The Digital Divide at an Urban Community Health Center

Improving communication between the patient and the office practice through new information technologies seems an obvious goal for office-based physicians. However, the skills and attitudes of a technology sophisticated office practice must be matched by the abilities and readiness of patients in order to successfully improve communication. There is little doubt that patients are increasingly taking advantage of the computer and internet for health-related reasons On the other hand, the gap between persons with effective access to information technology versus those with limited or no access, the socalled "digital divide", is well acknowledged. One obvious domain for technology partnership between patient and practice is that of computer-assisted patient education. With the limited time allotted the office encounter, and the multiple educational tasks assigned to the office-based clinician, patient education websites might compensate as education extenders for busy clinicians. Early advocates for referring patients to the internet for patient education have suggested that physicians might best assist their patients by serving as guides to help find accurate and reliable internet resources. How often clinicians offer "information prescriptions" for patient education websites, and how often patients actually view and learn from those sites is not known. Whether offering a patient computer -assisted education experience carried out in the office is more practical and more reliable than sending the patient home with the information prescription deserves consideration. A second domain for better technology partnership between the patient and the office practice is in managing access to care. Internet-based appointment systems, within web portals or as stand-alone software, offer a more patient-centered means of improving efficiency and convenience than do traditional phone systems.The advent of text messaging offers another approach that takes advantage of the increasing prevalence of the cellular telephone. As a safety net clinic serving an urban, indigent population, we questioned the importance of technological interfaces with our patients compared with more affluent clinics. We were particularly interested in determining whether the clinic needed a better web presence for the purposes of patient education, and whether patients could schedule appointments or communicate with office staff through the internet or cell phone text messages.

Building a Nursing Research Fellowship in a Community Hospital

Northwest Community Hospital (NCH) is a 488-bed hospital in Arlington Heights, IL. Approximately 1,100 RNs are employed by the hospital and 43% have been educated at the baccalaureate level. In February 2006, NCH was awarded Magnet status by the American Nurses Credentialing Center (ANCC) and received an exemplar from ANCC for the Nursing Research Fellow ship Program. The journey to Mag net began in 2002 when the chief nurse executive (CNE) met with the nursing leaders to dialogue about the process. NCH has a long history of having a professional practice environment where registered nurses (RNs) are engaged in participative decision making via the nursing practice councils. Additionally, the RN turnover and vacancy rates have been below the national average. The Fourteen Forces of Magnetism were reviewed and the nursing leaders felt confident that supporting evidence was in place to substantiate written narratives in terms of dissemination, sustainability, and enculturation in all areas except those related to re search and evidence-based practice. To meet the ANCC Magnet standards for research and evidence-based practice and to develop a strong research infrastructure, numerous initiatives were implemented. For example, journal clubs were expanded to all nursing units, the Iowa Model of Evidence-Based Practice was selected to provide a consistent model for the various evidence-based practice projects, and the Nursing Research Council (NRC) was created (Turkel, Reidinger, Ferket, & Reno, 2003). The CNE was committed to raising the bar for research in the community hospital setting by having direct care RNs serve as principal investigators for clinical nursing re search studies. The process for the development and related outcomes of the Nursing Research Fellowship Program, which was established in 2005 to advance excellence related to professional nursing practice and research, is described.

