Health promotion for people with disabilities: the emerging paradigm shift from disability prevention to prevention of secondary conditions.

The premise of this article is that, until recently, health promotion for people with disabilities has been a neglected area of interest on the part of the general health community. Today, researchers, funding agencies, and health care providers and consumers are leading an effort to establish higher-quality health care for the millions of Americans with disabilities. The aims of a health promotion program for people with disabilities are to reduce secondary conditions (eg, obesity, hypertension, pressure sores), to maintain functional independence, to provide an opportunity for leisure and enjoyment, and to enhance the overall quality of life by reducing environmental barriers to good health. A greater emphasis must be placed on community-based health promotion initiatives for people with disabilities in order to achieve these objectives.     

Counteractions to the paradigm shift

While the benefit of a health-focused paradigm is clear theoretically, the transition is tortuous. This article reviews the difficulties of implementing the paradigm shift presented in the preceding article. This article presents counteractions, clarifies underlying assumptions, presents the need for collaborative action, and highlights the potential contribution of case management to the paradigm shift.     

Hand washing. A paradigm shift

Washing one's hands is one of the principal methods to control infections. At present time, various studies provide evidence that decontaminating one's hands with an alcohol based solution is just as effective, quicker to use and easier. This fact is an important paradigm change in the control over the transmission of infections. The objective of this article is to present and discuss the most relevant aspects of these new recommendations.     

Health promotion in Asian-Americans

Healthy People 2010 was developed to meet the nation's goals for better health by the end of the present decade. Its purpose focuses on eliminating health disparities in the U.S. (Ghosh, 2003). Six areas for concentration of efforts were selected specifically because of their direct impact on the health of minorities: infant mortality, immunizations, diabetes, cardiovascular diseases, HIV/AIDS, and cancer. This paper reviews the six key areas to discover the most significant points of focus for health promotion of the Asian-American population to be lack of immunizations, which results in high incidence of hepatitis B infections and liver disease.     

Hemodynamic changes as a diagnostic tool in acute heart failure--a pilot study

Objectives

To examine whether posturally induced changes in cardiac output differentiate patients presenting with dyspnea to the emergency department (ED) with acute heart failure (AHF) from other causes.

Methods

This was an observational study of patients presenting to the ED with dyspnea. Exclusion criteria included ischemic chest pain, electrocardiographic changes diagnostic of acute myocardial infarction, pericardial effusion or chest wall deformities causing dyspnea, or heart transplant. Hemodynamic variables of cardiac index (CI), total peripheral resistance index, and thoracic fluid content (TFC) were determined in upright seated and supine positions 3 minutes apart using bioreactance technology (Cheetah Medical Inc, Portland, Ore). Acute heart failure was defined as either B-type natriuretic peptide 100 to 500 pg/mL and discharge diagnosis of AHF or a B-type natriuretic peptide greater than 500 pg/mL.

Results

Of 92 patients, 25 had AHF, 23 had asthma/chronic obstructive pulmonary disease (COPD), and 44 had dyspnea related to other conditions; 41 (44.1%) were male, 56 (60.2%) were African American, and the mean age was 58 ± 15.0 years. Mean baseline TFC was higher in AHF vs asthma/COPD (59.3 ± 26.0 vs 39.7 ± 14.8 1/kW, P = .003) and trended higher compared to other patients with dyspnea (49.2 ± 22.0, P = .10). Postural changes in mean CI were lower in AHF (−0.20 ± 0.84 L min⁻¹ m⁻²) vs asthma/COPD (1.20 ± 1.23 L min⁻¹ m⁻²; P = .002) and other dyspnea patients (0.82 ± 0.91 L min⁻¹ m⁻²; P = .007).

Conclusion

Patients with AHF have greater TFC but lower CI responses to postural changes compared to patients with asthma and COPD. Knowledge of these changes may help rapidly differentiate AHF from asthma and COPD in the ED.     

