Factors influencing physicians' orientation toward prevention

We examined the influence of various background characteristics as well as other variables such as personal health practices, specialty choice, and political orientation, on the attitudes of medical graduates toward the physician's role in prevention. The study was part of a 1979 survey conducted in three U.S. medical schools. The results revealed that graduates who believed more strongly in the physician's role in prevention tended to be in primary care training, had a more liberal political orientation, and came more often from physician families. These graduates also believed more strongly that physicians ought to be role models for their patients in health habits. However, they did not manifest better personal health practices than physicians less oriented toward prevention. There was also a medical school effect, although it could not be determined whether this represented the influence of the curriculum or of the selection process into medical school.     

What students bring to medical school: attitudes toward health promotion and prevention

INTRODUCTION: Health care providers' positive attitudes toward prevention and health promotion are important in achieving national health care goals. Limited studies of incoming medical students have been conducted that measure predictors of positive attitudes toward health promotion and prevention. METHODS: Data were obtained from a 1993 curriculum evaluation survey of first-year students at five different medical schools in California. Attitudes toward health promotion and prevention were measured using a nine-question Prevention Attitude Scale (PAS). We developed 2 multivariate linear regression models using demographics, education choices, and personal social values and beliefs to predict PAS scores. We also performed bivariate analysis. RESULTS: Five hundred ninety-nine completed surveys were analyzed, with a response rate of 95%. Mean PAS score was 36.47 +/- 3.7 on a 0 to 44 scale. Female gender, Democratic party preference, and a planned specialty choice in preventive medicine or primary care predicted the highest PAS scores on bivariate analysis (p < 0.002). Significant correlation ( p < 0. 001) was shown between PAS scores and 2 additional scales regarding beliefs in associations of social factors and illness and in the importance of caring for the poor. Linear regression model using personal social values and beliefs explained 34% of the variance, as opposed to the demographic model that explained only 9% of the variance. CONCLUSIONS: In the schools studied, participating first-year medical students had moderately positive attitudes toward health promotion and prevention, as measured by PAS scores. In designing curriculum to improve medical students' attitudes toward health promotion and prevention, medical educators may need to consider other personal and social values held by medical students and to address the "political" aspects of health promotion and prevention. Future studies are needed to longitudinally follow medical student attitudes.     

Childhood nutrition education in health promotion and disease prevention.

In the last 10 to 15 years, nutrition has become a major component of health promotion and chronic disease prevention. Two widely recommended strategies for incorporating nutrition education directed toward children and youth into health promotion and disease prevention efforts are school-based nutrition education and the integration of nutritional care into health care. School-based nutrition education programs targeted toward very specific eating behaviors are showing very promising results in regard to behavior and attitude change of children and adolescents. Substantial changes in health care providers'' attitudes and practices and in the funding and financing of health care will be needed if nutrition education delivered in the context of routine health care is to be a major force in health promotion and disease prevention for youth.     

Effects of educating local government officers and healthcare and welfare professionals in suicide prevention

Suicide is a major public health issue. In Japan, local governments are responsible for suicide prevention, and local government officers are therefore expected to act as gatekeepers for suicide prevention. In this study, through a questionnaire survey, the authors examined the current knowledge and attitudes concerning suicide prevention among local government officers and healthcare and welfare professionals, and the effects of providing suicide prevention education on their knowledge of and attitudes toward suicide and its prevention. One hundred eighty-three local government officers and 432 healthcare/welfare professionals completed the survey before and after a single education session. Before the session, the local government officers and healthcare/welfare professionals showed mainly positive attitudes toward suicide prevention efforts, with little difference between the two groups. After the training, knowledge and attitudes were further improved for most questionnaire items. Respondents with one or more experiences of suicide prevention training showed significantly more knowledge and positive attitudes before the training than those with no such experience. Moreover, knowledge of depression and having a sympathetic attitude were found to be especially associated with the overall attitude that "suicide can be prevented". Training in suicide prevention was shown to be effective in promoting appropriate knowledge and attitudes among local government officers and healthcare/welfare professionals who are gatekeepers for preventing suicide. Our findings confirm the importance of suicide prevention education, and will contribute to creating a standard educational program on suicide prevention in Japan.     

