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PubMedDate not supplied

Assessment of the integration of the ecological approach in health promotion programs.

PURPOSE: This article proposes a model of the ecological approach in health promotion programs. Based on system theory, the model identifies intervention settings and targets as two independent dimensions for assessing the integration of this approach in programs. Additional objectives are to present and pretest an analytical procedure that allows the assessment of integration of the ecological approach in programs. DESIGN: This was a descriptive study of the integration of the ecological approach in a sample of health promotion programs. SUBJECTS: Subjects were 44 health promotion programs drawn from the population of Canadian federally funded programs. MEASURES: Descriptions of programs were obtained by telephone interviews. A coding scheme was applied to the data to identify intervention settings and targets for each program. Using this information, a summative score of the integration of the ecological approach was estimated for each program. RESULTS: Single-setting programs were the dominant pattern in the sample. Individuals whose health was of concern were very frequently the direct targets of the programs. However, organizational and interpersonal environments were also often directly targeted. Single-setting or single-intervention strategy programs outnumbered ecological programs. CONCLUSION: The proposed model and analytical procedure is a useful framework for the assessment of integration of the ecological approach in health promotion programs. The pilot test having been conducted on a convenience sample, future work should replicate the study in a representative sample of programs.

Canada↗
PubMed1993

Transportation needs of the elderly population.

All evidence suggests that the elderly population of today and tomorrow will continue to depend on the private car to give them freedom, independence, and choice--as do younger travellers. Given the demographic changes in the United States, it seems very unlikely that other modes or options can provide anywhere near the level of mobility that the elderly want or need. Almost three fourths of those over age 65 will live in suburban or rural places after the turn of the century, places where transit and para-transit options are inherently impractical or costly. These elderly individuals will have made choices about doctors, hospitals, friends, and social and recreational options based on their lifelong access to the car. When they can no longer drive or receive rides, their mobility will drop and they may have to make drastic changes in their whole life network to be able to access just a few necessary services. Those concerned with the use of medical services by the elderly population must focus not only on transportation but on the other variables that create the need for a car. Transportation needs are clearly linked to where and how medical and social services are made available, so medical agencies must recognize the changing demographics of the elderly population by locating and programming their services accordingly. Medical and human service agencies will have to make an effort to make their programs accessible to the elderly population rather than simply locating their facilities where they please and assuming that elderly persons or transportation planners will somehow deal with the resulting loss of mobility.

Adult↗
PubMed1987

Growth-associated traits in parental and F1 populations of chickens under different feeding programs. 2. Ad libitum and intermittent feeding.

Growth traits and digestive enzyme activities were compared in parental lines and F1 crosses under ad libitum and alternate-day feeding. Responses to the feeding regimens were, in general, dependent on the background genome and age. Population by feeding regimen interactions were more prevalent for growth traits than for enzymatic activities. Although chickens adapted morphologically and physiologically to the particular feeding regimen to which they were exposed, the degree of adaptation was population dependent. Moreover, a line of White Leghorns differed considerably in response compared to a line of White Rocks selected for low body weight, demonstrating that weight is primarily a result of metabolic and behavioral processes rather than the determiner of those processes.

Animals↗
PubMed2003

Stage of chronic kidney disease predicts seroconversion after hepatitis B immunization: earlier is better.

BACKGROUND: Hepatitis B virus (HBV) infection remains a concern in dialysis populations, and vaccination programs have been less successful than those in the general population. Reasons for poor response include malnutrition, uremia, and the generalized immunosuppressive state of patients with chronic kidney disease (CKD). This prospective cohort study evaluated factors impacting on the effectiveness of a vaccination program before dialysis therapy initiation, including level of kidney function. METHODS: All patients receiving care in the Kidney Function Clinic (St Paul's Hospital, Vancouver, Canada) were screened for previous HBV infection or vaccination. Those who were marker negative were administered a standardized hepatitis B vaccination schedule recommended for patients with CKD. The primary outcome measure, seroconversion, is defined as hepatitis B surface antibody titer greater than 10 IU 3 months after completion of the vaccination schedule. RESULTS: The study population of 165 patients included 64% men with a mean age of 60 years, mean serum creatinine level of 3.4 +/- 1.5 mg/dL (300 +/- 133 micromol/L), and median estimated glomerular filtration rate (GFR) of 20 mL/min (interquartile range, 14 to 20). Seroconversion rate was 82%. Multivariate analyses showed the independent predictive value of level of GFR. The model showed that patients with the lowest level of kidney function and who were older and had diabetes were less likely to seroconvert (P < 0.05). CONCLUSION: This is the largest study to show in a well-characterized cohort that patients with higher GFR levels are more likely to respond to hepatitis B vaccination programs with seroconversion, independent of other factors. Future studies will explore specific mechanisms to explain this phenomenon.

