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PubMed1993

A model for implementing Healthy People 2000 objectives in African-American communities in California.

Using Healthy People 2000 as the source document, regional task forces were formed at the request of the Health Promotion Section of the California Department of Health Services to set health promotion objectives and recommendations for the state's ethnic populations. The topics chosen by regional African-American task forces were (1) violence and abusive behavior, (2) physical activity and fitness, (3) nutrition, (4) tobacco, (5) educational and community-based programs, (6) cancer, and (7) heart disease and stroke. Objectives were expanded, linked together, and revised to meet felt needs. The regional task forces presented the first draft of the document for review at the Multiethnic Health Promotion Conference held in Sacramento, California, June 11 through 13, 1991. The expanded task force, including conference participants, amended the recommendations and ranked the topic areas in order of priority. The group also responded to the challenge of developing implementation strategies for the recommendations. We discuss the early stages of dissemination and implementation of the agenda among California African-American communities. American Indian, Asian/Pacific Islander, and Latino Task Forces have prepared similar documents, and each document will be used to prepare the Multiethnic Health Promotion Agenda for California. We summarize the process by which the papers were developed and provide detailed analysis of the African-American process.

Black or African American↗
PubMedDate not supplied

Analysis of the current status of public health practice in local health departments.

This article describes the performance by local health departments of core public health functions. A post hoc analysis based on these essential functions was implemented using the 1994 dataset from a cooperative project with the Centers for Disease Control and Prevention (CDC) and National Association of County and City Health Officials, which involved a survey of the nation's 2,888 local health departments. Applying guidelines for each functional area drafted by the Office of Disease Prevention and Health Promotion/Office of the Assistant Secretary for Health, CDC, and the Public Health Foundation in conjunction with the health officers in five states, a score was created for each core public health function: (1) health-related data collection, surveillance, and outcomes monitoring, (2) protection of environment, housing, food, and water, (3) investigation and control of diseases and injuries, (4) public information and education, (5) accountability and quality assurance, (6) laboratory services, (7) training and education, and (8) leadership, policy development, and administration. The individual and summary scores provide a mechanism to measure and describe the 2,079 local health departments' performance of these core functions and to examine their relationship to several characteristics and practices--planning, administrative units, annual total expenditures, and jurisdiction population size. This article shows that the core performance index is highest for the data function and for local health departments serving a population of 50,000 or more people. In addition, the performance index increases as budget increases and is greater for all eight functions in those local health departments using health planning models such as Assessment Protocol for Excellence in Public Health (APEX-PH), Planned Approach to Community Health (PATCH), Healthy People 2000, or Healthy Communities 2000. These results may be used to facilitate cooperation between local, state, and federal health agencies and the communities they serve; strengthen the core functions at the local, state, and federal levels; and improve public health practice.

Health Expenditures↗
PubMed2004

Adolescent immunizations. are we ready for a new wave?

CONTEXT: Factors associated with vaccination coverage rates for the 20% of U.S. adolescents enrolled in managed care organizations (MCOs) are not known. OBJECTIVES: To examine recent trends in receipt of two doses of measles-mumps-rubella (MMR2) and three doses of hepatitis B (Hep B3) among U.S. adolescents enrolled in managed care organizations (MCOs); to determine whether specific characteristics of MCOs are associated with higher vaccination rates; and to assess the impact of state middle school immunization requirements on these rates. DESIGN: Longitudinal (1996-1999) and cross-sectional (1999) analyses of National Committee for Quality Assurance (NCQA) data to estimate adolescent vaccination coverage rates for MMR2 and Hep B3. In 2002, using 1999 data only, a cross-sectional analysis examined the relationship of specific plan characteristics and state immunization laws with immunization coverage. MAIN OUTCOME MEASURES: Percentage of 13 year olds in MCOs with documented receipt of MMR2 and Hep B3. RESULTS: From 1996 to 1999, MMR2 rates increased from 56% to 64%, and from 1997 to 1999, Hep B3 rates increased from 23% to 38%. By 1999, higher rates for both vaccines had been achieved in larger plans (p<0.001 and p<0.003 for MMR2 and Hep B3, respectively), those with the highest NCQA accreditation status (p<0.003), those in New England (p<0.001), and those in states with middle school immunization requirements (p<0.001). CONCLUSIONS: Despite encouraging increases, adolescent immunization rates are significantly below the Healthy People 2010 goal of 90%. State laws and accreditation incentives are effective. Research is needed to identify additional interventions to increase vaccination coverage in the adolescent population.

