Housing interventions and control of asthma-related indoor biologic agents: a review of the evidence.

Subject matter experts systematically reviewed evidence on the effectiveness of housing interventions that affect health outcomes, primarily asthma, associated with exposure to moisture, mold, and allergens. Three of the 11 interventions reviewed had sufficient evidence for implementation: multifaceted, in-home, tailored interventions for reducing asthma morbidity; integrated pest management to reduce cockroach allergen; and combined elimination of moisture intrusion and leaks and removal of moldy items to reduce mold and respiratory symptoms. Four interventions needed more field evaluation, 1 needed formative research, and 3 either had no evidence of effectiveness or were ineffective.

The Latino Health Insurance Program: a pilot intervention for enrolling Latino families in health insurance programs, East Boston, Massachusetts, 2006-2007.

Background: Thirteen percent of Latinos in Massachusetts lack health insurance, the highest rate of any ethnic or racial group. Families without health insurance are more likely to be in poor or fair health, to lack a regular medical provider, and to not have visited a medical provider in the past year.

Context: The Latino Health Insurance Program is designed as a response both to the high rate of uninsurance among Latinos in Boston and to the multiple obstacles that keep Latino parents from applying for insurance for their families.

Pesticides in urban multiunit dwellings: hazard identification using classification and regression tree (CART) analysis.

Many units in public housing or other low-income urban dwellings may have elevated pesticide residues, given recurring infestation, but it would be logistically and economically infeasible to sample a large number of units to identify highly exposed households to design interventions. Within this study, our aim was to devise a low-cost approach to identify homes in public housing with high levels of pesticide residues, using information that would allow the housing authority and residents to determine optimal strategies to reduce household exposures. As part of the Healthy Public Housing Initiative, we collected environmental samples from 42 public housing apartments in Boston, MA, in 2002 and 2003 and gathered housing characteristics; for example, household demographics and self-reported pesticide use information, considering information available with and without a home visit.

Partners in critical care.

Patient- and family-centred care (PFCC) concepts are increasingly cited in the critical care literature and are a welcome addition to the vernacular of the intensive care unit (ICU). The implementation and maintenance of a supportive PFCC environment is challenging, however, and usual strategies for knowledge translation using guidelines and policies, no matter how articulate, have not yet resulted in sustained practice change at the point of care delivery. In this article, co-authored by community partners, the physician director and nurse leader of one tertiary care ICU, we describe an initiative in which patient and family representatives were included in the ICU interdisciplinary team membership.

A multicenter survey of Ontario intensive care unit nurses regarding the use of sedatives and analgesics for adults receiving mechanical ventilation.

Background: Nursing-directed sedation protocols have been shown to reduce the duration of mechanical ventilation and shorten the length of intensive care unit (ICU) stay among critically ill adult patients.

Methods: We designed a self-administered questionnaire to understand nurses' satisfaction with current sedation and analgesia practices as well as drug therapies in the ICU setting and the perceived relevance of sedation protocols to patient care and nursing autonomy. We surveyed nurses from 3 academic medical-surgical ICUs that were not using a sedation protocol or a sedation scale.

The standardization of critical care nursing education and training: strategies for advancing clinical practice in Ontario's adult ICUs.

In 2004/2005, the Ontario Ministry of Health and Long-Term Care (MOHLTC) launched a critical care transformation strategy with a goal to enhance service delivery through improved access, quality and system resource management. Health human resources planning was seen as essential to the success of the strategy, particularly recruitment, education/training and retention of critical care nurses. A nursing task group was invited to articulate core competencies and practice standards that can be applied across Ontario's adult ICUs and to make recommendations for implementation and the training needed to encourage compliance with the initiative.

Reflections on critical care emergency preparedness: the necessity of planned education and leadership training for nurses.

ICU nurses who are involved in pandemic planning must advocate for the education and training they need to assume clinical leadership roles in emergency situations such as an infectious disease outbreak. Although many ICU nurses do advance to become clinical leaders, preparation is often inadequate and sometimes absent. This article focuses on two aspects of preparedness: the further development and integration of leadership competencies into day-to-day practice, and education and training using a computerized simulator.

Comment and controversies: since "Silent Spring": new voices, new analyses, and new movements.

