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Meeting the mental health needs of older adults.
Greater attention to the mental health needs of older adults is critical in light of recent research documenting substantial undertreatment of mental health problems in late life. As often the first and only point of professional contact for mentally ill older adults, primary care physicians have an important and unique role in reducing enduring unmet mental health needs in late life. This article reviews the current state of geriatric mental health care delivery and provides valuable information and resources for use in clinical practice to increase and enhance primary care detection, treatment, and referral of psychological problems in older patients.
Provider-staff discrepancies in reported immunization knowledge and practices.
BACKGROUND: The purpose of the study was to compare immunization-relevant knowledge, certainty about knowledge, self-efficacy, vested interest, and reported practices of providers and clinical staff in the same clinics. METHODS: A valid and reliable instrument measuring the aforementioned issues was developed and administered to a sample of 50 providers and 60 members of the clinical staff. RESULTS: Providers were significantly more knowledgeable than staff (P < 0.001); however, they were not more certain about their knowledge (P = 0.52) nor were they more confident in their capability to properly immunize all children in their practice (P = 0.10). Providers reported lower vested interest in immunizations than clinical staff (P < 0.05). Both groups were equally likely to immunize a child with a cold. Providers were less likely to defer needed immunizations for a 15-month-old child, and they were more likely to administer multiple injections to an 18-month-old (both P < 0.05). Providers were more likely than staff to immunize during acute and chronic illness visits (both P < 0.001), and both groups were equally likely to immunize during preventive visits. CONCLUSIONS: Discrepancies in reported immunization practices between providers and staff may be a barrier to full immunization.
Personal and professional correlates of US medical students' vegetarianism.
OBJECTIVE: To determine prevalence and correlates of US medical students' self-identification as vegetarians. DESIGN: Medical students were anonymously surveyed via questionnaire three times: at freshmen orientation, orientation to wards, and during senior year. SUBJECTS: Medical students in the Class of 2003 (n=1,849) at 15 US medical schools (response rate 80%). OUTCOME MEASURES: We examined self-reported vegetarianism, abstinence from meat items on a food frequency questionnaire, and associations between students' vegetarianism and their health-related outcomes. STATISTICAL ANALYSES: Bivariate associations were tested with chi(2) tests. RESULTS: During medical school, 7.2% of students self-identified as vegetarians; this percentage declined over time. Those who were vegetarians for health reasons (66% of vegetarians) ate more fruits and vegetables than those who were vegetarians for nonhealth reasons (P=0.02). Vegetarians were more likely (P<0.01) than nonvegetarians to eat more fruits and vegetables (P=0.002); be women (P=0.009); be Hindu, Buddhist, or Seventh Day Adventist (P< or =0.0004); be politically liberal (P=0.007); have a body mass index < or =25 (P=0.008); or, as freshmen, to perceive nutrition counseling as highly relevant to their intended practices (P=0.007). Vegetarian students were no more likely to counsel patients about nutrition than were nonvegetarians. CONCLUSIONS: Prevalence of vegetarianism was higher among US medical students than among other US adults, although the prevalence declined during medical school. Medical students and physicians with healthful personal practices are more likely to encourage such behaviors in their patients, although the specific nutrition habit of vegetarianism among medical students was unassociated with their nutrition counseling practices.
Promoting physical activity and exercise in older adults.
Although the benefits of increased physical activity and exercise are universally recognized, many older persons remain sedentary, and relatively few achieve recommended levels of activity. Effective interventions to reverse the lack of physical activity in older adults are clearly needed. By understanding correlates of inactivity and appreciating those factors that contribute to a sedentary lifestyle, appropriate strategies can be employed to help order patients reap the benefits of increased physical activity and exercise. In this article, we offer to the reader a brief overview of the field as well as our own thoughts on how clinicians might help individual patients at a more practical level.
Promulgation of guidelines for mucositis management: educating health care professionals and patients.
