is therefore important to start out at a more detailed level of evidence in order to present the overall picture, and to account for the variability even in such regional or chronological overviews. Fifteen Stone Age sites were included in this study, ranging chronologically from the Early Mesolithic to the Middle or Late Neolithic, c. 8300–2500 BC, and stretching geographically from the westernmost coast of Sweden to the easternmost part of Latvia within the confines of latitudes 55–59° N. The most prominent sites in terms of the number of human and faunal samples analysed are Zvejnieki, Västerbjers and Skateholm I–II. Human and faunal skeletal remains were subjected to stable carbon and nitrogen isotope analysis to study diet and ecology at the sites. Stable isotope analyses of human remains provide quantitative information on the relative importance of various food sources, an important addition to the qualitative data supplied by certain artefacts and structures or by faunal or botanical remains. A vast number of new radiocarbon dates were also obtained. In conclusion, a rich diversity in Stone Age dietary practice in the Baltic Region was demonstrated. Evidence ranging from the Early Mesolithic to the Late Neolithic show that neither chronology nor location alone can account for this variety, but that there are inevitably cultural factors as well. Food habits are culturally governed, and therefore we cannot automatically assume that people at similar sites will have the same diet. Stable isotope studies are very important here, since they tell us what people actually consumed, not only what was available, or what one single meal contained. We should not be deceived in inferring diet from ritually deposited remains, since things that were mentally important were not always important in daily life. Thus, although a ritual and symbolic norm may emphasize certain food categories, these may in fact contribute very little to the diet. By the progress of analysis of intra-individual variation, new data on life history changes have been produced, revealing mobility patterns, breastfeeding behaviour and certain dietary transitions. The inclusion of faunal data has proved invaluable for understanding the stable isotope ecology of a site, and thereby improve the precision of the interpretations of human stable isotope data. The special case of dogs, though, demonstrates that these animals are not useful for inferring human diet, since, due to the number of roles they possess in human society, dogs could deviate significantly from humans in their diet, and in several cases have been proved to do so. When evaluating radiocarbon data derived from human and animal remains from the Pitted-Ware site of Västerbjers on Gotland, the importance of establishing the stable isotope ecology of the site before making deductions on reservoir effects was further demonstrated. The main aim of this thesis has been to demonstrate the variation and diversity in human practices, challenging the view of a “monolithic” Stone Age. By looking at individuals and not only at populations, the whole range of human behaviour has been accounted for, also revealing discrepancies between norm and practice, which are frequently visible both in the archaeological record and in present-day human behaviour.

Intrusiones de la corriente de Kuroshio en el mar de China oriental

[EN]The Kuroshio is known to intrude onto the continental shelf in the southern East China Sea northeast of Taiwan. Two types of intrusions are observed: large and small, depending on how far the Kuroshio penetrates onto the ECS continental shelf, and on the location where it crosses the shelf break. This study demonstrates that cyclonic eddies from the western Pacific induce some of these large Kuroshio intrusions. The large intrusions are identified from more than 20 years of drifter tracks archived in the Global Drifter Program historical database and from weekly and biweekly drifter deployments carried out between April 2008 and September 2009 west of the Green Island (Taiwan). Kuroshio intrusions are observed in all seasons. Cyclonic mesoscale eddies, generated in the Subtropical Countercurrent and North Equatorial Current regions of the northwest Pacific Ocean, propagate westward into the Kuroshio and are well correlated with the observed intrusions. During the intrusions, the mean sea level anomaly computed from AVISO gridded maps shows a well defined cyclonic circulation southeast of the I-Lan ridge. The mean sea level anomaly also shows the meandering pattern of the Kuroshio when it intrudes onto the continental shelf of the southern East China Sea. The high correlation between the Kuroshio volume transport in the East Taiwan Channel (observed with moorings) and the satellite sea level anomaly permits us to use sea level anomaly as a proxy for the Kuroshio volume transport. When direct transport measurements are not available, this proxy is used to verify that intrusions due to the westward propagating eddies occur when the Kuroshio transport is low. An analytical reduced gravity model of an incident baroclinic current upon a step shelf is used to explain the difference between the large and small intrusions.

