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PubMed2004

Protease inhibitor phenotypes and serum alpha-1-antitrypsin levels in patients with COPD: a study from Hong Kong.

OBJECTIVE: Many studies have suggested that an imbalance of protease activation and inhibition might result in COPD with emphysema. Levels of alpha-1-antitrypsin (alpha1-AT), the key protease inhibitor, are genetically determined by alleles that present in many phenotypes/subtypes, some of which are associated with deficiency of the protein. We prospectively evaluated the prevalence of the protease inhibitor (Pi) alleles and phenotypes together with the serum alpha1-AT levels in Chinese patients with COPD. METHODOLOGY: The study population comprised 356 patients with COPD. The male-to-female ratio was 4 : 1 with a mean age of 72.4 years (range 44-93 years). Isoelectric focusing was used for Pi phenotyping/subtyping. The frequencies of Pi alleles and phenotypes were compared with the frequencies in 1085 healthy unrelated Chinese control subjects. The serum alpha1-AT levels were measured by the Cobas Fara assay. RESULTS: PiZ was not detected. No significant difference in distribution of PiM phenotypes/subtypes between patients with COPD and healthy controls was observed, except for M1M3 and M2M3. There was also a significant difference in the proportion of variant S and F alleles between the disease group and the control population. CONCLUSION: The low prevalence of deficiency Pi phenotypes/subtypes suggests a lack of contribution of alpha1-AT deficiency to the pathogenesis of COPD in Chinese patients. The strategy of launching an alpha1-AT deficiency detection program among COPD patients, based on the recommendation of the World Health Organization, may not be readily applicable in our local setting.

Adult↗
PubMed2004

[Recreational activities of Bydgoszcz youth at the age of pubescence].

The article presents results of inquiry carried out in October 2002 among 498 pupils selected by chance, from gymnasiums in Bydgoszcz: 297 girls and 261 boys aged 14-16. The aim of the inquiry was to distinguish hygiene of recreation of young people at the age of pubescence, as well as to show dependence in exploiting free time. For statistic evaluation the program of computing sheet EXCEL was used. Comprehensive study activities were presented according to stages of statistic survey: inquiry theses were prepared, inquiry measures selected and adequate inquiry tools chosen--in form of a questionnaire, results of the research were completed and statistically worked out, substantial valuation carried out and conclusions drown. In declared by the youth interests in sports, there are two form of realization: active--through institutional and individual practising sport in athletic clubs and centres of recreation and passive--through watching tv, looking on, reading press and sports collectorship. Surprising is the fact that girls are equal to boys in attending competitions as spectators. As expected, the preferable form of activity for boys is riding a bicycle and playing football, girls alike boys most willingly ride a bicycle and swim. The conception of 'healthy life style' is understood by boys as 'personal hygiene and lack of addictions', while girls are of opinion that the most important element is sleep, recreation and personal hygiene.

Adolescent↗
PubMed2006

Hawaii's "7 by 7" for school health education: a PowerPoint presentation on integrating the national health education standards with priority content areas for today's school health education in grades kindergarten through 12.

School-based health education can help young people develop the knowledge, skills, motivation, and support they need to choose health-enhancing behaviors and resist engaging in behaviors that put them at risk for health and social problems and school failure. The health of school-age youth is significantly associated with their school achievement. However, in the midst of today's increased emphasis on school accountability in the areas of reading, writing, and mathematics, subject areas such as health education tend to receive less prominence in the school curriculum. Recalling their own lackluster school experiences related to health topics, decision makers may not realize that today's skills-based school health curriculum involves a highly interactive and engaging approach to promoting good health and preventing the most serious health problems among youth. Health education is one important component of a coordinated school health program that includes health education, physical education, school health services, nutrition services, school counseling and psychological services, a healthy school environment, school promotion for faculty and staff, and involvement of family and community members. The purpose of this PowerPoint presentation--Healthy Keiki, Healthy Hawaii: Hawaii's "7 by 7" for School Health Education--is to educate health and education decision makers, teachers, parents, and community members on how Hawaii has integrated seven health education standards with seven priority health content areas to create an effective approach to school health education in grades kindergarten through 12. The goal of Hawaii's "7 by 7" curriculum focus is to ensure that all of Hawaii's keiki (children) have well-planned opportunities at school to become fit, healthy, and ready to learn.

