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PubMed2001

Beyond sex and cooking: health education for individuals with intellectual disability.

Issues of health education programming for people with intellectual disability are discussed. As environments in which such individuals live become more inclusive, and they are encouraged to make their own choices, the issue of whether current health education is sufficient to enable them to make healthy life choices is considered. More attention should be focused on programs in schools and the community to fulfill this need. Three aspects of health education programming are considered: physical activity, general health knowledge, and social supports for health. Continuity of information is viewed as important in policy development as well as in interprofessional coordination and cooperation to assure that these individuals are not further handicapped by poor health.

Cooking↗
PubMed1996

Teens for healthy living.

Improving the health and quality of life of adolescents is a fundamental aspiration of community health nurses. But developing health promotion programs that are attractive to young people can be a major challenge. In a rural Nova Scotia school district, this challenge has been met by bringing the teens themselves into the design and implementation of the program.

Adolescent↗
PubMedDate not supplied

Emotional reactions to predictive testing in Alzheimer's disease and other inherited dementias.

This work describes the reasons and emotional responses of healthy descendants after counseling for presenilin mutations in early-onset familial Alzheimer's disease (EOFAD), tau mutations in familial frontotemporal dementia (FTD), and prion mutations in fatal familial insomnia (FFI). A multidisciplinary protocol following Huntington's disease counseling guidelines and a post-test follow-up program were developed to counsel healthy descendants of affected families. The psychological consequences, anxiety levels, and depression status were assessed through validated scales before and after disclosing the information. Nine people from three different families, one with EOFAD, another with FTD, and the other with FFI came for counseling. Their main reason for testing was to initiate early treatment in the future. Disclosing the information decreased anxiety in two carriers, increased it temporarily in one, and had no effect in another. All noncarriers felt relieved. Overall, after a mean of 30 months of follow-up, no negative psychological reactions were observed. All participants positively valued the program. Although preliminary, our observations suggest that predictive testing in EOFAD, FTD, and FFI is safe and may be of benefit when performed with a delicate approach under strict pretest counseling protocols and post-test follow-up programs. The emotional reactions were similar, although the diseases, their phenotype, and mutation characteristics were different.

Adult↗
PubMed2001

Hospital architecture in the new era.

This paper will address 'health care' from a different perspective: The initial observation is that, for the most part, that which exists is 'sickness care' and not. Since early in the 20th Century, or before, public health has had a reduced effect on the preventitive aspects of the health of people. Only recently has emphasis begun to be placed on the prevention of disease and trauma through broad-based programs that include improving healthy life styles and the reduction of communicable diseases. Architects and their clients around the world, it is argued, have contributed to the lack of the preventitive aspect by what is referred to as their 'Edifice Complex', or the desire to build huge buildings that cause traffic problems, create pollution and make easy access to health care even more remote.

Architecture↗
PubMed2005

Statin efficacy and safety for lipid modification in apparently healthy male military aircrew.

INTRODUCTION: Military aircrew men represent an elite group of relatively young, fit, and healthy people. The effectiveness of statin treatment in reducing low-density lipoprotein cholesterol (LDL-C) according to the current National Cholesterol Education Program (NCEP) guidelines, its safety, and compliance in this group of people has not yet been determined. METHODS: We prospectively evaluated 84 military aircrew men (mean age 43 +/- 7 yr) with LDL-C above the current NCEP guidelines. The patients were divided into two groups according to their coronary risk factors: Group 1, LDL-C goal < 160 mg x dL(-1); Group 2, LDL-C goal < 130 mg dL(-1). All patients received statins in addition to therapeutic lifestyle changes and were followed for a mean of 3 +/- 1 yr according to a simple flow chart. Lipoprotein levels, liver function tests, creatinine phosphokinase, and subjective adverse reactions were checked periodically. RESULTS: LDL-C significantly declined by 32% (p < 0.0001) within the first month of treatment and 99% of subjects achieved their LDL-C goal within 114 +/-35 d from statin therapy initiation. The Framingham estimated 10-yr coronary risk showed a reduction at an average of 12 mo after statin therapy initiation from a baseline value of 6.54% to 3.95% (p = 0.003). No subjects were grounded or disqualified from duty, there were no cardiovascular events during follow-up, and compliance to therapy was high [82/84 (98%)]. DISCUSSION: Statin treatment in this highly select, relatively young group of aircrew men significantly and safely lowered LDL-C cholesterol levels.

Adult↗
PubMedDate not supplied

Peer and community leader education to prevent youth violence.