Valutazione del danno da stress ossidativo come indicatore di effetto biologico dell'esposizione professionale a xenobiotici

Oxidative DNA damages determine the activation of cell repair processes. These processes originate repair products, including the most studied one, 8-hydroxy-2’-deoxyguanosine (8-OH-dG). Several analytical techniques have been applied to measure urinary 8-OH-dG, but a discrepancy in basal urinary 8-OH-dG levels has been noted when comparing chromatographic techniques with immunoenzymatic assays (ELISA). Our laboratory has developed a fully validated, liquid chromatography-tandem mass spectrometry method presenting high sensitivity and specificity, which has participated in an inter-laboratory validation of assays for the measurement of urinary 8-OH-dG (ESCULA project). Mass Spectrometric techniques showed more accuracy and specificity than immunoenzymatic methods. Human spot urine samples were analyzed in order to investigate the possibility to correct urinary lesion measurements for creatinine and to evaluate the intra- and inter-day variability of 8-OH-dG excretion in urine. Our results confirm the opportunity to delve into these issues. Finally, we measured urinary 8-OH-dG in workers exposed to antineoplastic drugs and in a group of unexposed subjects to evaluate the relationship between occupational exposure and oxidative damage related to the internal dose. We found higher levels of 8-OH-dG in exposed nurses, but, as compared to the non-exposed subjects, the difference was not statistically significant, probably do to the very low level of exposure. The scientific literature is rapidly developing on the topic of DNA damage and related repair capacity. Nevertheless, further studies are needed to achieve a better understanding of the sources of DNA lesions in urine and their significance, both in clinical and occupational medicine.

A daily perspective on work interruptions

Diese Dissertation basiert auf einem theoretischen Artikel und zwei empirischen Studien.rnrnDer theoretische Artikel: Es wird ein theoretisches Rahmenmodell postuliert, welches die Kumulierung von Arbeitsunterbrechung und deren Effekte untersucht. Die meisten bisherigen Studien haben Unterbrechungen als isoliertes Phänomen betrachtet und dabei unberücksichtigt gelassen, dass während eines typischen Arbeitstages mehrere Unterbrechungen gleichzeitig (oder aufeinanderfolgend) auftreten. In der vorliegenden Dissertation wird diese Lücke gefüllt, indem der Prozess der kumulierenden Unterbrechungen untersucht wird. Es wird beschrieben,rninwieweit die Kumulation von Unterbrechungen zu einer neuen Qualität vonrn(negativen) Effekten führt. Das Zusammenspiel und die gegenseitige Verstärkung einzelner Effekte werden dargestellt und moderierende und mediierende Faktoren aufgezeigt. Auf diese Weise ist es möglich, eine Verbindung zwischen kurzfristigen Effekten einzelner Unterbrechungen und Gesundheitsbeeinträchtigungen durch die Arbeitsbedingung ‚Unterbrechungen‘rnherzustellen.rnrnStudie 1: In dieser Studie wurde untersucht, inwieweit Unterbrechungen Leistung und Wohlbefinden einer Person innerhalb eines Arbeitstages beeinflussen. Es wurde postuliert, dass das Auftreten von Unterbrechungen die Zufriedenheit mit der eigenen Leistung vermindert und das Vergessen von Intentionen und das Irritationserleben verstärkt. Geistige Anforderung und Zeitdruck galten hierbei als Mediatoren. Um dies zu testen, wurden 133 Pflegekräften über 5 Tage hinweg mittels Smartphones befragt. Mehrebenenanalysen konnten die Haupteffekte bestätigen. Die vermuteten Mediationseffekte wurden für Irritation und (teilweise) für Zufriedenheit mit der Leistung bestätigt, nicht jedoch für Vergessen von Intentionen. Unterbrechungen führen demzufolge (u.a.) zu negativen Effekten, da sie kognitiv anspruchsvoll sind und Zeit beanspruchen.rnrnStudie 2: In dieser Studie wurden Zusammenhänge zwischen kognitiven Stressorenrn(Arbeitsunterbrechungen und Multitasking) und Beanspruchungsfolgen (Stimmung und Irritation) innerhalb eines Arbeitstages gemessen. Es wurde angenommen, dass diese Zusammenhänge durch chronologisches Alter und Indikatoren funktionalen Alters (Arbeitsgedächtniskapazität und Aufmerksamkeit) moderiert wird. Ältere mit schlechteren Aufmerksamkeitsund Arbeitsgedächtnisleistungen sollten am stärksten durch die untersuchten Stressoren beeinträchtigt werden. Es wurde eine Tagebuchstudie (siehe Studie 1) und computergestützternkognitive Leistungstests durchgeführt. Mehrebenenanalysen konnten die Haupteffekte für die abhängigen Variablen Stimmung (Valenz und Wachheit) und Irritation bestätigen, nicht jedoch für Erregung (Stimmung). Dreifachinteraktionen wurden nicht in der postulierten Richtung gefunden. Jüngere, nicht Ältere profitierten von einem hohen basalen kognitivenrnLeistungsvermögen. Ältere scheinen Copingstrategien zu besitzen, die mögliche kognitive Verluste ausgleichen. rnrnIm Allgemeinen konnten die (getesteten) Annahmen des theoretischen Rahmenmodellsrnbestätigt werden. Prinzipiell scheint es möglich, Ergebnisse der Laborforschung auf die Feldforschung zu übertragen, jedoch ist es notwendig die Besonderheiten des Feldes zu berücksichtigen. Die postulieren Mediationseffekte (Studie 1) wurden (teilweise) bestätigt. Die Ergebnisse weisen jedoch darauf hin, dass der volle Arbeitstag untersucht werden muss und dass sehr spezifische abhängige Variablen auch spezifischere Mediatoren benötigen. Des Weiteren konnte in Studie 2 bestätigt werden, dass die kognitive Kapazität eine bedeutsamernRessource im Umgang mit Unterbrechungen ist, im Arbeitskontext jedoch auch andere Ressourcen wirken.

