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More than 400,000 deaths a year in the United States are attributed to active and passive tobacco smoke exposure. Healthy People 2000 objectives target a reduction in the tobacco use of high-risk populations such as youth and pregnant women. This article describes guidelines for health professionals to address smoking cessation when working with pregnant adolescents and teen mothers who smoke.
"As a consequence of diminished exercise tolerance, a large and increasing number of elderly people will be living below, at, or just above 'thresholds' of physical ability, needing only minor intercurrent illness to render them completely dependent" (Astrand, 1992, p. 1231S). The NP can play a crucial role in educating motivating, and encouraging geriatric clients to continue or initiate a fitness program. The exercise program that is prescribed by NPs for their patients "depends on their needs, goals, physical and health status, personal preference, and available time, equipment, and facilities" (Pollack et al., 1994, p. 588). Fitness is a goal for all geriatric patients, that they might remain healthy and physically fit longer, and therefore continue to lead active, fulfilling lives.
Sexually transmitted diseases (STDs) are serious public health concerns in many countries. One of the main strategies in prevention of STDs is training people who are at high risk for STDs. We aimed to train enlisted men in the Turkish Armed Forces while they served their compulsory military service because every healthy Turkish man has to complete this service and they are at high risk for STDs, as well. This study contains two main parts: trainer training and training of enlisted men. The target groups are health noncommissioned officer school students for the trainer training and enlisted men serving in a military medical academy for STD training. For both groups, we prepared and applied different training programs considering each group's knowledge needs on the topic. To describe knowledge needs, we administered a pretest on both groups. First, we trained candidate trainers, then they trained the enlisted men. We evaluated both programs comparing pre- and posttest results. In both programs, mean test scores of the groups increased significantly. Success levels of the groups also increased significantly after using a cutoff point for test scores. With respect to relative effectiveness, attributed effectiveness, and effectiveness ration, the trainers training program was more effective than the other. As a result, our approach to training enlisted men as young adults is effective. We should evaluate the limitations of the study and consider our experiences to make the program more effective.
The Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT) announces the availability of FY 1999 funds for the following activities. These activities are discussed in more detail under Section 3 of this notice. This notice is not a complete description of the activities; potential applicants must obtain a copy of the Guidance for Applicants (GFA) before preparing an application. (See table.) Note: SAMHSA also published notices of available funding opportunities for FY 1999 in subsequent issues of the Federal Register. The actual amount available for awards and their allocation may vary, depending on unanticipated program requirements and the volume and quality of applications. Awards are usually made for grant periods from one to three years in duration. FY 1999 funds for activities discussed in this announcement were appropriated by the Congress under Public Law No. 105-277. SAMHSA's policies and procedures for peer review and Advisory Council review of grant and cooperative agreement applications were published in the Federal Register (Vol. 58, No. 126) on July 2, 1993. The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of Healthy People 2000, a PHS-led national activity for setting priority areas. The SAMHSA Centers' substance abuse and mental health services activities address issues related to Healthy People 2000 objectives of Mental Health and Mental Disorders; Alcohol and Other Drugs; Clinical Preventive Services; HIV Infection; and Surveillance and Data Systems. Potential applicants may obtain a copy of Healthy People 2000 (Full Report: Stock No. 017-001-00474-0) or Summary Report: Stock No. 017-001-00473-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (Telephone: 202-512-1800).
The Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT) and the Center for Mental Health Services (CMHS) announce the availability of FY 1999 funds for the following activities. These activities are discussed in more detail under Section 4 of this notice. This notice is not a complete description of the activities; potential applicants must obtain a copy of the Guidance for Applicants (GFA) before preparing an application. (See table.) Note: SAMHSA also published notices of available funding opportunities for FY 1999 in subsequent issues of the Federal Register. The actual amount available for awards and their allocation may vary, depending on unanticipated program requirements and the volume and quality of applications. Awards are usually made for grant periods from one to three years in duration. FY 1999 funds for activities discussed in this announcement were appropriated by the Congress under Public Law No. 105-277. SAMHSA's policies and procedures for peer review and Advisory Council review of grant and cooperative agreement applications were published in the Federal Register (Vol. 58, No. 126) on July 2, 1993. The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of Healthy People 2000, a PHS-led national activity for setting priority areas. The SAMHSA Centers' substance abuse and mental health services activities address issues related to Healthy People 2000 objectives of Mental Health and Mental Disorders; Alcohol and Other Drugs; Clinical Preventive Services; HIV Infection; and Surveillance and Data Systems. Potential applicants may obtain a copy of Healthy People 2000 (Full Report: Stock No. 017-001-00474-0) or Summary Report: Stock No. 017-001-00473-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (Telephone: 202-512-1800).
