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PubMed2002

The shift in stages of the nutrition transition in the developing world differs from past experiences!

OBJECTIVE: This paper explores the unique nutrition transition shifts in diet and activity patterns from the period termed the receding famine pattern to the one dominated by nutrition-related non-communicable diseases (NR-NCDs). The paper examines the speed and timing of these changes; unique components, such as the issue of finding both under- and overnutrition in the same household; potential exacerbating biological relationships that contribute to differences in the rates of change; and political issues. SETTING: The focus is on lower- and middle-income countries of Asia, Africa, the Middle East and Latin America. RESULTS: These changes are occurring at great speed and at earlier stages of these countries' economic and social development. There are some unique issues that relate to body composition and potential genetic factors. The significance of the high number of persons exposed to heavy insults during pregnancy and infancy (foetal origins hypothesis) and the subsequent rapid shifts in energy imbalance remains to be understood. Countries that are still addressing major concerns of undernutrition are not ready to address these NR-NCDs. CONCLUSIONS: The developing world needs to give far greater emphasis to addressing the prevention of the adverse health consequences of this shift to the nutrition transition stage of degenerative diseases.

Africa↗
PubMed2000

A tale of teaching in two cities.

Internationally, nurses are health care educators, in institutions, clinics and field sites. This article describes a cross-cultural experience of sharing health care teaching methodologies, between a nurse from Israel and a small group of Ethiopian nurses in Addis Ababa. These nurses were working to prepare groups of Ethiopian Jews, through health education, for the transition to life in Israel. It is a prime example that nursing is without borders. This period of teaching produced a mutual learning experience of great value for the local nursing staff and visiting lecturer, which may provide useful insights for other nurses working in cross-cultural conditions.

Cross-Cultural Comparison↗
PubMedDate not supplied

Age-specific activities that support successful transition to adulthood for children with disabilities.

Twenty-two activities that support transition to adulthood previously published by Blomquist et al. 1998) were explored in a focus group with parents of successful young adults with disabilities. Parents rated these activities on a 5-point Likert scale, and comments were gathered about the activities parents felt were essential for transition to adulthood. Parents rated the activities high with highest agreement being: "Do not do for them what they can do for themselves," "Assign appropriate household chores," and "Help children interact with others in varied settings." The lowest agreement ratings involved issues about school to work transitions, vocational programs within schools, and strategies assuring continuity of care with adult health care providers. Parents offered insights into the daily activities in school, home, and community that support transition to adulthood. Through review and understanding of these transition activities, health care professionals gain insight into the activities fostering a child's independence throughout their development.

Adolescent↗
PubMed1984

Intestinal transit of solid and liquid components of a meal in health.

The aim of this study was to test the hypothesis that, under physiologic conditions, the human small bowel discriminates between the solid and aqueous components of chyme, that is, that in a fashion analogous to the stomach, the intestine would allow the liquid fraction to progress at a faster rate than solid particles. To evaluate this hypothesis, we took advantage of a gamma-emitting solid marker, 131I-fiber, previously developed in our laboratory, that is recognized by the stomach as a solid and that is emptied at a slower rate than liquid markers. Thus, 131I-fiber enters the intestine during feeding at a slower rate than a liquid marker, being eventually excreted in the feces physically and chemically unchanged. We also developed a mathematical method to calculate the intestinal transit spectrum based on scintigraphic data obtained from 6 healthy individuals who ingested 131I-fiber and technetium 99m (99mTc)-diethylenetriaminepentaacetic acid (DTPA)-water with a meal. The results disprove the hypothesis by showing that whereas 131I-fiber, as expected, leaves the stomach at a much slower rate than 99mTc-DTPA-water, both markers progress along the small bowel separately but at similar speeds. Our method for measuring intestinal transit provides a more comprehensive quantification of chyme transit in the human small bowel than earlier methods and should prove a useful technique for further noninvasive studies of transit after feeding.

Adult↗
PubMed1992

PRO update. Transition from the third to fourth scope of work.

The Health Care Financing Administration (HCFA) began implementation of the transition from the Third Peer Review Organization (PRO) Scope of Work to the Fourth PRO Scope of Work on October 1, 1991. PROs in 11 states are currently implementing newly-established medical review requirements under the "Scope of Work," the contract by which PROs are obligated to carry out their statutorily-mandated duties of determining the medical necessity, appropriateness and quality of care delivered to Medicare beneficiaries. Michigan's PRO (MPRO) is scheduled to implement requirements outlined in the Fourth Scope of Work beginning April 1, 1992. This article discusses the American Medical Association's (AMA) relationship to the PRO program and the transition from the Third to the Fourth Scope of Work including the status of the Uniform Clinical Data Set.

