The effectiveness of mammography promotion by volunteers in rural communities

INTRODUCTION: The Community Trial of Mammography Promotion assessed the effectiveness of mammography promotion by community volunteer groups in rural areas. Three interventions were tested. One used an individual counseling strategy, one used a community activities strategy, and a third combined the two strategies. METHODS: The effects of the interventions were tested by randomizing 40 communities either to the study interventions or to a control group. A cohort of 352 women from each community was randomly selected and used to evaluate the interventions' effectiveness. Of these, 6592 women were eligible for screening mammography at baseline and follow-up and were successfully interviewed prior to and after study intervention activities. RESULTS: Although the interventions did not significantly increase women's overall use of mammography, the community activities intervention increased use at follow-up by regular users over baseline by 2.9% (p = 0.01). Intervention appears to have increased the use of mammography among certain groups of women who were not regular users at baseline, including those in communities without female physicians (10% to 16%; p < 0.05), and among women with no health insurance (10% to 23%; p 相似文献   

开展农村社区健康教育与健康促进对农民健康的影响与体会

目的：探索农村社区健康教育与健康促进的工作模式。方法：将湖州市吴兴区经济发展及人文条件基本相似的二个乡镇分别设为实验区与对照区。实验区实施行政干预,开发促进健康行为规范的规章制度,改善影响健康的卫生设施,在社区卫生服务工作基础上开展各项健康干预;对照区仅做日常的社区卫生服务。课题研究前后分别开展基线与终末调查。结果：实验区干预有关的绝大部份项目明显高于对照区,并且实验区干预前后有非常显著差异。结论：农村社区健康教育与健康促进是新农村建设中的软肋,必须将农村社区健康教育与健康促进纳入政府工作范畴,制定支持性公共卫生政策,建立并完善基层健康教育网络,真正落实农村社区卫生服务六位一体,形成政府—健康教育机构—社区互动的长效管理机制,提高农民的健康素质。     

Cost and cost-effectiveness of digital mammography compared with film-screen mammography in Australia

Objective: A systematic review assessed the relative safety and effectiveness of digital mammography compared with film-screen mammography. This study utilised the evidence from the review to examine the economic value of digital compared with film-screen mammography in Australia.
Methods: A cost-comparison analysis between the two technologies was conducted for the overall population for the purposes of breast cancer screening and diagnosis. In addition, a cost-effectiveness analysis was conducted for the screening subgroups where digital mammography was considered to be more accurate than film-screen mammography.
Results: Digital mammography in a screening setting is $11 more per examination than film-screen mammography, and $36 or $33 more per examination in a diagnostic setting when either digital radiography or computed radiography is used. In both the screening and diagnostic settings, the throughput of the mammography system had the most significant impact on decreasing the incremental cost/examination/year of digital mammography.
Conclusion: Digital mammography is more expensive than film-screen mammography. Whether digital mammography represents good value for money depends on the eventual life-years and quality-adjusted life-years gained from the early cancer diagnosis.
Implications: The evidence generated from this study has informed the allocation of public resources for the screening and diagnosis of breast cancer in Australia.     

Health promotion for the rural elderly.

There has been increased interest in developing health promotion programs for the rural elderly as a means to foster successful aging. The present study describes one such program and identifies rural and urban differences in health promotion activities. Data come from the California Preventive Health Care for the Aging Program (PHCAP) which is one of the oldest and largest such programs in the United States. A sample of over 5,000 PHCAP clients was drawn from rural, semi-rural and urban projects. Though the rural and urban clients differed significantly with respect to demographic characteristics, differences in health promotion practices were relatively minor. However, the health promotion practices of semi-rural residents differed considerably from that in rural projects. Though less disabled, semi-rural clients received a greater scope of health promotion activities than rural clients. The authors discuss possible site, practitioner and client factors which may have accounted for rural health promotion activities being more restricted. Regardless of project site, the California PHCAP detected many health problems and a majority of clients were referred to other health professionals for treatment.     

A cost-effectiveness analysis of exercise as a health promotion activity.

We used cost-effectiveness analysis to estimate the health and economic implications of exercise in preventing coronary heart disease (CHD). We assumed that nonexercisers have a relative risk of 2.0 for a CHD event. Two hypothetical cohorts (one with exercise and the other without exercise) of 1,000 35-year-old men were followed for 30 years to observe differences in the number of CHD events, life expectancy, and quality-adjusted life expectancy. We used jogging as an example to calculate cost, injury rates, adherence, and the value of time spent. Both direct and indirect costs associated with exercise, injury, and treating CHD were considered. We estimate that exercising regularly results in 78.1 fewer CHD events and 1,138.3 Quality Adjusted Life Years (QALYs) gained over the 30-year study period. Under our base case assumptions, which include indirect costs such as time spent in exercise, exercise does not produce economic savings. However, the cost per QALY gained of $11,313 is favorable when compared with other preventive or therapeutic interventions for CHD. The value of time spent is a crucial factor, influencing whether exercise is a cost-saving activity. In an alternative model, where all members of the cohort exercise for one year, and then only those who like it or are neutral continue, exercise produces net economic savings as well as reducing morbidity.     