The program described here tests the effectiveness of a community-based and school-based program to reduce violence among African-American and Hispanic adolescents. The program methods are based on social network theory research, which has found that key lay people in communities can be identified and trained to carry out prevention programs. The educational content is based on theories suggesting that characteristics of healthy, adaptive individuals and communities can be taught. A violence-prevention leadership program is provided to a cohort of middle-school student peer leaders and their parents and for the leaders of the neighborhoods around the middle schools. Three matched pairs of urban middle-school attendance zones were randomly assigned to receive either the intervention or serve as a nonintervention control group. Surveys, interviews, and observations were conducted with the peer leaders, their parents, community leaders, and community residents. Sixty-six percent of the peer leaders reported that they had hit someone in the past 30 days. Twenty-six percent of the sixth-graders had punched or beaten someone in the past 30 days. Within the past year, 6% of the adults had slapped or kicked someone. Within the past 30 days, 14% of the sixth-graders had been punched or beaten. Within the past year, 6% of the adults had been punched or beaten. A large percentage of adolescents are victims and perpetrators of violence and are exposed to violence in their neighborhoods. Violence-prevention strategies can be implemented through collaborations among health departments, community-based organizations, universities, and schools.

Adult↗
PubMedDate not supplied

Promoting healthy bladder habits for seniors.

Urinary incontinence (UI) effects people of all ages, but is especially prevalent in the elderly population. Also significant is a lack of knowledge about UI. A health promotion project was developed and implemented in six ethnically diverse, predominantly minority, inner city senior centers, a program designed to address an elder population, as they are very likely to be experiencing UI and lacking knowledge concerning healthy bladder habits. The project consisted of three phases: orientation/training of key staff members/peer educators at the six senior centers; educating elder consumers through four one-hour weekly sessions involving visual aids and completion of bladder records and quizzes, and follow-up sessions with senior staff/peer educators to reinforce previous training. One result was that training of peer educators needed further refinement to allow for a more significant role throughout the program. The program was very well received by the participants and roughly 80 percent felt they had more control over their bladder by the end of the last session. This project will continue into 1997 and in addition to information on UI, the project will include prostate health for men and gynecological health for women, as this need became evident throughout the program.

Aged↗
PubMed2006

Evaluation of the Healthy Village program in Kapit district, Sarawak, Malaysia.

Sarawak, Malaysia has a large population of ethnic minorities who live in longhouses in remote rural areas where poverty, non-communicable diseases, accidents and injuries, environmental hazards and communicable diseases all contribute to a lower quality of life than is possible to achieve in these regions. To address these issues and improve the quality of life for longhouse people, the Kapit Divisional Health Office implemented the World Health Organization's Healthy Village programme in 2000. An evaluation was undertaken in 2003 to determine physical and behavioural changes resulting from the programme. The main changes evaluated were those involving smoking habits, exercise habits, health screening, fire safety, environmental improvements and food preparation and hygiene. A qualitative evaluation was conducted using participant observation and key-informant interviews, focus groups and observation. Results indicate that the programme is inspiring changes in various behavioural and physical characteristics of the study population. It is clear that the Healthy Village programme is a widely accepted way of improving health outcomes in longhouses, and that it is succeeding in making beneficial health changes.

Focus Groups↗
PubMed1992

The Washington Heights-Inwood Healthy Heart Program: a third generation community-based cardiovascular disease prevention program in a disadvantaged urban setting.

The Washington Heights-Inwood Healthy Heart Program (WHIHHP) is part of the New York State Healthy Heart Program, which comprises eight community-based programs in different areas of the state. WHIHHP is directed at a population of approximately 200,000 people, predominantly Hispanic and of low socioeconomic status, living in northern Manhattan in New York City. The initial 3 years of experience are presented. Six potential barriers to diffusion of the community-based disease prevention model in disadvantaged inner city communities are discussed: (a) issues of scale and complexity; (b) adaptation of this model to a "community" without geopolitical boundaries or infrastructure; (c) linguistic and cultural diversity; (d) competing problems; (e) the role of evaluation; and (f) sustainability of the program in a poor community. Strategies for addressing obstacles to model adoption are also described, including program legitimization, building program infrastructure, setting realistic expectations, focusing on one risk factor at a time, defining target population segments, and emphasizing a small number of communication channels. Finally, research issues related to the diffusion of the community-based model are discussed, specifically: (a) Does the model work in disadvantaged urban settings? (b) What are the program effects on social class gradients for risk factors? (c) What are the barriers to program adoption in such settings? (d) What changes in the model will facilitate adoption in such settings? (e) What are the best methods for conducting formative evaluation in such programs? (f) What is the best way to select communities that may be ready to adopt the model? Our initial experience implementing this model in a disadvantaged urban setting supports the feasibility of model adoption. Unanswered questions about efficacy in such settings and regarding research issues related to model diffusion will require additional research investment.

Adolescent↗
PubMed1998

The effect of six months training on weight, body fatness and serum lipids in apparently healthy elderly Dutch men and women.