中学生营养知识、态度及饮食行为的现状调查

目的:了解中学生营养知识的掌握情况及其对合理营养的态度和饮食行为情况,以便指导学生正确的饮食行为,改正不良饮食习惯,提高学生营养知识水平。方法:采用自行设计的问卷调查表,随机抽取样本进行中学生营养知识、态度和饮食行为的调查。结果:93.3%的中学生对了解营养知识的态度积极,营养知识测试最高分为50分(满分),最低分为5分,平均分为42.06分,比较理想;有50%以上的中学生选择食物时最关心的是个人口味和爱好,其次是价格。把既有营养又卫生,有利于健康作为第一考虑的仅有19.1%。结论:本次调查中学生常识性营养知识得分较高,饮食行为较合理,但选择食物的标准欠合理。     

Implications of Preventive Health Behaviour for Cervical and Breast Cancer Screening Programmes: A Review

The success of screening programmes for breast and cervicalcancer partly depends on women's acceptance and take-up of theservice. Uptake of preventive health care programmes appearsto be related to people's underlying motivations and attitudes,not only towards the disease in question, but towards healthand illness generally. The perceived costs to the individualof embarking on particular courses of action also have to betaken into consideration. These attitudes and motivations varybetween social groups. Unless the reasons for non-participationin preventive health care and screening programmes is understood,programmes will be misdirected and inappropriately designed.However, the failure of any one theory to account for most ofthe variance in health behaviour between social groups emphasizesthe importance of health education and provision of informationabout health and prevention on a personal basis. General practitionersand practice based nurses are in a good position to be ableto elicit the fears, prejudices and priorities of patients inthis area, and thus provide more effective health educationand information about preventive and screening services.     

Women's perceptions about the way social roles promote or constrain personal nutrition care.

Research suggests that roles may affect women's health promoting behavior. This study was designed to discover, understand and develop hypotheses about the ways in which women's social roles influence their attitudes and beliefs about personal nutrition care. In-depth interviews were conducted with 36 married mothers, both employed and homemakers, at three different life stages. Interviews were analyzed using the constant comparative method of qualitative analysis. These data suggest that social roles influence women's attitudes about personal nutrition care in both positive and negative ways; this influence is modified by women's changing interpretations of their family roles at different life stages. The results have important implications for the prevention of chronic disease among women.     

The association between Colombian medical students' healthy personal habits and a positive attitude toward preventive counseling: cross-sectional analyses

Background  

Physician-delivered preventive counseling is important for the prevention and management of chronic diseases. Data from the U.S. indicates that medical students with healthy personal habits have a better attitude towards preventive counseling. However, this association and its correlates have not been addressed in rapidly urbanized settings where chronic disease prevention strategies constitute a top public health priority. This study examines the association between personal health practices and attitudes toward preventive counseling among first and fifth-year students from 8 medical schools in Bogotá, Colombia.     

广州市海珠区配置校医学校健康教育效果研究*

目的评价海珠区配置校医学校健康教育效果,研究校医干预对学生健康素养水平的影响。方法采用回顾性队列研究,整群抽取海珠区10所小学391名三年级学生,回溯二年级时学校校医配置情况,分成校医干预组和对照组,并通过问卷调查考察两组学生基础健康素养水平,校医干预满一年后再比较两组健康素养水平差异。结果干预前两组基础健康素养水平无明显差异(P0.05)。干预后干预组健康素养水平81.96%高于对照组79.44%(P0.01)。其中,干预组健康知识知晓率80.77%高于对照组77.49%,差异有统计学意义(P0.05);两组健康行为形成率无明显差异。问卷涵盖的五个方面,干预组在膳食与营养、传染病防控及安全与急救的回答正确率均比对照组高(P0.05),在个人卫生习惯和生理功能保健上的回答正确率无明显差异(P0.05)。391名学生的健康素养水平为79.73%,膳食与营养和传染病防控部分回答正确率居前二,均达90.00%水平,安全与急救部分回答正确率最低,仅为70.33%。结论校医对学生的健康教育工作成效显著,明显提高其健康素养水平和健康知识知晓率。在膳食与营养、传染病防控及安全与急救这三方面的提高最突出。学生在安全与急救部分知晓情况较差,校医加强对薄弱环节的宣教,提高健康教育水平很有必要。     

