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1.
Chen Stein-Zamir Hannah Shoob Deena R. Zimmerman 《Israel journal of health policy research》2017,6(1):53
Background
Preventative health services are a pediatric health care cornerstone, which strives to promote health and prevent illness and injury. In Israel, Maternal Child Health Clinics (MCHC) provide these well child services for ages 0–6 years. MCHC care includes physician visits; however, the physician’s role is not well defined. The study purpose was to provide a basis for setting policies that determine the role of physicians in the provision of MCHC services. To get broad input we included MCHC stakeholders - parents, MCHC physicians, non-MCHC physicians and MCHC nurses, specifically to obtain insights regarding the MCHC physician role and to characterize the stakeholder demographics, service utilization, and practice patterns.Methods
Professional groups completed self-administered written questionnaires (n = 398). Parents were interviewed during MCHC visits using a structured questionnaire (n = 1052). All provided demographic data, service characteristics and agreement with ten potential MCHC physician roles - Physical Examination, Abnormal Health Condition Detection, Developmental Screening, Anticipatory Guidance, Parent-Child Interaction Counseling, MCHC Staff Advice, Children-at-Risk Detection, Growth Surveillance, Vaccination Counseling, and Inter-physician Communication.Results
The study findings seem to indicate a true shortage of MCHC physicians. The median age of MCHC physicians was significantly higher than both non-MCHC physicians and MCHC nurses. There was agreement among stakeholders regarding some roles (Physical Examination, Developmental Screening and Detection of Abnormal Health Conditions) but not others. Most parents reported having at least one MCHC physician encounter. Parents who did not visit the physician were younger and had fewer children.Conclusions
Stakeholders view MCHC physicians as integral to MCHC care. Roles traditionally regarded as part of primary prevention were less likely to be attributed to physicians than screening roles considered secondary prevention.Updating and standardization of the MCHC physician role is needed along with a national strategy to recruit and train MCHC physicians.to ensure optimal pediatric preventive health care in Israel.2.
Objectives
To examine the views and experiences of staff and users of Citizens Advice Bureau (CAB) services located in general practice, and to identify key factors perceived as contributing to the intervention’s effectiveness.Study design
A qualitative study in an urban and rural primary care setting in the UK.Methods
Semi-structured, face-to-face interviews (n = 22) with primary care and practice staff, CAB advisors and 12 service users.Results
Key positive service features reported by all groups were: the confidential, non-stigmatizing and familiar environment of a general practitioner’s (GP) surgery; the ability to make appointments and experienced advisor availability and continuity. Outcomes for service users were described as financial gain, managed debt, and beneficial social and mental health impacts. Perceived staff benefits were appropriate referral and better use of GP consultation time.Conclusion
Welfare advice in primary care has financial benefits and was perceived by participants to offer health and other benefits to patients and staff. However, while perceptions of gain from the intervention were evident, demonstration of measurable health improvement and well-being presents challenges. Further empirical work is needed in order to explore these complex cause-effect links and the cost-effectiveness of the intervention. 相似文献3.
Objectives
To investigate screening intentions and previous uptake of colorectal cancer (CRC) screening tests in a general population in Spain; and to determine knowledge about CRC, risk perceptions, major barriers to screening and perceived benefits of screening.Study design
Cross-sectional study.Methods
Six hundred consecutive Spanish individuals over 50 years of age completed a questionnaire to determine their screening intentions, previous CRC diagnostic procedures, and knowledge about screening procedures, risk factors for CRC, 5-year prognosis, warning signs and symptoms, incidence, age-related risk and perceived barriers to screening.Results
Although 78.8% of subjects reported that they were willing to participate in CRC screening, only 12% had ever undergone a screening test, and none with screening intention. Awareness of a breast cancer screening test [odds ratio (OR) 1.67, 95% confidence interval (CI) 1.04–2.70; P = 0.035], visiting a general practitioner in the preceding year (OR 3.08, 95% CI 1.86–5.08; P < 0.0001), awareness of risk factors (OR 2.32, 95% CI 1.49–3.61; P < 0.001), awareness of CRC signs or symptoms (OR 1.65, 95% CI 1.03–2.64; P = 0.04) and belief in the efficacy of CRC screening (OR 8.85, 95% CI 1.53–51.3; P = 0.01) were independent predictors for intention to participate in CRC screening. The most common reasons given for refusing screening were ‘CRC tests might be dangerous’ (28.2%), ‘CRC tests might be painful’ (17.9%) and ‘feeling healthy’ (16.2%).Conclusion
Although reported willingness to undergo CRC screening was high, CRC knowledge and actual uptake of CRC screening were low. An educational intervention to reduce barriers and increase awareness could improve uptake of CRC screening. 相似文献4.