BACKGROUND: The Multinational Association for Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) Mucositis and Patient and Professional Education Study Groups are collaborating to improve the promulgation of the updated mucositis management guidelines. The initial step in the collaboration was to survey cancer care health professionals to determine their awareness of the original 2004 guidelines and their opinions on the usefulness of patient educational materials based on the guidelines. MATERIALS AND METHODS: The authors surveyed four samples (three US and one European) of cancer health care professionals attending three cancer-related professional conferences between May and July 2005 using a ten-item questionnaire in both paper-and-pencil and web-based formats. Data were compiled and analyzed using descriptive statistics. RESULTS: All respondents were generally aware of the importance of mucositis as a treatment-limiting toxicity with life-threatening complications and endorsed regular oral assessment and dental care practices. Only about one third of the US respondents were aware of the 2004 guidelines in contrast to 80% of the European respondents. A majority of respondents across all four surveys (66-93%) felt strongly that educational materials based on the guidelines were needed and that they would use them, while a smaller number (7-29%) indicated they might use them if a patient had a problem with mucositis. CONCLUSIONS: Awareness of the guidelines remains limited in the US, and use of the guidelines worldwide is minimal. The Mucositis and Patient and Professional Education Study Groups have developed a set of strategies to enhance dissemination, awareness, and use of the updated guidelines and to promote patient education based on the guidelines. Future work will focus on implementation and evaluation of the guidelines in clinical practice.
A meta-analysis of predictors of positive health practices.
PURPOSE: To identify predictors of positive health practices from empirical studies in which the Personal Lifestyle Questionnaire was used. METHODS: Meta-analysis to determine the magnitude of the relationships between each of the predictors identified and positive health practices. Fourteen predictors of positive health practices were identified in 37 studies published since 1983; a meta-analysis was conducted on 14 predictors. RESULTS: Eight predictors (loneliness, social support, perceived health status, self-efficacy, future time perspective, self-esteem, hope, and depression) had moderate effect sizes, and six (stress, education, marital status, age, income, and sex) had small effect sizes. CONCLUSIONS: Findings enable health care professionals and researchers designing intervention studies to use the strongest predictors identified in this meta-analysis to promote positive health practices.
Health and development: knowledge systems and local practice in rural Thailand.
The specific framing of health within a development context has implications for constructions of wellness and illness and how people react in times of ill health. In Thailand, recent national HIV/AIDS education-prevention campaigns commonly use topdown relay of public health information. This pattern replicates numerous development projects that aim to bring useful and beneficial knowledge to rural villagers. How villagers integrate this information depends, in part, on previous experiences with development programs in general and public health programs in particular. This paper considers the political economy of medical knowledge and multiple local health strategies in rural Northeast Thailand as a background to the contingent response to public health directives.
Health promotion in the city: a review of current practice and future prospects in the United States.
To achieve its health goals, the United States must reduce the disproportionate burden of illness and poor health borne by urban populations. In the 20th century, patterns of immigration and migration, changes in the global economy, increases in income inequality, and more federal support for suburbanization have made it increasingly difficult for cities to protect the health of all residents. In the last 25 years, epidemics of human immunodeficiency virus infections and substance abuse and increases in homelessness, lack of health insurance, rates of violence, and concentrations of certain pollutants have also damaged the health of urban residents. Several common strategies for health promotion are described, and their relevance to the unique characteristics of urban populations is assessed. To identify ways to strengthen health promotion practices in U.S. cities, lessons have been taken from five related fields of endeavor: human rights, church- and faith-based social action, community economic development, youth development, and the new social movements. By integrating lessons from these areas into their practice, public health professionals can help to revitalize the historic mission of public health, contribute to creating healthier cities, and better achieve national health objectives.
Planning and implementing health promotion in the workplace: a case study of the Du Pont Company experience.
This case study describes the needs assessment, design, implementation, and preliminary evaluation of a comprehensive workplace health promotion program. The company had 110,000 U.S. employees at more than 100 locations engaged in a variety of manufacturing, research, sales, and support occupations in 1980. The PRECEDE framework was used to focus program planning and evaluation on key areas of health knowledge, attitudes, and behavior. The needs assessment included use of company morbidity and mortality data, a survey of medical and human resources staff, and a survey of employees, spouses, and pensioners. An in-house network of lay committees, site medical personnel, and corporate health education, nutrition and fitness specialists was used to staff critical program functions. Interventions included: public health approaches to program kick-off and health risk assessment; group and self-directed lifestyle change activities; recognition and awards; and workplace climate changes such as smoking policies that favor nonsmokers. One pilot location experienced a 47.5% decline in hourly employee absenteeism over six years versus a 12.5% decline in the total Du Pont hourly workforce. A number of lessons are discussed on how to improve the planning, implementation, institutionalization, and evaluation of health promotion programs in large industrial companies. Four areas where future research and practice should be focused include: reaching spouses, sales personnel, shiftworkers, and employees at small sites; balancing what is popular with what reduces risks over the long-term; documenting program impacts when research resources are scarce; and integrating health promotion programs with workplace medical, safety, employee assistance and benefits programs.