Accreditation↗
PubMed2003

Addressing current challenges to cardiac rehabilitation care.

Cardiac rehabilitation, the structured programming of exercise and risk reduction teaching and counseling to promote healthy living with heart disease, is grounded in a strong nurse-patient relationship. This relationship provides a foundation for meeting current healthcare challenges. Three challenges are presented and addressed through specific examples. The challenge of the changing cardiac rehabilitation population is addressed through the example of the heart failure patient. The challenge to create innovative programming is addressed through the example of the Therapeutic Rehabilitative Intensive Program, developed to meet the needs of people who live in communities without cardiac rehabilitation services. The challenge to measure outcomes is addressed through the example of choosing a blood pressure measurement method. In addressing each challenge, the role of the advanced practice nurse is described.

Blood Pressure↗
PubMed2004

Cardiovascular risks in firefighters: implications for occupational health nurse practice.

Limited cardiovascular risk data are available for firefighters. This cross sectional study of data collected during annual physical examinations described the prevalence of cardiovascular risk factors among firefighters (N = 200) and examined relationships between body mass index (BMI) and other cardiovascular risk factors. Evidence based guidelines were used to determine prevalence of cardiovascular risk factors and Framingham risk scoring was used to estimate probability of coronary heart disease (CHD). Firefighters ranged in age from 22 to 64 with a mean of 41. The prevalence of obesity, elevated total cholesterol, and elevated blood pressure in firefighters exceeded Healthy People 2010 targets. In addition, their prevalence of obesity, low high density lipoprotein (HDL), high low density lipoprotein (LDL), and high total cholesterol levels was higher relative to the general population. Elevated body mass index (BMI) values had positive significant (p < or = .01) associations with elevated blood pressures, triglycerides, and glucose levels, and a negative significant (p < .05) association with lower HDL cholesterol levels. Fire department worksite health and fitness policies and programs should proactively target firefighters' cardiovascular risks. Future firefighter related intervention research will benefit from considering not only the individual determinants of cardiovascular disease, but also the ecological framework that includes the influences of workplace and external environmental factors.

Adult↗
PubMedDate not supplied

Healthy People 2000.

Healthy People 2000 marks the continuation of a national public-private initiative whose aim is to improve the health status of Americans, reduce the risks of preventable death and disease, and improve health care services. This initiative is outlined here for Pediatric Nursing readers.

Adolescent↗
PubMedDate not supplied

[Motor activity--healthy development--aging successfully?].

Human science has re-discovered the human body. We hardly realize, however, how much a person really depends on his body. This article intends to make evident how the close relationship between motor activity, feeling, thinking, and social behavior can be utilized for the healthy development of young people and for keeping fit and healthy in old age. Examples from the fields of therapy and rehabilitation illustrate the working of motor activity when there are physical, psychic, and social deficiencies. If sports for the elderly is practiced in order to improve the process of successfully aging, we have to reconsider this subject, and we must integrate sports for the elderly into health routines. This will challenge physical education teachers and exercise program directors and they should prepare for the future.

Adult↗
PubMed1985

Age-related changes in lymphocyte subset proportions, surface differentiation antigen density and plasma membrane fluidity: application of the eurage senieur protocol admission criteria.

