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Information-seeking behaviour and sources of health information: associations with risk factor status in an analysis of three Queensland electorates.

Making a special effort to gain health information has been associated with healthy behaviour. This paper identifies the information-seeking dimension and the sources of information people use and examines whether there is an association between these and individual health status. In November 1989 a randomly selected sample of 2134 adults in the electorates of Maryborough, Toowoomba and Port Curtis (Gladstone) completed a self-administered questionnaire which aimed to measure health-related knowledge, attitudes and behaviour. Factor analysis identified clusters of items representing different dimensions of risky health behaviour as well as different perceived barriers to seeking preventive health care. Multiple regression analysis was then used to determine sociodemographic, attitudinal and behavioural variables related to a tendency not to seek health information and to be at risk for preventable diseases. The findings have implications for the development of future health promotion programs in provincial Australian cities. Both age and sex were significant in predicting where people obtain information on health. Women were more likely than men to seek health information and their sources of information reflected this proactive attitude to health. While there was no significant difference between the perceived health status of males and females, reported behavioural risk factors were much more prevalent in males. Most respondents had consulted a general practitioner in the previous twelve months and stated that they would change their behaviour on the advice of a medical practitioner. However, few nominated medical practitioners as their main source of health information.

Adult↗

Diffusing a research-based physical activity promotion program for seniors into diverse communities: CHAMPS III.

INTRODUCTION: Increasing the physical activity levels of older adults through diffusion of successful research-based programs into community settings is challenging because of differences between research and real-world settings. This project diffused the Community Healthy Activities Model Program for Seniors (CHAMPS) II, an individual-level research-based physical activity promotion program, through three community organizations to reach lower-income and minority (primarily Hispanic or Latino and African American) seniors. METHODS: Through an academic-community partnership, university staff worked with each organization to adapt the program to be appealing and effective, enable their staff and volunteers to provide the program, increase participants' physical activity, and leave sustainable programs in place. Evaluation was based on methods recommended by the Centers for Disease Control and Prevention. RESULTS: The adapted programs, referred to as CHAMPS III, differed from the original program and among organizations. Group-based components and resource guides were included and new features were added; however, individualized components were not offered because of limited resources. A total of 321 people enrolled among three organizations; there was a trend toward increased physical activity at two organizations (an estimated increase of 481 kcal/week [P = .08] and 437 kcal/week [P = .06] expended in physical activity). Evaluation revealed challenges and unexpected community-level benefits. All organizations are continuing efforts to promote physical activity for older adults. CONCLUSION: This project enabled community organizations to implement physical activity promotion programs. The overarching challenge was to retain original program features within each organization's resources yet be sustainable. Although the programs differed from the original research program, they were a catalyst for numerous community-level changes. Our findings can guide similar projects to reach underserved older adults.

Aged↗

Prevalence of hepatitis B virus infection and related risk factors in a rural community of Mexico.

A cross-sectional survey of the seroprevalence of hepatitis B virus (HBV) markers among healthy people was conducted in San Juanito, a rural community in the northern state of Chihuahua, Mexico. The overall prevalence in 970 people was 6.6% for antibody to hepatitis B core antigen. There was an age effect on the prevalence of HBV infection, and a gradual increase in prevalence was observed in patients up to the age of 40 years. Those subjects with a history of dental procedures had a 2-fold higher risk for HBV infection (odds ratio [OR], 2.4; 95% confidence intervals [CI], 1.01-5.86), and there was a 74% increased risk for each blood product transfusion (OR, 1.74; 95% CI, 1.09-2.77). Horizontal transmission seems to be the major source of endemicity in San Juanito because no woman was a chronic carrier. To lower HBV transmission rate, an adequate active screening program for blood donors should be implemented, together with a universal infant immunization program.

Adolescent↗

The influence of chronic illnesses on the incidence of invasive pneumococcal disease in adults.

