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PubMedDate not supplied

[The road will be mastered by the walker].

Anonymous questioning by the distribution of questionnaires among 1,600 young people (68.9% of them were city dwellers, 31.1% were villagers) was carried out. The questioning covered 1,079 adolescents aged 12-16 years (67.3%), 501 young people aged 16-19 years (31.3%) and 20 respondents aged 19-23 years (1.4%). The analysis of answers to questionnaires indicated that all respondents had the same level of knowledge on the subject, but the information they possessed was not duly analyzed and had no influence on their own behavior. It should be pointed out that 1% of persons aged 12-19 years took drugs by intravenous injection. These data, as well as other materials, gave grounds for the development of a new educational program on the prophylaxis of HIV/AIDS/STD and its introduction in 1997. The program is intended for a school course of 6 years (forms 6-11) and must provide adolescents with reliable and comprehensible information, conductive to the formation of a healthy mode of life.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Women who did not succeed in the work-based welfare program.

Welfare reform, enacted more than 5 years ago, created dramatic changes in the lives of single mothers living in poverty. The purpose of this study was to describe the lives of women who were unable to sustain involvement with work-based welfare. A multimethodological design and snowball sampling were used to gather qualitative and quantitative data from 31 urban women. Instruments were a demographic form, an interview guide, and the General Well-Being Schedule from the U.S. Health and Nutrition Examination Survey. Interviews were taped, transcribed, and entered into software to facilitate analysis. Thematic coding and narrative analysis were done. The study population had higher levels of severe and moderate distress than the reference standards for the general population. Barriers within the Temporary Assistance for Needy Families (TANF) system and personal barriers were identified by the women. Policy changes that address these obstacles would serve as blueprints for achieving the Healthy People 2010 goals for the nation.

Adult↗
PubMed2000

Building spirited multidisciplinary teams.

Managing multidisciplinary teams in complex settings such as the perianesthesia setting is a leadership challenge. With the addition of work redesign and cross-training initiatives, the task of helping people form healthy working relationships is substantial. The Team Spirit model (The Expanded Learning Institute, Del Mar, CA) demonstrates how employing the phases of Initiating, Visioning, Claiming, Celebrating, and Letting Go will build team spirit and more effective teams. The model and the phases are described with examples given of how getting to know each other, addressing differences, developing a shared vision, doing the work through effective communication, and celebrating will lead to spirited multidisciplinary teams.

Humans↗
PubMed2004

Is Oklahoma the weak link? The decline in vaccine coverage levels in Oklahoma.

Oklahoma has demonstrated a decline in vaccine coverage levels in children over the past two years, moving from a national ranking of 31st in 2000 to 48th in 2002. This decline has prompted a review of available evidence to identify approaches to move the state toward national averages and ultimately to the Healthy People 2010 Objectives. Oklahoma is one of nine states that are well below the established goal of 80% vaccine coverage for children. Oklahoma is near the bottom of this group with an estimated level of only 65%, placing not only Oklahomans at risk but the nation as well. The following is a plan aimed at both the health department and all health care professionals. Indeed, without physician involvement, the situation will not improve.

Child, Preschool↗
PubMed2004

Analysis of approach to therapy for chronic liver disease in an HCV hyperendemic area of Japan.

In 1990, we conducted an epidemiological study of 509 residents in a hepatitis C virus (HCV) hyperendemic area in Japan. The purpose of the present study was to examine the approach to therapy for liver diseases accompanied by HCV and hepatitis B virus (HBV) infections among the surviving residents in the town after 12 years. Fifty-three with HCV or HBV infections among 385 people who resided in the town were clearly analyzed in 2002. The number of persons diagnosed with the liver diseases was as follows: HCV-related asymptomatic healthy carrier (1), past history of HCV infection (15), chronic hepatitis C (22), HCV-related liver cirrhosis (6), HCV-related hepatocellular carcinoma (HCC) (5), and HBV-related asymptomatic healthy carrier (4). HCC was detected in residents who did not have periodic regular hospital checkups. Only 19% of the 53 inhabitants consulted liver medical specialists, and 75% (3/4) who received interferon therapy received treatment from a liver medical specialist. It is necessary to provide continuous medical treatment to HCV carriers, minimizing difference in treatment quality in different medical institution. An efficient HCV medical checkup and a program of subsequence health management are important problems to be solved for improved health care.

Journal Article↗
PubMed2004

The urban safety net: can it keep people healthy and out of the hospital?

