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PubMed2002

The unique aspects of the nutrition transition in South Korea: the retention of healthful elements in their traditional diet.

OBJECTIVE: The purposes of this paper are to describe the unique aspects of the nutrition transition in South Korea, including trends in food consumption and obesity, patterns of morbidity and mortality; to focus on efforts to maintain the traditional diet in the midst of rapid economic growth and the introduction of Western culture; and to provide insights for other countries. DESIGN: We analysed secondary dietary intake, anthropometric, morbidity and mortality data from published reports and articles. RESULTS: In South Korea, the level and rate of increase in fat intake have remained very low, whereas vegetable intake has been high and fruit intake has increased greatly. South Korea also has a relatively low prevalence of obesity compared with other Asian countries. The traditional Korean diet is a low-fat and high-vegetable diet. Therefore, the government and nutrition specialists have been initiating numerous efforts to advertise and teach the public that the traditional diet is a healthy diet. They are also working on revival of the traditional diet using an approach that is acceptable to contemporary Koreans. CONCLUSIONS: The nutrition transition in South Korea is unique. A range of government, nutrition specialists and some private organisation efforts has worked to retain healthful elements of the traditional diet in South Korea. The continued low level of total fat in the overall diet and the high intake of fruits and vegetables bode well for South Korea.

Adult↗
PubMedDate not supplied

Health consequences of Alzheimer's caregiving transitions: effects of placement and bereavement.

OBJECTIVE: To determine the extent to which the chronic stress of Alzheimer's disease caregiving may be alleviated by placement or death of the Alzheimer's disease patient, we prospectively compared groups of caregivers (CG) who continued to care for their Alzheimer's disease spouse at home, CG who placed their spouses, and CG whose spouses died with similarly aged noncaregiving comparison subjects (control subjects). METHODS: A sample of 119 CG who had been studied for at least 18 months at 6-month intervals was included in the present analyses (ie, had at least three assessments). Data were gathered on CG mood, blood pressure, and medical symptoms among 38 CG whose spouses were at home at all three visits (home-home-home [HHH]); 28 CG who placed their spouse at follow-up (home-placed-placed [HPP]); 27 CG whose spouses were placed and subsequently died at follow-up (home-placed-deceased [HPD]); and 26 CG whose spouses died at home (home-deceased-deceased [HDD]). Data were compared with 48 noncaregiving control subjects (NC group). RESULTS: CG in the HPP, HPD, and HDD groups showed improvement in depressive and physical symptoms compared with HHH and NCs. CG had significantly higher systolic blood pressure at rest than did NCs. Both placement and death of the Alzheimer's disease spouse were associated with higher systolic blood pressure in response to postural challenge in CG experiencing these transitions. CONCLUSIONS: Despite improvement seen in mood and medical symptoms among CG who place their spouses or experience the spouse's death, there may be longer term physiological alterations, possibly in sympathoadrenalmedullary arousal, that cause the cardiovascular system to continue to respond to acute stressors such as postural challenge more actively for a period of 6 to 12 months after such transitions.

Affect↗
PubMed2003

Transitioning adolescents with congenital heart disease into adult health care.

The effort and commitment dedicated to the treatment of children with congenital heart disease over the past 50 years has been astounding. Therefore, it is imperative to ensure these young patients who have survived the varying challenges of their conditions a smooth transition into a new world of adult health care. The key to the long-term management of an increasing number of children surviving congenital heart disease is the effective coordination of care from pediatric to adult health care. Strategies for facilitating the transition of the adolescent with congenital heart disease into adult health care practices are presented in this paper.

Adaptation, Psychological↗
PubMed2006

Women's mental health before, during, and after pregnancy: a population-based controlled cohort study.

BACKGROUND: Common mental health disorders like depressive and anxiety disorders are frequent in antenatal and postpartum women. However, no agreement about the prevalence of these disorders and the course of women's mental health during the transition to motherhood exists. This study compared women's mental health before, during, and after pregnancy with a control group of nonpregnant women. METHODS: Three hundred and twenty-four women were assessed before, during, and after their pregnancy with the 12-item version of the General Health Questionnaire (GHQ-12). A control group of 324 women who did not deliver during 3 subsequent years was assessed with the GHQ-12 at corresponding time-points. RESULTS: No differences in GHQ-12 mean scores, prevalence, and incidence of common mental health disorders between the study and control groups were found. No differences in prevalence and incidence rates within each group were found. The presence of a common mental health disorder before pregnancy or in early pregnancy predicted common mental health disorders in the postpartum period. CONCLUSIONS: Common mental health disorders are frequent during pregnancy and the postpartum period, but pregnant or postpartum women are not more at risk than those who are not pregnant or who did not deliver.

