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AIM: To develop a Theory of Change (ToC) pathway to facilitate the development of a multi-component intervention package supporting pressure Ulcer (PU) risk identification and management, in partnership with people with Long Term Neurological Conditions (LTNC) who self-manage care and live at home, their informal carers and PAs. METHODS: A participatory approach, with extensive input from those whose lives are the focus of the research, was used throughout the 4 interlinked work packages (WP): Iterative data analysis was undertaken with emerging findings from each WP informing subsequent stages of the study. FINDINGS: Overall, 74 participants contributed across the 4 WPs, incorporating 31 Service Users (SU), 8 carers, 9 Personal Assistants (PAs) and 26 professional stakeholders. We identified 8 key themes related to PU prevention, incorporating, learning, safe routines, third sector and peer support, navigating complex systems, adapting and reacting to change, perceptions of risk, risk negotiation and supporting roles. The findings indicate systemic and professional barriers which hamper people's ability to self-care and seek help. CONCLUSIONS: The study highlights the complexities and impact of managing PU prevention activities at home for people with LTNC and areas of learning for health professionals and systems. By understanding these complexities we developed a systems map, identified resource requirements and illustrated a Theory of Change (ToC) pathway, to underpin future work to develop and user test an interactive, multi-component intervention.

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A pilot study was conducted within the medical-surgical intensive care unit (MSICU) of the Toronto General Hospital site of the University Health Network during the winter/spring (March-June) of 1999 to examine nurses' learning preferences relevant to infection prevention and control (IPAC). The majority of the nurses sampled indicated a preference for face-to-face infection prevention and control education (seminars). Such seminars were preferred on an annual basis by most respondents. Common preferences for paper-based learning formats were observed to be portable flash cards, packages with text and pictures and reference manuals. Such paper-based modalities could be considered in concert with infection control seminars; possibly to serve as easily accessible reminders within hospital units. Although not observed in this study, exploring differences in learning preferences across various demographic characteristics of nurses (e.g., years of experience) could be valuable. It is important to assess the specific IPAC learning needs of nurses before designing educational interventions. Assessing the effectiveness of learning modalities in improving infection control practices is advised. The practicality of nurse participation in various educational initiatives also must be considered, as barriers to nurse participation in continuing education have been noted. Furthermore, organizational commitment to infection prevention/safety should be reinforced through future training opportunities for health care workers (HCWs). Challenges with the application of new technology to educational modalities have been cited, which bears relevance to these findings. These observations are presented in order to inform infection control training of nurses in the post-SARS milieu of health care provision in Canada.

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The provision of a positive HIV antibody test result and the direction and support given to the test recipient are critical components of care and prevention. There has been little research that describes what happens in such interactions between recipient and provider. The impact on the test provider of delivering the HIV test result is an important issue to consider. The discomfort experienced by some health providers in giving a positive test result may have adverse effects on the client interaction or may carry over into subsequent client interactions. Utilizing a thematic analysis on interview data from 24 HIV test providers, we describe the impact of delivering a positive test result on HIV test providers, identify the factors that influence this impact, and describe strategies used to manage the impact. As with other health care professionals communicating "bad news,"HIV test providers experience a variety of impacts. While a small number of providers indicated little or no impact of delivering the HIV positive test result because the diagnosis is ''not the end of the world,'' most indicated it was difficult as it was anticipated that the test recipient would (or did) find the news distressing. Several coping strategies were identified.

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IPPNW and Physicians for Social Responsibility, Finland organized an international conference on small arms and firearms injury in Helsinki from 28-30 September 2001, emphasizing the preventive medicine aspects of the issues discussed. This article describes the background to this conference and reports the work of IPPNW in following it up.

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The level of global small arms violence is enormous and the scale of human suffering it causes is immense, although poorly counted. It causes at least hundreds of thousands of deaths and more than a million injuries each year, as well as permanent physical and psychological damage, destruction of families, lost productivity, and diversion of resources from basic health services. Research is required on three basic issues, as follows: health effects of weapons; the contributing factors and causes, including behavioral issues; and impacts of interventions and their cost-effectiveness. Policies and programs designed to reduce the human and social impacts of small arms should make use of public health knowledge and analysis of risk factors as a means of bringing increased focus and effectiveness to their objectives. At its international conference on small arms, gun violence, and injury, "Aiming for Prevention" in Helsinki in September 2001, International Physicians for the Prevention of Nuclear War called on health professionals as well as scientists, activists, humanitarian and development workers to contribute to an effective confrontation of the small arms pandemic.

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