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PubMed2001

Building capacity for system-level change in schools: lessons from the Gatehouse Project.

The Gatehouse Project is an innovative, comprehensive approach to mental health promotion in secondary schools. It sets out to promote student engagement and school connectedness as the way to improve emotional well-being and learning outcomes. The key elements of the whole-school intervention are the establishment and support of a school-based adolescent health team; the identification of risk and protective factors in each school's social and leaning environment from student surveys; and, through the use of these data, the identification and implementation of effective strategies to address these issues. The project evaluation used a cluster-randomized controlled trial design involving 26 schools with initial results demonstrating considerable success in reducing smoking rates among Year 8 children. This article describes and accounts for how system-level changes have been made in schools through a process of capacity building. This encourages teachers, parents, and students to view the core business of education differently.

Adolescent↗
PubMed1993

Persuasive conversations between friends about health and safety precautions.

One hundred eighty-five conversations in which a college student attempted to convince a friend to adopt a health or safety precaution were examined. A detailed category coding system was developed to describe the content of such conversations and to answer nine specific questions about these interactions. Among other results, the data showed that subjects spend very little time describing the nature of the harm that might occur and usually speak of protection in dichotomous, all-or-none terms rather than acknowledging degrees of risk. Much time is spent discussing the correct actions to take and the problems faced in carrying out these actions. Initial and 2-month assessments of of persuasiveness found no significant relationships between the presence of specific themes and changes in intentions or behavior. The observed content of these conversations is discussed in relation to current theories of self-protective behavior and likely mechanisms of social influence.

Adult↗
PubMed2002

Personal goals as predictors of college student drinking motives, alcohol use and related problems.

OBJECTIVE: Although there has been extensive research examining drinking motives, relatively little of that research has focused on those factors that might underlie drinking motives. The present study examines whether nonalcohol-related motives (personal goals) can predict drinking motives, self-reported drinking and alcohol-related problems in a college student sample. METHOD: For an experiment on "attitudes and drinking," 290 volunteer undergraduate students (169 women and 121 men) completed measures of daily goal functioning (Personal Projects Analysis), drinking motives (Drinking Motives Questionnaire), frequency and quantity of alcohol consumed and alcohol-related problems (Drinkers Inventory of Consequences). RESULTS: Using path analysis, it was found that nonalcohol-related goals serve as significant distal predictors of alcohol-related problems, with their effects almost entirely mediated by drinking motives and/or drinking level. Perceptions of life goals involving goal self-efficacy, meaningfulness and social support appear to be significant protective factors, and goal-related distress is a significant risk factor. CONCLUSIONS: The present study extends previous research by focusing on a more idiographic, personally meaningful manifestation of motivation through the evaluation of nonalcohol-related personal goals. The daily pursuits of college students were shown to be predictive of drinking and drinking-related problems, especially as mediated through drinking motives. The findings suggest that several goal mechanisms could be considered for their potential role in improving interventions.

Adolescent↗
PubMed2005

Japan's ethical guidelines for epidemiologic research: a history of their development.

During the latter half of the 1990s, Japanese healthcare professionals and policy-makers recognized the value of an "evidence-based" approach. At the same time, an increased social awareness of the need to protect research participants and personal information began to appear. Recognition of an evidence-based approach further promoted epidemiologic research while regulations on personal information protection imposed certain limitations on this same research. In April 2000, as a solution to this conflict, a working group funded by Japan's Ministry of Health and Welfare (MHW; currently the Ministry of Health, Labour and Welfare: MHLW) proposed a first draft of ethical guidelines for epidemiologic research. Over the next two years, the collection of domestic and foreign data by working groups and governmental ad hoc committees, questions raised by the mass media, and public statements made by organizations, such as the Science Council of Japan and the Japan Epidemiologic Association (JEA), led to a collaborative effort between the Ministry of Education, Culture, Sports, Science and Technology and the MHLW. This effort led to the creation of the Ethical Guidelines for Epidemiologic Research in June 2002, which was revised in 2004. Furthermore, JEA also announced the Ethical Guidelines for Conducting of Epidemiologic Research in October 2002. While the development of these ethical guidelines has been a challenge for Japanese epidemiologists, it has also allowed the epidemiologic community to understand their role in society. This review aims to provide insight into the interaction between the epidemiologic community and society by assessing historically the developmental process of these ethical guidelines.

