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PubMedDate not supplied

[A proposal for programming at a didactic unit for nursing sciences (MED 45) in nursing degree courses].

Pre-registration nursing education in Italy has been recently transferred in University. Therefore, many changes, evaluations and innovations have been implemented in Insubria University (Università degli studi dell'Insubria, Varese). Starting from the reasons for the basis choice of three ample goals to reach in three years, a curricula proposal of the entire nursing disciplines and modules of the three years degree is presented. All nursing courses of the same disciplinary sectors ("MED 45" in the national university regulation) have been channelled into a few educational educational modules or units. The educational units of the first, second and third year are afterwards presented. The choice of these educational units is supported with examples while some tables show the topics of formal lectures together with the professionalising activities (i.e., laboratory, nursing skills acquisitiion, testimonies). Considering the difficulties one meets in evaluating teaching strategies, this three years experience has been positive for a few reasons. More precisely, it has contributed in decreasing the theory-practice gap, in developing critical thinking, and in answering to students'expectations at the beginning of the pre-registration course. The introductory module has favoured the development of skilla and abilities useful for self-education and the students' future professional development. The lack of human and structural resources together with the sometimes negative influence of the clinical placements climate (reality shock) is among the main difficulties found.

Curriculum↗

PubMed2026

Access to palliative care in rural settings: A mixed-methods systematic review.

BACKGROUND: Rural populations experience persistent inequities in access to palliative care. Existing evidence often describes individual barriers separately, with less attention to how access breaks down across the care pathway or how different service configurations shape access. OBJECTIVES: To synthesise evidence on access to palliative care in rural settings and examine how access barriers, service models, and implementation conditions interact across the care pathway. METHODS: A mixed-methods systematic review using a convergent integrated approach searched nine databases (PubMed, Embase, CINAHL, Web of Science, Scopus, PsycINFO, CNKI, WanFang, SinoMed) from inception to 15 March 2026, supplemented by hand-searching. Eligible studies were primary qualitative, quantitative, and mixed-methods studies on access to palliative care for adults in rural or non-urban settings. Two reviewers independently screened studies, extracted data, and assessed quality using the Mixed Methods Appraisal Tool. Findings were mapped to the Levesque access framework, analysed using the updated Consolidated Framework for Implementation Research, and integrated through mixed-methods synthesis, with additional coding of service models. RESULTS: Thirty-four studies were included, of which 26 were conducted in high-income countries and eight in low- and middle-income countries. Service configurations included specialist or hospice-oriented care, generalist or primary-care-oriented care, mixed specialist-generalist models, home-based and caregiver-centred care, nurse-coordinated services, telehealth-supported care, and community or implementation-oriented approaches. Access broke down cumulatively across four interdependent stages: recognition, entry, reach, and use and continuity, with affordability constraining every stage. Recognition was limited by low awareness, poor service visibility, and delayed identification of need. Entry was shaped by stigma, trust, family expectations, and unclear referral processes. Reach was constrained by distance, transport, workforce shortages, limited specialist capacity, and weak infrastructure. Use and continuity were affected by fragmented coordination, weak transitions, unstable follow-up, and reliance on family caregivers. Access problems varied across service configurations. Evidence on service innovations was methodologically less certain, and the overall evidence base remained concentrated in high-income countries. CONCLUSIONS: Access to palliative care in rural settings is best understood as a pathway and service-configuration problem rather than simply a deficit in service availability. Improving access requires earlier recognition, clearer referral routes, stronger specialist-generalist and nursing links, better support for family caregivers, and greater attention to affordability, continuity, and rural settings with limited resources. REGISTRATION: International Prospective Register of Systematic Reviews: CRD420261340783.

Health Services Accessibility↗

PubMed2003

Challenges to the practice of evidence-based medicine during residents' surgical training: a qualitative study using grounded theory.

PURPOSE: To examine surgical trainees' barriers to implementing and adopting evidence-based medicine (EBM) in the day-to-day care of surgical patients. METHOD: In 2000, 28 surgical residents from various subspecialties at a hospital affiliated with McMaster University Faculty of Health Sciences in Ontario, Canada, participated in a focus group (n = 8) and semistructured interviews (n = 20) to explore their perceptions of barriers to the practice of EBM during their training. Additional themes were explored, such as definitions of EBM and potential strategies to implement EBM during training. The canons and procedures of the grounded theory approach to qualitative research guided the coding and content analysis of the data derived from the focus group and semistructured interviews. RESULTS: Residents identified personal barriers, staff-surgeon barriers, and institutional barriers that limited their ability to apply EBM in their daily activities. Residents perceived their lack of education in EBM, time constraints, lack of priority, and fear of staff disapproval as major challenges to practicing EBM. Moreover, the lack of ready access to surgical EBM resource materials proved to be an important additional factor limiting EBM surgical practice. Residents identified several strategies to overcome these barriers to EBM, including hiring staff surgeons with EBM training, offering coursework in critical appraisal for all staff, improving interdepartmental communication, and providing greater flexibility for EBM training. CONCLUSIONS: Surgical residents identified a general lack of education, time constraints, lack of priority, and staff disapproval as important factors limiting incorporation of EBM. Curriculum reform and surgeon education may help overcome these barriers.

