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PubMed2001

Nutrition, physical activity, and quality of life in older adults: summary.

If health-related quality of life--and not longevity--is the key goal for health promotion, then it is captured only partly by the existing mortality and morbidity indexes. Researchers now urge that government agencies and health care providers begin collecting quality-of-life data on the populations they serve. Adding life to years, not years to life, is the current agenda for productive and successful aging. Policies and programs on aging are increasingly focused on identifying ways to improve quality of life and health status rather than just extending life span. In the Healthy People 2000 report, the chief goal of health promotion was to increase the span of healthy life. The focus was on mortality and morbidity data and symptom checklists as the principal measures of ill health. In contrast, the new emphasis in the Healthy People 2010 report is on quality of life and overall well-being. Helping people to increase life expectancy and improve their quality of life is the primary goal of the Healthy People 2010 report. The authors of this special issue of the Journals of Gerontology: Biological Sciences and Medical Sciences are united in the belief that optimal nutrition and physical activity make a significant contribution to the overall quality of life at any age and especially for older adults. The key research challenge lies in deciding which aspects of improved fitness, nutrition, and diet contribute the most to quality-of-life measures. We have attempted to provide a comprehensive review of research on exercise, nutrition, diet, and health in elderly adults. Past studies on diet, nutrition, and fitness have largely addressed biomedical outcomes, pointing to substantial benefits in physical functioning, remission of disease symptoms, and improved health. This special issue goes a step further in assessing the effect of improved nutrition and physical activity on the global quality of life and its four principal domains. Although links between diet and exercise and chronic disease risks have been well documented, more needs to be known about motivations for behavioral change and perceived benefits as assessed using quality-of-life measures. No single segment of our society can benefit more from regularly performed exercise and improved diet than elderly adults. These important articles provide a link between diet and exercise and quality-of-life issues, as outlined in the Healthy People 2010 report.

Aged↗
PubMed1996

Effects of ageism on individual and health care providers' responses to healthy aging.

Although misconceptions about the aging process have lessened over recent years, ageism is still having a detrimental effect on healthy aging. This article reviews the literature to support this contention and to demonstrate how stereotyping can affect the shape and nature of programs for elderly people. It is argued that for long-lasting change to occur, service providers need to directly target these negative attitudes in themselves, their professional institutions, their clients, and their communities. Suggestions are made for professional development, research, and program planning.

Aged↗
PubMed2006

Environmental barriers to health care among persons with disabilities--Los Angeles County, California, 2002-2003.

In 2002, an estimated 51.2 million persons in the United States (approximately 18.1% of the population) had a disability. Recent data suggest that substantial disparities in health behaviors and overall health status exist between persons with and without disabilities. Nonetheless, when they have access to adequate health care, persons with disabilities can lead healthy lives. The World Health Organization's International Classification of Functioning, Disability, and Health stresses the importance of environment (e.g., physical environment, attitudes of others, or policies) as either a barrier or facilitator in the daily activities of persons with disabilities. In addition, increasing access to health and wellness treatment programs for persons with disabilities and reducing the proportion of persons with disabilities who report environmental barriers to participation in daily activities are goals of Healthy People 2010 (objectives 6-10 and 6-12). However, few population-based studies have explored how environment affects the lives of those with disabilities. To determine the prevalence of disability among persons in Los Angeles County, California, and assess the effects of environmental barriers on these persons, residents were surveyed during 2002-2003. The results of that survey suggested that persons with physical or sensory disabilities experienced several environmental barriers and that the prevalence of barriers varied by demographic characteristics, household income, and severity of disability. To improve quality of life among persons with disabilities, public and private health agencies should implement measures to remove environmental barriers to health care and other services.

Adolescent↗
PubMed1995

Cancer screening behaviors and attitudes of women in southeastern Minnesota.

