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PubMed1995

Impact of attitudes on maternal decisions regarding infant feeding.

It is essential that physicians and other health care professionals seeking to increase the rate of initiation and duration of breast-feeding build on the body of information concerning factors that influence a woman's attitudes about breast-feeding. The relation between positive attitudes concerning breast-feeding and its initiation is important to the development of programs targeting women before they become pregnant, and to the provision of active support for breast-feeding throughout the pregnancy, perinatal, and postnatal period. However, it is not sufficient for these programs to target only the mother or potential mother; members of a woman's social network must be considered as information targets. Educational programs must also be directed to the appropriate racial or ethnic group to develop programs that reach the individuals (father, female relative, or friend) most likely to influence the mother's breast-feeding decision. Physicians may be very knowledgeable about the nutritional and immune properties of human milk and yet not be supportive of the act of breast-feeding. This lack of support may be manifested by the lack of verbal support for women who intend to or are in the process of breast-feeding, the provision of infant formula before or at the time of birth of the baby, or encouragement to terminate breast-feeding should the mother encounter any difficulties with lactation. To increase physician awareness of the process of breast-feeding and the properties of human milk, information about the benefits should be integrated in both the basic science and the clinical curricula of medical schools. Primary care training programs, including obstetrics, should actively involve trainees in the management of breast-feeding women so that trainees become aware of the spectrum of circumstances that confront women seeking to establish and maintain successful breast-feeding. This type of involvement would provide a contextual base for physicians' understanding the attitudes and behaviors supportive of breast-feeding. Attitudes and behavior of women, although more complex then demographic factors, provide a powerful tool for meeting the Healthy People 2000 goals for the initiation and duration of breast-feeding. It is important to build on the base of research reviewed here to develop new and and more powerful interventions. Thus the emphasis on the known health advantages of human milk or the discovery of additional health benefits of breast-feeding should continue to be discussed because they may tip the balance in favor of breast-feeding for some women. Nevertheless, it may ultimately be more important to increase the amount of information provided to women (and girls and boys) about the practical aspects of the breast feeding process (e.g., ease of night feeding, fathers ability to feed mother's milk by bottle, lower cost, strategies to control leaking) then to rely solely on the positive health outcomes related to breast-feeding.

Adult↗
PubMedDate not supplied

The scholars' nursery.

There has never been a more critical time for the development of cadres of younger, better-prepared nurse researchers. The following 3 current factors underscore this need: the current and prolonged nursing shortage that affects practice, research, and teaching; the increased emphasis on health promotion, disease prevention, and reduction in health disparities as articulated in Healthy People 2010; and the renewed effort to advance the image of nursing as an intellectual as well as compassionate enterprise. There are a limited number of institutions equipped to prepare these nurse scholars with undergraduate and graduate education and postdoctoral training in an accelerated manner, to provide mentoring throughout their education by funded faculty researchers, and to protect the focus of this career preparation and trajectory. Schools of nursing that have baccalaureate, master's, and doctoral programs and are highly ranked with respect to their National Institutes of Health funding have the opportunity and responsibility to create accelerated research-intensive tracks that link the baccalaureate through doctoral programs and move the graduates to postdoctoral training. These schools of nursing will have to identify which students to recruit and how the development of the research-intensive track will modify their schools' curricula and the institutions themselves. The profession will have to identify and create the environment that sanctions the legitimacy of scholars prepared in this way.

Curriculum↗
PubMed2003

Seasonal variation in insulin sensitivity in healthy elderly people.

OBJECTIVE: There is a seasonal variation in the incidence of diabetes mellitus and cardiovascular diseases. However, there is very little information about the seasonal variation in insulin sensitivity. We report the seasonal variation in insulin sensitivity in a group of elderly subjects followed for 1 y. METHODS: Healthy elderly (>/=70 y) subjects living independently were included. Fifty percent of subjects received a daily nutritional supplement that provided 400 kcal, 15 g of protein, and 50% of vitamin daily reference values (DRVs). Those receiving and not receiving supplements were randomly assigned to a resistance exercise training program. Every 6 mo (winter, summer, and winter), body composition was measured by dual-energy x-ray absorptiometry and blood samples were used to measure serum lipids, fasting and postprandial glucose, and insulin levels. RESULTS: One hundred eight subjects (31 supplemented and trained, 28 supplemented, 16 trained, and 33 without supplementation or training) completed the follow up. Higher homeostasis assessment of insulin sensitivity, postprandial insulin, and fasting triacylglycerol levels were observed during the summer than during the winter. Body fat increased steadily during the study period, and fat-free mass did not change. Serum low-density lipoprotein cholesterol decreased significantly in the supplemented and trained group and increased in the non-intervention group. CONCLUSIONS: In this group of elderly subjects, insulin resistance and triacylglycerol levels were higher during the summer. Nutritional supplementation and training had a positive effect on serum low-density lipoprotein cholesterol.

