A strategy for the management of HIV/ AIDS in the health sector of the city of Johannesburg

The HIV/AIDS pandemic is posing major challenges to all sectors in South Africa, including the health sector of the city of Johannesburg. The health sector of the city of Johannesburg, as a result of the pandemic, is faced with increasing demands on its scarce resources at a time of major reform at local government level including transformation of the health sector. The overall objective of the study is to explore and describe a strategy for the management of HIV/AIDS by the health sector of the city of Johannesburg. An exploratory, descriptive and quantitative research design was utilized and the UNAIDS "Guide to the strategic planning process for a national response to HIV/AIDS" (1998), was employed to formulate the strategy. The content validity of the strategy was determined according to the process originally described by Lynn (1986) and adopted by Muller (in Booyens, 1998:607-609). The research was conducted in two phases. The first phase, the developmental phase, involved the exploration and description of the theoretical framework and the response to the pandemic, and formulation of a draft strategy. The second phase, the quantification phase, involved the assertion of the content of the strategy by a group of experts and determination of the content validity index (CVI). The final strategy focused on the following: to lead and facilitate intersectoral collaboration; to strengthen primary health care services to provide comprehensive community-based care; prevention of new infections; community mobilization towards prevention, non discrimination and non stigmatization and empowerment of the health sector to deal with the AIDS.pandemic. The CVI results showed that the average content validity index determined during this study was adequate: full score (1.0) for acceptability and technical soundness, and 0.89 for feasibility and perceived affordability. The strategy formulated for the management of HIV/AIDS by the health sector of the city of Johannesburg is therefore acceptable, technically sound and feasible and perceived as affordable. It was finally recommended that the strategy be adopted for implementation within the health sector of the city of Johannesburg.

Surviving Ebola: understanding experience through artistic expression

BACKGROUND

A dearth of knowledge and information exist about the understanding of the experience of surviving a life-threatening illness such as Ebola Hemorrhagic Fever (Ebola).

OBJECTIVES

To understand the ways in which survivors of Ebola understood the experience of surviving a life-threatening illness.

METHODS

Eleven participants were asked to illustrate their understanding of the experience of surviving Ebola. (Only six of the drawings are published in this paper.) Using drawings and interviews as data, a phenomenographic approach was used to guide the research process and to analyse data.

RESULTS

Analysis revealed four ways of understanding the experience. These are described as categories of descriptions or conceptions, namely, escape in peaceful awareness, hope for a world outside of fear, persistence in defying death, and constant fear of dying. Importantly, the structure and referential aspects of the experiences are portrayed in the form of an outcome space, which is the understanding of the experience of living as survivors of Ebola, described as both "living in fear of the predatory spectre", while simultaneously "living in constant hopefulness". This experience is illustrated as paradoxically living in fear while concurrently hoping for life.

DISCUSSION

Understanding the experience of survivors of a life-threatening illness is significant to nursing and its practice. Critical to this significance is its influence on the practice of compassionate and competent nursing.

Development of an endometriosis quality-of-life instrument: The Endometriosis Health Profile-30

OBJECTIVE

To describe a new disease-specific questionnaire with established measurement properties that addresses the dimensions of health-related quality of life considered important to women with endometriosis.

METHODS

The Endometriosis Health Profile-30 was developed in three stages. Stage 1 included open-ended exploratory interviews with 25 women to generate the items on the questionnaire. Stage 2 was an 87-item questionnaire administered in a postal survey to identify the most salient dimensions of health-related quality of life. In stage 3, the reliability and validity of the questionnaire were evaluated.

RESULTS

The final instrument contained a core questionnaire with 30 items and five scales: pain, control and powerlessness, emotional well-being, social support, and self-image. Six modular parts consisting of 23 questions were also developed and measured the areas of sexual intercourse, work, relationship with children, feelings about the medical profession, treatment, and infertility. All the scales achieved high internal reliability, with Cronbach's alpha coefficient ranging from 0.83 to 0.93 (core questionnaire) and 0.79 to 0.96 (modules). The intraclass correlation coefficients to evaluate the test-retest reliability were high (range 0.88-0.98, P <.001). Content validity was demonstrated as the questionnaire was developed from interviews of patients rather than existing literature and clinical scales. Construct validity was assessed by correlating the Endometriosis Health Profile-30 scales with the relevant Short Form-36 scales. High correlations for all comparisons were found (-0.41 to -0.73).

CONCLUSION

The Endometriosis Health Profile-30 is a reliable, valid, patient-generated instrument to measure the health-related quality of life of women with endometriosis. Its application in various health care settings will provide new and valuable information on the effect of endometriosis on health-related quality of life from the patients' perspective.

Technology and humane nursing care: (ir)reconcilable or invented difference?