American Medical Association↗
PubMed2005

A cost-effectiveness analysis of fluvastatin in patients with diabetes after successful percutaneous coronary intervention.

BACKGROUND: The Lescol Intervention Prevention Study (LIPS) was a multinational randomized controlled trial that showed a 47% reduction in the relative risk of cardiac death and a 22% reduction in major adverse cardiac events (MACEs) from the routine use of fluvastatin, compared with controls, in patients undergoing percutaneous coronary intervention (PCI, defined as angioplasty with or without stents). In this study, MACEs included cardiac death, nonfatal myocardial infarction, and subsequent PCI and coronary artery bypass graft. Diabetes was the greatest risk factor for MACEs. OBJECTIVE: This study estimated the cost-effectiveness of fluvastatin when used for secondary prevention of MACEs after PCI in people with diabetes. METHODS: A post hoc subgroup analysis of patients with diabetes from the LIPS was used to estimate the effectiveness of fluvastatin in reducing myocardial infarction, revascularization, and cardiac death. A probabilistic Markov model was developed using United Kingdom resource and cost data to estimate the additional costs and quality-adjusted life-years (QALYs) gained over 10 years from the perspective of the British National Health Service. The model contained 6 health states, and the transition probabilities were derived from the LIPS data. Crossover from fluvastatin to other lipid-lowering drugs, withdrawal from fluvastatin, and the use of lipid-lowering drugs in the control group were included. RESULTS: In the subgroup of 202 patients with diabetes in the LIPS trial, 18 (15.0%) of 120 fluastatin patients and 21 (25.6%) of 82 control participants were insulin dependent (P = NS). Compared with the control group, patients treated with fluvastatin can expect to gain an additional mean (SD) of 0.196 (0.139) QALY per patient over 10 years (P < 0.001) and will cost the health service an additional mean (SD) of 10 pounds ( 448 pounds) (P = NS) (mean [SD] US $16 [$689]). The additional cost per QALY gained was 51 pounds (US $78). The key determinants of cost-effectiveness included the probabilities of repeat interventions, cardiac death, the cost of fluvastatin, and the time horizon used for the evaluation. CONCLUSION: Fluvastatin was an economically efficient treatment to prevent MACEs in these patients with diabetes undergoing PCI.

Angioplasty, Balloon, Coronary↗
PubMed2005

Welfare reform and health insurance: consequences for parents.

OBJECTIVES: We assessed the relation between the work promotion, welfare reduction, and marriage goals of welfare reform and the stability of health insurance of parents in transition from welfare to work. METHODS: We analyzed a panel survey (1999-2002) of a stratified random sample of Illinois families receiving welfare in 1998 (n=1363). RESULTS: Medicaid remains the foremost source of health insurance despite a significant decline in the proportion of parents with Medicaid. Regardless of work/welfare status in year 1, transitioning to work only or no work/no welfare increased the likelihood of having unstable health insurance in years 2 and 3 compared with those who remained on welfare only. CONCLUSIONS: Parents who meet the welfare reform goals of work promotion and reduction of welfare dependence experience significant loss and instability of health insurance.

Aid to Families with Dependent Children↗
PubMed2003

The role of self-enhancing evaluations in a successful life transition.

The objective of the study was to investigate how self-enhancing evaluations, obtained via positive social comparisons and reflected appraisals, were related to mental health in a later life transition. The sample consisted of 266 women who were interviewed once before and 3 times after the experience of community relocation. Results extended prior findings suggesting the dynamic impact of self-enhancing evaluative processes on psychological well-being and depressive symptoms. Additional analyses showed evidence for reverse causality, that is, that mental health also influenced self-evaluative processes. This study underscores the significance of holding a positive view of self vis-à-vis others in negotiating life challenges as well as the reciprocal influence of well-being on social self-evaluative processes.

Aged↗
PubMed1995

Collegiality, adaptation and nursing faculty.

Many nurse educators in the United Kingdom are currently faced with the challenge of change, of leaving the culture of the British National Health Service and integrating into the culture of tertiary education. This paper reports on a study of the process of developing collegial relationships in the context of a new collaboration to develop a combined curriculum for nurses within a tertiary institution. The aims of the study were to analyse this process of integration and to identify the conditions that enhanced the development of collegiality between members of the nursing group. The case study centred on the analysis of data collected on video during unstructured interviews with the five members of the group. Data were analysed using Burnard's method of thematic content analysis. The paper argues that during the transition from the National Health Service to tertiary education, individual nurse educators and their managers must address problems related to issues such as 'ingroupism', nursing the students, perceived difference between nurse academics and other academics, and expectations of power-relationships.

Education, Nursing↗
PubMed1996

Hospital and nursing home use in the last three months of life.

