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PubMed2001

An evaluation of Choose to Move 1999: an American Heart Association physical activity program for women.

BACKGROUND: Rates of physical inactivity and poor nutrition, which are 2 of the most important modifiable risk factors for cardiovascular disease in women, are substantial. Even so, studies of interventions designed to improve lifestyle behaviors in women have been limited and often confined to particular geographical areas. OBJECTIVE: To evaluate the effect of Choose to Move on increasing women's physical activity, improving their knowledge of heart disease and stroke, and improving their nutrition. PARTICIPANTS AND METHODS: A prospective, nonrandomized, 12-week educational intervention designed by the American Heart Association for women across the United States. Participants received a welcome kit and manual with weekly information about how to manage cardiovascular disease risk factors and how to build a support system for lifestyle change. Women (N = 23 171) aged 25 years or older were recruited by direct mail, the media, health care providers, and other means. Follow-up evaluations were returned from 6389 women at 2 weeks, 5338 at 4 weeks, 4209 at 8 weeks, 3916 at 10 weeks, and 3775 at 12 weeks. Participants self-reported their physical activity, diet, and knowledge about heart disease, stroke, and related symptoms. RESULTS: Ninety percent of the participants were white and 56% were aged between 35 and 54 years. Among the participants who completed the week 12 follow-up evaluation, the percentage who reported being active (at least moderate exercise > or =5 times per week or >2(1/2) hours per week for the past 1 to 6 months) increased from 32% at baseline to 67% at the program's end (P =.001). Participants currently limiting excess calories or fat increased from 72% to 91% at week 10 follow-up evaluation (P =.001). The proportion correctly identifying heart disease as the leading cause of death increased from 84% to 91% at week 10 follow-up evaluation (P<.001). CONCLUSIONS: Women who completed the Choose to Move program evaluation reported that they significantly increased their levels of physical activity, reduced their consumption of high-fat foods, and increased their knowledge and awareness of cardiovascular disease risk and its symptoms. This program provides an important model for public health, voluntary, and other health organizations of population-based, targeted low-cost self-help programs that support the Healthy People 2010 objectives for physical activity, nutrition, and cardiovascular health.

Adult↗
PubMedDate not supplied

A descriptive analysis of asthma-related medical services and prescription utilization among recipients in a Medicaid program.

One objective of the Healthy People 2010 initiative calls for the establishment of a surveillance system to track asthma illness and management in at least 25 states. Our objective was to report patterns of asthma-related medical services and pharmacotherapy use among recipients of Texas Medicaid. Texas Medicaid medical services and prescription administrative claims data dated between January 1 and December 31, 2000, for recipients between 6 and 64 years of age enrolled in a fee-for-service plan were extracted. Rates of recipients with asthma, rates of asthma-related medical services use, and patterns of pharmacotherapy use were reported. There were 31,509 recipients identified with asthma at a rate of 22.8 per 1000. Children under 15 years of age, males, and blacks had the highest rates of asthma, as well as asthma-related emergency department (ED) visits and hospitalizations compared with other demographic groups. Hispanics accounted for the largest proportion of ethnic groups but had the lowest rate of asthma compared with whites and blacks. The rate of ED visits and hospitalizations among children was more than twice the rate among adults. Blacks had more than twice the rate of ED visits and nearly double the rate of hospitalizations for asthma compared with other ethnic groups. Roughly 56% of the recipients had a claim for an inhaled anti-inflammatory medication. However, it appeared that recipients were using short-acting beta-agonists more frequently than inhaled corticosteroids. Use of medical services and prescription medications for asthma varied greatly on the basis of recipient demographic factors.

Adolescent↗
PubMedDate not supplied

Emerging research: a view from one research center.

