Cable Television and Health Promotion: A Feasibility Study with Arthritis Patients.

ERIC Educational Resources Information Center

Katz, David

1985-01-01

Describes a study undertaken to ascertain the extent to which arthritis patients could be targeted by arthritis-related programming over a local cable system. Some conceptual and practical issues involved in targeting chronic patient groups for health programming are discussed. (Author/CT)

Program Responses to Acute and Chronic Malnutrition: Divergences and Convergences123

PubMed Central

Bergeron, Gilles; Castleman, Tony

2012-01-01

Program approaches for addressing acute malnutrition and those for addressing chronic malnutrition have grown in different directions. Their specialization has led to productive advances in the efficacy of specific interventions but has also created divergences in implementation. Greater convergence and integration between the 2 sets of approaches would help programs respond to the diversity of conditions faced in the field and enable a more comprehensive continuum of care from prevention to treatment. After reviewing the causes of the differences in approach, this paper examines programmatic and scientific challenges to greater convergence and suggests steps to promote effective integration of acute and chronic malnutrition services. Steps include strengthening community linkages between program platforms, assessing the degree and type of integration needed in various situations, identifying cost efficiencies, and developing joint tools where possible. PMID:22516735

Continuing Day Treatment Programs Promote Recovery in Schizophrenia

PubMed Central

2009-01-01

Continuing day treatment programs focus on community stabilization through comprehensive individualized rehabilitation. They promote recovery through a variety of practical clinical therapeutic interventions. This empirically based report describes a continuing day treatment program’s rehabilitation of four clients with schizophrenia, chronic type in a western New York mental health clinic who were in each of the specialty services: a two-phase program, a program for seniors, and a program for co-occurring substance dependence. Some particularly difficult psychiatric symptoms of schizophrenia were successfully treated in this continuing day treatment program. Each of these clients showed improvements in their symptoms and overall community adjustment that may well have been unobtainable with less intensive outpatient treatment. PMID:19724730

A mobile phone enabled health promotion program for middle-aged males.

PubMed

Ding, H; Karunanithi, M; Duncan, M; Ireland, D; Noakes, M; Hooker, C

2013-01-01

The prevalence of chronic diseases among middle aged males outweigh their female counterparts in developed countries. To prevent this, delivery of health promotion programs targeting lifestyle modifications of physical activity and nutrition in middle-aged males has been essential, but often difficult. ManUp health promotion program was a recent initiative that uses current advances in information and communication technology (ICT) to reach the middle-aged males. One of the key components of the ICT approach was the development of smartphone application to enable middle-aged men to uptake the program with their own mobile phone. The smart phone application was aimed at providing varied level of challenges towards physical activity and healthy eating behavior, with interactive and motivational feedback SMS messages. The ManUp program was recently implemented and trialed in a randomized control trial in Gladstone and Rockhampton, Queens. This paper describes the components of the smart phone application integrated within the ManUp health promotion program.

National survey of training needs reported by public health professionals in chronic disease programs in state, territorial, and local governments.

PubMed

Wilcox, Lynne S; Majestic, Elizabeth A; Ayele, Missale; Strasser, Sheryl; Weaver, Scott R

2014-01-01

In 2009, the National Association of Chronic Disease Directors published desirable competencies for professionals in public health chronic disease programs. Assessing the training needs of these professionals is an important step toward providing appropriate training programs in chronic disease prevention and control competencies. Conduct a survey of the chronic disease workforce in state and local health departments to identify professional training needs. We conducted a cross-sectional survey of state, territorial, and local public health professionals who work in chronic disease programs to identify their self-reported training needs, using the membership lists of 3 professional organizations that included practitioners in chronic disease public health programs. The survey was national, used a convenience sample, and was conducted in 2011. The survey was developed using an algorithm to select anonymous participants from the membership lists of the National Association of Chronic Disease Directors, the Directors for Health Promotion and Education, and the National Association of County & City Health Officials. The survey included questions about professional background, chronic disease activities, confidence about skills, and needs for training. The survey had 567 responses (38% response ratio). The majority of the respondents were female, non-Hispanic white, and 40 years or older. Respondents were not confident of their skills in health economics (38%) and technology and data management (23%). The most requested training topics were assessing the effects of policies, laws, and regulations (70%) and health economics (66%). This survey included local, territorial, and state public health professionals who work in chronic disease programs. These reported training needs in quantitative measurement methods and policy-related topics suggest key subjects for future training and education curricula.