AIM(S) OF THE PAPER: This paper questions the validity of a boundary presumed to exist between technology and humane care. It argues the need for reconciliation of presumed tension(s) between technology and person focused care and the need to reconsider our ways of understanding the relations between technology and nursing.

BACKGROUND/RATIONALE

Recent scholarship in the social sciences related to reproductive and imaging technologies and emergency resuscitation are examined and arguments are presented that question the appropriateness of a humanist view that emphasizes technology on the nonhuman and nonnatural side of a human/nonhuman, nature/artifice divide. It is argued that what determines experiences such as dehumanization is not technology per se but how individual technologies are used and operate in specific user contexts, the meanings that are attributed to them, how individuals or cultural groups define what is human, and the organizational, human, political and economic technological system (technique) that creates rationale and efficient order within nursing, health care and society.

CONCLUSION

The paper concludes by asking whether the commonplace appeal to resolve tensions between humane care and technology has erroneously highlighted technology as the reason for impersonal care, and encourages re-examination of the relationship(s) between technology, humane care and nursing practice.

Influence of surface waves on measured and modeled irradiance profiles

Classical radiative transfer programs are based on the plane-parallel assumption. We show that the Gershun equation is valid if the irradiance is averaged over a sufficiently large area. We show that the equation is invalid for horizontal areas of the order of tens of meters in which horizontal gradients of irradiance in the presence of waves are much larger than vertical gradients. We calculate the distribution of irradiance beneath modeled two-dimensional surface waves. We show that many of the features typically observed in irradiance profiles can be explained by use of such models. We derive a method for determination of the diffuse attenuation coefficient that is based on the upward integration of the irradiance field beneath waves, starting at a depth at which the irradiance profile is affected only weakly by waves.

New nurse graduates' understanding of competence

This article describes the findings of a phenomenographic research approach used to understand the experiences of competence of new nurse graduates. The aim of phenomenography is to describe the qualitatively different ways in which people understand a phenomenon. Six new graduates, who had been employed in two paediatric metropolitan hospitals in Australia, participated in the research. The graduates were interviewed and asked to describe and draw their understanding of competence. The interviews were audio-taped and transcribed verbatim. Interview transcripts were analysed according to accepted phenomenographic methods of analysis. The graduates described eight conceptions of competence: competence as safe practice; competence as limited independence; competence as utilization of resources; competence as management of time and workload; competence as ethical practice; competence as performance of clinical skills; competence as knowledge; and competence as evolving. The final outcome of identification of conceptions led to the development of an outcome space (a diagrammatic representation of the logical relations between conceptions). The outcome space depicted a three-level hierarchical relationship between the eight conceptions of competence experienced within a global framework of safety. The findings contribute to nursing knowledge by describing the meaning of competence from the perspective of the new nurse graduate. The need for support and assistance by employers of new graduates is confirmed from the findings. New nurse graduate experiences of competence provide suggestions for improving undergraduate education programmes as well as clarification of entry-level competency standards.

Induction and excretion of ultraviolet-induced 8-oxo-2'-deoxyguanosine and thymine dimers in vivo: implications for PUVA

Molecular epidemiology has linked ultraviolet-induced DNA damage with mutagenesis and skin carcinogenesis. Ultraviolet radiation may damage DNA in one of two ways: either directly, leading to lesions such as cyclobutane thymine dimers (T<>T), or indirectly, via photosensitizers that generate free radical species that may ultimately produce such oxidative lesions as 8-oxo-2'-deoxyguanosine. We report the results of a pilot, case control study in which seven, healthy, human volunteers (skin type II; aged 23-56 y; three male, four female) received a suberythemal dose of whole body irradiation from ultraviolet-A-emitting fluorescent tubes used in psoralen plus ultraviolet A therapy. First void, mid-stream urine samples were collected pre-exposure and daily postexposure, for up to 13 d. Analysis of urinary 8-oxo-2'-deoxyguanosine and cyclobutane thymine dimers was by competitive enzyme-linked immunosorbent assay (interassay coefficient of variation < or = 10%) and compared with a matched, control group of unirradiated individuals. A maximal increase in levels of urinary 8-oxo-2'-deoxyguanosine was seen 4 d post-ultraviolet exposure. A subsequent reduction was noted, before finally returning to baseline. Similarly, cyclobutane thymine dimer levels peaked 3 d postexposure, before returning to baseline. In contrast to the 8-oxo-2'-deoxyguanosine analysis, however, a second peak was noted at days 9-11, before again returning to baseline. This is the first report examining urinary 8-oxo-2'-deoxyguanosine and cyclobutane thymine dimers following ultraviolet exposure of healthy human subjects. This work illustrates the induction and time course for excretion of ultraviolet-induced lesions, perhaps alluding to repair and ultimately offering the potential to define psoralen plus ultraviolet A dosage regimes in terms of minimizing DNA damage and hence cancer risk.