贵州部分大学生营养知识、态度及饮食行为

目的 了解贵州省大学生的营养知识、态度及饮食行为，为开展大学生营养健康教育提供依据。方法采用问卷调查，对贵州省685名大学生进行营养知识、态度及饮食行为调查。结果学生营养态度良好，营养知识女生优于男生，医科院校学生优于普通院校学生。绝大多数学生非常想了解营养知识，并且愿意为了健康而改变饮食习惯。结论贵州省大学生的营养知识缺乏，饮食行为不科学，应采取多种形式对大学生进行营养知识宣传和饮食行为的引导。     

Position of the American Dietetic Association: the roles of registered dietitians and dietetic technicians, registered in health promotion and disease prevention

It is the position of the American Dietetic Association (ADA) that primary prevention is the most effective, affordable course of action for preventing and reducing risk for chronic disease. Registered dietitians and dietetic technicians, registered, are leaders in delivering preventive services in both clinical and community settings, including advocating for funding and inclusion of these services in programs and policy initiatives at local, state, and federal levels. In addition, registered dietitians are leaders in facilitating and participating in research in chronic disease prevention and health promotion. Diet, nutrition, and physical activity are important factors in the promotion and maintenance of good health throughout the life cycle. Cost-effective interventions that produce a change in personal health practices are likely to lead to substantial reductions in the incidence and severity of the leading causes of disease in the United States. In an era of increasing health care expenditures and relative decreases in availability of federal funds, there is increasing demand on health promotion and disease prevention to be economically viable. Through clinical involvement and rigorous participation in research on chronic disease prevention and health promotion, the field of dietetics can lead the way to effectively translate the impact of nutrition on all ages.     

How negative are we to the idea of suicide prevention?

Assessment of attitudes amongst health care professionals to suicide prevention reveals a considerable degree of doubt with regards to its feasibility and appropriateness. The various professional groups may vary considerably in the degree of negative attitudes which they exhibit. Such findings suggest that there is an urgent need to ensure that health care professionals are fully informed about the key facts concerning suicide and preventive strategies. Key elements of clinical practice and service organization with regards to suicide prevention are discussed.     

Health promotion for older Americans

As American lifespans increase, there is greater concern for the quality of those longer lives. The Department of Health and Human Services, through its many component agencies, has inaugurated a major initiative to promote health and fitness among older Americans to improve life quality and to reduce health care costs. The older population is a fertile ground for such an initiative, because studies indicate that the elderly are extremely health-conscious and very willing to adopt habits that will maintain good health. Investigation disclosed six target areas of concentration at which the health promotion initiative could be aimed: fitness-exercise, nutrition, safe and proper use of drugs and alcohol, accident prevention, other preventive services, and smoking cessation. The initiative includes cooperative programs with States; dissemination of printed information; nutritious meals for the elderly; a Food and Drug Administration consumer education program; Centers for Disease Control programs on accident prevention; a special task force to deal with Alzheimer's disease; and, in cooperation with states, a media campaign of health promotion for the elderly. At least three national health and senior citizens organizations are working closely with HHS agencies on the initiative. A separate Department effort involves the encouragement of fast-growing health maintenance organizations to promote health and prevention for their Medicare members and the persuasion of Medicare beneficiaries generally to seek second medical or surgical opinions. State and local government and the private sector, responding to Department initiatives, have also been developing programs for the aging. Their interest and participation ensures that special health promotion and disease prevention efforts directed toward elderly Americans will continue and proliferate.     

