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The social role of alternative medicine is critical in empowering the large proportion of HIV-positive patients who choose to use nontraditionally prescribed medicines. Working toward an open scientific dialogue with HIV-related complementary therapies is a worthy goal for all providers.
There is increasing evidence that hypertension promotes low density lipoprotein (LDL) transportation into the subendothelial space of the vascular wall. Vascular smooth muscle cell (VSMC) proliferation plays an important role in the development and progression of cardiovascular diseases. Recently, several studies have demonstrated that LDL acts as a classic growth factor promoting VSMC growth via mitogenic signals normally elicited by classic growth factors. The present work summarizes current nontraditional concepts regarding possible cellular mechanisms through which hypertension and LDL may promote the development of atherosclerosis. Especially addressed are the possible effects of an elevated blood pressure in combination with LDL on VSMC growth. The new research concept concerning LDL as a growth factor and carrier for biological active phospholipids such as sphingosine-1-phosphate and sphingosylphosphorylcholine may contribute to an understanding of the pathogenesis of atherosclerosis by elevated high blood pressure.
This paper uses a postmodern family perspective to examine the interaction between Army Casualty Assistance Officers (CAOs) and the families of deceased soldiers. The data we examine are open-ended survey responses of CAOs (N = 188) who assisted bereaved families of soldiers killed in three unrelated air disasters. Five themes emerged from our analysis of the qualitative responses: postmodern family structures, contested definitions of "significant other," language, diversity, and emotion. These themes appear to be related to the difficult demands associated with bereavement work. We argue that the experiences of the CAO are comparable to the experiences of others who may work with the bereaved (e.g., police officers, medical workers, and disaster workers) when working in similar familial contexts.
In a Québec factory, a woman in a nontraditional job suffered from epicondylitis whereas her male coworkers were unaffected. A study was undertaken in order to enumerate the operations at risk for epicondylitis. Workers were interviewed in order to identify difficult operations and systematic observations were done over 4 work days. Although tasks were extremely varied, certain movements at risk for epicondylitis were repeated many times. Fifty-three valves were turned against resistance as part of this job, and one valve requiring a particularly difficult movement was turned 20 times in one day. There were at least 61 operations at risk for epicondylitis per day over a 4-day period. Strain on the elbow joint was particularly intense for the woman worker because the design of the workplace gave an advantage to taller workers with larger hands. Although this case study does not permit us to conclude that the worker's epicondylitis was due to her job, it enables us to suggest that it would be wise to adapt the dimensions of relevant equipment and worksites to a wider range of potential worker sizes. We also raise some questions about the definition of repetitive strain in epidemiological studies. We suggest that it may be necessary to consider not only the cycle time but also the total of forces exerted on a joint in order to study workplace injuries to the musculoskeletal system.
Innovative treatment techniques such as self-regulation of methadone dosage and client knowledge of dosage are not widely accepted by small community methadone maintenance programs. Take-home medication is more generally utilized. This study compares a traditional program approach with a nontraditional approach utilizing self-regulation, client knowledge of dosage, take-home medication, and a nonpunitive staff attitude in a small methadone clinic. Clients were attracted to the nontraditional program at a higher rate and stayed in treatment longer. The nontraditional approach was associated with higher client productivity in work and school. Clients attracted to the nontraditional program used drugs more frequently during treatment.
Changes taking place in the modern workplace, such as more flexible and lean production technologies, flatter management structures, and nontraditional employment practices fundamentally alter work organization factors and raise concerns about potentially negative influences on worker health and safety. These changes raise concerns about adverse effects on worker safety and health and call attention to the need for interventions to counter these effects. This forum article provides an overview of work organization intervention research, highlights gaps in the research literature, and sets forth an agenda for future intervention research. Research to date has focused primarily on individual-level interventions, with far less attention to interventions at the legislative/policy level, employer/organization level, and job/task level. Future research is recommended to establish the effectiveness of work organization interventions using improved methodological designs and giving increased attention to the circumstances within organizations that promote the adoption of such interventions.