We describe decedents' days of care and changes in residence due to episodes of hospital and institutional care in the last 90 days of life. Data are from the National Institute on Aging's Survey of the Last Days of Life (SLDOL) with informants' responses for a sample of 1,227 decedents age 65 years and older from Fairfield County, Connecticut. Overall, three-fourths of the decedents made only one transition to or from a health care facility in the last 3 months of life and another 10% made two or three transitions. Hospital days decreased slightly with age, but nursing home days increased dramatically. Physical disability, lack of social contacts, incontinence, and a diagnosis of dementia were significantly associated with a long, terminal, institutional stay. Future cost savings are likely to be achieved more through the reduction of nursing home care in the last months of life than in a reduction of hospital care.

Aged↗
PubMed2006

Quality improvement in gynecologic surgery: the new frontier.

The continual and disproportionate increase in health care costs without showing improvement has regulatory organizations and purchasers of surgical care demanding comparative documentation of surgical quality and outcomes. Support for implementing performance standards is derived from 2 risk-adjusted national surgical quality improvement programs which documented substantial decreases in perioperative morbidity and mortality. These dramatic improvements in patient outcomes and corresponding decreases in health care costs are transitioning to "pay-for-performance" for surgical disciplines. With the requisite budget-neutral environment, quality incentive payments will be offset by reduced reimbursement for substandard performances. For specialties that have not developed specific performance metrics, the implications are substantial. Therefore, the gynecologic surgical community has an exigent need to develop standards and methods to assess quality within our discipline that are specialty specific, equitable and risk adjusted.

Female↗
PubMed2006

A herd health approach to dairy cow nutrition and production diseases of the transition cow.

This paper presents a practical, on-farm approach for the monitoring and prevention of production disease in dairy cattle. This integrated approach, should be used in an interdisciplinary way by farmers, veterinarians, nutrition advisors and other relevant professionals for the improvement of animal health and welfare and producer profitability. The key areas that form the basis for this approach are body condition score management, negative energy balance, hypocalcaemia, rumen health and trace element status. Monitoring criteria are described for each of these key areas, which when considered collectively, will facilitate the assessment of dairy cow health with regard to clinical and subclinical disease. The criteria, which are informed by published scientific literature, are based on farm management and environmental factors, clinical data, milk production records, dietary analysis, and assessment of blood and liver concentrations of various metabolites or trace elements. The aim is to review the efficacy of production disease control measures currently in place, and if necessary to modify them or formulate new ones.

Animal Nutritional Physiological Phenomena↗
PubMedDate not supplied

Transition to college: A classification and regression tree (CART) analysis of natural reduction of binge drinking.

Approximately one in five teens that drank heavily in high school reduces or discontinues consumption while in college. Multiple paths might lead to the common outcome of natural reduction in heavy drinking. Statistical modeling of this complex process of natural reduction is a challenge with standard linear statistics. The purpose of this paper is to use a new statistical procedure, Classification and Regression Tree (CART), to model the equifinality of reduction in drinking by college students who drank heavily as adolescents. An appealing aspect of CART is that the resulting tree model that can easily be interpreted and applied by those who work with adolescents during the important transition from high school to college. Of 201 college students who first binged on alcohol while in high school, 71 (35.3%) denied heavy or binge drinking within the previous three months (Natural Reducers). The final model accurately classified 84.6% of the students as either continued heavy drinkers or natural reducers. Sensitivity was modest (accurate identification of 67.6% of the reducers); however, specificity was strong (correct classification of 93.8% of the continued heavy drinkers). The model revealed four pathways to natural reduction in drinking. Predominant in each path was the influence of social factors that maintain continued drinking (e.g., social facilitation outcome expectancies, perception of friends' drinking) or facilitate natural reduction (e.g., regular church attendance). The results support the application of CART to model health behaviors across the transition from adolescence to young adulthood.

Adolescent↗
PubMed2006

Does timing and sequencing of transitions to adulthood make a difference? Stress, smoking, and physical activity among young Australian women.

The major changes of the transition to adulthood are argued to be stressful, and health-related behaviors such as smoking and physical activity may be adopted, consolidated, or abandoned at this time. On the other hand, research has suggested that the normative transitions of emerging adulthood, although involving considerable change, may be associated with low stress because they are perceived as both positive and normal at this life stage. This article examines relations between the timing and sequencing of life transitions and stress and health-related behaviors, focusing on the transition to young adulthood among Australian women. A total of 853 women aged 22 to 27 provided information about the timing and sequencing of 6 life transitions: moving out of home, stopping full-time education, starting full-time work, having the first live-in relationship, marriage, and motherhood-and stress, smoking, and physical activity. Most had moved out of home, stopped full-time education, and started full-time work, but only 14% had undertaken all 6 transitions. Overall, 70% of participants had made transitions "in order." Overall, the findings suggest that the relations between timing and sequencing of transitions, and indicators of health, are moderate for smoking, but small for stress and for physical activity. These effects remained after controlling for socioeconomic status of the participants' families of origin. Matching current social norms for the timing and sequencing of life changes may be of less importance for women's well-being than is commonly believed. Although the significant relations between early or "out of order" transitions and smoking are of concern, the smaller relations with stress and with sedentariness suggest that such transitions may have limited negative consequences, and support the view that individuals are active in choosing the life path that is appropriate for them and their circumstances.

