Staff attitudes to oral health care. A comparative study of registered nurses,nursing assistants and home care aides

This study compares differences in attitude, of oral health care of nursing personnel working with dependent elderly and severely disabled patients. A questionnaire was administered to 398 personnel covering (1) personal oral health care habits. (2) experiences and attitudes in assisting oral care and (3) willingness to assist patients/residents with their daily oral hygiene. Three hundred and sixty - four persons answered the questionnaire, including 70 registered nurses, 148 nursing assistants and 146 home care aides. The study revealed that oral care assistance is viewed as more disagreeable than other nursing activities. Although registered nurses were found to have more positive attitudes toward oral care assistance than the other nursing groups, they were seldom invoked in the daily practice of oral hygiene care. The results indicate a gap between knowledge and practice in nursing personnel's attitudes toward oral health care of dependent elderly and severely disabled patients.     

Caregivers' perceptions of electric versus manual toothbrushes for the institutionalised elderly

Objective: To evaluate how caregivers feel about the use of electric vs. manual toothbrushes for the elderly in long‐term care. Materials and methods: After electric toothbrushes had been accessible in an institution for 15 months, a self‐administered questionnaire was distributed to the nursing staff. The questions posed were whether the electric toothbrushes were being used, how much time was spent on brushing and if electric toothbrushes simplified the provision of oral care for the residents. Results: The response rate was 79%. Of the 119 respondents, 78% replied that they always or frequently used an electric toothbrush. With regard to brushing times, 44% of the respondents reported that they spent less time on oral care procedures with an electric toothbrush than with a manual one. Equal amount of time for both types of toothbrushes was reported by 53%. Only 3% reported spending more time with an electric toothbrush than with a manual one. Oral care procedures were considered simpler with this device by 63% of the respondents, 22% registered no change and 15% found it more difficult. If patients suffering from dementia were considered separately, 45% found the procedures simpler when using electric toothbrushes, 24% registered no difference and 31% found it more difficult. Conclusion: The findings indicate that when given the choice, the caregivers prefer to use electric toothbrushes rather than manual ones as they feel this is simpler and often less time‐consuming.     

The clinical psychologist in a health centre: one year's work.

The Livingston integrated health services project is an attempt to provide a fully integrated area health service with special emphasis on developing multidisciplinary community health teams. As part of this experiment a clinical psychologist was appointed to work in general practice. Ninety-four patients with behavioural, emotional, and cognitive problems were referred in the first year (1% of the 10 000 patients registered at the practice). The psychologist thus provided treatment for some patients who would otherwise have been seen by a general practitioner with neither the time nor the training to deal adequately with their problems.     

How much personal care in four group practices?

OBJECTIVE--To establish the degree of continuity of care in general practice. DESIGN--Retrospective study of the records of all eligible patients attending the surgery at randomly selected sessions. SETTING--Four large group practices in the Southampton Health District, one of which operated a strict system of personal lists. PATIENTS--776 Patients who had been registered for at least two years and had consulted at least 12 times over six years or less. MAIN OUTCOME MEASURES--Continuity score for each patient calculated from the number of consultations (out of the past 12) with his or her usual doctor. Number of the times the patients had consulted the doctor with whom they were registered. RESULTS--In the practice with personal lists a mean of 10 of the 12 consultations had been with the same doctor (83% of consultations), but in the three practices with combined lists the means were 5.9 (49%), 6.2 (52%), and 6.9 (58%). Continuity was associated with increased age and with the recording of a major problem. In the practices with combined lists 63 of 72 children consulted at least five different doctors. Only 140 of 489 patients currently in the practice who were identified as being registered with a doctor had most usually consulted that doctor in the practices with combined lists. CONCLUSIONS--Personal continuity of care may be fairly low in group practice, especially for younger and healthier patients registered at practices with combined lists. These findings support the Department of Health''s recent decision to make "target payments" (for cervical smears and childhood immunisations) to groups rather than to individual principals but pose a question for the future of individual clinical responsibility.     

