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A vision for health in our new century.

Our vision of good health is changing. Extraordinary progress was made over the course of the 20th century--life expectancy at birth increased by nearly 30 years and scientific insights revealed that our health fates are determined by interacting factors within each of the five major health domains. As life expectancies extend far beyond customary notions of old age, attention shifts from survival and toward improving the quality of life. Our beliefs about what makes for a healthy life are reorienting around a vision of new possibilities, in which we take full advantage of what we know about getting each child off to the right start; providing all the opportunity for lifelong vitality borne of healthy lifestyles; designing safe and nurturing physical environments for our communities; assuring that all have access to the kind of medical care they need; protecting the isolated or estranged from the illness or injury that often accompanies their condition; and providing comfort and choices for all at the end of life.

Environmental Health↗

Proportion of trips made by walking: estimating a state-level baseline for Healthy People 2010 Objective 22-14.

PURPOSE: The purpose of this study was to investigate the proportion of short trips made by walking among Michigan adults and barriers to walking for transportation. METHODS: Four questions on walking for transportation were asked of 3808 respondents to the Michigan Behavioral Risk Factor Surveillance System (BRFSS) between January and December 2001. RESULTS: Three quarters (74.3%) of Michigan adults were estimated to have made at least one short trip (.25-1 mile) in the previous week; however, only 36.2% of them walked even one of these trips. The mean proportion of short trips walked was 21.4%; less than 10% of all respondents walked five or more trips per week. DISCUSSION: Our results provide a Michigan-specific baseline for Healthy People 2010 Objective 22-14 (i.e., increase the proportion of trips made by walking) and suggest the potential for these questions to be used to monitor active transportation via the BRFSS.

Adolescent↗

Status of U.S. military retirees and their spouses toward achieving Healthy People 2010 objectives.

PURPOSE: To assess the status of U.S. military retirees and their spouses 38 to 64 years of age relative to select Healthy People 2010 objectives and to identify sociodemographic characteristics associated with select health behaviors. DESIGN: Cross-sectional analyses with self-reported standardized measures from the U.S. Department of Defense Population Health Survey, 2003. SETTING: The continental United States. SUBJECTS: U.S. military retirees and their spouses 38 to 64 years of age. MEASURES: Data for this study were self-reported responses to the Population Health Survey. Dichotomous variables were created to indicate whether each Healthy People 2010 objective had been met. Each objective was measurable with the survey by using the definitions set forth in Healthy People 2010. These objectives included healthy weight and obesity based on body mass index (height and weight); daily fruit, vegetable, and grain-product consumption; physical inactivity, moderate physical activity, and vigorous physical activity; binge drinking; cigarette use; and smoking-cessation attempts. RESULTS: The study population did not meet any of the Healthy People 2010 objectives included in this study. Sociodemographic characteristics that were associated with this result included being male, not having a college degree, and a less-than-excellent self-reported general health status. CONCLUSION: Health-promotion interventions are needed to improve the health status of this population and to achieve the goals set forth in Healthy People 2010.

Adult↗

The colorectal carcinoma prognosis factors. Significance of diagnosis delay.

INTRODUCTION: detection of early-stage colorectal carcinoma (CRC)--( Dukes A or B)--provides better survival rates in these patients. Thus, the effectiveness of screening programs in asymptomatic patients or of early diagnosis in symptomatic individuals has been postulated. The aim of this study was to establish whether a delay in diagnosis or other factors are related to CRC stage. PATIENTS AND METHODS: a retrospective study was performed on 96 patients with CRC. Age at diagnosis, gender distribution, intestinal disorders, diagnosis delay, primary sign and -regarding CRC- localization, stage (Dukes) and grade of differentiation (well differentiated; non-well differentiated; poorly differentiated) were recorded. RESULTS: diagnosis delay was 185 +/- 190 days. Patients delay in obtaining a diagnosis was 119 +/- 158 days. In 40% of patients CRC was diagnosed at an early stage (Dukes A or B), and in 13% CRC was poorly differentiated. The only factor with an independent effect on Dukes stage was tumor differentiation (p: 0.0012). Distal location was associated with less advanced tumors without statistical significance (p: 0.156). CONCLUSION: based on the presented data, a greater effort regarding screening programs for healthy people seems warranted, as improved survival has been demonstrated when diagnosis delay is reduced, particularly in patients with the highest mean delay.

Age Factors↗

The Copenhagen declaration on reducing social inequalities in health.

