A controlled trial evaluated the impact of a 13-session medical self-care education program for 330 elders compared to a brief 2-hour lecture for controls. The results showed:
1) The education program significantly improved participants' health knowledge, skills performance, and confidence in skills compared to controls both immediately after and one year later.
2) The program stimulated many attempts by participants to improve lifestyle factors like weight, nutrition, and fitness.
3) While the program had little influence on healthcare utilization or health status, it generated improvements in quality of life.
The aim of this study was to investigate if a HWC program conducted by coaching trainees in a university/worksite setting would have a positive impact on participants’ health and well-being. Moreover, we wanted to evaluate the effects of HWC in wellness scores when face-to-face meetings and additional social-embedded support activities are offered to participants. HWC trainees in CtbW used several coaching strategies including coaching role definition, patient centeredness, visioning, participant self-determined goals through self-discovery, promotion of self-mastery and growth mindset, strengths support, accountability and ownership setting, intrinsic motivation, and supporting environmental and social activities.
Effectiveness of rehabilitation in the treatment ofalcohol abusepatients as d...inventionjournals
Alcohol use is one of the serious social threats which need comprehensive treatment and preventive measures. The effectiveness of rehabilitation in providing psycho education and social support to the patient and their family when comparedto treatment alone in dropping relapse rate and cumulative record of follow up rates in patients of alcohol abuse has been focused in the study. Patients who came for the treatment of alcohol abuse were motivated to participate in the study and with their consent they were selected as participants for this study. They were grouped into experimental and control group for the purpose of study. Experimental group participants were made to attend the rehabilitation program and psycho education with their family weekly once for10 sessions in four months after they were discharged from the hospital whereas controlled group were asked to see their doctor only on follow-up. The main objective of the study was to study the effectiveness of rehabilitation in treatment of alcohol abuse with regard to patients follow up for the treatment and their relapse rate. The subjects selected for the study were 100 patients (50 experimental group and 50 controlled groups) with substance abuse from Kripa Deaddiction and Revival Center, Bengaluru, Karnataka India. They were selected by random sampling technique. The exclusive personalized manual recording system was used by the researcher for maintaining cumulative record of the participant patients in their follow up to treatment and also to record the participant relapse rates. The data collected were tabulated in the by variable tables and examined the property movement of variables and the relationship between the variables. The resultant analysis positively corroborated with the objective described in the study. This study paves the way for promoting the incorporation of rehabilitation in the alcohol abuse treatment centers there by curtailing this social menace at large.
The aim of this study was to investigate if a HWC program conducted by coaching trainees in a university/worksite setting would have a positive impact on participants’ health and well-being. Moreover, we wanted to evaluate the effects of HWC in wellness scores when face-to-face meetings and additional social-embedded support activities are offered to participants. HWC trainees in CtbW used several coaching strategies including coaching role definition, patient centeredness, visioning, participant self-determined goals through self-discovery, promotion of self-mastery and growth mindset, strengths support, accountability and ownership setting, intrinsic motivation, and supporting environmental and social activities.
Effectiveness of rehabilitation in the treatment ofalcohol abusepatients as d...inventionjournals
Alcohol use is one of the serious social threats which need comprehensive treatment and preventive measures. The effectiveness of rehabilitation in providing psycho education and social support to the patient and their family when comparedto treatment alone in dropping relapse rate and cumulative record of follow up rates in patients of alcohol abuse has been focused in the study. Patients who came for the treatment of alcohol abuse were motivated to participate in the study and with their consent they were selected as participants for this study. They were grouped into experimental and control group for the purpose of study. Experimental group participants were made to attend the rehabilitation program and psycho education with their family weekly once for10 sessions in four months after they were discharged from the hospital whereas controlled group were asked to see their doctor only on follow-up. The main objective of the study was to study the effectiveness of rehabilitation in treatment of alcohol abuse with regard to patients follow up for the treatment and their relapse rate. The subjects selected for the study were 100 patients (50 experimental group and 50 controlled groups) with substance abuse from Kripa Deaddiction and Revival Center, Bengaluru, Karnataka India. They were selected by random sampling technique. The exclusive personalized manual recording system was used by the researcher for maintaining cumulative record of the participant patients in their follow up to treatment and also to record the participant relapse rates. The data collected were tabulated in the by variable tables and examined the property movement of variables and the relationship between the variables. The resultant analysis positively corroborated with the objective described in the study. This study paves the way for promoting the incorporation of rehabilitation in the alcohol abuse treatment centers there by curtailing this social menace at large.
Effects of Community-Based Health WorkerInterventions to Imp.docxSALU18
Effects of Community-Based Health Worker
Interventions to Improve Chronic Disease
Management and Care Among Vulnerable
Populations: A Systematic Review
Kyounghae Kim, RN, MSN, Janet S. Choi, MPH, Eunsuk Choi, RN, PhD, MPH, Carrie L. Nieman, MD, MPH, Jin Hui Joo, MD, MA,
Frank R. Lin, MD, PhD, Laura N. Gitlin, PhD, and Hae-Ra Han, RN, PhD
Background. Community-based health workers (CBHWs) are frontline
public health workers who are trusted members of the community they
serve. Recently, considerable attention has been drawn to CBHWs in pro-
moting healthy behaviors and health outcomes among vulnerable pop-
ulations who often face health inequities.
Objectives. We performed a systematic review to synthesize evidence
concerning the types of CBHW interventions, the qualification and
characteristics of CBHWs, and patient outcomes and cost-effectiveness
of such interventions in vulnerable populations with chronic, non-
communicable conditions.
Search methods. We undertook 4 electronic database searches—PubMed,
EMBASE, Cumulative Index to Nursing and Allied Health Literature, and
Cochrane—and hand searched reference collections to identify randomized
controlled trials published in English before August 2014.
Selection. We screened a total of 934 unique citations initially for titles
and abstracts. Two reviewers then independently evaluated 166 full-
text articles that were passed onto review processes. Sixty-one studies
and 6 companion articles (e.g., cost-effectiveness analysis) met eligi-
bility criteria for inclusion.
Data collection and analysis. Four trained research assistants extracted
data by using a standardized data extraction form developed by the
authors. Subsequently, an independent research assistant reviewed
extracted data to check accuracy. Discrepancies were resolved through
discussions among the study team members. Each study was evaluated
for its quality by 2 research assistants who extracted relevant study
information. Interrater agreement rates ranged from 61% to 91% (av-
erage 86%). Any discrepancies in terms of quality rating were resolved
through team discussions.
Main results. All but 4 studies were conducted in the United States.
The 2 most common areas for CBHW interventions were cancer pre-
vention (n = 30) and cardiovascular disease risk reduction (n = 26). The
roles assumed by CBHWs included health education (n = 48), counseling
(n = 36), navigation assistance (n = 21), case management (n = 4), social
services (n = 7), and social support (n = 18). Fifty-three studies provided
information regarding CBHW training, yet CBHW competency evalua-
tion (n = 9) and supervision procedures (n = 24) were largely under-
reported. The length and duration of CBHW training ranged from 4
hours to 240 hours with an average of 41.3 hours (median: 16.5 hours) in
24 studies that reported length of training. Eight studies reported the
frequency of supervision, which ranged from weekly to monthly. There ...
Clearing the Error: Patient Participation in Reducing Diagnostic ErrorJefferson Center
To generate new, patient-centered insights into diagnostic error, we convened diverse groups in public deliberation to recommend and evaluate actions that patients and/or their advocates would be willing and able to perform to improve diagnostic quality.