Epidemiology↗
PubMed2000

The dark side of Taiwan's globalization success story.

Government regulators and researchers in Taiwan (Republic of China) express optimism about their country's economic success in its transition from a traditional society to a first world, industrialized nation. But this economic success, as measured by the standards and ideology of globalization, also has a dark side for many ordinary workers, especially Taiwan's 300,000 foreign workers. The promise of growth and future prosperity is conditional upon global economic practices and an adherence to a science-technology ideological perspective that shapes political content. Multiple centers of opposition and critical thinking have no public presence in Taiwan; nor do organizational defiance and resistance by trade unions. Instead, individuals and small human rights groups seek to reveal areas of human degradation and suffering in a response to poverty and the American dream. Meanwhile, the dominant ideological perspective as articulated by globalism seeps into and directs all public policy on the work environment so that it is coherent with the neoliberal political agenda of multinational corporations. This direction is being questioned by students of the work environment and by labor activists in North America, who report the deterioration of working conditions and worsening of government regulatory instruments for protecting workers from physical, mental, and social risk and harm in the workplace.

Cultural Deprivation↗
PubMed2004

[Public health in Quebec at the dawn of the 21st century].

This paper summarises the status of public health in Quebec at the dawn of the 21st century. After introducing the current definition, the author lays out five basic functions of public health in Quebec: knowledge and surveillance of populations health and wellbeing, health protection; prevention of disease, trauma and social problems that influence health; health and wellbeing promotion; and service organization and evaluation. The organization of public health services is then described at the local level (CLSC), regional level (Public health units) and national level (Ministry, Public health directorate and National Institute of Public Health). Finally, the trends and priorities elaborated over the last ten years, as well as the National Public Health Program to be implemented over the next ten years are described.

Forecasting↗
PubMed2006

[Prevalence of obesity in children and adolescents attending school in Seine Saint-Denis].

In France, the increase of obesity prevalence in children constitutes a true "epidemic". The school doctors based in Seine Saint-Denis carried out a study during the 2003-2004 academic year on the prevalence of childhood obesity in students from nursery school and junior high school. It was also closely linked to an individually-based awareness campaign for better management of the students surveyed and selected. The results show a prevalence of obesity of 13.9% at 6 years old and 14.3% at 15 years, values which are higher than the national data (10.6% at 6 years old and 11.3% at 15 years old). On the other hand, a percentage of 5.15% of underweight children was found in the 6 year old group. The socio-economic and urban specificities of this specific county partially explain these numbers. It would seem judicious to sign-up the service for health promotion in support of students (SPSFE) with the task to pursue activities which can identify and manage their care, in partnership namely with the network for the management and prevention of pediatric obesity (REPOP-IdeF), county social services and maternal and child protection (PMI). It would also be recommended to engage in and commission new reflections on the schools' nutrition and food practices (both for snacks and cafeteria dining). The population of underweight children should serve as a target focus group for streamlining adapted care management as well as for more additional complementary information.

Adolescent↗
PubMedDate not supplied

Perceived health needs of inner-city street prostitutes: a preliminary study.

OBJECTIVE: To survey inner-city prostitutes' perceived health needs. METHODS: One hundred forty street prostitutes in Washington DC, were surveyed to determine their perceived health needs, in addition to levels of post traumatic stress disorder (PTSD). RESULTS: The final sample comprised 100 individuals, representing 3 subgroups of prostitutes, female, male, and transgender male. Major health needs included protection from physical and sexual assault, social support, counseling, addictions treatment, job training, and medical care. Over 42% of the population was identified as meeting established criteria for PTSD. CONCLUSION: Effective program development for inner-city prostitutes needs to acknowledge the presence of distinct subpopulations and the pervasive influence of PTSD on health status.

