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PubMed1992

Volunteers for community health. An Ohio hospital sponsors parish nursing programs for area churches and synagogues.

Since 1989, St. Elizabeth Hospital Medical Center, Youngstown, OH, has been conducting a hospital-based, multidenominational volunteer parish nurse program, which now extends to 11 Roman Catholic, Lutheran, Presbyterian, Methodist, Jewish, and Greek Orthodox congregations. Seventeen volunteer nurses are involved, responding to needs within their congregations by providing a variety of healthcare and educational services while revitalizing the Church's healing ministry. Volunteers selected are competent, experienced registered nurses who can relate to and communicate with people of all ages, accurately assess health-related problems, and make appropriate nursing decisions. Parish nurses focus on preventive care, health maintenance, and personal responsibility for maintaining a healthy life-style. Volunteer nurses determine their own schedule, contributing as much time as they can. Each volunteer nurse is responsible for developing a record-keeping system, documenting his or her parish activities, and submitting a quarterly report of volunteer hours and activities to the hospital. Hospital supports include the initial two-day orientation; monthly meetings at the hospital for information sharing, education, and mutual support; and nursing continuing education programs In addition, an advisory committee provides program support and education. St. Elizabeth Hospital Medical Center is exploring several methods of enhancing its health ministry outreach to congregations in dire need of such services.

Catholicism↗
PubMed2001

Assessing health system provision of adolescent preventive services: the Young Adult Health Care Survey.

BACKGROUND: Adolescents often do not receive recommended preventive counseling and screening services. Few measures are available to assess health care system performance in this area. OBJECTIVE: Develop a reliable, valid, and feasible method for measuring adherence to consensus guidelines for adolescent preventive counseling and screening services. METHODS: The 45-item Young Adult Health Care Survey (YAHCS) was tested with a diverse group of commercially and publicly insured adolescents enrolled in managed care organizations (n = 4,060). Psychometric, bivariate, and multivariate analyses were conducted to assess the reliability, validity, and patterns of variation in the preventive care measurement scales derived from the YAHCS. RESULTS: YAHCS measurement scales demonstrated strong construct validity (mean factor loading = 0.64) and reliability (mean Cronbach's alpha = 0.77). Average preventive counseling and screening scores ranged from 18.2% for discussing risky behavior topics to 50.4% for discussing diet, weight, and exercise topics. Adolescent demographic, health care use, and payer factors explained a small amount of variation across adolescent scores on YACHS scales (mean R2 = 0.086). Females and older teens were more likely to report private time with providers and counseling and screening on topics related to sex. Overall, the odds of receiving preventive counseling and screening for adolescents who reported having private time with providers, engaging in risky behaviors, or both were higher than for adolescents who did not meet privately or report risky behaviors (private visit OR, 3.60; 95% CI, 2.91-4.47; risky behaviors OR, 2.02; 95% CI, 1.62-2.52). CONCLUSIONS: The YAHCS provides a feasible, reliable, and valid method for assessing adherence to adolescent preventive services guidelines. It differentiates among varied aspects of preventive care provided to adolescents and is promising as a potential measure of health plan and provider quality. Improved performance on the YAHCS would indicate progress toward the achievement of Healthy People 2010 goals.

Adolescent↗
PubMed1999

The ability of trained nurses to detect lumps in a test set of silicone breast models.

BACKGROUND: Screening for breast carcinoma is a Healthy People 2000 objective and physical examination is an important component of the screening process. However, many women do not have access to a high quality breast examination. To help address this problem for Native American women, the authors developed the Nurses Providing Annual Cancer Screening (NPACS) training program, a week-long training session conducted at the nurses' clinical site. The goal of the current study was to demonstrate that, after receiving training, the nurses can detect masses in breast models at acceptably high rates. METHODS: Thirty-four nurses who had completed the NPACS training program performed examinations of a test set of six silicone breast models. True-positive and false-positive rates of lump detection were calculated. RESULTS: The nurses were able to detect more lumps in the simulated breasts than both untrained and trained physicians tested in previous trials using the same methodology. On the average, nurses found 76% of the 18 lumps in the 6 breast models. However, their rate of false-positive detections also was somewhat higher. Although the modal number of false-positive detections for both physicians and nurses was 0, the median number of false-positive detections was 0 for the physicians and 1.0 for the nurses. CONCLUSIONS: In the current study, trained nurses were able to detect masses in breast models at high rates. This observation suggests that widespread training of nurses to perform screening breast examinations might be considered as a response to the breast carcinoma screening needs of adult women.