Community-based Lifestyle Interventions: Changing Behavior and Improving Health

These findings suggest that, for residents of these neighborhoods, positive lifestyle changes such as increasing physical activity levels and increase in fruit and vegetable consumption are associated with positive changes in mental health. Mental health, a key area of health inequality is related to physical health, and associated with education, employment, and environment and community issues. There is growing international concern regarding the high prevalence of mental health disorders. Mental ill-health affects every fourth citizen in Europe, and is said to be the UK's biggest social problem with up to 25% of NHS costs attributed to neuropsychiatric disorders and diseases of the nervous system. The growing prevalence of mental illhealth is strikingly illustrated by recent trends in increasing number of claimants of incapacity benefit and severe disablement allowance for mental and behavioral disorders in the UK. Government statistics suggest that at any one time around one in six people of working age will have a mental health problem Overall, these figures represent just the tip of the iceberg as they exclude those with mental health problems that remain undiagnosed. Across the UK, in both local and national government policy, the need to enhance the promotion of good mental health has been increasingly highlighted and a National Service Framework (NSF) for Mental Health has been developed to standardize care. Initiatives such as Health Action Zones, Employment Action Zones, New Deal for Disabled People and Connexions are beginning to tackle the problems of social isolation, which can often lead to mental health problems. There is a NSF for Mental Health and mental health is a priority area identified in 'Saving Lives: Our Healthier Nation' and the government white paper 'Choosing Health'. Here we explore the association between change in physical activity rates and diet and self-reported mental and overall health of residents living in deprived English communities. These data were generated by the New Deal for Communities (NDC) Household Surveys conducted in 2002 and 2004.

Fertility and Sterility

Fertility awareness-based methods (FABMs) of family planning are methods that use physical signs and symptoms that change with hormone fluctuations throughout a woman's menstrual cycle to predict a woman's fertility. The unifying theme of FABMs is that a woman can reduce her chance of pregnancy by abstaining from coitus or using barrier methods during times of fertility. Natural family planning (NFP) is a subset of FABMs that specifically excludes concurrent use of all other forms of contraception, including barriers, as a supplement to the observation for fertile signs; pregnancy is avoided through abstinence alone. Several factors contribute to a woman's fertility. An ovum survives up to 24 hours after ovulation unless it is fertilized, leaving a finite time for sperm to reach the egg. Sperm have short life spans after ejaculation without hospitable cervical mucous, which is present only in the periovulatory period. In optimum conditions, the typical maximum life span of sperm is 5 days, leaving a fertile window of approximately 6 days. Although FABMs may be used to achieve pregnancy, that discussion is beyond the scope of this review. FABMs are diverse. They include the older calendar ("rhythm")- and basal body temperature-based methods and the newer methods that assess cervical mucus or a combination of signs and symptoms (which include the older methods). The former are generally not considered to be highly effective. The newer methods compare favorably with conventional contraceptives It is not certain where providers and patients obtain their information about FABMs. Anecdotal evidence suggests that in the United States instruction is not often available through physician providers, occasionally through hospital programs, and more often available from faith-based groups. When provided with positive information about FABMs more than 1 in 5 women in the United States expressed interest in using one of these methods to avoid pregnancy. However, only 1% to 3% percent of US women are currently using an FABM for this purpose. Despite an improved understanding of the science underlying FABMs, rates of use have declined to 11% from 22% of married couples in 1955. This decline is multifactorial. Clinicians and patients frequently perceive a difficulty in learning the methods. Many women also believe FABM are not efficacious.

Pharmacists and Home Health Care

Since the implementation of the diagnosis-related group (DRG) reimbursement system in the 1980s and the advances in health-related technologies in the 1980s and 1990s, the use of home healthcare (HHC) services has grown dramatically. Approximately 7 million patients received HHC services in the United States in 1996, representing 2.7% of the general population. Expenditures for services continued to expand as well. Data from the Health Care Financing Administration show that expenditures for HHC increased from $2.4 billion in 1980 to $32.3 billion in 1997, and are projected to exceed $60 billion by the year 2007. The dramatic growth of the industry has captured the attention of the federal government, resulting in the recent implementation of the DRG-like prospective payment system for Medicare home health services. However, while the growth of the HHC industry has effected appropriate changes in legislation, it could be argued that the expansion in HHC has gone relatively unnoticed by the pharmacy practice community. Pharmacy as a profession has fought to become an integral part of the care of institutionalized patients, mainly by controlling all medication dispensing and processing of orders, thereby enabling pharmacists to identify and resolve drug-related problems (DRPs). Unfortunately, to date, no equivalent standard of pharmaceutical care exists for patients receiving HHC services. The practice standards for home care pharmacy that have been developed by the American Society of Health-System Pharmacists relate primarily to the provision of home parenteral therapy, a service received by only a small minority (approximately 10%) of the HHC patient population. Although Medicare, the largest HHC services payer, requires that certified agencies identify all patient medications and screen patient medication profiles for DRPs, the program neither describes the process by which this should occur nor offers reimbursement for such services. The majority of patients requiring HHC services receive inconsistent levels of pharmaceutical care from various sources. Drugs may be prescribed by any number of physicians, and may be dispensed by an unlimited number of local or remote pharmacies. Dispensing pharmacists have limited access to comprehensive patient medical data, thereby reducing their ability to intervene effectively.