Pneumococcal disease is more frequent and more deadly in persons with certain comorbidities. We used 1999 and 2000 data from the Active Bacterial Core surveillance (ABCs) and the National Health Interview Survey (NHIS) to determine rates of invasive pneumococcal disease in healthy adults (> or =18 years old) and in adults with various high-risk conditions. The risks of invasive pneumococcal disease in persons with specific chronic illnesses was compared with that in healthy adults, controlling for age, race, and the other chronic illnesses. Overall incidence rates, in cases/100,000 persons, were 8.8 in healthy adults, 51.4 in adults with diabetes, 62.9 in adults with chronic lung disease, 93.7 in adults with chronic heart disease, and 100.4 in adults who abused alcohol. Among the high-risk groups evaluated, risk was highest in adults with solid cancer (300.4), HIV/AIDS (422.9), and hematological cancer (503.1). Incidence rates increased with advancing age in adults with chronic lung disease, diabetes, and solid cancer. Black adults had higher incidence rates than white adults, both in healthy adults and in adults with chronic illnesses. These data support recommendations to provide pneumococcal vaccine to persons in these at-risk groups and underscore the need for better prevention strategies for immunocompromised persons.

Acquired Immunodeficiency Syndrome↗

[Echinococcosis/hydatidosis in the VII Region of Chile: diagnosis and educational intervention].

This study was designed to embrace three areas: a) serologic and radiologic diagnosis and surgical treatment of hydatidosis in an asymptomatic human population, b) animal diagnosis and the treatment of dogs, and c) evaluation of extent of knowledge and performance of educational interventions among rural families and health, livestock, and education professionals and technicians, in order to help control the disease transmission cycle. Indirect hemagglutination and ELISA tests were performed on 5,556 apparently healthy people. Of these, 42 (0.8%) had positive results on both tests, for a seroprevalence of 754.6 per 100,000. These 42 subjects were scheduled for liver ultrasonography and a chest x-ray; of the 26 who complied, 16 showed images compatible with a hydatid cyst. Those 16 cases were sent to the hospital for surgery. In 9 of the cases the diagnosis was confirmed surgically, for a prevalence of 161.7 per 100,000. Arecoline hydrobromide was administered as a laxative to 2,358 dogs to detect the strobilar form of Echinococcus granulosus, and positive results were found in 11% of the dogs. Official data for slaughterhouses indicated the presence of hydatid cysts in 13% of the cattle, 4.4% of the sleep, and 4.2% of the pigs slaughtered in the region. The educational program included an evaluation of the extent of knowledge by surveying heads of household; an educational intervention among families through an informal active participatory process using educational games, in which 1,082 families participated; and an educational intervention with professionals and technicians using distance and in-person approaches. To evaluate the program, the results of knowledge tests before and after educational interventions with 200 families (cases) were compared with those from 95 families who did not participate (controls). Of the 1,423 heads of household initially surveyed about their knowledge of echinococcosis/hydatidosis, 783 of them (55%) said they knew nothing about the infection. It was found that the participatory educational games were well adapted to the lifestyle of people from rural areas and made change possible. Training was provided to 276 health professionals, 201 technical assistants, and 453 rural teachers. The program reached 100% of the staff members of the area's rural primary health care services.

Animals↗

Older adult perspectives on physical activity and exercise: voices from multiple cultures.

INTRODUCTION: Increasing physical activity is a goal of Healthy People 2010. Although the health benefits of physical activity are documented, older adults are less physically active than any other age group. The purpose of this study was to examine barriers and facilitators to physical activity and exercise among underserved, ethnically diverse older adults. METHODS: Seventy-one older adults were recruited through community agencies to participate in seven ethnic-specific focus groups: American Indian/Alaska Native, African American, Filipino, Chinese, Latino, Korean, and Vietnamese. Groups were conducted in the participants' primary language and ranged in size from 7-13 participants. Mean age was 71.6 years (range from 52 to 85 years; SD +/- 7.39). Professional translators transcribed audiotapes into the language of the group and then translated the transcript into English. Transcripts were systematically reviewed using content analysis. RESULTS: Suggested features of physical activity programs to enhance participation among ethnically diverse minority older adults included fostering relationships among participants; providing culture-specific exercise; offering programs at residential sites; partnering with and offering classes prior to or after social service programs; educating families about the importance of physical activity for older adults and ways they could help; offering low- or no-cost classes; and involving older adults in program development. Walking was the exercise of choice across all ethnic groups. Health served as both a motivator and a barrier to physical activity. Other factors influencing physical activity were weather, transportation, and personal safety. CONCLUSION: Findings from this study suggest strategies for culture-specific programming of community-based physical activity programs.