Breast Neoplasms↗
PubMed1993

Forging the future: the public health imperative.

During the 1980s, national policy promoted military expenditures and downsized domestic programs. These priorities, along with tax reform and deregulation, created a "domestic gulf crisis" with a new wave of vulnerable populations--poor children, the homeless, the elderly, and the uninsured. Our lack of a national health program compounds the problem. The 1990s will be a decade of change and challenge. To forge a healthier and stronger future for our nation, we must implement five public health imperatives: (1) We must have a national health program that is universal, comprehensive, and prevention-oriented, with built-in assurances for quality, efficiency, and a strong public health infrastructure. (2) We must have a comprehensive national health education and promotion program for all schoolchildren. (3) Women must have freedom of choice. (4) Prevention and public health must become one of our country's highest health priorities. (5) The federal government must increase its leadership, commitments, and resources to reach the goals set forth in Healthy Communities 2000 and Healthy People 2000.

Delivery of Health Care↗
PubMedDate not supplied

[Computer modeling of ESR spectra of the plasma in patients with Down's syndrome].

ESR technique at 77 degrees K was used for studying the blood plasma ESR signals of patients with Down syndrome and of healthy people. It was observed that the first exhibited a tendency towards a decrease of ESR signal with g = 4.3 and increase of the ratio of ceruplasmin (g = 2.05) and transferrin (g = 4.3) ESR signal amplitude. A computer simulation has been carried out by means of special mathematical program of experimental ESR spectra of the blood plasma.

Adolescent↗
PubMedDate not supplied

The national survey of children with special health care needs.

CONTEXT: The federal and state-level Children with Special Health Care Needs (CSHCN) programs are vested with the responsibility for planning and developing systems of care for children with special health care needs. To support achievement of this goal, the federal Maternal and Child Health Bureau (MCHB), in partnership with the National Center for Health Statistics (NCHS), has developed a new survey that will provide uniform national and state data on the prevalence and impact of special health care needs among children. PURPOSE: The National Survey of CSHCN is designed to produce reliable state- and national-level estimates of the prevalence of special health care needs using MCHB's definition of CSHCN. It will also provide baseline estimates for federal and state Title V Maternal and Child Health performance measures, for Healthy People 2010 national prevention objectives, and for each state's Title V needs assessment. In addition, it will provide a resource for researchers, advocacy groups, and other interested parties. It is anticipated that this survey will be repeated periodically, thereby making trend analysis possible. METHODS: This survey is being conducted using the State and Local Area Integrated Telephone Survey mechanism, which shares the random-digit-dial sampling frame of the National Immunization Survey (sponsored by the National Immunization Program and NCHS). Using the CSHCN Screener, developed under the auspices of the Foundation for Accountability, 750 children with special health care needs will be identified and selected from each state and from the District of Columbia. Parents or guardians of these children then complete a comprehensive battery of questions on demographics, health and functional status, health insurance coverage, adequacy of health insurance coverage, public program participation, access to care, utilization of health care services, care coordination, satisfaction with care, and the impact of the special need on the family. Data collection began in October 2000 and will continue through March 2002. Summary reports and electronic data files will be available to the public within 6 to 12 months following completion of data collection. CONCLUSIONS: The National Survey of CSHCN will offer a unique data source for individuals and organizations interested in understanding and improving service delivery for CSHCN. It is an accomplishment that reflects the contributions of state and federal Title V programs, family organizations, provider organizations, health services researchers, and the broader maternal and child health community.

Adolescent↗
PubMed2005

Metabolic syndrome as an independent risk factor of silent brain infarction in healthy people.