Towards a Variety of Family Models: Economic Contributions of Spouses and Family Power

In Western societies the increase in female employment (especially among married women) is seen as having brought about the crisis of the traditional model of the family, reinforcing the position of the "modern" model - the egalitarian family with two working spouses and a "dual-career" family. In contrast, the transitional situation in the post-communist countries during the 1990s is producing a crisis of the family with two working spouses (the basic type of the communist period) and leading to new power relations within the family. While the growth of dual-earner households in this century has implied modification of family models towards greater symmetry of responsibility for breadwinning and homemaking, there is considerable evidence that women's increased employment does not necessarily lead to a more egalitarian approach to gender roles within the family. The group set out to investigate the economic situation of families and economic power within the fame as a crucial factor in the transformation of families with two working spouses in order to reveal the specific patterns of gender contracts and power relations within the family that are emerging in response to the current political and economic transformation. They opted for a comparative approach, selecting the Czech Republic as a country where the very similar tendencies of a few years ago (almost 100% of women employed and the family as a realm of considerable private freedom where both women's and men's gender identities and the traditional distribution of family responsibilities were largely preserved) are combined with a very different experience in terms of economic inequalities during the 1990s to that of Russia. In the first stage of the study they surveyed 300 married couples (150 in each country) on the question of breadwinning. They then carried out in-depth interviews with 10 couples from each country (selected from among the educated layers of the population), focusing on the process of the social construction of gender, using breadwinning and homemaking as gender boundaries which distinguish men from women. By analysing changes in social position and the type of interpersonal interaction of spouses they distinguished two main types of family contracts: the neo-traditional "communal sharing" (with male breadwinner, traditional distribution of family chores and negotiated family power) and the modern one based on negotiated agreement. The most important pre-conditions of husband-wife agreement about breadwinning seemed to imply their overall gender ideology rather than the economic and/or family circumstances. In general, wives were more likely to express egalitarian views, supporting the blurring or even elimination of many gender boundaries. Husbands, on the other hand, more often gave responses calling for the continued maintenance of gender boundaries. The analysis showed that breadwinning is still an important gender boundary in these cultures, one that is assumed unless it is explicitly questioned and that is seen as part of what makes a man a "real man". The majority of respondents seemed to be committed to egalitarian ideology on gender roles and the distribution of family tasks, including decision making, but this is contradicted by the persistent idea of the husband as the breadwinner. This contradiction is more characteristic of the Russian situation than of the Czech. The quantitative study showed a difference in prevailing family models between the two countries, with a clearer shift towards the traditional family contract in the Russian case. The Czechs were more likely to consider their partnerships as based on negotiated agreement, while the Russians saw theirs as based on egalitarian contract, in both cases seeing this as the norm. The majority of couples said they felt satisfied with their marriage, although in both countries wives seemed to be less satisfied. There was however a difference in the issues that aroused dissatisfaction, with Czech women being more sensitive to issues such as self-realisation, personal independence, understanding and recognition in the family, and Russians to issues of love, understanding and recognition. The most disputed area for the majority of families was chores in the home, presumably because in many families both husband and wife were working hard outside the home and because a number of partners had differing views as to the ideal distribution of chores within the family. The distribution of power in the family seems to be linked to the level of well being. The analysis showed that in the dominant democratic model there is still an inverse connection between family leadership and well being: the more prominent the wife's position as head of the family is, the lower the level of family income. This may reflect both the husband's refusal to play the leading role in the family and even his rejection of any involvement in family issues in such a family. The qualitative research revealed that both men and women see the breadwinning role to be an essential part of masculine identity, a role which the female partner would take on temporarily to assist the male but not permanently since this would threaten the gender boundaries and the man's identity. At the same time, few breadwinners expressed a sense of job satisfaction and all considered their choice as imposed on them by the circumstances (i.e. having a family in difficult times). The group feel that family orientation and some loss of personal involvement in their profession is partly reflected in the fact that many of the men felt more comfortable and self-confident at home than at work. Women's work, on the other hand, was largely seen as a source of personal and self-realisation and social life. Eight out of ten of the Russian women interviewed were employed, although only two on a full-time basis, but none saw their jobs as adding substantially to the family budget. Both partners see the most important factor as the wife's wish to work or stay at home, and do not think it wise for the wife to work at the expense of her part of the "family contract", although husbands from the "egalitarian" relationships expressed more willingness to compromise. The analysis showed clearly that wives and husbands did not construct gender boundaries in isolation, with the interviews providing clear evidence of negotiation. At the same time, husbands' interpretations of their wives' employment were less susceptible to the influence of negotiation than were their gender attitudes and norms about breadwinning. One of the most interesting aspects of the spouses' negotiations was the extent to which they disagreed about what they seemed to have agreed upon. Most disagreements about the breadwinning boundaries, however, were over norms and were settled by changes in norms rather than in behavioural interpretation. Changes in norms were often a form of peace offering or were in response in changes in circumstances. The study did show, however, that many of the efforts at cooperation and compensation were more symbolic than real and the group found the plasticity of expressed gender ideology to be one of the most striking findings of their work. They conclude that the shift towards more traditional gednder distributions of incomes and domestic chores does not automatically mean the reestablishment of a patriarchal model of family power. On the contrary, it seems to be a compromise formation, relatively unstable, temporary and containing self-defeating forces as the split between the personal and professional value of work and its social value expressed in a money equivalent cannot be maintained for generations.