OBJECTIVES: To determine the rates at which women received screening Papanicolaou tests, clinical breast examinations, and mammography and to determine the extent to which these women might be expected to respond to screening recommendations from their physicians. DESIGN: Random-digit-dial telephone interviews conducted in January 1993. SETTING: Fifteen counties in southeastern Minnesota. SUBJECTS: A sample of 1019 women who completed the telephone interview. MAIN OUTCOME MEASURES: Self-reported Papanicolaou test, clinical breast examination, and mammography screening rates, with verification from medical records for a randomly selected subsample of 200 respondents who reported having had a test within 1 year of the interview. RESULTS: For women aged 18 years and older, 60% (95% confidence interval, +/- 3.4%) reported having had a Papanicolaou test within the preceding year. For women 40 years of age and older, 57% (95% confidence interval, +/- 3.5%) reported having had a clinical breast examination in the past year, and 46% (95% confidence interval, +/- 3.6%) reported having had a screening mammogram within 1 year. The verified 1-year Papanicolaou test and mammogram rates were 35% and 33%, respectively. More than 90% of the respondents expressed a willingness to have these tests if their physicians were to advise them that the tests were indicated. However, 53% and 54% of the respondents, respectively, said that they either did not care or did not want their physicians to remind them when they were due for a Papanicolaou test or a mammogram. CONCLUSIONS: Although self-reported screening rates in this population meet Healthy People 2000 goals, verified rates were significantly below target levels. A substantial proportion of women in this population remain ambivalent about participating in cancer detection programs.

Adult↗
PubMed1984

Effects in elderly people 67-76 years of age of three-month endurance training on a bicycle ergometer.

Eight women and 4 men, mean age 71.1 years, examined by a clinical check-up participated in a bicycle ergometer training program (12 weeks with 3 training sessions per week). Symptom limited ergometric bicycle tests were performed before and after the training period. The training work load was continuously controlled by maintaining the training heart rate according to 60% of the maximum work load of the first test. To hold the training heart rate (HR) on a constant level the work load had to be increased systematically during the whole training period up to 180% of the level at the beginning. The working time in each training session was increased from 2 X 10 mm at the beginning up to 2 X 20 min after the sixth week. The maximum work load (+ 16%) and the maximum oxygen uptake (+ 11%) increased significantly. The submaximal HR decreased significantly. In contrast there was no significant difference in maximum HR and maximal change of base excess between the initial exercise test and the control study at the end of the training program. This indicates that the increased exercise capacity represents a real endurance training effect and not only an increase in the degree of exhaustion. We conclude that also in healthy people between 67-76 years a significant endurance effect is possible when the training work load and training time is increased systematically according to the rules of training sciences.

Aged↗
PubMedDate not supplied

Communication for HIV/AIDS prevention in Kenya: social-cultural considerations.

The acquired immune deficiency syndrome (AIDS) epidemic is spreading fast in Africa in spite of the various efforts and resources put in place to prevent it. In Kenya, reproductive health programs have used the mass media and other communication interventions to inform and educate the public about the disease and to promote behavior change and healthy sexual practices. This effort has led to a discrepancy between awareness and behavioral change among people of reproductive age. In this article I examine the discrepancy in Kenya from a communications perspective addressing social cultural and related factors contributing to the lack of change in behavior and sexual practices. I draw on the theoretical framework of Grunig's model of excellence in communication, the importance of understanding and relationship building between programs and their stakeholders. Data were gathered qualitatively using focus groups and in-depth interviews among men and women in rural Kenya. Key findings indicate that although awareness of sexually transmitted diseases (STDs) including human immunodeficiency virus (HIV)/AIDS is high in Kenya, a majority of the population, particularly those in the rural communities, lack understanding of the communicated messages. They also lack the knowledge of other ways of transmitting HIV particularly among those not sexually involved. Cultural beliefs, values, norms, and myths have played a role in the rapidly increasing epidemic in the rural communities and yet HIV/AIDS communication programs have not addressed these factors adequately. I conclude that successful behavior change communication must include strategies that focus on increasing understanding of the communicated messages and understanding of the audience through application of appropriate methodologies. Building a relationship with the audience or stakeholders through dialogues and two-way symmetrical communication contributes toward this understanding and the maintenance of the newly adopted behaviors and practices.

Adolescent↗
PubMed2005

Exercise and improved insulin sensitivity in older women: evidence of the enduring benefits of higher intensity training.

