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PubMed2001

[A system of health education using dietary assessment].

We decided to focus attention on healthy young people, and to conduct a survey of their diet, as well as their physical activity and health condition, so that we made diagnoses and also give instructions on each subject using a computer program to promote their health. We carried out this experiment using this method with 836 young female subjects in order to find out whether it can be applied as a useful health education approach. 1. According to the survey, when the subjects made efforts in making the instructions as convenient as possible, the percentage of subjects who could carry out advice even 4 months later was seen to be higher. 2. The advice for which a significantly high percentage of subjects said "want to improve their daily action" and could actually carry out and improve them, was as follows: they should eat vegetables, have a substantial breakfast, drink milk every day, refrain from too much salt, not go without meals, increase the frequency of eating seaweed, and refrain from snacks. 3. The two kinds of scores used to evaluate diets showed that assessment after nine months gave lower values than those obtained when this survey started. Using these two evaluating scores, changes in diets were divided into five patterns, and their relation to the question "whether they used the advice or not" was examined. As a result, the percentage showing favorable diet changes in subjects who "took advice" was showed to be significantly high. 4. Subjects who received advice on physical activity exhibited improvement in carrying out routine exercises as well as making their daily life more active. 5. With subjects who took advice on both diet and physical activity, the number who complained about fatigue was significantly reduced. Although it is difficult to improve diet and exercise habits, the results of the survey suggest that our approach should be useful for improving health.

Adult↗
PubMed2003

Improving the cardio-respiratory fitness in older people and cardiac patients: findings from an Italian participatory research.

OBJECTIVE: We performed a before-after study--in the setting of a participatory research--aimed at improving the cardio-respiratory fitness in older people and cardiac patients by means of tailored advices on diet and exercise administered by trained personnel. METHODS: A volunteer sample of 336 patients underwent a 2-km walk test before and after a comprehensive assessment of health status and after the administration of tailored advices on healthy diet and a personalized exercise program at home by trained personnel. The main outcome measures were before-after changes in the cardiorespiratory fitness index and in the oxygen consumption at a "fast 2-km walking test". RESULTS: The participants had a mean age of 60.9 +/- 6.5 years (range 50-78 years), 62.5% were males. At the end of the study period (3 months), we found a significant improvement of all the exercise test parameters. CONCLUSIONS: A simple diet and exercise individualized 3 months program--administered by trained personnel--was effective at improving the cardio-respiratory fitness in older people and cardiac patients.

Age Factors↗
PubMed1992

HIV education for gay, lesbian, and bisexual youth: personal risk, personal power, and the community of conscience.

Adolescent gay and bisexual males face a higher risk of infection with HIV than most other young people because of their behaviors and because HIV prevention programs have failed to address their unique concerns. Ironically, current efforts to heighten public awareness about the AIDS pandemic may be nullifying the potential for gay, lesbian, and bisexual young persons at high risk to form the support networks needed to modify their behavior. The personal and group empowerment of gay, lesbian, and bisexual young people is a necessary prerequisite to their ability to make healthy behavioral choices around HIV and other health issues. This paper proposes a comprehensive health education model for HIV prevention for gay, lesbian, and bisexual adolescents. Current health education efforts would be augmented by broader self and group empowerment training that would develop self-esteem, social skills, support networks, and access to risk reduction materials. An integrated system of care involving school-based programs, multi-service youth agencies, and self-help groups would be in a position to deliver appropriate educational, mental health, medical, and social support services. Such a system of care presents gay, lesbian, and bisexual youth with their best chance to reduce their risk of infection with HIV and develop into emotionally healthy individuals.

Adolescent↗
PubMed1998

Food Cent$--implementing and evaluating a nutrition education project focusing on value for money.