Adult↗

PubMed1991

Towards an epistemological basis for andragogy in midwifery education.

In designing the curriculum for pre and post registration midwifery courses, the author has utilised an andragogical model. This term refers to the art and science of teaching adults (Knowles 1978). The ideas that Knowles (1978) put forward about andragogy while not new, have been implemented in adult education and are certainly relevant to the modern practice of midwifery education. The aim of this paper is to examine the two extreme philosophical views about the nature of man and to provide an epistemological basis for andragogy in midwifery education.

Adult↗

PubMed2004

SARS in Singapore: surveillance strategies in a globalising city.

Public health measures employed to fight against the spread of SARS need to be guided by biomedical knowledge as well as an understanding of the social science aspects of the disease. Using Singapore as a case study, we explore how the state constructs the disease and implements measures targeted at creating a ring of defense around the island and using surveillance to monitor and prevent its spread. While there is support, there is also resentment among some Singaporeans who complain that their right to privacy has been invaded and that over surveillance may have actually occurred. Marginalisation and discrimination have not only affected the local population but in this open economy which is striving to achieve global city status, businesses, tourism, foreign talent, foreign contract workers and foreign students studying in Singapore have also been negatively affected. While Singapore has been applauded by WHO and used as an example of quick and effective response, a holistic approach to the management of infectious disease must address the social implications of strategies that are drawn from medical knowledge alone because it impinges on the social lives of people and how people interact with each other under stressful circumstances.

Adult↗

PubMed2000

Shaped-pulse optimization of coherent emission of high-harmonic soft X-rays

When an intense laser pulse is focused into a gas, the light-atom interaction that occurs as atoms are ionized results in an extremely nonlinear optical process--the generation of high harmonics of the driving laser frequency. Harmonics that extend up to orders of about 300 have been reported, some corresponding to photon energies in excess of 500 eV. Because this technique is simple to implement and generates coherent, laser-like, soft X-ray beams, it is currently being developed for applications in science and technology; these include probing the dynamics in chemical and materials systems and imaging. Here we report that by carefully tailoring the shapes of intense light pulses, we can control the interaction of light with an atom during ionization, improving the efficiency of X-ray generation by an order of magnitude. We demonstrate that it is possible to tune the spectral characteristics of the emitted radiation, and to steer the interaction between different orders of nonlinear processes.

Journal Article↗

PubMed2001

Practice-based research: the Oregon experience.

BACKGROUND: Practice-based research links community-based physicians and their patients with investigators at academic institutions. In 1992, Western States Chiropractic College developed an infrastructure, the Center for Outcomes Studies, to support practice-based research. The Low Back Pain Study, undertaken in collaboration with Oregon Health Sciences University, 111 medical physicians, and 60 chiropractors, relied on the Center for Outcomes Studies infrastructure for support in project implementation and maintenance. RESULTS: Challenges, many of them critical, were a regular occurrence: dealing with unforeseen obstacles, establishing and maintaining physician buy-in, establishing and maintaining staff buy-in, implementing the protocol as directed and with minimal intrusiveness, maintaining enthusiasm for the project over time, and knowing where (and where not) to allocate the Study's time, energy, and money. Strategies were developed to overcome or minimize the impact of problems on a case-by-case basis. CONCLUSIONS: Successful practice-based research requires an awareness of study design issues and an appreciation of clinical practice logistics and priorities. Every effort must be made to include doctors and office staff in the implementation of the study in a manner that minimizes the study's intrusiveness and its economic impact on office organization, routine, and personnel. Investigators must understand and accept that there will be areas of the research environment over which they have no direct control. The challenges will be many, but they will be diminished by the rewards.

Algorithms↗

PubMed2002

A longitudinal women's health curriculum: a multi-method, multiperspective needs assessment.

OBJECTIVES: To define critical competencies in women's health for medical student education and to assess the degree to which they are taught. STUDY DESIGN: A set of competencies in women's health was developed. A multi-method needs assessment was implemented. RESULTS: Faculty and student evaluations revealed no major areas of disagreement but did identify major deficits in the basic sciences including the physiologic influence of estrogen on nongynecologic organ systems and of androgen on various organ systems, nutrition, and alternative medicine and the difference between the sexes in disease processes, presentation, and treatment. In the clinical years, there are important deficits in the teaching of diseases unique to women, limited attention to psychosocial aspects of women's health, and no cohesive teaching of a gender-specific approach to clinical evaluation. CONCLUSION: In the medical school curriculum, gender's effect on disease is inadequately addressed. An integrated longitudinal approach to gender-specific medicine is needed.