Black or African American↗

Rates and risks for co-morbid depression in patients with Type 2 diabetes mellitus: results from a community-based study.

AIMS/HYPOTHESIS: There is accumulating evidence that depression is common in people with Type 2 diabetes. However, most prevalence-studies are uncontrolled and could also be inaccurate from selection-bias, as they are conducted in specialized treatment settings. We studied the prevalence and risk factors of co-morbid depression in a community-based sample of older adults, comparing Type 2 diabetic patients with healthy control subjects. METHODS: A large (n=3107) community-based study in Dutch adults (55-85 years of age) was conducted. Pervasive depression was defined as a CES-D score greater than 15. Diagnosis of Type 2 diabetes was obtained from self-reports and data from general practitioners. RESULTS: A number of 216 patients (7%) were identified as having Type 2 diabetes. The prevalence of pervasive depression was increased in people with Type 2 diabetes and co-morbid chronic disease (20%) but not in patients with Type 2 diabetes only (8%), compared with the healthy control subjects (9%). Regression analyses in diabetic patients yielded that being single, being female, having functional limitations, receiving instrumental support and having an external locus of control were associated with higher levels of depression. CONCLUSIONS/INTERPRETATION: The Results suggest that the prevalence of pervasive depression is increased in patients with Type 2 diabetes and co-morbid disease(s), but not in patients with Type 2 diabetes only. Functional limitations that often accompany co-morbid chronic disease could play an essential role in the development of depression in Type 2 diabetes. These findings can enable clinicians and researchers to identify high-risk groups and set up prevention and treatment programs.

Aged↗

Who uses self-care books, advice nurses, and computers for health information?

OBJECTIVES: While evaluating the effect of a community-wide informational intervention, this study explored access, health, and demographic factors related to the use of medical reference books, telephone advice nurses, and computers for health information. METHODS: A random sample of households in the intervention city (Boise, Idaho) and two control cities were surveyed about their use of health information in 1996. Shortly thereafter, the Healthwise Communities Project (HCP) distributed health information to all Boise residents. A follow-up survey was conducted in 1998. Overall, 5,909 surveys were completed for a 54% response rate. RESULTS: The HCP intervention was associated with statistically significant increases in the use of medical reference books and telephone advice nurses. The increased use of computers for health information was marginally significant. Few access, health, or demographic factors were consistently associated with using the different resources, except that people with depression used more of all three information resources, and income was not a significant predictor. CONCLUSION: Providing free health information led to an increase in use, but access, health, and demographic factors were also important determinants. In particular, poor health status and presence of a chronic illness were associated with health information use. These results suggest that healthy consumers are less interested in health information, and it may take other incentives to motivate them to learn about prevention and healthy behaviors.

Adult↗

Evaluating Australia's National Medicines Policy using geographical mapping.