Emanuele Cereda Alexis Elias Malavazos Riccardo Caccialanza Mariangela Rondanelli Giuseppe Fatati Michela Barichella 《Clinical nutrition (Edinburgh, Scotland)》2011,30(6):718-723
Background & aims
To investigate the association between history of multiple weight loss diets followed by weight regain, namely weight cycling (WCy), and both body weight excess and abdominal fat accumulation.Methods
A one-day cross-sectional survey (“Obesity-Day”) including 914 participants (605F:309M). Anthropometric variables (body mass index [BMI], waist circumference [WC] and waist-to-height ratio [WtHR]), covariates and WCy (≥5 intentional weight loss episodes of ≥5 kg followed by rapid return to pre-diet or higher body weight) were assessed by a self-administered questionnaire, interview and physical examination.Results
Data on central fat accumulation (by WC and WtHR) were available in a representative sub-group (n = 600). WCy was reported by 119 participants (13.0%) of total population and by 79 (13.2%) of those with available data on central fat accumulation. At multivariable linear regressions WCy was independently associated with higher BMI (P = .004), WC (P = .011) and WtHR (P = .008). Sensitivity analyses, performed after excluding those being on a diet at the time of assessment, confirmed these findings.Conclusions
A history of WCy appears related to body weight excess and abdominal fat accumulation. These findings support the importance of designing adequate weight loss programs to achieve long-term weight maintenance and to prevent undesirable and unhealthy weight accumulation. 相似文献5.
Hernández-Mijares A Bañuls C Jover A Solá E Bellod L Martínez-Triguero ML Lagarda MJ Víctor VM Rocha M 《Clinical nutrition (Edinburgh, Scotland)》2011,30(5):604-609
Background & aims
Phytosterols (PS) lower LDLc, but their effect on metabolic syndrome (MetS) remains unknown. We evaluated whether low-fat milk enriched with PS improves cardiovascular risk factors in these patients.Methods
A randomised parallel trial employing 24 moderate-hypercholesterolaemic MetS patients and consisting of two 3-month intervention phases. After a 3-month healthy diet, patients were divided into two intervention groups: diet (n = 10) and diet + PS (n = 14) (2 g/day). A control group of 24 moderate-hypercholesterolaemic patients without MetS (matched in age and BMI) underwent the same procedure.Results
Neither dietary intervention nor enrichment of PS induced any improvement in the serum lipoprotein profile of MetS patients. By contrast, in the non-MetS population, a healthy diet effectively reduced TC, LDLc, non-HDLc and Apo B-100, with further decreases in TC (6.9%), LDLc (10.5%), non-HDLc (10.3%), Apo B-100 (6.2%) and Apo B-100/ApoA-I ratio (11.6%) being observed when PS were administered. No differences in LDL diameter, hsCRP or homocysteine were detected in any of the groups after consuming PS. This supplementation produced a significant increase in PS levels only in the non-MetS population.Conclusions
PS therapy appears to be of little value to MetS patients, likely due to its reduced intestinal cholesterol absorption. The efficacy of PS as hypocholesterolaemic agents is thus limited. 相似文献6.
7.
E. Daley V. Dodd R. DeBate C. Vamos C. Wheldon N. Kline S. Smith R. Chandler K. Dyer H. Helmy A. Driscoll 《Public health》2014
Objectives
Epidemiological research indicates an association between the Human Papillomavirus (HPV) with a subset of oral cancers (OC). Dentists may play a role in primary prevention of HPV-related OC by discussing the HPV vaccine with patients. This study assessed dentists' readiness to discuss the HPV vaccine with female patients.Study design
Cross-sectional web-based survey.Methods
A web-based survey based on the Transtheoretical Model was administered among Florida dentists (n = 210).Results
The majority of participants (97%) fell into the precontemplation and contemplation stages of readiness to discuss the HPV vaccine with patients. Perceived role and liability were determined to be predictive of dentists in contemplation stage as opposed to those in precontemplation (P < 0.05).Conclusions
Findings suggest liability and perceived role as processes of change necessary to guide dentists to primary prevention of HPV-related OC despite high levels of knowledge. As public awareness of HPV-related OC increases, dentists may become more involved in primary prevention. Results of the current study may assist in developing intervention strategies for engaging dentists in discussing the HPV vaccine with patients. 相似文献8.