Strengthening Chronic Disease Prevention Programming: The Toward Evidence-Informed Practice (TEIP) Program Evidence Tool

PubMed Central

Albert, Dayna; Fortin, Rebecca; Herrera, Christine; Hanning, Rhona; Lessio, Anne; Rush, Brian

2013-01-01

In public health and chronic disease prevention there is increasing priority for effective use of evidence in practice. In Ontario, Canada, despite various models being advanced, public health practitioners are seeking ways to identify and apply evidence in their work in practical and meaningful ways. In a companion article, “Strengthening Chronic Disease Prevention Programming: The Toward Evidence-Informed Practice (TEIP) Program Assessment Tool,” we describe use of a tool to assess and strengthen program planning and implementation processes using 19 criteria derived from best and promising practices literature. In this article, we describe use of a complementary Program Evidence Tool to identify, synthesize, and apply a range of evidence sources to strengthen the content of chronic disease prevention programming. The Program Evidence Tool adapts tools of evidence-based medicine to the unique contexts of community-based health promotion and chronic disease prevention. Knowledge management tools and a guided dialogue process known as an Evidence Forum enable community stakeholders to make appropriate use of evidence in diverse social, political, and structural contexts. Practical guidelines and worksheets direct users through 5 steps: 1) define an evidence question, 2) develop a search strategy, 3) collect and synthesize evidence, 4) interpret and adapt evidence, and 5) implement and evaluate. We describe the Program Evidence Tool’s benefits, strengths, challenges, and what was learned from its application in 4 Ontario public health departments. The Program Evidence Tool contributes to the development and understanding of the complex use of evidence in community-based chronic disease prevention. PMID:23721788

Cost-effectiveness of a school-based health promotion program in Canada: A life-course modeling approach.

PubMed

Ekwaru, John Paul; Ohinmaa, Arto; Tran, Bach Xuan; Setayeshgar, Solmaz; Johnson, Jeffrey A; Veugelers, Paul J

2017-01-01

The Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools) has been recognized as a "best practice" in preventing childhood obesity. To inform decision making on the economic implications of APPLE Schools and to justify investment, we evaluated the project's cost-effectiveness following a life-course approach. We developed a state transition model for the lifetime progression of body weight status comparing elementary school students attending APPLE Schools and control schools. This model quantified the lifetime impact of APPLE Schools in terms of prevention of excess body weight, chronic disease and improved quality-adjusted life years (QALY), from a school system's cost perspective. Both costs and health outcomes were discounted to their present value using 3% discount rate. The incremental cost-effectiveness ratio(ICER) of APPLE schools was CA$33,421 per QALY gained, and CA$1,555, CA$1,709 and CA$14,218 per prevented person years of excess weight, obesity and chronic disease, respectively. These estimates show that APPLE Schools is cost effective at a threshold of ICER < CA$50,000. In probabilistic sensitivity analysis, APPLE Schools was cost effective more than 64% of the time per QALY gained, when using a threshold of ICER

Cost-effectiveness of a school-based health promotion program in Canada: A life-course modeling approach