BACKGROUND: There has been a proliferation of quality use of medicines activities in Australia since the 1990s. However, knowledge of the nature and extent of these activities was lacking. A mechanism was required to map the activities to enable their coordination. AIMS: To develop a geographical mapping facility as an evaluative tool to assist the planning and implementation of Australia's policy on the quality use of medicines. METHODS: A web-based database incorporating geographical mapping software was developed. Quality use of medicines projects implemented across the country was identified from project listings funded by the Quality Use of Medicines Evaluation Program, the National Health and Medical Research Council, Mental Health Strategy, Rural Health Support, Education and Training Program, the Healthy Seniors Initiative, the General Practice Evaluation Program and the Drug Utilisation Evaluation Network. In addition, projects were identified through direct mail to persons working in the field. RESULTS: The Quality Use of Medicines Mapping Project (QUMMP) was developed, providing a Web-based database that can be continuously updated. This database showed the distribution of quality use of medicines activities by: (i) geographical region, (ii) project type, (iii) target group, (iv) stakeholder involvement, (v) funding body and (vi) evaluation method. At September 2001, the database included 901 projects. Sixty-two per cent of projects had been conducted in Australian capital cities, where approximately 63% of the population reside. Distribution of projects varied between States. In Western Australia and Queensland, 36 and 73 projects had been conducted, respectively, representing approximately two projects per 100,000 people. By comparison, in South Australia and Tasmania approximately seven projects per 100,000 people were recorded, with six per 100,000 people in Victoria and three per 100,000 people in New South Wales. Rural and remote areas of the country had more limited project activity. CONCLUSIONS: The mapping of projects by geographical location enabled easy identification of high and low activity areas. Analysis of the types of projects undertaken in each region enabled identification of target groups that had not been involved or services that had not yet been developed. This served as a powerful tool for policy planning and implementation and will be used to support the continued implementation of Australia's policy on the quality use of medicines.

Australia↗

Long-term fitness training improves the circadian rest-activity rhythm in healthy elderly males.

In old age, the circadian timing system loses optimal functioning. This process is even accelerated in Alzheimer's disease. Because pharmacological treatment of day-night rhythm disturbances usually is not very effective and may have considerable side effects, nonpharmacological treatments deserve attention. Bright light therapy has been shown to be effective. It is known from animal studies that increased activity, or an associated process, also strongly affects the circadian timing system, and the present study addresses the question of whether an increased level of physical activity may improve circadian rhythms in elderly. In the study, 10 healthy elderly males were admitted to a fitness training program for 3 months. The circadian rest-activity rhythm was assessed by means of actigraphy before and after the training period and again 1 year after discontinuation. As a control for possible seasonal effects, repeated actigraphic recordings were performed during the same times of the year as were the pre and post measurements in a control group of 8 healthy elderly males. Fitness training induced a significant reduction in the fragmentation of the rest-activity rhythm. Moreover, the fragmentation of the rhythm was negatively correlated with the level of fitness achieved after the training. No seasonal effect was found. Previous findings in human and animal studies are reviewed, and several possible mechanisms involved in the effect of fitness training on circadian rhythms are discussed. The results suggest that fitness training may be helpful in elderly people suffering from sleep problems related to circadian rhythm disturbances.

Activity Cycles↗

What participants understand about a maternal serum alpha-fetoprotein screening program.

We investigated the knowledge of pregnant women participating in a maternal serum alphafetoprotein (MSAFP) screening program for the detection of neural tube defects (NTDs) in the fetus. Women participating in the screening program scored higher on two knowledge tests than a comparison group of pregnant women who were not offered screening. However, there were substantial gaps in the knowledge base of women in the program, as measured by one of the tests. Women did not misinterpret a negative test result to mean that the test had identified a potential problem with the fetus; instead, there is a suggestion that they tended to interpret a negative result too positively, as an assurance that the baby was healthy in all respects.

Adult↗

Does cumulating endurance training at the weekends impair training effectiveness?

BACKGROUND: Due to occupational restrictions many people's recreational endurance activities are confined to the weekends. We intended to clarify if cumulating the training load in such a way diminishes endurance gains. DESIGN: We conducted a longitudinal study comparing training-induced changes within three independent samples. METHODS: Thirty-eight healthy untrained participants (45+/-8 years, 80+/-18 kg; 172+/-9 cm) were stratified for endurance capacity and sex and randomly assigned to three groups: 'weekend warrior' (n=13, two sessions per week on consecutive days, 75 min each, intensity 90% of the anaerobic threshold; baseline lactate+1.5 mmol/l), regular training (n=12, five sessions per week, 30 min each, same intensity as weekend warrior), and control (n=13, no training). Training was conducted over 12 weeks and monitored by means of heart rate. Identical graded treadmill protocols before and after the training program served for exercise prescription and assessment of endurance effects. RESULTS: VO2max improved similarly in weekend warrior (+3.4 ml/min per kg) and register training (+1.5 ml/min per kg; P=0.20 between groups). Compared with controls (-1.0 ml/min per kg) this effect was significant for weekend warriors (P<0.01) whereas there was only a tendency for the regular training group (P=0.10). In comparison with controls (mean decrease, 3 beats/min), the average heart rate during exercise decreased significantly by 11 beats/min (weekend warriors, P<0.01) and 9 beats/min (regular training, P<0.05). There was no significant difference, however, between the weekend warrior and regular training groups (P=0.99). CONCLUSION: In a middle-aged population of healthy untrained subjects, cumulating the training load at the weekends does not lead to an impairment of endurance gains in comparison with a smoother training distribution.

