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PubMed1987

Obesity in black women.

The marked excess of obesity among black women in the United States poses several interesting questions which provide the framework for this review: Is the apparent high prevalence of obesity in black women a valid finding? If so, does it show the expected disease and disease risk associations? Can the contributory genetic and environmental variables be identified? Regarding the validity issue, the high prevalence of obesity in black women seems to be neither artifactual nor primarily an indirect effect of socioeconomic status. On the issue of racial comparability of disease risks among women, the available evidence is less conclusive. Obesity appears to have qualitatively similar health consequences for black women and white women but may be less strongly related to some disease risks (for example, hypertension) in black women than in white women. Obesity risks of black women may, however, be enhanced by the presence of multiple risk factors. On the question of causes, no clear mechanism for the excess obesity in black women can be identified. There is some evidence to support hypotheses based on dietary, lifestyle, and metabolic influences. Genetic factors cannot be ruled out. Several relevant future research possibilities can be suggested. Epidemiologic studies of both genetic and environmental influences in female obesity are needed. Studies among black females might further specify patterns of body weight and body fat distribution according to degree of European admixture and developmental variables such as caloric exposure in utero and in early infancy. Studies to establish more clearly the relative risks of various health outcomes for obese black women are needed to assist in setting public health priorities. For example, what are the attributable and absolute risks of overweight or obesity compared with other risk factors that are potential intervention targets? Studies are needed to define effective means of preventing and treating obesity among black women. Effective interventions are likely to be culture-specific. Definitive comparisons of black women and white women on environmentally mediated aspects of obesity might contribute to models of obesity in the general population and might also elucidate points at which black women and white women diverge. For example, short-term prospective studies are needed to better specify the natural history of weight gain and weight loss among females of both races during critical periods such as adolescence, post partum, lactation and post lactation, and during major life stresses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Work stress differentials between psychiatric and general nurses.

Reducing occupational stress among nursing staff is a public health priority in many western countries. This study assessed stress differentials between psychiatric nurses (PNs) and general nurses (GNs), and the moderating function of social support. It was expected that PNs would report different (higher) stress levels than GNs given PNs' lower levels of social support. A questionnaire was completed and returned by 73 nurses at several public hospitals in England. Multivariate analysis of variance showed that social support moderated stress differentials between PNs and GNs, albeit not as anticipated; the latter group reported significantly higher and lower stress levels when social support was low and high, respectively. This interaction was applicable to both the quality and quantity of social support. Overall, the benefits of social support seemed to accrue primarily to GNs. Implications of these findings for the development of stress-reduction interventions are considered.

Adaptation, Psychological↗
PubMed1998

Factors influencing condom use among African American women: implications for risk reduction interventions.

Examined factors associated with condom use in a community-based sample of 423 sexually active African American women. Measures were selected to reflect the components in prevailing models of health behavior. Condom users were higher on AIDS health priority, prevention attitudes, stage of change, behavioral intentions, reported more frequent and comfortable sexual communication with partners, perceived greater partner and peer approval for condom use, and reported that peers also used condoms. Women in exclusive relationships evidenced earlier stage of change, lower intentions to use condoms, fewer peers who engaged in preventive behaviors, perceived themselves to have lower risk, and had lower rates of condom use, higher education, and family income. Women in fluid relationships were at particularly high risk, with lower rates of condom use relative to women not in a relationship and greater sexual risk for HIV. Implications for HIV-risk reduction interventions with African American women are discussed.

Adolescent↗
PubMed2006

Neurocognitive outcomes in children with chronic kidney disease: Current findings and contemporary endeavors.

