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PubMed2001

Training readiness of public health agencies: a framework for assessment.

The Healthy People 2010 Objectives and the Taskforce on Public Health Workforce Development both have recognized the important roles of state and local agencies in the education and training of their employees. This article describes an initial step in the development of a tool to assess agencies' training readiness using five factors derived from learning organization theory. These factors (resources, policies, learning culture, programs, and leadership) offer a useful framework for further development of a tool to assess training program readiness.

Education, Continuing↗
PubMed1995

Integrating informatics into the graduate community health nursing curriculum.

Advanced practice of community health nursing is enhanced if the nurse is able to identify, create, and use databases to support nursing assessments of communities and to manage and evaluate community health programs. The College of Nursing, Rutgers, The State University of New Jersey, has revised its curriculum for community health nursing graduate students to include a strong focus on nursing informatics. This paper summarizes the integration of theoretical content and practice exercises into a pre-course workshop and four-course sequence. A focal point of this effort has been the "Healthy People 2000 Nursing Informatics Project," in which students develop an automated community-assessment tool and database related to the Year 2000 objectives. The use of this database and related national, state, and local databases to document community needs is emphasized. Students also evaluate nursing information systems and use information technologies to design and evaluate community health grant proposals. Curriculum development, evaluation, and modification are detailed in relation to student learning needs, faculty preparation, and equipment and consultation requirements.

Community Health Nursing↗
PubMed2004

Health attitudes and behaviors: comparison of Japanese and Americans of Japanese and European Ancestry.

Adults living in Japan (N = 357) and the US (N = 223) completed semi-structured interviews assessing health-related attitudes and practices. The US respondents were of Japanese (N = 106) and European (N = 117) ancestry. Results indicated considerable similarity between the two US groups and significant differences between the Japanese and American respondents. The Japanese respondents placed less priority on health, had less belief in the efficacy of health screening tests, lower levels of internal health locus of control (HLOC), and higher levels of chance and powerful-others HLOC. While Japanese and Americans had similar overall levels of healthy behaviors, the Japanese were less likely to have obtained health screening tests (especially gynecologic exams). The findings have implications for adapting health promotion programs in the context of Japanese and American cultures.

Asian People↗
PubMedDate not supplied

Health promotion in minority adolescents: a Healthy People 2000 pilot study.

PURPOSE: The purpose was to evaluate the effects of a health promotion curriculum on health knowledge, behavior, cardiovascular fitness, and cardiovascular risk factors. METHODS: A multi-ethnic, multi-cultural sample (n = 54) of 10th grade males and females participated in a study of cardiovascular health promotion and coronary risk factor reduction. The sample was comprised of Asian-Americans (39%), blacks (33%), Hispanics (11%), whites (2%), and others (15%). Intervention consisted of a 10-week health promotion curriculum of classroom education modules in physical activity, nutrition, smoking cessation, stress management and personal problem solving, and an exercise program of walking and running. A nonintervention control group served as a basis for comparison. Classroom and exercise sessions met on alternate days. RESULTS: Following intervention, a significant treatment effect (P = .007) was observed in lowered total cholesterol, and significant within group improvements (P < .01) were observed in diet habits, percent body fat, and cardiovascular health knowledge. Comparisons of knowledge and social effects revealed higher cardiovascular health knowledge (P < .05) in subjects of nonsmoking compared to smoking parents, higher self-perception of health (P < .01) in more active vs less active subjects and better dietary habits (P < .07) in children whose parents were college educated compared to parents who did not attend college. CONCLUSIONS: Preliminary findings suggest that a health promotion curriculum consisting of health education, behavior modification, and regular aerobic exercise lowers cholesterol, improves health behavior and increases health knowledge.

Adolescent↗
PubMed1995

Community health CNSs and health care in the year 2000.

As our nation addresses health care reform and the need for programs at the community level that deal with preventable health problems, there is an increasing need for the community health clinical nurse specialist (CHCNS). In this article, the CHCNS's role, as defined by the profession, is discussed and ideas for implementing this role in the community, home health care and public health are proposed. Standards of Community Health Nursing Practice and Healthy People 2000 are resources the CHCNS can use to guide practice at the community level.

Community Health Nursing↗
PubMed1991

The Healthy Cities Project: a challenge for health education.