Adult↗

Sharing HIV test results with future and current marriage partners in Zambia.

Kara Counselling and Training Trust (Kara) began offering voluntary counseling and testing (VCT) for HIV to the Zambian public in 1992. In the first years, clients came for testing because they were sick. These days however, more and more healthy young people are requesting tests for other reasons: they may be planning to get married, to have children or to engage in unprotected sex after being in an intimate relationship for some time. More than 20% of the clients now come for marriage-related reasons--as individuals or as couples. People want to know their HIV status so they can share it with their current or future spouse in order to make informed choices and protect each other's sexual and reproductive health.

Africa↗

Osteoporosis: review of the evidence for prevention, diagnosis and treatment and cost-effectiveness analysis. Executive summary.

This report describes evidence for the diagnosis, prevention, and treatment of osteoporosis in postmenopausal healthy white women. Osteoporosis is becoming an increasingly important public health problem as our population ages. Although it is partially preventable, fractures related to osteoporosis are still common. Because of the economic and social burdens, comprehensive prevention programs are needed. Insufficient data prevent development of comparable analyses for men or nonwhite women. Discussed are the effectiveness, risks, and costs of diagnostic tests and treatments, the probabilities that women will have osteoporosis-related fractures, and the effects of various factors on these probabilities. Hormone replacement therapy is considered most cost-effective; women who refuse hormone replacement can consider bisphosphonates (alendronate) and calcitonin. Nomograms are presented for guiding treatment and testing decisions for individual patients. The following public health measures are recommended: Ensure that adults receive the optimal daily intake of calcium--between 1000 mg and 1500 mg; ensure that people at risk for vitamin D deficiency receive 400 IU to 800 IU of vitamin D daily; inform people that exercise, in addition to its other benefits, should help prevent osteoporosis; and discourage people from smoking.

Cost-Benefit Analysis↗

The intendedness of pregnancy: a concept in transition.

BACKGROUND: Although interest in the intendedness or the planning status of a pregnancy goes back many centuries, it is only since 1941 that questions about these issues have been asked systematically in large-scale surveys. More recently, questions about intendedness have become standard features of the National Survey of Family Growth and of the Pregnancy Risk Assessment Monitoring System (PRAMS). Interest in and concern about the large numbers of unintended pregnancies reported in those surveys resulted in an Institute of Medicine report on the subject and the inclusion of a national health objective for increasing the proportion of pregnancies that are intended in Healthy People 2000 and Healthy People 2010. NEEDS: The terms, "intended," "unintended," "mistimed," "wanted," "unwanted," and "planned" are often used without significant attention being paid to their meaning or how they are derived from survey questions. There is a particular need to distinguish between terms that define attitudes and those that define behaviors. In addition, research has revealed that women are often happy despite experiencing an unintended pregnancy and that contraceptive failures do not always result in a report of an unintended pregnancy. OBJECTIVES: Researchers have begun to ask questions about the meaning of the intendedness concept and its relationship to what women express as their feelings about pregnancies and births. This article, and this entire issue, is an attempt to make the reader aware of the current issues in this area and to suggest additional research that is needed to enable policy makers and program planners to design programs that will better assist couples in meeting their fertility goals.

Data Collection↗

Long-term weight gain prevention: a theoretically based Internet approach.