Given the rise in chronic kidney disease (CKD) in both children and adults, CKD has recently been targeted as a public health priority. Childhood onset kidney disease is generally a noncurable and progressive condition that leads to kidney failure by early adulthood. Fortunately, improved identification of kidney problems allows for early intervention, which is thought to slow progression toward end-stage renal disease. In addition, medical interventions for pediatric end-stage renal disease have also improved, allowing children to take advantage of lifesaving renal replacement treatments such as dialysis and kidney transplantation. In spite of improvements in identification and treatment, CKD causes both direct and indirect insults to a variety of organ systems. This paper reviews recently published studies pertaining to the neurocognitive and psychosocial impact of CKD on children of various ages and at various stages of kidney failure. Specific attention is focused on summarizing peer reviewed research that describes associations between kidney functioning and cognitive functioning, language acquisition, visual spatial abilities, memory, and executive functioning. In addition, peer reviewed research describing psychosocial outcomes associated with CKD related to academic achievement, social-behavioral functioning, and quality of life are summarized. The authors also identified disease-specific factors that likely mediate neurocognitive outcomes (e.g., anemia, hypertension, cardiovascular) and endorse the importance of continued interdisciplinary research collaborations that will provide a better understanding of the mechanisms responsible for improved neurocognitive functioning after transplantation. The authors conclude this review by describing a multicenter, prospective, longitudinal, National Institutes of Health funded study that is currently examining the developmental outcomes of children with mild to moderate CKD. The authors speculate that the Chronic Kidney Disease in Children Prospective Cohort Study (CKiD) findings will provide additional evidence-based guidance for clinicians and researchers working with children and adolescents with deteriorating kidney function to improve medical and developmental outcomes.

Adolescent↗
PubMed2002

[Management problems of malignant hemopathies among children in Senegal].

Malignant hemopathies are not considered as public health priority in Senegal because of their infrequency in comparison with infections and malnutrition. However they remain usually lethal instead of a great improvement of their prognosis in suitable therapeutic conditions. The objective of this study was to determine the epidemiologic and evolutionnal profile of these pathologies, and identify practical management problems in a reference public pediatric service in Senegal. We retrospectively analysed hospitals registers and records of all patients followed up in Albert Royer Children Hospital of Dakar from january 1989 to december 1998. During this ten years period 25 cases of malignant hemopathies were diagnosed among 32,789 hospitalised children, representing an hospital prevalence of 0.08 per cent. Mean age at the desease diagnosis was 9.5 years and sex ratio 2.57 (18 boys and 7 girls). The malignant type was acute leukemia (AL) in 11 cases (44%) including 9 cases of of acute lymphoblastic leukemia (ALL) and 2 cases of acute myeloblastic leukemia (AML); chronic myeloid leukemia (CML) in 2 cases (8%), Hodgkin's desease (HD) in 9 cases (36%) and non hodgkinian lymphoma (NHL) in 3 cases. NHLwere Burkitt type in 2casesand lymphoblastic type in 1 case. Their was no maxillary or facial localisation in Burkitt type lymphoma. The mean duration between the first clinical symptomes and the diagnosis of the disease was 4 months and delayed diagnosis was mainly due to delayed transfer from peripheral health services to hospital. Among 19 patients whose records were available, 17 were subjected to chemotherapy. However reference protocols were completely applyed in only 2 cases, one with HD and an other with lymphoblastic lymphoma. Transfusion managementwas not sufficient because of the lack of blood derived products (packed platelets or leucocytes) when needed. Thirteen patients died while followed up and mean survival after first hospitalisation in these cases was 120 days in ALL, 38 days in AML, 2.5 years in HD and 18 months in NHL The other patients were lost of sight and presumed to be dead at home. Eventually, this study showed that, in our hospital, children with malignant hemopathies did not derive benefit of therapeutic progress enregistered long time ago in developed countries, since they remain constantly lethal. The main factors of lethality could be delayed transfer to hospital because of lack of knowledge about these pathologies in the peripheral health services and poor therapeutic conditions in reference hospitals. Creation of specialised clinical haematology department could enable us to improve the prognosis of these affections by an optimal use of available human and material ressources.

Adolescent↗
PubMed1999

Cost effectiveness of single-dose nevirapine regimen for mothers and babies to decrease vertical HIV-1 transmission in sub-Saharan Africa.