Introduction
Primary health care in Tanzania is provided at two types of health units, the dispensary and the health centre. Theoretically, primary health workers (with knowledge of primary eye care [PEC]) are ideally placed to identify people in need of eye care services. In Tanzania, they are expected to be able to identify, treat, or correctly refer a number of eye conditions including cataract, trauma, presbyopia, and the ‘red eye’. They are also expected to be able to measure visual acuity correctly and to educate the community about prevention.Objectives
The objective was to determine the effect of enhanced supervision of health workers on PEC knowledge and skills in Kilimanjaro Region, Tanzania.Study design
This was a quasi-experimental, cluster randomized intervention study of an enhanced supervisory method compared to a routine supervisory method; 36 dispensaries were randomly allocated into the two groups.Participants
Health workers based at government dispensaries in Mwanga District.Data collection
Participants were interviewed pre and post intervention and the information was recorded using a standardized pretested questionnaire.Results
Mean scores of knowledge in healthcare workers was higher in the intervention group (score = 6.43, 80.4% improvement) compared to the non-intervention group (score = 4.71, 58.9% improvement). The ability to describe and demonstrate vision testing was better (score = 1.8) in the enhanced supervision group compared to the routine supervision group (score = 0.88, P = 0.03). There was a high level of attrition (24%) within one year from the time of baseline survey, especially amongst clinical officers (44%).Conclusion
During the pilot study, enhanced supervision improved PEC knowledge and skills of health workers compared to health workers with routine supervision.Recommendations
Training in PEC needs revision to become more practicum-based. There is need to revise supervision guidelines (to be skills-based) and the supervision skills of district eye coordinators (DECs) need to be enhanced. There is a huge need to improve governance (accountability and rule of law) of health staff. 相似文献9.
Kitti Sranacharoenpong Panrawee Praditsorn Piyanit Churak 《Zeitschrift fur Gesundheitswissenschaften》2018,26(5):515-522
Aim
To evaluate the effects of a randomized education program for community health care workers (CHCWs) on the knowledge, awareness and understanding of key messages related to healthy eating among community members at risk for diabetes (at-risk-DM) identified through community diabetes screening.Subjects and methods
Sixty-nine health centers from five districts in Chiang Mai Province, Thailand, were randomized into the intervention (CHCWs-IG, n?=?35) and control group (CHCWs-CG, n?=?34). CHCWs-IG participated in a diabetes prevention education program (DPEP) over 4 months. No training/support materials were provided to the CHCWs-CG. The knowledge of all CHCWs was assessed at baseline and the 4- and 8-month follow-ups. To test knowledge dissemination from CHCWs to at-risk-DM, awareness of key messages and other risk factors was tested between at-risk-DM in the CHCW intervention group (at-risk-DM-IG, n?=?511) compared with controls (at-risk-DM -CG, n?=?405) at baseline and 8 months.Results
CHCWs-IG knowledge scores improved from baseline [mean (SD), 56.5% (6.26)] after 4-month training [75.5% (6.01), p?<?0.001] and 8-month follow-up [71.3%(7.36), p?<?0.001) while those of CHCW-CG remained unchanged. Body weight, body mass index, waist circumference and systolic blood pressure within at-risk-DM-IG and at-risk-DM-CG at baseline and 8 months were not significantly different. Knowledge test scores of both groups after 8 months had increased from baseline (p?=?0.001) but were not different from each other.Conclusion
DPEP for CHCWs was effective in improving knowledge. However, it was likely that multiple influences resulted in improvements in community member knowledge. As expected, no difference between groups in physical measures was observed at 8 months. Long-term lifestyle changes towards the health outcome of diabetes prevention are suggested for future study.10.
