Project Dil: A Co-ordinated Primary Care and Community Health Promotion Programme for Reducing Risk Factors of Coronary Heart Disease Amongst the South Asian Community of Leicesterexperiences and evaluation of the project

Objectives To improve the effectiveness of primary and secondary prevention of coronary heart disease (CHD) in volunteer Leicestershire general practices with a high percentage of South Asian patients. To increase the awareness of lifestyle risk factors amongst the South Asian community with means of reducing CHD. Design Development and implementation of: A CHD training and awareness programme for health care professionals. Organizational change to ensure adoption of an effective secondary prevention programme for general practice. A public awareness campaign including a peer education programme for the South Asian community of Leicestershire. Interim evaluation using participation data, user satisfaction and organizational development of primary care is reported. Results A multi-disciplinary training programme accessed by 88% of staff from 23 volunteer practices has been developed and implemented. Organizational development in practices including CHD registers, action planning and establishing CHD clinics has taken place at a much faster pace than comparable non-Project Dil practices. An externally accredited peer education programme has been completed by 45 community volunteers. Within 6 months of completion, a total of 54 peer education sessions accessed by over 2,000 people from the Asian community had taken place. Project Dil, although initially funded only for 2 years, has now been adopted by Leicestershire Health Services (via a Primary Care Trust) as a mainstream programme. Conclusion Project Dil has made considerable progress in engaging and driving changes in general practices to facilitate improvement in CHD management. In parallel, the project has developed a community education programme, including the use of peer education. The project is now hosted by a Primary Care Trust on behalf of Leicester     

Acceptance and feasibility of school-based seasonal influenza vaccination in Singapore: A qualitative study

IntroductionInfluenza is a major cause of disease in children. School-based seasonal influenza vaccination can be a cost-effective tool to improve vaccine uptake among children, and can bring substantial health and economic benefits to the broader community. The acceptance and feasibility of school-based influenza vaccination are likely to be highly context-specific, but limited data exist from tropical settings with year-round influenza transmission. We conducted a qualitative study to assess acceptability and feasibility of a school-based seasonal influenza vaccination programme in Singapore.MethodsWe conducted qualitative in-depth interviews with key stakeholders, including healthcare professionals, representatives of relevant ministries, preschool principals and parents to understand their perspectives on a proposed school-based seasonal influenza vaccination programme. Interviews were transcribed verbatim and analysed using thematic analysis.ResultsWe conducted 40 interviews. Although preschool-aged children are currently the recommended age group for vaccination, stakeholders suggested introducing the programme in primary and/or secondary schools, where existing vaccination infrastructure would facilitate delivery. However, more comprehensive evidence on the local influenza burden and transmission patterns among children is required to develop an evidence-based, locally relevant rationale for a school-based vaccination programme and effectively engage policy-makers, school staff, and parents. Extensive, age-appropriate public education and awareness campaigns would increase the acceptability of the programme among stakeholders. Stakeholders indicated that an opt-out programme with free or subsidised vaccination would be the most likely to achieve high vaccine coverage and make access to vaccination more equitable.ConclusionsOverall, participants were supportive of a free or subsidised school-based influenza vaccination programme in primary and/or secondary schools, although children in this age group are not currently a recommended group for vaccination. However, a better informed, evidence-based rationale to estimate the programme’s impact in Singapore is currently lacking. Extensive, age-appropriate public education and awareness campaigns will help ensure full support across key stakeholder groups.     