Health care and health promotion in southern Italian communities.

Health promotion projects may be regarded as responses to insufficient health care in Europe, where modern health problems, consumer needs, participation and life quality are neglected. In Southern Italy and especially in Naples the situation is particularly difficult (poverty, poor accessibility of health care, high infant mortality, epidemics etc.); nevertheless there exist elements of everyday life which are advantageous for health promotion. The health projects described started around Naples in the 'seventies. They focused on the psychosocial problems of marginalized people (elderly people, women, mentally and physically handicapped men, big families etc.). Different elements of health care (prevention, primary health care, health education), social work and political and cultural activation were linked together in the local centres of social medicine. Thus the accessibility of health care was improved, social distance between suppliers and users reduced, and poor and disadvantaged people better integrated into the social life of the community. One important step in the realization of such aims was the stimulation of politically and socially defined homogeneous target groups with similar interests and needs. The specific measures, organizational structures and the personal staff are directed to these target groups in an integrated way. They are based on the teamwork of different professions and cooperation with other related organizations, and they include explicitly political, social and cultural activities, different from the self-help activities related only to health in most of Central Europe.(ABSTRACT TRUNCATED AT 250 WORDS)     

农村社区高血压分级管理现状分析

航头镇作为 1998年以来南汇区确立的农村心脑血管病防治试点社区 ,采取以控制高血压为主的社区人群综合性干预措施 ,实行社区高血压分级管理。由镇社区卫生服务中心专人负责 ,与村卫生室及政府机构组成网络 ,开展高血压分级管理工作。现就 2 0 0 3年航头镇高血压分级管理现状进行分析 ,总结2 0 0 0年以来社区高血压防冶工作经验 ,评价 2 0 0 3航头镇社区控制高血压的干预效果 ,探讨进一步的工作策略、方法 ,为完善农村高血压防治工作措施提供科学依据。1　资料与方法1.1　对象本次调查由航头镇派出所提供本镇的常住人口资料 ,以2 0 0 0～ 2 …     

Identifying churches for community-based mammography promotion: lessons from the LAMP study.

There is great potential in public health and faith communities partnering to promote health education and research. This article describes lessons learned from the design and implementation of such a partnership, the Los Angeles Mammography Promotion in Churches Program (LAMP). It is feasible, although challenging, to enumerate and survey churches in a geographically defined urban population, using data compiled from telephone directories, religious sources (e.g., denominational networks), chambers of commerce, and newspapers. Among those sources, telephone directories provided the broadest coverage, whereas religious sources yielded the highest recruitment rate. For collecting survey data from churches, telephone methods are superior to mail methods. For church-based health education programs that seek comprehensive coverage and have adequate resources, it is recommended that telephone directories be combined with religious sources to identify target churches. For programs with limited resources and less emphasis on comprehensive coverage, using religious sources alone is recommended.     

Levels of the consciousness of activities among health promotion volunteers. Comparison by years of volunteer's experience

OBJECTIVE: Health promotion volunteers (HPVs) are members of community health organizations. They are delegated health promotion activities in local communities in Japan, under support of municipal administrative officers, including public health nurses. The purpose of the present study was to compare the levels of consciousness of activities among HPVs by years of experience. METHODS: The subjects were 600 HPVs in two cities in a prefecture. A mail-in self-check questionnaire survey was conducted on November 2004, covering items on "demographic-data," "the condition of activities of HPVs," "self-evaluation of activities of HPVs," "self-esteem," and "consciousness in the community." RESULTS: A total of 514 questionnaires were analyzed (valid response rate: 85.7%). HPVs in the groups of 4-8 years and 9 and more years of experience, felt more challenge and had a greater feeling of self-growth than those in the group of 1-3 years, although HPVs in the group with many years of experience felt more difficulty with the activities. HPVs in the 4-8 year group experienced the highest sense of burden, and HPVs in the 9 and more years group the lowest. Moreover, consciousness in taking leadership in organization of HPVs was stronger, and sense of responsibility for roles as HPVs were greater in the group of HPVs who had many years of experience. CONCLUSION: In building structures of activity of HPVs it is important to consider their levels of consciousness of the activities by years of experience, as clarified in this study.     

Rehabilitation technicians for remote rural communities.