11.
Objectives
To determine the contraceptive needs [including emergency contraception (EC)] of women seeking care from a publicly funded sexually transmitted infection (STI) clinic and to better understand women's knowledge of and attitudes towards EC.Methods
An anonymous survey was administered to 197 women seeking services at one Chicago Department of Public Health STI clinic.Results
After excluding women unlikely to become pregnant within the next year because of age, sexual orientation, hysterectomy and those who desired pregnancy (n=47), data from 150 women were available for analysis. Thirteen percent were using “very effective” contraception (intrauterine contraception, implant or sterilization) and 26% were using “effective” contraception (contraceptive pill, patch, ring or injectable). Approximately 23% (95% CI 16.5–30.0%) may have benefited from immediate use of EC as they reported at least one act of unprotected intercourse within the past 5 days.Conclusion
Many women seeking care from public STI clinics are at high risk of unintended pregnancy. A substantial number of women have an immediate need of EC at the time of their clinical visit. Efforts are needed to improve provision of EC as well as effective ongoing contraception for this population. 相似文献12.
Pronk NP Krebs-Smith SM Galuska DA Liu B Kushner RF Troiano RP Clauser SB Ballard-Barbash R Smith AW 《Preventive medicine》2012,55(1):28-33
Objective
To assess primary care physicians' (PCPs) knowledge of energy balance related guidelines and the association with sociodemographic characteristics and clinical care practices.Method
As part of the 2008 U.S. nationally representative National Survey of Energy Balance Related Care among Primary Care Physicians (EB-PCP), 1776 PCPs from four specialties who treated adults (n = 1060) or children and adolescents (n = 716) completed surveys on sociodemographic information, knowledge of energy balance guidelines, and clinical care practices.Results
EB-PCP response rate was 64.5%. For PCPs treating children, knowledge of guidelines for healthy BMI percentile, physical activity, and fruit and vegetables intake was 36.5%, 27.0%, and 62.9%, respectively. For PCPs treating adults, knowledge of guidelines for overweight, obesity, physical activity, and fruit and vegetables intake was 81.4%, 81.3%, 70.9%, and 63.5%, respectively. Generally, younger, female physicians were more likely to exhibit correct knowledge. Knowledge of weight-related guidelines was associated with assessment of body mass index (BMI) and use of BMI-for-age growth charts.Conclusion
Knowledge of energy balance guidelines among PCPs treating children is low, among PCPs treating adults it appeared high for overweight and obesity-related clinical guidelines and moderate for physical activity and diet, and was mostly unrelated to clinical practices among all PCPs. 相似文献13.
Rutstein R Downes A Zemel B Schall J Stallings V 《Clinical nutrition (Edinburgh, Scotland)》2011,30(5):624-628
Background & aims
To assess vitamin D (Vit-D) [serum 25-hydroxyvitamin D (25-OHD) concentrations] in children and young adults with perinatally acquired HIV compared to geographically similar healthy children.Methods
25-OHD in children and young adults with HIV was compared to a healthy group. Vit-D deficiency and insufficiency were defined as 25-OHD <11 ng/mL and 25-OHD <30 ng/mL, respectively.Results
Children with HIV (n = 81), mean age 13.8 ± 4.1 years, 48% female, 83% Black, were compared to healthy subjects (n = 372), mean age 12.4 ± 3.4 years, 51% female, 37% Black. For the HIV group, 84% were on HAART, 54% had plasma HIV RNA <400 cpm, and 35% had moderate to severe immunosuppression (CD4+ count <500 cells/mm). Vit-D deficiency/insufficiency was present in 36% and 89% of those with HIV, and 15% and 84% of the comparison group, respectively. Vit-D deficiency was more prevalent in those with HIV (unadjusted odds ratio: 3.25; 95% CI: 1.9–5.5). For both groups, prevalence of Vit-D deficiency increased with age, BMI Z-score, Black race, and in winter/spring months. Vit-D deficiency was associated with a greater degree of immunosuppression in the subjects with HIV.Conclusions
Vit-D deficiency was increased in subjects with perinatally acquired HIV and may be associated with disease severity. 相似文献14.