OBJECTIVE: To investigate the effect of a six-months training program on changes in body weight and lipid concentrations, and their interrelationship in elderly people. DESIGN: Intervention study. The elderly subjects were randomly assigned to a control group or one of two supervised aerobic training groups, either all round activities or ergometer cycling, both exercising 3-4 times a week for six months. SUBJECTS: 229 elderly men and women, aged 60-80 y. MEASUREMENTS: Various fatness parameters by anthropometry, serum lipids and peak power output. RESULTS: During the intervention, no significant changes were observed in weight or body fatness in subjects of the training groups. Serum high density lipoprotein (HDL), low density lipoprotein (LDL) and total cholesterol and triglycerides tended to change in a favourable direction in the elderly of the intervention groups, but only triglyceride concentration in women of the cycle ergometer group (mean difference with controls: -0.24 mmol/L, 95% confidence interval (CI): -0.45, -0.03) and total serum cholesterol and HDL-cholesterol concentrations in subjects of the all-round activity group, (-0.32mmol/L, 95% CI: -0.63, -0.01 and -0.15mmol/L, 95% CI -0.25, -0.05, respectively) were significantly reduced as compared to controls. Regression analysis showed that the intervention-control difference in change of all lipids was independent of changes in weight, body fat and previous engagement in sport activity. CONCLUSION: Regular physical exercise in an elderly population resulted in favourable changes in serum lipid concentrations that were not significant, but no change in body weight or fatness. Change in lipid concentration could not be attributed to change in weight or body fat.

Aged↗
PubMed2004

Characteristics of long-term-care facility residents associated with receipt of influenza and pneumococcal vaccinations.

BACKGROUND: Studies have found residency in long-term-care facilities (LTCFs) a risk factor for influenza and pneumonia and have demonstrated that vaccinations against these diseases reduce the risk of disease. However, rates are below Healthy People 2010 goals of 90% for LTCFs. During 1999-2002, a multi-state demonstration project was conducted in LTCFs to implement standing orders programs for immunizations. OBJECTIVE: Identify nursing home resident-specific characteristics associated with vaccination coverage at baseline. METHODS: Facility-level data were collected from self-reported surveys of selected nursing homes in 14 states and from the On-line Survey and Certification Reporting System. Resident-level data, including demographics and physical functioning, were obtained from the Centers for Medicare & Medicaid Services' Minimum Data Set; 2000-2001 vaccination status was obtained by chart review. Influenza vaccination status reflected a single season, whereas pneumococcal vaccination status reflected vaccination in the past. Multilevel analysis was used to control for facility-level variation. RESULTS: Of 22,188 residents sampled in 249 LTCFs, complete data were obtained for 20,516 (92%). The average coverage for immunizations was 58.5% +/- 0.7% for influenza and 34.6% +/- 0.3% for pneumococcal. On bivariate analyses, residents with cognitive, psychiatric, or neurologic problems were more likely to be vaccinated; those with accidental injuries, unstable conditions, or cancer were less likely to receive either vaccine. On multilevel analysis, the strongest resident characteristics associated with receipt of immunizations, controlling facility variation, were cognitive deficits and psychiatric illness. CONCLUSION: The variation in baseline vaccination coverage associated with LTCF resident characteristics supports the need for strategies to increase vaccination coverage in LTCFs.

Aged↗
PubMed1992

Testing for limits of cognitive reserve capacity: a promising strategy for early diagnosis of dementia?

Examination of the range and limits of cognitive reserve capacity (plasticity) by means of cognitive training is proffered as a promising diagnostic strategy for the early (premorbid) identification of dementia, particularly Alzheimer's disease, in nonclinical populations. First data are presented from a sample of elderly independent-living people classified as healthy or at risk (beginning dementia) on the basis of a standardized psychiatric interview. Randomly assigned groups participated in a cognitive training program based on figural relations, a component of fluid intelligence. Stepwise regression analyses demonstrated that only healthy elderly profited from training and that only post-training scores predicted the psychiatric "at risk" diagnosis. The results hold promise for further development of testing-the-limits of individual differences in cognitive reserve capacity to identify premorbid states of dementia in nonclinical samples.

Aged↗
PubMed1997

Health care delivery in faith communities: the parish nurse model.

Religious institutions and nurses have a common bond--both are committed to empowering individuals to achieve their full potential and believe in the self-care capacity of individuals. The purpose of this study was to examine parish nursing as an evolving model of care within faith communities. Annualization of monthly reports and parish nurse interviews revealed that parish nurse activities contributed to the empowerment process and to the attainment of Healthy People 2000 objectives.

Community Health Nursing↗
PubMedDate not supplied

Health care, not sick care.