Adolescent↗
PubMed1992

AIDS and promiscuity: muddles in the models of HIV prevention.

AIDS has been blamed on promiscuity and the promiscuous, and a major goal of many HIV-prevention programs has been to induce people to reduce the number of their sexual partners. Despite the salience of this concept in the AIDS discourse of scientists, policymakers, the media, religious leaders, and the gay community, critical analysis of the role of promiscuity in this epidemic has been lacking. Following a review of promiscuity in various genres of AIDS discourse, this article discusses promiscuity in American society and in HIV-prevention campaigns. The relative risks associated with monogamy, abstinence and promiscuity are examined, and the author concludes that the partner-reduction strategy, instead of contributing to a reduction in HIV transmission has been an impediment to AIDS prevention efforts, exacerbating the problem by undermining the sex-positive approaches to risk reduction that have proven effective. Responsibility for this misguided strategy is attributed to a moralistic approach to AIDS and to the misapplication of epidemiological concepts and inappropriate social science models to the task of promoting healthy forms of sexuality.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Changes in VO2max, physical activity, and body fat with chronic exercise: effects on plasma lipids.

The effect of changes in physical activity levels during chronic exercise on plasma lipids and lipoproteins has not been reported. We examine the relationships between changes in VO2max, leisure time physical activity (LTPA), and percent body fat on changes in plasma lipids and lipoproteins in 137 men without coronary artery disease (CAD) and/or dyslipidemia, hypertension, or diabetes mellitus who participated in an employee exercise program. Measurements obtained at entry and 1- and 4-yr follow-up include VO2max, LTPA in kcal.wk-1, percent body fat, and plasma lipids and lipoproteins. The relationship between changes in the measurements between 1 and 4 yr of follow-up (N = 34) revealed the following significant (P < 0.05) correlations: i) changes in VO2max with changes in percent body fat (r = -0.289) and changes in plasma triglycerides (r = -0.354), ii) changes in LTPA with changes in percent body fat (-0.361), and iii) changes in percent body fat with changes in the total/high density lipoprotein (HDL)-cholesterol ratio (0.358), HDL-cholesterol (-0.212), and triglycerides (0.289). Multiple regression analysis revealed that changes in percent body fat affected changes in plasma triglycerides (P < 0.05). The effects of chronic physical activity on plasma triglycerides appear to result from exercise-related effects on body adiposity. These findings support the role of regular physical activity as mandated by Healthy People 2000 for CAD risk reduction.

Adult↗
PubMed2000

[Thinking about tuberculosis in Osaka City].

The incidence rate of tuberculosis in Osaka City (104.2 per 100,000 population) is extremely high, namely 3 times higher than the national average. Why the tuberculosis situation of Osaka City is so bad? The reason could be summarized as follows: Before the end of the World War II (1945), it was the sequelae of high prevalence observed in the era of Meiji, Taisho and early years of Showa. However, after the World War II, especially from the Heisei era (1989-), it is deeply affected by the influence of socio-economic background in Japan. Osaka City is characterized as the city of merchants and small enterprises. And therefore, the city substantially has the nature of the locality that brings in or produces some kinds of social vulnerability such as temporary laborers and homeless people. Of the tuberculosis patients in Osaka City, about 20% are homeless. In addition, patients of the smear positive infectious tuberculosis are often discovered among temporary laborers who change their residences and job sites from place to place and contact widely with citizens. These two are the most difficult problems in tuberculosis control program of Osaka City. In the meantime, there are many citizens who are careless of their health and do not follow the law or social rule, and this has apparently no direct connection with the problems of tuberculosis. However, it might be one of the factors of an undesirable trend of tuberculosis in Osaka City. In order to improve such a unfavorable tuberculosis situation in Osaka City, effective and strong supporting activities to the tuberculosis program are essentially needed. And these activities must be done from the standpoint of health-promotion, namely, health education for citizens and improvement of social environmental conditions to maintain healthy and cultural life.