Partner notification of chlamydia infection in primary care: randomised controlled trial and analysis of resource use

OBJECTIVE: To evaluate the effectiveness of a practice nurse led strategy to improve the notification and treatment of partners of people with chlamydia infection. DESIGN: Randomised controlled trial. SETTING: 27 general practices in the Bristol and Birmingham areas. PARTICIPANTS: 140 men and women with chlamydia (index cases) diagnosed by screening of a home collected urine sample or vulval swab specimen. INTERVENTIONS: Partner notification at the general practice immediately after diagnosis by trained practice nurses, with telephone follow up by a health adviser; or referral to a specialist health adviser at a genitourinary medicine clinic. MAIN OUTCOME MEASURES: Primary outcome was the proportion of index cases with at least one treated sexual partner. Specified secondary outcomes included the number of sexual contacts elicited during a sexual history, positive test result for chlamydia six weeks after treatment, and the cost of each strategy in 2003 sterling prices. RESULTS: 65.3% (47/72) of participants receiving practice nurse led partner notification had at least one partner treated compared with 52.9% (39/68) of those referred to a genitourinary medicine clinic (risk difference 12.4%, 95% confidence interval -1.8% to 26.5%). Of 68 participants referred to the clinic, 21 (31%) did not attend. The costs per index case were 32.55 pounds sterling for the practice nurse led strategy and 32.62 pounds sterling for the specialist referral strategy. CONCLUSION: Practice based partner notification by trained nurses with telephone follow up by health advisers is at least as effective as referral to a specialist health adviser at a genitourinary medicine clinic, and costs the same. Trial registration Clinical trials: NCT00112255.