Building Capacity to Improve Population Health using a Social Determinants of...Practical Playbook
The Practical Playbook
National Meeting 2016
www.practicalplaybook.org
Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was at the Hyatt Regency in Bethesda, MD, May 22 - 24, 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health. Key stakeholders from across sectors – representing professional associations, community organizations, government agencies and academic institutions – and across the country came together at the National Meeting to help catalyze a national movement, accelerate collaborations by fostering skill development, and connect with like-minded individuals and organizations to facilitate the exchange of ideas to drive population health improvement.
The National Meeting was also a significant source of tools and resources to advance collaboration. These tools and resources are available below and include:
Session presentations and materials
Poster session content
Photos from the National Meeting
The conversation started at the National Meeting is continuing in a LinkedIn Group "Working Together for Population Health" and Twitter. Use #PPBMeeting to provide feedback on the National Meeting.
The Practical Playbook was developed by the de Beaumont Foundation, the Duke University School of Medicine Department of Community and Family Medicine, the Centers for Disease Control and Prevention (CDC), and the Health Resources & Services Administration (HRSA).
Healthy People 2020Healthy People was a call to action and an.docxpooleavelina
Healthy People 2020
Healthy People was a call to action and an attempt to set health goals for the United States for the next 10 years.
Healthy People 2000 established 3 general goals:
Increase the span of healthy life.
Reduce health disparities.
Create access to preventive services for all.
Healthy People 2010 introduced 2 general goals:
Increase quality and years of healthy life.
Eliminate health disparities.
Practical Policy for Preventive Services
The U.S. health care system faces significant challenges that clearly indicate the urgent need for reform.
There is broad evidence that Americans often do not get the care they need even though the United States spends more money per person on health care than any other nation in the world.
Preventive care is underutilized, resulting in higher spending on complex, advanced diseases.
Practical Policy for Preventive Services
Patients with chronic diseases too often do not receive proven and effective treatments such as drug therapies or self management services to help them more effectively manage their conditions.
These problems are exacerbated by a lack of coordination of care for patients with chronic diseases.
Reforming our health care delivery system to improve the quality and value of care is essential to address escalating costs, poor quality, and increasing numbers of Americans without health insurance coverage.
Why policies need to be developed?
Basic needs are not being met (e.g., People are not receiving the health care they need)
People are not being treated fairly (e.g., People with disabilities do not have access to public places)
Resources are distributed unfairly (e.g., Educational services are more limited in neighborhoods of concentrated poverty)
Why policies need to be developed?
Current policies or laws are not enforced or effective (e.g., The current laws on clean water are neither enforced nor effective)
Proposed changes in policies or laws would be harmful (e.g., A plan to eliminate flextime in a large business would reduce parents' ability to be with their children)
Existing or emerging conditions pose a threat to public health, safety, education, or well-being (e.g., New threats from terrorist activity)
Marjory Gordon’s Functional Health Patterns
Marjory Gordon was a nursing theorist and professor who created a nursing assessment theory known as Gordon's functional health patterns.
It is a method to be used by nurses in the nursing process to provide a more comprehensive nursing evaluation of the patient.
Gordon's functional health pattern includes 11 categories which is a systematic and standardized approach to data collection.
List of Functional Health Patterns
1. Health Perception – Health Management Pattern
describes client’s perceived pattern of health and well being and how health is managed.
2. Nutritional – Metabolic Pattern
describes pattern of food and fluid consumption relative to metabolic need and pattern indicators of loca ...
Identify and summarize determinants of a public health problemMalikPinckney86
Identify and summarize determinants of a public health problem:
individual/ biological, interpersonal/
Intrapersonal Factors: involve an individual's beliefs, attitudes, and knowledge about a health condition.
Lifestyle Causal Beliefs about Obesity
when categorized as ‘some'/‘a lot', 94% of participants held not exercising causal beliefs, 95% held overeating causal beliefs, 90% held eating certain types of food causal beliefs, 70% held chemicals in food causal beliefs, and 41% held smoking causal beliefs about obesity, compared to the 69% who held genetic causal beliefs about obesity. There were few associations between lifestyle causal beliefs about obesity and any of the sociodemographic or health-related characteristics assessed.
Genetic Causal Beliefs about Obesity-Related Diseases
Overall, 82% of participants held genetic causal beliefs about type 2 diabetes (fig. 2), 79% about heart disease (fig. 3) and 75% about cancer (fig. 4), when categorized as ‘some/a lot.' table 3 shows that there were very few associations with participant sociodemographic or health-related characteristics.(all threse from https://www.karger.com/Article/Fulltext/343793)
This study is based on the Ecological Systems Theory and Family and Community Systems perspectives, which emphasize the need to consider the effects of individual, family, community, and societal factors on health and social outcomes (Bronfenbrenner & Morris, 1988; Campbell, Hesketh, & Davison, 2010; Elder et al., 2007; Fulkerson et al., 2015; Novilla, Barnes, De La Cruz, Williams, & Rogers, 2006; Valente, 2012).
This study contributes to the literature in several ways and emphasizes that peers and families are important sources of influence when it comes to healthy eating and choices of activities in young adolescents. Specifically, adolescents who reported a stronger connection with their family also engaged more frequently in physical activity than adolescents who reported lower familism. The benefits of targeting the family as part of lifestyle interventions are well established (Epstein, Paluch, Roemmich, & Beecher, 2007; Skelton, Buehler, Irby, & Grzywacz, 2012; St Jeor, Perumean-Chaney, Sigman-Grant, Williams, & Foreyt, 2002). The rationale underlying family-centered approaches is that modification of the youth’s environment is necessary to change and maintain children’s healthy habits. As a primary source of socialization, parents not only influence youths’ healthy lifestyle in providing access to resources and in modeling and reinforcing healthy habits, but they also provide the basis for the development of healthy peer relationships. Conceivably, stronger family connections may operate directly on young adolescents’ physical activity, but also indirectly in establishing the foundations for healthy peer relationships, which in turn promote healthier diet and a less sedentary lifestyle.
Furthermore, adolescents who reported higher PSF had a healthier diet and spent less time engagi ...
To accomplish community health goals and its aims the following approaches are to be utilized by community health professionals:-
1)persuasive approach 2)enforcement 3)team approach 4)community involvement 5)Intersectorial approach
For adventurous travel blog please visit http://wilsontom.blogspot.com
Gender Difference in Response to Preventative Health Careiowafoodandfitness
Luther College Students prepared the following community assessments as part of their Psychology of Health and Illness class in the Fall Semester 2008.
A Re-Introduction to Health Education and the knowledge in it
purpose
dimension
aspects
importance
The Change, its process and management
The Education Process
The Teaching Strategies
Reflective practice is the innovative way of learning through your own actions. This enhance the critical thinking abilities through forming strategies to overcome and prevent the same mistake happening again.