Use of a questionnaire in general practice to increase the recognition of patients with excessive alcohol consumption.

A self administered questionnaire, the health survey questionnaire, was designed to detect excessive alcohol consumption and mailed to patients who were registered with two general practices. Replies were received from 2572(75%) of 3452 patients. Excessive consumption was taken as 42 units of alcohol per week or more for men and 21 units per week or more for women: 1 unit = approximately 10 g ethanol and is equivalent to a half pint of beer, one glass of wine, or one standard measure of spirits. One hundred and twenty men (11%) and 68 women (5%) were identified by their responses to the questionnaire as excessive drinkers. According to their responses, roughly half of these expressed some concern about their drinking. In the practice where a disease register was kept 18 patients had been recorded as heavy drinkers before the study, and an additional 74 were detected by the questionnaire. Within 12 months after the questionnaire survey three groups of respondents were reviewed: (a) the excessive drinkers, (b) those who indicated concern about drinking but did not exceed the limits for excessive consumption, and (c) a random sample of those who were in neither of these two categories. Patients in these three groups were interviewed in a standard fashion to determine their alcohol consumption. Breath alcohol measurement was also carried out and a blood sample taken for the estimation of mean cell volume, gamma glutamyltranspeptidase activity, and serum aspartate transaminase activity. There were highly significant correlations between estimates of consumption obtained by the questionnaire and those obtained at interview except among the women who were excessive consumers, whose responses to the questionnaire indicated levels of consumption that were much higher than those to which they admitted at interview. Stated weekly consumption at interview that was above the limits set for the study was used as the standard measure for comparing the questionnaire with the other indicators of excessive drinking. The questionnaire had a considerably greater estimated sensitivity in detecting male excessive consumers than any of the blood tests. Among the women it apparently performed less well, although the numbers stating excessive consumption at interview were small. Breath alcohol measurement was positive in only a few of the excessive drinkers. The use of this simple and inexpensive instrument is likely to prove widely acceptable to patients in general practice and should result in a considerable increase in the recognition by general practitioners of patients with excessive alcohol consumption.     

Integrated care for diabetes: clinical,psychosocial, and economic evaluation. Diabetes Integrated Care Evaluation Team.

OBJECTIVES--To evaluate integrated care for diabetes in clinical, psychosocial, and economic terms. DESIGN--Pragmatic randomised trial. SETTING--Hospital diabetic clinic and three general practice groups in Grampian. PATIENTS--274 adult diabetic patients attending a hospital clinic and registered with one of three general practices. INTERVENTION--Random allocation to conventional hospital clinic care or integrated care. Integrated care patients seen in general practice every three or four months and in the hospital clinic annually. General practitioners were given written guidelines for integrated care. MAIN OUTCOME MEASURES--Metabolic control, psychosocial status, knowledge of diabetes, beliefs about control of diabetes, satisfaction with treatment, disruption of normal activities, numbers of consultations and admissions, frequency of metabolic monitoring, costs to patients and NHS. RESULTS--A higher proportion of patients defaulted from conventional care (14 (10%)) than from integrated care (4 (3%), 95% confidence interval of difference 2% to 13%). After two years no significant differences were found between the groups in metabolic control, psychosocial status, knowledge, beliefs about control, satisfaction with treatment, unscheduled admissions, or disruption of normal activities. Integrated care was as effective for insulin dependent as non-insulin dependent patients. Patients in integrated care had more visits and higher frequencies of examination. Costs to patients were lower in integrated care (mean 1.70 pounds) than in conventional care (8 pounds). 88% of patients who experienced integrated care wished to continue with it. CONCLUSIONS--This model of integrated care for diabetes was at least as effective as conventional hospital clinic care.     

Diabetes knowledge: Are resident physicians and Nurses adequately prepared to manage diabetes?