The Health Management Research Center at the University of Michigan has assembled a database on health risks, medical care costs, an in some cases, productivity measures for over 2,000,000 individuals. For employees of its corporate consortium members, the database contains seven to eighteen years of data. Working with this data, the research team has observed a number of emerging trends. These trends have been stable in this data set for a number of years, but some of them are yet to be subjected to rigorous external peer review. The trends are summarized below. 1) Annual participation rates of 20% to 30% in Health Risk Appraisal are typical; over 10 years, 80% participate at least once, 60% at least twice and 40% at least three times. 2) Among the employers in the data base, excess risk factors account for 21% to 31% of medical care costs, with a mean of 25%. 3) Medical care costs increase as the number risk factors and age increase. As risk factors increase, medical costs increase; as risk factors decrease, medical care costs decrease. The mean cost increase per risk factor increased ($350) may be more than double the mean cost decrease per risk factor decreased ($150). 4) Cost savings greatest among those who participate in programs multiple times. 5) Absenteeism seems to be higher and other measures of productivity lower for those with health risk factors. 6) Programs designed to keep healthy people healthy in addition to reducing the risks of those with multiple risks will probably provide the greatest return to the employers. 7) Best results may be achieved by focusing efforts on employees who have clusters of risk factors associated with low perceived health status. 8) A corporate wellness score which combines risk factor levels and participation rates may provide a "corporate wellness score" which can be used to compare health status across employer. 9) Increased use of longitudinal data sets, fuzzy cut points for data categories and data mining techniques may allow breakthroughs in future analysis efforts.

Academies and Institutes↗
PubMed1994

Can mental illness be prevented under managed care?

Ideally, managed care should force a focus on all the issues involved in prevention and treatment. Unfortunately, the decisions in managed care are based on costs, along with the intervention techniques, as the most important criteria in choice of treatment. Medical treatment accounts for only 10 percent of health. To find a solution means working together, making the goal "healthy people in a healthy community." Programs such as the Healthy Cities initiative, not managed care, are more likely to realize this goal.

Community Mental Health Services↗
PubMed2005

[A study of 202 periodontitis subjects in Chengdu].

OBJECTIVE: To study the severity of periodontitis and risk factors in Chengdu. METHODS: 202 periodontitis patients (65 male, 137 female), aged from 25 to 60, were requested to fill a questionnaire. Probing depth (PD), clinical attachment level (CAL), gingival recession and bleeding on probing (BOP) on 6 sites of each tooth were measured and recorded. RESULTS: The mean PD, AL, gingival recession and BOP% of 202 subjects was (3.2 +/- 0.31) mm, (3.5 +/- 0.37) mm, (0.3 +/- 0.02) mm and 21.16%. 59% of subjects missed at least one tooth. 129 subjects suffered with initial to moderate periodontitis. 73 subject suffered with advanced periodontitis. 40, 86, 55 and 21 subjects had received college education, high school education, middle school education and primary school education. 18% of subjects had smoking history, 67% subjects had tea/coffee history, 66% of subjects had psychosocial problem, and only 8% of subjects had received regular periodontal treatment. There is no relationship between the severity of periodontitis and education. CONCLUSION: It is very important to develop an education program on oral healthy for people in Chengdu.

Adult↗
PubMed2003

Hospital health promotion: swimming or sinking in an upstream business?

Healthy People 2000 (HP 2000) calls on hospitals to offer health promotion programs addressing priority health needs of the community. Historically, this upstream initiative has not been present in health care. With the increasing provision of these programs, this case study examined their content to further understand potential public health impact. The health promotion programs offered to the community--both the general public and corporate employees--by an urban Midwest hospital were assessed over 1 year. This article presents a content analysis of 216 programs that was conducted by measuring seven variables: target group, presentation format, fee, health focus, program providers, contact frequency, and activity. Based on this single case study, hospitals appear to be addressing objectives set forth by HP 2000 for community hospitals. Although moving upstream with health promotion, an analysis of program content suggests modifications may be necessary in order to serve as effective interventions for health priorities.

Academic Medical Centers↗
PubMed1989

Giving wellness a spiritual workout. Two model programs emphasize the development of self-reliance.