Few studies have compared the relative benefits of moderate- vs. higher intensity exercise training on improving insulin sensitivity in older people while holding exercise volume constant. Healthy older (73 +/- 10 yr) women (N = 25) who were inactive, but not obese, were randomized into one of three training programs (9-mo duration): 1) high-intensity [80% peak aerobic capacity (V(O2)peak); T(H)] aerobic training; 2) moderate-intensity (65% V(O2)peak; T(M)) aerobic training; or 3) low-intensity (stretching) placebo control (50% V(O2)peak); C(TB)). Importantly, exercise volume (300 kcal/session) was held constant for subjects in both the T(H) and the T(M) groups. V(O2)peak was determined by using a graded exercise challenge on a treadmill. Total body fat and lean mass were determined with dual-energy X-ray absorptiometry. The rate of insulin-stimulated glucose utilization as well as the suppression of lipolysis were determined approximately 72 h after the final exercise bout by using a two-step euglycemic-hyperinsulinemic clamp. We observed improved glucose utilization at the higher insulin dose with training, but these improvements were statistically significant only in the T(H) (21%; P = 0.02) compared with the T(M) (16%; P = 0.17) and C(TB) (8%; P = 0.37) groups and were observed without changes in either body composition or V(O2)peak. Likewise in the T(H) group, we detected a significant improvement in insulin-stimulated suppression (%) of adipose tissue lipolysis at the low-insulin dose (38-55%, P < 0.05). Our findings suggest that long-term higher intensity exercise training provides more enduring benefits to insulin action compared with moderate- or low-intensity exercise, likely due to greater transient effects.

Adaptation, Physiological↗
PubMedDate not supplied

Epidemiology of chronic non specific respiratory disease and the smoking-control program in young people.

In an epidemiological study in the Kolin-District, Czechoslovakia, the percentage of cigarette-smokers was 57% of the male inhabitants aged 15 years and over, and 14% of the females of the same age group. The greatest proportion of cigarette smokers was in the age-group 25-34 years. The prevalence of chronic bronchitis was 13% of all males aged 15 years and over, and 4% of all females. An association of chronic bronchitis with age and smoking habits was found, in both sexes. In another study in the Prague-District No. 7 the smoking habits of male adolescents were related to their socio-economic status. Conclusions of epidemiological studies are important for the formulation and accomplishment of smoking-control program in young people. Health education should encourage school-children and adolescents by methods corresponding to their age to participate actively in the formation of a healthy style of their life.

Adolescent↗
PubMedDate not supplied

Frequency spectra of normal expiratory nasal sound.

BACKGROUND: The computerized analysis of the nasal sound reflects the nasal airflow. We have developed a new software program that analyzes the nasal sound to use in the research area and clinical applications. We aimed to analyze automatically the spectral parameters of nasal sound in healthy people by our new versatile PC-based nasal sound analyzer software. METHODS: In this study, we analyzed and recorded the expiratory nasal sound in 30 healthy people. This analysis includes the time-expanded waveform, the spectral analysis with time-averaged fast Fourier transform, the automatic detection, and the waveform analysis of nasal sound. RESULTS: We calculated the mean frequency of low-intensity sound (LIS) and high-intensity sound (HIS). The mean frequency of LIS was found as 1254 +/- 10.23 Hz at the right nose and 1375 +/- 18.45 Hz at the left nose. The mean frequency of HIS was found as 2453 +/- 22.23 Hz at the right nose and as 2234 +/- 21.12 Hz at the left nose. These results showed that the values between LIS and HIS are statistically significant (p < 0.005) and different from each other. We found that the nasal sound of the similar nasal airflow was the same type and amplitude in the analysis of the nasal sound recordings. CONCLUSION: The frequency of the nasal sound is an indicator of the intensity of the nasal airflow. The method that provides the analysis of the nasal sound may lead to a new diagnostic method. The method, which is noninvasive, rapid, of low cost, and even applicable for small children, requires little cooperation of the subjects. In addition, it will be possible to record and save the analysis of the nasal airflow as digital data.

Adolescent↗
PubMed1998

Profile of public health nutrition personnel: challenges for population/system-focused roles and state-level monitoring.