Adult↗
PubMed2006

Depressed mood symptoms during the menopausal transition: observations from the Seattle Midlife Women's Health Study.

AIM: To describe patterns of depressed mood during the menopausal transition (MT) and to investigate relationships between patterns of depressed mood and MT stages. METHODS: Women during MT and early postmenopause rated depressed mood from 0 to 4 in a 3-day diary. Variables were percentage days with zero ratings, days with ratings of 3 or 4, and slope of ratings over time. Cluster analysis was used. RESULTS: Six distinct clusters were identified for 164 women. The three largest clusters (n = 134) had depressed mood ratings of zero (93% of days, 73%, 50%, respectively). Ratings of 3 or 4 were infrequent for these three clusters (0%, 3%, 9%, respectively). The three smallest clusters (n = 30) had zero ratings for 32% of days, 14% and 8%, respectively. The fourth cluster had 16% rated 3 or 4 with a positive slope. The fifth and sixth clusters had 23% and 6% of days at 3 or 4 with a negative slope. MT stage was not related to depressed mood ratings. Most women did not have depressed mood during the MT. Of those who did, some experienced improvement. IMPLICATIONS: The majority of women for the majority of the time experienced MT without a high severity of depressed mood while a small group of women had mood worsening over time and others improved. Depressed mood that occurs during the MT should not be attributed automatically to menstrual cycle changes or normative changes. Instead, features of a woman's life that contribute to depression should also be considered.

Adult↗
PubMedDate not supplied

Creating Healthy Futures: an innovative nurse-managed transition clinic for adolescents and young adults with special health care needs.

The Creating Healthy Futures (CHF) clinic is an innovative, nurse-managed service model that provides comprehensive transition services to youth and young adults with special health care needs. Unlike other transition service models reported in the literature that are medically based, comprehensive transition services were coordinated by a family nurse practitioner who worked in close collaboration with an interagency team of pediatric and adult service providers. The Creating Healthy Futures (CHF) service model was originally developed for use in educational settings but was adapted for use in health care settings. The components of the service model are described in detail as a model for replication in other health care settings.

Adolescent↗
PubMed1996

Addressing the epidemiologic transition in the former Soviet Union: strategies for health system and public health reform in Russia.

OBJECTIVES: This paper reviews Russia's health crisis, financing, and organization and public health reform needs. METHODS: The structure, policy, supply of services, and health status indicators of Russia's health system are examined. RESULTS: Longevity is declining; mortality rates from cardiovascular diseases and trauma are high and rising; maternal and infant mortality are high. Vaccine-preventable diseases have reappeared in epidemic form. Nutrition status is problematic. CONCLUSIONS: The crisis relates to Russia's economic transition, but it also goes deep into the former Soviet health system. The epidemiologic transition from a predominance of infectious to noninfectious diseases was addressed by increasing the quantity of services. The health system lacked mechanisms for epidemiologic or economic analysis and accountability to the public. Policy and funding favored hospitals over ambulatory care and individual routine checkups over community-oriented preventive approaches. Reform since 1991 has centered on national health insurance and decentralized management of services. A national health strategy to address fundamental public health problems is recommended.

Health Care Reform↗
PubMed1998

Nutritional concerns in American Indian and Alaska Native children: transitions and future directions.

The nutritional health of American Indian and Alaska Native children has changed dramatically over the past 30 years. The prevention and treatment of malnutrition (primarily undernutrition) was a major health issue until the mid to late 1970s. Now, a generation later, obesity in American Indian and Alaska Native children is a major health threat. In 1969, the National Institutes of Health sponsored a conference to review the nutritional status of North American Indian children and to set a national agenda to improve the nutritional health of Indian children. Subsequently, increased food availability; food assistance programs; and improved sanitation, transportation, and health care have eliminated undernutrition as a major health issue. However, the substantial reduction in undernutrition has been accompanied by a rapid increase in childhood obesity. The current epidemic of child and adult obesity and associated obesity-related morbidities, such as type 2 diabetes mellitus and other chronic diseases, has implications for the immediate and long-term health of young American Indians. This article reviews the current nutritional health of American Indian and Alaska Native children, the changes that have occurred the past 30 years, and the nutrition transition to increasing obesity and subsequent diabetes that is being seen in American Indians. Future directions to improve the health of American Indian and Alaska Native children are discussed, as is the urgent need for obesity prevention programs that are culturally oriented, family centered, and community- and school-based and that target healthful eating and physical activity beginning in childhood.