The Mental Health of Children in Out-of-Home Care

The scale of mental health problems among children in care is exceptional for a nonclinical population, approaching that of clinic-referred children. Children in residential care have more mental health problems than those in family-type foster care, while those in kinship care have fewer problems. Children manifest complex psychopathology, characterized by attachment difficulties, relationship insecurity, sexual behavior, trauma-related anxiety, conduct problems, defiance, inattention/hyperactivity, and less common problems such as self-injury and food maintenance behaviors.
Children in care have complex symptomatology that is not well represented in present classification systems. There is a need for research into the characteristics and meaning of these complex presentations, and some re-appraisal of present taxonomies. Clinicians should consider these difficulties in their entirety, rather than as discrete disorders. It is recommended that assessment and intervention are provided by clinical teams that have specialist knowledge of children in care, and that use an ecological approach to assessment. Children and youth residing away from their parents in court-ordered care represent one of the most vulnerable and disadvantaged groups in Western society. Their mental health problems are complex and exceptional for a nonclinical population. The present review considers what is known about the scale, characteristics and etiology of their problems.

Teen motherhood and long term health consequences

Traditional understanding of adolescent childbearing includes a belief that the social and economic consequences for both mother and child are almost universally negative. Recent research, however, reveals that the outcomes resulting from the birth of children to young mothers are diverse and complex. Social circumstances contributing to adolescent pregnancy and parenting, such as poverty, poor educational opportunity, and violence, are also causes of less than optimal outcomes for young mothers and their children; thus, attributions of cause and effect are difficult to make. By reviewing outcomes research that approaches this question in a number of more creative ways, clinicians can gain a more complete understanding of this phenomenon. It is hoped that health care providers with access to new evidence about the social consequences of adolescent childbearing will have improved success and satisfaction in providing competent, compassionate care to pregnant and parenting adolescents. Elena was 15 years old when she presented for her first prenatal care visit. During an interview, Elena remembered her experience there. "[At the clinic they treated me] like I was a young stupid kid pretty much... Yeah, the very first time... [They] measured my stomach, checked my insides, and checked everything, pushed on my belly." Elena went on to describe how one particular staff member at the clinic strongly expressed disapproval of her pregnancy after which the staff member "walked out of the room. I didn't ever want to go there again. I told my sister. I came home crying." Elena avoided further health care for a while, but eventually she found an adolescent-focused health center to care for herself and her baby. She is now 17 and lives independently with her son, with assistance from the health center, her baby's father, her family, and her community. They are both healthy and happy and Elena is full of plans for the future. Adolescent pregnancy and childbearing rates continue to be higher in the United States than the rates of adolescent pregnancy in other Western nations, although a trend toward lower rates is occurring in most industrialized countries.

Breastfeeding among first ( Early Milk Not Tied to Puberty Timing )