BACKGROUND AND PURPOSE: Metabolic syndrome (MetS) is associated with an increased risk of the subsequent development of cardiovascular disease or stroke. Moreover, a silent brain infarction (SBI) can predict clinical overt stroke or dementia. We examined the associations between SBI and MetS in apparently healthy individuals. METHODS: We evaluated 1588 neurologically healthy subjects (927 males and 661 females) who underwent brain MRI at Seoul National University Hospital Healthcare System Gangnam Center. MetS was defined using the criteria of the National Cholesterol Education Program Adult Treatment Panel III. We examined associations between full syndrome (> or =3 of the 5 conditions) as well as its components and SBI by controlling possible confounders. RESULTS: Eighty-eight (5.5%) were found to have > or =1 SBI on MRI. Age was found to be significantly related to SBI prevalence (odds ratio [OR], 1.06; 95% CI, 1.04 to 1.09). A history of coronary artery disease was associated with an elevated odds ratio of SBI (OR, 2.83; 95% CI, 1.38 to 5.82), and MetS was significantly associated with SBI (OR, 2.18; 95% CI, 1.38 to 3.44). The components model of MetS showed a strong significance between an elevated blood pressure (OR, 3.75; 95% CI, 2.05 to 6.85) and an impaired fasting glucose (OR, 1.74; 95% CI, 1.08 to 2.80) and the risk of SBI. CONCLUSIONS: MetS was found to be significantly associated with SBI. This finding has clinical utility in terms of identifying healthy people at increased risk of developing SBI.

Adult↗
PubMed2003

Methods for conducting systematic reviews of the evidence of effectiveness and economic efficiency of interventions to promote healthy social environments.

The social and physical surroundings in which people live affect their health. Knowing what basic conditions and opportunities in communities advance or impede improvement of community health can inform public health practice and policy. This article describes the methods for conducting systematic literature reviews of three community interventions to promote healthy social environments: early childhood development programs, programs to promote affordable family housing in safe neighborhoods, and interventions to increase the cultural and linguistic competence of healthcare systems. Existing methods, established for conducting systematic reviews for the Guide to Community Preventive Services, were applied to these interventions to promote healthy social environments.

Evidence-Based Medicine↗
PubMedDate not supplied

[Rehabilitation in ischemic cardiopathy. Results at the level of quality of life and prognosis].

Cardiac rehabilitation programs, by means of physical, psychosocial and risk control factors, intend to improve the life style and prognosis of coronary patients. In this study, we analyzed the results obtained from 349 patients, 310 with acute myocardial infarction and 39 after coronary artery surgery. The average follow up period was 36 months and the average age was 53.9 years. The results showed that 84.3% stopped smoking, 60% returned to work after a heart attack and 51.36% after coronary artery bypass. Functional capacity improved significantly with p < 0.001. Although 50% of the patients considered themselves sexually incapacitated, the number of coitus per month is similar to that of healthy people of the same age. There were 12 new infarctions (1.28 por 100 patients per year), and 11 cardiac-related deaths (1.18 per 100 patients per year). All the deaths occurred in the group of patients with myocardial infarction, and with a significant increase in the elevation of the ST in the necrosis area, during an exercise testing, indicating extensive areas of dyskinesis. Based on these results, we have reached the conclusion that steps must be taken to reduce the high percentage of patients who leave the program. In our study this was significantly low at 21.5%.

Adult↗
PubMed1993

The rural hospital as a provider of health promotion programs.

Although patient education has always been recognized as an essential function of a hospital, it was not until the health concerns of the nation focused on prevention that hospitals began to develop activities aimed at primarily healthy individuals. Hospital health promotion evolved from patient education about specific diseases to programs focused on modifying of lifestyle practices to prevent future debilitating conditions. Studies conducted in the early 1980s show hospital-based health promotion programs increasing in number and including such target populations as senior citizens, children, business people, and hospital employees. However, the extent of involvement of the rural hospital in offering health promotion programs has not been clearly established. The current study was conducted to determine the status of health promotion programs in rural North Carolina hospitals. Elements considered were types of programs, target audiences, methods of financing, staff use, and availability of specialized facilities for health promotion programs. The results indicate rural hospitals do offer health promotion programs, but their primary focus is on hospital employees. Most programs are offered at low or no cost, making those offered for the community readily accessible. If input from the community is used and programming is aimed at specific health needs of rural populations, the rural hospital could make a significant contribution to an overall primary prevention strategy, lowering community health care costs.