Practical sources of error in measuring pulmonary artery occlusion pressure: a study in participants of a special intensivist training program of The Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI)

BACKGROUND: Physiological data obtained with the pulmonary artery catheter (PAC) are susceptible to errors in measurement and interpretation. Little attention has been paid to the relevance of errors in hemodynamic measurements performed in the intensive care unit (ICU). The aim of this study was to assess the errors related to the technical aspects (zeroing and reference level) and actual measurement (curve interpretation) of the pulmonary artery occlusion pressure (PAOP). METHODS: Forty-seven participants in a special ICU training program and 22 ICU nurses were tested without pre-announcement. All participants had previously been exposed to the clinical use of the method. The first task was to set up a pressure measurement system for PAC (zeroing and reference level) and the second to measure the PAOP. RESULTS: The median difference from the reference mid-axillary zero level was - 3 cm (-8 to + 9 cm) for physicians and -1 cm (-5 to + 1 cm) for nurses. The median difference from the reference PAOP was 0 mmHg (-3 to 5 mmHg) for physicians and 1 mmHg (-1 to 15 mmHg) for nurses. When PAOP values were adjusted for the differences from the reference transducer level, the median differences from the reference PAOP values were 2 mmHg (-6 to 9 mmHg) for physicians and 2 mmHg (-6 to 16 mmHg) for nurses. CONCLUSIONS: Measurement of the PAOP is susceptible to substantial error as a result of practical mistakes. Comparison of results between ICUs or practitioners is therefore not possible.

Routine procedures in NICUs: factors influencing pain assessment and ranking by pain intensity

BACKGROUND: Pain associated with routine procedures in NICUs is often inadequately managed. Barriers to more appropriate pain management are nurses' and physicians' knowledge and the challenges of collaborative decision-making. Few studies describe the differing perceptions of procedural pain intensity among nurses and physicians in NICUs which could complicate common decision-making. This study set out to explore the factors influencing pain intensity assessment and to gain insight into a possible pain intensity classification of routine procedures in the NICU. METHOD: A survey was conducted among 431 neonatal health care professionals from 4 tertiary level NICUs. Each routine procedure was assessed on a 10-point visual analogue scale (VAS) assuming absence of analgesia. RESULTS: Multiple ANCOVA models showed that nurses rated 19 of the 27 procedures as significantly more painful than did physicians (p<0.05). We found no differences in pain assessment based on professional experience, gender or age. Of the 27 procedures listed, 70% were rated as painful and 44% were judged very painful. Ranking and classification of the pain intensity of routine procedures were drawn up. The general ranking of the median across all procedures shows that "insertion of a thoracic drain" is assessed as the most painful procedure. CONCLUSIONS: The majority of routine procedures in an NICU are considered to be painful. Nurses generally rate procedures as more painful than do physicians. This difference in assessment deserves exploration in regard to its impact on collaborative decision-making in neonate pain management.

Legislative Legacy: Big Changes in Legislative Article of 1972 Constitution -- Jerry Loendorf, Arlyne Reichert & Rich Bechtel “In the Crucible of Change”