Absorptiometry, Photon↗
PubMed2001

Vision, visual needs, and quality of life of older people in rural environments: a report and synthesis of a meeting.

Vision as an aspect of rural aging was a major portion of the First International Conference on Rural Aging. Various perspectives on the relationship of vision to rural aging were presented in two symposia, two paper sessions, one workshop and the poster session (a total of 28 presentations). In summarizing this rich and varied material, the author emphasizes that: (a) vision is important to maintaining a healthy, active life as one ages; (b) impaired vision is generally preventable or treatable; (c) well-designed community programs can assist in prevention and treatment; and (d) assessing the effects of these programs requires evaluation of patients' quality of life. More research is needed to refine strategies for creating, maintaining and evaluating community-based eye care programs and integrating them with existing public health or other community programs.

Aged↗
PubMed2006

Physical activity and body functionality: implications for obesity prevention and treatment.

Physical activity promotes metabolic adaptations that improve body functionality and contribute to the prevention of some diseases. With respect to energy and fat balance, physical activity facilitates the equilibrium between energy intake and expenditure as well as between fat intake and fat oxidation. When combined with a healthy diet that favors satiety with a reduced energy intake, exercise can induce a substantial mass loss in obese individuals. However, even the impact of an exemplary lifestyle does not seem to have the potential to decrease body mass in obese individuals down to the mass range of lean people. Up to now, we have not been able to induce mass changes exceeding 12%-15% initial body mass in obese male subjects under tolerable exercise and dietary habits, and this moderate success was accompanied by modifications in appetite and energy expenditure susceptible to compromise subsequent mass stability. As described in this paper, many environmental factors can influence energy balance and the ability to lose body fat in response to a healthy diet and (or) physical activity program. Particular attention is given to preliminary data obtained in our laboratory that suggest that knowledge-based work does not favor the same potential mass reducing effects as physical work. In fact, the acute effects of knowledge-based work suggest that this work modality may be rather susceptible to promote a more pronounced positive energy balance compared with what we may expect from a sedentary relaxing activity. This is problematic for obesity prevention in the future since knowledge-based work now represents the main working modality in a context of modernity.

Animals↗
PubMed1998

Reducing automobile traffic: an urgent policy for health promotion.

In recent decades traffic injuries have become a leading cause of death and disability the world over. In congested urban areas, the noise and emissions from vehicle engines cause discomfort and disease. More than one billion people are exposed daily to harmful levels of atmospheric contamination. Because internal combustion generates carbon dioxide (CO2), the automobile is a principal contributor to the greenhouse effect, which has significantly raised the temperature of the atmosphere. Scientists anticipate that in coming decades the greenhouse effect will produce alterations in climate that are very likely to be harmful and possibly catastrophic. Meanwhile, burgeoning traffic and rural and urban highway infrastructures are already among the principal causes of environmental degradation. Urban development, because it is nearly always "planned" to accommodate automobiles rather than people, reduces the quality of life and tears the social fabric. In contrast to private automobiles, public transportation, bicycles, and walking produce little environmental contamination or injury-related morbidity and mortality. These modes of transport involve more physical activity, with its positive health effects, and avoid contributing to the greenhouse effect. The reduction of automobile traffic and substitution of alternative modes of transport are essential policies for health promotion. They should be incorporated in "healthy cities" programs and general economic policies.

Accidents, Traffic↗
PubMedDate not supplied

The competency of internists in holistic global care to support healthy Indonesia 2010.