Literature ReviewA search was conducted using electronic database.docxssuser47f0be
Literature Review:
A search was conducted using electronic databases in the fields of nursing, medicine, education, psychology, and sociology. Using ProQuest Direct and EBSCO search engines, the following databases were accessed: CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE in PubMed, Ovid, and PsycINFO. The search terms were grouped in the following key concepts: (a) occupational stress in nursing, (b) stress perception in nursing, (c) occupational stressors in nursing, (d) nursing generational diversity, and (e) coping in nursing. In a commentary on patient safety in nursing practice from the Agency for Healthcare Research and Quality, Hughes and Clancy7 reported that complexity and bullying represent 2 clear examples of nurse stressors. Li and Lambert8 concluded that nurses who are more satisfied with their job are more likely to remain in the workforce and to be committed to delivering high-quality patient care. Hall9 found that healthcare professions have some unique characteristics leading to occupational stress including physical responsibility for people, potential catastrophic effects on the patient and the employee, frequent exposure to pain and suffering, and exposure to infectious diseases and potential hazardous substances. Hamaideh et al10 identified that death and dying were the strongest stressors perceived by Jordanian nurses. In this study, workload and guidance were found to be the most supportive behaviors provided to nurses facing stress followed by emotional support.10
Carver and Candela11 concluded that considering the global nursing shortage, managers should increase their knowledge of the generational diversity. It is suggested that understanding how to relate to multiple generations can lead to improved nursing work environments.11 Repar and Patton12 found that the combined effects of compassion fatigue, chronic grief, and emotional and physical exhaustion led to significant burnout and prolonged job dissatisfaction in the nursing profession. In this study, using guided sessions, a massage therapist gave 10-minute chair massages, and a visual, language, or musical artist engaged participants in imaginative and creative activities such as poetry reading, free writing, guided imagery, and listening to live music.12 The results suggest that the activities reduce some of the unpleasant, stressful, and tension-producing emotions that nurses typically experience at work, leaving them more peaceful and energized.12 Based on the findings of this review of the literature, it is recognized that stress is a major component of nursing and can be detrimental to nurse retention. In addition, most studies identified some differences that exist between the present generational nursing cohorts in terms of values and beliefs. No studies were identified reporting how work-related stress affects different generations of nurses, how the generations perceive stress, and what coping styles are used.
Study Des ...
Assessment 7 Course Textbook Edberg, M. (2015). Essentials .docxdavezstarr61655
Assessment 7
Course Textbook: Edberg, M. (2015). Essentials of health behavior: Social and behavioral theory in public health (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
Q.1 MUST BE ANSWERED ON SATURDAY, Mar. 10 NLT 10 PM EST (200 words A MUST for each question. Please provide reference for each question for each question. Keep them numbered.)
1. This unit provided the 10-step approach of putting a communication campaign together. Step 6 involves selecting the appropriate communication channels. Why would selecting the right channel or channels be so important? What would be some of the examples of those channels if you were trying to put a communication campaign together that was designed to increase awareness for young people about the need for physical exercise and better eating habits to address the problem of obesity?
2. What are some of the key components in the overall ecology of global health? Are these different from the ecological context for domestic health? If so, how? Please explain and provide supporting examples.
3. Does mobile technology and social media change the way communications theory can be applied? Or do these developments change the theory itself?
4. Imagine you are in charge of putting an anti-smoking communication campaign together (geared towards young adults) in your local community. Correctly identifying your target audience would be an important step. Who would be your target audience or audiences in this example? Are there any groups or sub-groups? Also, would you need to segment your audience in any way? Please address each of these questions and explain the overall importance of correctly identifying your target audience as part of your intended communication campaign.
Q.1 MUST BE ANSWERED ON SATURDAY, Mar. 10 NLT 10 PM EST (A PARAGRAPH ONLY)
Q. 1 Why is it important to specifically identify those individuals who are the most vulnerable in terms of getting a certain disease or diseases?
· Why do general or mainstream approaches typically not work on those high-risk populations or groups?
ARTICLE REVIEW (READ INSTRUCTIONS CAREFULLY AND PAY ATTENTION TO THE ITEM HIGHLIGHTED IN RED)
· MUST BE ANSWERED BY MONDAY, MAR. 12 NLT 10 PM EST
For this assignment, choose a peer-reviewed article to review. Use source that contains peer-reviewed articles, and find an article about a concept tied to the unit outcomes in this unit.
Write a three- to five-page review (not counting the cover page and references page) of the article that includes the following information:
Briefly introduce and summarize the article.
Identify the author’s main points.
Who is the author’s intended audience?
How does the article apply to this course? Does it support the information in your textbook?
How could the author expand on the main points?
The article must be no more than three years old. Use APA style when writing your review.
UNIT VII STUD.
Household survey as a tool for training medical students in measuring public ...Alim A-H Yacoub Lovers
Habib OS, Ajeel NAH, Yacoub AAH. Household surveys as a tool for training medical students in measuring population health. The Iraqi Journal of Community Medicine 2002; 15: 5-8.
William Zubkoff is one of the very few individuals solely involved in active groundwork and practices in order to help people get appropriate healthcare.
More Related Content
Similar to Medical Self-care Education for Elders: A Controlled Trial to Evaluate Impact
Effects of Community-Based Health WorkerInterventions to Imp.docxSALU18
Effects of Community-Based Health Worker
Interventions to Improve Chronic Disease
Management and Care Among Vulnerable
Populations: A Systematic Review
Kyounghae Kim, RN, MSN, Janet S. Choi, MPH, Eunsuk Choi, RN, PhD, MPH, Carrie L. Nieman, MD, MPH, Jin Hui Joo, MD, MA,
Frank R. Lin, MD, PhD, Laura N. Gitlin, PhD, and Hae-Ra Han, RN, PhD
Background. Community-based health workers (CBHWs) are frontline
public health workers who are trusted members of the community they
serve. Recently, considerable attention has been drawn to CBHWs in pro-
moting healthy behaviors and health outcomes among vulnerable pop-
ulations who often face health inequities.
Objectives. We performed a systematic review to synthesize evidence
concerning the types of CBHW interventions, the qualification and
characteristics of CBHWs, and patient outcomes and cost-effectiveness
of such interventions in vulnerable populations with chronic, non-
communicable conditions.
Search methods. We undertook 4 electronic database searches—PubMed,
EMBASE, Cumulative Index to Nursing and Allied Health Literature, and
Cochrane—and hand searched reference collections to identify randomized
controlled trials published in English before August 2014.
Selection. We screened a total of 934 unique citations initially for titles
and abstracts. Two reviewers then independently evaluated 166 full-
text articles that were passed onto review processes. Sixty-one studies
and 6 companion articles (e.g., cost-effectiveness analysis) met eligi-
bility criteria for inclusion.
Data collection and analysis. Four trained research assistants extracted
data by using a standardized data extraction form developed by the
authors. Subsequently, an independent research assistant reviewed
extracted data to check accuracy. Discrepancies were resolved through
discussions among the study team members. Each study was evaluated
for its quality by 2 research assistants who extracted relevant study
information. Interrater agreement rates ranged from 61% to 91% (av-
erage 86%). Any discrepancies in terms of quality rating were resolved
through team discussions.
Main results. All but 4 studies were conducted in the United States.
The 2 most common areas for CBHW interventions were cancer pre-
vention (n = 30) and cardiovascular disease risk reduction (n = 26). The
roles assumed by CBHWs included health education (n = 48), counseling
(n = 36), navigation assistance (n = 21), case management (n = 4), social
services (n = 7), and social support (n = 18). Fifty-three studies provided
information regarding CBHW training, yet CBHW competency evalua-
tion (n = 9) and supervision procedures (n = 24) were largely under-
reported. The length and duration of CBHW training ranged from 4
hours to 240 hours with an average of 41.3 hours (median: 16.5 hours) in
24 studies that reported length of training. Eight studies reported the
frequency of supervision, which ranged from weekly to monthly. There ...
Clearing the Error: Patient Participation in Reducing Diagnostic ErrorJefferson Center
To generate new, patient-centered insights into diagnostic error, we convened diverse groups in public deliberation to recommend and evaluate actions that patients and/or their advocates would be willing and able to perform to improve diagnostic quality.
Building Capacity to Improve Population Health using a Social Determinants of...Practical Playbook
The Practical Playbook
National Meeting 2016
www.practicalplaybook.org
Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was at the Hyatt Regency in Bethesda, MD, May 22 - 24, 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health. Key stakeholders from across sectors – representing professional associations, community organizations, government agencies and academic institutions – and across the country came together at the National Meeting to help catalyze a national movement, accelerate collaborations by fostering skill development, and connect with like-minded individuals and organizations to facilitate the exchange of ideas to drive population health improvement.