Diagnosing polycythemia vera: a paradigm shift

The primary objective during the evaluation of erythrocytosis is to ascertain the presence or absence of polycythemia vera (PV). Because of prognostic and treatment differences, PV must be distinguished from relative polycythemia and secondary erythrocytosis. This distinction is currently accomplished through the laboratory measurement of red blood cell mass, plasma volume, and arterial oxygen saturation and determination of oxygen pressure at 50% hemoglobin saturation (P50). Furthermore, according to the Polycythemia Vera Study Group guidelines, the demonstration of an increased red blood cell mass is an absolute criterion for the diagnosis of PV. This article discusses the use of the serum erythropoietin level and endogenous erythroid colony assay as a potential alternative in the diagnosis of PV.     

Helicobacter pylori therapy: a paradigm shift

Helicobacter pylori (H. Pylori) is a leading cause of gastroduodenal disease, including gastric cancer. H. pylori eradication therapies and their efficacy are summarized. A number of current treatment regimens will reliably yield >90% or 95% cure rates with susceptible strains. None has proven to be superior. We show how to predict the efficacy of a regimen in any population provided one knows the prevalence of antibiotic resistance. As with other infectious diseases, therapy should always be susceptibility-based. Susceptibility testing should be demanded. We provide recommendations for empiric therapies when that is the only option and describe how to distinguish studies providing misinformation from those providing reliable and interpretable data. When treated as an infectious disease, high H. pylori cure rates are relatively simple to reliably achieve.     

Health promotion in psychosis services

Early intervention in psychosis (EIIP) services work to detect and treat the condition early, which improves prognosis and saves money. This article reports on the impact of an EIIP team's efforts to promote health by raising awareness of psychosis and services available. An audit before and after health promotional activities showed referrals to EIIP increased by 10% and admissions to acute inpatient units fell by 75%.     

Health promotion in the office

Occupational therapists have the training and skill to modify office environments in order to promote employee health. Minor changes in the ways tasks are performed can improve work performance, decrease the incidence of minor health complaints, and help prevent repetition injury. Two employee health promotion education programs are described. They were conducted by an occupational therapist and can be replicated in other settings. One program was a seven-session series for bank employees; the other was a luncheon presentation to office workers employed by a health science university.     

Preconceptional health promotion: progress in changing a prevention paradigm

Preconceptional health promotion is a proven strategy to impact reproductive outcomes. Despite energy to incorporate this prevention strategy into the care of women in this country, little evidence exists that the paradigm shift necessary to reframe the clinical care of women has occurred or that public awareness about critical opportunities for preventing reproductive casualties is high. This article reviews the rationale for preconceptional counseling, discusses progress in moving the agenda of prepregnancy wellness forward, and reveals some of the lessons learned from efforts to redesign prevention emphases for reproductive healthcare.     

Monitoring right ventricular volumes: a paradigm shift

The resuscitation of critically ill patients frequently requires the administration of fluids for the purpose of increasing cardiac output and oxygen delivery to the tissues. The assessment of the patient's preload status during this process is vital. Traditionally, preload assessment has been through the use of right atrial pressure and pulmonary artery occlusion pressure, which are often referred to as the "filling pressures." The use of these filling pressures is based upon the assumption that ventricular compliance does not change. In recent years studies have demonstrated a poor correlation between these pressures and cardiac output. More recently, the ability to measure right ventricular end-diastolic volume (RVEDV) at the bedside using a modified pulmonary artery catheter became available. Initially the measurement was obtained using intermittent bolus measurements. Today, near continuous measurements of RVEDV are available. The shift from using pressure measurements for the purpose of assessing preload to the new paradigm of using right ventricular volumetric measurements is challenging. The purpose of this article is to review pertinent anatomy of the right ventricle and the interdependence of the ventricular chambers. The volumetric parameters are presented followed by a discussion of research supporting the use of the volumetric parameters in lieu of pressure measurements for preload assessment in a variety of patient populations. The technology providing continuous RVEDV measurements is presented followed by a discussion of a case study demonstrating the value of continuous measurements. Specific implications for the advanced practice nurse are addressed.