Many hospitals, corporations, and communities have developed wellness programs to help people maintain a healthy life-style. Today's wellness doctrine reflects modern medical thinking that, to achieve optimal human potential, a person must enjoy physical, mental, emotional, and spiritual well-being. Most wellness programs, however, concentrate on the physical; few take into account spiritual well-being. Wellness programs developed by the Boulder County YMCA, Longmont, CO, and the University of Maryland, College Park, were based on an interpretation of a model suggested by Carl Jung that defines spirituality as the development of self-reliance. According to Jung, the constituents of self-reliance include awareness, inner faith, self-worth, humility, patience, acceptance, and self-confidence. He suggested that the absence of any one of these could cause a breakdown in a person's belief system and lead to a spiritual crisis. These programs trained participants to recognize the importance of their spiritual well-being and to find practical ways to improve it. Key components were a stress management course; workshops in confidence building and values clarification; and classes, lectures, and workshops that emphasize the integration of spiritual and physical well-being.

Colorado↗
PubMed2006

Healthy People 2010 Emergency Medicine Module: a multicenter survey and educational intervention.

To educate emergency medicine (EM) residents about Healthy People 2010 (HP2010), the nation's public health agenda. Participating EM residency programs were given a 40-min slide presentation and a 4-item post-test that we developed. In two residency programs, we conducted a "before-after" study to assess the reliability of the test instrument. Fifteen residencies participated, with 289 individuals (70% EM residents) attending the lectures. Only 19% reported any knowledge of HP2010 before exposure to the Module. Nevertheless, after exposure, 182 (90%) scored 75% or better on the four questions specifically testing the informational content of the Module. In the reliability study, residents showed significant improvement from the pre-test on both the immediate and 2-week post-tests (both p<0.001). In conclusion, we found that EM residents' baseline knowledge of HP2010 was poor, and that the EM Module improved knowledge about this important public health document.

Cross-Sectional Studies↗
PubMed2006

Distribution of influenza vaccine to high-risk groups.

Vaccine distribution programs have historically targeted individuals at high risk of complications due to influenza. Despite recommendations from the Advisory Committee on Immunization Practices, vaccination coverage among high-risk populations has been generally low. This review systematically summarizes the recent literature evaluating programs in different settings, from within medical settings to venue-based and community-based approaches, in an effort to identify successful program components. The published literature was identified by using the MEDLINE database from 1990 to 2006 covering studies that reported on interventions or programs aimed at vaccinating high-risk populations. The authors reviewed 56 studies. In the United States, the Healthy People 2010 goals included 90% vaccination coverage for adults aged > or = 65 years and 60% for high-risk adults aged 18-64 years. Only a handful of the studies reviewed managed to meet those goals. Interventions that increased vaccination coverage to Healthy People 2010 goals included advertising, provider and patient mailings, registry-based telephone calls, patient and staff education, standing orders coupled with standardized forms, targeting of syringe exchange customers, and visiting nurses. Few studies evaluated the impact of vaccination programs by race/ethnicity and socioeconomic status. Few studies targeted individuals outside of the health-care and social services sectors. Given the growing disparities in health and health-care access, understanding the way in which interventions can remedy disparities is crucial.

Community Networks↗
PubMedDate not supplied

Rationale for tobacco cessation interventions for youth.

Tobacco use is the leading cause of preventable death in the United States. Four of every five persons who use tobacco begin before they reach adulthood; more than 3,000 young persons begin smoking each day. In addition, smoking is addictive-three of four teenagers who smoke have made at least one serious, yet unsuccessful, effort to quit. The importance of tobacco use cessation programs for youth is addressed in Healthy People 2000: National Health Promotion and Disease Prevention Objectives and in recently passed legislation related to the Goals 2000 National Education Goals. CDC's Guidelines for School Health Programs to Prevent Tobacco Use and Addiction states that tobacco cessation programs are needed to help young persons who already use tobacco. In 1994, both the Surgeon General's Report, Preventing Tobacco Use among Young People, and the Institute of Medicine's report, Growing Up Tobacco Free, indicated that there were very few effective cessation programs for youth and that more research is needed in this area. This project convened experts to provide recommendations on the design of a tobacco cessation intervention for youth, including helping pregnant teenagers who smoke to stop. This program is based on effective adult cessation programs with modifications relevant to adolescent development. During the first year the major foundational work for this project was accomplished. A database of key contacts and other related interventions in tobacco cessation for youth was developed, a review and analysis of prevalence and trends in adolescent smoking were conducted, and a cooperative agreement with the American Medical Association was established to complete the design, implementation, and evaluation of an effective tobacco cessation program for youth. During the second project year, this program was tested through quasi-experimental research at various school-based health clinics throughout the country. The third year involved follow-up data collection and program modification based on the results. Plans for dissemination of the intervention to youth-serving agencies across the nation will be developed. This is a 3-year project.