There is much discussion and debate over the relative vulnerability and capacity of the health care safety net to care for the growing numbers of uninsured and disenfranchised persons in urban poor communities. In this study, we present findings from a community-based survey of 248 adults identified at eight safety net provider sites in Baltimore, Maryland, to contextualize recent findings that described Baltimore's safety net capacity as having more hospital- and intensive service-based interventions, with higher proportions of the population reportedly unable to get care when needed compared with other cities. The average age of respondents was 41.2 years, most (87.3%) were African American, unemployed (75.8%), homeless (57.0%), and with at least one chronic medical problem (77.8%). Almost one half (47.6%) also reported a chronic mental health condition, and 51.2% reported having difficulty accessing health care services in the past. Overall, 76.9% reported accessing additional community sites for daily sustenance needs, with most of these sites community non-profit or faith-based organizations. In the multiple logistic regression model, only individuals with chronic mental health conditions were significantly more likely to report difficulties accessing health care. The lack of a Community Access Program or other structured efforts to facilitate integration of services among providers in Baltimore and an "all-payer" system that reimburses uncompensated care only for hospital admissions are postulated as two structural elements that may contribute to these findings.

Adult↗
PubMed1995

Range of serum cholesterol values in the population developing coronary artery disease.

Blood lipids have been established as fundamental to atherogenesis, and there is a better understanding of the pathogenesis of atherosclerosis and of the various pharmacologic agents available to counter the mechanisms involved. However, more optimal lipid levels must be established for treatment of both the healthy population and persons already with coronary artery disease (CAD). In the Framingham Study cohort, those with elevated serum total cholesterol (> 275 mg/dl) had an increased risk of adverse outcomes whether healthy or with CAD. Compared with persons with cholesterol levels < 200 mg/dl (< 5.17 mmol/liter), the risk ratios for patients with elevated cholesterol levels were 3.8 for reinfarction, 2.6 for CAD mortality, and 1.9 for overall mortality. The prevalence of cholesterol levels > or = 240 mg/dl (> or = 6.21 mmol/liter) in persons who had sustained myocardial infarction was 35-52% in men and 66% in women, but 20% of myocardial infarctions occurred in people who had cholesterol levels < 200 mg/dl (< 5.17 mmol/liter). The average levels of serum total cholesterol and low density lipoprotein (LDL) cholesterol (225 mg/dl [5.82 mmol/liter] and 150 mg/dl [3.88 mmol/liter], respectively) at which CAD events occurred in men were below the levels recommended for treatment according to the guidelines of the National Cholesterol Education Program. In women, these levels were only slightly above the guideline levels. The average cholesterol levels at which CAD events occurred were substantially higher in women and decreased with age. Also, a steady decline in the average cholesterol levels of patients over the decades reflected chiefly the aging of the cohort.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Addressing the health and lifestyle issues of people with a mental illness: the Healthy Living Programme.

OBJECTIVE: The physical health and well-being of mental health patients have been a concern to health professionals for many years. However, very few positive gains have been made to address this problem. This paper outlines the efforts of the Inner North Brisbane Mental Health Service, Royal Brisbane and Women's Hospital, to design and implement a structured educational programme, aimed at addressing and encouraging healthy lifestyle behaviours in its community mental health service recipients. METHODS: Three programme modules were designed, addressing the topics of Nutrition and Healthy Eating, Physical Health, and Community Based Activities and Interests. Referral of patients to the programme was by their case manager or doctor. At the conclusion of each module, participants were asked to complete a satisfaction survey evaluating the programmes. The survey also gathered feedback regarding any suggestions and/or recommendations to improve content suitability and relevance. RESULTS: Since commencing the Healthy Living Program, each module has been conducted at least twice, the topic of Healthy Eating receiving the most referrals and therefore conducted most frequently. To date, 35 satisfaction surveys have been evaluated. The overwhelming majority of respondents offered very positive feedback about the programme, most being able to identify some healthy lifestyle changes they planned to make in response to programme attendance. CONCLUSIONS: This paper highlights the importance of incorporating healthy lifestyle programmes into mental health service delivery. The majority of patients who have attended the Healthy Living Program have indicated satisfaction with the content, but as yet information pertaining to long-term lifestyle change has not been collated. The next phase aims to examine whether the programme attendance has more long-term outcomes in improving health and well-being and promoting healthy behaviour change of mental health service recipients.

Community Mental Health Services↗
PubMedDate not supplied

Establishing national health goals and standards.

