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PubMed2005

A qualitative study of exercise in older African American and white women in rural South Carolina: perceptions, barriers, and motivations.

Six focus groups were conducted with underactive African American (n = 16) and white (n = 23) women aged 50 years and older, residing in a nonmetropolitan county in South Carolina, to examine perceptions, barriers, and motivators related to exercise. Transcripts were coded and codes were entered into NUD*IST to assist with organizing and reporting themes. Participants could not reach consensus on the frequency, intensity, and duration of exercise needed for older women, and emphasized that PA recommendations should consider age, health, and physical abilities. While benefits and barriers to exercise were similar to those found in other groups, the risk of "overdoing it," being "too old," and environmental barriers specific to rurality were unique. Exercise enablers were also similar to those found in other groups, but rural women discussed the role that the church played in supporting exercise. Other enablers included transportation, free facilities, and age-appropriate programs. Results indicate the need to tailor recommendations and advice to older women, and to consider the rural context in which they live.

Black or African American↗
PubMed2006

Acculturation, socioeconomic status, obesity and lifestyle factors among low-income Puerto Rican women in Connecticut, U.S., 1998-1999.

OBJECTIVES: To examine the associations of socioeconomic status and acculturation with obesity and lifestyle characteristics that may be risk factors for diabetes and cardiovascular disease among low-income Puerto Rican women. METHODS: This cross-sectional study was conducted between 1998 and 1999 by interviewing a convenience sample of 200 low-income Puerto Rican female caretakers of young children in Hartford, Connecticut, United States of America. Various recruitment methods were used to ensure adequate representation of the target community. The associations of obesity (body mass index > or = 30.0) and lifestyle factors (physical activity, cigarette smoking, alcohol consumption, food intake) with socioeconomic status (education, employment, car ownership), acculturation, age, and marital status were examined with Spearman rho, chi-squared, and Mann-Whitney U tests and logistic regression analyses. RESULTS: Mean age was 29 years. Obesity (40%), physical inactivity (47%), and cigarette smoking (32%) were common. Less acculturated participants were 57% less likely to smoke and 54% less likely to be obese than their more acculturated counterparts. Lower socioeconomic status (not finishing high school or not owning a car) was associated with a higher likelihood of obesity, but unemployed (vs. employed) women were less likely to be obese (P < 0.05). Women who did not own a car consumed meat, eggs and fish less often than those who owned a car. Smokers were more likely to have an unhealthy food intake pattern than nonsmokers. CONCLUSIONS: The associations of acculturation and socioeconomic status with some lifestyle characteristics suggest the need for culturally appropriate programs to promote healthy lifestyle behaviors in this low-income community.

Acculturation↗
PubMed2005

American Society of Nephrology Renal Research Report.