The National Meeting was also a significant source of tools and resources to advance collaboration. These tools and resources are available below and include:
Session presentations and materials
Poster session content
Photos from the National Meeting
The conversation started at the National Meeting is continuing in a LinkedIn Group "Working Together for Population Health" and Twitter. Use #PPBMeeting to provide feedback on the National Meeting.
The Practical Playbook was developed by the de Beaumont Foundation, the Duke University School of Medicine Department of Community and Family Medicine, the Centers for Disease Control and Prevention (CDC), and the Health Resources & Services Administration (HRSA).
Healthy People 2020Healthy People was a call to action and an.docxpooleavelina
Healthy People 2020
Healthy People was a call to action and an attempt to set health goals for the United States for the next 10 years.
Healthy People 2000 established 3 general goals:
Increase the span of healthy life.
Reduce health disparities.
Create access to preventive services for all.
Healthy People 2010 introduced 2 general goals:
Increase quality and years of healthy life.
Eliminate health disparities.
Practical Policy for Preventive Services
The U.S. health care system faces significant challenges that clearly indicate the urgent need for reform.
There is broad evidence that Americans often do not get the care they need even though the United States spends more money per person on health care than any other nation in the world.
Preventive care is underutilized, resulting in higher spending on complex, advanced diseases.
Practical Policy for Preventive Services
Patients with chronic diseases too often do not receive proven and effective treatments such as drug therapies or self management services to help them more effectively manage their conditions.
These problems are exacerbated by a lack of coordination of care for patients with chronic diseases.
Reforming our health care delivery system to improve the quality and value of care is essential to address escalating costs, poor quality, and increasing numbers of Americans without health insurance coverage.
Why policies need to be developed?
Basic needs are not being met (e.g., People are not receiving the health care they need)
People are not being treated fairly (e.g., People with disabilities do not have access to public places)
Resources are distributed unfairly (e.g., Educational services are more limited in neighborhoods of concentrated poverty)
Why policies need to be developed?
Current policies or laws are not enforced or effective (e.g., The current laws on clean water are neither enforced nor effective)
Proposed changes in policies or laws would be harmful (e.g., A plan to eliminate flextime in a large business would reduce parents' ability to be with their children)
Existing or emerging conditions pose a threat to public health, safety, education, or well-being (e.g., New threats from terrorist activity)
Marjory Gordon’s Functional Health Patterns
Marjory Gordon was a nursing theorist and professor who created a nursing assessment theory known as Gordon's functional health patterns.
It is a method to be used by nurses in the nursing process to provide a more comprehensive nursing evaluation of the patient.
Gordon's functional health pattern includes 11 categories which is a systematic and standardized approach to data collection.
List of Functional Health Patterns
1. Health Perception – Health Management Pattern
describes client’s perceived pattern of health and well being and how health is managed.
2. Nutritional – Metabolic Pattern
describes pattern of food and fluid consumption relative to metabolic need and pattern indicators of loca ...
Identify and summarize determinants of a public health problemMalikPinckney86
Identify and summarize determinants of a public health problem:
individual/ biological, interpersonal/
Intrapersonal Factors: involve an individual's beliefs, attitudes, and knowledge about a health condition.
Lifestyle Causal Beliefs about Obesity
when categorized as ‘some'/‘a lot', 94% of participants held not exercising causal beliefs, 95% held overeating causal beliefs, 90% held eating certain types of food causal beliefs, 70% held chemicals in food causal beliefs, and 41% held smoking causal beliefs about obesity, compared to the 69% who held genetic causal beliefs about obesity. There were few associations between lifestyle causal beliefs about obesity and any of the sociodemographic or health-related characteristics assessed.
Genetic Causal Beliefs about Obesity-Related Diseases
Overall, 82% of participants held genetic causal beliefs about type 2 diabetes (fig. 2), 79% about heart disease (fig. 3) and 75% about cancer (fig. 4), when categorized as ‘some/a lot.' table 3 shows that there were very few associations with participant sociodemographic or health-related characteristics.(all threse from https://www.karger.com/Article/Fulltext/343793)
This study is based on the Ecological Systems Theory and Family and Community Systems perspectives, which emphasize the need to consider the effects of individual, family, community, and societal factors on health and social outcomes (Bronfenbrenner & Morris, 1988; Campbell, Hesketh, & Davison, 2010; Elder et al., 2007; Fulkerson et al., 2015; Novilla, Barnes, De La Cruz, Williams, & Rogers, 2006; Valente, 2012).
This study contributes to the literature in several ways and emphasizes that peers and families are important sources of influence when it comes to healthy eating and choices of activities in young adolescents. Specifically, adolescents who reported a stronger connection with their family also engaged more frequently in physical activity than adolescents who reported lower familism. The benefits of targeting the family as part of lifestyle interventions are well established (Epstein, Paluch, Roemmich, & Beecher, 2007; Skelton, Buehler, Irby, & Grzywacz, 2012; St Jeor, Perumean-Chaney, Sigman-Grant, Williams, & Foreyt, 2002). The rationale underlying family-centered approaches is that modification of the youth’s environment is necessary to change and maintain children’s healthy habits. As a primary source of socialization, parents not only influence youths’ healthy lifestyle in providing access to resources and in modeling and reinforcing healthy habits, but they also provide the basis for the development of healthy peer relationships. Conceivably, stronger family connections may operate directly on young adolescents’ physical activity, but also indirectly in establishing the foundations for healthy peer relationships, which in turn promote healthier diet and a less sedentary lifestyle.
Furthermore, adolescents who reported higher PSF had a healthier diet and spent less time engagi ...
To accomplish community health goals and its aims the following approaches are to be utilized by community health professionals:-
1)persuasive approach 2)enforcement 3)team approach 4)community involvement 5)Intersectorial approach
For adventurous travel blog please visit http://wilsontom.blogspot.com
Gender Difference in Response to Preventative Health Careiowafoodandfitness
Luther College Students prepared the following community assessments as part of their Psychology of Health and Illness class in the Fall Semester 2008.
A Re-Introduction to Health Education and the knowledge in it
purpose
dimension
aspects
importance
The Change, its process and management
The Education Process
The Teaching Strategies
Reflective practice is the innovative way of learning through your own actions. This enhance the critical thinking abilities through forming strategies to overcome and prevent the same mistake happening again.
Literature ReviewA search was conducted using electronic database.docxssuser47f0be
Literature Review:
A search was conducted using electronic databases in the fields of nursing, medicine, education, psychology, and sociology. Using ProQuest Direct and EBSCO search engines, the following databases were accessed: CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE in PubMed, Ovid, and PsycINFO. The search terms were grouped in the following key concepts: (a) occupational stress in nursing, (b) stress perception in nursing, (c) occupational stressors in nursing, (d) nursing generational diversity, and (e) coping in nursing. In a commentary on patient safety in nursing practice from the Agency for Healthcare Research and Quality, Hughes and Clancy7 reported that complexity and bullying represent 2 clear examples of nurse stressors. Li and Lambert8 concluded that nurses who are more satisfied with their job are more likely to remain in the workforce and to be committed to delivering high-quality patient care. Hall9 found that healthcare professions have some unique characteristics leading to occupational stress including physical responsibility for people, potential catastrophic effects on the patient and the employee, frequent exposure to pain and suffering, and exposure to infectious diseases and potential hazardous substances. Hamaideh et al10 identified that death and dying were the strongest stressors perceived by Jordanian nurses. In this study, workload and guidance were found to be the most supportive behaviors provided to nurses facing stress followed by emotional support.10
Carver and Candela11 concluded that considering the global nursing shortage, managers should increase their knowledge of the generational diversity. It is suggested that understanding how to relate to multiple generations can lead to improved nursing work environments.11 Repar and Patton12 found that the combined effects of compassion fatigue, chronic grief, and emotional and physical exhaustion led to significant burnout and prolonged job dissatisfaction in the nursing profession. In this study, using guided sessions, a massage therapist gave 10-minute chair massages, and a visual, language, or musical artist engaged participants in imaginative and creative activities such as poetry reading, free writing, guided imagery, and listening to live music.12 The results suggest that the activities reduce some of the unpleasant, stressful, and tension-producing emotions that nurses typically experience at work, leaving them more peaceful and energized.12 Based on the findings of this review of the literature, it is recognized that stress is a major component of nursing and can be detrimental to nurse retention. In addition, most studies identified some differences that exist between the present generational nursing cohorts in terms of values and beliefs. No studies were identified reporting how work-related stress affects different generations of nurses, how the generations perceive stress, and what coping styles are used.