All patients are entitled to good standards of practice and care from their doctors. The improved health of all peoples is the main goal of medical education, including for the education of internal medicine registrars. The future development of the direction and goal of education, the level of competence of internal medicine specialists, and the process of learning will be related to preparing the internal medicine specialist to have global competitive advantage. Identification of general competencies is the first step in a long-term effort designed to emphasize educational outcome, for assessment in residency programs, and in the accreditation process. To achieve that competence, a variety of learning opportunities need to be provided in order that the resident can achieve the necessary knowledge, skills, attitude, and behaviors. Identification of the role and function of internal medicine specialists is needed prior to the development of the general competencies. As educational objectives, the competencies fall into two main categories: knowledge-based and performance-based. Knowledge-based competency has two components, medical knowledge (bio-science and clinical medicine) and contextual knowledge (epidemiology, health service organization, and human behavior). The performance base has two components, intellectual skills and the interpersonal skills. Besides the two main categories of educational objectives, there are behavioral objectives that residents must achieve through the educational program, to ensure that residents are able to deal with a range of prescribed clinical situations effectively, safely, humanely, and economically. The achievement of behavioral objectives will ensure, at least in part, that the doctor will implement good medical practice. The index clinical/community situations (ICS) on which the educational objectives will be based are taken from diseases and illnesses that occur in clinical and community settings. No resident can master all medicine there is to know, as there are no limits to what can be known about medicine. It is important to make choices in selecting what residents should learn by analyzing the ICS.

Clinical Competence↗
PubMedDate not supplied

Putting prevention into practice.

One of the three broad goals of Healthy People 2000 is that preventive services will be available to all Americans. Although there is professional agreement on the merits of prevention, there are challenges related to implementing preventive health care. Six of these challenges are confusion in terminology, issues related to nursing autonomy and initiative, differing conceptual frameworks, complexity of coordination within a delivery system that does not reward preventive services, prevalent cultural beliefs, and lack of uniform recommendations regarding prevention. The Put Prevention into Practice (PPIP) program is a national strategy to address those challenges. The American Nurses Association and the American Academy of Nurse Practitioners contributed to the development of the PPIP program. These organizations are actively disseminating the information through train-the-trainer methodology and other educational programs that will prepare nurses to improve the health of the population through the provision of preventive health services.

American Nurses' Association↗
PubMed2006

Revisiting the metabolic syndrome.

Metabolic syndrome (MS) refers to the clustering of cardiometabolic risk factors - including abdominal obesity, hyperglycaemia, dyslipidaemia and elevated blood pressure - that are thought to be linked to insulin resistance. MS is associated with increased risk of cardiovascular disease and type 2 diabetes. MS is common, affecting a quarter to a third of adults, and its prevalence is rising, in parallel with increasing obesity and population ageing. Operational definitions of MS have been proposed by the World Health Organization and the National Cholesterol Education Program. Recently, the International Diabetes Federation proposed a global definition that emphasised the importance of central adiposity. In cardiovascular risk assessment, MS encapsulates the contribution of non-traditional risk factors and provides a clinically useful framework for early identification of people at increased long-term risk. It should be used in conjunction with standard algorithms based on conventional risk factors, which better predict short-term risk. Management of MS should emphasise lifestyle interventions (eg, physical activity, healthy diet and weight reduction) to reduce long-term risk of cardiovascular disease and diabetes. Those at increased short-term risk should also have individual risk factors treated according to established guidelines.

Cardiovascular Diseases↗
PubMed1997

Developing healthy local communities at local government level: lessons from the past decade.

There have been many approaches by the health sector to developing healthy communities based on local government areas in Australia in the past decade. Each has struggled with the need to establish realistic goals and to find ways of working more effectively with local government. This paper outlines four of these approaches--Healthy Cities, the Healthy Localities project, municipal health plans, and programs to address specific health problems or issues. Although the picture is one of huge diversity in the ways in which the issue is defined and action taken, a number of dimensions to a healthy community are emerging. However, if we are to be able to monitor change within and between the health of communities over time, indicators need to be developed and goals set. This will require a shift away from defining goals and targets in terms of populations (people), towards goals based on changes in organisations and systems. Engaging local government in this process will be vital and will require the health sector to develop a better understanding of the ways in which local government defines its role in creating healthy communities. It will also involve learning from local government the strategies that they have found most effective in dealing with complex problems that require action at many levels.

Australia↗
PubMedDate not supplied

Why girls smoke: a proposed community-based prevention program.