The Food Cent$ Project aimed to show low income earners a new way to allocate their food budget to obtain value for money and balance their diet. It also created an infrastructure for program delivery. Strategies included a recommended spending model, resources that addressed barriers to healthy eating, together with group activities to enhance knowledge and skills. Community volunteers, known as Food Cent$ Advisers, were trained to deliver the project by conducting budget and cooking sessions for people in their social networks. In 1992, the Food Cent$ Project was piloted in the Great Southern Health Region of Western Australia. It successfully reached its target group of low income earners who were identified as those holding Health Care Cards. Health Care Cards were held by 37% of the 150 trained advisers and 52% of the 373 people who attended the budget and cooking sessions. Evaluation results demonstrated positive changes in self-reported dietary, cooking and shopping behaviours.

Australia↗
PubMed2001

Introducing a pneumococcal vaccine to an existing influenza immunization program: vaccination rates and predictors of noncompliance.

PURPOSE: Influenza vaccination has been recommended for all elderly people in The Netherlands since 1996, with greater than 80% compliance. It is unknown, however, if the addition of another vaccine to this immunization program will affect compliance. SUBJECTS AND METHODS: General practitioners offered a pneumococcal vaccine together with the yearly influenza vaccination to 3365 patients aged 65 years and older. A questionnaire was then mailed to a stratified sample (n = 972) of these patients. Factors associated with noncompliance with vaccination were assessed using polytomous logistic regression. RESULTS: A total of 2529 patients (75%) received the pneumococcal vaccine and 2812 (84%) received the influenza vaccine. Predictors of noncompliance with the pneumococcal vaccine were perceived lack of recommendation by the general practitioner (odds ratio [OR] = 4.6; 95% confidence interval [CI], 2.6 to 8.3) and fear of local side effects (OR = 2.8; 95% CI, 1.6 to 4.6). Predictors of noncompliance with both vaccinations also included unwillingness to comply with the doctor's advice (OR = 6.1; 95% CI, 2.4 to 15.4), the belief that vaccinations weaken one's natural defenses (OR = 2.7; 95% CI, 1.4 to 5.3) or that influenza is not dangerous (OR = 2.9; 95% CI, 1.5 to 5.4), and the fear of becoming sick from pneumococcal vaccination (OR = 2.9; 95% CI, 1.1 to 7.9). People who felt healthy, found it difficult to visit the doctor's office, had private medical insurance, or were younger than 75 years of age also had a greater risk of not being vaccinated. CONCLUSION: Introducing a pneumococcal vaccine to an existing influenza immunization program resulted in high pneumococcal and influenza vaccination rates. A wider diversity of patient characteristics and attitudes was present when neither vaccination was received.

Aged↗
PubMedDate not supplied

Zinc deficiency in elderly patients.

Zinc is needed for growth and development, DNA synthesis, neurosensory functions, and cell-mediated immunity. Although zinc intake is reduced in elderly people, its deficiency and effects on cell-mediated immunity of the elderly have not been established. Subjects enrolled in "A Model Health Promotion and Intervention Program for Urban Middle Aged and Elderly Americans" were assessed for nutrition and zinc status. One hundred eighty healthy subjects were randomly selected for the study. Their mean dietary zinc intake was 9.06 mg/day, whereas the recommended dietary allowance is 15 mg/day. Plasma zinc was normal, but zinc in granulocytes and lymphocytes were decreased compared with younger control subjects. Of 118 elderly subjects in whom zinc levels in both granulocytes and lymphocytes were available, 36 had deficient levels. Plasma copper was increased, and interleukin 1 (IL-1) production was significantly decreased. Reduced response to the skin-test antigen panel and decreased taste acuity were observed. Thirteen elderly zinc-deficient subjects were supplemented with zinc, and various variables were assessed before and after zinc supplementation. Zinc supplementation corrected zinc deficiency and normalized plasma copper levels. Serum thymulin activity, IL-1 production, and lymphocyte ecto-5'-nucleotidase increased significantly after supplementation. Improvement in response to skin-test antigens and taste acuity was observed after zinc supplementation. A mild zinc deficiency appears to be a significant clinical problem in free-living elderly people.