Four statements of national health goals and standards were proclaimed from the U.S. Department of Health and Human Services during the 1970s. Two were based on statutory mandates--the National Guidelines for Health Planning and the Model Standards for Community Preventive Health Services. Two were the results of administrative initiatives--the Forward Plans for Health and the complementary publications "Healthy People" and "Promoting Health/Preventing Disease". These efforts present a variety of approaches and experiences and can provide direction and lessons for future endeavors along these lines. The four issuances include guidance on national priorities, resource standards, and accessibility to care. They also offer goals and objectives for local services and health status. They address a multiplicity of issues, ranging from hospital bed supply and recommended uses of specialized medical equipment to infant mortality and proposed reductions in death and disability. Almost all urge further actions to prevent illness and promote health. The development of statements of national health goals and standards has been advocated by some experts and questioned by others. Advocates believe that these materials can help clarify purposes and priorities for health programs, resulting in more effective and efficient uses of resources and greater accountability. Critics are particularly concerned about deleterious impacts on creativity and local initiatives. Among the major lessons identifiable from these undertakings is the importance of committed leadership, broad-based consultation, and reliable data. Implementation inevitably encounters the complexities of the health system and depends upon available resources. In influencing the agenda of deliberation and debate, the symbolic value of these statements may often be more significant than the specific details. The continuing interest in these approaches suggests that future efforts along these lines are likely.

Adolescent↗
PubMed2007

Effects of a behavioral intervention to reduce risk of transmission among people living with HIV: the healthy living project randomized controlled study.

CONTEXT: The US Centers for Disease Control and Prevention (CDC) strongly recommend comprehensive risk counceling and services for people living with HIV (PLH); yet, there are no evidence-based counseling protocols. OBJECTIVE: To examine the effect of a 15-session, individually delivered, cognitive behavioral intervention on a diverse sample of PLH at risk of transmitting to others. DESIGN: This was a multisite, 2-group, randomized, controlled trial. PARTICIPANTS: Nine hundred thirty-six HIV-infected participants considered to be at risk of transmitting HIV of 3818 persons screened were randomized into the trial. Participants were recruited in Los Angeles, Milwaukee, New York, and San Francisco. INTERVENTION: Fifteen 90-minute individually delivered intervention sessions were divided into 3 modules: stress, coping, and adjustment; safer behaviors; and health behaviors. The control group received no intervention until the trial was completed. Both groups completed follow-up assessments at 5, 10, 15, 20, and 25 months after randomization. MAIN OUTCOME MEASURE: Transmission risk, as measured by the number of unprotected sexual risk acts with persons of HIV-negative or unknown status, was the main outcome measure. RESULTS: Overall, a significance difference in mean transmission risk acts was shown between the intervention and control arms over 5 to 25 months (chi2 = 16.0, degrees of freedom = 5; P = 0.007). The greatest reduction occurred at the 20-month follow-up, with a 36% reduction in the intervention group compared with the control group. CONCLUSION: Cognitive behavioral intervention programs can effectively reduce the potential of HIV transmission to others among PLH who report significant transmission risk behavior.

Adult↗
PubMed2005

Healthy country: healthy people? Exploring the health benefits of indigenous natural resource management.

OBJECTIVE: Decades of health-related research have produced a large body of knowledge describing alarming rates of morbidity, mortality and social/cultural disruption among Indigenous Australians, but have failed to deliver sustainable interventions to arrest the deepening spiral of ill-health. This paper explores the potential of Indigenous natural resource management (NRM) activities to promote and preserve Indigenous health in remote areas of northern Australia. METHOD: A literature review of the health, social science and ecology peer-reviewed journals and secondary literature. CONCLUSIONS AND IMPLICATIONS: Effective interventions in Indigenous health will require trans-disciplinary, holistic approaches that explicitly incorporate Indigenous health beliefs and engage with the social and cultural drivers of health. Aboriginal peoples maintain a strong belief that continued association with and caring for ancestral lands is a key determinant of health. Individual engagement with 'country' provides opportunities for physical activity and improved diet as well as boosting individual autonomy and self-esteem. Internationally, such culturally congruent health promotion activities have been successful in programs targeting substance abuse and chronic diseases. NRM is fundamental to the maintenance of biodiversity of northern Australia. Increased support for Indigenous involvement in land and sea NRM programs would also deliver concrete social benefits for communities including opportunities for sustainable and culturally apt regional employment, applied education and economic development. NRM may also reinvigorate societal/cultural constructs, increasing collective esteem and social cohesion.