Study Des ...
Assessment 7 Course Textbook Edberg, M. (2015). Essentials .docxdavezstarr61655
Assessment 7
Course Textbook: Edberg, M. (2015). Essentials of health behavior: Social and behavioral theory in public health (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
Q.1 MUST BE ANSWERED ON SATURDAY, Mar. 10 NLT 10 PM EST (200 words A MUST for each question. Please provide reference for each question for each question. Keep them numbered.)
1. This unit provided the 10-step approach of putting a communication campaign together. Step 6 involves selecting the appropriate communication channels. Why would selecting the right channel or channels be so important? What would be some of the examples of those channels if you were trying to put a communication campaign together that was designed to increase awareness for young people about the need for physical exercise and better eating habits to address the problem of obesity?
2. What are some of the key components in the overall ecology of global health? Are these different from the ecological context for domestic health? If so, how? Please explain and provide supporting examples.
3. Does mobile technology and social media change the way communications theory can be applied? Or do these developments change the theory itself?
4. Imagine you are in charge of putting an anti-smoking communication campaign together (geared towards young adults) in your local community. Correctly identifying your target audience would be an important step. Who would be your target audience or audiences in this example? Are there any groups or sub-groups? Also, would you need to segment your audience in any way? Please address each of these questions and explain the overall importance of correctly identifying your target audience as part of your intended communication campaign.
Q.1 MUST BE ANSWERED ON SATURDAY, Mar. 10 NLT 10 PM EST (A PARAGRAPH ONLY)
Q. 1 Why is it important to specifically identify those individuals who are the most vulnerable in terms of getting a certain disease or diseases?
· Why do general or mainstream approaches typically not work on those high-risk populations or groups?
ARTICLE REVIEW (READ INSTRUCTIONS CAREFULLY AND PAY ATTENTION TO THE ITEM HIGHLIGHTED IN RED)
· MUST BE ANSWERED BY MONDAY, MAR. 12 NLT 10 PM EST
For this assignment, choose a peer-reviewed article to review. Use source that contains peer-reviewed articles, and find an article about a concept tied to the unit outcomes in this unit.
Write a three- to five-page review (not counting the cover page and references page) of the article that includes the following information:
Briefly introduce and summarize the article.
Identify the author’s main points.
Who is the author’s intended audience?
How does the article apply to this course? Does it support the information in your textbook?
How could the author expand on the main points?
The article must be no more than three years old. Use APA style when writing your review.
UNIT VII STUD.
Household survey as a tool for training medical students in measuring public ...Alim A-H Yacoub Lovers
Habib OS, Ajeel NAH, Yacoub AAH. Household surveys as a tool for training medical students in measuring population health. The Iraqi Journal of Community Medicine 2002; 15: 5-8.
Similar to Medical Self-care Education for Elders: A Controlled Trial to Evaluate Impact (20)
William Zubkoff is one of the very few individuals solely involved in active groundwork and practices in order to help people get appropriate healthcare.
Dr. William Zubkoff is a highly skilled and experienced cosmetic surgeon who has been performing successful procedures for over 20 years. He is double board certified by the American Board of Cosmetic Surgery and the American Board of Otolaryngology-Head and Neck Surgery. Dr. Zubkoff’s exceptional training, natural talent and artistic eye have helped him to become one of the top cosmetic surgeons in New York City.
William Zubkoff went on to study medicine at the State University of New York Downstate Medical Center, graduating with his M.D. degree in 1959. He did his internship and residency training in Internal Medicine at the Montefiore Hospital Medical Center in the Bronx, New York.
Dr. William Zubkoff joined the board of Plaza Health Network based in Miami FL, bringing added expertise in real estate and health care administration to the team.
Dr. William Zubkoff is one of the very few individuals solely involved in active groundwork and practices in order to help people get appropriate healthcare.
William zubkoff and his personal life & career.pdfWilliam Zubkoff
He was rewarded with grants and donations to support his endeavours towards improvement from various concerned public authorities as well as the universities and schools themselves to encourage his interest and hard work.
Apart from community service, Zubkoff is known for his catchy and impressive classes and guest lectures which he regularly carries out across the country. He also likes to take part in educational programs and seminars which are organised by renowned hospital associations. He is a regular at the educational programs and conferences arranged by the American Hospital Association and has been a faculty member for all their public health-related programs.
After serving as Chief of Staff at the Veterans Administration Medical Centre, Dr. Zubkoff did his Ph.D. in Medical care organization in the following year 1980. He completed his Ph.D. from the University Of Michigan School Of Public Health.
William Zubkoff Miami - CEO & President - Plaza Health Network William Zubkoff
Dr. William Zubkoff is one of the very few individuals solely involved in active groundwork and practices in order to help people get appropriate healthcare.
Dr. William Zubkoff is a highly educated and experienced professional who is known for his acts of community service and implementation of innovative and impressive measures to help improve the public health of various sectors within the State of Florida, especially in and around Miami.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Medical Self-care Education for Elders: A Controlled Trial to Evaluate Impact
1. Medical Self-care Education for Elders:
A Controlled Trial to Evaluate Impact
EUGENE C. NELSON, DSc, GREGORY MCHUGO, PHD, PAULA SCHNURR, BA, CAROLEE DEVITO, PHD,
ELLEN ROBERTS, MPH, JEANNETTE SIMMONS, DSC, AND WILLIAM ZUBKOFF, PHD
Abstract: We conducted a trial to evaluate the impact ofmedical
self-care education on 330 elders whose average age was 71. The test
group participated in a 13-session educational intervention with
training in clinical medicine, life-style, and use of health services.
The comparison group received a two-hour lecture-demonstration.
Both groups were assessed pre-intervention, post-intervention, and
one year after entry. The results indicate medical self-care instruc-
Introduction
One of the greatest challenges facing our nation is how
best to maintain the health and functional independence of
older adults at a reasonable cost. 12 Solutions proposed most
often emphasize an extension of the formal health and
welfare system. Somers, for example, argues for a new long-
term care policy based on an extension of Medicare benefits
and coordination of services at the community level.3 The
federal government and the Robert Wood Johnson Founda-
tion have launched major demonstrations to test the benefit
of changing the system.45
The emphasis on system change is logical, but fails to
recognize the potential for improving the capacity of individ-
uals for self-care. The role of self-care has gained wide
public recognition.-8 Self-care has been defined by profes-
sionals9"'0 and has received scrutiny in non-experimental
studies.' '-'3 This recognition has been accompanied by a
booming market in medical self-help books and a working
definition of self-care as "part of a matrix in the health care
process whereby lay persons can actively function for them-
selves and/or others to: 1) prevent, detect, or treat disease;
and 2) promote health so as to supplement or substitute for
other resources."'4 In addition, non-experimental studies
indicate that self-care, rather than physician consultation, is
the most common response to symptoms, accounting for 50
per cent to 90 per cent of actions taken to manage illness.'5
During the past decade, self-care also generated contro-
versy. Linn and Lewis surveyed 165 physicians and found
that a majority expressed negative attitudes toward self-
care.'6 Silver warns that promoting self-care may divert
attention away from the need to deliver essential services. '7
Few experimental studies have been conducted on
comprehensive self-care interventions. Exceptions include
studies by Kemper'8; Moore, LoGerfo, and Innui'9; Morell,
Avery, and Watkins20; Vickery, Kalmer, Lowry, Constan-
tine, et al2'; and Zapka and Averill.22 Three studies'8-20
indicate no substantial reduction in the total number of
physician visits, although rates for certain types of problems
From the Dartmouth Institute for Better Health, Department of Commu-
nity and Family Medicine and Department of Psychiatry, Dartmouth Medical
School; Department of Family Medicine, University of Miami School of
Medicine; and South Shore Hospital, Miami Beach, Florida. Address reprint
requests to Eugene C. Nelson, DSc, Vice Chairman, Community Medicine,
and Executive Director, Dartmouth Institute for Better Health, Dartmouth
Medical School, NH 03756. This paper, submitted to the Journal September 2,
1983, was revised and accepted for publication May 24, 1984.