5'-Nucleotidase↗
PubMed1994

The relationship between needs assessments and state strategies for meeting healthy people 2000 objectives: lessons from the Maternal and Child Health Services Block Grant.

Recognizing the critical role of needs assessments in the development of public health policy, the Omnibus Budget Reconciliation Act of 1989 required states to include needs assessments in their Maternal and Child Health Services Block Grant applications and to demonstrate a link between needs and programs. We examined this link by analyzing the relationship between strategies to meet health objectives and needs assessments in the applications for fiscal year 1992 for the eight states in the southeast (DHHS Region 4). Overall, the proportion of strategies based on reported needs was 88%. Numerous other needs, however, were not related to any strategies. Furthermore, there were neither needs nor strategies described for many objectives. These data required extensive analysis of the applications. A uniform structured report would facilitate the explicit collection of this information and thus the usefulness of this important document for policy development and accountability.

Child↗
PubMedDate not supplied

Pharmacist involvement in Healthy People 2010.

OBJECTIVES: To review opportunities through which pharmacists can help the United States achieve its public health goals as expressed in Healthy People 2010, a document issued by the federal government that expresses the areas of focus for Americans in the first decade of the 21st century. SUMMARY: Healthy People 2010 provides general goals for 10 leading health indicators (such as tobacco use, over-weight and obesity, and immunizations), and these are then further subdivided into 28 focus areas, many of them with quantifiable goals (such as, "Reduce hospitalization rates for three ambulatory care-sensitive conditions--pediatric asthma, uncontrolled diabetes, and immunization-preventable pneumonia and influenza."). As health care professionals, pharmacists have the responsibility to help the country meet these goals. Ideas for increased pharmacist involvement are described in the article, including the conduct of screening programs and provision of specialized services that focus on such areas as hypertension, diabetes, asthma, patient education, smoking cessation, or general medication management. Pharmacists can build their efforts in these and similar areas by collaborating with physicians and other appropriate professionals, identifying target patients who have obtained services at the pharmacy, contacting patients in at-risk populations within the pharmacy's patient base and/or the community, choosing and monitoring an objective of interest, and maintaining efforts for sustained time periods. CONCLUSION: The message of Healthy People 2010 is that the health of the individual is closely linked to the health of the community and hence the health of the nation. Pharmacists, uniquely positioned as the most accessible health care providers in the community, can dedicate their considerable strengths toward using Healthy People 2010 as a tool to organize their own efforts and motivate their patients.

Adult↗
PubMed1995

Community-oriented primary care programs.

BACKGROUND: Systems are being proposed by health planners in an effort to improve access to health care for the uninsured and underinsured, including the vulnerable and indigent populations. The lack of affordable and adequate health care for significant numbers of our citizens raises the potential for a serious economic crisis for our nation. Modern medicine has been more interested in developing high tech care for the well insured than in preventive and early intervention health care. While the development of this high technology is of great value and will be beneficial to many, it is out of financial reach for increasing numbers of individuals. As a nation we must reduce the demand for high priced medical care by providing a system that keeps people healthy or intervenes in their illness at a stage when less dramatic medical measures are able to restore them to health. To maintain a population that is healthy and productive in the school setting and in the work place, systems must be developed that reach out into the community with prevention-oriented health education programs and health care services at the primary care level. METHODS: A limited literature review was made in order to present to the optometric community the concept of Community Oriented Primary Care (COPC) as a cost-effective method of improving access to primary care services. RESULTS: The literature review demonstrated that Community Oriented Primary Care (COPC) as a health-oriented strategy brings the benefits of primary care closer to those in need. The history of the development of community oriented primary care services as a health delivery methodology, as well as the current utilization of the COPC concept, is presented in this paper. CONCLUSIONS: Optometry, as a provider of primary eye and vision care services should be included in these cost effective programs.

