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At least 775 records · Page 43Linked to original sources
PubMed1997

Validity of subjective assessment of changes in respiratory health status: a 30 year epidemiological study of workers in Paris.

The validity of scales used for subjective assessment of health, particularly transitional indices, is under discussion. The aim of the present study was to assess the concurrent and predictive validity of a simple estimate of long-term subjective assessment of respiratory health changes. A longitudinal study of 915 workers was conducted over 30 yrs, with both retrospective self-assessment of respiratory health changes and objective measurements of spirometric values 12 yrs apart. An assessment of the reason for death during the subsequent 20 yrs was performed. Subjective assessment of respiratory deterioration over 12 yrs was significantly related to both cross-sectional lung function values and longitudinal lung function changes (forced expiratory volume in one second (FEV1) decline), an association which remained after adjustment for FEV1 level. It was also related to the same risk factors as decline in FEV1 (smoking, occupational exposure). Self-evaluation of respiratory deterioration was significantly predictive of death from all causes, with the highest (but nonsignificant) rate ratio for respiratory causes. Asthmatics exhibited greater long-term variability (objective and subjective) than nonasthmatics. Independent of dyspnoea, self-assessment of respiratory health deterioration was significantly related to FEV1. Subjective assessment of long-term changes in respiratory health provides valid information.

Adult↗
PubMed1999

Place therapies for older adults: conceptual and interventive approaches.

The study of place transitions-moves between places as well as changes occurring in environments of elders who age in place-is a relatively new, diverse research area of high relevance for adult developmentalists and gerontologists. This article explores the usefulness of a tractable model of environmental stress and proposes three potential "place therapies" that may minimize the negative impacts of place transitions upon older adults. Specifically, a transactional model of environmental stress linked to behavior setting theory is proposed for understanding both positive and negative outcomes associated with different kinds of place transitions. Three distinct "place therapies" are considered as interventions that may hold promise for preventing, ameliorating, and enriching the diverse impacts of place transitions on older adults and their environmental milieu.

Adaptation, Psychological↗
PubMed2004

Survey of dietary habits of in-school adolescents in Damascus, Syrian Arab Republic.

This study aimed to describe dietary habits of Syrian adolescents attending secondary schools in Damascus and the surrounding areas. A descriptive, cross-sectional study was carried out on 3507 students in 2001. A stratified, 2-stage random cluster sample was used to sample the students. The consumption pattern of food items during the previous week was described. More than 50% of the students said that they had not consumed green vegetables and more than 35% had not consumed meat. More than 35% said that they consumed cheese and milk at least once a day. Only 11.8% consumed fruit 3 times or more daily. Potential determinants of the pattern of food consumption were arialysed. Weight control practices and other eating habits were also described.

Adolescent↗
PubMed2003

Healthcare-financing reforms in transitional society: a Shanghai experience.

Since the 1950s, China has had a very wide coverage of healthcare service at the local level. In urban areas, the employment-based healthcare-insurance schemes (Government Insurance Scheme and Labour Insurance Scheme) worked hand in hand with the full employment policy of the Government, which guaranteed basic care for almost every urban resident. However, since the economic reforms of the early 1980s, China's healthcare system has met great challenges. Some came from the reform of the labour system, and other challenges came from the introduction of market forces in the healthcare sector. The new policy of the Chinese Government on the Urban Employees' Basic Health Care Insurance is to introduce a cost-sharing plan in urban China. Like other major social policy changes, this new health policy also has a great impact on the lives of the Chinese people. Affordability has been the major concern among urban residents. Shanghai implemented the cost-sharing healthcare policy in the spring of 2001. It may be too early to assess the pros and cons of the new policy, but evidence shows that the employment-based health-insurance scheme excludes those at high risk and in most need. It is argued that the cost-sharing healthcare system will limit access by some people, especially those who are most vulnerable to the consequences of ill health and those in low-income groups, unless the deductibles vary according to income and unless low-income groups are exempt from paying premiums and deductibles.

Adult↗
PubMed1989

Strategies for promoting a viable rural health care system.