C 1984 American Journal of Public Health 0090-0036/84$1.50
tion: produces substantial improvements, that were sustained for
one year, in health knowledge, skills performance, and skills confi-
dence; stimulates many attempts to improve life-style; and gener-
ates improvements in life quality. The program had little influence
on utilization of medical care or health status. (Am J Public Health
1984; 74:1357-1362.)
(e.g., upper respiratory infections, fever, and minor trauma)
do decline. One study2' showed a drop in total ambulatory
visits of 17 per cent in one of two health maintenance
organizations studied, but no decrease in the other. A study
of college students demonstrated that self-care education
can reduce visits for upper respiratory infections.22
Little information is available on the impact of self-care
programs designed specifically for the elderly. A small study
by Sehnert (n = 20) indicates that self-care education for
Medicare patients can improve the appropriateness of utili-
zation, boost knowledge, and increase skills, although self-
care subjects also increased their physician visits.23
Methods
Two communities in New Hampshire (Manchester and
Nashua) were selected as test and control communities,
respectively, to evaluate the Self-Care for Senior Citizens
(SCSC) program. These two communities are similar with
respect to cultural, social, and economic characteristics. The
full intervention and brieflecture-demonstration were adver-
tised to potential participants using identical techniques to
ensure that participants in both communities were similar
with respect to level of interest in self-care training. Pretest
interviews were conducted by trained research assistants
using a structured questionnaire. Posttest and follow-up data
were gathered three months and 12 months, respectively,
after the intervention.
Subjects
To be entered into the study, participants needed to be
60 years of age or older, consent to be interviewed three
times during a 12-month period, and indicate their intent to
participate in an educational experience.
The study group comprised 341 individuals who had
interviews available for analysis from either pretest, post-
test, or follow-up. Eleven of the 341 study group members
took the intervention but did not take the pretest. Posttest
interviews (at three months) were completed on 251 persons.
Follow-up interviews (at one year) were obtained for 241
individuals, producing a response rate of 71 per cent be-
tween intake and one-year follow-up.
Forty-three persons did not complete the full interven-
tion or lecture-demonstration: 24 participants in the test
community, and 19 persons from the control community.
Dropouts were compared to completers to assess biased
attrition on major pretest measures such as demographic
factors, health status, and medical and human service needs.
In expressing the results, we give the 95 per cent confidence
AJPH December 1984, Vol. 74, No. 12 1 357
2. NELSON, ET AL.
limits of the difference between group means in parentheses;
the difference itself is at the midpoint. The results of this
comparison indicate that, among both test and comparison
group subjects, the income of completers ($6,540) was
$1,744 higher than that of dropouts ($186-3302), and within
the comparison group dropouts were less likely to be living
with their spouse (24 per cent-46 per cent).
Intervention
The Self-Care for Senior Citizens (SCSC) program is a
self-care education program that consists of 13 two-hour
classes plus reinforcement learning activities. The sessions
are designed to promote active learning through group
discussion, skills training, role playing, and self-contracting.
The SCSC program is taught to groups of 15 to 25 persons by
an educational team. The team is trained during a three-day
workshop that emphasizes self-care philosophy, knowledge,
skills, and teaching techniques based on the fundamentals of
the learning process for older adults.
An integrated package of educational materials for both
the educators and the participants is used throughout the
program to ensure that the educational experience is com-
prehensive and consistent. The course is divided into three
content blocks: 1) Clinical Medicine focuses on acute illness-
es, chronic conditions, medications, and emergencies; 2)
Life-style addresses physical fitness, nutrition, and emotion-
al well-being; and 3) Independent Living concentrates on
appropriate use of health and human resources in the com-
munity and coordination of one's own health and welfare
needs. Reinforcement activities continue for one year after
the course is finished.
A lecture-demonstration was given in the control com-
munity, addressing two topics: foot care and hypertension.
It was taught by local health professionals who received no
special instruction on philosophy or content of self-care or
on teaching methods that tend to be effective when educating
older persons. No follow-up education activities were sched-
uled. Participants in the control community did not know
that they were serving as a comparison group, but they were
informed that they would be eligible to enroll in a self-care
course to be conducted one year later.
No tuition was charged, although most persons in the
test community did purchase the educational materials: The
Family Medical Handbook24 and the Dartmouth Self-Care
Planner.25
Data Collection and Analysis
Interviews were conducted by trained interviewers and
averaged one and one-quarter hours. The list of variables
measured is shown in the Appendix. A brief skills perform-
ance test was conducted at time of posttest and follow-up.
The analysis addressed three questions:
* Prior Status: Are there pretreatment differences be-
tween the test and comparison groups?
* Direct Program Impact: Does the self-care interven-
tion cause immediate changes in self-care knowledge,
skills, attitudes, and life-style? If so, do they persist
over time?
* Longer-Term Outcomes: Are there important, longer-
term differences between the test and comparison
groups on indirect outcomes-utilization, health sta-
tus, and life quality-after adjusting for pre-program
differences?
The first question was answered using variables from
three domains-demographic characteristics, health
status, and medical and social service needs-collect-
ed at intake. Direct program impact was evaluated
using analysis ofcovariance on posttest and follow-up
levels to detect immediate change and durability of
effects. The answer to the third question was obtained
by using analysis of covariance to compare test and
comparison groups at the one-year follow-up on a set
of variables that were hypothesized to have been
affected indirectly by the program.
The statistical methods used to assess differences be-
tween the groups were standard parametric techniques for
continuous variables. In general, univariate analysis of vari-
ance and analysis ofcovariance were used. In the latter case,
pretest status on the dependent variable served as the
covariate. The discrete variables were analyzed using con-
tingency table analysis.
Methodological Limitations
Subjects were not randomly assigned to groups. A
randomized trial design was discussed initially with the
health and social service professionals who were needed to
cosponsor the intervention. They indicated that their organi-
zations would not be willing to support a program in their
community if random assignment were used, and that it
would be impossible to avoid contamination since many
persons assigned to the test group would be closely associat-
ed with friends and relatives in the comparison group.
Because self-report data were gathered, a second limitation
is the possibility that some of the differences observed
(except for self-care skills and knowledge) were produced by
the demand characteristics of the interview situation.
Results
Prior Status: Test versus Comparison Group
Table 1 shows that the test group (n = 204) and
comparison groups (n = 126) were similar before the inter-
vention with respect to most demographic, health status, and
formal support need variables. About four-fifths of both
groups were females with lower incomes and some high
school education. The test group was somewhat younger
(0.99 to 3.95 years) than the comparison group and less likely
to be widowed (4 per cent to 26 per cent). Both groups had
few functional health limitations and low rates of social
dependence, perceived their health as "good," and had few
concerns about health care. Although test and comparison
groups were functioning well and independently, they re-
ported a substantial number of chronic conditions, e.g.,
hypertension (46 per cent), hearing impairments (33 per
cent), permanent stiffness (33 per cent), angina (24 per cent);
diabetes (15 per cent), myocardial infarction (8 per cent),
stroke (7 per cent).