Peripheral blood lymphocytes from 260 "apparently healthy" males and females, aged 20-97, have been investigated for age-related changes in a number of immunological parameters (percent and number of lymphocytes, OKT 4+ and OKT 8+ cells; OKT 4/8 ratio; intensity of fluorescence of OKT 4 and OKT 8 stained cells; membrane fluidity). Data were then reassessed after exclusion of people who did not conform to the SENIEUR PROTOCOL admission criteria of EURAGE (European Economic Community's Concerted Action Program on Aging) in order to investigate whether the differences observed were attributable to underlying disease. A slight decrease in the number and percentage of lymphocytes, OKT 4+ and especially OKT 8+ cells was found. Intensity of fluorescence of OKT 4 and OKT 8 stained cells from the elderly was reduced and may explain the lower percentages. Membrane fluidity was decreased in old persons (over the age of 75); the free cholesterol/phospholipid molar ratio in the serum increased up to the age of 75 and then declined, and it did not correlate with decreased membrane fluidity. Exclusion of the 20-60% of the study groups who were not eligible for admission according to the SENIEUR PROTOCOL criteria did not affect these results. The feasability and applicability of the PROTOCOL is discussed.

Adult↗
PubMed1998

The first clinical and epidemiological programme on renal disease in Bolivia: a model for prevention and early diagnosis of renal diseases in the developing countries.

BACKGROUND: The prevalence and incidence of renal diseases in developing countries are not known. This lack of knowledge is an obstacle to the adoption of preventive measures which may be of great value in a social and economic environment where treatment options for end-stage renal failure are simply not available to the vast majority of the population. Urinalysis, a simple and inexpensive test, remains a cornerstone in the evaluation of the kidney and may also be easily employed in mass screening for renal abnormalities in a developing country. METHODS: An educational campaign on renal diseases was conducted in three selected areas of Bolivia. Urine samples were collected and sent to one of 21 participating clinical centers. Fresh urine specimens were screened using a dipstick for chemical analysis and by microscopic urinalysis after centrifugation. In those patients in whom urinary abnormalities were found, further investigations were carried out in order to define the diagnosis; these patients were enrolled in a 3-year follow-up program. RESULTS: Apparently healthy subjects (n = 14,082) were referred to the First Clinical and Epidemiological Program of Renal Diseases from rural and metropolitan areas in Bolivia. Urinary abnormalities were detected in 4261 subjects at first screening. The most common form of urinary abnormality was hematuria, which was found in 2010 (47% of positively screened subjects). Other renal abnormalities were leukocyturia (41%) and proteinuria (11%). Confirmatory tests and further clinical studies were then carried out in 1019 people. On a second screening 35% of the subjects had no urinary abnormalities; in the remaining people the following diagnosis were made: asymptomatic urinary-tract infection (48.4%), isolated benign hematuria (43.9%), chronic renal failure (1.6%), renal tuberculosis (1.6%). Other diagnosis were: renal stones 1.3%, diabetic nephropathy 1% and polycystic kidney diseases 1.9%. CONCLUSIONS: This study helped define for the first time the frequency of asymptomatic renal diseases in Bolivia. It shows that it is possible to screen a large population of patients at relatively low cost, providing the framework for further action that may help in the prevention and timely diagnosis of renal diseases.

Adolescent↗
PubMed2002

Twenty-four-Hour blood pressure variability after acute ischemic stroke.

In people who are healthy, circadian rhythm in blood pressure is well established, with a 10% to 20% decrease in systolic and diastolic blood pressure during nighttime. Deviations correlate with target organ disease such as left ventricular hypertrophy, retinopathy, renal disease, and stroke. Little is known about blood pressure and circadian patterns in stroke patients. This study examined 13 patients hospitalized after ischemic stroke and monitored 24-hour blood pressure with ambulatory blood pressure monitors programmed tocollect readings every 30 minutes. All subjects had an abnormal pattern in blood pressure that did not dip during nighttime. Blood pressure load, a reported indicator of risk for target organ damage, was exceeded in all subjects during daytime and nighttime. Thus stroke patients are at high risk for target organ disease including recurrent stroke. Hypertensive management of stroke patients requires further investigation.

