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Health Goals (health + goal)
Kinds of Health Goals Selected AbstractsChanging Dentate Status of Adults, Use of Dental Health Services, and Achievement of National Dental Health Goals in Denmark by the Year 2000JOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2004DrOdontSci, MSc (Sociology);, Poul Erik Petersen DDS ABSTRACT Objectives: This study analyzes the current profile of dentate status and use of dental health services among adults in Denmark at the turn of the millennium, assesses the impact on dentate status of sociodemographic factors and use of dental health services in adulthood and in childhood, and highlights the changes over time in dental health conditions among adults. Finally, the intention of the study was to evaluate the Danish dental health care system's level of achievement of the official goals for the year 2000 as formulated by the World Health Organization and the National Board of Health. The subjects of this study included a national representative sample of 16,690 Danish citizens aged 16 years and older (response rate=74.2%). A subsample (n=3,818) took part in a survey of dental care habits in childhood and prevalence of removable dentures; 66 percent of persons selected responded. Methods: Personal interviews were used to collect information on dentate status, use of dental health services and living conditions; data on dental care habits in childhood and prevalence of removable dentures were collected by self-administered questionnaires. Results: In all, 8 percent of interviewed persons were edentulous, while 80 percent had 20 or more natural teeth. At age 65,74 years, 27 percent were edentulous and 40 percent had 20 teeth or more; 58 percent wore removable dentures. Dentate status and prevalence of dentures were highly related to educational background and income, particularly for older age groups. Among persons interviewed, 80 percent paid regular dental visits and visits were most frequent among persons of high education and income. At age 35,44 years 95 percent had participated in regular dental care in childhood compared to 49 percent of 65,74-year-olds. Multivariate analyses revealed that sociobehavioral factors had significant effects on dentate status. Conclusions: Compared to similar studies carried out in 1987 and 1994, the present survey indicates a positive trend of improved dentate status in adult Danes in general and regular use of dental health services increased considerably over time. The WHO goals for better dental health by the year 2000 were achieved for 35,44-year-olds, whereas the goal of more people with functional dentitions at age 65 years or older was not achieved. It remains a challenge to the Danish dental health system to help even out the social inequalities in dental health. [source] Risk factors and outcome in ambulatory assault victims presenting to the acute emergency department setting: Implications for secondary prevention studies in PTSDDEPRESSION AND ANXIETY, Issue 2 2004Peter P. Roy-Byrne M.D. Abstract Prevention of post-traumatic stress disorder (PTSD) in trauma victims is an important public health goal. Planning for the studies required to validate prevention strategies requires identification of subjects at high risk and recruitment of unbiased samples that represent the larger high-risk population (difficult because of the avoidance of many trauma victims). This study recruited high-risk victims of interpersonal violence (sexual or physical assault) presenting to an urban emergency department for prospective 1- and 3-month follow-up. Of 546 victims who were approached about participating, only 56 agreed to be contacted and only 46 participated in either the 1- or 3-month interviews. Of the 46, 43 had been previously victimized with a mean of over six traumas in the group; 21% had prior PTSD, 85% had prior psychiatric illness, and 37% had prior substance abuse. Sixty-seven percent had positive urine for alcohol or drugs on presentation. Fifty-six percent developed PTSD at 1 or 3 months with the rate declining between 1 and 3 months. There was high use of medical and psychiatric services. These findings document both the difficulty of recruiting large samples of high-risk assault victims to participate in research, and the high rate of prior traumatization, PTSD, substance use, and psychiatric morbidity in these subjects which, if still active at the time of victimization, may complicate efforts to document preventive treatment effects. Depression and Anxiety 19:77,84, 2004. © 2004 Wiley-Liss, Inc. [source] Increasing Dietary Protein Requirements in Elderly People for Optimal Muscle and Bone HealthJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2009Erin Gaffney-Stomberg MS Osteoporosis and sarcopenia are degenerative diseases frequently