OBJECTIVES: The purpose of this study was to assess blood pressure control and the determinants of uncontrolled blood pressure among African-American hypertensive patients. DESIGN: Baseline clinical data were collected as part of a nationwide hypertension quality improvement initiative. An analysis of determinants of uncontrolled blood pressure was conducted using logistic regression for the following variables: angina, congestive heart failure, coronary artery disease, diabetes, family history of cardiovascular disease or stroke, hyperlipidemia, left ventricular hypertrophy, and tobacco use. SETTING: 10 managed care/advanced physician organizations. PATIENTS: Pharmacy and medical claims covering 1,965,000 lives were reviewed and 292,996 members with a hypertension-related claim were identified between June 1, 1998 and July 1, 2001. A random sample (N = 5,935) was selected for chart review. The present analysis was conducted on the subset of African-American patients (N = 440) included in this sample. RESULTS: Approximately 66% of the African-American patients were female, the mean age was 60.4 years, 47.8% had dyslipidemia, and 31.4% had diabetes. Approximately 64% had uncontrolled hypertension. Patients with diabetes were 3 times more likely to have uncontrolled blood pressure as were patients without diabetes (OR = 2.92; P < .0001). CONCLUSIONS: Blood pressure control in the African-American population is lower than the Healthy People 2010 goal of 50%. African Americans with hypertension and diabetes are at an increased risk for uncontrolled blood pressure. Treating this high-risk population more aggressively may reduce long-term complications and decrease mortality.
On August 29-31, 2004, 84 academic and industry scientists from 16 countries gathered in Copper Mountain, Colorado USA to discuss certain issues at the forefront of the science of probiotics and prebiotics. The format for this invitation only meeting included six featured lectures: engineering human vaginal lactobacilli to express HIV-inhibitory molecules (Peter Lee, Stanford University), programming the gut for health (Thaddeus Stappenbeck, Washington University School of Medicine), immune modulation by intestinal helminthes (Joel Weinstock, University of Iowa Hospitals and Clinics), hygiene as a cause of autoimmune disorders (G. A. Rook, University College London), prebiotics and bone health (Connie Weaver, Purdue University) and prebiotics and colorectal cancer risk (Ian Rowland, Northern Ireland Centre for Food and Health). In addition, all participants were included in one of eight discussion groups on the topics of engineered probiotics, host-commensal bacteria communication, 'omics' technologies, hygiene and immune regulation, biomarkers for healthy people, prebiotic and probiotic applications to companion animals, development of a probiotic dossier, and physiological relevance of prebiotic activity. Brief conclusions from these discussion groups are summarized in this paper.
In a Psycholgeriatric Assessment Program, the statistical evaluation of clinical and laboratory data related to thyroid function in 80 patients led to the conclusion that: 1) differences in thyroid function between psychogeriatric patients of the organic and functional types were only slight, as determined by clinical symptoms and thyroxine blood levels, and 2) factor analysis for 53 selected variables indicated that loading for "gross disturbance of psychobiologic function" may be related to the symptom complex of hyperthyroidism/hyperadrenergism, and particularly to psychobiologic symptoms rather than purely somatic symptoms of hyperthyroidism. In comparison with a group of 60 healthy old people, the psychogeriatric patients showed many more signs of hyperactivity and other characteristics of this symptom complex. The results supported the preliminary impression of an energetic (hyperthyroid-sympathicotonic) reaction to mental decline, accompanied by plasma corticosteroid and electroencephalographic changes.
The Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services (CMHS) announces the availability of FY 1999 funds for the following activity. This activity is discussed in more detail under Section 4 of this notice. This notice is not a complete description of the activity; potential applicants must obtain a copy of the Guidance for Applicants (GFA) before preparing an application. (See table.) Note: SAMHSA also published notices of available funding opportunities for FY 1999 in subsequent issues of the Federal Register. The actual amount available for awards and their allocation may vary, depending on unanticipated program requirements and the volume and quality of applications. Awards are usually made for grant periods from one to three years in duration. FY 1999 funds for the activity discussed in this announcement were appropriated by the Congress under Public Law no. 105-277. SAMHSA's policies and procedures for peer review and Advisory Council review of grant and cooperative agreement applications were published in the Federal Register (Vol. 58, No. 126) on July 2, 1993. The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of Healthy People 2000, a PHS-led national activity for setting priority areas. The SAMHSA Centers' substance abuse and mental health services activities address issues related to Healthy People 2000 objectives of Mental Health and Mental Disorders; Alcohol and Other Drugs; Clinical Preventive Services; HIV Infection; and Surveillance and Data Systems. Potential applicants may obtain a copy of Healthy People 2000 (Full Report: Stock No. 017-001-00474-0) or Summary Report: Stock No. 017-001-00473-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (Telephone: 202-512-1800).