Background
Adolescent women have a high risk of unintended pregnancy. Currently, there are little data about their choice to initiate long-acting reversible contraception (LARC).Study Design
We evaluated the association of age and preference for a LARC vs. a non-LARC method among adolescent participants in the Contraceptive CHOICE Project, comparing those aged 14–17 years to adolescents aged 18–20 years. We then analyzed the association between age and choice of the implant vs. the intrauterine device (IUD) among adolescents.Results
Of the 5086 women enrolled, 70% (n=3557) of participants chose a LARC method. Among adolescents aged 14–20 years, 69% of 14–17-year-olds chose LARC, while 61% of 18–20-year-olds chose LARC (relative risk 1.16, 95% confidence interval 1.03–1.30). Among adolescents choosing a LARC method, 63% (n=93/148) of the 14–17-year-olds chose the implant, whereas 71% (n=364/510) of the 18–20-year-olds chose the IUD.Conclusion
Long-acting reversible contraception use is clearly acceptable and common among adolescents enrolled in the Contraceptive CHOICE Project, with the younger group being most interested in the implant. 相似文献15.
Background
Anti-müllerian hormone (AMH) is secreted from granulosa cells of antral follicles into the circulation of adult women and hence could serve as an ovarian function test. This would be of value to hormonal contraceptive users if its serum level is unaffected by the use of hormonal contraceptives.Study Design
We prospectively recruited 95 women using combined oral contraceptive (n=23), combined injectable contraceptive (n=23), progestogen-only pills (n=9), progestogen-only injectable (n=20) and levonorgestrel intrauterine system (n=20), and measured their serum AMH concentration before and 3–4 months after treatment.Results
No significant difference in pre- and post-treatment serum AMH level was evident in all the treatment groups studied.Conclusions
Being unaffected by hormonal contraceptives, serum AMH measurement is potentially a useful clinical test in hormonal contraceptive users for the differential diagnosis of anovulatory disorders and determination of menopause. 相似文献16.
Schneider A Markowski A Momma M Seipt C Luettig B Hadem J Wilhelmi M Manns MP Wedemeyer J 《Clinical nutrition (Edinburgh, Scotland)》2011,30(5):599-603
Background & aims
To compare early supplementation with antioxidants and glutamine using a low-volume enteral supplement containing key nutrients to an energy adjusted standard elementary diet and to investigate its effect on clinical efficacy and tolerability in critically ill patients with sepsis/SIRS. The primary endpoints were length of stay in the ICU and sufficient enteral feed.Methods
This was a randomized, prospective, single-blind, controlled study in 58 critically ill patients (56.9% male, mean age 46.7 years, mean APACHE II score 21.6). They received either a low-volume enteral supplement containing key nutrients or a diluted standard nutrition solution. After 10 or 14 days inflammatory parameters, catecholamine need, and maximal enteral delivery were determined.Results
Patients receiving a low-volume enteral supplement containing key nutrients did not reach sufficient enteral feed more often than controls (76 vs. 62%, respectively, p = 0.17). The difference in vitamin E and selenium uptake was higher in the treatment group than controls (12.4 vs. 3.7 and 54.7 vs. 16.3, respectively, p ≤ 0.011). Parameters such as fever, antibiotic treatment, artificial ventilation, and death were comparable. This was also true for days of ICU or hospital stay (33 ± 23 and 49 ± 34 days, respectively).Conclusions
The low-volume enteral supplement containing key nutrients was well tolerated and led to a better vitamin E and selenium supply. However, it did not affect length of ICU or hospital stay. Further studies are necessary to determine which disease-specific subgroups may benefit from this supplementation or which group may be harmed. 相似文献17.