Health Education↗
PubMed1999

Powerful connections for public health: the National Library of Medicine and the National Network of Libraries of Medicine.

As incorporated in Healthy People 2010 objectives, data and information systems and a skilled workforce are 2 of the critical components of the public health infrastructure. The National Library of Medicine (NLM) and the National Network of Libraries of Medicine (NN/LM) are important resources for improving Internet access and providing related training to the public health workforce and to those in training for public health careers. The NLM and the NN/LM have joined forces with the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and the Public Health Foundation. The goal of this collaboration is to improve electronic resources useful in public health practice and increase awareness of them, to train public health professionals to use electronic information services, and to help public health agencies obtain the equipment and Internet connections needed to use these services effectively. The databases, outreach programs, and connection grants available to public health professionals from the NLM, and the training and ongoing support available from the NN/LM for accessing these programs and services, are described.

Centers for Disease Control and Prevention, U.S.↗
PubMed2004

Wisconsin Medical Home Learning Collaborative: a model for implementing practice change.

A child with special health care needs is defined as having, or are at increased risk for, a chronic physical, developmental, behavioral, or emotional condition that requires health and related services of a type or amount beyond that required by children generally. In Wisconsin nearly 14% of children are identified as having or being at risk for special health care needs. Healthy People 2010 and the federal Child Health Maternal Bureau have challenged each state to "assure access to ongoing comprehensive health care through a medical home" for all children with special health care needs. A medical home is defined as "an approach to providing continuous and comprehensive primary pediatric care." States are challenged to translate the concepts of medical home to clinical practice activities. This article discusses Wisconsin's participation in a national Medical Home Learning Collaborative and Wisconsin's replication of the Collaborative as a means to develop practical strategies for practice implementation of a medical home.

Child↗
PubMed1996

Muscular response to sudden load. A tool to evaluate fatigue and rehabilitation.

STUDY DESIGN: Subjects were exposed to fatiguing and restorative interventions to assess their response to sudden loads. OBJECTIVES: To investigate the erector spinae and rectus abdominis response characteristics to "sudden load" and the effect of fatigue and rehabilitation. SUMMARY OF BACKGROUND DATA: Unexpected loads which people often experience, can lead to high forces in the spine and may be a cause of low back injury. METHODS: Muscle responses to sudden load were mediated by fatigue, walking, expectation, method of load application, exposure to vibration, and cognitive-behavioral rehabilitation in patients with chronic low back pain. A novel technique, perfected in this work, called wavelet analysis, was used to analyze these data. RESULTS: Reaction time was affected by fatigue and expectation. Vibration exposure significantly increased the muscle response time. Walking was able to ameliorate that effect. Back muscles responded differently, depending on whether loads were applied to the back through the hands or through the trunk. Electromyographic reaction time and magnitude decreased in patients after a 2-week rehabilitation program. CONCLUSIONS: Sudden loads can exacerbate fatigue effects. Walking after driving reduces the risk to the back caused by handling unpredictable loads. Vibration exposure guidelines should be more conservative. Patients have longer response times than healthy subjects, but patients can improve their response to sudden loads via rehabilitation. Patients exhibit a flexion-extension oscillation at 5 Hz in response to a sudden load, suggesting that the 5-Hz, seated, natural frequency observed during whole-body vibration may result from neurophysiologic control limits.

Adult↗
PubMed2004

Characteristics of community dwelling elderly not vaccinated for pneumococcus in 1998 and 2001.