Forty years ago, in the enormously praised and fiercely criticized book, "Silent Spring", Rachel Carson demonstrated the dangers of pesticides to humans and ecosystems and called for precaution in their use. Yet, the majority of environmental regulations passed since 1962 have primarily addressed pollutant discharge rather than cleaner products and technologies. The number of active ingredients in pesticides used in the United States has risen from 32 in 1939 to 860 in recent times, while the overall volume of agrochemicals applied has nearly doubled since the publication of Silent Spring.

SPRAWL IN THE 1990S Measurement, Distribution, and Trends.

Although sprawl is a growing national debate, there have been few efforts to measure or monitor changes in degree of sprawl over time. By using a methodology that employs census data, this sprawl index allows computation of levels of sprawl and examination of temporal and geographic changes. The results show that sprawl has increased over the past decade in many metropolitan areas.

Obesity, physical activity, and the urban environment: public health research needs.

Persistent trends in overweight and obesity have resulted in a rapid research effort focused on built environment, physical activity, and overweight. Much of the focus of this research has been on the design and form of suburbs. It suggests that several features of the suburban built environment such as low densities, poor street connectivity and the lack of sidewalks are associated with decreased physical activity and an increased risk of being overweight.

Dealing with aggressive behavior within the health care team: a leadership challenge.

During an interdisciplinary Canadian leadership forum [ (click on the Conferences icon)], participants were challenged to develop an approach to a difficult leadership/management situation. In a scenario involving aggressive behavior among health care providers, participants identified that, before responding, an appropriate leader should collect additional information to identify the core problem(s) causing such behavior. Possibilities include stress; lack of clear roles, responsibilities, and standard operating procedures; and, finally, lack of training on important leadership/management skills.

Developing leadership skills in critical care nurses: a case scenario--part one.

During a recent CACCN board meeting, directors were challenged with developing an approach to a difficult case scenario. In a situation where inappropriate communication toward a new nurse was observed and reported directly to the charge nurse, participants identified that before responding, the charge nurse should seek out additional information to identify the problems causing the behaviour. Possible core problems included lack of clarity around the roles and responsibilities, plus the lack of training on preceptorship and the principles of effective communication.

Investigations into the indoor environment and respiratory health in Boston public housing.

The self-reported prevalence of asthma in the United States increased by 75% from 1980 to 1994, a trend found to be significant and evident in every region of the country. The increase was most marked in children from birth to 14 years of age; and growing evidence indicates that, as with lead poisoning, inner-city and urban populations are most at risk. Attention has turned to the role of indoor environmental risk factors, especially in homes and schools.

About critical thinking.

Although a universally accepted definition of critical thinking has yet to be determined, there is much discussion in the literature about its meaning and, in particular, how it can be expressed in professional nursing practice. The simultaneous use of related terms such as reflective thinking, problem solving and clinical decision-making contributes to the lack of clarity around exactly what critical thinking is and, subsequently, how it can be taught and evaluated in the clinical setting. The purpose of this article is to provide an overview of the various components of critical thinking and to discuss barriers, facilitators and strategies that can enhance nurses' attainment of this core competency.

Analgesic and sedative pharmacology in the intensive care unit.

Sedation and analgesia are central elements in the care of critically ill, mechanically-ventilated patients. The goal of analgesic therapy is to provide relief from pain and physical discomfort which may lead to poor sleep, agitation, or a stress response. Opioids, such as morphine, fentanyl, and hydromorphone, are considered first-line agents for treating pain.

The effects of housing interventions on child health.

Housing hazards contribute to considerable morbidity and mortality among millions of children each year in the US, but few interventions are proven to control asthma and lead poisoning. Moreover, there is little evidence that many of the current recommendations to control residential hazards are safe and efficacious. The only interventions that have been found to work consistently are home visitation programs and home modification, such as installment of window guards and carpet removal.

"Where does the damp come from?" Investigations into the indoor environment and respiratory health in Boston public housing.

The self-reported prevalence of asthma increased by 75% from 1980 to 1994, a trend found to be significant and evident in every region of the country. The increase has been most marked in children 0-14 years of age, and there is evidence that, as with lead poisoning, inner-city and urban populations are most at risk. Attention has turned to the role of indoor environment risk factors, especially in homes and schools.