BACKGROUND: Identification of economical interventions to decrease HIV-1 transmission to children is an urgent public-health priority in sub-Saharan Africa. We assessed the cost effectiveness of the HIVNET 012 nevirapine regimen. METHODS: We assessed cost effectiveness in a hypothetical cohort of 20,000 pregnant women in sub-Saharan Africa. Our main outcome measures were programme cost, paediatric HIV-1 cases averted, cost per case averted, and cost per disability-adjusted life-year (DALY). We compared HIVNET 012 with other short-course antiretroviral regimens. We also compared two implementation strategies: counselling and HIV-1 testing before treatment (targeted treatment), or nevirapine for all pregnant women (universal treatment, no counselling and testing). We did univariate and multivariate sensitivity analyses. FINDINGS: For universal treatment with 30% HIV-1 seroprevalence, the HIVNET 012 regimen would avert 603 cases of HIV-1 in babies, cost US$83,333, and generate 15,862 DALYs. The associated cost-effectiveness ratios were $138 per case averted or $5.25 per DALY. At 15% seroprevalence, the universal treatment option would cost $83,333 and avert 302 cases at $276 per case averted or $10.51 per DALY. For targeted treatment at 30% seroprevalence, HIVNET 012 would cost $141,922 and avert 476 cases at $298 per case averted or $11.29 per DALY. With seroprevalence higher than 3.0% for universal and 4.5% for targeted treatment, the HIVNET 012 regimen was likely to be as cost effective as other public-health interventions. The cost effectiveness of HIVNET 012 was robust under a wide range of parameters in the sensitivity analysis. INTERPRETATION: The HIVNET 012 regimen can be highly cost-effective in high seroprevalence settings. In lower seroprevalence areas, when multidose regimens are not cost effective, nevirapine therapy could have a major public-health impact at a reasonable cost.

Africa South of the Sahara↗
PubMed1992

Evaluating the drug dependency unit.

An evaluation of the St Mary's Drug Dependency Unit is described. Unit staff were interviewed and a retrospective analysis of 156 records was performed. The advent of HIV infection has led to an emphasis on public health priorities in the treatment of drug misuse. However, DDU staff retain a highly individualistic approach to their work. Staff aiming at abstinence within treatment may compromise important advice on harm minimization. The mean delay between first contact and entering treatment was 10 days; 42% of clients failed to complete the initial assessment. The need to extend access to the service is not easy to reconcile with the increasingly specialised support role for such units implied in recent strategy documents. Little is known of the effectiveness of different services for drug misusers. In this study, only 6% of clients were known to have achieved abstinence at one year. The efficiency of the DDU could be improved by closer definition of the unit's goals and target population, regular progress reviews, shortening the assessment procedure and the computerisation of data collection.

Adult↗
PubMed2002

The California Tobacco Control Program and potential harm reduction through reduced cigarette consumption in continuing smokers.

Harm reduction for continuing smokers has been suggested as a public health priority. We evaluated whether tobacco control programs might reduce cigarette consumption among current smokers through strategies aimed primarily at protecting nonsmokers from secondhand smoke (SHS). Data were from adult (18+ years) respondents to multiple (1990, 1992, 1996, 1999), large, cross-sectional, population-based surveys of smoking behavior, conducted to evaluate the California Tobacco Control Program. Adult daily smoking prevalence decreased from 15.9 +/-0.4%(+/-95% confidence interval) of the California adult population in 1990 to 13.0 +/-0.3% in 1999. Concurrently, moderate-to-heavy daily smoking (>or= 15 cigarettes/day) decreased from 10.3 +/-0.4% in 1990 to 7.4 +/-0.3% in 1999, and heavy daily smoking (>or= 25 cigarettes/day) from 3.4 +/- 0.2% in 1990 to 1.9 +/- 0.1% in 1999. Decreased daily smoking was observed in all demographic subgroups except young adults. Among college graduates, the daily smoking prevalence in 1999 was 6.4 +/- 0.4%, a level previously observed only among U.S. physicians. In 1999, nearly 30% of current smokers did not smoke daily, and more than 60% said they now smoked less than previously. In 1999, self-reported cigarette consumption was inversely related to believing SHS is harmful to nonsmokers, having a smoke-free workplace, and living in a smoke-free home. In California, tobacco control strategies that educated the population about SHS and resulted in smoking restrictions may have led continuing smokers to smoke less, which should reduce the harm from smoking to the public health in the long term.

Adolescent↗
PubMed1998

Doctoral training of African scientists.