The World Health Organization Healthy Cities Project assists participating cities in developing and implementing plans to create health promoting policies, programs, and environmental conditions. The project, which has its origins in the strategy of Health for All by Year 2000, seeks to bring the rhetoric down to earth and ground it in policy and practice. So far the project has been very successful in interesting and involving people at the local level. What began as a small European project in 1986 has become part of a global movement four years later. This movement is based on a recognition of the ecological context of health and the need to reconcile human lifestyles with their environmental and planetary impact. In the process of involving many people from nonmedical sectors in urban health promotion, the continuing relevance of health education to public health is becoming apparent. The challenge to Health Education is to broaden its perspective from the individual and biological, to the social and environmental if it is to play a full part in tackling the ecological crises which confront us.

Global Health↗
PubMed2005

Health care costs in old age are related to overweight and obesity earlier in life.

Obesity is responsible for at least 90 billion dollars in direct U.S. health care costs annually. A high proportion of people who were overweight or obese at younger ages survives past age sixty-five to experience adverse consequences. The determinants of obesity are complex and multifactorial, with genetic, biological, behavioral, social, and environmental contributors. The effects of adverse weight in older age have negative implications for healthy aging and lead to greater societal expenditures. Given the high costs and ineffectiveness of existing programs to treat obesity, perhaps the only solution to the obesity epidemic is primary prevention of weight gain beginning in youth.

Health Expenditures↗
PubMed2004

Improving health insurance coverage for Latino children: a review of barriers, challenges and State strategies.

OBJECTIVES: To summarize key findings on disparities in health insurance coverage for latino children, to present selected socioeconomic and healthcare access indicators for the nine states with latino populations over 500,000, and to recommend state strategies to increase public health insurance coverage for latino children. METHODS: Literature review performed on latino children and health insurance coverage, key informant interviews with frontline service providers, review of outreach sections of eight state 1115 waiver requests approved by the Secretary of the U.S. Department of Health and Human Services, and national and state data compiled on sociodemographic and healthcare access indicators for nine states with the largest latino populations. RESULTS: Eligibility and enrollment into Medicaid and State Children's Health Insurance Program (SCHIP) are hindered by financial, nonfinancial, and social policy barriers. Disparities in insurance and access indicators show that lack of parental employment-linked benefits, procedural barriers to enrollment, and lack of clarification on eligibility for children of noncitizen parents are associated with low levels of insurance coverage among latino children. CONCLUSION: To state strategies consistent with the overarching goal of Healthy People 2010 to eliminate health disparities can increase health insurance coverage for children of low-wage latino workers.

Child↗
PubMed2006

Change in protein intake in elderly French people living at home after a nutritional information program targeting protein consumption.

OBJECTIVE: The purpose of the study was to assess the impact of a nutrition information program targeting protein consumption in elderly people. DESIGN AND INTERVENTION: Participants individually completed a questionnaire on food consumption and answered an attitude questionnaire (first survey period). Half of the participants (message group) participated in an information program targeting protein consumption, whereas the other half (control group) were not given any information. Two weeks after the program, both groups participated in the same surveys again (second survey period). SUBJECTS: Eighty-two healthy subjects (65 to 75 years old) living at home participated in this study. STATISTICAL ANALYSES: A two-way multivariate analysis of variance, paired t tests, and chi2 tests were performed to determine the influence of group (control versus message) and gender on the differences in protein consumption and in attitudes between the first and second survey periods. RESULTS: In the second survey period, the control group participants decreased their protein intake by an average of 0.049 g/lb/day, mainly by a reduction in meat product consumption. Conversely, the message group participants increased their protein intake by 0.041 g/lb/day, with a greater increase for the women (0.059) than the men (0.023 g/lb/day). After the nutrition information program, knowledge, perceived control on health, and belief that sensory perception decreased with age were higher among the message group participants. CONCLUSIONS: Nutrition knowledge and protein intake increased significantly among the message group participants. Thus, it is possible to change dietary practice and knowledge in elderly individuals by information targeting one nutrition message.

Aged↗
PubMed1998

The conceptual and empirical link between health behaviors, self reported health, and the use of home health care in later life.

The primary qualification for Medicare's home health care benefit is being homebound, typically by a chronic disability. Disability and functional ability in late-life are heavily influenced by the long-term practice of health behaviors. One of the goals of Healthy People 2000 is to increase the years of healthy life which are measured, in part, by self reported health status. This compression of morbidity would, in effect, reduce the need for long term care. This paper examines three conceptual models linking health behaviors to self reported health in a unique sample of older adults who have chosen to participate in a corporate sponsored wellness program. It is hoped that these findings will encourage further research on formulating empirical pathways from health behaviors to reduced need for home health care.