Strategies for promoting a viable rural health care system in the context of the rapidly changing rural health care environment are presented. Also included is a series of guiding principles that support rural health care. They focus on the need for cooperation rather than competition among rural communities and health providers; the need for leadership and empowerment in rural communities; the dependence of rural health on generalists; the need to transform the reimbursement system to reward rural health services; the importance of quality of care for rural providers; the challenge of providing health and social services to the aged; and the instability caused by uncertain government attention to rural concerns. Examples of current activities that exemplify the effective use of these principles with respect to rural hospitals are discussed. These include the proposed demonstration of a new health care institution called the Medical Assistance Facility, the development of rural hospital consortia, the establishment of a rural health care transition grants program, and the activities of the New York State Legislative Commission on Rural Resources.

Community Participation↗
PubMed1999

Ambulatory care transitioning for the rural hospital.

As rural community hospitals continue their transition of health care delivery to predominantly outpatient and ambulatory services, many factors are being considered in design, planning, and operations to enact this change both efficiently and effectively. The following examines strategies that allow these changes to be incorporated successfully while maintaining the flexibility for the continued transition that these organizations will experience in the future.

Ambulatory Care Facilities↗
PubMed2005

International humanitarian assistance: where do emergency physicians belong?

As human civilization faces new and challenging humanitarian crises, the entrance of EPs into the realm of HA is needed and timely. As noted by Jennifer Leaning [35], an EP at Harvard University, "Medical and public health personnel who respond to these crises enter a domain of perilous complexity. Road maps do not exist, but the possibility of good favors the prepared mind." Thus, with proper training in the principles of public health and experience, EPs have a tremendous opportunity to affect the realm of international HA, particularly via the analysis and development of international emergency health systems and building the capacity for effective relief. EPs with training in HA can be valuable assets to relief programs in the field and administratively, especially after the initial disaster and during the transition to health system reconstruction and development.

Altruism↗
PubMed2000

Comparison of particle size distributions and elemental partitioning from the combustion of pulverized coal and residual fuel oil.

U.S. Environmental Protection Agency (EPA) research examining the characteristics of primary PM generated by the combustion of fossil fuels is being conducted in efforts to help determine mechanisms controlling associated adverse health effects. Transition metals are of particular interest, due to the results of studies that have shown cardiopulmonary damage associated with exposure to these elements and their presence in coal and residual fuel oils. Further, elemental speciation may influence this toxicity, as some species are significantly more water-soluble, and potentially more bio-available, than others. This paper presents results of experimental efforts in which three coals and a residual fuel oil were combusted in three different systems simulating process and utility boilers. Particle size distributions (PSDs) were determined using atmospheric and low-pressure impaction as well as electrical mobility, time-of-flight, and light-scattering techniques. Size-classified PM samples from this study are also being utilized by colleagues for animal instillation experiments. Experimental results on the mass and compositions of particles between 0.03 and > 20 microns in aerodynamic diameter show that PM from the combustion of these fuels produces distinctive bimodal and trimodal PSDs, with a fine mode dominated by vaporization, nucleation, and growth processes. Depending on the fuel and combustion equipment, the coarse mode is composed primarily of unburned carbon char and associated inherent trace elements (fuel oil) and fragments of inorganic (largely calcium-alumino-silicate) fly ash including trace elements (coal). The three coals also produced a central mode between 0.8- and 2.0-micron aerodynamic diameter. However, the origins of these particles are less clear because vapor-to-particle growth processes are unlikely to produce particles this large. Possible mechanisms include the liberation of micron-scale mineral inclusions during char fragmentation and burnout and indicates that refractory transition metals can contribute to PM < 2.5 microns without passing through a vapor phase. When burned most efficiently, the residual fuel oil produces a PSD composed almost exclusively of an ultrafine mode (approximately 0.1 micron). The transition metals associated with these emissions are composed of water-soluble metal sulfates. In contrast, the transition metals associated with coal combustion are not significantly enriched in PM < 2.5 microns and are significantly less soluble, likely because of their association with the mineral constituents. These results may have implications regarding health effects associated with exposure to these particles.

Air Pollution↗
PubMedDate not supplied

Nurses transition from hospital to home: bridging the gap.