The International Conference on Reducing Social Inequalities in Health was held in Copenhagen from 27 to 29 September 2000. Policy makers, researchers and decision makers at the community level took part in the conference. The conference brought into focus the problem of social inequalities in health and called attention to ways of reducing them by promoting equity in health. Building on existing international agreements that access to healthcare is a fundamental human right we urge all communities to accept their responsibility for reducing social inequalities in health when documented and effective methods are available for doing so. These methods should be acceptable, participative and improve health for everyone. Healthcare, disease prevention and health promotion should particularly benefit disadvantaged people. The conference endorsed the Declaration on 29 September 2000.

Europe↗

An overview: expanding the women's health research frontier.

The articles featured in this issue are focused on health topics that are important to improving the health of women across the life span. Cancer and other chronic diseases will need to continue to be the focus for research efforts in the future. However, additional research on women's health must go beyond the biomedical model and encompass issues related to the cultural aspects of health. further, there is a great need for health services researchers and others to expand the frontier of policy research to explore the development of innovative health care delivery systems to improve the health and health status of all women.

Biomedical Research↗

Preventive-care practices among persons with diabetes--United States, 1995 and 2001.

Effective interventions are available to persons with diabetes that can prevent or delay the development of serious health complications such as lower limb amputation, blindness, kidney failure, and cardiovascular disease. However, the use of preventive-care practices is lower than recommended, and the national health objectives for 2010 aim to improve care for all persons with diabetes. To assess progress toward meeting these goals, CDC analyzed data on selected diabetes-related preventive-care practices, including influenza and pneumococcal vaccination coverage, from the Behavioral Risk Factor Surveillance System (BRFSS) from 1995 and 2001. This report presents the findings of these analyses, which indicate that levels of preventive-care practices among persons with diabetes in the United States increased from 1995 to 2001. Further efforts are needed to improve care among persons with diabetes, reduce the burden of diabetes-related complications, and achieve the national health objectives, including continued surveillance of diabetes-related preventive-care practices and collaboration with community-based organizations, health-care providers, public health officials, and persons with diabetes.

Adult↗

Healthy people in Hawaii?: an overview of ethnic health disparities in Hawaii for the Healthy People 2010 initiative targeted health concerns.

Significant health disparities exist between ethnic groups in the United States. The authors reviewed literature examining the epidemiology of health disparities in Hawaii's multiethnic population. One of the primary goals of the Healthy People 2010 initiative is to eliminate health disparities, specifically cancer, cardiovascular disease, diabetes, infant mortality, child and adult immunizations and HIV/AIDS. However, the research on ethnic health disparities is fragmented, especially in Asian/Pacific Islanders. Unclear definitions of ethnicity (i.e., self-report, mixed ethnicity, etc) and aggregated study populations (i.e., combining multiple ethnic groups into one category) obscure the true health status of ethnic minorities in Hawaii. This paper presents an overview of the state of the literature on Hawaii ethnic health disparities.

Acquired Immunodeficiency Syndrome↗

Mental health: the missing link in primary care? Health for All by the Year 2000 revisited.

The effects on the uptake of services offered in primary health care of a demonstration community mental health project in Pakistan were assessed. A subdistrict with the project was compared with a matched area without the project over 7 years. Routinely collected information on service use was used, including the detection and treatment of mental disorders. Compared with the comparison subdistrict, the index subdistrict showed an increase in use of primary care by men, reduction in pregnancy rate, increased use of antenatal care, reduced maternal mortality, increased immunization coverage, and increased detection and treatment of mental disorders.

Adolescent↗

Prevalence of breastfeeding in the United States: the 2001 National Immunization Survey.

OBJECTIVE: To address key gaps in the annual monitoring of breastfeeding prevalence in the United States, 3 breastfeeding questions concerning the initiation, duration, and exclusivity of breastfeeding were added to the rotating modules of the National Immunization Survey (NIS) beginning in the third quarter of 2001. The present study examines the current prevalence of breastfeeding in the United States using NIS data from this initial quarter. METHODS: The NIS is a random-digit-dialing survey of households with children aged 19 to 35 months, followed by a mail survey of the eligible children's vaccination providers to validate the child's vaccination information. In the third quarter of 2001, a randomly selected subset of households interviewed in the NIS (N = 896) were asked questions about breastfeeding. RESULTS: Almost two thirds (65.1%) of children had ever been breastfed. At 6 and 12 months, 27.0% and 12.3%, respectively, were receiving some breast milk. Non-Hispanic blacks had the lowest rates of breastfeeding initiation and continuation. Exclusive breastfeeding rates were low in the United States with only 7.9% at 6 months. CONCLUSIONS: Although breastfeeding initiation is near the national goal of 75%, breastfeeding continuation lags behind the national goals of 50% and 25% at 6 and 12 months, respectively. Strenuous public health efforts are needed to improve breastfeeding practices among blacks.

Black or African American↗