Adolescent↗
PubMedDate not supplied

Attitudes of low-income parents toward seeking help with parenting: implications for practice.

Fifty-two low-income parents were surveyed to determine attitudes toward parenting and help seeking. Although a majority agreed that most parents, even "good" parents, need help or advice about parenting and thought they would seek help with parenting, low-income parents were less likely to believe in or seek out help than those with higher incomes. The most frequently selected sources of help were family, books and videos, telephone help-lines, and friends. The least likely sources of help were child protective services, school personnel, clergy, and social service/counseling agencies. Parent support and education groups were likely sources of support for only one in four low-income parents.

Adolescent↗
PubMed2002

Human rights approach to health.

Adopting human rights approach to health carries many benefits, because it emphasizes the equality of all persons and their inherent right to health as the foundation of the health care system. It also argues that promotion and protection of health are fundamentally important social goals, focuses particularly on the needs of the most disadvantaged and vulnerable communities, balances individual needs with the common good, and so forth. However, it also raises some practical issues, such as organization of interdisciplinary education and work, and different use of the language, which often goes unacknowledged. The relationship between human rights and health is a reciprocal one, and can be beneficial or harmful. For the relationship to be beneficial and successful, the differences between human rights and public health approach to health, centered around the perspective taking, attitudes, and abilities of health professionals, need to be acknowledged and reconciled, and the need for interdisciplinarity adequately fulfilled.

Female↗
PubMed2002

Chronic widespread pain: a three year followup of pain distribution and risk factors.

OBJECTIVE: To describe the change of pain reports over time in 3 cohorts derived from the general population: (1) no chronic pain (NCP; n = 1156); (2) chronic regional pain (CRP; n = 502); and (3) chronic widespread pain (CWP; n = 242). To identify risk factors that predict the development or persistence of chronic widespread pain. METHODS: A 3-year followup from 1995 to 1998 with postal questionnaire to 2425 subjects of both sexes aged 20-74 years on the west coast of Sweden. RESULTS: At followup, a larger proportion of subjects with initial CRP compared to initial NCP reported CWP (16.4 and 2.2%, respectively; p < 0.001). The majority of subjects (56.9%) who primarily reported CWP remained in that group at followup, but 26.8% had changed status to CRP and 16.3% to NCP. The number of painful regions (7-12 vs 0 regions) reported at baseline was the strongest predictor for the development of CWP with an odds ratio (OR) of 12.13 (95% CI 4.47-32.88). The development of CWP was also predicted by higher age (OR = 3.13, 95% CI 1.47-6.69, age-group 59-74 years vs age-group 20-34 years), and a family history of chronic pain (OR = 1.87, 95% CI 1.14-3.07). A habit of drinking alcohol weekly (OR = 0.42, 95% CI 0.21-0.85) compared to the habit of never or seldom drinking alcohol was protective, as well as having personal social support (OR = 0.49, 95% CI 0.28-0.85). The persistence of CWP was predicted by the number of painful regions (13-18 vs 1-6 regions) at baseline (OR = 7.56, 95% CI 2.17-26.30), and being an immigrant (OR = 3.22, 95% CI 1.33-7.77). CONCLUSION: Although the overall prevalence of CWP was stable over a 3-year period there was a considerable variation on an individual basis. This variability in expressing CWP was moderately predicted by a combination of risk factors, the most important being the number of painful regions at baseline. Future research will need to show how useful the identified factors are in clinical practice and whether intervention aimed at changing these factors will improve pain outcome.

Adult↗
PubMed2002

[Role and interactions of the cardiologist in a regional institutional project of primary prevention].