Alaska↗
PubMed2002

Role of teleconsultation in moving the healthcare system forward.

The equitable access to quality healthcare by Malaysians has consistently been the primary objective of the Ministry of Health (MOH). The epidemiological transition to chronic illnesses, advances in medical technology, escalating healthcare costs and rising patient expectations has necessitated the strategic use of information systems in healthcare delivery. Malaysia has broken new ground by implementing a nationwide network to address inadequate access to healthcare, as well as to lower costs and achieve better health outcomes. Teleconsultation refers to the electronic transmission of medical information and services from one site to another using telecommunication technologies. This technology transforms the healthcare system by rapidly matching patient needs with the appropriate level of care however geographically remote they may be. Our findings suggest that even in these early stages of implementation, teleconsultation has led to cost savings, a more efficient allocation of resources, enhanced diagnostic options and better health outcomes.

Delivery of Health Care↗
PubMed2001

Determinants of customer satisfaction with the health care system, with the possibility to choose a personal physician and with a family doctor in a transition country.

Many Eastern and Central European counties are reforming their health care systems. The aim of this study was to determine customer satisfaction with a reformed health care system, with the possibility of free choice of a family physician and patient satisfaction with the family physician in Slovenia and their major determinants. We used a postal survey of the patients who attended their family physician's offices during the study period. We obtained an 84% response rate. Some 72.9% of the respondents were satisfied with the current organisation of health care services, 95.5% of the respondents were satisfied with the possibility of choosing their own family physician and 58% of participants were very satisfied with the level of care received from their personal family practitioners. It was shown that higher patient satisfaction with the family physician was the most powerful predictor of patients' satisfaction with the health care system. The results show that health care reform in Slovenia has a positive impact on the consumers' perceptions of health care quality, measured in terms of consumer satisfaction with the health care system, the possibility to choose a family physician and the overall satisfaction with the family physician.

Delivery of Health Care↗
PubMed1989

The health care-child welfare partnership: transitioning medically complex children to the community.

There is a growing number of medically complex children residing in hospitals who could benefit from home care. This paper describes a unique federally funded grant project designed to develop alternative home resources for those medically complex children whose parents are unable to provide the requisite home care. Building on an innovative partnership between a pediatric hospital and a community child welfare agency, this project recruited, trained, and supported foster parents to care for those children. Problems, solutions, and strategies for developing alternative home care resources for this population are presented.

Chicago↗
PubMed2003

The cost effectiveness of Apligraf treatment of diabetic foot ulcers.

BACKGROUND: Diabetic foot ulcers (DFUs) present a treatment challenge and result in a large economic burden, requiring careful evaluation of the clinical efficacy and cost effectiveness of new treatment modalities. DFU clinical trials of the bio-engineered skin substitute Apligraf (Novartis Pharma AG, Basel, Switzerland) have demonstrated improved clinical efficacy compared with good wound care (GWC) alone. OBJECTIVE: To determine the economic impact and cost effectiveness of Apligraf plus GWC compared with GWC alone in the treatment of DFUs. STUDY PERSPECTIVE: Societal. METHODS: A Markov-based simulation model was created to compare the costs and effects of Apligraf plus GWC to those of GWC alone over a 12-month period. The primary health states were 'uninfected ulcer', 'infected ulcer', 'gangrene', and 'healed ulcer'. Transition probabilities were based on clinical trial results, while cost estimates were based on estimates of resource utilisation in the Netherlands. The cost-effectiveness outcome measures were the incremental cost per ulcer-free month gained and the incremental cost per amputation avoided. RESULTS: Costs in the first year of treatment were Euro 4656 for Apligraf plus GWC and Euro 5310 for GWC alone (1999 values). Treatment with Apligraf led to lower costs since its greater effectiveness offset the added cost of the product. This benefit was realised after 5 months, the crossover point of the two cost curves. Apligraf use increased the amount of ulcer-free time by by 1.53 months (7.78 vs 6.25) and reduced the risk of amputation (6.3% vs 17.1%). Sensitivity analyses showed that cost parameters (e.g. units of Apligraf required, cost of treatment practice) and transition probabilities between health states affected the cost results. CONCLUSIONS: Treatment with Apligraf plus GWC resulted in a 12% reduction in costs over the first year of treatment compared with GWC alone. The increased ulcer-free time coupled with a reduced risk of amputation to a large extent offset the initial costs of the product.

Ambulatory Care↗
PubMed1998

[Expertise in occupational health nursing (II)--Report on the 17th UOEH International Symposium].