These analyses suggest that the two groups were com-
parable. Furthermore, since age was weakly correlated with
measures of program impact, including age as a covariate in
the analysis of program impact would have little effect.
Skills and Knowledge (Table 2)
Participants in the SCSC program registered greater
gains on a direct test of skills performance at posttest (0.69-
1.51), and were more confident that they could execute self-
care tasks (0.3-0.5). The favorable gains achieved by the test
group did not deteriorate substantially as time passed. The
test group performed substantially better than the compari-
son group on two (of six) individual skills performance tests
at posttest (pulse and Heimlich maneuver), and on four of six
at follow-up (pulse, Heimlich maneuver, swollen glands
AJPH December 1984, Vol. 74, No. 12
1358
3. MEDICAL SELF-CARE EDUCATION FOR ELDERS
TABLE 1-Demographic Characteristics, Health Status, and Formal Support Needs at Pretest by Test and
Comparison Groups
Pretest
Descriptive Variables Test Comparison
Group (N = 204) Group (N = 126)
Demographics
Sex (% Female) 83 77
Age (Mean Years) 69.7 72.4
Income (Mean Family) $6190 $6470
Education (Mean Years) 10.4 10.6
Marital Status (% Widowed) 39 54
Household (Number of Persons) 1.75 1.74
Health Status
Functional Health (Mean Score)
(6 = Excellent Function) 4.5 4.5
Health Rating (Mean Score)
(4 = Excellent Health) 3.0 3.1
Bothersome Health Problems (Mean Number) 1.1 1.2
Personal Support Needs
Daily Activities Dependence (Mean Score)
(3 = High Dependency) .11 .15
Get Enough Health Care: % "Yes" 96 94
Worry about Getting Health Care: % "No" 81 81
check, and throat examination). The level of mastery at-
tained by cases on individual skills was highly variable,
ranging from 71 per cent able to read a clinical thermometer
within one degree to 9 per cent able to completely check for
swollen glands.
Life-style Change (Table 3)
The average number of change attempts per person
among those individuals making an attempt was 2.3 for the
test group compared to only 1.3 for the comparison group
(0.57-1.43). The facets of life-style that were most often the
subject of short-run change attempts were, in rank order,
weight loss (12-36 per cent), nutrition (21-45 per cent),
physical fitness (8-32 per cent), and tension reduction (12-36
per cent). There was no substantial difference in self-report-
ed success between groups; a substantial proportion of both
groups rated their life-style change attempts as "very suc-
cessful."
The overall difference between groups on life-style
change attempts diminished over the longer run. Among
those who had rated their success at life-style change
attempts to be low at the posttest, however, test subjects
reported a greater number of attempts at the follow-up than
did comparison persons (0.52-1.56); there was little differ-
ence between groups among individuals who had rated their
success high at posttest. Also, at the follow-up, program
participants reported more attempts to improve nutrition (8-
34 per cent). There was also a difference between groups in
attempts to lose weight (0-26 per cent) and stay physically fit
(1-27 per cent).
Problem-Solving Behavior (Table 4)
The self-care intervention changed problem-solving be-
havior by promoting use of a reputable self-care book.* At
one year follow-up, program graduates were much more
likely to own a self-care book (45-63 per cent) and use it.
When asked, "How do you initially solve a medical prob-
lem?", 35 per cent ofthe test group, in contrast to only 8 per
*Ownership and use of reference materials to aid effective decision-
making can be beneficial. The SCSC program encouraged the purchase and
use of a reputable self-care book. These results, shown in Table 4, should not
be viewed as pure outcomes, since they were promoted by the intervention.
They are, nevertheless, important findings.
TABLE 2-Impact of Program on Self-Care Skills and Health Knowledge at Three-Month Posttest and One-
Year Follow-up by Test and Comparison Groups
Three-month Posttest One-year Follow-up
Test Comparison Test Comparison
Skill and Knowledge Variables Group (N = 147) Group (N = 104) Group (N = 150) Group (N = 91)
Skills Indices
Skills Performance Index (Mean Score)
(10 = Excellent Performance)1 5.7 4.6 4.9 4.3
Skills Confidence Index (Mean Score)
(10 = Very Confident)2 9.3 8.9 9.3 9.1
Knowledge Index
Health Knowledge Index (Mean Score)
(10 = Excellent Knowledge)3 6.4 5.8 7.1 5.8
'Range on Skills Performance Index is 0-10.
2Range on Skills Confidence Index is 8-10.
3Range on Health Knowledge Index is 1-10.
AJPH December 1984, Vol. 74, No. 12 1 359
4. NELSON, ET AL.
TABLE 3-Impact of Program on Life-style Change Attempts and Perceived Success at Three-Month Posttest and One-Year Follow-up by Test and
Comparison Groups
Three-month Posttest One-year Follow-up
Test Comparison Test Comparison
Life-style Variables Group (N = 147) Group (N = 104) Group (N = 150) Group (N = 91)
Overall Attempts
Life-style Change Attempts (% of Persons At-
tempting Change) 86 58 52 46
Ufe-style Change Attempts (Average Number
per Person) 2.3 1.3 1.7 1.4
Individual Type of Attempts and Success (%)
Physical Fitness % % % %
Attempts 51 31 47 37
Success 43 47 39 50
Weight Loss
Attempts 56 32 50 37
Success 28 36 27 39
Nutrition
Attempts 55 22 48 27
Success 53 59 49 65
Tension Reduction
Attempts 45 21 35 25
Success 37 26 38 40
cent of the comparison group, responded that they first refer
to their self-care book (16-38 per cent).
Attitudes
One important shift in attitudes, i.e., self-rated ability to
communicate with physicians, was observed. At follow-up,
84 per cent of the test group, compared to 41 per cent of the
comparison group, believed they could communicate more
effectively with their physician (30-56 per cent). The pro-
gram did not stimulate attitudinal change in other dimensions
measured.
Utilization
There were no differences between groups on physician
visits or hospital stays at follow-up (Table 5). The interven-
tion group tended to use formal health and social agencies
more intensively (0.43-1.77 episodes per year), but both
groups had relationships with a comparable number of
agencies (2.0 vs 1.6 agency relationships).
Health Status and Life Quality
Table 6 indicates that the program had no measurable
influence on four standard health status indicators-func-
tional health, general health, emotional health, or disability
days. Both groups started out at high levels of health and
maintained them over the year of observation.
The self-care intervention did seem to have a favorable
effect on two measures of life quality. First, quality and
quantity of social activities was better for test subjects at
follow-up (social interaction scale: 1.5 vs 1.6 (0-0.2). This
was mostly due to gains registered among persons who had
lower levels at pretest (0.07-0.93). There was little overall
difference between groups on the second measure of life
quality; when we controlled for pretest level, however, test
group participants who had lower baseline values scored
better one year later than their counterparts in the compari-
son group (0-2.4 on life quality ratings).
Discussion
The intervention produced substantial improvement
that was sustained for one year in health knowledge, the
performance of self-care skills, use of a home treatment
book, confidence in skills performance, and the belief that
communication with one's personal physician had improved.