There are two principal rationales for doctoral training of African scientists in health: 1) these scientists are essential for the nations of sub-Saharan Africa to define and implement their own health priorities, and 2) the research they perform is essential for development. However, this training is difficult because of its expense (> $20,000 per year), because many developed country mentors are unaware of the realities of research in sub-Saharan Africa, and because major differences in salary provide a financial disincentive to return. We describe a training strategy that reduces attrition because it is linked to the investigators' responsibilities before and after training, and to home country priorities. This strategy requires a close relationship between the developing country (on-site) and developed country (off-site) mentors, with joint participation in the selection and funding process, followed by course work and short-term, independent projects off-site that lead to a thesis project in the developing country, and subsequently to a defined professional position in the developing country after completion of the doctoral degree. For this strategy to succeed, the developed country mentor must have both field experience and investigative expertise; the developing country mentor must have an understanding of modern biology, as well as clinical and epidemiologic experience. In addition, we would like to emphasize that the long-term retention of these talented, highly-trained individuals requires a similar long-term commitment by their developed country mentors, well beyond the short term of most research funding.

Africa South of the Sahara↗
PubMed2006

Hard gains through soft contracts: productive engagement of private providers in tuberculosis control.

Over the past decade, there has been a rapid increase in the number of initiatives involving "for-profit" private health care providers in national tuberculosis (TB) control efforts. We reviewed 15 such initiatives with respect to contractual arrangements, quality of care and success achieved in TB control. In seven initiatives, the National TB Programme (NTP) interacted directly with for-profit providers; while in the remaining eight, the NTP collaborated with for-profit providers through intermediary not-for-profit nongovernmental organizations. All but one of the initiatives used relational "drugs-for-performance contracts" to engage for-profit providers, i.e. drugs were provided free of charge by the NTP emphasizing that providers dispense them free of charge to patients and follow national guidelines for diagnosis and treatment. We found that 90% (range 61-96%) of new smear-positive pulmonary TB cases were successfully treated across all initiatives and TB case detection rates increased between 10% and 36%. We conclude that for-profit providers can be effectively involved in TB control through informal, but well defined drugs-for-performance contracts. The contracting party should be able to reach a common understanding concerning goals and role division with for-profit providers and monitor them for content and quality. Relational drugs-for-performance contracts minimize the need for handling the legal and financial aspects of classical contracting. We opine that further analysis is required to assess if such "soft" contracts are sufficient to scale up private for-profit provider involvement in TB control and other priority health interventions.

Antitubercular Agents↗
PubMed2001

[Prevalence and management of pain in a hospital: a cross-sectional study].

OBJECTIVES: Improved management of pain, particularly in inpatients, is a public health priority. We conducted this study to ascertain current practices and identify indications useful for measuring their impact. PATIENTS AND METHODS: A "given day" cross-sectional study was conducted in 18 units (11 medicine units and 7 surgery and obstetrics units) at the Cochin Hospital, Paris. All patients hospitalized over 24 hours were included in the study. A short one-page questionnaire was administered by an investigator (nurse or physician) after the patient agreed to participate in the study. All pertinent information concerning pain at admission and/or during the 24 hours of hospitalization (quantified on a simple verbal scale), percent pain relief compared with the initial level, and any circumstances leading to an increase in the pain level during hospitalization were recorded. Data were also collected on antalgesia prescription administered the day of the survey. Social and demographic data as well as discharge diagnosis(es) were also recorded. RESULTS: Nearly 60% of the patients stated they had experienced pain at the time of admission or during the 24-h preceding the survey. In medicine units, 29% of the inpatients with pain were not given any anti-pain treatment (this percentage was 12% in surgery) and 35% stated their pain had been relieved by less than 50% (13% of the patients in surgery). Hospitalization in a medicine unit was associated with fewer and less effective prescriptions in patients experiencing pain. CONCLUSION: Regular and simple indications, specifically the number of patients complaining of pain who have not been given an antalgesic, would provide the health care team with a measurement of pain management useful for assessing its impact and improving patient care.

Acetaminophen↗
PubMedDate not supplied

Focus groups in the design of prostate cancer screening information for Hispanic farmworkers and African American men.