Rural professionals’ perceptions of interprofessional continuing education in mental health

We describe the impact of an interprofessional education programme in mental health for professionals in six rural Canadian communities. The 10‐session programme, offered primarily via videoconference, focussed on eight domains of mental health practice. One hundred and twenty‐five professionals, representing 15 professions, attended at least some sessions, although attendance was variable. Data were collected between September 2006 and December 2007. The programme was evaluated using a mixed methods approach. Participants reported high levels of satisfaction for all topics and all aspects of the presentations: they were most satisfied with the opportunity to interact with other professionals and least satisfied with the videoconference technology. Professionals’ confidence (n = 49) with mental health interventions, issues and populations was measured pre‐ and post‐programme. There was a significant increase in confidence for seven of the eight mental health interventions and four of the six mental health issues that had been taught in the programme. Participants reported developing a more reflective mental health practice, becoming more aware of mental health issues, integrating new knowledge and skills into their work and they expressed a desire for further mental health training. They noted that interprofessional referrals, inter‐agency linkages and collaborations had increased. Conditions that appeared to underpin the programme’s success included: scheduling the programme over an extended time period, a positive relationship between the facilitator and participants, experiential learning format and community co‐ordinators as liaisons. Participants’ dissatisfaction with the videoconference technology was mitigated by the strong connection between the facilitator and participants. One challenge was designing a curriculum that met the needs of professionals with varied expertise and work demands. The programme seemed to benefit most of those professionals who had a mental health background. This programme has the potential to be of use in rural communities where professionals often do not have access to professional development in mental health.     

Enabling the NSW health workforce to provide evidence-based smoking-cessation advice through competency-based training delivered via video conferencing

Tobacco-related disease is estimated to cost the NSW health system more than $476 million in direct health care costs annually. Population-based smoking-cessation interventions, including brief intervention by health professionals, are effective and cost effective. As the prevalence of smoking in the general community declines, more highly dependent 'treatment-resistant' smokers may present a challenge to the health system. International guidelines recommend that health systems invest in training for health professionals in best practice smoking cessation. As part of the NSW Tobacco Action Plan 2005-2009, NSW Department of Health developed national competency standards in smoking cessation, designed learning and assessment materials and delivered training to more than 300 health professionals via video conference. Building the capacity of the NSW Health workforce to address smoking cessation as part of their routine practice is essential for addressing future challenges in tobacco control.     

Data on the community health education of social workers at the Ecole d'études sociales et pédagogiques

Social workers may be an essential link between health professionals and patients. Their possibilities of action in health education and prevention could be used more systematically. From this viewpoint, the various functions they carry out are an absolute advantage. They are confronted with countless relevant matters of social and preventive medicine and often resort to "original" intervention models. This article presents a programme of training in social and preventive health developed in the Social and Educational School of Lausanne for future social workers and health promoters. The critical analysis of this programme shows the numerous difficulties which are linked to this training, but also the necessity of such a training for the social workers who are more and more involved in interventions where health problems are in the front rank.     

Exploration of current challenges in rehabilitation from the perspective of healthcare professionals: Switzerland as a case in point

Rehabilitation is a health strategy with the potential to mitigate the negative health consequences of population ageing and the rise of noncommunicable diseases. Literature indicates that even in high-income countries rehabilitation services can be improved. The purpose of this study is to engage rehabilitation professionals in Switzerland in identifying and prioritizing current challenges in the development and delivery of rehabilitation services.We conducted a qualitative study consisting of interviews with key informants and a stakeholder consultation. Thirteen interviews were conducted and analysed using inductive thematic analysis. Identified challenges were refined, extended, and prioritized through multi-voting in a workshop attended by a wide range of rehabilitation professional organizations. Final results were subject to further analysis and member checking.We identified nineteen challenges, of which eight were viewed as highly important. Results suggest the need to revise the financing system for rehabilitation services, highlighted a poor integration of rehabilitation in primary care, a lack of academic rehabilitation training, and insufficient funding for research. Finally, we identified a perceived lack of awareness for rehabilitation among policy-makers and the public.This study provides a unique perspective on challenges in rehabilitation practice and policy and offers an opportunity for professionals, policy-makers, and other stakeholders, to influence and guide the rehabilitation service agenda both in Switzerland and in terms of mutual learning also in other countries.     