Community pharmacies in the UK are an excellent setting for health promotion in the community; they see over 90% of the population per year. Pharmacy education and training is changing and health promotion is now part of the undergraduate curriculum. There is an increasing body of research about the effects of pharmacy health promotion and a number of examples of good practice. The UK research is reviewed and examples of good practice highlighted. The paper concludes with a discussion about the contribution of pharmacists can make and about some of the issues that will need to be overcome first. Pharmacists see healthy as well as sick people. They have a special relationship with many of their regular customers which enables them to promote health, they can also give population messages to passing trade. A number of issues such as training and remuneration must be addressed before health promotion becomes fully integrated into the pharmacist's role.
INTRODUCTION: In the State of Victoria in Australia, diabetes is considered one of the top 10 health problems for people living in the rural Mallee Track region (which is centred on the town of Ouyen and extends west to the border with South Australia). A project entitled 'Diabetes Management Along the Mallee Track' was conducted through a Rural Chronic Disease Initiative (RCDI) program grant from the Australian Government's Department of Health and Ageing, Canberra, with the aim of improving the delivery of diabetes services in this region. The project's aims were achieved through the implementation of a community risk assessment program and the establishment of an integrated, multidisciplinary 'one-stop' service for the management of people with diabetes. The use of on-site point-of-care (POC) pathology testing equipment was the key component of both arms of the project. METHODS: Community risk assessment sessions were held in seven towns across the Mallee Track region using a local settings approach. Risk assessment included POC pathology testing for glucose and lipids, as well as blood pressure, age, personal and family history of diabetes, smoking status, and self-assessed weight and level of exercise. The multidisciplinary 'one-stop' service for the management of people with diabetes involved having a single appointment with their local GP, during which time they met the local diabetes educator and podiatrist as well as the GP, and on-site POC testing (POCT) performed for haemoglobin A1c (HbA1c), urine albumin : creatinine ratio (ACR), lipids and glucose. A written survey was conducted among patients with diabetes, local GPs and local health professionals to assess the level of satisfaction with the project and the use of POCT, and to assist policy development for the future planning and development of diabetes services along the Mallee Track region. RESULTS: Risk assessment: 320 adults were assessed for their risk of diabetes during community sessions (representing approximately 20% of the adult population of the region). Two-thirds of people tested had equivocal random blood glucose levels (5.1-11.0 mmol/L), while hypertension and high cholesterol were found in more than one-third. Management of established diabetes: 49 people with known, established diabetes were initially entered into a Central Diabetes Register (with 5 more joining the register since). These diabetes patients (n = 54) have now been monitored by POCT for a mean of 10 months (range 3-18 months). Since the introduction of the 'one-stop shop', the percentage of persons achieving optimal glycaemic control (HbA1c <7%) has increased by 30% (from 33% to 63%), the percentage achieving controlled glycaemia (HbA1c < 8%) has increased by 32% (59% to 91%), while the number exhibiting poor control has reduced by 7% (13% to 6%). The mean HbA1c has fallen from 7.6% at the commencement of the program to 7.1% (p = 0.03, paired t-test). Falls in cholesterol and blood pressure were also observed. Satisfaction with new management services for diabetes: 36 patients with diabetes (73% of all known diabetes patients in the region at the time) completed satisfaction questionnaires. There was overwhelming support within this group for the use of POCT as part of their management, because it was convenient, encouraged self-management and enhanced doctor-patient relationships. The proportion of patients with diabetes who were satisfied/very satisfied with the available diabetes services was significantly greater following the introduction of the project (before: n = 18 (64%), after: n = 29 (91%), chi2 = 6.10, p = 0.01). Doctors agreed that the immediate availability of POCT results at the time of consultation was convenient for them, contributed positively to patient compliance and improved their relationship with the patient. Health professionals felt confident in using the POC analysers and believed the program had raised community awareness about diabetes and enhanced community ownership. CONCLUSION: Point-of-care pathology testing has enabled the introduction of a community-friendly risk assessment program for diabetes and provided a convenient and rapid service for monitoring the control of diabetes in people with established disease in the Victorian Mallee Track region. The number of diabetes patients accessing diabetes services has more than doubled since the introduction of the program. All community and health professional groups surveyed agreed that the POC model delivered as part of this project should be available to all people throughout the Mallee Track region. The model, although conducted in a small rural community, has the potential to form a suitable template for the broader introduction of POCT services for diabetes in rural and remote communities across Australia. As an independent measure of the success of the program, the Australian Government's Department of Health and Ageing selected the Diabetes Management Along the Mallee Track project as one of three demonstration projects from the RCDI grants for showcasing to all rural health services in Australia through the production of an education resource called 'Building Healthy Communities'.