Attitude of Health Personnel↗

PubMed1996

Medical students' attitudes toward the autopsy.

BACKGROUND: The autopsy is an educational experience that helps students correlate clinical findings with basic science issues. Because of the sensitive nature of the autopsy, students' attitudes should be considered prior to its design and implementation. METHOD: In 1992-1993, all 147 second-year students at the Medical College of Ohio completed a 26-item Likert questionnaire about their attitudes toward the autopsy. After participating in an elective autopsy experience, 26 students completed the same questionnaire plus 18 additional questions about the environment and behavior of the pathologist. Pre- and post-autopsy responses were factor analyzed using principal-components analysis with a varimax rotation. Student's t-tests were used to compare (1) the pre-autopsy factor scores of the elective participants and the rest of the class and (2) the pre- and post-autopsy scores of the participants. RESULTS: Factor analysis of the attitude questions identified seven factors. Comparison of the pre- and post-autopsy scores of the elective participants revealed statistically significant positive increases on four factors; three factors remained positive or neutral. CONCLUSION: It was concluded that the autopsy elective had a positive influence on the student's attitudes. In addition, the pathologist's behavior and the environment in which the autopsy occurred influenced the students. Twenty-two (85%) of the students indicated the autopsy should be mandatory for all students.

Adult↗

PubMed2003

Esthetic techniques and restorative systems used in the second-year undergraduate dental curriculum.

Metal-free tooth-colored restorative systems for fabricating indirect intracoronal and extracoronal restorations have been developed because of patients' demand for superior esthetics. During the past decade, long-term clinical studies have demonstrated the success of many of these types of restorations in terms of function and esthetics. Ceramic veneers, all-ceramic crowns, ceramic onlays, and composite-resin inlays are becoming an integral part of contemporary clinical practice. The constant evolution in bonding techniques, adhesive systems, and cements plays a major role in the success of these metal-free restorations. In addition, home-bleaching procedures have become an integral part of the esthetically oriented dental practice. This article discusses the rationale, scientific basis, and implementation of a new undergraduate preclinical esthetics course for second-year dental students at the Louisiana State University Health Sciences Center School of Dentistry.

Crowns↗

PubMed2006

A community-based participatory health information needs assessment to help eliminate diabetes information disparities.

This article describes the participatory research process, results, action plan, and implications of the community health information needs assessment conducted within the African American community in two South Carolina counties. The REACH 2010: Charleston and Georgetown Diabetes Coalition library program is a partnership among community organizations, public and health sciences libraries, and lay community health advisors. A planning committee studied digital divide issues related to health information, designed and implemented a survey, held focus groups, analyzed data, identified needs and assets, and formulated an action plan to increase the dissemination of diabetes information. Key survey findings show that older (older than 60) and less educated (fewer than 12 years of education) African Americans in Charleston and Georgetown counties lack skills to access Internet and library services and suffer disparities in health information. Based on assessment evidence, the community plans to increase Internet access points and provide a train-the-trainer program to teach people skills for using Internet and library resources to get high-quality information about diabetes and its complications. This process taps community resources, builds local capacities and technical skills, educates about health, and empowers participants as active partners in their own health and their community's health.

Adult↗

PubMed2003

[Social participation in health services: concepts of users and community leaders in two municipalities of Northeastern Brazil].

Social participation in management of the health care system at different levels of government is one of the key policies promoted by the Unified National Health System (SUS) in Brazil. As with any new policy, success hinges on several factors such as stakeholders' interests and opinions, which have not always been considered in the past. This paper analyzes the underlying concepts of two groups of stakeholders with respect to social participation in health and the potential influence of these concepts on the effectiveness of policy implementation. A case study of two municipalities in Northeast Brazil was conducted using a combination of qualitative and quantitative social science research methods. Health services users and community leaders were interviewed. Various concepts were found in which the participatory approach to health policies was only partially reflected. Likely influences on stakeholders' concepts of social participation in health are the evolution of the broader Brazilian social context and the traditional performance of health services. Particular attention should be paid to stakeholders' opinions and concepts if policy effectiveness is to be improved.

Adolescent↗

PubMed2002

[Stressors in the teacher's workplace].

Psychosocial stressors are common problem affecting social functioning and health in many social groups. A great variety of stressors affect people working in auxiliary professions. Those stressors may induce professional burnout. The article outlines differences and similarities between Maslach burnout construct and a few concepts of stress. It also gives the literature review concerning job stressors in teachers. A wider view on teaching profession from the perspective of social sciences aims at deepened diagnosis and therapy in the context of psychiatric disturbances and constitutes the basis for planing and implementing environmental programmes of health promotion for this profession. Such perspective is consistent with the latest decisions of European Union.