Three hundred and fifty-two OHNs and collaborative persons from 17 countries and the ILO assembled at UOEH to participate in the 17th UOEH International Symposium to commemorate the inauguration of the UOEH School of Health Sciences from October 20 to 22, 1997. The main theme of this Symposium was "Occupational Health Nurse (OHM) Expertise." The Symposium was opened by greetings from Dr. Akira Koizumi, followed by a message from ILO presented by Dr. G.H. Cappee, head of the Medical Section Occupational Safety & Health Branch, ILO. Dr. Bonnie Rogers of North Carolina University, Chapel Hill, and President of AAOHN, lectured on the main theme of the Symposium, and Dr. M.A. Fingerhut gave a lecture on "Partnership in Occupational Safety and Health." At the general sessions, 5 themes were discussed.--1) Partnership in Occupational Health, 2) Education and Training of OHNs, 3) Intervention/Behavior to Disease Prevention and Health Promotion, 4) How to Integrate Computing into Occupation Health Nursing and 5) Cost/Benefit Effectiveness of Occupational Health Nursing. For all 5 sessions, there were keynote lectures, oral and poster presentations. This report reviews the lectures by Dr. B. Rogers on "Expertise in Occupational Health Nursing," by Dr. Kuchinski on "Education and Training of Occupational Health Nurses in The US," the presentation by Mrs. J. Fanchette, DIUST/GIT Service de Pathologie Professionnelle Hospital Civil, France, on "Evaluation of An Interuniversity Diploma Course Occupational Health Nurse Qualification," by Dr. K. June, Soonchunhyang Univ., Korea, on "Transition of Occupational Health Nursing Education in Korea" and finally, the lecture by Dr. F. Mitsuhashi on "Revisions in the Industrial Safety and Health Law and Expected Models for Occupational Health Nursing Staff."

International Cooperation↗
PubMed1999

'Coming out' as a life transition: homosexual identity formation and its implications for health care practice.

This paper explores the formation of homosexual identity through the complex transitional process of 'coming out'. Linear developmental models are discussed as is the influence of societal norms on identity formation. In considering the implications for professional practice the author challenges the heterosexism in health care and suggests ways in which health care professionals can provide a supportive environment for gay men and lesbians.

Female↗
PubMed1993

Establishing a student health all-appointment system: making the transition from a walk-in approach.

The authors offer a process for critically evaluating a walk-in system for patient and care provider satisfaction, for developing goals for a new patient flow system, and for designing and implementing an appointment system at a student health center. Their suggestions are based on their recent experience in making the transition from a walk-in approach to an all-appointment system in the general medicine division of the university's student health service. They give specifics of the appointment system established at their facility, including an explanation of the weekly appointment schedule, the monthly duty schedule, and a strong triage system. Key areas for consideration in converting to an all-appointment system, such as reeducational techniques for various staffing responsibilities and strategies for marketing a new system to patients, are outlined in detail.

Adult↗
PubMedDate not supplied

Meeting the continuing education needs of rural nurses in role transition.

BACKGROUND: The community health center (CHC) model of care delivery is gaining acceptance throughout Canada's newly created rural health regions. The resulting change in nursing functions presents a challenge to regional health authorities to ensure the attainment and maintenance of practice competencies. METHOD: This qualitative study examined strategies used in selected parts of Canada to prepare and support rural diploma-prepared nurses for role transition from acute care into CHCs. RESULTS: In light of CHC nurses' increased degree of autonomy, skill level, and focus on community wellness, the findings indicate a need for additional educational preparation and supportive strategies for transitioning nurses. CONCLUSION: Regions should educate the public and staff about the principles of primary health care, population health, and factors that determine health to help stakeholders understand their community, the current gaps in service delivery, and the role of CHC nurses. Key players at the provincial level should work together to address competency issues and continuing education needs of nurses in career transition.

Canada↗
PubMedDate not supplied

Mortality and morbidity transition in Kuwait: the role of health and development policies.

Kuwait has, in recent years, achieved a marked improvement in the health status of its population, as measured by a variety of mortality and morbidity indicators. This can be attributed to the implementation of two sets of policies that impact upon health, namely the health and socio-economic development plans of the Kuwaiti government. This article seeks to outline these recent changes in mortality and morbidity levels, and traces out the key policies considered to be the major determinants for these changes. Data is presented on health status, and on patterns and trends of health services' utilization. These trends suggest strongly that, for Kuwait, the health goals set for the year 2000 are achievable.

Health Policy↗