PURPOSE/OBJECTIVES: To gain a better understanding of men's everyday concerns as part of formative research for creating relevant prostate cancer screening education; to describe methods and processes used to conduct community-based focus groups. SETTING: Community-based settings in catchment areas surrounding Tampa, FL. SAMPLE: 8 community-based focus groups: a total of 71 Hispanic farmworkers and African American men. METHODS: Focus group discussions were tape-recorded, transcribed, and analyzed for identification of emergent themes. MAIN RESEARCH VARIABLES: General life and health priorities, prostate cancer knowledge, screening attitudes, cancer beliefs, and learning preferences. FINDINGS: Major themes among African American men were importance of work, family, and faith. Major themes among Hispanic farmworkers were importance of family, employment, education of children, and faith. A common issue that surfaced among most men was that a cancer diagnosis was considered to be a death sentence. Preferred learning methods included use of cancer survivors as spokespeople, interactive group education, and the provision of easy-to-understand information. Issues of trust, respect, and community involvement were key to the successful conduct of focus groups among ethnically diverse groups. CONCLUSIONS: Study findings have important implications for the content of information developed for prostate cancer education materials and media. IMPLICATIONS FOR NURSING: Insights gained from focus group methodology can help nurses and other healthcare professionals design and develop appropriate prostate cancer education tools for use in community-based prostate cancer screening programs.

Adolescent↗
PubMed2002

Environmental factors associated with adults' participation in physical activity: a review.

BACKGROUND: Promoting physical activity is a public health priority, and changes in the environmental contexts of adults' activity choices are believed to be crucial. However, of the factors associated with physical activity, environmental influences are among the least understood. METHOD: Using journal scans and computerized literature database searches, we identified 19 quantitative studies that assessed the relationships with physical activity behavior of perceived and objectively determined physical environment attributes. Findings were categorized into those examining five categories: accessibility of facilities, opportunities for activity, weather, safety, and aesthetic attributes. RESULTS: Accessibility, opportunities, and aesthetic attributes had significant associations with physical activity. Weather and safety showed less-strong relationships. Where studies pooled different categories to create composite variables, the associations were less likely to be statistically significant. CONCLUSIONS: Physical environment factors have consistent associations with physical activity behavior. Further development of ecologic and environmental models, together with behavior-specific and context-specific measurement strategies, should help in further understanding of these associations. Prospective studies are required to identify possible causal relationships.

Adult↗
PubMedDate not supplied

Use of interactive health communication to affect smoking intentions in middle school students: a pilot test of the "Headbutt" risk assessment program.

PURPOSE: Developing and disseminating innovative and effective approaches for smoking prevention among middle school children remains a public health priority. This pilot study evaluates the use of a Web-based tobacco prevention program, Headbutt, to change intentions of middle school children to smoke tobacco. METHODS: Headbutt was implemented with the use of a single-group pretest-posttest study design in sixth grade classes of nine middle schools in Texas (student n = 2227). The program assesses cognitive determinants of smoking and provides intervention feedback tailored to the child's responses. RESULTS: Headbutt significantly affected smoking intentions, prosmoking attitudes, self-efficacy expectations, and knowledge of negative consequences (all p < or = .001) measured with scales adopted from the Texas Tobacco Initiative Survey. Change in prosmoking attitudes had the greatest predictive effect on smoking intentions (p < .001). These results were moderated by ethnicity and age of students. CONCLUSION: Findings need to be interpreted in the light of study design limitations. However, strong associations between the Headbutt program and intention change suggests that a more rigorous effectiveness trial is indicated.

Child↗
PubMed2005

[Assessment of the budgetary impact of treatment guidelines in type II diabetes mellitus in France].

BACKGROUND: Type II diabetes mellitus is associated with an increasing prevalence and incidence, and with a heavy economic burden in Western countries. As a consequence, health authorities consider that avoidance or delay of occurrence of diabetes-related micro- and macro-angiopathic complications is a public health priority, leading to the definition of treatment guidelines. The aim of the study was to assess the budgetary impact of the application of the French guidelines. METHODS: Etiologic cost ratios. RESULTS: Our results conclude that 10% decrease in body mass index (BMI) among overweight patients, smoking cessation, initiation to undertake a preventive treatment with low-dose aspirin, initiation to undertake or intensify blood pressure control, initiation to undertake or intensify lipidic control, and shift to biguanides among overweight patients are factors associated with significant benefits (avoided costs) which compensate for the increase in treatment costs. The main beneficial strategies are, in decreasing order, initiation to undertake a preventive treatment with low-dose aspirin, smoking cessation, and control of BMI. CONCLUSION: Our results support interest in reinforcing the application of current treatment guidelines for type II diabetes mellitus.