NEW YORK (Reuters Health) Aug 23 - Some research has hinted that breastfeeding or milk drinking might affect when kids hit puberty, but a new study casts doubt on that. Studies have suggested that girls who are breastfed tend to start their menstrual periods later, while others have tied cow's milk intake to earlier onset of menses. But not all studies have found such connections. The question is important, researchers say, because earlier puberty has been tied to certain health risks. "Early puberty is associated with a higher risk of obesity, cardiovascular disease and diabetes," explained C. Mary Schooling, a researcher at the University of Hong Kong who worked on the study. "All in all, it would be best to avoid exposures that induce early puberty," Schooling said in an email. But her team's findings, reported Monday online in Pediatrics, do not suggest cow's milk is one of those exposures. Nor do they support the theory that breastfeeding might delay puberty. The results are based on 7,523 Hong Kong children who'd been followed since birth, in 1997. When the kids were 11 or 12, parents were asked to recall and report on their children's breastfeeding and cow's milk intake at the ages of six months and three and five years. Overall, the researchers found no relationship between breastfeeding and the timing of puberty. The same was true when they looked at milk intake. One problem with studies of early nutrition and puberty timing in Western countries has been that both breastfeeding and milk drinking are related to economic factors. In higher-income families, moms tend to breastfeed longer and kids' milk intake tends to be lower, Schooling's team notes in its report. And kids from those families tend to start puberty later. In Hong Kong, though, things are different, the researchers say. Timing of puberty appears to be unrelated to socioeconomics. And, if anything, moms with more education tend to stop breastfeeding earlier. When Schooling and her colleagues factored in family income, parents' education and other variables, there was still no link between breastfeeding or milk intake and puberty timing.

Cow's milk is not part of the traditional Chinese diet. But few kids in this study drank no milk: at the age of three, 68% were drinking it every day, as were 45% at age five.

Improving Maternal and Child Health in Difficult Environments

The evidence base on organising, delivering, and paying for effective and equitable health services in any resource-constrained setting is very weak. To improve maternal and child health (MCH), emphasis must be given to strengthening health systems, increasing access to information and care, and addressing the related community and development issues. In the high mountainous areas of Central Asia, the successor states of the Russian and British empires govern communities that are often forgotten and frequently unserved. In some measure, the health status of these communities, especially that of the women and children living in the contiguous border areas of three states (Afghanistan, Pakistan, and Tajikistan) reflects the challenges, successes, and failures of these states. Although the communities in these adjacent geographical areas share a common ethnicity, religion, and culture, MCH indicators vary widely along with the capacities and efforts of governmental and non-governmental actors to reduce the disparities. In the rural province of Afghan Badakhshan, a remote region with minimal infrastructure and few modern health services, Linda Bartlett and others recently carried out a reproductive age mortality survey. Reported in 2005, this survey found the highest maternal mortality ratio ever documented (6,507 per 100,000 live births) for a three-year time period (April 1999 through March 2002), and a very high infant mortality rate (217 per 1,000 live births). . In the Northern Areas of Pakistan, a disputed territory but contiguous with the other regions, local government institutions have traditionally been very weak. However, important improvements in maternal and child health indicators, including a substantial reduction in the maternal mortality ratio (from 550 to 68 per 100,000 live births) and infant mortality rate (from 158 to 31 per 1,000 live births) have been observed over the last 20 years. While under-reporting of maternal, infant, and especially neonatal deaths is a global problem, and variations in data collection methods challenge the comparability of the measures across the three regions, the substantial differences strongly suggest true distinctions that should be examined to determine why women and infants in the Northern Areas and Gorno-Badakhshan have markedly lower risk of death.

Axillary Nerve Injury Associated With Sports

This study retrospectively reviewed 26 axillary nerve injuries associated with sports between the years 1985 and 2010. Preoperative status of the axillary nerve was evaluated by using the Louisiana State University Health Science Center (LSUHSC) grading system published by the senior authors. Intraoperative nerve action potential recordings were performed to check nerve conduction and assess the possibility of resection. Neurolysis, suture, and nerve grafts were used for the surgical repair of the injured nerves. In 9 patients with partial loss of function and 3 with complete loss, neurolysis based on nerve action potential recordings was the primary treatment. Two patients with complete loss of function were treated with resection and suturing and 12 with resection and nerve grafting. The minimum follow-up period was 16 months (mean 20 months). Results. The injuries were associated with the following sports: skiing (12 cases), football (5), rugby (2), baseball (2), ice hockey (2), soccer (1), weightlifting (1), and wrestling (1). Functional recovery was excellent. Neurolysis was performed in 9 cases, resulting in an average functional recovery of LSUHSC Grade 4.2. Recovery with graft repairs averaged LSUHSC Grade 3 or better in 11 of 12 cases CONTACT and low-intensity sports can result in axillary nerve injury, resulting in loss of deltoid function. This muscle is the major abductor of the shoulder. The axillary nerve arises from the posterior cord of the brachial plexus and contains fibers derived from C-5 and C-6 spinal nerve roots via the posterior division of the upper trunk. It passes through the quadrilateral space along with the posterior circumflex artery just distal to the shoulder joint. The nerve then curves around the posterolateral surface of the humerus deep to the deltoid and divides into anterior and posterior branches, both of which innervate that muscle. The nerve is tethered posteriorly as a result of the overlying muscle, making it susceptible to stretch. Etiologies include not only fracture and dislocation of the humerus, but less frequently compensation due to prolonged pressure arising from common sports-related activities. The purpose of this paper is to analyze indications for surgical repair and to access outcomes in patients with solitary axillary nerve injury associated with sports.

