[The young people of foreign extraction in the Federal Republic of Germany and the labor market in 2000].
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Communication↗
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Results for “Tertiary Sector”
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Patterns of population industrial structure and their alterations.
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Asia↗
Exodus to cities and quality of life.
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Asia↗
[The challenge of immigration: general issues and the specific problems posed by the case of Italy].
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Acculturation↗
Joint appointments: the Deakin experience.
This paper explores the concept of joint appointment as a means of forming a bridge between the service sector and tertiary education systems in nursing. Joint appointments are not new, having existed in the USA and the UK in various forms since the early 1970s. The practicalities of establishing a joint appointment are described and the positive and negative aspects identified.
Education, Nursing, Baccalaureate↗
Revisiting the role of the nurse practitioner in the 1990s: a Canadian perspective.
The role of the nurse practitioner was first introduced in the North American health care scene in the early 1960s. In the 1970s, the concept of an expanded practice role for nurses was gaining interest in Canada. The impetus for development of the role in the United States was stimulated by a shortage of physicians. In Canada, the original nurse practitioner (NP) movement was influenced by the changing role of the nurse, the debate over a new category of health care worker in the United States (the physician assistant), and a perceived physician shortage. Canadian nurses saw the NP role as an opportunity to expand their scope of practice. This role expansion into traditional medical areas of practice was operationalized in various settings largely outside of the tertiary care sector. The role was controversial at times in terms of title and role function. However, it did present the nursing profession with an opportunity to demonstrate the impact nurses have on the health status of Canadians.
Canada↗
Use of the Internet as a resource of health information by patients: a clinic-based study in the Indian population.
BACKGROUND: There is abundant literature documenting that the Internet is fast changing the way patients access health-related information, learn about their illnesses, and make healthcare-related decisions. However, there is hardly any data regarding Indian patients accessing health-related information available on the Internet. AIMS: To determine patients' use of the Internet as a medical information resource and to determine their experience, their perceptions of the quality and reliability of the information available. SETTING: The study was carried out in the outpatient clinic of an urban, tertiary care private sector hospital in November 2004. MATERIAL AND METHODS: Our survey instrument consisted of an anonymous single-page questionnaire. Eight hundred and eighty consecutive adults aged 18-70 years, attending the general outpatient clinic of a tertiary care private hospital completed the questionnaire. RESULTS: Two hundred and eighty-one (32%) patients acknowledged surfing the Internet, while 75% (212/281) of them acknowledged that they accessed health-related information. Amongst those who accessed the Internet, 130 (61%) found the information on the net to be of average quality. Almost all patients (211/212) felt that the information served the purpose and 95% (201/212) also found also found it to be reliable. Only 7% (21/281) patients were aware of the presence of any quality standards pertaining to health information sites and none could name any accreditation standard. CONCLUSIONS: One in four patients attending the private set-up is using the Internet for health information. A majority of patients find the information on the net reliable and of good quality. Awareness about health information quality standards is a rarity.
Adolescent↗
Sexually inappropriate behaviors in seriously mentally ill children and adolescents.
This study examined the prevalence and clinical correlates of sexually inappropriate behaviors in all youth treated at a tertiary care public sector psychiatric hospital over a 5-year period. A retrospective chart review was completed on 499 subjects. Subjects were grouped in four mutually exclusive categories: no inappropriate sexual behaviors (n = 296), hypersexual (n = 82), exposing (n = 39) and victimizing (n = 82) behaviors. Those with histories of sexually inappropriate behaviors had much higher rates of being sexually abused (82 vs. 36%), and also had higher rates of physical abuse and neglect, behavior disorders, developmental problems, and family histories of antisocial behavior. They were less likely to have affective disorders. The hypersexual group had a higher proportion of females, and was associated in part with variables relating to sexual abuse and posttraumatic stress disorder. The more severe offending groups (exposing and victimizing) were associated with variables related to sexual abuse, developmental delays, lower IQ's, peer problems, and other acting-out behavior problems. These findings underscore the importance of evaluating for sexually inappropriate behaviors in seriously mentally ill youth, especially in those with histories of sexual abuse.
Acting Out↗
Clinical characteristics related to severity of sexual abuse: a study of seriously mentally ill youth.