Aged↗
PubMed2001

HIV surveillance among injecting drug users.

Injecting drug users (IDUs) should be considered a 'partially hidden population' at high risk for HIV infection. In almost all locations it should be possible to locate and conduct research with IDUs, but it will probably never be possible to enumerate or draw random samples from an IDU population. Surveillance research studies with IDUs should include risk behaviors, as surveillance of HIV infection only will not be sufficiently time sensitive, and be used to develop and refine HIV prevention programming for the population. Contacts with IDUs can be developed at multiple settings, including voluntary treatment programs, law enforcement settings, and through 'street outreach.' Each type of setting has different advantages, disadvantages and ethical concerns. HIV testing as part of surveillance also raises additional important ethical concerns. The primary risk behaviors that should be included in surveillance studies are 'sharing' of drug injection equipment, the potential for rapid partner change among risk partners, and sexual risk behavior. Additional important objectives for surveillance research include: (1) the size of the local IDU population, (2) patterns of drug use, (3) availability injection equipment, (4) participation in prevention activities, and (5) access to and use of anti-retroviral treatments. HIV incidence is an ultimate objective for surveillance research, but there are no currently available cost-efficient methods for studying HIV incidence, so estimation from indirect measurements is usually required.

HIV Infections↗
PubMed1991

Difference in prevalence of human papillomavirus genotypes in cytomorphologically normal cervical smears is associated with a history of cervical intraepithelial neoplasia.

The prevalence of human papillomavirus (HPV) genotypes was investigated by the polymerase chain reaction (PCR) method in cytologically normal and abnormal cervical scrapes obtained from asymptomatic women (n = 1,346), participating in a triennial screening program for cervical cancer, and from a gynecological outpatient population (n = 593). In the symptom-free population oncogenic HPV types 16, 18, 31 and 33 were present in 1.5% of cytologically normal scrapes, while the overall HPV prevalence rate was 3.5%. Significantly, higher HPV prevalence rates of 7% (oncogenic HPV; p less than 0.01) and 14% (all HPV; p less than 0.01), respectively, were found in cytologically normal scrapes of the gynecologic outpatient population. It appeared that in this outpatient group 78% of the smears containing HPV 16 and 18 were associated with a history of cervical pathology, i.e. cervical intraepithelial neoplasia grade I to III. In smears with mild and severe dysplasia and smears suspected of carcinoma in situ from both populations, the overall HPV prevalence was 70%, 84% and 100%, respectively. In all squamous-cell carcinomas of the cervix (n = 50) HPV was detected. Frequencies of HPV 16 and 18 increased from 41% in mild dysplasia to 94% in cervical carcinomas. Since a low prevalence of HPV was found in cytomorphologically normal cervices of women without a clinicopathological history, the findings in this study suggest that HPV detection in population-based screening programs for cervical neoplasia can be an important tool in identifying women who are at risk of developing dysplasia and cervical cancer.

Adult↗
PubMed1998

Abundant mitochondrial genome diversity, population differentiation and convergent evolution in pines.

We examined mitochondrial DNA polymorphisms via the analysis of restriction fragment length polymorphisms in three closely related species of pines from western North America: knobcone (Pinus attenuata Lemm.), Monterey (P. radiata D. Don), and bishop (P. muricata D. Don). A total of 343 trees derived from 13 populations were analyzed using 13 homologous mitochondrial gene probes amplified from three species by polymerase chain reaction. Twenty-eight distinct mitochondrial DNA haplotypes were detected and no common haplotypes were found among the species. All three species showed limited variability within populations, but strong differentiation among populations. Based on haplotype frequencies, genetic diversity within populations (HS) averaged 0.22, and population differentiation (GST and theta) exceeded 0.78. Analysis of molecular variance also revealed that >90% of the variation resided among populations. For the purposes of genetic conservation and breeding programs, species and populations could be readily distinguished by unique haplotypes, often using the combination of only a few probes. Neighbor-joining phenograms, however, strongly disagreed with those based on allozymes, chloroplast DNA, and morphological traits. Thus, despite its diagnostic haplotypes, the genome appears to evolve via the rearrangement of multiple, convergent subgenomic domains.

DNA, Mitochondrial↗
PubMed1997

Markets and public programs: insights from Oregon and Tennessee.

Medicaid is the major national program promoting access to care for low-income populations, but the program also is a federal-state partnership. With costs rising and universal access still a remote objective, many states have turned to market-based strategies involving managed care, with the goals of generating savings for the state, improving access for Medicaid beneficiaries, and sometimes expanding coverage to those who were previously uninsured. Yet Medicaid is a complex social insurance system that over time has been used to finance a variety of needs, often using cross-subsidies. In addition, states vary in both the scope of their Medicaid programs and the sophistication of the skills and resources they can bring to bear in shaping them. Understanding how these influence the ability to implement market-based strategies in Medicaid and what the effects of these strategies appear to be is of crucial importance because most states now include some features of this approach in their programs.