PubMed Central

2017-01-01

Background The Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools) has been recognized as a “best practice” in preventing childhood obesity. To inform decision making on the economic implications of APPLE Schools and to justify investment, we evaluated the project’s cost-effectiveness following a life-course approach. Methods We developed a state transition model for the lifetime progression of body weight status comparing elementary school students attending APPLE Schools and control schools. This model quantified the lifetime impact of APPLE Schools in terms of prevention of excess body weight, chronic disease and improved quality-adjusted life years (QALY), from a school system’s cost perspective. Both costs and health outcomes were discounted to their present value using 3% discount rate. Results The incremental cost-effectiveness ratio(ICER) of APPLE schools was CA$33,421 per QALY gained, and CA$1,555, CA$1,709 and CA$14,218 per prevented person years of excess weight, obesity and chronic disease, respectively. These estimates show that APPLE Schools is cost effective at a threshold of ICER < CA$50,000. In probabilistic sensitivity analysis, APPLE Schools was cost effective more than 64% of the time per QALY gained, when using a threshold of ICER

Workplace Wellness Programs to Promote Cancer Prevention.

PubMed

Soldano, Sharon K

2016-08-01

To define the diversity of and business case for workplace wellness programs, highlight best practices for a comprehensive health promotion program, and describe the opportunities for employees to become wellness advocates. Current literature and articles published between 2010 and 2016, Centers for Disease Control and Prevention, Health Enhancement Research Organization, National Business Group on Health, Wellness Councils of America, best practice program guidelines and internet resources. Employers are increasingly affected by rising health care costs and epidemic rates of obesity and associated chronic diseases within the workforce. Employers who offer workplace wellness programs can contribute to the overall health and well-being of their employees, improve employee productivity and retention, and reduce absenteeism and health care costs. Employees participating in workplace wellness programs can reduce their health risks and serve as health promotion advocates. Nurses can lead by example by participating in their workplace wellness programs, serving as an advocate to influence their employers and colleagues, and educating their patients regarding the benefits of workplace wellness programs. Copyright © 2016 Elsevier Inc. All rights reserved.

Paradigms for investigating rehabilitation and adaptation to childhood disability and chronic illness.

PubMed

Harper, D C

1991-10-01

Significant research perspectives in investigating chronic illness and disability are presented. Historical research conceptualizations in childhood disability are reviewed and newer contexts for evaluating disorder are presented. Future research in childhood illness and disability is directed toward basing investigations on theoretical models and promoting prospective longitudinal programs. Pediatric psychologists are encouraged to consider more collaborative efforts to move the field forward systematically.

Factors Facilitating the Implementation of Church-Based Heart Health Promotion Programs for Older Adults: A Qualitative Study Guided by the Precede-Proceed Model.

PubMed

Banerjee, Ananya Tina; Kin, R; Strachan, Patricia H; Boyle, Michael H; Anand, Sonia S; Oremus, Mark

2015-01-01

To describe the factors facilitating the implementation of heart health promotion programs for older adults in Anglican, United, and Catholic churches. The study used qualitative methods comprising semistructured interviews and focus groups. The interviews and focus groups were conducted in Anglican, Catholic, and United churches located in the Canadian cities of Toronto and Hamilton, Ontario. Twelve ordained pastors and 21 older parishioners who attended church regularly and who had no health conditions were recruited to best explain how churches could be suitable locations for health promotion activities targeting older adults. Twelve semistructured interviews with the pastors and three focus groups with the 21 parishioners were undertaken. A component of the Precede-Proceed model (a model for planning health education and health promotion programs and policies) was applied to the findings after direct content analysis of the data. Participants identified pastor leadership, funding for a parish nurse, community-focused interventions, secured infrastructure, and social support from congregation members as pertinent factors required for implementing health promotion programs in Anglican, United, and Catholic churches. The findings have particular relevance for health promotion and public health because they suggest factors that would be necessary to design church-based heart health promotion programs for older adults at risk of chronic diseases.

Evaluation of chronic disease management on outcomes and cost of care for Medicaid beneficiaries.