OBJECTIVE: In this study we examined demographic, social, and clinical variables related to sexual abuse histories in a sample of severely mentally ill youth. METHOD: Data were collected via a retrospective chart review of all patients treated over a 5-year period (1987-1992) at a tertiary care public sector psychiatric hospital. The sample was divided into four groups: no history of sexual abuse (n = 226); isolated events (n = 62); intermittent abuse (n = 61); and chronic (n = 150). RESULTS: Youth with sexual abuse histories were more often female, had higher rates of social chaos and associated physical abuse and neglect, and had higher rates of post-traumatic stress disorder (PTSD) and substance abuse disorders. Chronically abused subjects came from the most chaotic and abusive backgrounds; were younger when first abused; had the highest number of abusers; were more likely to have been molested; and were more often abused by their father/stepfather and/or their mother/stepmother. Using logistic regression analyses, sexual abuse histories were predicted by sexually inappropriate behaviors, symptoms of PTSD and borderline personality disorders, dissociative symptoms, substance abuse and animal cruelty. CONCLUSION: Sexual abuse histories were quite common in this sample. Sexually abused subjects had increased rates of inappropriate sexual behaviors, substance abuse, and post-traumatic reactions; and were frequently exposed to other confounding environmental risk factors, including physical abuse, family problems and social chaos.
Adolescent↗
Effects of nurse follow-up on emergency room revisits: a randomized controlled trial.
The emergency room (ER) is the gatekeeper of the hospital. It receives clients seeking help from the health care system, then refers them for necessary further care or, discharges them back into the community. A 1-year randomized control trial was conducted in an acute general hospital in Hong Kong to see if post-ER nurse follow-up helped to change health outcome and health care utilization. The intervention group received two follow-up calls from an experienced ER nurse, within 1-2 days and 3-5 days after ER discharge. The calls' content and the management options decisions were protocol driven. A total of 795 patients (intervention group=395, control group=400) completed the study. Bivariate analysis shows two significantly different variables between the intervention and control groups, improvement of the condition and ER revisit within 30 days. When other factors are controlled in a multivariate analysis using logistic regression, the effect of the intervention on re-visits to ER within 30 days is reversed. Gender, times of attending general practitioner after ER visits, and not considering other doctors are risks factors related to a higher chance of re-visiting ER within 30 days. Those who have an improved health condition and higher number of times attending general outpatient after ER visits are associated with a lower 30-day ER revisit rate. Nurse telephone follow-ups might have sensitized subjects to health care needs. Some subjects tended to use the ER as a primary care setting and some were doctor-shoppers. A more structured ER transitional model that incoporates nurse telephone follow-up and better interfacing between private and public health care sector, primary and tertiary care might help to decrease inappropriate ER use.
Aftercare↗
Short-term risk of AIDS or death in people infected with HIV-1 before antiretroviral therapy in South Africa: a longitudinal study.
BACKGROUND: In sub-Saharan Africa, data for short-term risk of AIDS or death, which might inform decisions about when to start antiretroviral therapy (ART), are scarce. Our aim was to investigate these risks in patients who had no access to ART or who were given zidovudine alone. METHODS: 6-month risks (%) of death, AIDS, and combined risk of AIDS and death (AIDS/death) were calculated according to CD4-cell count category of less than 200 cells per microL, 200-350 cells per microL, or greater than 350 cells per microL, stratified by WHO clinical stages 1 and 2 combined, 3, or 4 in untreated patients (n=1399) seeking care in tertiary public-sector HIV clinics before widespread availability of ART in Cape Town, South Africa. FINDINGS: Risk of death for WHO stages 1 and 2 was 3.5% for those with less than 200 cells per microL, 2.8% for 200-350 cells per microL, and 1.2% for greater than 350 cells per microL. The corresponding rates for WHO stage 3 were 10.8%, 4.3%, and 4.9% and for stage 4, 22.2%, 10.3%, and 13.8%. 52% (90) of deaths took place in patients without AIDS. 6-month risk of AIDS for WHO stages 1 and 2 was 3.5% for those with less than 200 cells per microL, 1.6% for 200-350 cells per microL, and zero for greater than 350 cells per microL. The corresponding rates for those with WHO stage 3 disease were 17.4%, 7.0%, and 2.2%. INTERPRETATION: In this study, risk of AIDS in patients with a CD4-cell count of less than 200 cells per microL or greater than 350 cells per microL was similar to that previously reported from European cohorts, but was 1.9 times greater for those with CD4-cell counts of between 200 and 350 cells per microL. The high death rate before development of AIDS and a high risk of AIDS in those with CD4-cell counts of 200-350 cells per microL indicate that delay in initiation of ART is associated with increased morbidity and mortality. These findings might help to amend criteria for start of ART in resource-limited settings.
Acquired Immunodeficiency Syndrome↗
Age of onset of sexual abuse: relationship to sexually inappropriate behaviors.