Catholic healthcare's mission is keeping people healthy, and providers must listen closely to determine their needs in these fast-paced, stressful times. In a society preoccupied with technology and acute care, which has the least overall impact on people's health, providers must implement more preventive strategies. The shift to promoting community health will require diverse, creative approaches. Catholic facilities must offer holistic healing, becoming community resources for children and the elderly. Religious institutes also must prepare for the laity's increasing role in the ministry. Providers must develop initiatives that define Catholic healthcare, such as the Welfare-to-Work Program in St. Louis, which offers women employment opportunities and benefits as a starting point to gain control of their lives. With increased school collaboration, nurses can help children develop good health habits. The guiding vision must be the health of the whole person and the community. Catholic providers must restore public trust and confidence by emphasizing person-centered healthcare. Only by becoming an integral part of the community can Catholic healthcare make a difference in people's lives.
Signal detection methodology was used to identify the best combination of predictors of long-term exercise adherence in 269 healthy, initially sedentary adults ages 50-65 years. Less educated individuals who were assigned to supervised home-based exercise of either higher or lower intensity and who were less stressed and less fit at baseline than other individuals had the greatest probability of successful adherence by the 2nd year. Overweight individuals assigned to a group-based exercise program were the least likely to be successful 2 years later. Predictors of short-term (1-year) adherence were generally similar to predictors of 2-year adherence. Signal detection analysis may be useful for identifying subgroups of people at risk for underadherence who subsequently might be targeted for intervention.
The Healthy Directions-Small Business randomized, controlled study aimed to reduce cancer risk among multiethnic workers in small manufacturing businesses by increasing fruit and vegetable consumption, physical activity, and daily multivitamin in take and decreasing consumption of red meat. The intervention incorporated participatory strategies and was built on a social-contextual framework that addressed people with varying cultural backgrounds and literacy levels. In addition, the intervention aimed to reduce worker exposure to occupational hazards. Process evaluation was conducted using quantitative and qualitative research methods. Quantitative results showed high levels of worker awareness of and participation in programs. Qualitative findings suggested that management support, worker input, and a history of social interaction between workers and management may have contributed to high participation rates. Future studies need to examine characteristics associated with participation and nonparticipation of both managers and nonmanagers to increase the likelihood of participation and ultimately improve health behavior.
Cervical cancer is still called the most frequent neoplasm refer to women's genital tract (incidence rate 30-35/100,000/year). Scandinavian countries experiences have shown that effective screening program especially used multimedia (radio, TV, Internet) is one of the based elements, which should improve situation in prevention of cervical cancer. The aim of this study was an attempt to create medical Website including specialized and basic informations for doctors and patients about cervical and breast cancer, their prophylactic and treatment. An influence of these data to increase active participation in screening program was also analysed. Material covers a random sample of 1200 women (30-59 years of age) who were invited to participate in cytology screening in two edition of the program (1997-99, 2000-02). In the years of 2000-02 information about Website was added to the invitation. Medical Website was created as server information. A special questionnaire prepared by Sociology Department was distributed to 1200 women. In both group participation during two screening edition was compared and analysed. All data were statistically correlated. Website address was created: http://pkzr.ac.bialystok.pl. From the group of 1200 questioned (mean age--41.8) answered 1059 women (88.25%). 6.98% (n=74) have never used this Website but 20 of them have done cytology test after receiving an invitation which were posted to all 1200 women. The last of 985 women analysed Website. 80.4% (n=792) have received enough informations about cervical and breast cancer (4.67 point) and decided to participate in cervical cancer screening. From this group only 428 women actively took part in cytology exams in 1997-99. 189 women participated in the screening programme from the last 193 patients (19.6%) who analysed server informations (4.89 point). From 141 people who have not answered for the questionnaire 23 have done cytology test. Participation in the second edition of cervical cancer screening programme (1997-99) was 41.9%. It was really two times lower than in the same group who could used Internet and was estimated on 85.3%. Internet site--http://pkzr.ac.bialystok.pl seems to be a basic digital textbook about cervical and breast neoplastic disease and their prophylactic. It is also interactive transferring data source that could create healthy attitude to increase effectiveness of screening programmes.