In the spring of 2004, the Board of Advisors and the Council of the American Society of Nephrology believed it necessary to conduct a series of research retreats to steer priorities appropriately in an era of limited resources. In this regard, retreats were conducted by five working groups in areas that were identified to require distinct attention: acute renal failure, diabetic nephropathy, hypertension, transplantation, and uremic cardiovascular toxicity. The goal of each retreat was to join experts, both within and outside the renal community, to identify areas of basic science and clinical research that should receive highest priority in the next five years. The five retreat summaries with their individual listings of research priorities allow for the distillation of three overriding recommendations that strongly emanate from them: Continued support and expansion of investigator initiated research projects. In each of the five subjects on which this report is focused, there are areas of investigation that require the support of investigator-initiated projects if ultimately progress is to be made in the understanding of the basic mechanisms that underlie the diseases processes on which we want to have an impact in the next decade. It is recommended that there be an expansion of support for research in the areas highlighted in this report that lend themselves to this mechanism of funding by encouraging applications with appropriate program announcements and requests for proposals. In addition to vigorous support for RO1 grants, continued funding of Concept Development and R21/R33 grants is essential to support development of investigator-initiated clinical studies in these areas of high priority. Support for the development of a collaborative research infrastructure. The reader of this article cannot but be impressed by the common theme that independently emerged from each report regarding the urgent need to develop an infrastructure for kidney research. This infrastructure requires the development of core facilities for the centralized processing of biologic materials (genomics, proteomics, and metabolomics), in vivo imaging, development and distribution of antibodies and other molecular reagents, development and distribution and phenotyping of mouse models, and perhaps others. These need to be complemented with core bioinformatics centers that collect and analyze data and finally with a network of clinical study coordinating centers. Expansion of kidney research infrastructure can be achieved by vigorous funding of a program of kidney research core centers. Specifically, we propose that the number of kidney centers be increased with the goal of providing core facilities to support collaborative research on a local, regional, and national level. It should be emphasized that such a program of competitively reviewed kidney core centers would facilitate investigator-initiated research in both laboratory and patient-oriented investigation. This approach is also very much in line with the collaborative research enterprise conceived in the National Institutes of Health's Road Map. Support programs that have an impact on the understanding of the relationship between renal and cardiovascular disease (CVD). It is now widely recognized that chronic kidney dysfunction is an important risk factor for the development of CVD. It therefore is not surprising that essentially every one of the retreat reports emphasizes the urgency to examine this relationship. It is recommended that the National Institute of Diabetes and Digestive and Kidney Diseases and the National Heart, Lung, and Blood Institute (NHLBI) work cooperatively to support both basic and clinical science projects that will shed light on the pathogenesis of this relationship and to support the exploration of interventions that can decrease cardiovascular events in patients with chronic kidney disease. Thus, we specifically propose that the NHLBI support investigator-initiated research (RO1, Concept Development, and R21/R33) grants in areas of kidney research with a direct relationship to CVD. Similarly, the NHLBI should work collaboratively with the National Institute of Diabetes and Digestive and Kidney Diseases to support the proposed program of kidney core research centers. This subject provides an excellent opportunity to foment a collaboration between two institutes, along the lines of the present-day overall philosophy of the National Institutes of Health.

Acute Kidney Injury↗
PubMed1989

Health policy and implementations in Tanzania.

This paper describes the current health policy in Tanzania and its implementations. The present health policy in Tanzania originated from Arusha declaration of 1967, the country's most popular national policy after independence. Arusha declaration proclaims socialism and self-reliance, which has had important impact on the form and content of the present country's health policy in mainland Tanzania. Much of the wide-spread health care services infrastructure that is evident now in rural areas of Tanzania mainland is a result of the re-emphasis of the Arusha declaration in 1971. In Tanzania, the Ministry of Health has the responsibility for elaborating the health policy, ensuring that strategies and appropriate program are developed to give effect to the policy. In the present health policy discussed, the goal is seen to have shifted from having one dispensary in each village to one primary health unit in each village. One dispensary is intended to serve several villages together. In Tanzania, according to the present health policy, the village primary health care are mainly preventive oriented and only being managed by short term trained health staff. The candidate for training in each village is selected, among the village residents, by the villagers themselves. The primary health care system adopted by Tanzania is viewed as the only way through which it can achieve the social goal of health for everyone by the year 2000, provided the present political will which is evident continue, and enough availability of, human, financial and material resources.(ABSTRACT TRUNCATED AT 250 WORDS)

Delivery of Health Care↗
PubMed1995

Vestibular evoked responses in man: methodological aspects.

We have developed a stimulation method where the subject is sitting and the head is rotated with shock bursts elicited by a shaker with a repetition rate of 2 Hz. The head movement is monitored with an accelerometer mounted on the cheek by a head band. The maximum amplitude of the head movement is 3 degrees. The electrodes were places on vertex with a negative electrode on the mastoid. During stimulation, 90 dB white noise was applied to the ears to mask the noise generated by the stimulus. We recorded following responses: i) VER from ipsilateral ear, ii) VER from contralateral ear, iii) eye movement with EOG, and iv) movement of the head. Amplification and averaging of the signal were made with an evoked response recorder (Nihon Kohden, Neuropac four). From 200 to 2,000 averaged responses were collected and stored for further analysis on a floppy disc. During second stage filtering the data were fed into a microcomputer where appropriate programs were used to eliminate the EMG and movement artifacts.

Acceleration↗
PubMedDate not supplied

Strength training for children and adolescents.