Fashion icon: Past and present

We all have our personal favorites. On her list of style icons, Smith includes silver screen stars of the 1920s and 30s Clara Bow, Louise Brooks, and Josephine Baker; classic beauties Elizabeth Taylor and Grace Kelly; leading men of cinema Cary Grant and James Dean; and blonde game changers Twiggy and Debbie Harry. Every decade, every period has its icons. To single out a few is to single out that period of time that we each consider most important to us, says fashion designer Claude Brown. Icons are created from both a broad appeal and the narrowest of preferences. Fashion and style icons represent a spectrum of tastes and backgrounds from hippies to First Ladies. But according to Bo Breda, academic director of Fashion Design at The Art Institute of California San Francisco, they do have a few things in common. The first thing is they do something new, she says. I think they know who they are and find fashion that fits them. Even if they reinvent themselves many times over the years like Madonna has they put their personal stamp on what they wear. Those bestowed with the label of style icon possess that certain je ne sais quoi that attracts people to them. Janis Joplin, for example, had this look and you could not put your finger on it, Breda says. Why is it that when she wore her blue jeans and T-shirt, she stood out? Many fashion icons, like Joplin, are created in the crosscurrents of colliding cultural shifts and changing style demands, says Brown, who is also the academic director of Fashion Design and Fashion Marketing & Management at The Art Institute of California Los Angeles. Each icon defines a style which often represents long-time coming cultural waves swept up in the fast churning waters of quickly changing fashion, he says.

Nature Photography (How to Shoot Waterfalls)

Lighting: Like shooting trees in autumn, the best lighting is overcast, especially in between rain storms. In the Upper Peninsula, it rains almost every day in the fall. You want that dark diffused lighting in order to slow down your shutter speed. Shutter Speed: In order to get that blurred-smooth-flow look to your waterfall scene, you need to shoot at a shutter speed of 1 to 1.6 seconds. In order to achieve a properly exposed scene at those slow shutter speeds, youll need to set your aperture to a setting of f/16 or smaller, up to f/22. Youll get great depth of field, with the entire frame in focus too. If the lighting is too bright to bring your shutter speed down to 1 to 1.6 seconds, try a neutral density filter. ND Filter: A neutral density (ND) filter is a must for waterfall shooting. Placing an ND filter over your lens reduces the amount of light, thus decreasing the shutter speeds to accommodate the reduction of light, without affecting color in your scene. Tripod and Remote Shutter Release: At shutter speeds of 1 to 1.6 seconds, use of a tripod, a good tripod is a must. Additionally, at those speeds, youll also need the assistance of utilizing a remote shutter release. Using a remote shutter release eliminates any vibration introduced to your camera when your finger actually presses the shutter. Trust me, a remote release, available for almost all camera models, makes a huge difference in obtaining sharp images. If you dont have a remote shutter release, try the "poor-mans/womens remote shutter release". Your Camera's Self-Timer: Using your cameras self-timer feature will accomplish the same effect as using a remote shutter release. When this feature is set, you press the shutter, and the camera doesnt expose your film or image sensor for a pre-set number of seconds. Setting yourself timer to 5 seconds will allow for any vibrations to cease when pressing the shutter button.