Position of the Academy of Nutrition and Dietetics: Oral Health and Nutrition

It is the position of the Academy of Nutrition and Dietetics that nutrition is an integral component of oral health. The Academy supports integration of oral health with nutrition services, education, and research. Collaboration between dietetics practitioners and oral health care professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between diet, nutrition, and integrity of the oral cavity in health and disease. Oral health and nutrition have a multifaceted relationship. Oral infectious diseases, as well as acute, chronic, and systemic diseases with oral manifestations, impact an individual's functional ability to eat and their nutrition status. Likewise, nutrition and diet can affect the development and integrity of the oral cavity and progression of oral diseases. As knowledge of the link between oral and nutrition health increases, dietetics practitioners and oral health care professionals must learn to provide screening, education, and referrals as part of comprehensive client/patient care. The provision of medical nutrition therapy, including oral and overall health, is incorporated into the Standards of Practice for registered dietitians and dietetic technicians, registered. Inclusion of didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in education programs for both professional groups. Collaborative endeavors between dietetics, dentistry, medicine, and allied health professionals in research, education, and delineation of practice roles are needed to ensure comprehensive health care. The multifaceted interactions between diet, nutrition, and oral health in practice, education, and research in both dietetics and dentistry merit continued, detailed delineation.     

北京市区医院医务人员吸烟状况及参与控烟干预态度调查

目的 了解目前我市医务人员的吸烟状况及对参与控烟的态度及其成因，为有针对性地对医务人员这一专业群体进行戒烟培训，提高其控烟意识，促使其在日常工作中积极参与控烟工作提供依据。方法 1999年对北京市4所医院的300名医务人员进行问卷调查。结果 男性医务人员吸烟率48．1％，其中40－49岁年龄组的吸烟率明显低于其它年龄组。医务人员对有关吸烟的心脏病，糖水病，溃疡病等危害认识率不足50％。认为医务人员的戒烟建议会有效的比例占61．6％。有73．6％的医务人员愿意工作中加入戒烟内容，不吸烟者与吸烟者的态度存在显著差异。不愿意参与控烟的原因主要有：工作忙，忘记和自己本身吸烟。结论 必须加强对所有卫生专业人员进行基本的专业戒烟培训，引导医务工作者正控烟态度，把控烟视为一种职责。     

Child psychiatry in Bombay: the school mental health clinic

The school mental health clinic is an unusual amalgamation of the mental health and education sectors in Bombay. It aims to detect emotional problems in schoolchildren, increase mental health awareness in teachers and other professionals and determine any risk or causal factors in schoolchildren suffering from mental health problems. It also offers cross-cultural research opportunities.     

台州市某高校学生高血压相关知识及行为的调查

目的:对台州市某高校学生高血压相关知识及行为进行调查,为当地高校开展高血压健康宣教提供一定的现实依据。方法:对2019年9月台州市某高校新入学的大学一年级新生开展高血压相关知识及行为的问卷调查,回收有效调查问卷共3 203份。结果:高校学生对高血压诊断标准的知晓率为26.82%。对高血压危险因素吸烟、糖尿病、长期精神紧张的知晓率分别为:35.03%、25.60%和31.60%。知晓率最高的高血压并发症为冠心病,占90.35%;知晓率最低的为眼病,占9.71%。结论:高校学生对高血压认知较低且存在着一定比例的高血压相关行为。建议应在高校大力加强高血压相关的健康知识教育,引导其健康行为。     

A panic foretold: Ebola in the United States

This paper reconsiders the Ebola response in the US as a panic that was both predictable and problematic. Public health professionals and policy-makers have historically drawn attention to and prepared for emerging infectious diseases by raising the specter of catastrophe, generating fears that the media and politicians are often willing to amplify. Although this approach can increase awareness of and funding for global health threats, it also sows the seeds of panic, stigmatizing people associated with the disease, and compromising an effective, evidence-based response. We offer lessons for public health leaders as they review the US Ebola response in order to prepare more responsibly for future disease scares such as that posed by the Zika virus.     