associated with aging. The loss of bone and muscle results in significant morbidity, so preventing or attenuating osteoporosis and sarcopenia is an important public health goal. Dietary protein is crucial for development of bone and muscle, and recent evidence suggests that increasing dietary protein above the current Recommended Dietary Allowance (RDA) may help maintain bone and muscle mass in older individuals. Several epidemiological and clinical studies point to a salutary effect of protein intakes above the current RDA (0.8 g/kg per day) for adults aged 19 and older. There is evidence that the anabolic response of muscle to dietary protein is attenuated in elderly people, and as a result, the amount of protein needed to achieve anabolism is greater. Dietary protein also increases circulating insulin-like growth factor, which has anabolic effects on muscle and bone. Furthermore, increasing dietary protein increases calcium absorption, which could be anabolic for bone. Available evidence supports a beneficial effect of short-term protein intakes up to 1.6 to 1.8 g/kg per day, although long-term studies are needed to show safety and efficacy. Future studies should employ functional measures indicative of protein adequacy, as well as measures of muscle protein synthesis and maintenance of muscle and bone tissue, to determine the optimal level of dietary protein. Given the available data, increasing the RDA for older individuals to 1.0 to 1.2 g/kg per day would maintain normal calcium metabolism and nitrogen balance without affecting renal function and may represent a compromise while longer-term protein supplement trials are pending. J Am Geriatr Soc 57:1073,1079, 2009. [source] Tooth loss and prosthodontic rehabilitation among 35- to 44-year-old IraniansJOURNAL OF ORAL REHABILITATION, Issue 4 2008H. HESSARI Summary, This study aimed to investigate the frequency of tooth loss and the magnitude of prosthodontic rehabilitation based on socio-demographic information among 35- to 44-year-old Iranians. Data (n = 8240) were collected by 33 examiners as part of a national survey using WHO criteria for sampling and clinical diagnosis. Gender, age, place of residence and level of education served as socio-demographic information. The number of teeth, functional dentition (subjects with 20 or more teeth) and prosthodontic rehabilitation were used as clinical variables. The chi-square test and logistic regression analysis were the methods of statistical evaluation. Of all subjects, 3% were edentulous. Of dentate subjects, 3% had 1,9 teeth, 21% had 10,19 teeth, 37% had 20,24 teeth and 39% had 25,28 teeth. In total, 76% of dentate subjects enjoyed a functional dentition. Among dentate subjects, 11% of the men and 16% of the women had prosthodontic rehabilitation with higher figures (P < 0·001) among women, older subjects and urban residents. Having a functional dentition was more likely among those with higher levels of education [odds ratios (OR) = 1·8, 95% confidence intervals (CI) = 1·6,2·1]. Women (OR = 2·4, 95% CI = 1·8,3·0) and urban residents (OR = 2·4, 95% CI = 1·8,3·3) were the most likely groups to have prosthodontic rehabilitation. Having prosthodontic rehabilitation was more likely among those lacking a functional dentition (OR = 6·0, 95% CI = 4·8,7·6). The greatest unmet treatment needs were found among those without a functional dentition. Functional dentition should be set as a primary oral health goal among working-age adults. [source] Effect of oleocanthal and its derivatives on inflammatory response induced by lipopolysaccharide in a murine chondrocyte cell lineARTHRITIS & RHEUMATISM, Issue 6 2010Anna Iacono Objective In joint diseases, cartilage homeostasis is disrupted by mechanisms that are driven by combinations of biologic factors that vary according to the disease process. In osteoarthritis (OA), biomechanical stimuli predominate, with up-regulation of both catabolic and anabolic factors. Likewise, OA progression is characterized by increased nitric oxide (NO) production, which has been associated with cartilage degradation. Given the relevance of cartilage degenerative diseases in our society, the development of a novel pharmacologic intervention is a critically important public health goal. Recently, oleocanthal isolated from extra virgin olive oil was found to display nonsteroidal antiinflammatory drug activity similar to that of ibuprofen, a drug widely used in the therapeutic management of joint inflammatory diseases. We undertook this study to evaluate the effect of oleocanthal and its derivatives on the modulation of NO production in chondrocytes. Methods Cultured ATDC-5 chondrocytes were tested with different doses of oleocanthal and its derivatives. Cell viability was evaluated using the MTT assay. Nitrite accumulation was determined in culture