Adult↗
PubMed2003

The impairments caused by social phobia in the general population: implications for intervention.

OBJECTIVE: Although social phobia is common, treatment remains low. In order to gauge public health implications of this low treatment, information is needed on the impairments caused by social phobia. METHOD: A computer literature review searched for the terms 'social anxiety disorder' and 'social phobia' in the MEDLINE and PsycLIT databases. New analyses were carried out in the US National Comorbidity Survey. RESULTS: The literature shows that social phobia has serious effects on role functioning and quality of life. These effects are least severe for pure non-generalized social phobia and most severe for comorbid generalized social phobia with avoidant personality disorder. The most direct impairments involve social interactions and information processing errors in these interactions. Indirect effects are even more important. Three indirect effects are highlighted: effects on secondary mental (e.g. depression), substance (e.g. alcoholism) and physical (e.g. cardiovascular disease) disorders; effects on normative role transitions (e.g. educational attainment); and effects on help-seeking. CONCLUSION: Given the early age of onset and impacts on secondary disorders and early adult life course transitions, the greatest public health impact of increasing treatment of social phobia is likely to be achieved by developing programs targeted at early identification and treatment through schools.

Adolescent↗
PubMed1981

Teaching and learning DSM-III.

This article presents recommendations for training programs in DSM-III to help counter feelings of apprehension expressed by many mental health professionals over the transition to the new nomenclature and its multiaxial evaluation system. The authors suggest educational objectives, didactic curricula, and methods for training in the clinical application of DSM-III and discuss supervising the use of DSM-III in patient intake and evaluation. Thorough mastery of DSM-III should not be expected after a limited program; learning its strengths and limitations will be a continuing process.

Adult↗
PubMed2003

Changes and associations in healthy diet among the Finnish elderly, 1985-2001.

BACKGROUND: diet is related to health and studies of transitions in diet among elderly people are scarce. The aim of this study was to monitor any recent changes in healthy diet among the 65- to 79-year-old population of Finnish citizens. Possible disparities in 5-year age groups, occupation and marital status were examined. METHODS: biennially conducted nationwide monitoring cross-sectional surveys among Finnish elderly people were used to study 11,793 (response rate 82%) men and women from 1985-2001. Data were pooled into three time periods. Analysis of logistic regression was used to compare and test for changes in healthy diet in categories of sociodemographic factors. RESULTS: the diet of the elderly population clearly improved from the mid-1980s to the early 2000s. The change over the monitoring period was slightly steadier among women than men. The youngest respondents, especially women, retired office employees and married persons had the healthiest diet. CONCLUSIONS: continuing improvement in diet might indicate positive health outcomes in the future. Nevertheless, there are still subgroups with unhealthier diets that include persons who are also underprivileged as far as functional ability is concerned.

Age Factors↗
PubMed2006

Primary Health Care Nurses' conceptions of involuntarily migrated families' health.

BACKGROUND: Involuntary migration and adaptation to a new cultural environment is known to be a factor of psychological stress. Primary Health Care Nurses (PHCNs) frequently interact with refugee families as migrant health needs are mainly managed within Primary Health Care. AIM: To describe the health of the involuntary migrated family in transition as conceptualized by Swedish PHCNs. METHOD: Thirty-four PHCNs from two municipalities in Sweden were interviewed and phenomenographical contextual analysis was used in analysing the data. FINDINGS: Four family profiles were created, each epitomizing the health characteristics of a migrated family in transition: (1) a mentally distressed family wedged in the asylum-seeking process, (2) an insecure family with immigrant status, (3) a family with internal instability and segregated from society, and (4) a stable and well-functioning family integrated in society. Contextual socio-environmental stressors such as living in uncertainty awaiting asylum, having unprocessed traumas, change of family roles, attitudes of the host country and social segregation within society were found to be detrimental to the well-being of the family. CONCLUSION: Acceptance and a clear place in society as well as clearly defined family roles are crucial in facilitating a healthy transition for refugee families. Primary Health Care Nursing can facilitate this by adopting a family system perspective in strengthening the identity of the families and reducing the effects of socio-environmental stressors.

Acculturation↗