石家庄市社区医疗卫生人员伤害及安全社区知信行情况调查

目的了解石家庄市社区医疗卫生人员伤害及安全社区的认知水平、态度、行为情况,为开展伤害健康教育及建设安全社区工作提供依据。方法选取社区卫生服务机构医疗卫生人员612人,采用自填式问卷进行集中调查,其中资料完整的596人。结果接受调查的社区医疗卫生人员伤害及安全社区总知晓率为79.43%,其中能准确回答伤害定义的仅有8.89%,知晓安全社区的有25.38%,1年内有过不安全行为经历的有97.15%,男性医务人员知识知晓情况高于女性,但伤害行为发生率高于女性。认同应由社区医务人员对居民进行伤害防治教育的有45.77%,曾在日常工作中参与居民伤害防治教育工作的只有0.13%。结论该市社区医疗卫生人员对伤害的认知水平较高,但对伤害定义和安全社区缺乏了解,应加强对其进行伤害及安全社区知识培训。     

Emerging illness and bioterrorism: Implications for public health

Biological weapons have the potential to inflict deliberate, potentially devastating epidemics of infectious disease on populations. The science and technology exist to create deliberate outbreaks of human disease, as well as disease among plants and animals, crops, and livestock. A new awareness among policymakers of the link between public health and national security requires the attention of public health professionals. The issues posed by biological weapons are likely to challenge the political assumptions of many progressive public health professionals and will demand new coalitions. The prospect of bioterrorism may offer new opportunities for improving the public health infrastructure and its capabilities.     

鄞州社区居民高血压综合干预效果评价

[目的]评价社区居民高血压防治健康教育干预效果。[方法]2004与2006年采用问卷和体检方式，对社区35岁以上居民810人进行调查，并分析健康教育干预效果。[结果]干预后，居民高血压知识知晓率、行为形成率，服药率和血压控制等指标等都有明显提高；吃盐量明显下降；吸烟和被动吸烟率也明显降低；参加体育锻炼的人数增加。居民对开展的各项健康教育活动满意度达到90％以上。[结论]健康教育是社区高血压综合防治有效和可行的形式，应积极推广。     

Use of evidence to support healthy public policy: a policy effectiveness�Cfeasibility loop

Public policy plays a key role in improving population health and in the control of diseases, including non-communicable diseases. However, an evidence-based approach to formulating healthy public policy has been difficult to implement, partly on account of barriers that hinder integrated work between researchers and policy-makers. This paper describes a “policy effectiveness–feasibility loop” (PEFL) that brings together epidemiological modelling, local situation analysis and option appraisal to foster collaboration between researchers and policy-makers. Epidemiological modelling explores the determinants of trends in disease and the potential health benefits of modifying them. Situation analysis investigates the current conceptualization of policy, the level of policy awareness and commitment among key stakeholders, and what actually happens in practice, thereby helping to identify policy gaps. Option appraisal integrates epidemiological modelling and situation analysis to investigate the feasibility, costs and likely health benefits of various policy options. The authors illustrate how PEFL was used in a project to inform public policy for the prevention of cardiovascular diseases and diabetes in four parts of the eastern Mediterranean. They conclude that PEFL may offer a useful framework for researchers and policy-makers to successfully work together to generate evidence-based policy, and they encourage further evaluation of this approach.     

Sexual differences in smoking behaviour and dental caries experience in young adults

Smokers have been reported to exhibit a low awareness of their health. However, oral health awareness in smokers has not been fully studied. Having adequate oral care and high awareness of oral health from youth is necessary to prevent the deterioration of oral health in middle and old age. The aim of this study was to investigate the oral health status and oral health behaviour in young smokers. A survey composed of a questionnaire and an oral examination was administrated to adults aged 20-29 y who consulted dentists. The relationship between smoking behaviour and oral health status and oral health behaviour in subjects was analysed. In women, though no significant relationship between smoking behaviour and the number of decayed, missing, and filled teeth was seen, current smokers had significantly more decayed teeth, missing teeth and fewer filled teeth than ex-smokers and non-smokers. Current smokers tended to practice less oral health behaviour than non-smokers. In men, there was no significant relationship between smoking behaviour and each oral health status item. These findings suggested that the smoking group had lower oral health awareness than the non-smoking group in women.     