Removing barriers to care among persons with psychiatric symptoms.
Many persons with serious psychiatric conditions who could benefit from available treatments do not receive care, and the barriers are generally understood to be limited knowledge, inadequacies in insurance coverage, and stigma. Sophisticated approaches are needed to realistically eliminate these and other barriers. Public policy should focus on criteria for need for care and encourage interventions that facilitate treatment when it can be helpful. Appropriate insurance coverage is indispensable, and achieving mental health parity will require careful management of care. Policymakers must help to create a trustworthy management structure that is inclusive, that develops and disseminates models of best practice, that encourages evidence-based decision processes, and that ensures continuing dialogue and procedural fairness in managed care decision making.
Long-term effects of a community-wide alcohol server training intervention.
OBJECTIVE: The Rhode Island Community Alcohol Abuse and Injury Prevention Project (CAAIPP), implemented from 1984 through 1989, employed the "community gatekeeper" approach to reduce alcohol-related injuries and deaths. Targeting alcohol servers rather than drinkers, community-wide interventions were designed and implemented to encourage responsible serving behaviors through the adoption of techniques of responsible service. The primary goal of the CAAIPP server intervention evaluation was to assess both short-term and long-term changes in behavior of alcohol beverage servers who were recipients of CAAIPP training. METHOD: A 5-hour training curriculum on "Responsible Alcohol Service" was offered to all alcohol servers in a randomly selected study community. A prospective study design was used to evaluate long-term changes in the self-reported behavior of 321 trainees using three time-points over 5 years. A cross-sectional survey was conducted 4 years posttraining to compare rates of self-reported server behaviors in the intervention community (n = 106) with two comparison communities (nA = 56, nB = 49). RESULTS: Fifteen months after training, trainees reported significantly higher levels of desired serving behavior than nontrained servers. Though positive effects of server training diminished with time, responsible serving behavior 4 years posttraining remained higher than pretraining levels. The impact appeared greatest for servers with fewer years serving experience, wait-persons, younger servers and servers who worked in establishments without written policies regarding serving practices. CONCLUSIONS: The results with regard to modifying server behavior are positive and indicate that server interventions shown to be efficacious should be implemented. Training programs that target specific serving skills in repeat sessions may be most promising for improving server behavior, particularly among both young and new servers working in establishments without written policies regarding serving practices.
Personal health among midlife women hospital employees.
We hypothesized that women employees working in a hospital environment would be particularly attuned to aspects of personal health, well-being, and disease prevention. We performed an observational study at a local hospital, offering free assessments in its outpatient women's wellness screening program to women employees aged 39-60 years. Data from the first 60 women to enroll in the program are presented as a test of our hypothesis. Undiagnosed hypertension, abnormal lipid profiles, glucose intolerance, alcohol abuse, abnormal cervical cytology, breast masses, depression, or combinations of these were found in 49 of the 60 women. Twenty-one women were obese. Most women with abnormal findings did not follow specific personalized recommendations for remedial follow-up, including referral to a specialist. An important percentage of midlife women employees at this hospital exhibited unhealthful personal behaviors, had unrecognized disease, and did not use recommended health screening practices. The data emphasize the benefit for employees who participate in medical facility worksite health promotion programs.
[Attitudes and exposuer of Israeli medical students to complementary medicine--a survey].
The use of alternative medicine is increasing rapidly and currently includes more than a third of the adult population in the US. Hence, two-thirds of US medical schools are presently including courses in complementary or alternative medicine as part of their curriculum. We addressed the deans of the four medical schools in Israel in order to determine the exposure of Israeli medical students to theoretical and practical aspects of complementary therapies within the curriculum, as well as future plans to include such programs. We also surveyed 154 medical students attending the Hebrew University medical school in order to ascertain interest and knowledge regarding complementary medicine, as well as their views on the introduction of these topics as part of their educational program. Most of the medical students were interested in learning about complementary therapies. Ninety-three percent stated that they would like to include an elective course in complementary medicine as part of the medical school program. Fifty four percent of the students surveyed had prior theoretical knowledge of complementary therapies through personal reading or had practical experience through treatments or courses. The present curriculum of Israeli medical schools, excluding Ben Gurion University, does not meet the students' growing interests in complementary medicine. However, all schools are considering the possibility of including these topics in future educational programs.
Using action research in nursing practice with older people: democratizing knowledge.