OBJECTIVES: To review the literature on reasons teenage girls start smoking and to identify the role and opportunities for nurses to have an impact on this public health problem. In addition, a proposed smoking prevention program targeted to teenage girls is presented. DATA SOURCES: Information was gathered from professional journals and texts and from MEDLINE and PROQUEST. Keywords used in the searches were smoking prevention, tobacco use, smoking and adolescents, teenage girls and smoking, health education and smoking, and smoking prevention programs. DATA SYNTHESIS AND CONCLUSIONS: Smoking initiation in teenage girls is a problem with ramifications for individual health as well as for public health. Although the literature demonstrates the rising incidence of smoking in teenage girls and evidence suggests the reasons girls start smoking differ from those of their male counterparts, a dearth of information on smoking prevention programs exists for this population. It is reasonable to assume that the best practices for adolescent smoking prevention can be applied to programs specifically for girls, along with efforts to address social influences, self-image, and self-esteem, which may be particularly important to teenage girls. The theory of reasoned action provides a framework for prevention strategies that target the behavioral beliefs and attitudes that influence teenage girls to smoke. Nurses can educate themselves about contributing factors that lead teenage girls to start smoking. Implementing this knowledge into nursing practice in a variety of settings could help meet the Healthy People 2010 goals of reducing teenage smoking to 16%.

Adolescent↗
PubMed2005

Texas' community health workforce: from state health promotion policy to community-level practice.

BACKGROUND: Imagine yourself in Texas as a newly arrived immigrant who does not speak English. What would you do if your child became ill? How would you find a doctor? When you find one, will the doctor speak your native language or understand your culture? In a state of approximately 22 million people, many Texas residents, marginalized by poverty and cultural traditions, find themselves in this situation. To help them, some communities across Texas offer the services of promotores, or community health workers, who provide health education and assist with navigating the health care system. CONTEXT: In 1999, Texas became the first state in the nation to recognize these workers and their contributions to keeping Texans healthy. This paper examines a state health promotion policy that culminated in a training and certification program for promotores and the impact of this program on the lay health education workforce in Texas. METHODS: In 1999, the Texas legislature established the 15-member Promotor(a) Program Development Committee to study issues involved in developing a statewide training and certification program. During its 2-year term, the committee met all six of its objectives toward establishing and maintaining a promotor(a) certification program. CONSEQUENCES: By the end of December 2005, it is estimated that there will be more than 700 certified promotores in Texas. State certification brings community health workers into the public health mainstream as never before. INTERPRETATION: Promotores, a community health safety net and a natural extension of the health and human services agencies, improve health at the neighborhood level. Certification brings renewed commitment to serving others and a distinction to those who have been the unsung heroes of public health for decades.

Community Health Services↗
PubMedDate not supplied

Serological study of rubella in pregnancy: two years of experience in Palermo (1984-1986).

A serological survey was carried out by means of an ELISA capture-immunoassay for IgM and by means of the haemagglutino-inhibition method or ELISA for IgG antibodies on 715 women in fertile age and on 12 patients suffering from rubella or rubella-like syndrome. Fetal serum samples were obtained at fetoscopy from 4 pregnant women at different gestational age. The overall results show that although the high percentage (greater than 80.0%) of anti-rubella positive women in fertile age in our country, 18 out of 54 women in pregnancy, having had contacts with people affected by rubella or rubella-like syndrome, showed a seroconversion for rubella virus. The outcome of the pregnancy in these patients is known for 11 cases only: six women decided for abortion, four had a normal baby and one, mother of twins, bore an apparently healthy child the other one being dead 4 hrs after the delivery owing to fetal respiratory distress. Conclude this study some considerations on the necessity to emphasize the opportunity for a mass vaccination program and on the importance for more than one serological test to discriminate among different rubella-like syndromes.

Adolescent↗
PubMed2004

Healthy living in Nunavut: an on-line nutrition course for inuit communities in the Canadian arctic.

OBJECTIVES: It is recognized that empowerment of Indigenous Peoples through training and education is a priority. The objective was to design a course that would provide an innovative training approach to targeted workers in remote communities and enhance learning related to the Nunavut Food Guide, traditional food and nutrition, and diabetes prevention. STUDY DESIGN: A steering committee was established at the outset of the project with representation from McGill University and the Government of Nunavut (including nutritionists, community nurses and community health representatives (CHRs), as well as with members of the target audience. Course content and implementation, as well as recruitment of the target audience, were carried out with guidance from the steering committee. METHODS: An 8-week long course was developed for delivery in January - March, 2004. Learning activities included presentation of the course content through stories, online self-assessment quizzes, time-independent online discussions and telephone-based discussions. Invitations were extended to all prenatal nutrition program workers, CHRs, CHR students, home-care workers, Aboriginal Diabetes Initiative workers and public health nurses in Nunavut. RESULTS: Ninety-six health-care workers registered for Healthy Living in Nunavut, with 44 actively participating, 23 with less active participation and 29 who did not participate. CONCLUSIONS: Despite having to overcome numerous technological, linguistic and cultural barriers, approximately 40% of registrants actively participated in the online nutrition course. The internet may be a useful medium for delivery of information to target audiences in the North.