Evaluating early education programmes

This paper examines a variety of methods for evaluating early education programmes, based on examples from developing as well as developed countries. It considers various components of programme, the size of research studies, and their “outcomes”. It is argued that future policy-makers will require stricter cost-benefit analyses before making funds available for programmes of early childhood education. Because programmes on health, literacy, income generation and skill training are strong competitors for governmental and NGO money, Early Childhood Education will have to prove to policy-makers and donors that it has measurable cost effective outcomes.     

北京市海淀区医务人员吸烟状况及控烟知识、态度、行为现况调查

[目的]了解北京市海淀区医务人员吸烟和控烟能力现状,为开展医务人员戒烟活动,提高控烟服务能力提供科学依据。[方法]采用系统抽样方法,调查6家医院的医务人员。[结果]现吸烟率9.7%,男性吸烟率39.8%。吸烟者主要是临床一线的中年医生,且为中、高级职称的医院内业务骨干。43.3%的医务人员在吸烟区吸烟。71.2%的医务人员没有接受过戒烟方面的培训。大多数的医务人员对控烟态度积极。27.9%的医务人员能根据患者的吸烟情况为其制定戒烟计划。87.9%的医务人员提醒过吸烟的患者戒烟,但吸烟的医务人员提醒患者戒烟的比例低于从不吸烟的医务人员。[结论]开展控烟系列培训提高医务人员整体的控烟能力。运用行政干预与健康教育相结合的手段促使吸烟的医务人员戒烟。     

Smoking cessation in New Zealand: education and resources for use by midwives for women who smoke during pregnancy

This study describes the development and evaluation of educationprogrammes and associated resource materials to support smokingcessation and reduction, and breastfeeding promotion strategiesfor pregnant women who smoke, during usual primary maternitycare by midwives. Education programmes and resource materialswere developed by midwives and researchers as part of a clusterrandomized trial of Midwifery Education for Women who Smoke(the MEWS study). Development included a cohort study, advicefrom lactation consultants and smoking cessation counsellors(including Ma-ori professionals), and early consultation withmidwives who would be delivering the programmes. Resources developedincluded videotapes, charts and laminated information cards.Resources were pre-tested with pregnant women and opinion leaders.Consultation with the midwives allocated to each of the interventiongroups in the trial raised a number of issues. These were addressed,and solutions incorporated into each of the programmes, to enableeffective delivery within usual care. Following delivery ofthe programmes, women and their midwives were surveyed and asample interviewed to ascertain attitudes to the programmesand resources. Women and their midwives responded positivelyto the smoking cessation education programme, the breastfeedingpromotion programme and the resources used. Those women whodid not stop smoking completely often succeeded in significantlyreducing their tobacco consumption. Women identified their midwifeas a valuable resource and appreciated her ongoing encouragement.Involvement of health professionals who are to deliver healthpromotion interventions is essential for successful integrationof programmes into usual care. Midwives were able to effectivelydeliver programmes that were developed and targeted to theirneeds as health educators. The pregnancy-specific resourcesdeveloped for women who smoke played an important part in helpingmidwives deliver their health promotion messages more effectively.     

The development of an adolescent smoking cessation intervention--an Intervention Mapping approach to planning

The objective of this project was to develop a theory- and evidence-based adolescent smoking cessation intervention using both new and existing materials. We used the Intervention Mapping framework for planning health promotion programmes. Based on a needs assessment, we identified important and changeable determinants of cessation behaviour, specified change objectives for the intervention programme, selected theoretical change methods for accomplishing intervention objectives and finally operationalized change methods into practical intervention strategies. We found that guided practice, modelling, self-monitoring, coping planning, consciousness raising, dramatic relief and decisional balance were suitable methods for adolescent smoking cessation. We selected behavioural journalism, guided practice and Motivational Interviewing as strategies in our intervention. Intervention Mapping helped us to develop as systematic adolescent smoking cessation intervention with a clear link between behavioural goals, theoretical methods, practical strategies and materials and with a strong focus on implementation and recruitment. This paper does not present evaluation data.