PubMed

Zhang, Ning Jackie; Wan, Thomas T H; Rossiter, Louis F; Murawski, Matthew M; Patel, Urvashi B

2008-05-01

To evaluate the impacts of the chronic disease management program on the outcomes and cost of care for Virginia Medicaid beneficiaries. A total of 35,628 patients and their physicians and pharmacists received interventions for five chronic diseases and comorbidities from 1999 to 2001. Comparisons of medical utilization and clinical outcomes between experimental groups and control group were conducted using ANOVA and ANCOVA analyses. Findings indicate that the disease state management (DSM) program statistically significantly improved patient's drug compliance and quality of life while reducing (ER), hospital, and physician office visits and adverse events. The average cost per hospitalization would have been $42 higher without the interventions. A coordinated disease management program designed for Medicaid patients experiencing significant chronic diseases can substantially improve clinical outcomes and reduce unnecessary medical utilization, while lowering costs, although these results were not observed across all disease groups. The DSM model may be potentially useful for Medicaid programs in states or other countries. If the adoption of the DSM model is to be promoted, evidence of its effectiveness should be tested in broader settings and best practice standards are expected.

Epigenetic regulation of the glucocorticoid receptor promoter 1(7) in adult rats.

PubMed

Witzmann, Simone R; Turner, Jonathan D; Mériaux, Sophie B; Meijer, Onno C; Muller, Claude P

2012-11-01

Regulation of glucocorticoid receptor (GR) levels is an important stress adaptation mechanism. Transcription factor Nfgi-a and environmentally induced Gr promoter 1 7 methylation have been implicated in fine-tuning the expression of Gr 1 7 transcripts. Here, we investigated Gr promoter 1 7 methylation and Gr 1 7 expression in adult rats exposed to either acute or chronic stress paradigms. A strong negative correlation was observed between the sum of promoter-wide methylation levels and Gr 1 7 transcript levels, independent of the stressor. Methylation of individual sites did not, however, correlate with transcript levels. This suggested that promoter 1 7 was directly regulated by promoter-wide DNA methylation. Although acute stress increased Ngfi-a expression in the hypothalamic paraventricular nucleus (PVN), Gr 1 7 transcript levels remained unaffected despite low methylation levels. Acute stress had little effect on these low methylation levels, except at four hippocampal CpGs. Chronic stress altered the corticosterone response to an acute stressor. In the adrenal and pituitary glands, but not in the brain, this was accompanied by an increase in methylation levels in orchestrated clusters rather than individual CpGs. PVN methylation levels, unaffected by acute or chronic stress, were significantly more variable within- than between-groups, suggesting that they were instated probably during the perinatal period and represent a pre-established trait. Thus, in addition to the known perinatal programming, the Gr 1 7 promoter is epigenetically regulated by chronic stress in adulthood, and retains promoter-wide tissue-specific plasticity. Differences in methylation susceptibility between the PVN in the perinatal period and the peripheral HPA axis tissues in adulthood may represent an important "trait" vs. "state" regulation of the Gr gene.

Measuring public health practice and outcomes in chronic disease: a call for coordination.

PubMed

Porterfield, Deborah S; Rogers, Todd; Glasgow, LaShawn M; Beitsch, Leslie M

2015-04-01

A strategic opportunity exists to coordinate public health systems and services researchers' efforts to develop local health department service delivery measures and the efforts of divisions within the Centers for Disease Control and Prevention's National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) to establish outcome indicators for public health practice in chronic disease. Several sets of outcome indicators developed by divisions within NCCDPHP and intended for use by state programs can be tailored to assess outcomes of interventions within smaller geographic areas or intervention settings. Coordination of measurement efforts could potentially allow information to flow from the local to the state to the federal level, enhancing program planning, accountability, and even subsequent funding for public health practice.

[Disease prevention in the elderly: misconceptions in current models].