Community-Institutional Relations↗
PubMed2001

Putting to use a clinical guideline for treating tobacco dependency.

The issuance last year of the U.S. Public Health Services' clinical guideline for treating tobacco use and dependency offered managed care a tool that could help them achieve the Healthy People 2010 goals of cutting adult smoking rates in half. The authors describe how the guidelines approach this difficult public health issue.

Adolescent↗
PubMed2005

Brisk walking, fitness, and cardiovascular risk: a randomized controlled trial in primary care.

STUDY OBJECTIVE: To examine the effects of 30 min of self-paced, non-supervised, brisk walking, 5 days per week on the health and fitness of people aged 50-65 years. DESIGN: Randomized controlled trial. Members of the intervention group (n = 21) were directed to walk briskly for 30 min, 5 days per week, for 12 weeks. Individuals were given the choice to complete the 30 min of walking in one session or in shorter bouts of no less than 10 min. They were asked to record in a diary the time spent walking and the number of steps taken during a single walk using a pedometer. Participants in the control group (n = 10) were asked to maintain their habitual lifestyle and not change their activity or dietary habits. Measurements of body mass index (BMI), waist/hip ratio (WHR), blood pressure, functional capacity, total cholesterol, triglyceride, and lipoprotein subfractions were taken before and after the program. Changes in 10-year risk estimate for coronary heart disease and stroke were calculated using Framingham risk equations. SETTING: Three urban general practices patients: 31 healthy, sedentary 50- to 65-year-old participants recruited following contact by their general practitioner. MAIN RESULTS: The mean time spent walking by the intervention group was 27.72 (+/-9.79) min/day: their adherence to the protocol was 90.3%. Significant decreases in systolic and diastolic blood pressure, reduction in stroke risk, and increased functional capacity were found within the walking group between baseline and 12-week measurements. No changes were found in these parameters within the control group. Significant reductions in 10-year risk of CHD were observed in both groups. No significant changes were found in lipid levels or anthropometric measurements in either group. CONCLUSIONS: The study provides evidence for the benefit to fitness and cardiovascular risk of the "30-min brisk walking, 5 days a week" message to people aged 50-65 years who participated in an unsupervised home-based walking program. Further study to overcome the problem of poor recruitment and determine the minimum effective dose of exercise to improve cardiovascular risk prediction scores is required.

Aged↗
PubMedDate not supplied

A controlled evaluation of an elementary school primary prevention program for eating problems.

Researchers have recently called for the development of primary prevention of eating disorders programs aimed at elementary school students. The present study reports on the development of a curriculum for fifth graders designed to encourage healthy eating, exercise, and body image while discouraging calorie-restrictive dieting, exercising for weight loss, and the development of body dissatisfaction. The program consisted of ten lessons taught by the classroom teachers. The influence of the curriculum on (1) knowledge about nutrition, body fat, and dieting; (2) attitudes about fat people and own body (body esteem); and (3) behaviors, including attempts at weight reduction, consumption of fruits and vegetables, and exercising, were evaluated in a pre-post controlled experimental design. There were 222 white public school children who participated in both the pre- and posttesting, 167 of whom were in the classrooms receiving the curriculum. Results indicated that knowledge was broadly improved by the curriculum. There were information improvements in terms of nutrition, effects of dieting, and causes of body fat. Attitudinal changes were less pronounced, although the curriculum did positively affect attitudes about fat people. Behavior, including eating patterns, exercise patterns, weight reduction attempts, and teasing of fat children, was not changed by participation in the curriculum.

Body Image↗
PubMed2002

Transition: a future promise for children and adolescents with special health care needs and disabilities.

Transitions are a part of everyone's life experience. Most young people with special health care needs and disabilities (SHCN/D) become independent partners in adult society, but some need deliberate guidance and support. This latter group is growing in number. Through a new consensus statement from the American Academy of Pediatrics and the U.S. Federal Government (Healthy People 2010), society is recognizing the need to assist young people with SHCN/D in attaining their potential in adulthood. This article discusses the growing number of young people with SHCN/D, their desires for their transition, the definition and areas of transition that should be addressed, and the key elements of successful transition programs. The article ends with a suggested list of actions a health care professional can undertake to foster a successful transition and a selected list of helpful resources for health professionals, families, and young people with SHCN/D.