ObjectiveTo assess and compare the diabetes knowledge of nurses and residents in surgery, internal medicine, and family practice.MethodsA 21-question survey based on current diabetes standards of care was developed and administered. The results were stratified by type of participant and analyzed statistically.ResultsA total of 52 internal medicine residents (IMR), 21 family practice residents (FPR), 42 surgery residents (SR), and 48 registered nurses (RN) participated. The survey had good overall internal consistency (Cronbach α of 0.78) and test-retest reliability (Pearson correlation coefficient of 0.71). The total mean percent correct for all participants was 61%. The total scores of IMR, FPR, and RN groups were similar (69%, 64%, and 66%) and significantly greater (P < 0.001) than the SR score (44%). Collectively, all survey participants averaged less than 50% correct on several items. The IMR scored higher than the SR and FPR on several items. The nurses outscored the physicians on items regarding insulin preparations, treatment of hypoglycemia, and perioperative insulin management. A subgroup of 13 RN with additional diabetes training earned the highest total score (82%).ConclusionOur novel survey was shown to be a statistically valid tool for assessment of diabetes knowledge. IMR, FPR, and inpatient RN have similar but insufficient levels of knowledge about diabetes. SR may have a more profound deficit of diabetes knowledge. Previous additional diabetes training among nurses was associated with greater diabetes knowledge. Most nurses and residents require additional education in order to provide optimal care to patients with diabetes. (Endocr Pract. 2007;13: 17-21)     

氮素营养与水分胁迫对大豆产量补偿效应的影响

在大豆营养生长期,对大豆进行不同程度的干旱锻炼,同时改变土壤中的施氮水平,研究大豆产量及其构成因子对干旱胁迫复水的反应机制,为大豆节水增产及抗旱机制的实践探索提供理论依据。水分胁迫强度、历时和氮素营养都对大豆产量及其构成因子的补偿效应产生明显影响,水分胁迫抑制了大豆单株粒数的增长,但可以显著提高百粒重;氮素营养会抑制大豆百粒重的增加,但在一定水分条件下可以显著提高单株籽粒的数量,然而随着水分胁迫程度的加重,单株粒数的增加幅度也会相应减少。虽然氮素营养和水分胁迫使大豆产量构成因子产生补偿效应的阈值范围不同,但二者具有一定的耦合区域,在耦合区域内(水分胁迫时间14d左右、土壤含水量为田间持水量的50%—55%、施氮量在97.5—225kg/hm2之间)单株粒数和百粒重都产生较强的补偿效应,二者的协同作用显著提高了大豆的经济产量,使大豆产量表现出较强的补偿效应。结果表明:氮素营养和适度水分胁迫可以通过不同途径提高大豆植株的生长能力,当二者结合后大豆的补偿生长机制更为复杂,最终表现为水分胁迫提高了大豆的百粒重,而氮素增加了大豆单株粒数,二者协同作用使大豆经济产量显著增加。     

Psychological and social problems in HIV infection: interviews with general practitioners in London.

OBJECTIVE--To assess current practice and opinions of general practitioners in London about managing psychological and social problems relating to HIV infection. DESIGN--A stratified random sample of general practitioners, including those with a range of experience of people with HIV infection, were interviewed by medically trained interviewers. SETTING--Doctor''s surgeries. PARTICIPANTS--270 General practitioners working within the area covered by London postcodes. RESULTS--Two thirds of doctors had treated at least one patient with HIV infection and described their work with these patients. General practitioners were counselling and educating many of their patients about AIDS and associated risk behaviours and were aware of the need for careful attention to confidentiality. Doctors with no experience of patients with HIV infection were often older, in singlehanded practice, less inclined to deal with drug abusers or to counsel their patients on risk behaviours, and more in favour of insurance companies'' policies towards people with HIV infection. CONCLUSIONS--General practitioners in London are quickly becoming involved in the care of patients with HIV infection and their relatives and friends. Many are counselling patients and testing for antibodies themselves and regard this as an integral part of their work. A considerable workload in primary care comprised patients who obsessively fear contracting HIV infection.     