AIM: This paper reports on an action research study which raised some questions about the processes of developing a sense of shared ownership in action research in a research environment which does not always have the appropriate mechanisms to support and sustain action research. BACKGROUND: Action research has gained popularity in nursing and healthcare research, offering a way of developing practice-based knowledge, which can assist in changing practice and democratizing inquiry. METHODS: There are other organizational constraints on action research which arise at different levels, and which also require discussion. These can be issues about communication and ownership at a practice level and issues of funding and project management procedures. This paper reports on a study in which these issues came to the fore, and offers some thoughts on how they can affect the processes of action research. CONCLUSION: While the principles of action research appear to offer much towards the development of a practice-rooted body of knowledge for nursing, unless some of the issues of ownership are resolved, it is unlikely to move beyond academic rhetoric. RELEVANCE TO CLINICAL PRACTICE: If nursing is to engage in action research, this must be done critically and reflectively and careful attention paid to developing an inclusive and collaborative approach to knowledge and practice development. Furthermore, to develop in nursing and health care research, it must find ways to meet the requirements of funding bodies.
Acute-care nurses' attitudes towards older patients: a literature review.
With increases in life expectancy and increasing numbers of older patients utilising the acute setting, attitudes of registered nurses caring for older people may affect the quality of care provided. This paper reviews recent research on positive and negative attitudes of acute-care nurses towards older people. Many negative attitudes reflect ageist streotypes and knowledge deficits that significantly influence registered nurses' practice and older patients' quality of care. In the acute setting, older patients experience reduced independence, limited decision-making opportunities, increased probability of developing complications, little consideration of their ageing-related needs, limited health education and social isolation. Available instruments to measure attitudes towards and knowledge about older people, although reliable and valid, are outdated, country-specific and do not include either a patient-focus or a caring perspective. This paper argues for the development and utilisation of a research instrument that includes both a patient focus and a caring dimension.
Knowledge and attitudes towards attention deficit hyperactivity disorder among elementary school teachers.
OBJECTIVE: Attention deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in child and adolescent psychiatry. ADHD children are at risk for academic and psychological difficulties. Lack of cooperation between schools, parents and therapeutic institutions inhibits a multimodal treatment program. This study surveys teachers' knowledge and attitudes towards attention deficit hyperactivity disorder. METHOD: One hundred and ninety six elementary school teachers in Shiraz, Iran, anonymously completed a self-report questionnaire on ADHD. RESULTS: Knowledge about ADHD was relatively low. 46.9% of respondents agreed that ADHD is due to biological and genetic vulnerabilities and causation. 53.1%of all the teachers considered ADHD to be the result of parental spoiling. The attitude score towards ADHD children was also low. 64.8% agree that the same disciplinary rules used for all students should also be applied to ADHD children. 77.6% believe that ADHD students experience difficulties in their relations with their classmates. There was a significant correlation between teachers' knowledge of ADHD and their attitude. The main sources of knowledge about ADHD were: Television and radio; friends and relatives; periodical, newspapers and magazines. CONCLUSION: Knowledge about ADHD was sound to be very low. PRACTICE IMPLICATIONS: Health and/or Educational Ministry should promote a special course on ADHD for teachers and education should be part of the curriculum in faculty training. Providing these educational programs on television and radio may be highly effective as they were the most common source of information.
Health workers' support for breastfeeding in Ibadan, Nigeria.
Breastfeeding in Nigeria is universal, and exclusive breastfeeding was introduced in 1992, yet no study has assessed health workers' support for breastfeeding at the grassroots level. This study assessed health workers' tangible support for breastfeeding at primary care facilities in Ibadan and factors affecting it, including knowledge of and attitudes toward breastfeeding. Among the 386 workers, there was moderate support for breastfeeding (median score = 15.0, maximum = 20). Following multivariate analysis, young age of worker (20-29 years; odds ratio [OR] = 2.9, 95% confidence interval [CI]: 1.2-6.8), more than 5 years of post-training experience (OR = 2.3, 95% CI: 1.2-4.4), senior profession (OR = 2.1, 95% CI: 1.0-4.4), high breastfeeding knowledge scores (OR = 2.5, 95% CI: 1.4-4.5), and sufficient opportunities to practice tangible breastfeeding support (OR = 4.3, 95% CI: 2.4-7.7) were found to predict tangible breastfeeding support. Deliberate efforts should be made to incorporate continuing education workshops to better prepare health professionals for their role in providing tangible breastfeeding support at the primary care level.