Spousal concordance in health behavior change.

OBJECTIVE: This study examines the degree to which a married individual's health habits and use of preventive medical care are influenced by his or her spouse's behaviors. STUDY DESIGN: Using longitudinal data on individuals and their spouses, we examine changes over time in the health habits of each person as a function of changes in his or her spouse's health habits. Specifically, we analyze changes in smoking, drinking, exercising, cholesterol screening, and obtaining a flu shot. DATA SOURCE: This study uses data from the Health and Retirement Study (HRS), a nationally representative sample of individuals born between 1931 and 1941 and their spouses. Beginning in 1992, 12,652 persons (age-eligible individuals as well as their spouses) from 7,702 households were surveyed about many aspects of their life, including health behaviors, use of preventive services, and disease diagnosis. SAMPLE: The analytic sample includes 6,072 individuals who are married at the time of the initial HRS survey and who remain married and in the sample at the time of the 1996 and 2000 waves. PRINCIPAL FINDINGS: We consistently find that when one spouse improves his or her behavior, the other spouse is likely to do so as well. This is found across all the behaviors analyzed, and persists despite controlling for many other factors. CONCLUSIONS: Simultaneous changes occur in a number of health behaviors. This conclusion has prescriptive implications for developing interventions, treatments, and policies to improve health habits and for evaluating the impact of such measures.

Application of the Intervention Mapping protocol to develop Keys, a family child care home intervention to prevent early childhood obesity.

BACKGROUND: Many families rely on child care outside the home, making these settings important influences on child development. Nearly 1.5 million children in the U.S. spend time in family child care homes (FCCHs), where providers care for children in their own residences. There is some evidence that children in FCCHs are heavier than those cared for in centers. However, few interventions have targeted FCCHs for obesity prevention. This paper will describe the application of the Intervention Mapping (IM) framework to the development of a childhood obesity prevention intervention for FCCHs METHODS: Following the IM protocol, six steps were completed in the planning and development of an intervention targeting FCCHs: needs assessment, formulation of change objectives matrices, selection of theory-based methods and strategies, creation of intervention components and materials, adoption and implementation planning, and evaluation planning RESULTS: Application of the IM process resulted in the creation of the Keys to Healthy Family Child Care Homes program (Keys), which includes three modules: Healthy You, Healthy Home, and Healthy Business. Delivery of each module includes a workshop, educational binder and tool-kit resources, and four coaching contacts. Social Cognitive Theory and Self-Determination Theory helped guide development of change objective matrices, selection of behavior change strategies, and identification of outcome measures. The Keys program is currently being evaluated through a cluster-randomized controlled trial CONCLUSIONS: The IM process, while time-consuming, enabled rigorous and systematic development of intervention components that are directly tied to behavior change theory and may increase the potential for behavior change within the FCCHs.

Risk stratification of latent tuberculosis defined by combined interferon gamma release assays.

Most individuals infected with Mycobacterium tuberculosis develop latent tuberculosis infection (LTBI). Some may progress to active disease and would benefit from preventive treatment yet no means currently exists to predict who will reactivate. Here, we provide an approach to stratify LTBI based on IFN-γ responses to two antigens, the recombinant Early-Secreted Antigen Target-6 (rESAT-6) and the latency antigen Heparin-Binding Haemagglutinin (HBHA).

Aspects of midwifery care 2: 'enhanced role' and social aspects

This is the second in a series of six papers presenting key findings from a national study that was undertaken to investigate the role and responsibilities of midwives and to identify and address continuing educational need. The background to the study and the titles of other papers in the series were outlined in the first paper. This paper focuses on two key aspects of the midwife’s role: ‘enhanced role’ activities and social and emotional care. The implications of the findings for practice and education are discussed.

Aspects of midwifery care 3: organisation of midwifery care

This is the third in a series of six papers presenting key findings from a national study that was undertaken to investigate the role and responsibilities of midwives and to identify continuing educational need. The background to the study and the titles of the other papers in the series have been outlined in the first paper. Issues related to the way midwifery care is organized nationally are discussed in this paper. Midwives and supervisors indicated a strong commitment to providing woman-centred care in a caring and sensitive manner, often in the face of enormous structural and organizational change. This paper addresses key issues that arose for midwives and supervisors when planning and providing an optimum quality service.

Aspects of care 4: views of professionals and mothers

This is the fourth in a series of six papers presenting key findings from a national study that was undertaken to investigate the role and responsibilities of midwives and to identify continuing educational need. The background to the study and the titles of the other papers in the series have been outlined in the first paper. This paper focuses on midwives’, supervisors’, doctors’ and mothers’ views regarding quality of care issues, with particular emphasis on what makes a ‘good’ midwife.

Aspects of care 5: the continuing educational needs of midwives

This is the fifth in a series of six papers presenting key findings from a national study that was undertaken to investigate the role and responsibilities of midwives and to identify continuing educational need. The background to the study and the titles of the other papers in the series have been outlined in the first paper. This paper focuses on the methods used to identify the continuing educational needs of midwives, and provides an overview of the findings related to midwives' perceived confidence/competence to practice and their continuing educational needs.

Aspects of care 6: continuing educational needs of midwives 2

This is the last in a series of six papers presenting key findings from a national study that was undertaken to investigate the role and responsibilities of midwives in England and to identify and address continuing educational needs. The background to the study and the titles of other papers in the series have been outlined in the first paper. The first five papers have provided an overview of the main research findings that have been used to determine the continuing educational needs of midwives. This paper provides a more detailed picture of the issues that were identified in relation to educational need, and an overview of the way in which an educational package was developed on the basis of the research findings for use by midwives nationally.