Adaptation, Psychological↗

PubMed2006

Privacy protection in HealthGrid: distributing encryption management over the VO.

Grid technologies have proven to be very successful in tackling challenging problems in which data access and processing is a bottleneck. Notwithstanding the benefits that Grid technologies could have in Health applications, privacy leakages of current DataGrid technologies due to the sharing of data in VOs and the use of remote resources, compromise its widespreading. Privacy control for Grid technology has become a key requirement for the adoption of Grids in the Healthcare sector. Encrypted storage of confidential data effectively reduces the risk of disclosure. A self-enforcing scheme for encrypted data storage can be achieved by combining Grid security systems with distributed key management and classical cryptography techniques. Virtual Organizations, as the main unit of user management in Grid, can provide a way to organize key sharing, access control lists and secure encryption management. This paper provides programming models and discusses the value, costs and behavior of such a system implemented on top of one of the latest Grid middlewares. This work is partially funded by the Spanish Ministry of Science and Technology in the frame of the project Investigación y Desarrollo de Servicios GRID: Aplicación a Modelos Cliente-Servidor, Colaborativos y de Alta Productividad, with reference TIC2003-01318.

Databases as Topic↗

PubMed1990

Environmental health policies in the 1990s.

After almost a decade of suspension between progress and retrogression, environmental issues are back at the top of the national agenda. The evidence is visible in many forums of public discussion. But the development and implementation of a new wave of environmental policies will require attention to at least three issues: setting priorities, emphasis on science and technology, and a focus on human resources development.

Environmental Health↗

PubMedDate not supplied

Engineering control technology in polyvinyl chloride polymerization plants.

The National Institute for Occupational Safety and Health, Division of Physical Sciences and Engineering has initiated a research program in control technology. The objective of this program is to facilitate the implementation of effective preventative measures in order to prevent occupational illness. The plastics and resins industry control technology assessment has recently been completed. The objectives of this study were to document and evaluate effective control technology for plastics and resins polymerization plants. Particular emphasis was given to PVC polymerization processes, since the relatively recent lowering in the personal exposure limit for vinyl chloride monomer (VCM) to an 8-hour 1-ppm time-weighted average has required the application of state-of-the-art controls. The present paper contains a summary of the control technology that was found to be effective in controlling VCM in processes manufacturing PVC by suspension, bulk, and dispersion polymerization. Controls necessary for VCM include process and equipment modification, isolation, local and general ventilation, work practices, personal protective equipment, workplace monitoring systems, employee/employer education, and on-going effort by both workers and management. All of these components must function together as an integrated coordinated system in order to assure worker protection under normal operating conditions or under conditions of process upset or maintenance.

Chemical Industry↗

PubMed1995

A soft systems approach to designing an information system model to be used as a tool support in the prevention and control of sexually transmitted diseases in a health jurisdiction of Mexico.

The purpose of this work is to present the preliminary results of research in progress on the design of an information system model that is capable of supporting prevention and control activities related to sexually transmitted diseases (STD) in a Mexican health jurisdiction. The project is being developed in the following five phases: 1) informetric indicators on the prevention and control of STD; 2) information flow models representing the access and use of information by the actors involved in the activities; 3) system analysis; 4) system design; and 5) implementation. Bibliometric/scientometric techniques have been applied to conduct the first phase of the project. A soft systems approach is to be conducted throughout phases 2-5. Austin and Kendall and Kendall criteria are to be used for system analysis, design, and implementation. Expected products and benefits include: a) a bibliographic database on the prevention and control of STD in Mexico; b) science policy indicators to improve decision making; c) an information system model/prototype; and d) the development of the soft systems methodology, as applied to improving information-problem-situations in a health system.

Databases, Bibliographic↗

PubMed1997

Compliance with the recommendations of the Institute of medicine report, The Future of Public Health: a survey of local health departments.

In 1989 a survey of state health officials was conducted to ascertain the extent that the recommendations of the 1988 Institute of Medicine's report, The Future of Public Health, were in place. We applied a similar survey in 1996 to assess the level of implementation of the IOM recommendations at the local health department level. Agreement with the specific IOM recommendations at the local level was, in almost all cases, greater than 90%. However, when one views the extent of these recommendations in place, nearly half fall below 50%. While there have been improvements in areas such as education of the public and outreach towards legislators and voluntary health organizations, our results show that there are still major short-comings when it comes to implementing the recommendations. Lack of resources at the local level appears to be the predominant cause of the low level of implementation, with restricted authority and lack of support also contributing to the problem. We feel the IOM recommendations can provide a strong foundation for our public health system, and hope these results help serve as a benchmark for further study.

Forecasting↗