Practice transition between health care settings is often fraught with frustration, stress, and even traumatic learning experiences for nurses. As the need for qualified infusion therapists in home care increases, more acute care nurses are making the transition from hospital to home. This article is designed to profile the differences between the care settings and offer suggestions to smooth the change from hospital to home care.

Adaptation, Psychological↗
PubMedDate not supplied

Cancer mortality in Benghazi, Libyan Arab Jamahiriya, 1991-96.

We present a descriptive study of 1221 cancer deaths among Libyans in Benghazi for the period 1991-96. The cancer mortality rates per 10(5) person-years at risk for males, females and both sexes were 39.8, 26.5 and 33.3 respectively. The age-standardized cancer death rate per 10(5) standard world population was 91.5, 60.0 and 76.5 respectively. The 10 most common cancer deaths by site (comprising 67.7% of the total), in descending order of frequency, were: trachea, bronchus and lung, blood (leukaemia), colon/rectum, other lymphatic and haemo-poietic tissue (lymphomas), stomach, breast, prostate, liver, bladder, and larynx. The results point to the necessity for conducting comprehensive prospective studies, initiating a cancer registry and establishing a national cancer control programme.

Adolescent↗
PubMed2004

Regional overview of maternal and child malnutrition: trends, interventions and outcomes.

The proportions of underweight, wasted, and stunted children, as well as the infant and under-5 mortality rates, have all exhibited downward trends in the Region over the past 2 decades. This is in part attributable to maternal and child nutrition intervention programmes, especially those in which women were actively involved. Programmes which support and promote breastfeeding, such as the Baby Friendly Hospital Initiative, have also contributed to this trend, although the number of baby friendly hospitals varies considerably between countries. Available information also shows that anemia is quite common among women, many of whom also have a low weight and stature and seem to suffer from osteoporosis. In several countries of the Region a number of micronutrient deficiency control programmes are in progress, such as iron supplementation for pregnant women, fortification of flour and iodization of salt. Iodine deficiency disorders are under control in 2 countries of the Region and legislation for salt iodization is in place in 17 countries. Prevalence of severe malnutrition in children is much lower than that of milder levels, thus, promotion of the nutrition status of mildly to moderately malnourished children could lead to a sizeable reduction in child mortality.

Child↗
PubMed1995

Infant mortality in rural Riyadh region of Saudi Arabia.

OBJECTIVE: The purpose of this study was to estimate the level of infant mortality in the rural area of Saudi Arabia central region. SETTING: Rural villages in the Riyadh area. DESIGN: A prospective study of a cohort of infants born in 1987 until they were one year old. METHODS: Five random villages were selected by simple random method. All the babies born in these villages were identified by a group of trained nurses. These nurses collected morbidity and mortality data on these children each time the events occurred using a structured data collection form. Data were analyzed using relevant demographic and statistical techniques. RESULTS: A total of 4,960 babies were born during the period of study. The neonatal mortality rate was 21.4 per 1000 live births and infant mortality rate was 53.8 per 1000. The post neonatal death rate was 32.5 per 1000 live births. The causes of infant deaths as presumed from reported signs of last illness were gastroenteritis, respiratory problems, preterm birth complications and congenital abnormalities. CONCLUSION: There is a decline in infant mortality rate compared with previous estimated rates. But the high levels of neonatal death rates calls for improved antenatal and obstetric health services. The high post neonatal death rate indicates the potential for a further reduction.

Age Distribution↗
PubMed2004

PASSCLAIM--gut health and immunity.