Senator Tom Harkin announces his introduction of the HeLP (Healthy Lifestyles and Prevention) Act. This comprehensive legislation provides incentives to stimulate health promotion in workplace, school, and community settings, with specific programs for disabled people, food marketing, Medicare reimbursement for preventive services, and research on obesity, and creation of a National Health Promotion Trust Fund to pay for programs by penalties on tobacco companies that fail to cut smoking rates among children, ending federal subsidies for tobacco advertising, and closing other tax loopholes.

Centers for Disease Control and Prevention, U.S.↗
PubMed2005

Delivering pneumococcal vaccine to a high risk population: the Navajo experience.

High rates of preventable diseases such as pneumococcal disease occur among the Navajo despite their universal health insurance through the Indian Health Service. The objective of this study was to determine the proportion of Navajo adults vaccinated with pneumococcal polysaccharide vaccine and to examine key features of vaccination programs of the Navajo Indian Health Service. For this cross-sectional study, medical charts of Navajo patients with vaccine indications were randomly selected and reviewed to determine who had been vaccinated as of January 1, 1999. Among 480 Navajo>or=65 years old, 73% were vaccinated (95% confidence interval [CI]: 69%-77%). Among 111 Navajo 18-64 years old with vaccine indications, 54% were vaccinated (95% CI: 45% -63%). Vaccination programs utilized extensive public health nursing, home visits, standing orders, and "express lane" clinics. In spite of excellent delivery systems and universal healthcare, the proportion of Navajo persons vaccinated was still below the goals for Healthy People 2010 of having 90% of persons>or=65 years old vaccinated and 60% of high-risk persons 18-64 years old vaccinated.

Adolescent↗
PubMed1993

Youth health report card: asthma.

Asthma is a serious, chronic illness among U.S. children. Approximately 6% of all children under 18 years of age in the United States suffer from asthma--prevalence rates in our inner cities are even higher. The impact this disease has on children, their families, and society is profound and easily translatable into loss of time at work and school, a concomitant loss of productivity, and added stress to an already overburdened health care system. Recognizing the significance of asthma as a serious public health problem, Healthy People 2000 has targeted improvements in asthma care as one of its objectives and the National Heart, Lung, and Blood Institute has research and education programs to improve the health of our children with asthma.

Adolescent↗
PubMed2001

Disparities in cholesterol screening: falling short of a national health objective.

BACKGROUND: The objective of this study was to determine whether the Year 2000 national health objective for cholesterol screening was attained and to identify disparities in cholesterol screening across racial or ethnic and socioeconomic groups. METHODS: Using data from 149,692 persons interviewed by the 1999 Behavioral Risk Factor Surveillance System, we estimated the proportion of adults age > or =20 years who were screened for high blood cholesterol within the preceding 5 years. RESULTS: Overall, an estimated 70.8% of the U.S. population was screened for cholesterol, falling short of the Year 2000 objective of 75%. Screening prevalence was lowest at ages 20-44 years (58.2%), in contrast to ages 45-64 years (81.9%) and > or =65 years (87.1%). Screening prevalence was also low among Asian or Pacific Islanders (62.7%) and Hispanics (60.7%), particularly Hispanic men (55.3%). After multivariate adjustment, Asian Pacific Islanders were significantly less likely to be screened compared with white non-Hispanics (OR = 0.76, 95% CI 0.65, 0.89). The likelihood of screening decreased with decreasing income level (P < 0.05) and persons with health insurance were 1.6 times more likely to have been screened during the past 5 years than adults with no insurance (P < 0.05). CONCLUSIONS: Significant disparities in cholesterol screening exist across age, gender, racial or ethnic, and socioeconomic groups in the United States. As we look to attain the objectives of Healthy People 2010, state and local health officials and policy makers should be aware of these disparities in order to design and target effective cholesterol screening programs and cardiovascular disease prevention programs to those most in need.

Adult↗
PubMed2004

School-based opportunities for physical activity in West Virginia public schools.

BACKGROUND: Schools have the unique potential to provide numerous opportunities for promoting physical activity. This article describes findings from a statewide survey of opportunities for physical activity in West Virginia (WV) schools. The purpose was to provide baseline data for two of the WV Healthy People 2010 objectives related to schools and youth to identify priorities for action. METHOD: Survey questions were adapted from the 2000 School Health Policies and Programs Study (SHPPS), conducted by CDC. Random stratified sampling across school level and size resulted in a final sample of 296 elementary schools, 146 middle and junior high schools, and 124 high schools (total = 566). The overall response rate was 73%. RESULTS: Eleven percent of elementary, 2% of middle or junior high, and 31% of senior high schools met the SHPP's criterion of providing daily physical education. Ninety-four percent of elementary schools reported offering daily recess. Overall, 42.3% of schools provided student and community access to indoor facilities outside of normal school hours, while 80.7% of schools provided access to outdoor facilities beyond normal school hours. CONCLUSIONS: Survey results are being used to target increased physical education in elementary schools and increased opportunities beyond physical education at all school levels.

Adolescent↗