The fulcrum upon which were leveraged many of the dramatic progressive changes in Montana that are documented "In the Crucible of Change" series was the lead up to, preparation, writing and adoption of the 1972 Montana Constitution. As Montana citizens exhibited their concern over the dysfunctional state government in MT under its 1889 Constitution, one of the areas that stood out as needing serious change was the Montana Legislature. Meeting for only sixty calendar days every two years, the Legislature regularly tried to carry off the subterfuge of stopping the wall clock at 11:59 PM on the sixtieth day and placing a shroud over it so they could continue to conduct business as if it were still the 60th day. Lawyers hired by the Anaconda Company drafted most bills that legislators wanted to have introduced. Malapportionment, especially in the State Senate where each county had one Senator regardless of their population, created a situation where Petroleum County with 800 residents had one senator while neighboring Yellowstone County with 80,000 people also had one senator -- a 100-1 differential in representation. Reapportionment imposed by rulings of the US Supreme Court in the mid-1960s created great furor in rural Montana to go along with the previous dissatisfaction of the urban centers. Stories of Anaconda Company “thumbs up – thumbs down” control of the votes were prevalent. Committee meeting and votes were done behind closed doors and recorded votes were non-existent except for the nearly meaningless final tally. People were in the dark about the creation of laws that affected their daily lives. It was clear that change in the Legislature had to take the form of change in the Constitution and, because it was not likely that the Legislature would advance Constitutional amendments on the subject, a convention seemed the only remedy. Once that Convention was called and went to work, it became apparent that the Legislative Article provided both opportunity for change and danger that too dramatic a change might sink the whole new document. The activities of the Legislative Committee and the whole Convention when acting upon Legislative issues provides one of the more compelling stories of change. The story of the Legislative Article of the Montana Constitution is discussed in this episode by three major players who were directly involved in the effort: Jerry Loendorf, Arlyne Reichert and Rich Bechtel. Their recollections of the activities surrounding the entire Constitutional Convention and specifically the Legislative Article provide an insider’s perspective of the development of the entire Constitution and the Legislative portion which was of such a high degree of interest to the people of Montana during the important period of progressive change documented “In the Crucible of Change.” Jerry Loendorf, who served as Chair of the Legislative Committee at the 1972 Montana Constitutional Convention, received a BA from Carroll College in 1961 and a JD from the University of Montana Law School in 1964. Upon graduation he served two years as a law clerk for the Montana Supreme Court after which he was for 34 years a partner in the law firm of Harrison, Loendorf & Posten, Duncan. In addition to being a delegate to the Constitutional Convention, Jerry served on the Board of Labor Appeals from 2000 to 2004. He was designated a Montana Special Assistant Attorney General to represent the state in federal court on the challenge to the results of the ratification election of Montana's Constitution in 1972. Jerry served on the Carroll College Board of Directors in the late 1960s and then again as a member of the Board of Trustees of Carroll College from 2001 to 2009. He has served on the Board of Directors of the Rocky Mountain Development Council since 1970 and was on the board of the Helena YMCA from 1981 to 1987. He also served on the board of the Good Samaritan Ministries from 2009 to 2014. On the business side, Jerry was on the Board of Directors of Valley Bank to Helena from 1980 to 2005. He is a member of the American Bar Association, State Bar of Montana, the First Judicial District Bar Association, and the Montana Trial Lawyers Association. Carroll College awarded Jerry the Warren Nelson Award 1994 and the Insignias Award in 2007. At Carroll College, Jerry has funded the following three scholarship endowments: George C and Helen T Loendorf, Gary Turcott, and Fr. William Greytek. Arlyne Reichert, Great Falls Delegate to the Constitutional Convention and former State Legislator, was born in Buffalo, NY in 1926 and attended University of Buffalo in conjunction with Cadet Nurses Training during WWII. She married a Montanan in Great Falls in 1945 and was widowed in 1968. She is mother of five, grandmother of seven, great-grandmother of four. Arlyne was employed by McLaughlin Research Institute in Great Falls for 23 years, serving as Technical Editor of Transplantation Journal in 1967, retiring as Assistant Director in 1989. In addition to being a state legislator (1979 Session) and a delegate to the 1972 Montana Constitutional Convention, she has filled many public roles, including Cascade County Study Commissioner (1974), MT Comprehensive Health Council, US Civil Rights Commission MT Advisory Committee, MT Capitol Restoration Committee, and Great Falls Public Library Trustee. Arlyne has engaged in many non-profit activities including League of Women Voters (State & Local Board Officer – from where her interest in the MT Constitutional change developed), Great Falls Public Radio Association (President & Founder), American Cancer Society (President Great Falls Chapter), Chair of MT Rhodes Scholarship Committee, and Council Member of the National Civic League. She also served a while as a Television Legislative Reporter. Arlyne has been recipient of numerous awards, the National Distinguished Citizens Award from the National Municipal League, two Women of Achievement Awards from Business & Professional Women, the Salute to Women Award by YWCA, Heritage Preservation Award from Cascade County Historical Society and the State of Montana, and the Heroes Award from Humanities Montana. She remains active, serving as Secretary-Treasurer of Preservation Cascade, Inc., and as Board Member of the McLaughlin Research Institute. Her current passion is applied to the preservation/saving of the historic 10th Street Bridge that crosses the Missouri River in Great Falls. Rich Bechtel of Helena was born in Napa, California in 1945 and grew up as an Air Force brat living in such places as Bitberg, Germany, Tripoli, Libya, and Sevilla, Spain. He graduated from Glasgow High School and the University of Montana. Rich was a graduate assistant for noted Montana History professor Professor K. Ross Toole, but dropped out of graduate school to pursue a real life in Montana politics and government. Rich has had a long, varied and colorful career in the public arena. He currently is the Director of the Office of Taxpayer Assistance & Public Outreach for MT’s Department of Revenue. He previously held two positions with the National Wildlife Federation in Washington, DC (Sr. Legislative Representative [1989-91] and Sr. Legislative Representative for Wildlife Policy [2004-2006]). While in Washington DC, he also was Assistant for Senator Lee Metcalf (D-MT), 1974-1976; Federal-State Coordinator for State of Montana, 1976-1989; Director of the Western Governors’ Association Washington Office, 1991-2000; and Director of Federal Affairs for Governor Kitzhaber of Oregon, 2001- 2003. Earlier in Montana Government, between 1971 and 1974, Rich was Research Analyst for MT Blue Ribbon Commission on Postsecondary Education, Legislative Consultant and Bill Drafter for MT Legislative Council, Research Analyst for the MT Constitutional Convention Commission where he provided original research on legislatures, as well as Researcher/Staff for the MT Constitutional Convention Legislative Committee, from where he drafted the various provisions of the Legislative Article and the majority and minority reports on behalf of the Committee members. Rich has represented Montana’s Governor on a trade and cultural mission to Republic of China and participated in US-German Acid Rain Committee sessions in Germany and with European Economic Community environmental officials in Belgium. He is married to Yvonne Seng (Ph.D.) - T’ai Chi apprentice; author and birder.