PubMed

Veras, Renato Peixoto

2012-10-01

The Brazilian population is aging significantly within a context of gradual improvement in the country's social and economic indicators. Increased longevity leads to increased use of health services, pressuring the public and social welfare health services, generating higher costs, and jeopardizing the system's sustainability. The alternative to avoid overburdening the system is to invest in policies for disease prevention, stabilization of chronic diseases, and maintenance of functional capacity. The current article aims to analyze the difficulties in implementing preventive programs and the reasons for the failure of various programs in health promotion, prevention, and management of chronic diseases in the elderly. There can be no solution to the crisis in financing and restructuring the health sector without implementing a preventive logic. Scientific research has already correctly identified the risk factors for the elderly population, but this is not enough. We must use such knowledge to promote the necessary transition from a healthcare-centered model to a preventive one.

Evaluation of the National Guard Health Promotion Program for Chronic Diseases and Comorbid Conditions Among Military Personnel in Jeddah City, Saudi Arabia, 2016.

PubMed

Aljasir, Badr A; Al-Mugti, Hani Saad; Alosaimi, Majed Naif; Al-Mugati, Amer Saad

2017-11-01

Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Preventive efforts mainly target the reduction of modifiable CVD risk factors through community-based promotion programs. One of these programs is the National Guard Health Promotion Program for Chronic Diseases and Comorbid Conditions among military personnel in Jeddah City, Saudi Arabia. Researchers have asserted that to improve every intervention program, especially those targeting public health issues, regular monitoring and evaluation are needed to determine the strength and weakness of the program. The objective of this study was to assess the effectiveness of National Guard Health Promotion Program for Chronic Diseases and Comorbid Conditions among military personnel in Jeddah City by estimating Framingham risk score, diabetes risk score, and satisfaction level for the participants covered by the program for at least 6 months. Through pre- and poststudy design, a systematic random sample of military personnel who fulfilled the inclusion criteria (n = 267) were enrolled in the study. To assess the program's effectiveness, participants were subjected to clinical and laboratory assessment based mainly on Framingham risk scores before and after involvement in the program; satisfaction was assessed concurrently using a self-administered questionnaire. The Wilcoxon signed rank test was used to compare changes in non-normally distributed quantitative variables. Multiple logistic regression analysis was used to identify independent predictors of risk of CVDs. The subjects were all military men, with mean age of 35.8 ± 6.6 years; 6% officers with the remainder "non-officers" primarily working in the combat services. After at least 6 months of the preventive program, there were statistically significant decreases in body mass index (-0.4 ± 1.5 kg/m 2 ), waist circumference (-0.9 ± 6.2 cm), fasting blood glucose (-12.3 ± 29.6 mg/dL), and total cholesterol (-15.4 ± 40.2 mg/dL). Despite this observed improvement, the overall Framingham risk score showed a modest nonsignificant change (-0.1 ± 2.1 points). Similarly, although specific predictors scores of diabetes mellitus showed significant improvement (decreased blood glucose [-0.4 ± 1.8 points] and increased fruit and vegetable consumption [-0.2 ± 0.6 points]), there was no significant change in the overall diabetes risk score (-0.01 ± 2.5). The majority of the participants (96%) expressed that they were satisfied with the program. The National Guard Health Promotion Program is effective in improving specific risk factors such as body mass index, waist circumference, blood glucose, and intake of fruits and vegetables; in addition, it was perceived as being satisfactory. Nevertheless, it had no statistically significant impact on the overall total risk scores for CVDs and diabetes mellitus. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Evaluation of a School-Linked Program for Children with Cancer

ERIC Educational Resources Information Center

St Leger, Pamela; Campbell, Lyn

2008-01-01

Purpose: The purpose of this paper is to show that the "Back on Track" program is designed to support students with a chronic illness (usually cancer) to maintain contact with their school and peers whilst undergoing treatment, to promote socio-emotional wellbeing and to facilitate the ease of return to school when they are well. An…

Self-Reported Barriers to Quality Physical Education by Physical Education Specialists in Texas

ERIC Educational Resources Information Center

Barroso, Cristina S.; McCullum-Gomez, Christine; Hoelscher, Deanna M.; Kelder, Steven H.; Murray, Nancy G.