Community Health Services↗
PubMed1999

Ventilatory responses to exercise in patients with asymptomatic left ventricular dysfunction.

PURPOSE: Based on reports that patients with severe left ventricular (LV) dysfunction have a greater ventilatory response to effort than healthy people, we evaluated the ventilatory responses to effort of patients with coronary artery disease and various degrees of LV impairment before and after 6 months of exercise training in a community-based cardiac rehabilitation program. METHODS: Out of 171 patients consecutively referred for cardiac rehabilitation, 102 were enrolled in the study. Fifteen patients were excluded because of lung disease and 54 because of poor adherence to the exercise program. Patients were divided into three groups according to their ejection fraction (EF): Group 1 (G1) included 63 patients with EF > or = 50%, Group 2 (G2) included 21 patients with EF > or = 35 and < 50% and group 3 (G3) included 18 patients with EF < 35%. Peak oxygen uptake, minute ventilation (V(E)), and minute carbon dioxide production (VCO2) were measured before and after training in all participants. RESULTS: All groups showed a significant increase in peak oxygen uptake and treadmill time after training (G1: P = 0.0001 and P = 0.0001; G2: P = 0.0001 and P = 0.001; G3: P = 0.01 and P = 0.01; respectively). Patients in G3 had a significantly higher V(E)/VCO2 ratio than patients in G2 and G1 at 9 min and peak exercise, before (9 min: P = 0.046 and P = 0.025, peak: P = 0.024 and P = 0.002, respectively) and after training (9 min: P = 0.011 and P = 0.005, peak: P = 0.001 and P = 0.0001, respectively). The slope of the relation V(E) to VCO2 was significantly higher in G3 patients than in those in G2 and G1 (P = 0.0001, respectively) and was not reduced by exercise training in any group. CONCLUSIONS: Patients with severe LV dysfunction had a greater ventilatory response to exercise than those with moderately impaired or normal LV function. Exercise training increased the effort tolerance of all patients irrespective of their degree of LV dysfunction but failed to reduce the higher ventilatory responses to effort of patients with EF below 35%.

Adult↗
PubMed1999

Lifestyle modifications to prevent and control hypertension. 2. Recommendations on obesity and weight loss. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada.

OBJECTIVE: To provide updated, evidence-based recommendations concerning the effects of weight loss and maintenance of healthy weight on the prevention and control of hypertension in otherwise healthy adults (except pregnant women). OPTIONS: The main options are to attain and maintain a healthy body weight (body mass index [BMI] 20-25 kg/m2) or not to do so. For those at risk for hypertension, weight loss and maintenance of healthy weight may prevent the condition. For those who have hypertension, weight loss and maintenance of healthy weight may reduce or obviate the need for antihypertensive medications. OUTCOMES: The health outcome considered was change in blood pressure. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A MEDLINE search was conducted for the years 1992-1996 with the terms hypertension and obesity in combination and antihypertensive therapy and obesity in combination. Other relevant evidence was obtained from the reference lists of the articles identified, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design and graded according to level of evidence. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS, HARMS AND COSTS: Weight loss and the maintenance of healthy body weight reduces the blood pressure of both hypertensive and normotensive people. The indirect benefits of a health body weight are well known. The negative effects of weight loss are primarily the frustrations associated with attaining and maintaining a healthy weight. The costs associated with weight loss programs were not measured in the studies reviewed. RECOMMENDATIONS: (1) It is recommended that health care professionals determine weight (in kilograms), height (in metres) and BMI for all adults. (2) To reduce blood pressure in the population at large, it is recommended that Canadians attain and maintain a healthy BMI (20-25). (3) All overweight hypertensive patients (BMI greater than 25) should be advised to reduce their weight. VALIDATION: These recommendations are similar to those of the World Hypertension League, the National High Blood Pressure Education Program Working Group on Primary Prevention of Hypertension, the Canadian Hypertension Society and the Canadian Coalition for High Blood Pressure Prevention and Control. They have not been clinically tested. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada.