Redesigning patient care delivery is vital to the quality of care delivered and has resulted in the development of new nursing practice models that use some form of "nurse extender." In this article, the authors describe the design, implementation, and evaluation of an educational program for a new nursing practice model at a medical center in the Southeast. The major focus of the educational program is the use of modules to train a new nontraditional nurse extender who works in partnership with an RN. The role of the partner in patient care was developed to expedite the provision of a variety of services at the bedside and to help the nurse deliver quality patient care. The training program consisted of five modules: fundamentals of nursing, selected respiratory therapy skills, selected physical therapy skills, electrocardiogram (EKG)/arrhythmia interpretation, and phlebotomy. A major factor in the success of the program was that it was carefully developed and evaluated to meet the needs of students and staff members. This program can serve as a model for other hospitals that plan to use nurse extenders.
This paper describes the roles and responsibilities of the associate director for medical education at the Primary Care Resource Center (PCRC), School of Medicine and Biomedical Sciences, State University of New York at Buffalo (UB). The PCRC was established to increase the number of UB medical school graduates who selected graduate medical education in the generalist disciplines. The associate director, who is a health sciences librarian, has established collaborative working relationships with primary care physicians in the clinical departments of family medicine, pediatrics, and internal medicine with the goal of improving the teaching effectiveness of faculty and residents. Another goal is to incorporate the use of computerized information technologies into clinical practice by training physicians and residents, at specially equipped ambulatory training sites, in how to access and manage information for the purpose of providing quality medical care. This has been accomplished in part through the provision of highly personalized instruction to participants. In addition to describing these activities, this paper examines how the duties of the associate director reflect the potential for long-term change in the roles and responsibilities of health sciences librarians, whether they work in a traditional or nontraditional setting.
Over the past several decades, Latin America underwent rapid urbanization, a demographic shift led by women. Women now make up almost half of the economically active population and the feminization of urban poverty is being reported as well. The majority of men and women now work in unregulated, unorganized "informal" and nontraditional industries and services lacking occupational and environmental regulations. There is a marked paucity of health studies examining possible hazardous exposures, especially where gender-based social etiologies are concerned. This is true even in concentrated industries such as manufacturing assembly plants and in potentially hazardous occupations in mining and nontraditional agricultural exports, for which data from other disciplines are available and raise serious concerns. The need to ensure enough jobs at sufficient levels of income to alleviate poverty will remain a major challenge at the turn of the century and the environmental health implications of doing so could be far-reaching. What data are available and, more strikingly, the paucity of published epidemiologic studies warrant deep concern and support calls for urgent, multidisciplinary research into the health effects of the combined, multiple assaults of hazardous industrial waste, inadequate water and sewage treatment, and occupational exposures. Given the complex and varied work roles of women, the information reviewed also points to the need to conduct such research in the region within a social-etiologic framework of gender analysis.
This study examined learning styles of faculty members and senior students in coordinated programs in dietetics and compared learning styles by area of career expertise (faculty) or interest (students). Respondents included 108 faculty members and 324 students. The survey included a standardized Learning Styles Inventory and questions regarding demographics and career preferences. chi(2) analysis was used to compare learning style with selected variables. Significant differences were found between student and faculty learning styles (P=.006). Faculty also had significant differences in learning styles within various areas of expertise (P=.037), but no significant differences were found in learning style by expected career choice of students. Students listed entry-level and 5-year career choices. Most (55.6%) plan to work in clinical nutrition following graduation, but 37.0% anticipate being in a nontraditional area of dietetics 5 years postgraduation. Only 6.8% plan to work in management at entry, dropping to 3.4% at 5 years.
