Healthy people, healthy worksites.
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A specific program was adopted to obtain organs, for transplant purposes from people who die at home or in the street from sudden or unexpected death (type I non-heart-beating donors [NHBD] according to the Maastricht classification). The objective of our program was to increase the donor pool by obtaining organs from well-selected potential donors who die at home, work, or in the street and are maintained on advanced life support (ALS) until hospital arrival. The great number of people who die in a previously healthy situation constitute an excellent source of organs for transplant purposes. Our program includes pre- and in-hospital attendance. Prehospital attendance is based on application of cardiopulmonary resuscitation in situ and ALS until arrival at hospital. In hospital, specific preservation maneuvers must be performed and family assessment and judge permission obtained. In the last 15 years, we developed a kidney transplant program with better results than transplants performed with organs obtained from encephalic death donors (EDD). A specific NHBD subprogram for lung transplant was developed with excellent results as well. We are now improving the liver transplant program. NHBD are an important source of human tissues, including pancreas islets. It is clear that NHBD are a great source of organs and tissues for transplant, and that this kind of program must be established in all countries in which legal regulations allow it.
Occupational health nursing has evolved from a single dimension practice into a complex role providing primary care, health maintenance, and disease prevention programs at the worksite. The focus of the 1990s will be on managed care, health care reform, and competition for resources. Occupational health nurses are in a strategic position to foster the objectives set forth in Healthy People 2000. Occupational health nurses must take the lead in the development and implementation of cost effective health care programs at the worksite. Occupational health nurses must communicate and demonstrate the nature and value of their contributions; demonstrate their competencies; and become knowledgeable in all areas of occupational health and safety. They must acknowledge that they are leaders in workplace health and safety.
Investigations concerning the temporal organization of the sleep/wake cycle (SWC) in healthy active elderly, specially focusing possible relationships between regular daily routines, sleep fragmentation and sleep quality in aging are still scarce. We studied the SWC of 23 healthy active elderly (65-76 years old) of both sexes (15 female, 8 male), engaged in an exercise program for old people, considering that physical exercise sessions could represent a strategy for keeping structured daily routines. We report the relationships between SWC characteristics and performance of physical exercises viewed as time cues. We collected SWC data by means of sleep logs and data about light exposition by means of actigraphy during 23 consecutive days. Individuals who chose earlier times for exercising showed longer exposition to natural bright light and reported better sleep quality. Indications that physical exercises could be beneficial upon sleep were scarce (better subjective sleep quality). Strength of semicircadian component of the SWC was greater for subjects who exercised longer, suggesting they have advantageously used naps as part of their active and healthy lifestyle, and indicating the need for studying more closely the temporal organization of naps.
This study was designed to investigate the electrical conductance of meridian in the obese during weight reduction. Ten obese including overweight (Body Mass Index, BMI > 26) and 30 healthy (non-overweight) people were recruited from Chung Yuan Christian University. The obese subjects were instructed to follow a weight reduction program that included diet control, exercise and oral intake of Prozac. A device, the design of which is based on the Ryodoraku theorem, was used to measure the electrical conductance of 12 meridians on both sides of the subjects. The results showed that: (1) the average coefficient of variation of the electrical conductances in 24 meridians of the obese group was statistically different from that of the healthy group (p < 0.05); (2) the average coefficient of variation of electrical conductance in the obese after weight reduction was significantly decreased than before the weight reduction program (p < 0.05); (3) the BMI and the electrical conductance of meridian was correlated in the obese (r = -0.77, p < 0.001) as well as in the healthy group (r = -0.92, p < 0.001). These findings suggest that electrical conductance of meridians can be a parameter to monitor weight, especially for obese people.
OBJECTIVE: To assess by self-reported participation in vigorous physical activity, the quantity and quality of school physical education, team sports, and television watching among 11,631 American high school students. RESULTS: Of all students in grades 9 through 12, 37% reported engaging in 20 minutes of vigorous physical activity three or more times per week. Participation in vigorous physical activity was higher among boys than girls (P < .01) and higher among white students than among those of other races and ethnic groups (P < .01). Overall, 43.7% of boys and 52% of girls reported that they were not enrolled in physical education classes. Of the students who reported attending physical education class during the past 2 weeks, 33.2% reported exercising 20 minutes or more in physical education class three to five times per week. In contrast, rates of participation in varsity and junior varsity sports remained constant across grade levels, but participation in recreational physical activity programs showed a lesser magnitude and also decreased with advancing grade. More than 70% of students reported spending at least 1 hour watching television each school day, and more than 35% reported watching television 3 hours or more each school day. CONCLUSIONS: Participation in vigorous physical activity and physical education class time devoted to physical activity are substantially below the goals set in Healthy People 2000. As students move toward graduation, we observed disturbing declines in participation in community recreation programs and overall vigorous activity. Students appear to spend considerably more time watching television than participating in physical activity. Public health efforts should focus on increasing the physical activity levels of our youth to enhance their current well-being and to reduce the risks of future chronic disease.