流域上游居民接受生态补偿意愿及其偏好研究——以新安江流域为例

上游居民实践中甚少收到生态补偿资金,流域生态补偿的普惠性亟需提高。普惠的生态补偿不仅要增加上游居民的获得感,还要通过准确把握上游居民接受生态补偿意愿及其偏好让他们得以获得与生态增益行为贡献相匹配的补偿。以中国首个跨省流域生态补偿机制试点——新安江流域生态补偿为例,基于条件价值法研究了上游居民接受生态补偿的意愿及其影响因素。研究发现：（1）上游地区基于居民最小受偿意愿的合意生态补偿规模约为165.60亿元/a,其中浙江淳安县和安徽黄山市的合意受偿规模分别为44.32亿元/a和121.28亿元/a。（2）上游居民的受偿意愿随其年龄和家庭人口数的增加而提高,农村居民的补偿诉求比城镇居民更高,收入变化带来的受偿意愿边际变化约为0.04。（3）淳安县居民受到的环境规制强度偏高,他们的受偿意愿也更高;上游居民参加环保志愿活动的频率与他们的受偿意愿正相关。（4）上游居民感知的政府环保投入负担与实际负担不匹配,流域政府需增加有效生态公众宣传以实现政府环保投入和治理成效的价值。（5）异地移民就业安置政策在一定程度上可以缓解补偿资金缺口压力和地方有效就业压力。     

Continuing dental care for Highlands elderly: current practice and attitudes of dental practitioners and home supervisors

Objective : To investigate current practice and attitudes of Highland dentists and home supervisors to continued dental care of elderly residents. Methods : A cross‐sectional questionnaire was designed to survey the current practice and attitudes of Highland dentists and residential care supervisors in their provision of dental care for the elderly at home and in long stay accommodation. Results : The response rate was 94% of dentists and 79% of homes. Despite 86% of dentists providing domiciliary care and 93% of homes transport to a surgery, no more than a quarter of residents had had contact with a dentist in the previous year. The distribution of residents varied with dependant individuals living in nursing units and the least dependant in residential homes. Only 1% of all residents were totally bed bound. Domiciliary patients were less likely to receive continuing care compared with those seen in a surgery and 75% of homes had to initiate dental care. In terms of patient referral, the majority of GDPs would refer uncooperative patients, salaried dentists would refer those with complex medical histories and community dentists would refer those requiring complex treatments. A dental assessment was undertaken in 46% of homes and 81% of these kept a record of dental care. Conclusion : This study highlights the need for a co‐ordinated, seamless continuing dental care service, tailored to the actual needs of the elderly individuals it is designed to serve, particularly in a remote and rural area.     

Overland transport of recreational boats as a spreading vector of zebra mussel <Emphasis Type="Italic">Dreissena polymorpha</Emphasis>

In aquatic ecosystems invasive species are among the most important threats to biodiversity worldwide. Understanding the dispersal mechanisms of aquatic invaders is very important for protection and management of vulnerable water bodies. Here we ask how recreational boats that are transported overland could contribute to the dispersal of invasive zebra mussels among lakes in Switzerland. Using a questionnaire sent to registered boat owners, we surveyed properties of transported boats and collected information on self-reported mussel fouling and transport activities of boat owners. We also sampled boat hulls at launching ramps and harbors for biofouling invertebrates. Boats that were kept seasonally or year-round in water were found to have high vector potential with mussel fouling rates of more than 40 %. However, only about 6 % of boats belonging to these groups were transported overland to other water bodies. Considering that approximately 100,000 recreational boats are registered in Switzerland, we estimated that every year around 1400 boats fouled with mussels are transported overland. Such boats pose a high risk of distributing zebra mussels between water bodies. Our results suggest that there is a considerable risk that recreational boats may spread new fouling species to all navigable water bodies within the study area. We speculate that one such species could be the quagga mussel, which has not yet invaded lakes in Switzerland. On a more positive note, our study has identified the group of high-risk boats so that possible control measures would only affect a relatively small number of boat owners.     