Risk factors associated with first symptomatic infection of {\it Cryptosporidium parvum\/} in an infant population in Bilbeis, Egypt

Diarrhea disease is a leading cause of morbidity and mortality, especially in children in developing countries. An estimate of the global mortality caused by diarrhea among children under five years of age was 3.3 million deaths per year. Cryptosporidium parvum was first identified in 1907, but it was not until 1970 that this organism was recognized as a cause of diarrhea in calves. Then it was as late as 1976 that the first reported case of human Cryptosporidiosis occurred. This study was conducted to ascertain the risk factors of first symptomatic infection with Cryptosporidium parvum in a cohort of infants in a rural area of Egypt. The cohort was followed from birth through the first year of life. Univariate and multivariate analyses of data demonstrated that infants greater than six months of age had a two-fold risk of infection compared with infants less than six months of age (RR = 2.17; 95% C.I. = 1.01-4.82). When stratified, male infants greater than six months of age were four times more likely to become infected than male infants less than six months of age. Among female infants, there was no difference in risk between infants greater than six months of age and infants less than six months of age. Female infants less than six months of age were twice more likely to become infected than male infants less than six months of age. The reverse occurred for infants greater than six months of age, i.e., male infants greater than six months of age had twice the risk of infection compared to females of the same age group. Further analysis of the data revealed an increased risk of Cryptosporidiosis infection in infants who were attended in childbirth by traditional childbirth attendants compared to infants who were attended by modern childbirth attendants (nurses, trained midwives, physicians) (RR = 4. 18; 95% C.I. = 1.05-36.06). The final risk factor of significance was the number of people residing in the household. Infants in households which housed more than seven persons had an almost two-fold risk of infection compared with infants in homes with fewer than seven persons. Other risk factors which suggested increased risk were lack of education among the mothers, absence of latrines and faucets in the homes, and mud used as building material for walls and floors in the homes. ^

Caring for ageing migrants in nursing homes: 'doing diversity' while 'doing death'