Age Factors↗
PubMed2003

Characteristics of teenage mothers and predictors of breastfeeding initiation in the Michigan WIC Program in 1995. Women, Infants, and Children.

Although breast milk is recommended as the optimal source of infant nutrition, breastfeeding initiation is below recommended levels, especially among teenage mothers. Breastfeeding initiation rates among Michigan (US) teenage mothers (12-19 y) were compared by demographics and health behaviors. Multivariate analyses determined which factors were significant independent predictors of breastfeeding initiation among teenage mothers enrolled prenatally in the Michigan Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program in 1995. Significant predictors independently associated with breastfeeding initiation were race/ethnicity, education, marital status, postpartum anemia status, parity, prenatal trimester of WIC enrollment, and smoking. The strongest predictor of breastfeeding initiation differed for white mothers (positive predictor: education beyond high school [OR = 3.13]) and black mothers (negative predictor: multiparous [OR = 0.25]). Initiation rates for this population of teenage mothers fall below the national average for mothers of all ages and the US Healthy People 2010 goals. Research is needed concerning how breastfeeding support and education can be improved to reach the US national health goals.

Adolescent↗
PubMed1995

Is there a pathology of prevention? The implications of visualizing the invisible in screening programs.

The preventive orientation that has been gaining ground in Sweden is indicative of ways in which our society is organized to sustain values like "a healthy life," "a healthy body," and "a healthy society." Search for health dangers and risks shows how medical technology has been integrated with our thinking about health. Preventive language, like all language of medicine, besides describing a pre-existing biological reality, creates in the process its own objects of analysis. This also has an impact and influences how lay people experience their bodies. The study presented focuses on one form of prevention in an attempt to describe how the ambition to secure a healthy society, through the detection of early disease, may have the opposite effect. Medical health-care ambitions in screening for cholesterolaemia will be related to implications for a group of men in whom cholesterol was found to be elevated. The men feel healthy yet are in some sense diseased. This raises the issue of visualizing the invisible in health care and the implications of such a process for the patients concerned.

Adult↗
PubMedDate not supplied

What's new: the AHCPR guideline update on urinary incontinence.

The Agency for Health Care Policy and Research (AHCPR) released their first updated guideline in March, 1996. Three documents were released: the Clinical Practice Guideline, Urinary Incontinence in Adults: Acute and Chronic Management; the Quick Reference Guide, Managing Acute and Chronic Urinary Incontinence; and the Patient Guide, Understanding Incontinence. The new areas are outlined and addressed. Unlike the 1992 version, the update emphasizes the problem of urinary incontinence (UI) in a specific population, those with chronic "intractable" incontinence. It provides an algorithm in the Quick Reference Guide for selecting appropriate behavioral, pharmacologic, and surgical treatments and supportive devices for use in managing UI. The concept of "prevention" of UI and the promotion of healthy bladder habits is introduced. The updated guideline developed recommendations for each assessment and treatment method. Specific interventions that can impact individuals with chronic "intractable" incontinence are discussed including toileting assistance programs, physical and environmental alterations, fluid and dietary management, management of nighttime voiding, and other measures and supportive care. Skin care and social and organizational environmental factors are also discussed. In August, 1996 the AHCPR released two additional, original documents, the Caregiver Guide, Helping People with Incontinence, and Alert for Directors of Nursing, which are briefly discussed.

Aged↗
PubMed2002

Racial differences in prenatal care use in the United States: are disparities decreasing?