A Survey of Attitudes of Local Citizens of a Residential Area Toward Urban Stray Cats in Japan

This study surveyed the attitudes of local residents living in an urban area in Japan toward stray cats. An anonymous questionnaire asked local residents (359 houses) about their attitudes toward stray cats. Responses were received from126 houses (35%). Answers about nuisance, respondents' actions, and actions to be taken with regard to stray cats did not differ by place or type of residence of respondents. More than one third (36.7 ± 16.6%) of the respondents answered that the “bad smell of the feces and urine” was a nuisance. Respondents who lived in detached houses tended to like cats compared with those who lived in condominiums. Respondents who liked cats took care of cats more frequently, whereas those who disliked cats chased cats away and prevented their intrusion into their houses and land. However, it is noteworthy that one third or more (minimum value: 37.8%) of respondents of all kinds answered that neutering is one effective way to suppress the population of stray cats.     

Low Back Pain in Men Receiving Workmen's Compensation

In Ontario, only about 10% of compensation patients with low back pain are disabled more than six weeks and hence tend to have chronic complaints. Six hundred and twenty-three such patients were studied to determine the distribution of diagnoses and to test the effectiveness of various programs of conservative therapy.Two hundred and thirteen patients were assigned in rotation to one of four treatments. The results were inconclusive. In 70% of these, the pain was due to intervertebral disc degeneration with added trauma.Two hundred and sixteen patients were assigned randomly to a treatment involving mild exercise, or one with vigorous exercise. Neither was found to be superior. In 76% of these, the pain was due to disc degeneration with added trauma.Using 194 patients, the results of treatment in the Compensation Board Rehabilitation Centre were compared with those obtained by treatment at home. Satisfactory improvement was achieved in 15 of 95 treated at home, and in 42 of 99 in the Centre. The failure of treatment in six of each 10 cases indicates that present-day methods of management of such patients are unsatisfactory.     

Bipolarization of Risk Perception about the Health Effects of Radiation in Residents after the Accident at Fukushima Nuclear Power Plant

The late health effects of low-dose rate radiation exposure are still a serious public concern in the Fukushima area even four years after the accident at Fukushima Daiichi Nuclear Power Plant (FNPP). To clarify the factors associated with residents’ risk perception of radiation exposure and consequent health effects, we conducted a survey among residents of Kawauchi village in May and June 2014, which is located within 30 km of FNPP. 85 of 285 residents (29.8%) answered that acute radiation syndrome might develop in residents after the accident, 154 (54.0%) residents responded that they had anxieties about the health effects of radiation on children, and 140 (49.1%) residents indicated that they had anxieties about the health effects of radiation on offspring. Furthermore, 107 (37.5%) residents answered that they had concerns about health effects that would appear in the general population simply by living in an environment with a 0.23 μSv per hour ambient dose for one year, 149 (52.2%) residents reported that they were reluctant to eat locally produced foods, and 164 (57.5%) residents believed that adverse health effects would occur in the general population by eating 100 Bq per kg of mushrooms every day for one year. The present study shows that a marked bipolarization of the risk perception about the health effects of radiation among residents could have a major impact on social well-being after the accident at FNPP.     

Career Preferences of First-year Students at Canadian Medical Schools, 1966-67 to 1968-69

The principal findings of this study of the career preferences of first-year Canadian medical students were:Over 70% of the first-year students expressed a preference for specialty practice, with only 20% oriented towards practice as a family practitioner.There were considerable differences between the medical schools in the proportion of medical students preferring general practice, ranging from less than 10% at McGill to nearly 33% at Queen''s.Nearly one-third of the students stated that they preferred primarily salaried practice. These students were largely those who preferred specialty practice or a career in an area such as public health or research.Nearly 70% of the students looked for a career with part-time teaching, while 8% preferred a full-time teaching career.Only 1% preferred a full-time research career although 90% expected to have at least some research involvement.Students from smaller communities were more likely to express a preference for general practice than those from large urban areas.Men and women had similar practice preferences in terms of general practice and clinical specialty, but significantly more women than men preferred a career in salaried practice. Significantly fewer women expressed a preference for major involvement in either teaching or research.     

Influence of Royal College of Radiologists' guidelines on referral from general practice. Royal College of Radiologists Working Party.

