Use Of Health Personnel Research Articles

Audit of school entry health assessments: to maximise efficient use of health personnel at school entry assessments at 5 years

During the last 3 years in which doctors saw all school entrants, the decisions made about each child on examination were recorded and a protocol about decision-making to support children with health needs was drawn up. In September 1994, school entry health care assessments by the school nurses were introduced. Having previously recorded the numbers in each school who required medical interest and support, it was possible to rationalise which schools should be the primary responsibility of the nurses, which should retain medical contact for all children and in which schools assessments should be shared.The outcomes in decision making after introducing nurse assessments were recorded in the same format as used by thedoctors, so that the effect of passing responsibility to nurse colleagues could be assessed. The findings suggested that an equivalent number of children were referred to other services or selected for continuing review. However, the proportion of children whose needs were discussed with the headteacher without the children being selected for review was reduced. Issues to take forward were identified.

Paraguay 1990: Results from the Demographic and Health Survey

Preliminary results from the Paraguay Demographic and Health Survey, 1990, are presented for population, fertility, contraceptive usage, postpartum activity, infant mortality, immunization coverage, oral rehydration treatment, use of health personnel during delivery, and nutritional status. Data were compiled by the Paraguay Center of Population Studies. Surveys were conducted in only the eastern region which contains 98% of the population. Interviews were conducted with 5827 women aged 15-49 years between May 21 and August 24, 1990. 28 tables, graphs, or charts are provided. General demographic data is presented for 1965 and 1985 and the percent change. The percentage of urban or rural women by their educational status is provided. Total fertility rate is shown in 5-year spans between 1955 and 1985, with estimates given for 1990. Fertility differentials are shown for urban or rural residence and educational level. Age-specific fertility is given. The ideal number of children is plotted against the number of living children. Also given the number of women desiring to stop childbearing and the planning status by birth order. Contraceptive prevalence is expressed for residence and educational level, as well as for age and parity. Sources of supply are indicated by choice of modern method, Knowledge of contraception by method of use and knowledge is provided. Intention to use contraception is supplied in terms of number of living children. The reasons for nonuse are generated by age group 30 years and 30 years. Duration of postpartum by status (breast feeding, nonsusceptible, amenorrhea, abstinence) is provided. Status is given by months and mean duration. Survival of children ever born indicates ever born, surviving, and dead. Infant mortality differences are expressed by residence and educational level. Demographic characteristics of those immunized by type of vaccine is given. Statistics on the percentage of children 5 years of age with diarrhea 2 weeks prior to the survey are given. Health personnel involved during the delivery are given. Nutritional status is measured by the status of undernourishment based on weight for height and age data and residence and mother's educational level.

Would PNPs Be More Efficient?

As a student in the pediatric nurse practitioner (PNP) program at the University of Iowa, I was delighted to see the article by Hoekelman1 which presented an experimental study to compare the adequacy of well-baby care given by physicians alone vs. a combination of physicians and PNPs. The review of previous experimental studies2-3 and suggestions for further studies recognizes the need to determine the most efficient use of health personnel. One question that this study leaves in my mind concerns the well-baby visits that the R.N. conducted in both of the reduced-frequency groups.

Evaluation of trained midwives in a copper-T IUD insertion Program in Isfahan, Iran.

From four centers in Isfahan, data from 252 insertions of the Cu-T-200 made by midwives and 646 insertions of the same device made by doctors are compared. Although the net cumulative one-year continuation rate for women who had a copper-T inserted by a midwife is significantly lower than for women who had a copper-T inserted by a doctor there are no significant differences between the one-year event rates for the two groups of patients. These data suggest that an expanded role for midwives in IUD insertion programs would be an efficient use of health personnel.