OBJECTIVE: Our 3 objectives were to document the current public health nutrition workforce in the United States, identify top public health nutrition priorities for the next 5 years, and assess the capacity of public health nutrition personnel to address these priorities and the nutrition-related objectives of Healthy People 2000. DESIGN: A census survey was distributed to public health nutrition personnel in all state and local health agencies and nonprofit and for-profit agencies funded by official health agencies throughout the United States and US territories. Also, state and territorial nutrition directors were sent a different questionnaire. SUBJECTS: Data were collected from 49 states, the District of Columbia, and 2 territories; 7,550 public health nutrition personnel were represented. STATISTICAL ANALYSIS: Data were analyzed using EpiInfo software. Descriptive statistics are presented. RESULTS: Almost half of the respondents worked in local or county health agencies and about two thirds were involved in direct care services. Only about 40% were registered dietitians and about one fourth had a master's degree. Almost 90% of all full-time equivalent positions were funded through federal dollars; 78% of all funding was from the Special Supplemental Nutrition Program for Women, Infants, and Children. Top health concerns identified were diet/nutrition to prevent chronic disease, low breast-feeding rates, low birth weight, iron deficiency anemia, and obesity/overweight. Public health nutrition personnel will be challenged to assume population/system-focused roles and state-level monitoring of Healthy People 2000 objectives. Only 2 of the 17 nutrition objectives of Healthy People 2000 were monitored by more than 50% of the states. APPLICATIONS: If official health agencies are to shift to public health core functions, as recommended by an Institute of Medicine report, then a substantial proportion of the public health nutrition workforce must not only change how they practice but also obtain the knowledge and skills to do so. Strategies to improve workforce capacity are discussed, including continuing education interventions through professional organizations, distance and on-campus educational opportunities through approved public health nutrition programs, and advocacy for new funding streams focused on public health core functions.

Dietetics↗
PubMed1995

Put prevention into practice: a systematic approach.

Use of a systematic program, such as Put Prevention Into Practice (PPIP), to improve the delivery of clinical preventive services by public health nurses is recommended. The Public Health Service, a part of the U.S. Department of Health and Human Services, designed PPIP to help achieve the goals of Healthy People 2000. PPIP is a research-based team approach using a kit of materials targeted at patients, providers, and the office/clinic system. It includes pocket-sized patient booklets, a Clinician's Handbook of Clinical Preventive Services, posters for the waiting and examination rooms, flowcharts and alert stickers for medical records, prescription pads, and reminder postcards. Sources of the materials, implementation and evaluation strategies, and groups implementing the program are discussed.

Delivery of Health Care↗
PubMed2006

Vitamin G: effects of green space on health, well-being, and social safety.

BACKGROUND: Looking out on and being in the green elements of the landscape around us seem to affect health, well-being and feelings of social safety. This article discusses the design of a research program on the effects of green space in the living environment on health, well-being and social safety. METHODS/DESIGN: The program consists of three projects at three different scales: at a macro scale using data on the Netherlands as a whole, at an intermediate scale looking into the specific effect of green space in the urban environment, and at micro scale investigating the effects of allotment gardens. The projects are observational studies, combining existing data on land use and health interview survey data, and collecting new data through questionnaires and interviews. Multilevel analysis and GIS techniques will be used to analyze the data. DISCUSSION: Previous (experimental) research in environmental psychology has shown that a natural environment has a positive effect on well-being through restoration of stress and attentional fatigue. Descriptive epidemiological research has shown a positive relationship between the amount of green space in the living environment and physical and mental health and longevity. The program has three aims. First, to document the relationship between the amount and type of green space in people's living environment and their health, well-being, and feelings of safety. Second, to investigate the mechanisms behind this relationship. Mechanisms relate to exposure (leading to stress reduction and attention restoration), healthy behavior and social integration, and selection. Third, to translate the results into policy on the crossroads of spatial planning, public health, and safety. Strong points of our program are: we study several interrelated dependent variables, in different ordinary settings (as opposed to experimental or extreme settings), focusing on different target groups, using appropriate multilevel methods.

Attention↗
PubMed2005

Pharmacists' role in increasing pneumococcal and influenza vaccination.

PURPOSE: The role of the pharmacist in increasing pneumococcal and influenza vaccination rates and the clinical efficacy of pneumococcal and influenza vaccines are discussed. SUMMARY: Institutional pharmacists often play key roles on multidisciplinary committees and have the opportunity to make preventive therapies, such as vaccination, a priority. Standing-order programs authorize health care professionals to screen for vaccine eligibility and contraindications, administer vaccines, and monitor for adverse effects when following a physician- or institution-approved protocol. Current vaccination levels for the influenza and pneumococcal vaccines are suboptimal and well below the Healthy People 2010 goal of 90% of high-risk patients. Pharmacists should be familiar with the composition, immunogenicity, dosage, administration, efficacy, adverse reactions, contraindications, precautions, and cost-effectiveness of each vaccine, as well as with Advisory Committee on Immunization Practices recommendations and the supporting literature. CONCLUSION: Health-system pharmacists have the opportunity and responsibility to protect those at highest risk of pneumococcal disease and influenza through the use of standing-order vaccination programs.