Alteration to will as an experience of technology and nursing

This paper presents one finding to arise from a recent qualitative research study that examined ways of understanding technology in surgical nursing, and examines its implications for nursing and health care practice. Although the research reported identified eight qualitatively different ways of understanding technology, this paper examines the specific experience that technology can alter will (volition). The experience described is a new area of knowledge and is in need of further examination and research. Nonetheless, it is significant to understanding technology, contemporary nursing practice and the provision of health care services. The paper concludes with some suggested approaches for curtailing the experience and a discussion related to challenges that arise from the finding that technology can alter the free will of nurses.

Nursing and the primacy of technological progress

This article identifies assumptions common to interpreting technological progress in contemporary nursing practice. Technology is described in terms of its characteristics and progress is identified as an ideological assumption influencing the way we think about, practice, and explain technology in contemporary nursing. Arguments associated with linear development, the elimination of scarcity, the technological imperative, the advancement of nursing, and technology as a neutral phenomenon are examined. It is argued that understanding progress assists us to develop insight into the relationship between technology and nursing.

Understanding technology in contemporary surgical nursing: a phenomenographic examination

The purpose of this paper is to describe the result of phenomenographic research undertaken to identify the qualitatively different ways technology is understood and experienced by contemporary surgical nurses. Twenty surgical nurses were interviewed and conversations were recorded through the use of drawings and audiotape that were analysed using a series of seven analytical steps. There were two major outcomes of the research: eight categories of description were revealed and each one constitutes a conception of the experience and understanding of technology, and an outcome space portraying the logical relations between conceptions was identified. Conceptions revealed demonstrate the importance of technology to the theory, practice, research and education of nurses, and highlight the complexity and significance of technology in contemporary surgical nursing experience.

Phenomenography: a qualitative research approach for exploring understanding in health care

Phenomenography is a little-known qualitative research approach that has potential for health care research, particularly when people's understanding of their experience is the goal. Phenomenography is explained as a qualitative, nondualistic research approach that identifies and retains the discourse of research participants. This article seeks to present the major assumptions associated with phenomenographic research. An example of the way in which research outcomes are presented is included to emphasize its distinctiveness. It is noted that phenomenography has potential in the area of qualitative health research and will benefit from ongoing development and application.

In vitro immune modulation by antibodies coupled to tumour cells

Modification of autologous tumour cells to express the immune costimulator B7.1 is a potential strategy for immunotherapy of cancer. Previously, this has involved introduction of genetic material into cells, in vitro culture, and confirmation of the protein product on the cell surface. This is possible only if sufficient tumour is obtainable and efficiently modified in a short time. Whilst progress has been made on ex vivo tumour cell culture and transfection/infection procedures there are still tumour types for which the present means of gene transfer are not efficient enough. We describe a highly efficient in vitro procedure for the modification of over 99% of the cells in a population, allowing the expression of cell surface proteins with potential immune modulatory activities. This procedure, which can be completed in as little as 24 h with no upper limit on cell number, utilizes succinimide esters to label cell surface proteins with biotin covalently. Biotinylated cell membrane proteins then anchor an avidin bridge for immobilizing protein G'-biotin. This can serve to bind immunoglobulin (Ig) molecules via their Fc region such that the variable region of the antibody is freely and functionally available. In the present study the binding of a stimulatory mouse anti-human CD28 monoclonal antibody to the surface of tumour cells is used to show that the modified cells are capable of co-stimulating T cells in vitro. The simplicity of the method, and the use of common reagents, represents a further step towards a realistic, truly 'off-the-shelf', nongene immunotherapy protocol.

A critical review of the belief that technology is a neutral object and nurses are its master

This paper discusses technology in relation to nursing practice. The purpose of the paper is to introduce to nursing literature a critique of an important and common assumption concerning the relationship between nurses and technology. The discussion centres on the belief that technology is a neutral influence upon the practice of nursing. Technology is argued to be more pervasive an influence upon the politics of practice, the values of individuals, nursing practice and decision making, than many nurses identify. Therefore adequate understanding of the relationship between technology and nursing practice must address the need to be more critical of the belief that technology is a neutral object, and originates from being cognisant of arguments which both support and oppose the assertion.

Technology and nursing: an anatomy of definition

This paper discusses technology in relation to nursing practice development in order to demonstrate the need to apprehend nursing within the context of technological advancement. Issues pertinent to formulating an understanding of technology are reviewed and four common approaches to the definition of technology within the domain of nursing are critiqued. The purpose of the paper is to analyse issues relevant to defining technology, and to make obvious the limitations of current nursing literature.

