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Engaging general practitioners in the management of hazardous and harmful alcohol consumption: results of a meta-analysis.
OBJECTIVE: A systematic review was undertaken of studies that test the effectiveness of different strategies used to increase general practitioners' rates of screening for and giving advice about hazardous and harmful alcohol consumption. METHOD: Resources were MEDLINE, EMBASE, Cinahl and the Cochrane Library (1966-2001). Inclusion criteria were those of the Effective Practice and Organisation of Care Group of the Cochrane Collaboration. A meta-analysis was undertaken, using a random effects model, of 15 programs identified in 12 trials. Effect sizes, calculated using the logged odds ratio, were adjusted by inverse variance weights to control for the sample sizes of the studies. RESULTS: Analysis of the intervention groups resulted in screening and advice-giving rates of 45% (95% CI: 33%-56%) and analysis of the comparison groups resulted in rates of 32% (95% CI: 20%-43%). The weighted mean effect size (logged odds ratio = 0.73; 95% CI: 0.56-0.90) was heterogeneous. Regression analysis to explain the heterogeneity found a significant effect for alcohol-specific programs compared with general prevention programs in which alcohol was included, and for multicomponent programs compared with single component programs. No significant differences were found between educational-based or office-based interventions. CONCLUSIONS: Although the small numbers of programs studied suggest caution be used in interpreting the results, it seems it is possible to increase the engagement of general practitioners in screening and giving advice for hazardous and harmful alcohol consumption. Although considerably more research of high quality is needed, promising programs are those that have a specific focus on alcohol and those that are multicomponent.
[Prevalence of sedentarism and its associated factors among urban adolescents].
OBJECTIVE: To evaluate the prevalence and determinants of sedentarism among adolescents living in Pelotas, State of Rio Grande do Sul, Brazil. METHODS: A cross-sectional study was carried out in Pelotas, in 2002. An anonymous, self-administered questionnaire was answered by a representative sample of 960 adolescents with ages ranging from 15 to 18 years old. Those who reported that their participation in some kind of physical activity amounted to less than 20 minutes a day with a frequency of less than 3 times a week were considered to have a sedentary lifestyle. Sociodemographic and behavioral variables were evaluated. The chi-squared test was used for comparisons between proportions. The Poisson regression was used for multivariate analysis with robust adjustment for variances. Corrections were made for study design effects. RESULTS: Interviews were held with 960 adolescents. Of these, 39% were classified as having a sedentary lifestyle. The prevalence of sedentarism was higher among girls than among boys (prevalence ratio of 2.45; 95% CI 2.06-2.95). The adolescents from lower social levels had the highest percentage of sedentarism (prevalence ratio of 1.35; 95% CI 1.06-1.72). There was an inverse relationship between the adolescent's and the mother's schooling and sedentarism. After adjusting for confounding factors, there was also a positive association between sedentarism and minor psychiatric disturbances, and in relation to sexual activity. CONCLUSIONS: Higher prevalences of sedentarism are associated with girls, low social class, low levels of schooling and being the child of a mother with a low level of schooling.
A private-sector preferred provider network model for public health screening of newly resettled refugees.
US law and regulations stipulate a process for the health screening of refugees. The responsibility of caring for refugees resettled in the United States rests, in part, with public health or welfare departments. Massachusetts has met its screening responsibilities through the innovative creation of a network of private preferred providers. We explore the Massachusetts model of public-private collaboration within the context of federal refugee health priorities and current state fiscal restraints affecting public health programs, and demonstrate the model's accomplishments.
Screening behaviors among relatives of breast cancer patients.
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Possible involvement of phosphatidylcholine in school recognition in the catfish, Plotosus lineatus.
The catfish, Plotosus lineatus, forms a dense ball-shaped school soon after hatching. The involvement of a chemical cue(s) in this behavior was indicated from the observations that P. lineatus was attracted not only to seawater conditioned with the schoolmates (schoolmate seawater) but also to the skin mucus collected from the schoolmates. To determine the nature of the chemical cue, we first established a novel bioassay that monitored a characteristic 'turn behavior' toward an agar block containing skin mucus collected from the schoolmates. The bioassay-guided fractionations of skin mucus led to a final preparation wherein activity was contained in a single peak in high performance liquid chromatography on a polyamine column. The spectral data of the final preparation indicated that the purified material was a mixture of phosphatidylcholine molecular species, which was supported by the fact that the final active preparation lost the activity when treated with phospholipase A2, indicating that the school recognition substance is degraded by phospholipase A2. From these results, we proposed that the chemical cue to recognize the school in P. lineatus may be PC molecular species.
Pre-participation physical evaluations. Development of uniform guidelines.
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Adolescent suicide clusters: evidence, mechanisms and prevention.
Cluster suicides account for an estimated 5% of all teenage suicides in the USA. Not all hypothesised clusters are verified, however, when submitted to statistical analysis. This paper reviews possible mechanisms underlying adolescent cluster suicides using the "infectious disease model", key concepts of which are host susceptibility, modes of transmission, degree of virulence, and dose dependency. Preventive measures against cluster suicides are reviewed, including primary prevention against youth suicide, tempered media reporting of suicide, and "postvention strategies" directed to communities affected by suicide.
Prevention and control of melanoma: the public health approach.
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Risk-taking behaviour of young women in Australia: screening for health-risk behaviours.