OBJECTIVE: To examine how the age of onset of sexual abuse predicted inappropriate sexual behaviors in a sample of seriously mentally ill youths. METHOD: A retrospective chart review was completed for all youths treated from 1987 through 1992 at a tertiary care public sector psychiatric hospital (n = 499). Subjects were grouped according to the age at which they were first sexually abused: no sexual abuse (n = 225), 0 through 3 years (n = 78), 4 through 6 years (n = 105), 7 through 12 years (n = 71), and 13 through 17 years (n = 19). RESULTS: The rates of sexually inappropriate behaviors in subjects with sexual abuse histories were quite substantial, ranging from 79.5% of the 0- through 3-year group to 42.1% of the 13- through 17-year group. Subjects first abused during early childhood, especially during the ages 0 through 3 years, had significantly elevated rates of hypersexual, exposing, and victimizing sexual behaviors. They also were significantly younger at the time of admission, came from more disrupted family settings, and had significantly higher rates of physical abuse, neglect, chronic sexual abuse, sexual abuse by either parent/stepparent and a higher total number of victimizers. When logistic regression analyses were done to examine the predictive power of potential risk factors, early age of onset of sexual abuse was the most significant predictor of all three types of inappropriate sexual behaviors. CONCLUSIONS: Onset of sexual abuse prior to 7 years of age was significantly associated with hypersexual, exposing, and victimizing sexual behaviors. Early sexual abuse is also associated with a number of other poor prognostic factors, and further research is needed to define how these variables interact.
Adolescent↗
Relationship between sexual abuse, gender, and sexually inappropriate behaviors in seriously mentally ill youths.
OBJECTIVE: To examine gender differences in sexual abuse histories and in the development of inappropriate sexual behaviors in a sample of seriously mentally Ill youths. METHOD: A retrospective chart review was completed for all patients from 1987 through 1992 at a tertiary care public sector psychiatric hospital for youths (N = 499). Subjects were categorized by gender, sexual abuse status, and whether they had sexually reactive or victimizing behaviors. RESULTS: Girls were more likely to have been sexually abused, and their abuse histories were more severe. Sexual behavior problems in girls were almost exclusively associated with sexual abuse, whereas 29% of boys with victimizing behaviors had no sexual abuse history. Among sexually abused youths, boys were more likely to display victimizing behaviors, whereas both genders displayed similar rates of sexually reactive behaviors. Of the 19 girls who displayed victimizing behaviors, 95% were chronically sexually abused and one third had also received a major injury due to physical abuse. CONCLUSIONS: Boys appear to have a lower threshold of abuse exposure required to develop sexually inappropriate behaviors and are significantly more likely to display victimizing behaviors. Conversely, victimizing behaviors in girls may require a catastrophic maltreatment history. These gender differences should be incorporated into treatment interventions directed at sexual abuse victims.
Adolescent↗
Effects of the technique of cryopreservation and dilution/centrifugation after thawing on the motility and vitality of spermatozoa of oligoasthenozoospermic men.
OBJECTIVE: Comparing in human semen samples with low initial quality, the effects of 2 techniques of cryopreservation and dilution/centrifugation after thawing on the spermatic motility and vitality. MATERIALS AND METHODS: Semen samples from 15 oligo and/or asthenozoospermic individuals assisted in the infertility sector of a tertiary hospital were obtained through masturbation. The samples were divided into 2 portions of equal volume, and diluted (1:1; v/v) with the cryoprotector containing glycerol (Test yolk buffer). One portion was frozen through the technique of liquid nitrogen vapor with static phases (group I - GI), while the other was frozen through a programmable biological freezer with linear speed (Planer, Kryo 10, series III) (group II - GII). The following parameters were assessed before freezing and after thawing: percentage of spermatozoa with progressive motility (Prog%) and percentage of live spermatozoa (Vit%). After defrosting, Prog% was assessed before and after removal of cryoprotector diluent, in different time intervals (zero, 3 h, and 24 h). The statistical analysis has been accomplished by using the non-parametric tests of Wilcoxon and Friedman. RESULTS: There was significant reduction of Prog% and Vit% from before freezing to after defrosting in both groups, I and II (p < 0.001). Values of Prog% and Vit% were not statistically different between groups, after thawing. It has been observed a significant reduction in Prog% among portions frozen with the automated technique after dilution and centrifugation for removal of cryoprotector (p = 0.006). After cryoprotector removal, Prog% has been kept unaltered, in both groups, during the first 3 hours of incubation, although being superior in group I (p = 0,04). There was a significant decrease in Prog% after 24 hours of incubation, in both groups (p < 0,01). CONCLUSION: For human semen samples with low initial quality, freezing through vapor technique or through the automated technique showed to be equivalent in regarding recovery of live spermatozoa with progressive motility. The effects of dilution and centrifugation to remove the cryoprotector had a negative impact only in samples frozen through the automated technique. In both techniques, progressive motility is kept constant during the first 3 hours after thawing and removal of the cryoprotector, but is drastically diminished by the end of an incubation period of 24 hours.