OBJECTIVES: We examined trends and racial disparities (White, African American) in trimester of prenatal care initiation and adequacy of prenatal care utilization for US women and specific high-risk subgroups, e.g., unmarried, young, or less-educated mothers. METHODS: Data from 1981-1998 US natality files on singleton live births to US resident mothers were examined. RESULTS: Overall, early and adequate use of care improved for both racial groups, and racial disparities in prenatal care use have been markedly reduced, except for some young mothers. CONCLUSIONS: While improvements are evident, it is doubtful that the Healthy People 2000 objective for prenatal care will soon be attained for African Americans or Whites. Further efforts are needed to understand influences on and to address barriers to prenatal care.

Adolescent↗
PubMed2006

Outcomes of a multifaceted physical activity regimen as part of a diabetes self-management intervention.

BACKGROUND: Physical activity (PA) is important for management of diabetes, yet practical interventions that achieve sustained behavior change are rare. PURPOSE: The goals of this research were to evaluate the effectiveness of a multifaceted PA intervention for people with type 2 diabetes that emphasized participant choice in activity selection. Baseline activity patterns were examined to determine whether they predicted changes in PA at 2 months. METHODS: Three hundred thirty-five participants were recruited from 42 primary care physicians and then randomized to either a computer-assisted, tailored self-management intervention (N = 174) or health risk appraisal with feedback control (N = 161). Primary outcome measures included the Community Healthy Activities Model Program for Seniors Questionnaire, diet, and psychosocial assessments at baseline and 2 months. RESULTS: For 301 participants who completed the 2-month follow-up, the intervention significantly improved all PA (p < .01) and moderate PA (metabolic equivalents > 3.0, p < 01) relative to controls. Baseline cluster analyses grouped participant activity patterns into three categories. At 2 months, cluster assignment differentially predicted change in calories expended in moderate, rote, sport, and lifestyle PA. CONCLUSIONS: A computer-assisted, multifaceted approach to PA demonstrated improvement after 2 months. The results suggest that individuals are capable of adjusting their activity patterns to maximize their PA.

Choice Behavior↗
PubMedDate not supplied

Health of the chronically mentally ill who rejoin the community: a community assessment.

This article describes findings from a community assessment project on 25 chronically mentally ill individuals who rejoined the community following discharge from psychiatric hospitals. The focus was to identify health concerns or problems and health promotion patterns using Healthy People 2000 as a guiding framework. Findings suggest that most participants found relocation to the community easy. Stress, depression, and abuse were mental health problems reported by participants. Physical health problems included high tobacco use, low exercise level, poor oral health, high-risk sexual behavior, and limited contact with physicians and dentists. Health promotion activities were good sleeping behavior, limited use of alcohol and drugs, and a strong interest in participating in health promotion programs including exercise, stress management, and smoking cessation programs. Interventions to promote the health of the chronically mentally ill and implications for community mental health nurses are discussed.

Adult↗
PubMed2006

Recommendations to improve preconception health and health care--United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care.

This report provides recommendations to improve both preconception health and care. The goal of these recommendations is to improve the health of women and couples, before conception of a first or subsequent pregnancy. Since the early 1990s, guidelines have recommended preconception care, and reviews of previous studies have assessed the evidence for interventions and documented the evidence for specific interventions. CDC has developed these recommendations based on a review of published research and the opinions of specialists from the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. The 10 recommendations in this report are based on preconception health care for the U.S. population and are aimed at achieving four goals to 1) improve the knowledge and attitudes and behaviors of men and women related to preconception health; 2) assure that all women of childbearing age in the United States receive preconception care services (i.e., evidence-based risk screening, health promotion, and interventions) that will enable them to enter pregnancy in optimal health; 3) reduce risks indicated by a previous adverse pregnancy outcome through interventions during the interconception period, which can prevent or minimize health problems for a mother and her future children; and 4) reduce the disparities in adverse pregnancy outcomes. The recommendations focus on changes in consumer knowledge, clinical practice, public health programs, health-care financing, and data and research activities. Each recommendation is accompanied by a series of specific action steps and, when implemented, can yield results within 2-5 years. Based on implementation of the recommendations, improvements in access to care, continuity of care, risk screening, appropriate delivery of interventions, and changes in health behaviors of men and women of childbearing age are expected to occur. The implementation of these recommendations will help achieve Healthy People 2010 objectives. The recommendations and action steps are a strategic plan that can be used by persons, communities, public health and clinical providers, and governments to improve the health of women, their children, and their families. Improving preconception health among the approximately 62 million women of childbearing age will require multistrategic, action-oriented initiatives.