BACKGROUND: The gut and immune system form a complex integrated structure that has evolved to provide effective digestion and defence against ingested toxins and pathogenic bacteria. However, great variation exists in what is considered normal healthy gut and immune function. Thus, whilst it is possible to measure many aspects of digestion and immunity, it is more difficult to interpret the benefits to individuals of variation within what is considered to be a normal range. Nevertheless, it is important to set standards for optimal function for use both by the consumer, industry and those concerned with the public health. The digestive tract is most frequently the object of functional and health claims and a large market already exists for gut-functional foods worldwide. AIM: To define normal function of the gut and immune system and describe available methods of measuring it. RESULTS: We have defined normal bowel habit and transit time, identified their role as risk factors for disease and how they may be measured. Similarly, we have tried to define what is a healthy gut flora in terms of the dominant genera and their metabolism and listed the many, varied and novel methods for determining these parameters. It has proved less easy to provide boundaries for what constitutes optimal or improved gastric emptying, gut motility, nutrient and water absorption and the function of organs such as the liver, gallbladder and pancreas. The many tests of these functions are described. We have discussed gastrointestinal well being. Sensations arising from the gut can be both pleasant and unpleasant. However, the characteristics of well being are ill defined and merge imperceptibly from acceptable to unacceptable, a state that is subjective. Nevertheless, we feel this is an important area for future work and method development. The immune system is even more difficult to make quantitative judgements about. When it is defective, then clinical problems ensure, but this is an uncommon state. The innate and adaptive immune systems work synergistically together and comprise many cellular and humoral factors. The adaptive system is extremely sophisticated and between the two arms of immunity there is great redundancy, which provides robust defences. New aspects of immune function are discovered regularly. It is not clear whether immune function can be "improved". Measuring aspects of immune function is possible but there is no one test that will define either the status or functional capacity of the immune system. Human studies are often limited by the ability to sample only blood or secretions such as saliva but it should be remembered that only 2% of lymphocytes circulate at any given time, which limits interpretation of data. We recommend assessing the functional capacity of the immune system by: measuring specific cell functions ex vivo. measuring in vivo responses to challenge, e. g. change in antibody in blood or response to antigens. determining the incidence and severity of infection in target populations during naturally occurring episodes or in response to attenuated pathogens.

Constipation↗
PubMedDate not supplied

A conceptual framework for a clinical nurse leader program.

Developing a map to guide the design of a novel educational program for nursing students can assist educators in piecing together identified conceptual variables in a logical and reasonable manner. We developed a conceptual model for a clinical nurse leader (CNL) program to present to a school of nursing faculty and a state board of nursing for approval and adoption. The concept map was created following a literature review and analysis of the American Association of Colleges of Nursing description of the CNL. Following the identification of certain variables, such as theories underpinning nursing practice, clinical processes, and education, each team member researched identified variables of the conceptual diagram, wrote a thoughtful explanation of the components, and frequently met with the others to discuss each element of the model and the relationships among the variables. Over time, an emerging model developed and was adopted by the school of nursing and approved by the state board of nursing. An explanation of the components of the conceptual framework and their relationship to the CNL role may assist educators in developing and implementing other emerging CNL programs.

Clinical Competence↗
PubMed1999

Gender differences in illhealth in Finland: patterns, magnitude and change.

The common wisdom about gender differences in illhealth has been encapsulated in the phrase "women are sicker, but men die quicker". Recently this wisdom has been increasingly questioned. The purpose of this study is first to analyse the patterns and magnitude of gender differences across various indicators of illhealth; second to examine changes over time in these differences and third to assess whether sociodemographic and socioeconomic, family status and social network determinants have any bearing on the differences. The data derive from nationally representative 1986 and 1994 Surveys on Living Conditions in Finland. Women showed poorer health for five out of eight indicators analysed; that is somatic symptoms, mental symptoms, disability among those 50 years or older, long-standing illness and limiting long-standing illness were more prevalent among women than men. Male excess was found for perceived health below good and extremely limiting long-standing illness among those 50 years or older. However, the male excess was statistically significant only for poor perceived health among those 50 years or older. Adjusting for a number of suggested determinants of health had a negligible effect on gender differences. Further analyses showed that gender differences in illhealth remained largely stable over the eight year study period which saw a steep increase of unemployment for both genders. Only in the case of mental and somatic symptoms have gender differences declined, with a simultaneous increase in the prevalence of such symptoms. Otherwise gender differences in illhealth turned out to be resistant to the deep labour market crisis over this relatively short period of time. Although women had poorer health than men for a number of health indicators, we also find gender equality and even male excess for some indicators. Furthermore, the results suggest that a male excess in illhealth is likely to be found with more severe domains of illhealth among elderly people.

Adult↗