BACKGROUND: We estimate proportions and numbers of elderly (>65 years old) not vaccinated for pneumococcus in 1998 and 2001 by ethnic group, socioeconomic status, health history, and access and use of health care. METHODS: Self-reported lifetime pneumococcal vaccination and participant characteristics were obtained from 10,624 community dwelling elderly in the 1998 and 2001 National Health Interview Surveys (NHIS). Robust descriptive and inferential statistical analyses were fit. Outcome. Non-receipt of pneumococcal vaccination. RESULTS: In 2001, about 13 million (or 45% of all) community dwelling elderly were unvaccinated against pneumococcus, including 11.5 million who saw a doctor at least once, 4 million who received an influenza vaccination and 2.3 million who were hospitalized, during the previous year. In 1998 and 2001 non-US born, Hispanic, African-American, and Medicaid recipient elderly were disproportionately un-vaccinated, with about 65% of each group not vaccinated in 2001. CONCLUSIONS: In 2001, lifetime pneumonia vaccination of community dwelling elderly (55%) was below the goal (60%) for Healthy People 2000. While there has been important progress in improving overall vaccination rates, much more needs to be done to attain national goals and reduce large, persistent racial/ethnic and socioeconomic disparities. Lack of a usual source of healthcare and lower frequency of physician visits were among the factors associated with non-vaccination. However, most unvaccinated individuals had seen a physician in the last year, and many had received influenza vaccination or been hospitalized, suggesting the need for more consistent implementation and monitoring of guidelines for routine pneumococcal vaccination in healthcare settings.

Aged↗
PubMed1992

Ethical aspects of genetic screening.

Public and professional concern associated with the idea of genetic screening has generated numerous publications on the ethics of genetic screening (e.g. 1-4). Concerns revolve around inadequate consultation before screening is carried out, the unearthing of worrying risks, the use of genetic information in ways that could be disadvantageous to the person involved, stigma, and a phenomenon known as the 'technological imperative', which means that simply because a technology is available there is a tendency to use it. Most reports agree that, in practice, the main ethical problems are likely to involve screening for risk of common diseases of adult life, because of the possible impact on a person's healthy self-image, implications for health and life insurance, and the possibility of commercial exploitation of people who know themselves to be vulnerable. In this paper I do not propose to address these issues directly. I have been invited to discuss this subject as a clinician involved with genetic screening, counselling and prenatal diagnosis for the haemoglobin disorders, the most common serious human recessively inherited diseases. Since we are scientists, any recommendations we make should be based on experience: my aim is to show that experience is often surprising, and that it is often possible to meet public concerns by taking quite simple practical steps.

Ethics, Medical↗
PubMed2006

Current state of community pharmacy in Japan: practice, research, and future opportunities or challenges.

OBJECTIVE: To describe the activities related to pharmaceutical care and research in community pharmacies in Japan. FINDINGS: Japan is an aging society; the proportion of elderly people aged at least 65 years was 19.9% in 2005 and is expected to rise to 26.0% by 2015. This increase will result in ballooning healthcare costs. To curb the huge and rapidly increasing expenditure on medical treatment, many structural reforms have been undertaken in Japan. The healthcare services in community pharmacies will also undergo reforms to meet social needs and patient/customer requirements. In 2006, the undergraduate pharmacy program offered by universities was changed to a 6 year program, including 6 months of clinical training in both hospitals and community pharmacies. This change should provide an opportunity for community pharmacists and academics to communicate with each other, and we anticipate that it will further the research in community pharmacies. Accreditation programs will also improve the level of health care. DISCUSSION: The healthcare system should undergo reforms to address the problems related to Japan's low birth rate and the needs of an aging population. Such reforms are also required to ensure a healthy aging society and should not have adverse effects on socially vulnerable children and the elderly. Pharmacists should contribute to the development of a healthcare system for an aging society by providing appropriate pharmaceutical care. Since a large number of prescriptions are dispensed through community pharmacies, pharmacists have a greater opportunity to improve health care. In addition, pharmacist associations are encouraging their members to actively participate in home medical care services. An effective community healthcare program should reduce the need for institutional care. CONCLUSIONS: Although Japanese pharmacists are not fully capable of providing pharmaceutical care at this stage, they will play a crucial role in ensuring a healthy aging society in the future, particularly in the community setting.

Forecasting↗
PubMed1988

America's elderly.