Female↗
PubMed2003

Cost-benefit evaluation of routine influenza immunisation in people 65-74 years of age.

OBJECTIVES: To determine the cost-effectiveness of influenza vaccination in people aged 65-74 years in the absence of co-morbidity. DESIGN: Primary research: randomised controlled trial. SETTING: Primary care. PARTICIPANTS: People without risk factors for influenza or contraindications to vaccination were identified from 20 general practitioner (GP) practices in Liverpool in September 1999 and invited to participate in the study. There were 5875/9727 (60.4%) people aged 65-74 years identified as potentially eligible and, of these, 729 (12%) were randomised. INTERVENTION: Participants were randomised to receive either influenza vaccine or placebo (ratio 3:1), with all individuals receiving pneumococcal vaccine unless administered in the previous 10 years. Of the 729 people randomised, 552 received vaccine and 177 received placebo; 726 individuals were administered pneumococcal vaccine. MAIN OUTCOME MEASURES AND METHODOLOGY OF ECONOMIC EVALUATION: GP attendance with influenza-like illness (ILI) or pneumonia (primary outcome measure); or any respiratory symptoms; hospitalisation with a respiratory illness; death; participant self-reported ILI; quality of life (QoL) measures at 2, 4 and 6 months post-study vaccination; adverse reactions 3 days after vaccination. A cost-effectiveness analysis was undertaken to identify the incremental cost associated with the avoidance of episodes of influenza in the vaccination population and an impact model was used to extrapolate the cost-effectiveness results obtained from the trial to assess their generalisability throughout the NHS. RESULTS: In England and Wales, weekly consultations for influenza and ILI remained at baseline levels (less than 50 per 100,000 population) until week 50/1999 and then increased rapidly, peaking during week 2/2000 with a rate of 231/100,000. This rate fell within the range of 'higher than expected seasonal activity' of 200-400/100,000. Rates then quickly declined, returning to baseline levels by week 5/2000. The predominant circulating strain during this period was influenza A (H3N2). Five (0.9%) people in the vaccine group were diagnosed by their GP with an ILI compared to two (1.1%) in the placebo group [relative risk (RR), 0.8; 95% confidence interval (CI) = 0.16 to 4.1]. No participants were diagnosed with pneumonia by their GP and there were no hospitalisations for respiratory illness in either group. Significantly fewer vaccinated individuals self-reported a single ILI (4.6% vs 8.9%, RR, 0.51; 95% CI for RR, 0.28 to 0.96). There was no significant difference in any of the QoL measurements over time between the two groups. Reported systemic side-effects showed no significant differences between groups. Local side-effects occurred with a significantly increased incidence in the vaccine group (11.3% vs 5.1%, p = 0.02). Each GP consultation avoided by vaccination was estimated from trial data to generate a net NHS cost of 174 pounds. CONCLUSIONS: No difference was seen between groups for the primary outcome measure, although the trial was underpowered to demonstrate a true difference. Vaccination had no significant effect on any of the QoL measures used, although vaccinated individuals were less likely to self-report ILI. The analysis did not suggest that influenza vaccination in healthy people aged 65-74 years would lead to lower NHS costs. Future research should look at ways to maximise vaccine uptake in people at greatest risk from influenza and also the level of vaccine protection afforded to people from different age and socio-economic populations.

Aged↗