Anthropology, Cultural↗
PubMed2002

'Opportunity structures': urban landscape, social capital and health promotion in Australia.

This paper presents data from 40 in-depth interviews that were conducted as part of a study of social capital and health in relation to people's perceptions of the influence of 'place' on their participation levels and health. These data were used to examine features of the western suburbs of Adelaide that were perceived as health damaging and health promoting. The paper demonstrates that our Australian suburban respondents expressed a considerable concern about these features and the impact they have on their perception of community and their ability to participate in it. Safety, connectedness to the area, the reputation of an area and the extent and nature of community facilities are all seen as important to a healthy community. The research found that in the more deprived socioeconomic areas within the study area, there was a significant degree of dissatisfaction with features of the urban environment, such as availability of amenities, provision of public transport, and proximity of industry to private dwellings. The paper concludes by considering certain features of urban environments that might make them more supportive of health through encouraging contact between people. We conclude that these environments could be improved using the following measures: a subsidy scheme to support the viability of local shops and cafés (thereby providing meeting places and employment); parks with facilitators (who could play a role in increasing safety in the park but also encouraging community development); attractive places to walk; and a general environmental improvement program.

Attitude to Health↗
PubMed2005

Screening of colorectal cancer.

Cost-effectiveness analyses have shown that the cost per year of life saved by screening with any of the tests recommended is reasonable by US standards. Although the specific results vary among analyses, in general the marginal cost-effectiveness of this screening is less than $25,000 per year of life saved. Screening for CRC was among the highest ranked services in an analysis of the value of preventive services based on the burden of disease prevented and cost-effectiveness. Although the up-front costs vary by screening modality, the long-term cost-effectiveness is similar across screening tests, so that decisions about which options to include--in the long run and from the perspective of society--do not need to be affected heavily by costs. Costs increase out of proportion to benefits with shorter intervals between screening examinations. Screening has provided great opportunities. Screening can prevent CRC by polypectomy and find early-stage cancers for treatment with less morbidity. Screening can reduce the burden of treating advanced cancers and can identify families at increased risk. Screening also has provided a better understanding of the biology of CRC. Screening for CRC should be part of a complete prevention program that includes a healthy lifestyle and familial risk assessment. Individuals with increased familial risk require special screening approaches, whereas individuals with average risk can have more standard screening. The average-risk individuals can be stratified further into persons who require intensive follow-up and persons who require less intensive or no follow-up at all. We are beginning to learn how to apply screening and surveillance approaches based on risk stratification for a more cost-effective approach to conserve resources and reduce complications and costs. Chemoprevention can be added to the program when substantial benefit of agents has been demonstrated. We have a better understanding of the biology of CRC and the technology to intervene in that biology to make a difference in the lives of many people. We have the concepts and technology to reduce substantially the mortality for CRC and even prevent it entirely. Newer screening tests or others yet to be developed may, with time, replace the modern options. Screening should take place with the tests currently available and not wait until something better comes along. In this way, needless suffering and loss of life can be avoided for this leading cause of cancer death. Screening may become even more successful if the promise of new technologies is confirmed and they enter clinical practice. In the last analysis, the best test is the one that gets done and gets done immediately.

Adenoma↗
PubMed1998

Dietary fat and disease patterns in Chukotka Native adults.

It is well documented that dietary patterns have been changing for northern indigenous peoples as they adapt to a contemporary lifestyle. Recent dietary research among Chukotka Native adults showed a higher intake of saturated fatty acids (15% of energy) and sugar, and lower content of polyunsaturated fatty acids (5%) compared with our previous studies. We showed a higher percentage of dietary fat from animal fats (31%) and meat products (28%) than from seafoods and fish, which provide only 11% of daily fat intake. Increasing use of marketed foods and decreasing consumption of traditional foods among Chukotka Native adults contribute to more frequent cases of overweight, diabetes mellitus, and cancer. Dietary recommendations with an emphasis on traditional eating patterns should be considered for promotion of a healthy diet in Chukotka inhabitants. Promoting local foods of high biological value and establishing educational nutrition programs are of great importance.

Adult↗
PubMed1994

The University of California at San Francisco AIDS Health Project. A community psychiatry approach to the AIDS epidemic.