Strength, or resistance, training for young athletes has become one of the most popular and rapidly evolving modes of enhancing athletic performance. Early studies questioned both the safety and the effectiveness of strength training for young athletes, but current evidence indicates that both children and adolescents can increase muscular strength as a consequence of strength training. This increase in strength is largely related to the intensity and volume of loading and appears to be the result of increased neuromuscular activation and coordination, rather than muscle hypertrophy. Training-induced strength gains are largely reversible when the training is discontinued. There is no current evidence to support the misconceptions that children need androgens for strength gain or lose flexibility with training. Given proper supervision and appropriate program design, young athletes participating in resistance training can increase muscular strength and do not appear to be at any greater risk of injury than young athletes who have not undergone such training.

Adolescent↗
PubMed1997

Health promotion and early detection of cancer in older adults: a practical approach.

Little is known about the cancer-related knowledge, attitudes and health behaviours of older adults (> 55 years), or about designing health promotion and early detection interventions responsive to their learning needs. A collaborative project was established with the intent of designing an appropriate program for older adults. The initial work included a community needs assessment using focus groups, one-on-one interviews and self-report surveys. The use of key community contacts was effective in locating older adult subjects (> 55 years) through pre-established linkages with agencies. Various ethnocultural groups, low income communities and isolated individuals, as well as other pre-established groups, were included in this study. The needs assessment found that: age is not perceived as a cancer risk factor; transportation is a barrier to screening; fear inhibits people from being screened; physicians are viewed as both the main source of expert cancer knowledge and as the gatekeepers to screening; family and peers are the main source of support, ethnospecific groups have different information needs; and finally, that lifestyle suggestions can reduce the risk of cancer. The findings indicated that community health promotion programs for older adults will require multiple approaches with a combination of strategies in order to meet their learning needs.

Aged↗
PubMed2004

Antidepressant medication use among First Nations peoples residing within British Columbia.

Very little is known about antidepressant medication use among First Nations people in Canada. This information would be useful to begin estimating the prevalence of conditions treated with this class of medications and planning appropriate programs. Antidepressant medication claims for First Nations people residing within British Columbia were extracted from the Non-Insured Health Benefits pharmacy database. During 2001, 9.8% (95% CI = 9.81, 9.79) of the population filled a prescription for antidepressant pharmacotherapy, claimant mean age was 40.3 years and the female:male ratio was approximately 3:1. The most common medications were Paxil, Apo-Amitriptyline, Effexor, and Celexa. Use of this medication class is common and more research is needed in this area of study.

Adult↗
PubMed1990

Competition, integration, and diversification: seven hospitals of Growthville, U.S.A.

Summing up across the three phases of this case, the pattern of evolution was (1) emergence of a market orientation by hospitals as the industry moved away from regulation; (2) steady expansion of what the hospitals considered to be their business, to include nonacute hospital and medical services as well as insurance, with vertical integration and concentric diversification serving as the vehicles for accomplishing this expansion; (3) remarkable change with respect to who was competing with whom, stemming from restructuring of hospital relationships away from open competition among many toward domination by a few; (4) a shift in the market from one of consumer choices among physicians and hospitals toward one of competitive choice among health plans; and (5) the emergence of negotiated pricing within the context of the new oligopoly, stemming from the heightened and organized power of corporate purchasers. Finally, we return to a concept presented in the introduction to this case: strategic alignment. The case has described the substantial realignment of our study hospitals to their new and changing environment. And it has highlighted their managers' use of boundary scanning, competitor analysis, and strategy to achieve this realignment. James Thompson's word for this process is "co-alignment," referring to "the most critical managerial function, and the skill closest to creativity." This case has illustrated this management skill, defined as "the discernment of hitherto unnoticed relationships in the complex environment, calculating their cause-effect relationships, and translating them into appropriate programs of action". This is both a summary of the performances of our case study managers and a powerful prescription for those who might face similar circumstances and challenges.

Economic Competition↗
PubMed1982

Supplemental Security Income for the aged, blind, and disabled; deeming of income and resources--SSA. Interim rules with comment period.

These rules address the problem of certain beneficiaries of Supplemental Security Income (SSI) payments who remain unnecessarily institutionalized because returning home for less costly medical treatment would result in loss of Medicaid eligibility. The rules provide that the Secretary, in appropriate circumstances, will not apply the ordinary SSI rules for deeming certain family members' income and resources to a noninstitutionalized individual. This is a temporary policy that will deal with this concern while States develop appropriate programs of home and community-based services under their Medicaid programs.