The older population in the US has grown twice as fast as the rest of the population in the last 20 years. This growth is expected to accelerate early in the next century as the large baby boom cohorts move through middle age and become elderly. Today, about 1 in 8 Americans is 65 years of age or older. By 2030, 1 out of every 4 persons will be in older person. Substantial improvements in life expectancy at all ages, particularly at extreme old age, mean that not only will there be a greater proportion of elderly in the population, but the more will be the "oldest-old," over 85. By 2050, they will be more than 1/4 of the population. As people live longer, many are active and healthy well past retirement. However, many individuals living into their 80s have to cope with chronic disabilities affecting their capacity to perform day-to-day activities. Modern medicine has made great inroads against mortality from such illnesses as heart disease and stroke, but has not eliminated all the effects of these diseases. As the population ages, the issues of health care funding and availability, particularly long-term care, increase in importance. Contrary to widespread belief, the elderly are not abandoned by their families to nursing home care. The vast majority--95%--live in the community. Those needing assistance generally receive help from family and friends. This has created a tremendous demand for federal subsidies to support community-based long-term care services. 1/4 of the federal budget is now spent on the elderly--$270 billion in 1986. Medicaid and Medicare are among the government's success stories, but these programs are threatened by their very success. Economists estimate that government expenditures are 3 times greater for the elderly than for children, raising the issue of "intergenerational equity"--how to balance the amount of care society provides to those who have already contributed with what is provided to those who will contribute in the future. The view that the young and old simply compete for fixed resources is misleading. It ignores the interdependence among generations, and the burdens and benefits of intergenerational transfers at all stages of the life course.

Adult↗
PubMed2003

Art and "the language of well-being" in adolescent health care.

Feeling effective as a young person depends on a capacity to draw upon one's own resources in the service of healthy living and development. In adolescent health care, there is the need to call upon the talents and creativity of young people, to introduce new and exciting experiences, and to facilitate involvement in their own care in order to nurture optimal growth and development on a physical and psychological level. While hospitalisation can represent a major crisis point in adolescence, the provision of a stimulating environment and the opportunity for creative activities offers an exciting, transformative and healing experience. Art allows adolescents to use alternative languages beyond illness, to engage in endeavours that are distanced from overt therapeutic intent, and to embrace attributes of self-esteem and resilience. Through the process and production of art, and the inclusion of music, poetry, film or theatre, young people can experience personal growth, acquire skills, develop socially and contribute to environmental change. In seeking to illustrate the value and importance of such approaches, this paper draws upon the experiences of a youth arts program attached to an adolescent ward. In a project called Art Injection, art students worked with adolescents to make sculptures from old hospital equipment, with startling results. More recently, the development of personal totem poles and an imaginative mosaic mural has powerfully engaged creativity and community in care. Group and individual art sessions, including the media arts project Creative Well, are offered on weekdays as part of the general hospital routine, enabling hospitalised young people to experience creativity as a daily part of their lives.

Adolescent↗
PubMed2006

State-specific prevalence of obesity among adults--United States, 2005.

Obesity, one of the 10 leading U.S. health indicators, is associated with increased risk for hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, and certain cancers. A Healthy People 2010 objective is to reduce to 15% the prevalence of obesity among adults in the United States (objective 19-2). Both national-level data from the National Health and Nutrition Examination Survey (NHANES) and state-level data from the Behavioral Risk Factor Surveillance System (BRFSS) indicate that the prevalence of obesity among adults continued to increase during the past decade. In 2003, one study estimated that state-specific, obesity-attributable medical expenditures ranged from $87 million in Wyoming to $7.7 billion in California. To assess the prevalence of obesity among adults by state and demographic characteristics since 1995, data were analyzed from the 1995, 2000, and 2005 BRFSS surveys. The results of these analyses indicated that 23.9% of U.S. adults were obese in 2005, and the prevalence of obesity increased during 1995-2005 in all states. To reverse this trend, a sustained and effective public health response is needed, including surveillance, research, policies, and programs directed at improving environmental factors, increasing awareness, and changing behaviors to increase physical activity and decrease calorie intake.

