Communication in Smoking Cessation and Self-management : a study at Nurse-led COPD-clinics in Primary Health Care

ABSTRACTThe general aim of this thesis was to investigate behavioral change communication at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care, focusing on communication in self-management and smoking cessation for patients with COPD.Designs: Observational, prospective observational and experimental designs were used.Methods: To explore and describe the structure and content of self-management education and smoking cessation communication, consultations between patients (n=30) and nurses (n=7) were videotaped and analyzed with three instruments: Consulting Map (CM), the Motivational Interviewing Treatment Integrity (MITI) scale and the Client Language Assessment in Motivational Interviewing (CLAMI). To examine the effects of structured self-management education, patients with COPD (n=52) were randomized in an intervention and a control group. Patients’ quality of life (QoL), knowledge about COPD and smoking cessation were examined with a questionnaire on knowledge about COPD and smoking habits and with St. George’s Respiratory Questionnaire, addressing QoL. Results: The findings from the videotaped consultations showed that communication about the reasons for consultation mainly concerned medical and physical problems and (to a certain extent) patients´ perceptions. Two consultations ended with shared understanding, but none of the patients received an individual treatment-plan. In the smoking cessation communication the nurses did only to a small extent evoke patients’ reasons for change, fostered collaboration and supported patients’ autonomy. The nurses provided a lot of information (42%), asked closed (21%) rather than open questions (3%), made simpler (14%) rather than complex (2%) reflections and used MI non-adherent (16%) rather than MI-adherent (5%) behavior. Most of the patients’ utterances in the communication were neutral either toward or away from smoking cessation (59%), utterances about reason (desire, ability and need) were 40%, taking steps 1% and commitment to stop smoking 0%. The number of patients who stopped smoking, and patients’ knowledge about the disease and their QoL, was increased by structured self-management education and smoking cessation in collaboration between the patient, nurse and physician and, when necessary, a physiotherapist, a dietician, an occupational therapist and/or a medical social worker.Conclusion The communication at nurse-led COPD clinics rarely involved the patients in shared understanding and responsibility and concerned patients’ fears, worries and problems only to a limited extent. The results also showed that nurses had difficulties in attaining proficiency in behavioral change communication. Structured self-management education showed positive effects on patients’ perceived QoL, on the number of patients who quit smoking and on patients’ knowledge about COPD.

Consumption of bottled water by children in the city of Bauru, State of São Paulo, Brazil - A brief communication

Objectives: To determine the consumption of bottled water by children in the city of Bauru, State of São Paulo, Brazil. Methods: A stratified sample of the 17 areas established by the city plan was used to identify a total of 1,000 homes for visitation. Information was collected using a questionnaire concerning the type of water consumed and population demographics. Results: Overall, around 30 percent of all residences used bottled water. Among all households where bottled water was consumed, about 26 percent had children residing. For those with children and bottled water, 81 percent reported to use bottled water for the preparation of the children's foods and beverages. Conclusions: An important percentage of children consume bottled water in the city of Bauru, State of São Paulo, Brazil. Considering previous studies showing that fluoride concentrations vary in bottled water, public health measures should be implemented in order to guarantee adequate levels of fluoride in commercialized water. © 2007, American Association of Public Health Dentistry.

Plan de acción sobre la sociedad de la información y del conocimiento de América Latina y el Caribe (eLAC2015)

Plan of action for the information and knowledge society in Latin America and the Caribbean (eLAC2015)

Propuesta de plan de acción sobre la sociedad de la información de América Latina y el Caribe (eLAC2015)

Esta es la versión de la propuesta del Plan de Acción eLAC2015 acordada en la reunión preparatoria de la tercera Conferencia Ministerial sobre la Sociedad de la Información de América Latina y el Caribe, celebrada en Montevideo, los días 23 y 24 de septiembre de 2010, con los cambios editoriales introducidos por la CEPAL.

Draft plan of action for the information society in Latin America and the Caribbean (eLAC2015)

This is the version of the draft Plan of Action eLAC2015 agreed upon at the regional preparatory conference for the third Ministerial Conference on the Information Society in Latin America and the Caribbean, held in Montevideo on 23 and 24 September 2010, incorporating editorial changes made by ECLAC.

Monitoreo del Plan de Acción eLAC2015: Cuarta Conferencia Ministerial sobre la Sociedad de la Información en América Latina y el Caribe

Incluye Bibliografía

Where do Latin America and the Caribbean stand in relation to the eLAC2007 Plan of Action?: evidence from available information

Includes bibliography

Avanzando con la implementación del Plan de Acción eLAC2007

Avanzando con la implementación del Plan de Acción de ALC sobre la Sociedad de la Información eLAC2007. Avances de Grupos de Trabajo eLAC2007. Indicadores Clave para medir las TIC para el desarrollo La falta de información sobre la Sociedad de la Información en ALC y soluciones en construcción. Seminario en el Caribe sobre Políticas Públicas de TIC. CEPAL y Comisión Europea firman memorando en materias de cohesión social e integración regional El gobierno electrónico y la interoperabilidad ¿Cómo impactan las TIC en la economía? ¿Cuáles son las temáticas más relevantes de eLAC2007? Enfocarse en el Caribe: mucho está pasando y mucho falta por pasar en políticas públicas …y ahora la solución ¿es TV Digital Terrestre y Convergencia Tecnológica en América Latina y el Caribe? Sin monitoreo del eLAC2007 no se constatan los avances. Últimas publicaciones. Preparando la II Conferencia Ministerial sobre la Sociedad de la Información eLAC2007.