Journal Article↗
The nurse academic in the clinical learning setting: an evolving partnership role.
Student readiness for practice as a registered nurse can only be achieved through a committed and cooperative partnership between the tertiary and clinical sectors. One important role in the development and maintenance of clinical learning partnerships is that of the nurse academic. As nursing faculties continue to evolve this role it is important that positive initiatives be shared and challenges discussed. With this in mind, the role of the nurse academic in clinical practice introduced at the University of Technology, Sydney (UTS) will be presented. A nurse academic who fulfils this role at UTS is known as an Academic Liaison Person (ALP). This paper begins with a general exploration of the role of the academic in the clinical learning setting and then discusses the associated challenges. The role of the ALP at UTS and its integration with the UTS clinical model for final year students will be presented as a response to these challenges. Through this model the educational expertise of the ALP and the clinical expertise of the practitioner is brought together for the benefit of the nursing student.
Adaptation, Psychological↗
Levels of health care at academic and regional hospitals in KwaZulu-Natal.
OBJECTIVE: To assess the levels of health care based on hospital bed utilisation at seven academic and regional hospitals in KwaZulu-Natal. DESIGN: A prospective study. The registrar in charge of patients documented the level of care needed for each patient over 7 consecutive days. Independent assessment by consultants was used to validate the results. SETTING: All wards in public sector regional and tertiary hospitals with acute general beds in Durban and Pietermaritzburg, except intensive care, coronary care and respiratory units. PARTICIPANTS: All inpatients present in the wards. The response rate of wards participating in the study varied between hospitals from 32% to 75%. Data on 14,858 patient days were analysed. OUTCOME MEASURES: Inpatients were classified according to levels of care based on patient days. RESULTS: The proportion of patients in the tertiary (King Edward) and regional hospitals requiring levels of care below that for which the hospital was designated ranged from 54% to 72% of the patient days. Wentworth Hospital, which is a tertiary referral centre, had 30% of its patient days judged to be below the designated level. Patient days below the designated level of care for that hospital were significantly higher in tertiary than in regional hospitals (P < 0.001). CONCLUSIONS: All seven hospitals admitted patients at levels of care below that for which the hospital was designated. These findings have important implications for the efficient utilisation and planning of health and hospital services, and for their evaluation and management.
Bed Occupancy↗
A multimedia approach to raising awareness of information and communications technology amongst healthcare professionals.
This study is concerned with the application of advanced multimedia technology to the development of a programme aimed at raising awareness of information and communications technology (ICT) amongst health professionals in Ireland. The programme is delivered in the form of a symposium supplemented by a multimedia CD and associated web site. It examines how ICT can be used effectively in healthcare across all sectors - primary, secondary and tertiary - with a strong emphasis on supporting shared care. The aim is to empower users to make informed technological choices and to actively participate in the exploitation of ICT in the health sector. The programme was successfully completed and delivered to over 2300 health professionals across Ireland and follow-up activities include the active encouragement of leaders and champions within the sector. This will be supported by interactive web-based education and training material focused on specialised topics of particular interest within the broader context of continuing medical education (CME).
Computer Literacy↗
US health care reform and the economy of prevention.
The current dialogue on reform of the US health care system is conspicuous for the absence of an epidemiologically driven framework that focuses on the prevention of disease. Review of epidemiologic and demographic trends in the American population illustrates that if reform fails to advance the point of intervention to earlier in the course of disease, a restructured health care system is unlikely to provide comprehensive services with universal access. Sustainable reform warrants a preventive orientation and greater balance between primary, secondary, and tertiary levels of intervention. This report considers trends that may render economically driven reform rapidly obsolete, as well as cultural obstacles to the development of a prevention ethos in US health care and culture. The economy of prevention is described in the context of leading causes of US morbidity and mortality. Elements of a national disease prevention strategy are considered that include changes in mechanisms of physician/provider reimbursement, the orientation of private-sector biotechnology/health care research, tertiary medical centers and academia, and improved abilities to reduce the concentration of preventable morbidity and mortality in high-risk communities and to use epidemiology in formulating health policy.
Culture↗