Attitudes toward prevention of cardiovascular diseases among first-year students at eight American medical schools, 1983-1985

First-year medical students at eight U.S. medical schools were surveyed by written questionnaire in 1983-1985 to determine their attitudes toward cardiovascular diseases prevention at medical school entry. An overall response rate of 92% was achieved (2,654 questionnaires), and 97% of responders provided complete and analyzable survey data. Response rates at five of eight medical schools were 98-100%, and one school each had rates of 67, 84, or 90%. Differences in mean attitude responses from school to school were small, as were differences between men and women or between blacks and whites. This survey found that entering medical students have generally positive attitudes toward the effectiveness of preventive cardiology practice as well as toward the importance of research efforts in cardiovascular disease prevention. Students frequently indicated, however, that it is "extremely difficult" to change patients' unhealthful habits and that "physician encouragement" may not be sufficient to help patients achieve more healthful behaviors. These findings could be helpful in directing educational efforts for medical students. The data suggest that major emphasis should be placed on conveying facts regarding the physicians' efficacy in clinical preventive cardiology and on teaching the skills of preventive cardiology practice. Less emphasis appears to be necessary on encouraging positive attitudes about the importance of prevention since current students' attitudes appear to be already positive in this dimension.     

上海市梅陇地区居民肺结核防治知识知晓情况分析

目的 通过调查上海市梅陇地区居民的个人卫生习惯以厦对肺结核防治知识的知晓情况，阐述加强肺鲒核防治健康教育的重要性。方法 随机调查梅陇地区居民311人，调查其个人卫生习惯和对肺结核防治知识的知晓情况。结果 83．28％的被调查者知道肺结核这个疾病；72．99％的被调查者经常会看到有人随地吐痰；仅有39．55％的被调查者会阻止随地吐痰。结论 提出加强肺结核防治的健康教育的必要性，提示养成良好卫生习惯是肺结核防治的关键。     

贵州省少数民族地区大学生营养知识,态度及行为调查

前期的营养调查工作中我们发现大学生营养不平衡。结果显示大学生对营养知识缺乏深入的了解，尤其对营养与疾病的关系缺乏认识，以致多根据自己的爱好和口味或饮食习惯选购食物，结果造成偏食、膳食结构不合理，导致营养不平衡。但学生具有较好的营养态度，愿意接受更多的营养与健康知识。通过营养宣教也表明学生营养知识有所提高，择食摸式也有改进。因此认为对学生加强营养教育是纠正营养不平衡的措施之一，并且应通过多方式、多途径的长期宣传才能收到良好的效果。     

Challenges to HIV prevention in psychiatric settings: perceptions of South African mental health care providers

Mental health services in South Africa increasingly feel the brunt of the AIDS epidemic. Despite the high prevalence of infection in the psychiatric setting, HIV risk reduction interventions targeting South Africans with psychiatric illness remain few and far between. The attitudes of mental health care providers about sexual relations and HIV among people with mental illness continue to influence the extent to which these issues are addressed in care settings. This study examines these attitudes through the use of a semi-structured interview administered to 46 mental health care providers in four provinces of South Africa. I found that personal, contextual and political factors in the clinic and the hospital create barriers to integrating prevention activities. In particular, providers face at least three challenges to intervening in the epidemic among their patients: their own views of psychiatric illness, the transitions occurring in the mental health care system, and shifting social attitudes toward sexuality. Barriers operate at the individual level, the institutional level, and the societal level. At the individual level providers' perceptions of psychiatric symptoms shape their outlook on intervention with psychiatric patients. At the institutional level disruptive transitions in service delivery relegate HIV services to lesser importance. At the societal level, personal beliefs about sexuality and mental illness have remained slow to change despite major political changes. Minimizing barriers to implementing HIV prevention services requires institutional and health care policies that ensure adequate resources for treating people with mental illness and for staff development and support.     