Humans↗
PubMed1997

Special Olympics, special smiles: assessing the feasibility of epidemiologic data collection.

No comprehensive national study has ever been completed on the oral health status of people with disabilities, their patterns of use of oral health services and access-to-care barriers. The authors describe the Special Olympics, Special Smiles program, conducted as part of the New Jersey Summer Special Olympics Games, and assess a pilot-tested model for collecting epidemiologic data. The results of this initial data collection are also compared with the goals of the U.S. Public Health Service, as outlined in the Healthy People 2000 publication.

Adult↗
PubMed1991

Tracking of serum lipids and lipoproteins from childhood to adulthood. The Bogalusa Heart Study.

Serum lipids (total cholesterol and triglycerides) and lipoprotein cholesterol fractions (low density lipoprotein (LDL) cholesterol, very low density lipoprotein (VLDL) cholesterol, and high density lipoprotein (HDL) cholesterol) have been measured approximately every 3 years on children and young adults since 1973-1974 in Bogalusa, Louisiana, a community of approximately 22,000 individuals, one-third of whom are black and two-thirds of whom are white. A total of 1,586 children were examined both at baseline (1973-1974) and at the most recent survey (1984-1986), providing 12 years of follow-up. The decreases in levels noted during puberty for total cholesterol and LDL cholesterol, primarily for boys, were followed by a rise until age 26 years. HDL cholesterol levels, particularly for white boys, continued to drop after age 14 years, yielding increasingly high LDL cholesterol/HDL cholesterol ratios. Tracking, as measured by both correlation coefficients and persistence at extreme quartiles, was evident for all of the lipids and lipoproteins. The 12-year correlation coefficients were greatest for LDL cholesterol and no trend in the magnitude of the correlation coefficients with age was noted. Tracking for HDL cholesterol was better after age 9 years, particularly for white males. Approximately 50% of those children who had total cholesterol levels or LDL cholesterol levels above the 75th percentile at baseline remained elevated 12 years later. For HDL cholesterol, a trend with age was noted for white boys: 42% of those aged 9-14 years in the lower most quartile persisted in this rank 12 years later. The best predictor of follow-up lipid or lipoprotein level was baseline level. The next best predictor was increase in weight as defined by weight/height, an index of obesity. That serum lipid and lipoprotein levels continue to track from childhood into young adulthood points to the necessity of measurement early in life and, where indicated, the introduction of preventive and interventional programs aimed at developing healthy lifestyles.

Adolescent↗
PubMed1991

Independent associations of educational attainment and ethnicity with behavioral risk factors for cardiovascular disease.

The authors examined the independent associations of educational attainment and ethnicity with behavioral risk factors for cardiovascular disease using data from the 1989 baseline survey for the New York State Healthy Heart Program. This telephone survey used the Centers for Disease Control Behavioral Risk Factor Survey interview instrument and was conducted in eight communities (total population, approximately 1.24 million people) in New York State. The response rate was 65.5% (n = 4,179); 3,606 subjects aged 20-64 years with self-described ethnicity of white (n = 1,935), black (n = 1,035), or Hispanic (n = 636) and of known educational status were retained in the analysis. After adjustment for age, sex, and ethnicity, significant associations were found between educational attainment and smoking, lack of regular exercise, overweight, diet atherogenicity, and knowledge about blood pressure and cholesterol. After adjustment for age, sex, and educational attainment, associations were found between ethnicity and most of these same variables. Blacks and Hispanics generally had less favorable risk factor profiles. These data indicate that the differences in cardiovascular disease risk profiles between whites and blacks or Hispanics cannot be fully explained by underlying differences in educational attainment. The differing patterns of risk factor distribution by educational attainment within ethnic groups have implications for the segmentation of risk reduction programs.

Adult↗
PubMed1992

A personal recovery program for codependent nurse practitioners.

Codependence is a progressive emotional and behavioral disease that makes life painful. Because of nursing's historical roots and the present role of advance-practice nurses in the health care system, nurse practitioners are at risk for developing this disease. Codependence interferes with nurse practitioner's job performance by causing dysfunctional interactions with supervisors, peers and subordinates. A personal program of recovery is the only way to halt the progress of this syndrome and to re-establish healthy work patterns. The stages of recovery from codependence are identification, awareness, reintegration and genesis. Tools of recovery include involvement in a 12 Step program, connecting with other recovering people, daily affirmations and meditations, and attending programs and workshops on codependence.

Compulsive Behavior↗