Adult↗
PubMed1987

Reference values for pulsed Doppler signals from the blood flow on both sides of the aortic valve.

Pulsed Doppler signals were recorded in 215 healthy subjects, 120 males and 95 females, between 1 and 65 years of age. The measurements were performed in the left ventricular outflow tract (LVOT) and in the ascending aorta (AAO). Amplitude spectra from the Doppler signals were stored in digital form together with adjustment data for the instrument, the simultaneously registered ECG and respiration signal. The maximum velocity (Vmax), the maximum acceleration (Amax) and the width of the velocity distribution around Vmax (width) were derived from these spectra and used for the characterization of the signals. These parameters were computed without observer interaction using a computer program. Effects of age, sex, body surface area, heart rate and respiration were studied. Reference ranges were calculated. The following conclusions can be drawn: Vmax and Amax in the AAO decrease clearly with increasing age from approximately 100 to 60 cm s-1 and from 2000 to 1000 cm s-2 (medians), respectively. The variation of the width in the AAO is greater for people over 45 years. Vmax, Amax and width in the LVOT increase slightly with advancing age from approximately 60 to 80 cm s-1, 800 to 1000 cm s-2 and 12 to 15 cm s-1 (medians), respectively. These parameters of flow were either unrelated or only weakly related to other physiological variables in this study group.

Adolescent↗
PubMed1989

Knowledge about AIDS among Zimbabwean teacher-trainees before and during the public awareness campaign.

Knowledge about AIDS was studied among 4,189 Zimbabwean teacher-trainees from January to March, 1988, about six months after a national AIDS awareness campaign began. Knowledge about AIDS among part of this sample of teacher-trainees surveyed after the AIDS campaign began was also compared with that displayed by 630 teacher-trainees studied in January, 1987, roughly six months before the AIDS campaign began. Over 85 percent of 1988 subjects knew that AIDS is fatal and incurable. More than 80 percent of 1988 respondents knew that a condom is an effective precaution against AIDS. However, among 1988 participants, 35 percent did not know that many people carrying the AIDS virus look healthy, 36 percent believed that many AIDS victims in Africa are homosexual, 36 percent did not know that one cannot contract AIDS from a toilet seat, 40 percent believed that kissing transmits AIDS and nearly half believed that mosquitoes transmit AIDS. Males and subjects from urban homes were better informed about AIDS than females and those from rural homes, respectively. Teacher-trainees surveyed in 1988 were generally more knowledgeable about AIDS than those studied in 1987. The implications of these results for further educational efforts are considered.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Estimating the health consequences of replacing cigarettes with nicotine inhalers.

BACKGROUND: A fast acting, clean nicotine delivery system might substantially displace cigarettes. Public health consequences would depend on the subsequent prevalence of nicotine use, hazards of delivery systems, and intrinsic hazards of nicotine. METHODS: A spreadsheet program, DEMANDS, estimates differences in expected mortality, adjusted for nicotine delivery system features and prevalence of nicotine use, by extending the data and methods of the SAMMEC 3 software from the US Centers for Disease Control and Prevention. The user estimates disease risks attributable to nicotine, other smoke components, and risk factors that coexist with smoking. The public health consequences of a widely used clean nicotine inhaler replacing cigarettes were compared to historical observations and public health goals, using four different risk attribution scenarios and nicotine use prevalence from 0-100%. MAIN OUTCOME MEASURES: Changes in years of potential life before age 85 (YPL85). RESULTS: If nicotine accounts for less than a third of smokers' excess risk of SAMMEC diseases, as it most likely does, then even with very widespread use of clean nicotine DEMANDS predicts public health gains, relative to current tobacco use. Public health benefits accruing from a widely used clean nicotine inhaler probably equal or exceed the benefits of achieving Healthy People 2010 goals. CONCLUSIONS: Clean nicotine inhalers might improve public health as much as any feasible tobacco control effort. Although the relevant risk estimates are somewhat uncertain, partial nicotine deregulation deserves consideration as part of a broad tobacco control policy.

Administration, Inhalation↗