Adolescent↗
PubMed2005

[The social and health burden of alcohol abuse].

Based on the recent report on alcohol-related health and social burdens issued by the World Health Organization (WHO), this paper explores and discusses the evidence in support of the view that concerns about alcohol consumption extend far beyond consideration of personal and family health consequences, but should be considered in the context of major socio-political and public health priorities. The global findings of the WHO report are first discussed, followed by analysis of the specific findings regarding the burden of alcohol problems in Brazil. The social burden of alcohol problems is quantified by applying a unifying methodology which incorporates outcomes for alcohol-related violence, family problems, child abuse, public disorder, lost productivity, and other consequences. By analyzing the epidemiological date on alcohol-related morbidity and mortality data from each continental region and sub-region, and cross-tabulating data on average consumed volume and patterns of consumption, the burden of disease are estimated for the various regions of the world. The final results provide a comparative analysis of risk, basically using a representative indicator of number of productive years lost because of illness or premature mortality due to alcohol consumption ("DALYs" -- Disability Adjusted Life Years). The DALYs global value in 2000 was 4% of world mortality, with this rate predicted to increase as global alcohol consumption increases. Variations among various regions in the planet are critically analyzed on predictive factors.

Alcohol Drinking↗
PubMed2006

Awareness of eye diseases and risk factors: identifying needs for health education and promotion in Canada.

BACKGROUND: Little is known about the level of general public knowledge in Canada regarding the risk factors, prevention, and treatment of major blinding eye diseases. METHODS: The study was a cross-sectional survey using self-administered questionnaires of patients presenting to 33 family practitioners' offices in British Columbia. We asked patients' opinions on the "value" of preventing blindness; the possibility of preventing cataract, glaucoma, and macular degeneration; the possibility of treating these conditions; and their knowledge of risk factors. RESULTS: A total of 882 adults completed the questionnaires. Preventing vision loss was reported as one of 2 top health priorities in 28% of the questionnaires, more commonly by those with higher education and non-European ancestry. Overall, 69.2% reported familiarity with cataract as a cause of vision loss, 41.2% with glaucoma, and 20.2% with macular degeneration. Of these, 97.5% recognized the possibility of treatment for cataract, 91.5% for glaucoma, and 77.0% for macular degeneration, yet few respondents knew risk factors (amenable to intervention) for specific eye diseases. Men and younger respondents were more likely to report not knowing risk factors. Chinese-Canadians were least familiar with the association between smoking and cataract. Family history, probably the most important factor to help diagnose glaucoma, was recognized by only 23% of respondents. INTERPRETATION: Although loss of vision was reported as a major medical concern, there is little understanding of the risk factors for different eye diseases. The association of non-European ancestry and low educational attainment with poor knowledge of eye diseases suggests that innovative education programmes in primary and secondary schools and in non-English languages are needed to improve knowledge, attitudes, and practices.

Adult↗
PubMed2004

Perceived environment attributes, residential location, and walking for particular purposes.

BACKGROUND: Identifying environmental factors that can influence physical activity is a public health priority. We examined associations of perceived environmental attributes with walking for four different purposes: general neighborhood walking, walking for exercise, walking for pleasure, and walking to get to and from places. METHODS: Participants (n =399; 57% women) were surveyed by mail. They reported place of residence, walking behaviors, and perceptions of neighborhood environmental attributes. RESULTS: Men with the most positive perceptions of neighborhood "aesthetics" were significantly more likely (odds ratio [OR]=7.4) to be in the highest category of neighborhood walking. Men who perceived the weather as not inhibiting their walking were much more likely (OR=4.7) to be high exercise walkers. Women who perceived the weather as not inhibiting their walking were significantly more likely to be high neighborhood walkers (OR=3.8) and those with moderate perceptions of "accessibility" were much more likely to do more walking for pleasure (OR=3.5). CONCLUSIONS: Different environmental attributes were associated with different types of walking and these differed between men and women. Approaches to increasing physical activity might usefully focus on those attributes of the local environment that might influence particular subsets of walking behavior.

Adult↗