Aged↗
PubMed2000

A prospective study of gestation and birthweight in Aboriginal pregnancies in far north Queensland.

This study aimed to determine the cause(s) of the increased incidence of low birthweight birth in Aboriginal pregnancies. The study prospectively examined a cohort of Aboriginal women presenting for antenatal care before 20 weeks gestation (ultrasound proven) and a reference cohort of Caucasian women in four remote North Queensland communities served by the Far North Regional Obstetric and Gynaecological Service (FROGS) and the antenatal clinic at Cairns Base Hospital. Women with no known medical factors affecting fetal growth or gestation were recruited. Of the 102 Aboriginal and 101 Caucasian women recruited, 96 Aboriginal and 96 Caucasian women completed the study, providing groups of sufficient size to allow statistical assessment at 80% power and 95% significance. Outcomes measured were gestation at delivery, planned or spontaneous birth, neonatal anthropometric measurements and Dubowitz score. The phenotypic and demographic characteristics of the women, their pregnancies, and their babies were also compared to understand the major associations with low birthweight birth in the Aboriginal women. Apart from Aboriginal ethnicity, excessive alcohol use in pregnancy, low maternal body mass index (BMI), and low maternal age had significant negative correlations with birthweight, and excessive tobacco use in pregnancy and high maternal gravidity showed strong similar trends. Culturally appropriate programs need to be funded and developed to reduce the incidence of low birthweight Aboriginal birth, rather than medical programs primarily aimed at the reduction of the incidence of preterm labour.

Adult↗
PubMedDate not supplied

Australian clinicians and educators identify gaps in specialist cardiac nursing practice.

Change is endemic in both the health care and higher education sectors in Australia. Consequently professional roles and educational pathways must also evolve and adapt, often catalysed by those in leadership positions. Two national Delphi panels, one of cardiac nurse educators and the other of cardiac nurses, were convened to answer the question 'What knowledge, skills and attitudes are required for an expert nurse practising in the highly technological cardiac care environment?' Respondents indicated on a Likert scale the importance of 107 items to the nurse's role in both the 'real' and 'ideal' worlds of practice. Overall there was very strong agreement between the two panels with results indicating that Australian nurses perform close to their ideal in many areas of practice. For 31 of the items, both panels identified that the reality of practice is quite far from their ideal. Both panels agree that 10 of the behaviours are carried out or valued very little in practice. Reasons why nurses are not carrying out these elements of the role to their satisfaction are discussed and remediation strategies suggested. The findings can inform both curriculum development and clinical practice. In the dynamic health care arena, the nursing profession continues to respond to community and professional needs, seeking to establish sound research-based practice and maintain a high quality of clinical care and nursing management. The development of competencies by the Confederation of Critical Care Nurses (1996) is a good example of professional groups taking the initiative both in defining the practice role and providing tools that assist educational bodies to develop programs appropriate for a practice based discipline. Specialty nursing practice is 'under the microscope' in Australia as the profession seeks the best methods to weight nursing activities, measure nursing outcomes and recruit, retain and justify the use of specialist practitioners.

Attitude of Health Personnel↗
PubMed2002

Knowledge, attitudes, and behavior of homeless African-American adolescents: implications for HIV/AIDS prevention.

The purpose of this pilot study was to describe the knowledge of HIV/AIDS, attitudes about condom use, and the sexual behavior of African-American adolescents who reside in a children's emergency homeless shelter. The Attitudes Toward Condom Usage Questionnaire, the AIDS Knowledge and Attitude Survey, and a Perceived Risk of HIV/AIDS Scale were modified and administered to 37 African-American male and female adolescents who reside in an emergency shelter. HIV/AIDS knowledge and attitudes about condoms among these respondents were comparable to those of other adolescents described in the literature in that there was a strong knowledge of HIV/AIDS, although sexual behavior and attitudes toward condoms were not consistent with this knowledge. Significant differences between male and female respondents were only found on three items of the Attitudes Toward Condom Usage Questionnaire and on the Perceived Risk of HIV/AIDS Scale at the 0.05 level. The knowledge, attitudes, and sexual behavior of homeless, African-American adolescents should be examined to develop and implement appropriate programs to address the specific needs of this population. Further research should focus on this population and expand on this preliminary data.

Adolescent↗