A vision for older adults and health promotion

Our rapidly aging population is expected to place heavy demands on all segments of society, particularly the health care resources needed to attend to health concerns associated with aging. Is this a looming crisis, as some predict, or a challenge to use resources more wisely and to help older adults and their caregivers share in the responsibility for health promotion and chronic disease self-management activities? Community-based organizations serving older adults are uniquely positioned to augment health care providers' health promotion counseling activities and to bridge the gap between the research and practice of health promotion in older adults. They already play a crucial role by providing appropriate health promotion education, screening and referral, service planning, and reinforcement to facilitate self-care activities and behavior changes that promote healthy aging. By increasing teamwork across the network of services for the aging, the health sector, public and private organizations, and academe, there is a great opportunity to enhance the health and well-being of all older Americans.     

Position of the American Dietetic Association: the role of dietetics professionals in health promotion and disease prevention

In the United States, the leading determinants of morbidity and mortality are rooted in behavioral choices related to eating habits, exercise, tobacco, alcohol consumption, and stress reduction. Scientific data consistently provide evidence that diet plays an important role in health promotion and disease prevention. Healthy eating habits--coupled with other healthful lifestyle behaviors--have the potential to reduce the risk of chronic disease. Health care typically assumes a curative or treatment role in the United States. However, dietetics professionals are shaping an alternate view of health, which includes developing healthy public policies, creating safe and supportive environments, building communities and coalitions, and reorienting health services to include health promotion as a primary approach to delivering health care. Individual-level approaches, such as counseling and group education, have been employed most often in modifying health behaviors. However, population-level approaches that affect availability of or access to healthy foods, opportunities for physical activity, and other healthy lifestyle determinants also are important. Dietetics professionals have pivotal roles in both individual- and population-level approaches.     

Position of the American Dietetic Association: the role of nutrition in health promotion and disease prevention programs

A healthful diet and wise food choices are critical components of promoting health and reducing the risk of chronic disease. A substantial amount of health care resources could be saved by expanding health promotion and disease prevention programs that target dietary change among Americans. To effectively reduce health care costs, the emphasis and delivery of health care must promote health as well as deliver treatment and rehabilitative services to the sick. Prevention measures, such as nutrition interventions that also encourage physical activity, can help prevent or halt progression of full-blown chronic disease and thus decrease chronic disease disability. Health promotion and disease prevention need to be integral parts of all health care, community, public health, and worksite programs across the life cycle. Correspondingly, such programs must be culturally competent and address the specific needs of vulnerable or underserved populations. Dietetics professionals in all areas of practice should play an integral role in health promotion and disease prevention programs. Achieving this goal will require expansion of training programs and active learning by dietetics professionals that includes theory and practice in using team approaches, developing coalitions, and managing complex systems. Dietetics professionals also need to amplify their understanding of politics, administration, health care financing, and reimbursement. Attention must also be expanded to include social and behavioral sciences and to address program evaluation, outcomes, and cost-benefit and cost-effectiveness in nutrition-focused health promotion and disease prevention programs. Continued training in program development, research, and evaluation will help build the body of evidence that supports ongoing inclusion of prevention in a rapidly changing health care environment.     

The Marketing of Dental Wellness

Dentists are often credited with being pioneers in the field of wellness. For years, dentists have espoused the virtues of periodic checkups, eating right, and regular oral care. Dentists wishing to promote oral health (dental) wellness have many tools available to them. Speaking engagements, newsletters, public service announcements, group activities and advertising can all be utilized to spread the word on the methods and benefits of possessing good oral health. Dentists that stress preventive dentistry in their practices can positively and directly impact the oral health of their patients. Good practice management, besides being adminsitratively sound, can be another factor in promoting dental wellness. Dental wellness does not happen by accident. It is the result of committed professionals working in conjunction with concerned individuals toward a common goal-good oral health.     