Th1/Th2 cell dichotomy in acquired immunity to Bordetella pertussis: variables in the in vivo priming and in vitro cytokine detection techniques affect the classification of T-cell subsets as Th1, Th2 or Th0

In studies of the mechanism of immunity to Bordetella pertussis in a murine respiratory infection model, we have previously demonstrated that natural infection of immunization with a whole cell vaccine induces a potent protective immune response, which is mediated by T-helper type-1 (Th1) cells. In contrast an acellular vaccine generates Th2 cells and is associated with delayed bacterial clearance following respiratory challenge. In the present study we have investigated the apparent Th1/Th2 cell dichotomy in acquired immunity and have examined the factors that affect their induction or detection. The cytokine profiles of B. pertussis-specific T cells in immune animals were determined using antigen-stimulated ex vivo spleen cells or CD4+ T-cell lines and clones established in the presence of interleukin-2 (IL-2) or IL-4. Antigen-specific T cells derived from mice immunized with the acellular vaccine were almost exclusively of the Th2 cell type. In contrast, T-cell lines and clones established following respiratory infection or immunization with the whole cell vaccine were predominantly of the Th1 type. However, a proportion of T cells from convalescent mice, especially when cultured in the presence of IL-4, secreted IL-4 and IL-5 with or without detectable IL-2 and interferon-gamma (IFN-gamma), suggesting that Th0 or Th2 cells were also primed during natural infection in vivo. Furthermore, when mice were assessed 6 months after infection, spleen cells produced significant levels of IL-4 and IL-5, which were not evident at 6 weeks. The route of immunization and the genetic background of the mice were also found to influence the preferential priming of Th1 cells, and this was directly related to the level of protection against respiratory or intracerebral (i.c.) challenge. Our findings underline the critical role of CD4+ Th1 cells in immunity to B. pertussis, but also demonstrate that a number of factors in the in vivo priming and in vitro restimulation can skew the apparent dominance of one Th cell type over another.

The humanities and nursing: using popular literature as a means of understanding human experience

The rapid advances in technology during the twentieth century have encouraged science and technology to be the main focus of the nursing curricula. The effect of this focus tends to hinder the importance of the human condition. This paper discusses the benefits of including the humanities, particularly but not exclusively the inclusion of literary study in nursing curricula. It is argued that the study of popular literature by students of nursing provides them with the opportunity to understand and to appreciate life experiences. This assists them in gaining awareness and sensitivity to the many physical and psychological components of people's reactions to health, illness and hospitalization. The power of literary study to promote an appreciation of the hurt and pain of disease is considered by the authors to be an effective teaching tool within a comprehensive programme for students of nursing.

Immune responses and protection against Bordetella pertussis infection after intranasal immunization of mice with filamentous haemagglutinin in solution or incorporated in biodegradable microparticles

The intranasal (i.n.) immunization of mice with Bordetella pertussis filamentous haemagglutinin (FHA) either as a solution or incorporated in biodegradable microparticles induced very similar immune responses. Both resulted in strong systemic IgG responses to FHA and good levels of anti-FHA IgG and IgA in the lungs of immunized mice. In comparison, the intraperitoneal (i.p.) immunization of mice with FHA, as a solution, engendered anti-FHA antibody responses which were stronger for serum IgG, similar for lung IgG and lower for lung IgA. The anti-FHA antibody levels, as measured by immunosorbent assay, were shown to correlate with their functional activity in the blocking of B. pertussis adhesion to HeLa tissue-culture cells. All three forms of immunization appeared to stimulate T-cell responses as assessed by in vitro antigen-specific spleen cell proliferation and IL-2 secretion indicative of a Th1 type response, however, cells from i.p. immunized mice only secreted low levels of IL-5. All three methods of FHA immunization provided mice with significant protection against subsequent aerosol challenge with virulent B. pertussis. Mice which had been immunized intra-nasally eliminated the bacteria from their lungs slightly more rapidly than i.p. immunized mice, demonstrating the efficacy of intranasal administration of FHA in solution and in the more practical biodegradable microparticle form.

The reading habits of RACGP Training Program doctors

AIM

To describe the reading habits of a cohort of Western Australian RACGP Training Program doctors undertaking general practice terms in 1992.

METHOD

A questionnaire that included a list of journals and books relevant to general practice was distributed to trainees. Information obtained included demographic data, the frequency of journal reading and the number of books read.

RESULTS

There were 68 respondents from a total of 100. Time spent in medical reading ranged from one to 12 hours per week, with a mean of 3.3. The number of journal titles read in the past six months ranged from three to 16. The number of books actually read (from the 39 titles presented) ranged from zero to 17. The most frequently read were the reference type books. Very few of the 'core' books about the nature, scope and philosophy of general practice had been read.

CONCLUSIONS

RACGPTP doctors read mainly for information. To produce educated doctors knowledgeable about their chosen discipline, the Training Program will need to place greater emphasis on introducing their vocational trainees to the writings of the thinkers and philosophers of general practice and family medicine.