supernatant using the Griess reaction. Inducible NO synthase (NOS2) protein expression was examined using Western blotting analysis. Results Oleocanthal and its derivatives decreased lipopolysaccharide-induced NOS2 synthesis in chondrocytes without significantly affecting cell viability at lower concentrations. Among the derivatives we examined, derivative 231 was the most interesting, since its inhibitory effect on NOS2 was devoid of cytotoxicity even at higher concentrations. Conclusion This class of molecules shows potential as a therapeutic weapon for the treatment of inflammatory degenerative joint diseases. [source] The Cannabis Use Problems Identification Test (CUPIT): development, reliability, concurrent and predictive validity among adolescents and adultsADDICTION, Issue 4 2010Jan Bashford ABSTRACT Aims To describe the empirical construction and initial validation of the Cannabis Use Problems Identification Test (CUPIT), a brief self-report screening instrument for detection of currently and potentially problematic cannabis use. Design In a three-phase prospective design an item pool of candidate questions was generated from a literature review and extensive expert consultation. The CUPIT internal structure, cross-sectional and longitudinal psychometric properties were then systematically tested among heterogeneous past-year users. Participants Volunteer participants were 212 high-risk adolescents (n = 138) and adults (n = 74) aged 13,61 years from multiple community settings. Measurements The comprehensive assessment battery included several established measures of cannabis-related pathology for CUPIT validation, with DSM-IV/ICD-10 diagnoses of cannabis use disorders as criterion standard. Findings Sixteen items loading highly on two subscales derived from principal components analysis exhibited good to excellent test,retest (0.89,0.99) and internal consistency reliability (0.92, 0.83), and highly significant ability to discriminate diagnostic subgroups along the severity continuum (non-problematic, risky, problematic use). Twelve months later, baseline CUPIT scores demonstrated highly significant longitudinal predictive utility for respondents' follow-up diagnostic group membership. Receiver operating characteristic (ROC) analysis identified a CUPIT score of 12 to be the optimal cut-point for maximizing sensitivity for both currently diagnosable cannabis use disorder and those at risk of meeting diagnostic criteria in the following 12 months. Conclusions The CUPIT is a brief cannabis screener that is reliable, valid and acceptable for use across diverse community settings and consumers of all ages. The CUPIT has clear potential to assist with achievement of public health goals to reduce cannabis-related harms in the community. [source] The Impact of Welfare Reform on Insurance Coverage before Pregnancy and the Timing of Prenatal Care InitiationHEALTH SERVICES RESEARCH, Issue 4 2007Norma I. Gavin Objective. This study investigates the impact of welfare reform on insurance coverage before pregnancy and on first-trimester initiation of prenatal care (PNC) among pregnant women eligible for Medicaid under welfare-related eligibility criteria. Data Sources. We used pooled data from the Pregnancy Risk Assessment Monitoring System for eight states (AL, FL, ME, NY, OK, SC, WA, and WV) from 1996 through 1999. Study Design. We estimated a two-part logistic model of insurance coverage before pregnancy and first-trimester PNC initiation. The impact of welfare reform on insurance coverage before pregnancy was measured by marginal effects computed from coefficients of an interaction term for the postreform period and welfare-related eligibility and on PNC initiation by the same interaction term and the coefficients of insurance coverage adjusted for potential simultaneous equation bias. We compared the estimates from this model with results from simple logistic, ordinary least squares, and two-stage least squares models. Principal Findings. Welfare reform had a significant negative impact on Medicaid coverage before pregnancy among welfare-related Medicaid eligibles. This drop resulted in a small decline in their first-trimester PNC initiation. Enrollment in Medicaid before pregnancy was independent of the decision to initiate PNC, and estimates of the effect of a reduction in Medicaid coverage before pregnancy on PNC initiation were consistent over the single- and two-stage models. Effects of private coverage were mixed. Welfare reform had no impact on first-trimester PNC beyond that from reduced Medicaid coverage in the pooled regression but separate state-specific regressions suggest additional effects from time and income constraints induced by welfare reform may have occurred in some states. Conclusions. Welfare reform had significant adverse effects on insurance