BACKGROUND: A major focus of Healthy People 2010 is promoting weight management and physical activity because overweight, obesity, and a sedentary lifestyle are strongly associated with risk for heart disease and stroke, diabetes, cancers, and premature death. METHODS: Prevalence data and a focused review of weight management and physical activity studies point to the long-term weight gain prevention in normal weight (21-25 BMI), overweight (25-29 BMI), and even moderate obese (30-34 BMI) people as one alternative to prioritizing weight loss in health behavior interventions. This is because on a population basis annual weight gain is small (approximately 0.8 kg/year) and preventing weight gain appears to require only an energy shift of about 100 cal/day either through a modest increase in physical activity and/or consuming slightly less calories to maintain an energy balance. A more dynamic use of social cognitive theory (SCT) for developing programs to maintain health behavior changes is emerging with some evidence of long-term maintenance. The high use of the Internet provides a vehicle to reach different population segments with readily accessible, SCT-tailored long-term programs. Research studies using the Internet with tailored SCT interventions have shown changes in nutrition practices, physical activity, and weight loss for up to a year. CONCLUSIONS: One promising approach to weight gain prevention in population segments is the development and wide spread use of longer-term Internet programs using specific principles and procedures from SCT.

Counseling↗

Protecting children: reducing their environmental tobacco smoke exposure.

The present review examines the current status of efforts to reduce environmental tobacco smoke exposure (ETS) among infants and young children. Estimates of the number of children exposed vary, but it is probably over 20 million or about 35% of all U.S. children. Healthy People 2010 sets as an objective the reduction, to 10%, of the proportion of children regularly exposed to tobacco smoke at home. Children with ETS exposure are at higher risk for upper respiratory illnesses, asthma, otitis media, and sudden infant death syndrome. Eight experimental or quasi-experimental studies of attempts to reduce children' ETS exposure with sample sizes of greater than 100 were conducted in the United States and published between 1990 and 2003. Most of these studies showed a significant impact on maternal smoking and on the number of cigarettes smoked in the home, although intervention-control differences were relatively small. Despite support from professional organizations and federal government groups, many pediatricians and family physicians do not routinely engage in intensive efforts to reduce children's ETS exposure. Training in techniques for reducing tobacco dependence should be included in professional education programs. Public and private insurance should reimburse providers for efforts in this area. An overall strategy for reducing children's ETS exposure should combine individual counseling and education in offices, clinics, and homes with community education and regulatory and economic policies (i.e., smoking bans and excise taxes). Additional funding is needed for studies of provider knowledge, attitudes, and practices; of the effectiveness of various communication strategies; and of office- and community-based strategies to reduce ETS exposure.

Adult↗

[Physical activity for the elderly].

UNLABELLED: Prolongation of life expectancy requires inevitable care for the quality of life of the elderly. Regular physical activity has a very important role in preserving the quality of life and independence, and not only reducing illness and mortality. A better understanding of this issue should enable us to set guidelines for regular physical activity for the elderly. The reaction to regular physical activity of older adults without cardiovascular diseases is similar to the reaction of young people to regular physical activity. In men, the mechanism of cardiovascular adaptation is mainly central, while in old women it is mainly peripheral. Elderly with cardiovascular diseases suffer from oxygen consumption and cardiac output reduction, compared to healthy old people. They also enjoy the cardiovascular benefits of aerobic physical activity and gain the risk factors profile improvement. Therefore, it is recommended to include aerobic physical activity as an integrative part of the daily lifestyle. Resistance strength training in elderly of both sexes leads to similar or even higher values for muscle mass and strength compared to young people, reduces the body fat mass, body weight and helps to preserve the active tissue mass. More beneficial effects of physical activity are: an improvement of posture and physical stability, improved flexibility and mobility capacity, a better cognitive function and a lower level of depression. The beneficial effects of physical activity in the very aged and frail elderly include physiological, metabolic, psychological and functional adaptations, which can substantially contribute to the quality of life and cannot be achieved by other treatments. SUMMARY: Participation in a regular physical activity program is an effective and secure means to avoid and reduce the functional decline associated with aging and to improve the quality of life. The recommended exercise program is multifactorial and includes aerobic and resistance training, and exercises of balance and flexibility.

Aged↗