Medical students' improved attitudes toward prevention of cardiovascular diseases from entry to graduation. Preventive Cardiology Academic Cooperative Research Group of the National Heart, Lung, and Blood Institute.

First-year medical students have been previously reported to have positive attitudes about disease prevention, in general, and about cardiovascular disease prevention, in particular. Whether medical school experiences exert a positive, negative, or neutral effect on prevention-oriented attitudes in medical students is not known. We assessed attitudes toward heart disease prevention in 770 entering medical students enrolled at six selected American medical schools, each having some curricular emphasis on preventive cardiology, and repeated the attitude survey near graduation in the 750 fourth-year students enrolled in the six schools. Response rates were similar at each of the schools for each administration and averaged 88% in entering students and 74% in the graduating students. We used two mean attitude scores, ranging from 1.0 to 5.0 on a Likert scale, 5.0 representing the most positive attitude. The score treating the importance of primary prevention increased from 4.08 +/- 0.39 to 4.35 +/- 0.41. The attitude score concerning the importance of research in preventive cardiology also increased from 3.65 +/- 0.56 to 3.90 +/- 0.64 (P less than .0001 for both comparisons of first-year to fourth-year students). Analyses by school revealed similar increases, as did analyses for men, women, whites, and nonwhites. The results indicate that positive attitudes toward heart disease prevention can become even more positive during medical school. The perpetuation of positive attitudes should contribute to improved clinical prevention behaviors when these graduates embark on careers in medicine.     

Which Physicians Are Best Prepared to Advise Seniors about Nutrition? A Pilot Survey in Israel

Physicians' knowledge and attitudes can profoundly impact the quality of nutritional care provided to older patients. We assessed physicians' knowledge and attitudes concerning nutritional care for older adults and its correlates. Questionnaires were mailed to 898 physicians in the second largest HMO in Israel: the response rate was 26.5%. Questionnaires assessed aspects of geriatric nutrition, such as food choices, functioning, and medical conditions. Results indicated highest knowledge of nutritional issues for family physicians and for those who were younger (<50 age) and female. Although 68% believed it is important for physicians to explain nutritional issues to older patients, this role was also deemed important for dietitians (83%) and nurses (59%). A variety of factors influencing geriatric nutrition, especially functional and medical conditions, were identified; likewise, nutrition was perceived as influencing various health conditions. Although the low response rate limits generalizability, it appears that physicians in this survey recognized the impact of proper nutrition health and take responsibility for explaining nutrition to their older patients.     

Parental nutrition knowledge and nutrient intake in an atherosclerosis prevention project: the impact of child-targeted nutrition counselling

Most of the counselling in health care targeted at child nutrition is delivered via the parents, but little is known about the effects of such counselling on the nutrition knowledge and dietary habits of the parents. In the Special Turku Coronary Risk Factor Intervention Project for Children (STRIP), we studied how 6.5 years of child-targeted nutrition counselling affected the knowledge, attitudes and dietary habits of the parent mainly responsible for food purchase and preparation. We used a questionnaire and a 24-h recall interview in a time-restricted cohort of 98 families belonging to the intervention group and 89 families belonging to the control group in the STRIP project. After controlling for background variables, the intervention parents had better knowledge than the control parents of causal relationships between food choices and coronary heart disease and of the nutritional composition of foods. Knowledge of nutrition concepts did not differ between the two groups. The quality of fat was better in the diet of the intervention parents, they consumed less salt and they also had more knowledge concerning these subjects compared to the control parents (higher behavioural capability scores). The behavioural capability scores of the total group correlated poorly with their nutrient intakes. Thus, child-targeted nutrition intervention delivered to the parents increased parental nutrition knowledge and improved the quality of the parents' diet. However, as nutrition knowledge of the parents correlated poorly with their nutrient intakes, other factors than knowledge appear to influence parental dietary decisions.