Adult↗
PubMed2003

Organized dentistry as an agent for helping others: the leadership of Donna J. Rumberger.

Dr Donna Rumberger graduated from New York University College of Dentistry in 1980 and has practiced dentistry in Manhattan ever since. Even before her graduation, she was active in organized dentistry, always viewing it as a conduit for helping other people. Working with the American Association of Women Dentists, she was cofounder of the Smiles for Success Foundation, a program started in New York City that helps women advance from welfare into the workforce with restored, healthy smiles. That program now has expanded to 14 other cities. Working with organized dentistry in New York City, she has been instrumental in initiating and running the Skate Safe program, which provides mouthguards and oral home care education for inner city children in Harlem. In addition, she has worked with the dentistry merit badge program for the Boy Scouts of America Jamborees, helped coalesce women's dental organizations in New York City, and led her dental society to collaborate with Columbia University in a program to improve access to dental care. As further evidence of her ability to get things done, she also has served as president of the American Association of Women Dentists, the Midtown Dental Society, and the New York County Dental Society--one of the largest dental societies in the country.

Dentists, Women↗
PubMed2006

Trends in occupational and adult lead exposure in Wisconsin 1988 - 2005.

Seventeen years of adult blood lead surveillance data (37,694 individuals and 71,622 total tests) reveal a Wisconsin success story. While lead continues to be widely used, most Wisconsin industries have made substantial strides toward reducing occupational lead exposure. The improvement is reflected in the reduced number of blood lead levels >40 microg/dL. In 2005 only a single adult blood lead test was >50 pg/dL, and since 2003 none have been reported above 60 microg/dL. However, as long as lead is used industrially, lead-based products remain in use, and new consumer products containing lead are marketed to the public, lead poisoning will remain a threat, not only to workers handling lead, but also to children exposed to lead-containing products already in existence. Wisconsin industry and workers, as well as the medical and public health community, must remain vigilant about new and reemerging lead exposures. Wisconsin's Adult Blood Lead Epidemiology and Surveillance program will continue to investigate unusual lead exposure circumstances identified through statutorily mandated physician and laboratory reporting of adult blood lead levels. However, Wisconsin will need further advances if it is to achieve the US Healthy People 2010 objective of no adult blood lead level >25 microg/dL.

Adult↗
PubMed1998

Effect of physical training on QTc interval in elderly people.

In order to assess whether heart rate-adjusted QT duration (QTc) is reduced by physical activity in an elderly population, a randomized, controlled intervention study of the effect of a 6-month intensive training program on QTc was undertaken. The participants were 229 healthy men and women, aged 60-80 years. The subjects of the intervention group trained three to four times a week at a work load of about 70% of their maximum capacity for 6 months, while the control subjects maintained their habitual activities. The main outcome measures were change in QTc and resting heart rate. For women, the mean QTc interval (ms) of the intervention group changed by -6.7 (SE 2.8) versus 0.6 (SE 2.4) in the control group (P = .05), while for men, the change in the intervention group subjects was -2.7 (SE 2.2) versus 0.4 (SE 3.1) in the control subjects (P = .39). Also, resting heart rate (beats/ min) changed in intervention group women by -4.6 (SE 1.7) as against -0.06 (SE 1.1) in the control subjects (P = .02), and in intervention group men it changed by -3.2 (SE 1.2) versus -0.9 (SE 1.5) in the control subjects (P = .25). These data indicate that regular physical activity favorably affects QTc in elderly women. A similar, but not significant, trend was observed in men. The beneficial shift in QTc may be caused by a more favorable autonomic balance through increased parasympathetic activity. The reduced resting heart rate in subjects of the intervention group supports this view. Although the reduction was relatively small, it may represent a favorable effect on cardiovascular risk.

Aged↗
PubMed2000

Healthy People 2000: an assessment based on the Health Status Indicators for the United States and each state.