Adolescent↗
PubMed1992

Low to moderate intensity endurance training in healthy older adults: physiological responses after four months.

OBJECTIVE: To determine the physiological adaptations in previously sedentary healthy older men and women (mean age = 68) to a 16-week low-to-moderate-intensity exercise program. DESIGN: Randomized, controlled trial. SETTING: An exercise facility and testing laboratory in a gerontological research institute. PARTICIPANTS: Two-hundred forty-seven community-dwelling older persons free of significant cardiovascular, pulmonary, or uncontrolled metabolic disease, anemia, electrolyte abnormality, resting BP of 165/90 or greater, or chronic disease affecting the ability to exercise on a bicycle. INTERVENTION: Subjects were randomly assigned to either an exercise (n = 166) or attention control group (n = 81). Exercisers trained thrice weekly for 40 minutes on a cycle ergometer (5-minute warm up, 30 minutes at training heart rate (THR), 5-minute cool down). THR was set at 70% of peak heart rate attained on a maximal exercise test (mean = 115 +/- 15). Control subjects attended weekly group talks. Testing took place before and after the program. RESULTS: Peak attained oxygen uptake (VO2max) increased 8.5% in exercisers and decreased slightly in controls (p less than .001) and oxygen uptake at ventilatory threshold (VeT VO2) increased by 3.5% in exercisers and decreased by 3% in controls (p less than .001). This pattern of a greater increase in VO2max than VeT VO2 is different from that seen in young and middle-aged subjects. CONCLUSION: This study demonstrated that a large scale training program is feasible for healthy older people, that physiologic improvements can be measured after 16 weeks of low-to-moderate-intensity training, and that mechanisms of adaptation to exercise may be different in elderly subjects from those in younger ones.

Adaptation, Physiological↗
PubMed2004

The "every child deserves a medical home" training program: more than a traditional continuing medical education course.

OBJECTIVES: 1) To develop and implement an innovative, interactive, and nontraditional continuing medical education (CME) curriculum to educate primary care physicians, pediatric office staff, child health advocates, allied health care professionals, and parents of children with special health care needs (CSHCN) about the medical home concept of care and 2) to identify key partners in communities to plan the CME program and ultimately plan for fostering medical homes at the community and state levels. METHODS: Participant outcomes for the CME program and planning process include 1) explaining the elements of the medical home concept as applied to their practice environment or child's care; 2) understanding the concepts, skills, and information necessary to care successfully for CSHCN who are enrolled in managed care organizations; 3) accurately describing trends and developments in caring for CSHCN; 4) identifying programs in the community that serve CSHCN; and 5) assessing and, if necessary, improving pediatric office practices to ensure that they are sensitive to families of children and youths with special health care needs. CONCLUSION: A diverse national committee that included physicians, nonphysicians, and family members developed the Medical Home Training Program curriculum. The medical home curriculum was written to meet the needs of the local community. The training program can offer CME credit and use a direct, outcome-based adult learning technique (eg, determine short- and long-term goals). Furthermore, the program parallels and complements the Healthy People 2010 goals and objectives.

Child↗
PubMed1995

Suicide prevention in the elderly (age 65-99).

Suicide rates by age are highest among older adults. Subpopulations of elderly adults at high risk are identified, including White males, the target of a Healthy People 2000 Objective. Several specific programs are described and a range of measures to prevent suicide in late life are suggested. These measures include primary prevention steps related to education and information dissemination, and secondary prevention involving early identification and assessment of the depressed and suicidal as well as improved referral efforts.

Aged↗
PubMed1997

Healthy aboriginal communities.