coverage and first-trimester PNC initiation among our nation's poorest women of childbearing age. Improved outreach and insurance options for these women are needed to meet national health goals. [source] Tuberculosis control and managed competition in ColombiaINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue S1 2004Maria Patricia Arbelaez Abstract Law 100 introduced the Health Sector Reform in Colombia, a model of managed competition. This article addresses the effects of this model in terms of output and outcomes of TB control. Trends in main TB control indicators were analysed using secondary data sources, and 25 interviews were done with key informants from public and private insurers and provider institutions, and from the health directorate level. We found a deterioration in the performance of TB control: a decreasing number of BCG vaccine doses applied, a reduction in case finding and contacts identification, low cure rates and an increasing loss of follow up, which mainly affects poor people. Fragmentation occurred as the atomization and discontinuity of the technical processes took place, there was a lack of coordination, as well as a breakdown between individual and collective interventions, and the health information system began to disintegrate. The introduction of the Managed Competition (MC) in Colombia appeared to have adverse effects on TB control due to the dominance of the economic rationality in the health system and the weak state stewardship. Our recommendations are to restructure the reform's public health component, strengthen the technical capacity in public health of the state, mainly at the local and departmental levels, and to improve the health information system by reorienting its objectives to public health goals. Copyright © 2004 John Wiley & Sons, Ltd. [source] Can paying for results help to achieve the Millennium Development Goals?JOURNAL OF EVIDENCE BASED MEDICINE, Issue 2 2009Overview of the effectiveness of results-based financing Abstract Objective Results-based financing and pay-for-performance refer to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. Results-based financing is widely advocated for achieving health goals, including the Millennium Development Goals. Methods We undertook an overview of systematic reviews of the effectiveness of RBF. We searched the Cochrane Library, EMBASE, and MEDLINE (up to August 2007). We also searched for related articles in PubMed, checked the reference lists of retrieved articles, and contacted key informants. We included reviews with a methods section that addressed the effects of any results-based financing in the health sector targeted at patients, providers, organizations, or governments. We summarized the characteristics and findings of each review using a structured format. Results We found 12 systematic reviews that met our inclusion criteria. Based on the findings of these reviews, financial incentives targeting recipients of health care and individual healthcare professionals are effective in the short run for simple and distinct, well-defined behavioral goals. There is less evidence that financial incentives can sustain long-term changes. Conditional cash transfers to poor and disadvantaged groups in Latin America are effective at increasing the uptake of some preventive services. There is otherwise very limited evidence of the effects of results-based financing in low- or middle-income countries. Results-based financing can have undesirable effects, including motivating unintended behaviors, distortions (ignoring important tasks that are not rewarded with incentives), gaming (improving or cheating on reporting rather than improving performance), widening the resource gap between rich and poor, and dependency on financial incentives. Conclusion There is limited evidence of the effectiveness of results-based financing and almost no evidence of the cost-effectiveness of results-based financing. Based on the available evidence and likely mechanisms through which financial incentives work, they are more likely to influence discrete individual behaviors in the short run and less likely to create sustained changes. [source] Medical ethics contributes to clinical management: teaching medical students to engage patients as moral agentsMEDICAL EDUCATION, Issue 3 2009Catherine V Caldicott Objectives, In order to teach medical students to engage more fully with patients, we offer ethics education as a tool to assist in the management of patient health issues. Methods, We propose that many dilemmas in clinical medicine would benefit by having the doctor embark on an iterative reasoning process with the patient. Such a process acknowledges and engages the patient as a moral agent. We recommend employing Kant's ethic of respect and a more inclusive definition of patient autonomy drawn