Each program within the AIDS Health Project is designed to work with individuals at different points along the continuum between a state of health at one end of the spectrum and the clinical disorder of AIDS at the other. Thus, individual programs reflect different levels of prevention. For example, the Prevention and Support Services (formerly the Worried Well) Program is an example of primary prevention; i.e., services are provided to healthy individuals who are at risk in an attempt to keep them from contracting the disease. The HIV Positives Being Positive Program is an example of secondary prevention in which services are provided to those who have premonitory symptoms of disease but have not yet developed the full-blown illness. The AIDS antibody counseling and testing program has elements of both primary and secondary prevention, as individuals who are counseled may prove to have either a positive or a negative test. Finally, the Mental Health Program at San Francisco General Hospital and the AIDS and Substance Abuse Program (ASAP) are examples of tertiary prevention. (Note: The ASAP actually incorporates all three levels of prevention through its various activities. As the original impetus for its development was to provide services to people with AIDS, however, we have listed it as a tertiary program.) In these programs, services are provided to individuals with the illness in an attempt to prevent psychological decompensation, to provide relief of current distress, and, perhaps, to delay disease progression.

Acquired Immunodeficiency Syndrome↗
PubMed2004

[Primary prevention of non-communicable diseases. Experiences from population based intervention in Finland for the global work of WHO].

Globally most people die from noncommunicable diseases. Especially in developing countries noncommunicable diseases are on the rise, effecting especially poorer societal segments. The noncommunicable diseases contribute greatly to societal and economic losses and inequities in health status. The North Karelia Project was started in Finland to prevent noncommunicable diseases and with the main aim to curb the high mortality from cardiovascular diseases. In collaboration with the community, the health sector, the food industry and mass media, initiatives were started to promote a healthy diet, physical activity and reduce smoking. Over the last 25 years, the age adjusted mortality rate among men of 25-64 years of age from cardiovascular diseases fell by 73%, from lung cancer by 71% and total mortality fell 49%. Each country should plan and implement its own prevention programs, but lessons can be learned from the North Karelia Project. The paper discusses some key lessons and recommendation from the project for countries and for global work. In the last few years WHO has started to up-grade its work to fight noncommunicable diseases. Some initiatives are presented and discussed.

Adult↗
PubMed2004

Clinical prevention and population health: curriculum framework for health professions.

The Clinical Prevention and Population Health Curriculum Framework is the initial product of the Healthy People Curriculum Task Force convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers. The Task Force includes representatives of allopathic and osteopathic medicine, nursing and nurse practitioners, dentistry, pharmacy, and physician assistants. The Task Force aims to accomplish the Healthy People 2010 goal of increasing the prevention content of clinical health professional education. The Curriculum Framework provides a structure for organizing curriculum, monitoring curriculum, and communicating within and among professions. The Framework contains four components: evidence base for practice, clinical preventive services-health promotion, health systems and health policy, and community aspects of practice. The full Framework includes 19 domains. The title "Clinical Prevention and Population Health" has been carefully chosen to include both individual- and population-oriented prevention efforts. It is recommended that all participating clinical health professions use this title when referring to this area of curriculum. The Task Force recommends that each profession systematically determine whether appropriate items in the Curriculum Framework are included in its standardized examinations for licensure and certification and for program accreditation.

Advisory Committees↗
PubMedDate not supplied

[Diagnostic clinical trial with allergen extract from Blomia tropicalis in allergic adults and healthy volunteers].

BACKGROUND: There are no antecedents in Cuba of studies developed to prove the efficacy of an allergy test to Blomia tropicalis despite of being one of the main mites which cause this ailment which affects more than 2,200,000 people. OBJECTIVES: Evaluate the allergenic extract Blomia tropicalis elaborated at the Centro Nacional de Biopreparados (BioCen), in the prick skin test, as a diagnose of allergy to this allergen which exists in all the tropical and subtropical countries. MATERIAL AND METHODS: We selected 50 patients with a positive clinic history of allergy to house dust and 50 healthy persons. Al the persons selected were skin prick tested with dilution's of the extracts (20,000 UB/mL) and positive and negative control. We measured the average diameter of the wheal and the perpendicular diameter, then we calculated the average. We also calculated size of the wheal in the duplicated, which constituted the size of the reaction. We estimated the validity of the test calculating the sensitivity and specificity. We used the EPITABLE program to do this. RESULTS: The skin prick tested positive in 78% of the patients and 6% in the healthy persons, for a sensitivity of 78% the interval of confidence (IC) 63.7-88.0 and a specificity of 94%, IC 82.5-98.4 the predictive negative value 81%, IC 68.2-89.7. CONCLUSIONS: The allergenic extract of Blomia tropicalis elaborated in BioCen is very sharp to test the allergy to this mite.

Acari↗