OBJECTIVE: To develop recommendations for practising physicians on the advisability of screening for human papillomavirus (HPV) infection in asymptomatic women. OPTIONS: Visual inspection, Papanicolaou testing, colposcopy or cervicography, use of HPV group-specific antigen, DNA hybridization, dot blot technique, Southern blot technique or polymerase chain reaction followed by physical or chemical therapeutic intervention. OUTCOMES: Evidence for a link between HPV infection and cervical cancer, sensitivity and specificity of HPV screening techniques, effectiveness of treatments for HPV infection, and the social and economic costs incurred by screening. EVIDENCE: MEDLINE was searched for articles published between January 1966 to June 1993 with the use of the key words "papillomavirus," "cervix neoplasms," "mass screening," "prospective studies," "prevalence," "sensitivity," "specificity," "human" and "female." VALUES: Proven cost-effective screening techniques that could lead to decreased morbidity or mortality were given a high value. The evidence-based methods and values of the Canadian Task Force on the Periodic Health Examination were used. BENEFITS, HARMS AND COSTS: Potential benefits are to prevent cervical cancer and eliminate HPV infection. Potential harmful effects include the creation of an unnecessary burden on the health care system and the labelling of otherwise healthy people as patients with a sexually transmitted disease for which therapy is generally ineffective. Potential costs would include expense of testing, increased use of colposcopy and treatment. RECOMMENDATIONS: There is fair evidence to exclude HPV screening (beyond Papanicolaou testing for cervical cancer) in asymptomatic women (grade D recommendation). VALIDATION: The report was reviewed by members of the task force and three external reviewers who were selected to represent different areas of expertise. SPONSORS: These guidelines were developed and endorsed by the task force, which is funded by Health Canada and the National Health Research and Development Program. The principal author (K.J.) was supported in part by the National Health Research and Development Program through a National Health Fellowship (AIDS).
The association between aerobic fitness, exercise, and psychophysiological reactivity was assessed in cross-sectional and prospective analyses. Seventy-five healthy but sedentary adults carried out a sub-maximal exercise test and easy and difficult problem solving tasks. Blood pressure, heart rate, skin conductance level, respiration rate, tidal volume, and oxygen consumption were monitored and additional heart rate was also computed. Differences between relatively fit and unfit individuals were found in respiration rate during tasks and in skin conductance level during post-task recovery periods, with a tendency toward diminished heart rate reactivity in fitter people. Subjects were subsequently allocated to four conditions: high intensity aerobic training, moderate intensity aerobic training, an undemanding strength and flexibility program (designed as an attention-placebo condition), and waiting list control. Training programs were conducted over a 10-week period, and were followed by a second laboratory session. Appropriate changes in aerobic performance over the training period were observed in the 12-min run/walk test. There were no important modifications in psychophysiological stress reactions associated with the different experimental conditions. These results are discussed in relation to the literature concerning the effects of fitness and physical activity on physiological response patterns.
OBJECTIVE: Most studies of falls among older people have focused on those with some degree of balance or mobility impairment. This study aimed to establish whether falls and associated injuries were a major problem among healthy, older women, whether there were some common features in the falls, and whether these falls could be accurately predicted. METHOD: Ninety-six healthy, active community-dwelling women in Melbourne, Australia, aged at least 70 years (mean 74.1 +/- 4.0) were initially measured on a comprehensive series of laboratory and clinical balance tests, gait, strength and psychometric measures. Subjects were monitored for falls events, circumstances and consequences by use of falls diaries and monthly phone calls. Baseline measures of clinical balance measures and gait were comparable to other studies reporting scores on these measures in samples of healthy older people. RESULTS: During the 12-month follow-up period, 49% of subjects fell, with 23% falling more than once; 9% suffered fractures as a result of their fall and 10% suffered strains or other moderate injuries. Many of the falls occurred during non-threatening activities such as walking, often under altered sensory or environmental conditions. Multivariate logistic regression identified gait symmetry and gait double support duration as the variables most strongly associated with prediction of multiple fallers. CONCLUSIONS: The results highlight that falls are a major problem among healthy active older women, and that targeted falls prevention programs are required for this group.