Health Care Reform↗
PubMed2006

Major advances in teaching dairy production.

A survey of 38 universities that grant 4-yr degrees as well as 12 institutions that grant technical degrees of 2 yr or less revealed that degree programs in dairy production remain popular, but have changed significantly over the last 25 yr. Enrollment in dairy production programs remains strong (1,189 and 417 students in baccalaureate and nonbaccalaureate degrees, respectively) even though this is viewed as a traditional industry. There are significant differences in size of programs across the United States, and some are struggling to maintain both the visibility and faculty numbers to keep pace with the industry. The percentage of students enrolled in 4-yr programs who are female has increased to the majority. More students hail from a nondairy farm background in our university programs today than in 1994. Computer and information technology has become a mainstream part of our educational programs. A high percentage of undergraduate students elect to engage in an internship or work experience, and there is a high correlation between internship and career paths selected by our students. The dairy industry initiated and financially supports the North American Intercollegiate Dairy Challenge; an educational activity among university teams to foster skills in analyzing a dairy farm business. This collaboration between universities and private industry is strong evidence that our undergraduate programs are relevant to the dairy industry. Extracurricular activities like dairy science clubs also remain popular, and are perceived by faculty members to be an important part of our educational experience. An analysis of nonbaccalaureate degree programs was not reported previously, but was a part of the present survey. In the nonbaccalaureate institutions that responded to the survey, there were 417 students enrolled in 12 dairy programs across the United States in 2004. This student population in nonbaccalaureate programs has a higher percentage of female enrollment than in 1994, but enrollment is still predominantly male. Computer and information technologies are an important part of their curricula and a very high percentage of these students remain in production agriculture upon graduation. Many of the challenges in undergraduate education described previously continue to be challenges in 2005. However, there are many reasons for optimism; as the number of students electing enrollment in dairy production remains strong, there is great interest in keeping the curricula relevant and interaction with and support by the dairy industry continues to be significant.

Career Choice↗
PubMed1983

Prevalence of growth stunting and obesity: Pediatric Nutrition Surveillance System, 1982.

Pediatric surveillance data for 1982 are examined in terms of the prevalence of growth stunting and obesity. Results indicate that growth stunting is observed in approximately 6%-16% of children in the age group from birth through 4 years. Overall, the prevalence of stunting trends to increase with age. Native American and Hispanic children show the highest prevalence of stunting. Obesity is observed to vary from 5%-13% in different age and ethnic subgroups. Obesity increases in prevalence among 1-year-olds relative to infants less than 1 year of age, but from 2-4 years of age there are no consistent trends in the prevalence of obesity with increasing age. Native American children, followed by Hispanic children, have the highest prevalence of obesity as reflected in high weight-for-height. The prevalence of growth stunting and obesity in the populations under surveillance is greater the 5% level "expected" when compared with the reference population, suggesting that the children attending publicly supported health programs are at increased nutritional risk. At the same time, the prevalence of low weight-for-height is generally less than the 5% level, suggesting that thinness is not a significant public health program in the populations under surveillance. The observation of increased stunting as well as high weight-for-height among Hispanic and Native American children raises a number of issues in interpretation and suggests that the diet of these children may be relatively adequate in quantity but inadequate in quality of nutrient intake.

Black People↗
PubMed1994

Age-specific effectiveness of the Nijmegen population-based breast cancer-screening program: assessment of early indicators of screening effectiveness.

BACKGROUND: The benefits of mammographic screening for breast cancer are not clear for women less than 50 years old. PURPOSE: Our aim was to evaluate the effectiveness of breast cancer screening in different age groups. METHODS: A mammographic breast cancer-screening program with a 2-year screening interval has been under way in Nijmegen, The Netherlands, since 1975. After eight rounds, more than 40,000 women have been invited to participate. All breast cancer cases diagnosed in the invited population, whether detected by screening or clinically, have been considered in this study. The age groups are younger than 50 years, 50-69 years, and 70 years or older at last invitation before diagnosis. Our assessment of the effectiveness of screening is based on the proportion of screen-detected cancers among all cancers and on the disease stage at diagnosis. RESULTS: For women younger than 50, compliance was 75%, and 37% (85/230) of the cancers were detected by screening. The age group 50-69 years had a compliance of 65% with 48% (288/595) of cancers detected by screening, and the group 70 years or older had a 25% compliance with 35% (108/305) of cancers detected by screening. The sizes of the cancers detected by screening were smaller than those detected clinically for all age groups. The age group under 50 showed no substantial difference in the proportion of positive axillary lymph node status between screening-detected and clinically diagnosed cancers, while among older women, the proportion of lymph node involvement was substantially higher for clinically detected cases. A significantly lower frequency of advanced stages was observed in screen-detected compared with clinically diagnosed cancers for women 50 years of age or older (P < .001) but not in women under 50 (P = .35). CONCLUSIONS: No positive effect of the biennial screening program is apparent for women under age 50. For women aged 50 and above, the screen-detected cancers have a more favorable stage distribution than clinically diagnosed cancers, a prerequisite for a reduction in breast cancer mortality.