Woman-centred care

Changes over the past decade have emphasised the individual service user and their relationship with the health service. Within the maternity services this has been interpreted as woman-centred care a result of key initiatives; the Winterton Report (House of Commons, 1992. Maternity Services. Second Report of the Health Committee (Winterton Report), Vol. 1. HMSO, London) and Changing Childbirth (DoH, 1993a, Changing childbirth: reports of the expert maternity group parts 1 & 2. HMSO, London). Changing Childbirth outlined key principles of the maternity services and the need for the woman (and her partner, if she wishes) to be the focus of care. The key principles are choice, continuity and control. High quality care depends on the recognition of individuals as having unique needs which continues to be reflected within contemporary policy documents (DoH, 1997, The new NHS: modern and dependable. HMSO, London). This paper presents findings related to the provision of woman-centred care from a national research and development study. The study design incorporated (i): a national survey which was undertaken with midwives, midwife supervisors and doctors; and (ii): in-depth case studies in which information was obtained through interviews with midwives, midwife supervisors, educators, managers, doctors and mothers. Midwives, at all levels, are involved in changing maternity service provision and adapting to new systems of care which aim to increase continuity of care and carer for the woman. The researchers sought to understand how woman-centred care was interpreted and experienced in practice. The findings have been used to identify the continuing educational needs of midwives, and to develop an open learning educational package to meet identified need. The curriculum was designed to enhance the move towards the provision of a more integrated woman-centred service.

Multi-function oxidases are responsible for the synergistic interactions occurring between repellents and insecticides in mosquitoes

Background: With the spread of pyrethroid resistance in mosquitoes, the combination of an insecticide (carbamate or organophosphate) with a repellent (DEET) is considered as a promising alternative strategy for the treatment of mosquito nets and other relevant materials. The efficacy of these mixtures comes from the fact that they reproduce pyrethroid features and that positive interactions occur between insecticides and repellent. To better understand the mechanisms involved and assess the impact of detoxifying enzymes (oxidases and esterases) in these interactions, bioassays were carried out in the laboratory against the main dengue vector Aedes aegypti. Methods: Topical applications of DEET and propoxur (carbamate), used alone or as a mixture, were carried out on female mosquitoes, using inhibitors of the two main detoxification pathways in the insect. PBO, an inhibitor of multi-function oxidases, and DEF, an inhibitor of esterases, were applied one hour prior to the main treatment. Results: Results showed that synergism between DEET and propoxur disappeared in the presence of PBO but not with DEF. This suggests that oxidases, contrary to esterases, play a key role in the interactions occurring between DEET and cholinesterase inhibitors in mosquitoes. Conclusion: These findings are of great interest for the implementation of "combination nets" in the field. They support the need to combine insecticide with repellent to overcome insecticide resistance in mosquitoes of public health importance.

Nursing resources and patient outcomes in intensive care: a systematic review of the literature

Objectives: To evaluate the empirical evidence linking nursing resources to patient outcomes in intensive care settings as a framework for future research in this area. Background: Concerns about patient safely and the quality of care are driving research on the clinical and cost-effectiveness of health care interventions, including the deployment of human resources. This is particularly important in intensive care where a large proportion of the health care budget is consumed and where nursing staff is the main item of expenditure. Recommendations about staffing levels have been trade but may not be evidence based and may not always be achieved in practice. Methods: We searched systematically for studies of the impact of nursing resources (e.g. nurse-patient ratios, nurses' level of education, training and experience) on patient Outcomes, including mortality and adverse events, in adult intensive care. Abstracts of articles were reviewed and retrieved if they investigated the relationship between nursing resources and patient Outcomes. Characteristics of the studies were tabulated and the quality of the Studies assessed. Results: Of the 15 studies included in this review, two reported it statistical relationship between nursing resources and both mortality and adverse events, one reported ail association to mortality only, seven studies reported that they Could not reject the null hypothesis of no relationship to mortality and 10 studies (out of 10 that tested the hypothesis) reported a relationship to adverse events. The main explanatory mechanisms were the lack of time for nurses to perform preventative measures, or for patient surveillance. The nurses' role in pain control was noted by One author. Studies were mainly observational and retrospective and varied in scope from 1 to 52 units. Recommendations for future research include developing the mechanisms linking nursing resources to patient Outcomes, and designing large multi-centre prospective Studies that link patient's exposure to nursing care oil a shift-by-shift basis over time. (C) 2007 Elsevier Ltd. All rights reserved.

Staff training in the mental health needs of people with learning disabilities in the UK

This paper gives a general overview of some of the factors involved in the training and knowledge of learning disabilities staff relating to mental health. Early indications from research have shown that training may be effective as a way of addressing these problems, but further research and clear guidance on best practice in implementing staff training are needed in this important area.

Healthcare: rejection of privatisation and patient fees in Central Europe

Since 2006, there have been successful campaigns against commercialisation of public health services in the four central European countries – Czech Republic, Hungary, Poland and Slovakia.

Can evidence-based healthy housing interventions be put into practice in the UK's private housing sector?

The UK’s public health agenda has encouraged enhanced housing and health interventions. The private housing sector (privately rented and owner occupied) is the favoured and majority UK tenure, but is it seen as a primarily health promoting environment, or a commercial asset? There has been a growing interest in integrating health and housing policy in recent years. However, housing and public health fall under separate government departments and funding regimes. Partnership working has sought to overcome silo working and encourage evidence-based practice, yet is particularly challenging for interventions in the private housing sector, with an increased emphasis on ‘personal responsibility’ for conditions. Strategic public health frameworks are in place, but barriers remain and there is pressure for organisations to revert to core activities. An accessible, continually updated evidence base specific to private sector housing is recommended, to help estimate health gain arising from interventions to prioritise activities and address inequalities.