BACKGROUND: Evidence is available in support of the policies for a population-wide approach to shifting risk factor distribution; on the other side, setting up enduring projects of primary prevention is difficult, as well as gathering the right experts. METHODS: In 1999 the Piedmont Region's Administration set up a multi-year intervention with the aim at reducing risk factors and increasing protective factors of oncologic and cardiovascular diseases in the general population, particularly in disadvantage groups. The cardiologists played a primary role by supporting the project of evidence-based guidelines, producing bibliographic reviews and spreading coronary risk maps. A main group of trainers was set up in each Local Health Service to promote a system of counseling lifestyles, with the central reference of the general practitioner activity. As a second step, a mass-media campaign has been set up using health advertisements on newspapers, television, public transports, notice-boards on the following subjects: nutrition, hypertension, tobacco, physical activity, stress; warehouses, food markets, trains and squares were involved. Moreover, a newsletter review has been published since January 2000, to produce basic models, most effective interventions and recommendations for their implementation. RESULTS: A new care for the primary prevention and counseling arguments as well as the need for continuous training to promote preventive actions were shown to general practitioners. A system to identify the best channels, communication ways and the most effective messages for healthy lifestyles was settled. A model of monitoring risk factor changes and protective behaviors in the population, describing social differences, was established to better plan and assess effective interventions. CONCLUSIONS: After more than half a century of productive public health science, there is an urgent need that Government Administrations steer their health policies towards determinants of health and create the best conditions to make citizens to improve their lifestyle.

Cardiology↗
PubMed2003

Safeguarding children: 4. Needs of refugees and asylum seekers.

The problems faced by all refugees and asylum seekers arriving in Britain are great but unaccompained children have a particularly difficult time, separated from the people and places they know, and experiencing difficulties with language and a strange environment. This fourth paper in our series on child protection examines how health- and social-care staff can help.

Adaptation, Psychological↗
PubMed2002

[Urethral discharge in Morocco: prevalence of microorganisms and susceptibility of gonococcos].

We studied 422 patients with urethral discharge recruited from 4 sentinel sites in Morocco to determine sociodemographic characteristics, history of STI infection, infecting organism and antibiotic susceptibility of Neisseria gonorrhoeae. The mean age of the sample was 28 years (range 16-67 years), and most were single, had multiple sex partners without taking protective measures and came from all social backgrounds; 59.9% had a history of a previous STI. The majority (87%) of the infections were the acute form. By polymerase chain reaction of urine samples of 399 patients, 41.6% had N. gonorrhoeae infection, 6.3% Chlamidia trachomatis and 10.8% both organisms; in 41.4% no organism was identified. N. gonorrhoeae was strongly susceptible to ciprofloxacin.

Acute Disease↗
PubMed1992

Interdisciplinary evaluations of alleged sexual abuse cases.

Children who are alleged to have been sexually abused often go through gruelling interrogations to relate their experiences to adults and, even then, most are not viewed as reliable sources of information. The Victim Sensitive Interviewing Program (VSIP) was initiated to decrease the number of interviews endured by a child who allegedly had been sexually abused. The program brought together the disciplines involved in the evaluation of these cases: hospital-based social worker and pediatrician, state child protective agency worker, police, and assistant state's attorney. This team established a protocol for an investigative interview to be conducted by a team member. Pre-VSIP sexual abuse evaluations from 1985 and 1986 (38) were compared with VSIP evaluations (226) from 1987 and 1988. There was no significant difference between the two groups in relation to gender or age of victim, physical symptoms, physical findings, sexually transmitted diseases present, age of perpetrator, or length of stay in hospital. However, there were significant differences between the two groups in (1) number of interviews, 11% pre-VSIP vs 79% VSIP receiving only one interview (P less than .001); (2) number of interviewers, 24% pre-VSIP vs 88% VSIP were interviewed by only one interviewer (P less than .001); (3) indicated cases of sexual abuse, 68% pre-VSIP vs 88% VSIP (P less than .006); (4) identification of the perpetrator, 71% pre-VSIP vs 85% VSIP (P less than .035); and (5) charges pressed if perpetrator identified, 33% pre-VSIP vs 60% VSIP (P less than .010). It is concluded that interdisciplinary evaluations of alleged sexual abuse in children not only decreased the number of interviews a child must undergo but also increased the likelihood of indicated cases, identification of the perpetrator, and charges being pressed. Therefore, it is strongly recommended that interdisciplinary teams be formed to assess alleged sexual abuse in children.

Adolescent↗