Improving the health of Aboriginal and Torres Strait Islander populations is the greatest challenge facing public health in Australia today. The gains in the health of the population overall have not been matched by gains among these communities. Much of the information about the health of Aboriginal and Torres Strait Islander communities and people is negative, and little information is available about what Aboriginal and Torres Strait Islander people themselves consider to be indicators of healthy people and healthy communities. This paper identifies some successful programs and highlights the need for community ownership of decisions about goals, services and programs. By looking to ways that Aboriginal people view their health (and its determinants), and to the examples of successful action to date, it is possible to begin to develop a vision of healthy Aboriginal communities in which the relationship between body, land and spirit has been restored. The need, now, is to build the partnerships that will be necessary to turn the vision into reality.

Attitude to Health↗
PubMed2002

Developing a health promotion program for faith-based communities.

The article describes the partnership formed between community outreach programs, a school of nursing, and hospitals to implement Healthy People 2010 goals in urban, faith-based communities. To date this program has provided health promotion programs to 125 people from more than 18 congregations in the context of their faith setting. The program has allowed congregants to develop ministry strategies to meet health care needs within the congregation and community. The article provides overall program goals, specific lesson plans, and evaluation strategies. Outcome measures include an increase in health promotion knowledge, participant satisfaction, and improved health in congregations.

Adult↗
PubMedDate not supplied

Curriculum revision: product innovation for quality outcomes.

The education of any professional discipline rests on a curricular foundation that reflects the discipline's theory and knowledge bases, practice patterns, and unique skills. In addition, professional health care education must respond to and reflect changes in technology, societal definitions of health and wellness, and broad social issues such as access to care, health care funding, and changing patient demographics. These issues are interwoven with efforts to also provide high-quality education with positive learning outcomes. In this article, the authors describe a school of nursing's efforts to revise its curriculum to reflect a professional shift in focus to community-based nursing practice and the goals of the federal health goals outlined in Healthy People 2010. The revision also served as the starting point for a change in the process through which the college will seek accreditation in the future; this process-Academic Quality Improvement Program-requires institutions of higher learning to use a continuous quality model as its base.

Community Health Services↗
PubMed1991

Consensus set of health status indicators for the general assessment of community health status--United States.

Healthy People 2000 establishes a framework for the development of an explicit prevention program for the nation (1); the Year 2000 Health Objectives Planning Act* provides legislative support for such a program. To address both the requirements of that act and Objective 22.1 of Healthy People 2000, a consensus set of 18 health status indicators has been developed to assist communities in assessing their general health status and in focusing local, state, and national efforts in tracking the year 2000 objectives. Priority in selecting the indicators was given to measures for which data are readily available and that are commonly used in public health.

Aged↗
PubMed2003

Racial differences in influenza vaccination among older Americans 1996-2000: longitudinal analysis of the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey.

BACKGROUND: Influenza is a common and serious public health problem among the elderly. The influenza vaccine is safe and effective. METHODS: The purpose of the study was to determine whether frequencies of receipt vary by race, age group, gender, and time (progress from 1995/1996 to 2000), and whether any racial differences remain in age groups covered by Medicare. Subjects were selected from the Health and Retirement Study (HRS) (12,652 Americans 50-61 years of age (1992-2000)) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (8,124 community-dwelling seniors aged 70+ years (1993-2000)). Using multivariate logistic regression, adjusting for potential confounders, we estimated the relationship between race, age group, gender, time and the main outcome measure, receipt of influenza vaccination in the last 2 years. RESULTS: There has been a clear increase in the unadjusted rates of receipt of influenza vaccination for all groups from 1995/1996 to 2000. However, the proportions immunized are 10-20% higher among White than among Black elderly, with no obvious narrowing of the racial gap from 1995/1996 to 2000. There is an increase in rates from age 50 to age 65. After age 70, the rate appears to plateau. In multivariate analyses, the racial difference remains after adjusting for a series of socioeconomic, health, and health care related variables. (HRS: OR = 0.63 (0.55-0.72), AHEAD: OR = 0.55 (0.44-0.66)) CONCLUSIONS: There is much work left if the Healthy People 2010 goal of 90% of the elderly immunized against influenza annually is to be achieved. Close coordination between public health programs and clinical prevention efforts in primary care is necessary, but to be truly effective, these services must be culturally appropriate.

Age Distribution↗