Prevention researchers should join political and professional efforts to maximize coverage for validated preventive services and programs as part of health care reform. We have a useful framework from Healthy People 2000, the Guide to Clinical Preventive Services, and preventive clinical trials. We must anticipate the clinical and community-based questions for which prevention research can provide needed answers. Cancer prevention trials, serum cholesterol and prostate-specific antigen screening, prevention of Helicobacter-related diseases, and comprehensive health promotion strategies for older adults are excellent examples of policy-laden research challenges. To assure future prevention research capability, we must invest in training in epidemiology, biostatistics, behavioral, environmental, and health services research.
Body composition and the components of energy metabolism were examined in 12 men and women, aged 56-80 y, before and after 12 wk of resistance training. Subjects were randomly assigned to groups that consumed diets that providing either 0.8 or 1.6 g protein.kg-1.d-1 and adequate total energy to maintain baseline body weight. Fat mass decreased 1.8 +/- 0.4 kg (P < 0.001) and fat-free mass (FFM) increased 1.4 +/- 0.4 kg (P < 0.01) in these weight-stable subjects. The increase in FFM was associated with a 1.6 +/- 0.4 kg increase in total body water (P < 0.01) but no significant change in either protein plus mineral mass or body cell mass. With resistance training, the mean energy intake required for body weight maintenance increased by approximately 15%. Increased energy expenditure included increased resting metabolic rate (P < 0.02) and the energy cost of resistance exercise. Dietary protein intake did not influence these results. Resistance training is an effective way to increase energy requirements, decrease body-fat mass, and maintain metabolically active tissue mass in healthy older people and may be useful as an adjunct to weight-control programs for older adults.
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PURPOSE/OBJECTIVES: To review the state of the science on sleep/wake disturbances in people with cancer and their caregivers. DATA SOURCES: Published articles, books and book chapters, conference proceedings, and MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and the Cochrane Library computerized databases. DATA SYNTHESIS: Scientists have initiated studies on the prevalence of sleep/wake disturbances and the etiology of sleep disturbances specific to cancer. Measurement has been limited by lack of clear definitions of sleep/wake variables, use of a variety of instruments, and inconsistent reporting of sleep parameters. Findings related to use of nonpharmacologic interventions were limited to 20 studies, and the quality of the evidence remains poor. Few pharmacologic approaches have been studied, and evidence for use of herbal and complementary supplements is almost nonexistent. CONCLUSIONS: Current knowledge indicates that sleep/wake disturbances are prevalent in cancer populations. Few instruments have been validated in this population. Nonpharmacologic interventions show positive outcomes, but design issues and small samples limit generalizability. Little is known regarding use of pharmacologic and herbal and complementary supplements and potential adverse outcomes or interactions with cancer therapies. IMPLICATIONS FOR NURSING: All patients and caregivers need initial and ongoing screening for sleep/wake disturbances. When disturbed sleep/wakefulness is evident, further assessment and treatment are warranted. Nursing educational programs should include content regarding healthy and disrupted sleep/wake patterns. Research on sleep/wake disturbances in people with cancer should have high priority.
BACKGROUND: Memory enhancement programs that can significantly improve actual memory performance and subjective perceptions of everyday memory in elderly people are rare. This study was designed to evaluate a new memory enhancement program incorporating principles of successful aging, designed to enhance subjective and objective everyday memory in community-dwelling old people. METHODS: Two matched groups of 20 healthy community-dwelling elderly adults were assessed on measures of objective and subjective memory performance before and after participating in a memory enhancement or active control condition. RESULTS: Planned multivariate analysis of variance (MANOVA) on change scores showed that participants in the memory enhancement program improved significantly on both objective and subjective measures. Specifically, greater improvement was demonstrated on a verbal paired associates task, story recall, face recognition, contentment with memory, and use of memory strategies. CONCLUSIONS: Although a fully randomized design was not used, the results are promising, suggesting that memory training incorporating principles of successful aging can enhance memory performance in healthy old people, objectively and subjectively.
This article offers a creative approach to promote family and community health, beginning with the conversion of the office of Surgeon General of the United States into the Wellness General of the United States. The content ranges from federal initiatives to promote quality health research to individuals and families who will be the beneficiaries at medical clinics and community health programs. The proposal recommends changes to institutions and policies, including junk food taxes, the National Institutes of Health, the United States Preventive Services Task Force, the Healthy People 2010 initiative, the Health Plan Employer Data and Information Set, the Medicare Coverage Advisory Committee, state health mandates, local health plans, community medical clinics, and community health programs. The goal is to stimulate ideas and actions among policymakers, researchers, practitioners, educators, and students.