Arctic Regions↗
PubMed2000

Hormonal and immunologic risk factors for the development of rheumatoid arthritis: an integrative physiopathogenetic perspective.

Evidence indicates that women who are susceptible to premenopausal onset of RA and men each have identifiable risk factors or risk markers long before onset of the clinical disease. Accordingly, further definition of such predictive factors promises to identify persons who are susceptible to developing RA during preclinical phases. Like coronary artery disease, once risks for developing RA can be reliably quantitated, research in primary prevention should become a realistic objective. Disease prevention objectives are central to the public health strategy of the National Arthritis Action Plan and the US Public Health Service "Healthy People 2000" plan (2010 plan also proposed). The decade of arthritis and musculoskeletal diseases (2000-2010) offers an incentive to nurture a new paradigm of RA prevention. Further research in neuroendocrine, immunologic, and microvascular risk factors for the development of RA promises to unravel its complex physiopathogenetic mechanisms and permit identification of persons who are at high risk for developing this disease. Successful research in identifying reliable risk factors (or markers) can be expected to lead to prevention strategies. Effective programs in identifying persons susceptible to RA could lead to earlier control measures and significantly reduce the enormous burden of this common disease, which affects all segments of the population.

Adolescent↗
PubMed2004

Health rights in secondary schools: student and staff perspectives.

This paper examines the perspectives of secondary school students and staff about the extent to which young people's health rights are catered for at school. The United Nations Convention on the Rights of the Child and the concept of Health-Promoting Schools encourage the provision of healthy school environments. A postal survey of secondary schools in New Zealand elicited responses from 821 Year 11 (15-16 year olds) students and 438 staff in 107 schools. Most students and staff reported that sources of health advice were available at their schools, but only a minority of students saw these sources as accessible or trustworthy. In every area of health promotion, students saw information and advice as less accessible than staff did. Most staff and students identified mental health problems such as depression as a source of concern in schools, but only a quarter of students (compared to half of staff) thought that this topic was covered during classtime. Students in lower-income schools reported the school environment as slightly less healthy than did students in high-income schools. The paper concludes that schools and policy makers should seek the voices and opinions of young people in order to improve effectiveness in catering for health rights.

Access to Information↗
PubMedDate not supplied

[Effects of exercise on anxiety, depression and mood].

This article reviews the studies on the effects of physical activity on the emotional states--anxiety, depression and mood. The meta-analyses of correlational and experimental studies reveal positive effects of exercise, in healthy people and in clinical populations (also in patients with emotional disorders) regardless of gender and age. The benefits are significant especially in subjects with an elevated level of anxiety and depression because of more room for possible change. The most improvements are caused by rhythmic, aerobic exercises, using of large muscle groups (jogging, swimming, cycling, walking), of moderate and low intensity. They should be conducted for 15 to 30 minutes and performed a minimum of three times a week in programs of 10-weeks or longer. The results confirm the acute effect of exercise i.e. the reductions in anxiety and depression after single sessions of exercise. The changes in anxiety, depression and mood states after exercise are explained most frequently by the endorphin and monoamine hypotheses. Exercise may also increase body temperature, blood circulation in the brain and impact on hypothalamic-pituitary-adrenal axis and physiological reactivity to stress. The possible psychological mechanisms include improvement of self-efficacy, distraction and cognitive dissonance.

Affect↗
PubMed1989

[The theoretical and organizational basis for the Comprehensive Program for Disease Prevention and Health Improvement of the Population].

The authors present a general characterization of a complex programme of disease prevention developed by the Ministry of health care, Academy of medical science and by other authorities of the USSR. At first, there is an outline of demographic and health state indicators of soviet population and of factors leading to morbidity increase. The major part of the paper deals with an analysis of the aims of this programme, i.e. air pollution control, improvement of social and medical care of working and child-bearing women, education of young people to a healthy life-style, health care of children and adolescents, reinforcement of health of young families, expanding and improvement of the recreation, sporting and cure facilities, propagation of mass-physical training, rationalization of nutrition, intensification of health education of citizens, dispensary care of population, and medical personnel education in the field of preventive medicine.

Health↗