Activities of Daily Living↗
PubMed1998

Working in addictions treatment services: some views of a sample of service providers in Ontario.

Respondents in a survey of specialized addiction treatment providers indicated a strong commitment to the addictions field. In a multivariate analysis, intention to stay in the addictions field was positively related to a measure of attitudes toward staying or leaving, to age, involvement in an addictions studies program, working in a residential service, and job satisfaction. Intention to stay was negatively related to education and working in a nonresidential setting. Attention to factors that create positive attitudes to the addictions field, especially among younger, more educated people and those working in nonresidential services, is necessary to ensure a healthy future for addictions treatment.

Adult↗
PubMedDate not supplied

The Older Men's Health Program and Screening Inventory: a tool for assessing health practices and beliefs.

Men experience greater health risks, poorer health, and shorter life expectancy than women.(1) However, a systematic literature review revealed no measure to assess the health practices and beliefs of elderly men. In response, the Older Men's Health Program and Screening Inventory (OMHPSI) was developed. Nursing practice experience and a review of literature informed instrument development. Subsequent to an expert panel survey and pilot-testing, the OMHPSI was completed by 135 community-dwelling older men and found to be an informative baseline assessment tool congruent with the Healthy People 2010 goal of increasing elders' participation in organized health promotion activities.(2) Furthermore, several statistically significant correlations were found between items on the OMHPSI and demographic variables. Of particular note, the younger participants in this study experienced more barriers to health-promoting behaviors (P < or =.01), had less healthy lifestyles (P < or =.05), and were less satisfied with their health behaviors (P < or =.001) compared with their older counterparts.

Aged↗
PubMedDate not supplied

Social implications of sexually transmitted cancer.

The long, tedious search for the causes of and cure for the human nemesis, cancer, has not resulted in one astounding breakthrough discovery. Instead, researchers have slowly and painstakingly made small inroads into the understanding of the way cell growth goes awry and becomes malignant, destroying tissues and, if unchecked, spreading to other organs of the body and eventually causing death. One of those inroads is the discovery that a cancer of the uterine cervix is almost certainly caused by a virus transmitted through sexual contact. This article presents the biological, clinical, and psychosocial aspects of cervical cancer. Cancer of the cervix usually is preceded by a slowly progressive preinvasive lesion, dysplasia, which can be detected by a screening test, the Papanicolaou smear, and effectively treated with organ-preserving local therapy. Because dysplasia and early invasive cancer usually develop in young women, the need for conservative management is of utmost importance to preserve a woman's ability to have children. The social and psychological impacts of a cancer occurring in young women are enormous and are further magnified by the fact that this cancer may be caused by a sexually transmitted virus. Sexual practice patterns, number of sexual partners, smoking, and other behavioral aspects contribute to the complexity of this disease. However, early detection of preinvasive and invasive cancer is possible with fairly simple and inexpensive means, and curative therapy is available. The disastrous impact of cervical cancer theoretically could be contained if patients at risk regularly participate in early detection programs. Also, the disease could, to a large extent, be prevented altogether through healthful behavior and sexual practices. The social challenge is to provide this information to the public in a nonthreatening, nonmoralistic fashion. We especially need to help young people to accept that sex within a caring, responsible relationship is a healthy human response and, at the same time, understand that there are dangers associated with transmittable diseases that can have profound effects on their ability to have children and on their lives.

Female↗
PubMedDate not supplied

Soft drink "pouring rights": marketing empty calories to children.

Healthy People 2010 objectives call for meals and snacks served in schools to contribute to overall diets that meet federal dietary guidelines. Sales in schools of foods and drinks high in calories and low in nutrients undermine this health objective, as well as participation in the more nutritious, federally sponsored, school lunch programs. Competitive foods also undermine nutrition information taught in the classroom. Lucrative contracts between school districts and soft drink companies for exclusive rights to sell one brand are the latest development in the increasing commercialization of school food. These contracts, intended to elicit brand loyalty among young children who have a lifetime of purchases ahead of them, are especially questionable because they place schools in the position of "pushing" soft drink consumption. "Pouring rights" contracts deserve attention from public health professionals concerned about the nutritional quality of children's diets.

Adolescent↗