The promotion of health careers to high school students in the New England health area: the views of high school careers advisers

ABSTRACT: One way to impact positively on the shortage of health professionals in rural areas is to effectively promote health careers to rural high school students. Rural high school careers advisers play a pivotal role in this. In order to assess how rural health careers advisers working in the north-west of New South Wales currently promote health careers to their students, the New England Area Rural Training Unit carried out a survey of the area's high school careers advisers. Of the 47 high school careers advisers, 38 returned completed questionnaires, yielding a response rate of 81%. While only about one-third of careers advisers use visits by undergraduate students enrolled in tertiary health courses (42%), visits by locally practising health professionals (39%) and/or health careers site visits (27%), all careers advisers consider such promotional activities to be most effective. Improved exposure to such effective health career promotional activities for the area's high school, increasing collaboration between careers advisers and health professionals, as well as renewed efforts to identify and to foster interested students prior to Year 10, should lead to an increasing number of rural high school students enrolling in tertiary health courses.     

Community pharmacy and public health in Great Britain, 1936 to 2006: how a phoenix rose from the ashes

The pharmacy profession in Great Britain has identified public health as a key area for future development; at the same time the government has been keen to make full use of pharmacists in pursuing its public health goals. To date, pharmacy has focused on microlevel activities such as health promotion, medicines management and prescribing advice, rather than on wider public health issues such as health inequalities. The role in health promotion has its origins in the traditional advisory role of the pharmacist, which largely died out following the establishment of the National Health Service in 1948, and was resurrected only following ministerial intervention in 1981. This article traces the origins of the pharmacist's role in public health, illustrating both shifting definitions of public health and changes in pharmacy practice. It describes how the profession was able to re-establish its advisory role and to develop it into a wider contribution to public health, indicating that this process came about as a result of convergence between a professional imperative to develop its role, on the one hand, and state recognition of the need to draw a broader range of health professionals and lay people into public health activities, on the other. Convergence required the securing of government support, confirmed in policy documents; the recognition by pharmacy's professional body that embracing public health is a desirable activity; incentives for community pharmacists to carry out such activities; and support from the wider public health community. This article describes how each of these was achieved.     

Work activity analysis of Finnish occupational health professionals

BACKGROUND: Some Finnish studies have dealt with how occupational health nurses divide their working hours but other occupational health professionals have not been evaluated. AIMS: This study describes how occupational health professionals allocate their working hours between main tasks. METHODS: Questionnaires were sent to 250 occupational health professionals, of whom 176 (70%) returned the completed forms. The data were analysed by using frequencies, means and one-way analysis of variance test. RESULTS: Employee-oriented tasks accounted for roughly 50% of working hours from all occupational health professionals. The remaining working hours were shared between workplace visits, co-operation with partners, other occupational health care responsibilities and tasks in other health care fields, especially in the health care centres. These working hours varied greatly between the different occupational health professional groups. All units employed full-time occupational health nurses, but the services of physicians, physiotherapists and psychologists were usually provided part-time or even restricted to a few hours each week because these services were difficult to obtain. Occupational health nurses working in the municipal health care centres spent more time on workplace visits than other nurses. Employee-oriented tasks were emphasized more in physicians', physiotherapists' and psychologists' work, especially in private medical health care units and in the jointly owned health care units. CONCLUSIONS: The amount of time occupational health professionals are able to spend on workplace activities appears to be determined by the type of their employer.     

跨学科合作在生命早期1000天口腔健康促进中的应用

生命早期1 000天的口腔保健与健康密切相关。非口腔卫生专业人员比口腔专业人员有更多机会接触到孕妇和低龄儿童,是全生命周期中生命早期的口腔健康促进的重要实施者。口腔专业人员与非口腔卫生专业人员需通过合作来承担口腔卫生整合的重任。文中从生命早期1 000天对口腔保健的重要意义、国内外口腔保健现状、非口腔专业人员在口腔健康促进中的角色与职责、跨专业教育模式助力跨学科合作等方面,对跨学科合作在生命早期1 000天口腔健康促进中的意义和现状作综述。     

Health beliefs and behaviors of physician assistants in Texas: implications for practice and education