Adult↗
PubMed2005

A factors influencing applicant selection of entry-level physical therapist education programs in the United States.

Physical therapist education programs must compete for qualified applicants due to a nationwide reduction in the applicant pool. To develop successful recruitment strategies, faculty members need information on factors influencing applicant selection of a program. The purpose of this study was to analyze factors influencing selection of an entry-level physical therapist education program. Survey subjects were students enrolled in the first professional year of an accredited entry-level physical therapist education program. A survey instrument was developed based on the literature and interviews with physical therapist students and faculty members. Results of pilot studies to determine face and content validity were acceptable. Stratified random cluster sampling was applied to select 66 entry-level physical therapy programs from an available population of 150 of the 199 accredited programs. Forty-nine programs were not included in the population for various reasons. Using a five-point Likert scale, subjects rated the influence of 51 items on their selection of a specific physical therapist education program. The overall return rate was 70.4% (1,250 surveys returned). Data were analyzed by response frequency. Four factors were selected as "very influential" by 50% or more of the subjects: degree offered, accreditation status, perception of educational quality, and program atmosphere. Additional factors selected by 45% or more of respondents as "very influential" were pass rate on licensing examination, marketability of degree, student/faculty ratio, and small class size. Factors rated "not influential" by 50% or more of subjects included ethnic, cultural, and gender issues. Since 1998, the physical therapy profession has experienced changes in entry-level degree requirements, practice requirements, and employment opportunities, resulting in increased competition for qualified applicants to education programs. The information gained in this study may assist faculty in the development of recruitment strategies.

Accreditation↗
PubMed2000

[Incidence of dental caries in a child population from Mostoles: evaluation of a preventive program after 2 years].

OBJECTIVE: To know the efficacy and effectivity od dental health program after 2 years. DESIGN: The study of prospective cohorts not aleatorized. POPULATION AND METHODS: The exposed cohort is composed of 583 school children, 296 girls and 287 boys, the non-exposed cohort is composed of 261 school children, 132 girls and 129 boys. We carried out and odontological exploration following the criteria of the WHO the preventive measures we carried out are health education, weekly mouthrinse of NaFl at 0.2%, occlusive sealant in the first permanent molar and external application fluorine gel. We measured and compared the different indexes of tooth decay and sociodemographic variables between both cohorts, the statistic meaning has been determined through the U est of Mann Whitney. RESULTS: We have found statistically significant differences between both cohorts in the indexes of decay in the exposed cohorts. The indexes of decay in the exposed cohort being DMFT: 0.31; DMFM (first permanent molar): 0.31; DMFS: 0.4. And in the non-exposed cohort DMFT: 0.81; DMFM: 0.81; DMFS; 1.09. Existing an epidemiological association between the preventive program and the prevention of dental decay with a relative risk of 0.24 (95% CI, 0.17-0.33) and the prevention fraction of 76.3% (95% CI, 67-83). CONCLUSIONS: The preventive program after two years elapsed is effective and has a clear protector effect.

Child↗
PubMed2005

Experience with a program for prevention of chronic renal failure in India.

BACKGROUND: For the past eight years, the Kidney Help Trust of Chennai has run a program to prevent chronic renal failure by regular screening of an entire population of 25,000, and treatment of diabetes and hypertension with the cheapest available drugs. The total cost amounts to 25 cents per capita of the study population. METHODS: The program has recently been expanded to cover the adjacent area with a population of 21,500. Both the original population and the new population are being surveyed. Persons at risk of renal failure are identified as reported earlier, and glomerular filtration rate (GFR) is estimated by the MDRD formula. The survey is as yet incomplete. Six thousand one hundred people in the new area, and 20,986 in the old, have been studied so far, and the numbers and percentage of those with GFR below normal have been compared. RESULTS: The prevalence of impaired renal function (GFR below 80 mL/min) in the original population is 8.6 per thousand, and in the new population is 13.9 per thousand (P= 0.005, RR 1.61, CI 1.15-2.24). CONCLUSION: This model provides an effective method for prevention of chronic renal failure at the community level.

Humans↗