Age Factors↗
PubMed1992

Private insurance reform in the 1990s: can it solve the health care crisis?

A number of health insurance reform proposals have surfaced at the state governmental level in the United States. These include Medicaid expansion for the below-poverty or near-poverty uninsured, state subsidy to individuals and/or businesses for the purchases of health insurance, risk pools for the medically uninsurable, insurance industry-initiated reforms within the small group market, the promotion of "stripped down" insurance plans that reduce premium cost, and state mandating of employer-sponsored health insurance for the employed uninsured. All of these insurance reform proposals have serious limitations: (1) they fail to address the inequities of the underwriting principle by which older and sicker people pay more for health insurance than the young and healthy population; (2) they extend the illogical linkage of employment and health insurance; and (3) they do not slow the rate of health cost inflation nor do they contain a mechanism to finance broader health coverage through savings within the health sector. An alternative to insurance reform is the establishment of a social insurance program that brings the entire population into a single risk pool.

Adult↗
PubMed2003

"Razoo Health": a community-based nursing education initiative.

When statistics depicted a health crisis for people of all ages living in Louisiana, and New Orleans in particular, school of nursing faculty designed and instituted a neighborhood-based initiative to "Razoo Health." This initiative facilitated a paradigm shift from exclusively illness management to include health promotion and disease prevention. "Razoo," a local colloquialism used to claim an opponent's marble during game play, means to snatch or claim. Appropriately, Razoo Health refers to the intent of Louisiana citizens to reclaim and take back the health of the people in the cities' neighborhoods. Working with four inner-city parochial schools and churches as hubs, nursing faculty and students mobilize neighborhood assets, talents, and capacities to form partnerships for healthy change. The Centers for Disease Control and Prevention Coordinated School Health Model is employed within each neighborhood school to provide health care access, decrease absenteeism, raise test scores, and deliver worksite health programming to faculty and staff and to neighbors and parishioners. Nursing students work with citizens and students of other health care professions to learn community assessment skills and deliver primary, secondary, and tertiary services to individuals, families, and the community. Citizens wear crowns of empowered sovereignty as they take back, or razoo, what is rightfully theirs--health.

Attitude to Health↗
PubMed1992

Obesity and its relation to cardiovascular disease risk factors in Canadian adults. Canadian Heart Health Surveys Research Group.

OBJECTIVE: To describe the distribution of weight and abdominal obesity among Canadian adults and to determine the association of obesity with other risk factors for cardiovascular disease. DESIGN: Population-based cross-sectional surveys. Survey nurses administered a standard questionnaire and recorded two blood pressure measurements during a home visit. At a subsequent visit to a survey clinic two further blood pressure readings were made, anthropometric measurements recorded and a blood specimen taken for plasma lipid determination. SETTING: Nine Canadian provinces, from 1986 to 1990. PARTICIPANTS: A probability sample of 26,293 men and women aged 18 to 74 years was selected from the health insurance registration files of each province. Anthropometry was performed on 17,858 subjects. OUTCOME MEASURES: Body mass index (BMI), ratio of waist to hip circumference (WHR), mean plasma lipid levels, prevalence of high blood pressure (diastolic greater than or equal to 90 mm Hg or patient on treatment) and self-reported diabetes mellitus. MAIN RESULTS: The prevalence of obesity (BMI greater than or equal to 27) increased with age and was greater in men (35%) than in women (27%). Abdominal obesity was likewise higher in men and increased with both age and BMI. The prevalence of high blood pressure was greater in those with higher BMI, especially in those with a high WHR. Although total plasma cholesterol levels increased only modestly with BMI, levels of low density lipoprotein (LDL) cholesterol and triglycerides and the ratio of total cholesterol to high density lipoprotein (HDL) cholesterol increased steadily, while HDL-cholesterol decreased consistently with increasing BMI. High total cholesterol levels (greater than or equal to 5.2 mmol/L) were more prevalent among people with high BMI, especially those with a high WHR. The prevalence of diabetes increased with BMI among those 35 years or older, especially those with abdominal obesity. About half of men and two-thirds of women who were obese were trying to lose weight. CONCLUSION: Obesity remains common among Canadian adults. There is a need for broad-based programs that facilitate healthy eating and activity patterns for all age groups. Health professionals should incorporate measurement of BMI and WHR into their routine examinations of patients to enhance their evaluation of health risk.