A programme is described in which indigenous personnel are trained to provide culturally appropriate rehabilitation services for islanders of the Pacific Basin. The disabling conditions most commonly dealt with are associated with stroke, diabetes, arthritis, trauma, and back and neck pain. The programme could be adapted to meet needs in other remote rural communities lacking suitably trained carers.     

Alcohol consumption in young adults in the rural communities of Spain.

In the spring of 1987, the patterns of alcohol consumption in 1,886 young people (14-30 years old) from the rural communities (less than 10,000 inhabitants) of Castile and León (Spain) were analysed. 64.1% of the young adults took alcoholic drinks at least once a week, while 24.4% were 'daily' consumers. Beer (56%) was the preferred drink, followed by gin (22.4%) and wine (21.3%). The age of starting to drink was close to 16 years old and the alcohol intake per capita was 19 g/day. Both frequency and intake were higher among males and at weekends. The main reported reason for drinking was 'because I like its taste' (39.1%). The results confirm the common consumption of alcoholic drinks among Spanish young adults, the establishment of beer as the preferred drink and the more extensive consumption of alcohol by males and at weekends.     

The local public health workforce in rural communities.

This work describes the public health workforce and training needs of rural local public health agencies (LPHAs) in comparison with suburban and metropolitan LPHA jurisdictions. A survey was sent to 1,100 LPHAs nationwide. The rural urban commuting area codes (RUCAs) defined LPHAs as rural or urban, and the Standard Occupational Classification system enumerated the workforce. Most occupational classifications had significantly fewer staff in rural LPHAs. Public health nurses ranked as the most needed staff and serve in various important capacities in rural LPHAs. In terms of training, job-specific or programmatic continuing education was identified as the most important training need. Developing leadership and public health workforce capacity within rural public health is an essential agenda item for rural America. Decision makers may need to consider different organizational structures while balancing the need for local input and control. Regionalization and collaborative approaches to difficult workforce issues may present potential solutions to workforce challenges.     

Microbial quality of water in rural communities of Trinidad.

A cross-sectional study was conducted in four rural communities of northeastern Trinidad to determine the microbial quality of water supply to households and that quality's relationship to source and storage device. Of the 167 household water samples tested, total coliforms were detected in 132 of the samples (79.0%), fecal coliforms in 102 (61.1%), and E. coli in 111 (66.5%). There were significant differences among the towns in the proportion of the samples contaminated with coliforms (P < 0.001) and E. coli (P < 0.001). Of 253 strains of E. coli studied, 4 (1.6%) were mucoid, 9 (3.6%) were hemolytic, and 37 (14.6%) were nonsorbitol fermenters. Of 69 isolates of E. coli tested, 10 (14.5%) were verocytotoxigenic. Twenty-eight (14.0%) of 200 E. coli isolates tested belonged to enteropathogenic serogroups. Standpipe, the most common water source, was utilized by 57 (34.1%) of the 167 households. Treated water (pipeborne in homes, standpipes, or truckborne) was supplied to 119 households (71.3%), while 48 households (28.7%) used water from untreated sources (rain, river/stream, or well) as their primary water supply. The type of household storage device was associated with coliform contamination. Water stored in drums, barrels, or buckets was more likely to harbor fecal coliforms (74.2% of samples) than was water stored in tanks (53.3% of samples), even after controlling for water source (P = 0.04). Compared with water from other sources, water piped into homes was significantly less likely to be contaminated with total coliforms (56.9% versus 88.8%, P < 0.001) and fecal coliforms (41.2% versus 69.8%, P < 0.01), even when the type of storage device was taken into account. However, fecal contamination was not associated with whether the water came from a treated or untreated source. We concluded that the drinking water in rural communities in Trinidad was grossly unfit for human consumption, due both to contamination of various water sources and during household water storage.     

Engaging diverse underserved communities to bridge the mammography divide

Background  

Breast cancer screening continues to be underutilized by the population in general, but is particularly underutilized by traditionally underserved minority populations. Two of the most at risk female minority groups are American Indians/Alaska Natives (AI/AN) and Latinas. American Indian women have the poorest recorded 5-year cancer survival rates of any ethnic group while breast cancer is the number one cause of cancer mortality among Latina women. Breast cancer screening rates for both minority groups are near or at the lowest among all racial/ethnic groups. As with other health screening behaviors, women may intend to get a mammogram but their intentions may not result in initiation or follow through of the examination process. An accumulating body of research, however, demonstrates the efficacy of developing 'implementation intentions' that define when, where, and how a specific behavior will be performed. The formulation of intended steps in addition to addressing potential barriers to test completion can increase a person's self-efficacy, operationalize and strengthen their intention to act, and close gaps between behavioral intention and completion. To date, an evaluation of the formulation of implementation intentions for breast cancer screening has not been conducted with minority populations.