It stimulated a great number of attempts to change health
habits related to physical fitness, nutrition, weight control,
TABLE 4-Impact of Program on Medical Problem-solving at One-year Follow-up by Test and Comparison
Groups
One-year Follow-up
Test Comparison
Problem Solving Variables Group (N = 150) Group (N = 91)
Self-care Book (% Possessing) 93 39
Self-Care Book (Average Number of Uses
Past Four Weeks) 5.0 2.9
Self-Care Book (Median Number Uses Past
Four Weeks) 2.0 1.0
Problem-solving Approach'
How Solve Medical Problem (% Using Self-
Care Book Initially) 35 8
1) "Problem-Solving Approach" was assessed by response to this question: "How do you initially prefer to solve a minor medical
problem?" The response categories were: a) contact a doctor; b) use a self-care medical book; or c) other, e.g., discuss it with family or
friends.
AJPH December 1984, Vol. 74, No. 12
1360
5. MEDICAL SELF-CARE EDUCATION FOR ELDERS
TABLE 5-Utilization Differences after One Year by Test and Comparison Groups
One-year Follow-up
Test Comparison
Utilization Variables Group (N = 150) Group (N = 91)
Physician Visits (Average No. Past Year) 5.6 5.1
Hospital Stays (% One Or More Past Year) 21 20
Health and Social Agency Use Episodes2
(Average Number Past Year) 2.8 1.7
Health and Social Agency Relationships
(Total Number of Different Agencies Contacted
Past Year) 2.0 1.6
1) "Physician Visits" estimated based on self-report of total number of encounters with physician during past four weeks.
2) "Health and Social Agency" refers to community-based programs such as health departments, visiting nurse associations, health
promotion centers, housing authority, nutrition centers, etc. It excludes facilities such as physicians' offices, hospitals, pharmacies, and
nursing homes.
and stress management. The program also provided a boost
in the quality of life among persons who were in need of
enhanced social support.
These are all favorable outcomes. Nevertheless, there
were no changes in two "bottom line" measures of impact-
medical care utilization and health status. The net level of
physician visits was not influenced by the program-both
test and comparison groups averaged slightly over five visits
per person per year. All the health status measures had high
values at pretest and did not improve or decline.
We did not anticipate a major change in health status
during only one year of observation. Most study subjects
enjoyed good health and, since participation was voluntary,
were likely to be more health-oriented than the general
population. These factors diminish the likelihood of observ-
ing gains in health status.
The results on number of physician visits are discourag-
ing but not altogether surprising. First, other studies have
generated mixed findings.1'823 Second, a utilization effect
might be expected to be greatest for acute problem visits that
are patient-initiated and more common among younger per-
sons in contrast to chronic problem visits that are primarily
physician-directed and predominate among older persons.
Third, the intervention only involved self-care education
directed at the. patient and was not fortified with further
incentives involving either the source of care or payment
mechanisms. Fourth, the absence of change in volume of
physicians visits does not rule out the possibility that medi-
cal self-management and the appropriateness of utilization
(i.e., rate of visits for conditions that cannot be safely and
effectively managed by self-care) improved.**
The subjects in this study all volunteered for the pro-
gram and, therefore, are not necessarily similar to the
population of elderly living independently in the community.
We compared the study population with a national sample of
non-institutionalized persons age 65 years of age and older
**For example, persons in need of physician-directed chronic disease
care could have increased utilization; this would drive visits per person up. On
the other hand, rates of visits for self-limited conditions or for reassurance
purposes could have decreased, which would decrease visit rates. These
changes could offset one another and result in no net change in physician
visits. Appropriateness of utilization cannot be assessed adequately using
patient-reported information as the sole source of data. Further research
incorporating the physician's ratings on need for care is required to gauge
appropriateness of utilization.
TABLE 6-Health Status and Life Quality after One Year by Test and Comparison Groups
One-year Follow-up
Test Comparison
Health Status and Life Quality Variables Group (N = 150) Group (N = 91)
HEALTH STATUS
Functional Health (Mean Score)
(6 = Excellent Function) 4.4 4.4
Health Rating (Mean Score)
(4 = Excellent Health) 3.0 3.1
Emotional Health Rating (Mean Score)
(4 = Excellent Health) 3.4 3.5
Bed Disability Days (Mean Number Past
Four Weeks) 1.2 1.5
LIFE QUALITY
Social Interaction Scale (Mean Score)
(1.1 = High Interaction)' 1.5 1.6
Pretest Score = Low Interaction 1.7 2.2
= Moderate Interaction 1.5 1.5
= High Interaction 1.4 1.4
Life Quality Rating (Mean Score)
(10 = High Quality) 8.4 8.4
Pretest Rating = Low Quality 7.6 6.4
= Average Quality 8.4 8.5
= High Quality 9.0 9.2
'Range on Social Interaction Scale is 1.1-4.2 with low values indicating higher levels of social interaction.
AJPH December 1984, Vol. 74, No. 12 1361
6. NELSON, ET AL.
(from the National Health Interview Survey)26,27 on selected
health status and utilization variables and found that the
study group is similar to the nation's elderly on utilization
measures (5.6 vs 6.3 physician visits per person per year)
and on persons with one or more hospital stays in the past
year (21 per cent vs 18 per cent). The respective values for
health status measures were 3.0 vs 2.9 for mean score on
self-assessed health status (excellent = 4), and 1.4 vs 1.2 bed
disability days per person per month. Thus, although the
study group may have been more motivated to learn about
self-care because they volunteered for the program, their
health status patterns seem similar to those of the general
population.
It was easy to attract persons to register for the SCSC
program and 87 per cent completed the entire program.
Many graduates subsequently entered spin-off educational
or self-help pfograms on various topics such as fitness,
weight loss, cardiopulmonary resuscitation, and spiritual
self-help.
We have shown that it is possible to educate older
persons about self-care, and that the skills and knowledge
thereby acquired do not deteriorate substantially within the
year following training. More importantly, we have also
shown that elders trained in self-care are likely to attempt
changing behaviors, such as eating and exercise patterns,
that have long-run implications for improving health status.
In addition, the data also suggest that individuals who
interact less frequently with others, and those who tend to
rate the quality of their life as somewhat low, are likely to
improve on these dimensions as a consequence of a self-care
education program with active participant involvement.
Many older people are eager to learn ways to maintain
their independence and self-esteem. Medical self-care repre-
sents one strategy that merits further study to determine its
potential for enabling elders to feel better and live longer,
and to conserve health and social service resources.
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ACKNOWLEDGMENT
This study was funded by a grant from the Department of Health and
Human Services, Administration on Aging, Grant #90-AR-1949.
APPENDIX
Major Study Variables
Demographics Personal Support Needs Life-style
Sex (1)* Personal Care (2) Life-style Change Attempts: Type and Number
Age (1) Mobility (2) (7)
Family Income Home Management (4) Success at Life-Style Change: Perceived Level
Education (1) Transportation (6) of Success (7)
Marital Status (1) Skills and Knowledge Smoking Practices (2)
Number of Persons in Household (1) Self-care Skills Performance Index (6) Alcohol Use (1)
Health Status Self-care Confidence Index (1 1) Utilization of Health and Social Services
Elderly Functional Health Scale (6) Medical Problem Solving (10) Physician Visits (1)
Health Rating: Perceived Physical Health (1) Health Knowledge Index (10) Medical Provider Visits (1)
Emotional Health Rating: Perceived Mental Attitudes and Beliefs Hospital Stays (1)
Health (1) Satisfaction with Personal Physician (6) Nursing Home Stays (1)
Bothersome Health Problems: Type and Num- Control over Health (6) Health and Social Agency Use (24)
ber (2) Unmet Medical Care and Social Service Needs Life Quality
Bed Disability Days Past Four Weeks (1) (6) Social Interaction Scale for the Elderly: Number
Chronic Conditions (13) and Quality (8)f
Life Quality Rating (2)
Numbers in parentheses indicate the number of items used to measure variable or to construct scale.
tSOURCE: See reference 28. tSOURCE: See reference 29.