OBJECTIVE: Lack of knowledge is one of the factors responsible for the persistence of infectious diseases in Brazil. This study had the objective of developing, implementing and evaluating a low-cost educational program using schistosomiasis patients as a model. METHODS: This was a descriptive study developed using a population of healthy people (group 1) and schistosomiasis patients (groups 2 and 3), with 20 individuals in each group. Teaching material (illustrated manual and album of leaflets) and a questionnaire consisting of 17 questions to evaluate the groups' knowledge were devised. The questionnaire was applied to groups 1 and 2 before and to group 3 after the educational program. The variables studied were the educational program, level of schooling, age, clinical form of schistosomiasis, symptoms, and the subject's performance when answering the questionnaire. For the statistical analysis, Fisher's exact test and variance analysis with one fixed factor were utilized. RESULTS: The educational program was evaluated in the form of four topics: cycle, clinical presentation, treatment and prevention of the disease. The median number of correct responses to the questionnaire was higher for group 3 than for groups 1 and 2, for all the topics dealt with. This median was also higher for group 2 than for group 1, for all topics except for the item "prevention". CONCLUSIONS: The educational process applied was efficient and improved the knowledge of the disease. It may provide an effective low-cost methodological model that can also be applied to combating other endemic diseases.
Health promotion programs provide information, education for health and opportunity for the development of the skills that people need to make healthy choices. The current climate of health care practice also directs its focus to the needs and wants of the health care consumers. This entails active input from the target group. The present study used focus groups in an attempt to ensure input from women in early postpartum into the development of a postpartum continence promotion program. The focus groups revealed anomalies in women's perceived susceptibility to, and knowledge about, urinary incontinence and pelvic floor exercises, while highlighting other areas of need. Focus groups proved an invaluable tool in the development of a more effective physiotherapy continence promotion program.
OBJECTIVE: To describe the prevalence and distribution (by demographic characteristics and body mass index [BMI] category) of sedentary behaviour among Australian adolescents aged 11-15 years. METHOD: Cross-sectional representative population survey of school students (n = 2,750) in New South Wales, conducted in 2004. Students' self-reported time spent during a usual week in five categories of sedentary behaviour (small screen recreation [SSR], education, cultural, social and non-active travel). Height and weight were measured. RESULTS: Grade 6, 8 and 10 students spent approximately 34 hours, 41 hours and 45 hours/week of their discretionary time, respectively, engaged in sedentary behaviour. Urban students and students from Asian-speaking backgrounds spent significantly more time sedentary than students from rural areas or other cultural backgrounds. SSR accounted for 60% and 54% of sedentary behaviour among primary and high school students, respectively. Overweight and obese students spent more time in SSR than healthy weight students. Out-of-school hours educational activities accounted for approximately 20% of sedentary behaviour and increased with age. Girls spent twice the time in social activities compared with boys. Time spent in cultural activities declined with age. CONCLUSION: Sedentary behaviours among young people differ according to sex, age and cultural background. At least half of all time spent in sedentary behaviours was spent engaged in SSR. BMI was significantly associated with sedentary behaviour among some children, but not consistently across age groups. IMPLICATIONS: A clear understanding of young people's patterns of sedentary behaviour is required to develop effective and sustainable intervention programs to promote healthy living.
Since 1961, Special Olympics has provided sports training and athletic competition for people with mental retardation. A recent addition to these Olympics has been the Healthy Athletes Program, designed to help the athletes improve their health and fitness, leading to enhanced sports experiences and well being. Original health services included dental and eye screening. In 2002, Special Olympics Delaware piloted a Wellness Park to add nutrition, blood pressure, and flexibility screening. Faculty from a university's health college trained discipline-specific students to conduct the screenings. Thirty nutrition and dietetics students measured height, weight, waist circumference, and calculated body mass index (BMI) for the athletes. Figures and risk-assessments were recorded on a "health report card." Two hundred ten athletes attended the nutrition screening. Ages ranged from 8 to 63 years; 81 percent males and 19 percent females. According to BMI standards, 32 percent of the athletes were overweight; 17 percent were obese. Twenty-five percent of adult males and 73 percent of adult females had a high risk waist circumference. Athletes at high risk for obesity-related diseases were referred to their primary physician for follow up. Nutrition education handouts included a simplified Food Guide Pyramid, tips for healthy eating in restaurants, 5 A Day information, and healthful hydration guides. Approximately 1,250 athletes participate in Special Olympics Delaware each year, providing a great opportunity to do some much needed health screening and improve access to health care for this often neglected population.
We investigated body composition in older patients who had experienced a cerebrovascular accident (CVA) and were participating in a recovery program that included physical exercise. We studied 61 persons in two groups. One group consisted of 13 men and 12 women (mean age, 68 years) who were receiving day center care to recover from a CVA that had occurred from six months to one year previously. The second group (control) consisted of 20 men and 16 women (mean age, 68 years) in good health, residing in a retirement home. Most subjects in both groups were able to perform normal activities of daily living without help and showed a high degree of independence (> 60 on the Barthel scale). Bioelectric impedance and anthropometric methods were used to measure the magnitude of changes in fat-free mass and fat mass. Percentage total body fat measured with bioelectric impedance was higher in both groups than when measured anthropometrically. The anthropometric values and bioelectric impedance results in patients who participated in a physical exercise program were similar to the findings in control subjects. The anticipated loss in muscle mass and gain in body fat as a result of inactivity associated with illness was not seen, possibly because of the personalized program of continuous physical exercise. Our comparison of older people recovering from CVA and apparently healthy older people illustrates the benefits of physical exercise in compensating for changes in body composition as a result of immobility during convalescence.