Concern has been expressed over how the volume and effectiveness of physicians' practices relative to prevention can be increased. While a review of the health care services provided by physician assistants in medical practices indicated an emphasis on health education and patient counseling, there has existed an absence of data regarding their beliefs and practices in the area of health promotion. Based upon an analysis of self-reported data from 256 respondents (89%) of a random sample (n = 289) of the 870 physician assistants in Texas, it appears that physician assistants perceive themselves as having a role in health promotion, are generally satisfied with their preventive health care role, view health promotion activities as being more important in the future, and disagree with the idea that health promotion would not be well received by patients. They routinely gather information on health behaviors and discuss or recommend ways to reduce at-risk behavior. Furthermore, while expressing certainty about their knowledge and skills to educate and influence individuals to change certain risk behaviors, physician assistants indicate less certainty about patient follow-through when it relates to such activities as smoking, drinking, and the use of illicit drugs. Considering the perceived challenge and the view that health promotion will become an even larger component of the physician assistant's future role, these findings suggest a need for additional skills training to better assist patients to modify their more complex health risk behaviors.     

Interviewing and counseling skills. Techniques for their evaluation.

Assessment of knowledge and cognitive skills has been traditionally included in examinations for certification and licensure of health professionals. Evaluation techniques for assessing complex cognitive and interpersonal skills, however, have not been as widely developed or incorporated in national examination programs. Specifically, the evaluation of interviewing and counseling skills has been complicated by difficulties in: (a) defining what consititutes skillful interviewing and counseling and in specifying criteria against which performance can be assessed; (b) developing evaluation procedures to permit accurate and reliable observations of these activities; (c) solving logistic problems of standardizing the content and format of these evaluation procedures; and (d) establishing standards for identifying individuals who have not yet achieved acceptable levels of proficiency. Progress has been made in defining the criteria for evaluating the interviewing and counseling skills of several categories of health professionals. Definitions can be developed to identify specific behaviors associated with acceptable and unacceptable skills in this area of professional competence. On the basis of these definitions, interaction analysis techniques have been developed for accurate and reliable recording of behavior as it occurs in an interviewing and counseling session. Moreover, the use of actors programmed to portray the roles of patients has enabled the standardization of this evaluation procedure so that examinees can be assessed on the basis of equivalent testing conditions. A number of research studies are under way to determine whether paper-and-pencil, as well as audiovisual, simulations can be substituted for evaluation in a live, interactive setting. However, little has yet been done to identify appropriate procedures for establishing standards of proficiency. Perhaps such efforts will be more feasible when appropriate evaluation techniques are more fully developed. Of relevance in determining whether the evaluation of counseling and interviewing skills is pertinent to dietetics are questions such as: How frequently do dietitians interact with patients? In what settings and for what purposes do these interactions take place? What impact do dietitian-patient interactions have on the quality of the health care provided?     

Employee dependents: the future focus of worksite health promotion programs and the potential role of the allied health professional

The prevalence of health promotion activities has increased in worksites over the last five years. Many companies that have offered health promotion programs in the past have done so primarily for their employees. In the last several years, programs have extended to employee dependents by opening current employee programs to dependents. However, employee health promotion programs may not be relevant or accessible to employee dependents, particularly when children or elderly parents are taken into consideration. This paper outlines several reasons for expanding health promotion benefits to include dependents, suggests a working construct for dependent programs, and discusses the possible roles of allied health professionals in these programs.     

Reexamining preventive health standards for women in a new century: successful screening strategies of one community-based health center

In caring for women, health care professionals are challenged to provide adequate preventive health counseling and disease screening services. Recent studies have illustrated that providers often do not take the time to counsel, even though they believe such a service is worthy and necessary. This article examines possible reasons for the lack of provider counseling and suggests successful strategies set forth by one community-based health center for women and children. Surprisingly, many solutions to this present dilemma can be found in the highly successful public health programs of the past.     