from philosophy and clinical medicine, rather than simply presenting dichotomous choices to patients, which represents a common, but often suboptimal, means of approaching both medical and moral concerns. Discussion, We describe how more nuanced teaching about the ethics of the doctor,patient relationship might fit into the medical curriculum and offer practical suggestions for implementing a more respectful, morally engaged relationship with patients that should assist them to achieve meaningful health goals. [source] Parish Nursing: Nurturing Body, Mind, Spirit, and CommunityPUBLIC HEALTH NURSING, Issue 2 2003Ingrid Brudenell R.N., Ph.D. Abstract Parish nursing is a model of nursing care that focuses on health promotion and disease prevention within a faith community. A descriptive study was conducted in the intermountain West to determine how faith communities form parish nursing programs and what their effect is. Thirteen congregations representing eight denominations with parish nurse/health ministries participated. Parish nurses, parish nurse coordinators from two medical centers, pastors, and hospital chaplains (n = 24) were interviewed and provided documents from their programs. Over time, congregations formed parish nursing/health ministries using strategies in a developmental process. The process involved significant support from the pastor, congregation members, and the parish nurses. Collaboration between faith communities and health organizations were successful using a limited domain approach to attain specific health goals. Parish nursing is making a contribution to integrating faith and health practices, promoting health, and increasing accessibility to health care and congregational activities. Conclusions and recommendations are included for future research, practice, and education. [source] Cost-effective Targeting of Riparian BuffersCANADIAN JOURNAL OF AGRICULTURAL ECONOMICS, Issue 1 2004Wanhong Yang This paper develops an integrated economic, hydrologic and GIS modeling framework to examine the cost-effective targeting of land retirement for establishing riparian buffers in agricultural watersheds. Previous studies have examined the efficiency of targeting large land parcels for retirement or targeting management practices such as conservation tillage but have not considered narrow variable buffer strips. An empirical application of the framework in the Canagagigue Creek watershed in Ontario shows that average and marginal costs of sediment abatement increase at an increasing rate as the environmental goal becomes more stringent. The locations of the buffer strips vary across the watershed and are not necessarily located on those sites with greatest slope or those adjacent to visible streams. Cost effectiveness is further increased if the targeting is extended to allow for the width of the buffer strip to vary by location rather than assume a uniform width. The modeling results have important policy implications for the design of conservation stewardship programs such as setting appropriate environmental health goals based on marginal abatement costs relative to marginal benefits, and setting physical characteristics of the riparian buffers for selection along the drainage network in targeted sub-catchments. L'auteur propose un modèle intégrant l'économie, l'hydrologie et les SIG pour déterminer l'efficacité du choix des terres retirées de la production en vue de l'aménagement de zones tampon dans les bassins hydrographiques agricoles. D'autres auteurs se sont déjà penchés sur l'efficacité du retrait de vastes parcelles de la production ou sur certaines pratiques de gestion environnementales comme le non-travail du sol, sans toutefois s'intéresser aux étroites bandes tampon aux propriétés variables. L'application empirique du modèle au bassin du ruisseau Canagagigue, en Ontario, révèle que les coûts moyens et marginaux des mesures de lutte contre la sédimentation augmentent à un taux croissant quand l'objectif environnemental se fait de plus en plus rigoureux. L'emplacement des bandes tampon varie le long du bassin hydrographique et ces derniéres ne se situent pas nécessairement là où la pente est la plus raide ni à proximité des cours d'eau visibles. Le rendement augmente quand on laisse la largeur de la bande tampon varier en fonction de l'endroit, au lieu de présumer une largeur uniforme. Les résultats de la modélisation revêtent une grande importance pour l'élaboration de politiques relatives aux programmes de conservation et d'intendance comme l'établissement d'objectifs de protection de l'environnement fondés sur une comparaison des coûts et des avantages marginaux des mesures de lutte, et le choix de zones riveraines tampon selon leurs caracteristiques physiques dans le réseau de drainage des zones de captage secondaires. [source] | ||||||||||