Healthy risk-taking is a normal part of adolescence. Young people who participate in multiple risk-taking increase the chance of damaging their health. There appears to be a growing range and prevalence of health-risk behaviours among young women, notably in their use of alcohol and marijuana. Research suggests that such health-risk behaviours may be related to psychological factors such as stress and depression. General practitioners have a central role in identifying and preventing health-risk behaviours and associated mental health problems in young people. Comprehensive assessment includes a series of screening questions about home, education (or employment), activities, drugs, sexuality and suicide for young people, known as the HEADSS technique.
Consumer choice and the National Bowel Cancer Screening Program.
The opportunity for informed choice in screening is limited.
Change in diet, physical activity, and body weight in female college freshman.
OBJECTIVE: To examine diet, physical activity, and body-weight changes associated with relocation from home to university. METHODS: Diet, fitness/physical activity, body-weight parameters and self-efficacy were assessed among 54 freshman women upon college entry and 5 months later. RESULTS: Although caloric intake significantly decreased, a significant increase occurred in body-weight parameters that may be attributed to significant decreases in total physical activity. CONCLUSIONS: Interventions are needed aimed at increasing physical activity; improving diet quality related to consumption of vegetables, fruits, breads and pasta, and meats; and decreasing alcohol consumption.
Weight control practices of U.S. adults trying to lose weight.
OBJECTIVE: To estimate the relative prevalence of different types and combinations of practices among weight-loss practitioners and to describe the relations between individual characteristics and various features of weight-loss regimens. DESIGN: A telephone survey of a random digit-dialed probability sample of adults in the continental United States who reported that they were trying to lose weight. PARTICIPANTS: A total of 1431 persons 18 years or older who were attempting to lose weight. MEASUREMENTS: Self-reports of a detailed inventory of more than 35 specific practices that might be used as part of a voluntary weight-loss plan, along with information about individual characteristics such as current weight, weight-loss history, demographic profile, motivations to lose weight, sources of information, and knowledge about diet and health. RESULTS: The average respondent had a current weight-loss attempt lasting from 5 to 6 months, had tried a similar plan before, and had averaged one attempt a year for the past 2 years. Seventy-one percent of women and 62% of men reported that they were both changing their diet and exercising more as part of a current weight-loss attempt. Frequently reported weight-loss practices included weighing oneself regularly (71% and 70% for women and men, respectively), walking (58% and 44%), using diet soft drinks (52% and 45%), taking vitamins and minerals (33% and 26%), counting calories (25% and 17%), skipping meals (21% and 20%), using commercial meal replacements, (15% and 13%), taking diet pills (14% and 7%), and participating in organized weight-loss programs (13% and 5%). Sex, education, and overweight status influenced the choice of a weight-loss practice. CONCLUSIONS: Individual approaches to weight-loss vary and are characterized by their duration and by their recurrent nature. Policy efforts should be directed toward increasing the long-term effectiveness of individual weight-loss plans.
A current perspective of suicide and attempted suicide.
Suicide and suicide attempts are a major cause of death and morbidity worldwide. Suicide is generally a complication of a psychiatric disorder, but it requires additional risk factors because most psychiatric patients never attempt suicide. This review includes a hypothesized stress-diathesis model, which has implications for detection of high-risk patients and treatment interventions, and discusses promising treatment approaches that have been recently identified.
Substance abuse prevention and the media.
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Strategy and the new economics of information.
We are in the midst of a fundamental shift in the economics of information--a shift that will precipitate changes in the structure of entire industries and in the ways companies compete. This shift is made possible by the widespread adoption of Internet technologies, but it is less about technology than about the fact that a new behavior is reaching critical mass. Millions of people are communicating at home and at work in an explosion of connectivity that threatens to undermine the established value chains for businesses in many sectors of the economy. What will happen, for instance, to dominant retailers such as Toys "R" Us and Home Depot when a search through the Internet gives consumers more choice than any store? What will be the point of cultivating a long-standing supplier relationship with General Electric when it posts its purchasing requirements on an Internet bulletin board and entertains bids from anybody inclined to respond? The authors present a conceptual framework for approaching such questions--for understanding the relationship of information to the physical components of the value chain and how the Internet's ability to separate the two will lead to the reconfiguration of the value proposition in many industries. In any business where the physical value chain has been compromised for the sake of delivering information, there will be an opportunity to create a separate information business and a need to streamline the physical one. Executives must mentally deconstruct their businesses to see the real value of what they have. If they don't, the authors warn, someone else will.
RNs and the media: thin coverage.
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Reducing complications from alcohol use during pregnancy through screening.
Prenatal providers are reluctant to discuss alcohol use in the clinical setting, even though heavy alcohol use is associated with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE), sometimes known as alcohol-related neurodevelopmental disorder. Fourteen percent to 20% of pregnant women report drinking some alcohol during pregnancy. Approximately 0.2% to 1% meet the criteria for heavy drinking. Reducing drinking during pregnancy has the potential to reduce the risk for FAS and FAE. Routine screening for alcohol use during pregnancy followed by referrals for those considered to be at risk is recommended. Women are often more receptive to intervention during pregnancy, as they focus on positive health behaviors. A number of brief screening tools designed for use on a routine basis are reviewed. Physicians who learn to comfortably discuss alcohol use during pregnancy can help substantially reduce the impact of these disorders.