Consensus Recommendations for Optimizing Electronic Health Records for Nutrition Care

Provision of nutrition care is vital to the health and well-being of any patient who enters the health care system, whether in the ambulatory, inpatient, or long-term care setting. Interdisciplinary professionals—nurses, physicians, advanced practice providers, pharmacists, and dietitians—identify and treat nutrition problems or clinical conditions in each of these health care settings. The documentation of nutrition care in a structured format from screening and assessment to discharge allows communication of the nutrition treatment plans. The goal of this document is to provide recommendations to clinicians for working with an organization’s Information Systems department to create tools for documentation of nutrition care in the electronic health record. These recommendations can also serve as guidance for health care organizations choosing and implementing health care software.     

Health promotion is peace promotion.

This paper discusses the effects of the arms race on health, in the absence of nuclear war. High levels of military expenditure are inextricably linked to unemployment, poverty, starvation and ill health. Alternatives to the escalation of military expenditure are possible; health promotion can be involved in wider public health initiatives towards economic and industrial conversion to peaceful, socially useful production. The interests of the health and scientific communities have traditionally transcended narrow chauvinism and nationalism. World Health Organization activities such as work towards primary health care and the Expanded Programme on Immunization actively involve international co-operation, demystify potential enemies and promote health and peace.     

Promoting and protecting the health of children and young people

BACKGROUND: The health-related behaviours adopted by children and young people can have both immediate and long-term health effects. Health promotion interventions that target children and young people can lay the foundations of a healthy lifestyle that may be sustained into adulthood. This paper is based on a selective review of evidence relating to health promotion in childhood, carried out to support the external working group on the 'Healthy Child' module of the Children's National Service Framework. METHODS: This is a selective review of mainly secondary research. It focuses on injury prevention, support for parenting and the promotion of good mental health, and promoting a healthy diet and physical activity amongst children and young people. FINDINGS: In many areas, the quality of primary research into health promotion interventions aimed at children and young people is poor. Interventions are heterogeneous and not described in sufficient detail. Sample sizes tend to be small, and there are commonly problems of bias. Despite these difficulties, there is good evidence for a range of interventions, including (1) area road safety schemes; (2) combining a variety of approaches to the promotion of the use of safety equipment, including legislation and enforcement, loan/assisted purchase/giveaway schemes, education, fitting and maintenance of safety equipment; (3) school-based mental health promotion; (4) parenting support; (5) interventions that promote and facilitate 'lifestyle' activity for children, such as walking and cycling to school, and those that aim to reduce sedentary behaviours such as parent education to reduce the time children spend watching TV and using computers; and (6) controlling advertising of unhealthy food that is aimed at children. CONCLUSIONS: There are effective interventions to promote and protect the health of children and young people that require action across the five areas described in the Ottawa Charter. Health, social care and education services have a direct role in the delivery of many of these interventions and, in other areas, a role in collaborative work with other agencies, in lobbying for policy change and in raising the profile of child health promotion. Further research is needed using larger study populations, and closely defined interventions, both targeted and universal, in order to fill some of the current gaps in the evidence base for health promotion in children and young people.     

Health care professionals’ perspectives on physical activity within the Ugandan mental health care system

BackgroundMental health care systems in Africa are faced with a high burden of mental disorders. There is need to explore evidence-based, scalable interventions to compliment the “traditional” health care system. Physical activity (PA) can augment the effectiveness of existing programs. However, little is known about the perspectives of health care professionals on PA. Understanding this is key to implementation.MethodsThis was a qualitative exploratory study based on 13 key informant interviews among experienced health care professionals working at Butabika National Referral and Teaching Hospital, Uganda. Data was analyzed through content thematic analysis.ResultsParticipants reported PA benefits were: improved individual competences and engagement, social reintegration and reduced family and community burden. Self-stigma, lack of community support, lack of infrastructure and equipment, lack of monitoring capacity, human resource challenges and a focus solely on pharmacotherapy were among the most reported barriers to application of PA in management of mental health problems.ConclusionDespite the high level of understanding of PA among health care professionals, PA promotion largely depends on implementation of strategies to deal with community and health systems barriers. Although patients need to be empowered to deal with their individual barriers, greater support and action is needed by policy makers. Public health programs should support PA through community engagement and social re-integration programs. The government should promote a holistic mental health care perspective and provide adequate infrastructural and human resources to support PA in the existing primary and mental health care systems.