Adult↗
PubMed1991

Effect of exercise on muscle function decline with aging.

As people age, changes in muscle occur that are associated with a decrease in strength and endurance. These changes result in decreased functional capacity and quality of life. A substantial portion of this decrease is the result not of aging but of the sedentary life-style so frequently associated with aging. In "healthy old" persons and in older animals in experiments, an appropriate exercise program can result in increased strength and endurance. This is true both in longitudinal and short-term studies. As physical impairment increases, the exercise program must be individualized, and results are not as readily predictable. Much work remains before we may be certain how much exercise can be tolerated in these more impaired persons and what the effects may be.

Aged↗
PubMed1980

Family life education for the handicapped.

Only a small percentage of America's handicapped population presently receives adequate instruction in family life education. The development of healthy attitudes and a positive self-concept are enhanced by education in sexuality with openness toward this sensitive area. Parents are the primary sex educators of their children, with schools, religious groups and various community agencies playing a supplementary role. In not educating handicapped individuals, society further burdens them with additional insecurities and feelings of inadequacy. People who are exposed to family life education programs tend to act more responsibly in their personal relationships and feel better about themselves.

Child↗
PubMed1984

Hemoglobin D "Los Angeles" in an Austrian family: biochemical identification, clinical aspects, and kindred study.

During a screening program for gestational diabetes, hemoglobin D "Los Angeles" (beta 121 Glu----Gln) was detected by HPLC in an overweight but healthy pregnant Austrian woman. The chromatogram of the hemolysate revealed an unusual splitting of the hemoglobin A1 peak. Sequential analysis of the abnormal peptide indicated hemoglobin D "Los Angeles" heterozygosity in the patient. This is the first description of this variant in Germanic-appearing people. In a kindred study of 49 of the 57 living family members spanning four generations, 22 were heterozygous for hemoglobin D "Los Angeles". How this gene got to this region of Austria is unknown, but transfer via Iran and Turkey seems likely.

Austria↗
PubMed2005

[The plasma homocysteine, folic acid and vitamin B12 levels in young people with high risk for cardiovascular disease and its relation to metylentetrahydrofolate reductase (MTHFR) gene polymorphism].

INTRODUCTION: Hyperhomocysteinemia is an independent risk factor for cardiovascular morbidity. AIM: The study was designed to evaluate the total homocysteine level and MTHFR C677T polymorphism frequency of 122, healthy, young adults who had increased risk for cardiovascular disease. The serum levels of folic acid and vitamin B12 were also measured. METHODS: Immunoassay, PCR-RFLP methods were used. The statistical analysis was performed by SPSS program. RESULTS: The frequency of the gene-polymorphism was not different significantly in the study group compared to a Hungarian neonatal sample: although in the increased risk group the frequency of homozygous 677TT polymorphism was higher (14.8%), and heterozygosity was smaller (41%). There was no association between MTHFR gene polymorphism and homocysteine levels. A significant negative correlation was found between the folic acid and homocysteine, and between the vitamin B12 and homocysteine levels correlating with the literature. The mean serum total homocysteine level of the group without vitamin supplementation (n: 86) was 9.8 +/- 3.3 micromol/l, while in the other group with vitamin uptake (n: 36) this level was 7.5 +/- 3.0 micromol/l. There was a significant difference between the homocysteine levels of men and women. CONCLUSION: The results of the study correlate with the literature. It would be useful to call the attention of the Hungarian population to the importance of vitamin supply.

Adult↗
PubMed1983

Utilizing tenets of inoculation theory to develop and evaluate a preventive alcohol education intervention.

With the advent of the Surgeon General's Report, Healthy People, a renewed interest in and concern for the health-risky practices of the school aged has emerged. Moreover, because the mortality rates for the 15 to 24 year age group continues to increase while the mortality rates for every other age group continues to decline, a school health education imperative has become prevention-based interventions. The experimental, prevention-based alcohol education program reported here describes one such intervention directed at 9th grade students. The program was grounded on the principles of Inoculation Theory and evaluated using a Solomon Four-Group Design. Results indicate that the formulation of preventive alcohol education programs utilizing Inoculation Theory in a school setting is both feasible and productive in achieving designated objectives. Longitudinal assessment of the subjects with regard to their alcohol-related behavior is continuing throughout their high school careers.

Adolescent↗