The proposed paper will present first results of a research project investigating how nursing homes in Switzerland deal with migrant elders who are in intensive need of care. Focusing on the end-of-life in institutional care settings, the intention is to explore the dimensions of ‘doing death’ in Swiss nursing homes when the elderly involved are of migrant background. The focus is laid on the co-construction of end of life in interactions between residents of migrant background and professional carers involved (often of migrant background themselves), and will thereby focus on processes of ‘doing diversity’ while ‘doing death’. To do so, we chose an ethnographic approach focusing on the participant observation of everyday practices of ‘doing death’ and ‘death work’ and on interviewing staff, residents and their relatives. Caring for ageing migrants at the end of their lives is studied in different types of assisted living at the end of life: The field of research was entered by studying a group specific department for residents of so-called ‘Mediterranean’ background. It was contrasted by a department stressing the individuality of each resident but including a considerable number of residents with migrant background. We are interested in how (and if at all) specific forms of ‘doing community’ within different types of departments may also lead to specific ways of ‘doing death’, which aim at a stronger embeddedness of dying trajectories in social relations of reciprocity and exchange. Furthermore, migrant ‘doing death’ is expected to be particularly negotiable since the potential diversities of symbolic reference systems and daily practices are widened. If the respective resident is limited in his/her capacities to play an active part in negotiating about ‘good care’ and ‘good dying’ – either due to language competences, which would be migrant specific, or due to degenerative diseases, which is not migrant specific – the field of negotiations will be left up to the professionals within the organization (and to the relatives, which are, however, not constantly present). Strategies of stereotyping the ‘other’ as well as driving nurses, caring aides and other professionals of migrant background into roles of ‘cultural experts’ or ‘transcultural translators’ are expected to be common in such situations. However, the task of negotiating what would be a ‘good dying’ and what measures are appropriate is always at stake in contemporary heterogeneous societies. Therefore we would argue that studying dying processes involving migrant residents is looking at paradigmatic manifestations of doing death in recent contexts of reflexive modernity.

The assessment of standardized training programs in public health preparedness

The Texas Bioterrorism Continuing Education Consortium (BCE) provided National Disaster Life Support (NDLS) training courses throughout the state of Texas in 2005, to help improve knowledge and skills pertaining to bioterrorism and other public health emergencies. The NDLS training courses include curriculum in Basic Disaster Life Support (BDLS) and Core Disaster Life Support (CDLS). A course evaluation which included items assessing ability and willingness of training participants, role of responders, and other variables was mailed to all NDLS participants who provided contact information. An analysis was conducted to determine whether the survey respondents participated in the Hurricanes Katrina and/or Rita relief efforts, as well as to evaluate the impact of the NDLS training courses on the participant's ability and willingness to respond during a disaster. The study population (n = 2150) consisted mostly of nurses (50%) (n=1074). A chi-square test of analysis indicated the following results. Among the survey respondents who took the CDLS course, there was no statically significant difference by occupation pertaining to ability or willingness to respond (x2 [df = 5] = 4.02, p= 0.546); (x2 [df = 5] = 2.45, p = .783). However, there was a statistically significant difference among those respondents who took the BDLS course with respect to ability, and a slightly significant difference with respect to willingness (x2 [df = 5] = 13.35, p = .020 and (x2 = [df = 5] = 10.299, p = .067). These findings are similar to previous studies assessing willingness to respond to a disaster.^ A second analysis was conducted with these survey data to evaluate the implications for disaster response training for the NDLS courses. Results indicated that the majority of disaster responders served in the role for which they were professionally trained (Physicians=68%; Nurses = 50.4%). Nurses, EMT, and Fire professionals served in multiple roles. These results suggest the importance of developing training programs that will prepare professionals to serve in multiple roles. The development of standardized evaluation methods would fill an important gap in assessing impact of national training programs. ^

A COMPARISON OF COUNTY HOSPITAL UTILIZATION BEFORE AND AFTER INTERVENTION BY THE HOSPITAL'S ALCOHOLISM SERVICES PROGRAM

This study examines the reduction in hospital utilization of 393 public hospital patients who were referred to the hospital's alcoholism screening program for intervention. The 393 patients were the total patient population of the alcoholism screening program for the period of September through December, 1982. Medical records of these patients were investigated to assess the total number of hospital days six months before and six months after intervention. The findings support the hypothesis of decreased utilization. The total number of hospital days for 393 patients before intervention of the alcoholism program was 3,458, with a mean length of stay of 8.80 days. The total number of hospital days after intervention was 458 days, with a mean length of stay of 6.50 days. The average individual difference (decrease) was 7.63 days for one year. From a total of 393 patients counseled by the alcoholism program, 106 (27%) went to treatment for their alcoholism. Other aims were to examine the referral sources (physicians, nurses, social workers and the MAST); study the impact of familial history of alcoholism on referrals, and explore the MAST scores of patients successfully referred. Implications of the study are that it would benefit the public hospital, with their disproportionate numbers of alcoholics, to intervene in the behavioral patterns of alcoholism. Such intervention would be a factor in reducing the overall hospitalization of the alcoholic. ^