Background
Clinical guidelines are frequently used as a mechanism for implementing evidence-based practice. However research indicates that health professionals vary in the extent to which they adhere to these guidelines. This study aimed to study the perceptions of stakeholders and health professionals on the facilitators and barriers to implementing national stroke guidelines in Ireland.Methods
Qualitative interviews using focus groups were conducted with stakeholders (n = 3) and multidisciplinary team members from hospitals involved in stroke care (n = 7). All focus group interviews were semi-structured, using open-ended questions. Data was managed and analysed using NVivo 9 software.Results
The main themes to emerge from the focus groups with stakeholders and hospital multidisciplinary teams were very similar in terms of topics discussed. These were resources, national stroke guidelines as a tool for change, characteristics of national stroke guidelines, advocacy at local level and community stroke care challenges. Facilitators perceived by stakeholders and health professionals included having dedicated resources, user-friendly guidelines relevant at local level and having supportive advocates on the ground. Barriers were inadequate resources, poor guideline characteristics and insufficient training and education.Conclusions
This study highlights health professionals’ perspectives regarding many key concepts which may affect the implementation of stroke care guidelines. The introduction of stroke clinical guidelines at a national level is not sufficient to improve health care quality as they should be incorporated in a quality assurance cycle with education programmes and feedback from surveys of clinical practice. 相似文献18.
Background
A well-developed health-related knowledge during youth is a major health resource for the adolescent population. The purpose of the present study was to investigate the health-related knowledge of pupils in the 7th grade in school regarding (1) prevention, (2) nutrition, (3) leisure time and (4) knowledge of their own body.Methods
For this purpose we developed a health quiz regarding the four mentioned topics. In total, 10 schools with 699 pupils of different German school forms participated in the survey [secondary school (GYM) (n=195), comprehensive school (GS) (n=81) and secondary modern schools (intermediate, RS) (n=231) (general, HS) (n=192)].Results
All together the participants achieved 50.1% of the maximum score. There were no gender-specific differences. Students of the GYM showed greater general health-related knowledge than students from lower school levels, i.e. GS, RS and HS (p<0.001). In all topics similar differences were demonstrated, apart from the topic??leisure time??. Here no differences between school forms were shown.Conclusion
It can be concluded that the health-related knowledge of pupils in the 7th grade revealed great deficits. Especially in the secondary modern school forms there are fundamental needs for effective promotion of health-related knowledge. 相似文献19.
Deutz NE Safar A Schutzler S Memelink R Ferrando A Spencer H van Helvoort A Wolfe RR 《Clinical nutrition (Edinburgh, Scotland)》2011,30(6):759-768
Objective
Maintenance of muscle mass is crucial to improving outcome and quality of life in cancer patients. Stimulating muscle protein synthesis is the metabolic basis for maintaining muscle mass, but in cancer patients normal dietary intake has minimal effects on muscle protein synthesis. Adding leucine to high protein supplements stimulates muscle protein synthesis in healthy older subjects. The objective was to determine if a specially formulated medical food, high in leucine and protein, stimulates muscle protein synthesis acutely in individuals with cancer to a greater extent than a conventional medical food.Design
A randomized, controlled, double-blind, parallel-group design was used in 25 patients with radiographic evidence of cancer. Patients were studied before their cancer treatment was started or 4 weeks after their treatment was completed or halted. The fractional rate of muscle protein synthesis (FSR) was measured using the tracer incorporation technique with L-[ring-13C6]-phenylalanine. The experimental group (n = 13) received a medical food containing 40 g protein, based on casein and whey protein and enriched with 10% free leucine and other specific components, while the control group (n = 12) was given a conventionally used medical food based on casein protein alone (24 g). Blood and muscle samples were collected in the basal state and 5h hours after ingestion of the medical foods.Results
The cancer patients were in an inflammatory state, as reflected by high levels of C-reactive protein (CRP), IL-1β and TNF-α, but were not insulin resistant (HOMA). After ingestion of the experimental medical food, plasma leucine increased to about 400 μM as compared to the peak value of 200 μM, after the control medical food (p < 0.001). Ingestion of the experimental medical food increased muscle protein FSR from 0.073 (SD: 0.023) to 0.097 (SD: 0.033) %/h (p = 0.0269). In contrast, ingestion of the control medical food did not increase muscle FSR; 0.073 (SD: 0.022) and 0.065 (SD: 0.028) %/h.Conclusions
In cancer patients, conventional nutritional supplementation is ineffective in stimulating muscle protein synthesis. This anabolic resistance can be overcome with a specially formulated nutritional supplement. 相似文献20.
Martín-González C González-Reimers E Santolaria-Fernández F Fernández-Rodríguez C García-Valdecasas-Campelo E González Díaz A Alvisa-Negrín J Martínez Riera A 《Clinical nutrition (Edinburgh, Scotland)》2011,(6):822-830