Parenting has been affected by several 20th century changes. Among the most important changes are a shift from a rural farm family environment to an urban society, the increased impact of the media, an increased number of working mothers, a shift to more nontraditional family forms, and a greater emphasis on personal happiness and self-fulfillment. This article considers the impact of these changes within the context of parental role responsibilities and their potential impact on the quality of life for children. The role of nursing in reframing parenting in response to these changes is considered. It is concluded that the nursing profession needs to specify an action-oriented agenda that addresses parenting issues with consideration of 20th century changes, if improved parenting and child outcomes are to be realized on a broad-scale basis.
There is little knowledge of the number or the work characteristics of dental hygienists outside the private-practice setting. This survey was conducted to determine the percentage of hygienists practicing in nontraditional (nonprivate-practice) settings and the types of settings in which they are employed. Mail questionnaires were returned from a total of 21,847 (56.9%) of the hygienists in the survey sample. The percentage of active hygienists practicing in nontraditional settings was 11.8. Dental or dental hygiene schools, and government and nongovernment-supported clinics were the most frequent nontraditional practice settings. State supervision requirements were found to be associated significantly with the prevalence of nontraditional hygiene practice.
This study of employed single-parent (n = 52) and married women (n = 87) investigated employment characteristics (time spent at work, income), psychological resources (self-esteem, sex-role attitudes), and management of domestic activities (evaluation and satisfaction with performance) in relation to depression. For the most part, correlates of depression were quite different for the two groups of women. Nontraditional sex-role attitudes, more time at work, higher income, low work-family strain, and high self-esteem were associated with less depression among single parents. Positive work orientation, high self-esteem, less time spent at work, and satisfaction with domestic tasks were linked with lower depression among married women.
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Some of these programs would not work in every rural (or urban) practice. A partnership practice helps considerably. The ability to step into a medical center position with patient acceptance has been important. We feel that many similar opportunities exist--we have more planned--for other surgeons, and should be utilized. Both our geographic isolation and our small medical community have given us a sense of need for continuing education that is perhaps more acute than that of the urban-based private practicing surgeon. However, one has only to look about at most university surgical grand rounds and to note the paucity of surgeons practicing in those urban communities to realize that the feeling of isolation of the rural surgeon may be a very positive and beneficial force in his continuing education.
This article describes two novel contexts for language and memory stimulation in individuals with Alzheimer's disease (AD): student-supervised physical exercise and partnered volunteering at community agencies. Information presented is based on 5 years of the authors' experiences at the University of Arizona supervising student-administered interventions with mildly to moderately affected home-dwelling AD patients in the Volunteers in Partnership and Elder Rehab programs. The authors report significant mood and fitness improvements by program participants, as measured on direct testing as well as by caregiver perceptions regarding the relative benefits of the four program components. Finally, they advocate for greater use of nontraditional approaches and utilizing students and volunteers when working with persons who have AD.
There is an excitement about the potential for nursing to make a difference in meeting rural health needs in the 1990s. Work places are attempting to respond to salary compressions and offering more autonomy for nursing over its own practice. There is better communication among hospital administrators, physicians, and nurses. Schools of nursing are more responsive to the needs of nontraditional students, and the federal and state governments are working together to find solutions. Innovation and creativity are key ingredients in our approach to ensuring rural nurse providers for the future.
Nurses have been working in the AMI/ABLE ISA for the past 6 years as part of a multidisciplinary team. The nursing contribution is important to the Team, not only because of nursing expertise in providing psychiatric mental health care, but also because nurses can provide services unique to nursing, such as health assessments and education, and medication support (Fur-long-Norman, Palmer-Erbs, & Jonikas, 1997). More than 80 people who are disabled by mental illnesses have been served by this innovative program since 1991, and members' hospitalization rates have been cut approximately in half by integrating services and reducing fragmentation, and by using aggressive outreach and a psychosocial rehabilitation approach. Psychosocial rehabilitation nursing has become a subspecialty that has expanded the profession. Experience in the AMI/ABLE program demonstrates that nurses, as fully integrated members of multidisciplinary teams, adapt to working in partnerships with clients and their families, in nontraditional settings.