The Health Status Indicators (HSIs) were developed as part of the Healthy People 2000 process to facilitate the comparison of health status measures at national, State and local levels. In this report, the number of HSIs where the national target has been attained and the number of HSIs that have improved significantly are enumerated for the United States, the District of Columbia, and each State. Based on data for 1998, the United States had attained targets for 6 of the 17 HSIs with national targets. Twenty-three States had attained targets for 9 or more of the HSIs and 37 States had either attained the target for, or had made significant progress on, at least 12 of the indicators. Substantial progress has therefore been made since the Healthy People 2000 National Health Promotion and Disease Prevention Objectives were published in 1991.

Forecasting↗
PubMed2005

CASASTART: a community-based, school-centered intervention for high-risk youth.

During the past decade, increasing numbers of drug- and alcohol-related delinquency cases have entered the juvenile justice system. The majority of these young people face multiple challenges and risks, yet have few resources to mitigate these risks. This article suggests that the skills, competencies and supports, and protective factors needed to help young people grow into healthy adulthood are not readily available to high-risk youth. We offer lessons from the development, implementation, and institutionalization of one promising model of an evidence-based, community-, and school-centered program for high-risk youth (CASASTART). The experience with this program thus far suggests that program models that encompass a youth development, strength-based, and community-focused approach can intervene successfully with many high-risk youth and their families, reduce use of drugs and alcohol, reduce violent crime, and achieve funding and programmatic stability.

Adolescent↗
PubMed1977

For a healthy tomorrow.

When health education becomes mired in the past, our cause is lost. Education must be dynamic to respond to constantly changing needs. All changes in our approach to educating young people about cancer have been carefully planned. Changes in the American Caner Society's program have enabled us to reach more young people than ever before, and these young people are more involved in learning about cancer and meople, they have a fear-free attitude about the disease that we are encouraging them to maintain throughout their lives. The more young people know about cancer and their own role in preventing or treating the disease, the less chance there is that cancer will pose a serious threat to their health as adults.

Adolescent↗
PubMed2006

[Screening induced by health services: impact and consequences. Ethical issues].

The main aim of screening is to identify people with an increased probability to benefit from preventive interventions, generally from secondary prevention but also from primary prevention activities. The goal is to facilitate early diagnosis and treatment in order to modify positively the prognosis (the former case), or to recognize people exposed to risk factors which increase the incidence rate of disease, and then to prevent the disease (the latter case). Good intentions are not enough to achieve good results in terms of effectiveness, safety, efficiency or equity. It is necessary to have a systematic assessment of the consequences of screening, particularly on the impact on peoples health and on the health services. Due to the diversity of types of screenings that are done, it is very difficult to estimate the net impact caused by their implementation. Moreover, the changes in the health of a population depend on many factors other than health service interventions. Thus, it is very important to determine the effectiveness and safety of the screening methods that are most frequently applied. Unfortunately, assessment of the benefits and the harm potentially caused by preventive interventions has not been done often. In Spain only a few partial assessments have been published, and they focus on the activities and the processes themselves rather than the final outcomes. Given that screening activities are carried out in health care services, and that the populations screened are mostly healthy people, the ethical issues have great importance when health policies are designed and implemented. Thus, it is recommended that screenings activities be analyzed applying the ethical principles of autonomy, benefit, safety and justice. If any screening program cannot reasonably satisfy these principles then they should be removed from the list of public health activities that are financed by public resources. In the same sense, all screening procedures offered to the population must be subjected to a systematic evaluation of their effectiveness, safety, efficiency and equity in terms of how the procedure would be applied. Lastly, to achieve an effective implementation of the principle of autonomy as well the desired goal of empowering the population to exercise some control over their determinants of health, it is recommended to explore new ways of achieving active citizen participation to establish preventive priorities and to assess the impact of screening interventions.

Early Diagnosis↗