OBJECTIVE--To measure the effect on general practitioner referrals for radiography of introducing guidelines of good practice together with monitoring and peer review. DESIGN--Collection of referral data during 1 January 1989 to 31 December 1990. Guidelines were introduced on 1 January 1990. SETTING--Open access radiology services provided by one non-teaching district in England. SUBJECTS--144614 registered patients from 22 practices. MAIN OUTCOME MEASURES--Number of referrals per 1000 registered patients for radiography of the chest, skull, spine, abdomen, limbs, and joints and for barium investigation and excretion urography. RESULTS--Overall referrals fell from 88.4/1000 registered patients to 77.2/1000 after the guidelines were introduced. The commonest reasons for referral were for examination of the chest, spine, and limbs and joints and referrals for these fell by 9.4%, 17.5%, and 13.5% respectively. Referrals for skull radiography fell by 30% (from 241 to 168). CONCLUSIONS--By helping general practitioners to be more selective in their use of diagnostic radiology, the guidelines reduced the rate of referral and thus patients'' exposure to radiation.     

Association between Social Integration and Health among Internal Migrants in ZhongShan,China

Internal migrants are the individuals who migrate between regions in one country. The number of internal migrants were estimated at 245 million in China in 2013. Results were inconsistent in the literature about the relationship between their health statuses and social integration. The main difference exists on how to measure the social integration and whether health statuses of internal migrants improve with years of residence. To complement the existing literature, this study measured social integration more comprehensively and estimated the internal migrants’ health statuses with varying years of residence, and explored the associations between the migrants’ social integration and health. We used the data from 2014 Internal Migrant Dynamic Monitoring Survey of Health and Family Planning in ZhongShan, China. Health status was measured from four aspects: self-reported health, subjective well-being, perception of stress, mental health. We measured social integration through four dimensions: economy, social communication, acculturation, and self-identity. The analyses used multiple linear regressions to examine the associations between self-reported health, subjective well-being, and perception of stress, mental health and social integration. The analytical sample included 1,999 households of the internal migrants and 1,997 local registered households, who were permanent residents in ZhongShan. Among the internal migrants, Adults in the labor force, who were aged 25 to 44 years old, accounted for 91.2% of the internal migrant population, while 74.6% of the registered population were in that age group. Median residential time among migrants was 2.8 (1.3–6.2) years, and 20.2% of them were migrating in the same Guangdong province. Except for mental health, other health statuses among migrants had significant differences compared with local registered population, e.g. self-reported health was better, but subjective well-being was worse. However, these health measurements were improved with more years of residence. Moreover, our results show that two aspects of social integration, economic integration and self-identity, were significantly associated with health status. Subjective feeling of relative social status levels were more associated with health, which prompted the attention to social fairness and the creation of a fair and respectful culture. More interventions could be experimented, such as encouraging internal migrants to participate in community activities more actively, educating local registered residents to treat internal migrants more equally, and developing self-identity among internal migrants. Better social, economic, and cultural environment can benefit internal migrants’ health statuses.     

The habitat hectares approach to vegetation assessment: An evaluation and suggestions for improvement

Summary The habitat hectares approach is an explicit, quantitative method for assessing the quality of vegetation by adding scores that are assigned to 10 habitat attributes. We believe it will be more repeatable and transparent than other methods that rely on subjective judgement. However, we have four principal criticisms of the method as it is currently proposed: (i) measurement of some of the attributes may be subject to considerable error that varies among assessors; (ii) the comparison of each measure with a single benchmark does not accommodate appropriate disturbance regimes; (iii) the proposed combination of attributes leads to some apparent internal inconsistencies; and (iv) it is not clear how the method will actually be used in practice. We suggest modifications to address these concerns and improve the proposed method. Finally, we make additional suggestions about the method's potential application, including: separate reporting of the extent and quality of different vegetation types to avoid the inappropriate combination of measures of area and quality; valuing appropriate disturbance regimes in natural areas; and considering very carefully the application of compensation or mitigation measures.