2005-01-01

School-based programs offer an efficient means of promoting the health of a large number of children. The Coordinated Approach to Child Health (CATCH) program was designed to decrease risk factors for chronic disease in elementary school children and includes separate coordinated interventions for child nutrition services, physical education (PE),…

German diabetes management programs improve quality of care and curb costs.

PubMed

Stock, Stephanie; Drabik, Anna; Büscher, Guido; Graf, Christian; Ullrich, Walter; Gerber, Andreas; Lauterbach, Karl W; Lüngen, Markus

2010-12-01

This paper reports the results of a large-scale analysis of a nationwide disease management program in Germany for patients with diabetes mellitus. The German program differs markedly from "classic" disease management in the United States. Although it combines important hallmarks of vendor-based disease management and the Chronic Care Model, the German program is based in primary care practices and carried out by physicians, and it draws on their personal relationships with patients to promote adherence to treatment goals and self-management. After four years of follow-up, overall mortality for patients and drug and hospital costs were all significantly lower for patients who participated in the program compared to other insured patients with similar health profiles who were not in the program. These results suggest that the German disease management program is a successful strategy for improving chronic illness care.

Qualitative evaluation of a physical activity-based chronic disease prevention program in a low-income, rural South African setting.

PubMed

Draper, Catherine E; Nemutandani, Simon M; Grimsrud, Anna T; Rudolph, Michael; Kolbe-Alexander, Tracy L; de Kock, Lauren; Lambert, Estelle V

2010-01-01

Chronic diseases, an increasing global concern, are prevalent in the low-income communities of South Africa, where rural health systems bear the double burden of infectious and chronic diseases. The Discovery Healthy Lifestyle Programme (DHLP) is a physical activity-based chronic disease prevention program that has been implemented in a low-income, rural setting in South Africa. The DHLP consists of both school- and primary healthcare clinic-based interventions for learners (Healthnutz) and adults (Live it Up), facilitated by teachers, nurses and community volunteers. The aim of this evaluation was to qualitatively assess the process by which the DHLP was implemented, identifying enabling factors and barriers. Data were collected in target communities at schools and clinics from semi-structured focus groups of program leaders and members, teachers and community members (n = 45), situational analyses of the school physical activity environment, informal community observations and informal interviews with program coordinators. The target communities faced socioeconomic and health inequalities and remained under-resourced and under-served. In spite of these and other challenges, the DHLP was well received by community members and stakeholders. It was valued by respondents for its health and psychosocial outcomes, evidenced by increased knowledge and awareness of the importance of physical activity and healthy lifestyles, and positively altered perceptions of physical activity. Program implementers believed the Live it Up component was growing, and this suggested the sustainability of the program. There were, however, some concerns about the fidelity of the Healthnutz intervention, due to timetabling difficulties. Despite this, teachers were positive about the program and its value for their learners, staff and school. The community characteristics of being under-resourced and under-served appeared to positively influence DHLP implementation. Local government involvement in the DHLP resulted in greater ownership of the program, which enabled successful implementation. This study presents a unique opportunity to assess the implementation and sustainability requirements of programs in environments of limited resources, considerable burden of infectious and chronic diseases and extensive socioeconomic challenges. The findings suggest that through enhancement of knowledge, transfer of appropriate skills and the provision of an enabling environment, participation in physical activity can be effectively promoted in a low-income, rural setting. Physical activity interventions that promote the participation and empowerment of rural communities can be feasible and accessible, thereby assisting in addressing the growing burden of chronic diseases in low-income.

Evidence-Based Programs for Older Adults: A Disconnect Between U.S. National Strategy and Local Senior Center Implementation.

PubMed

Bobitt, Julie; Schwingel, Andiara

2017-01-01

While U.S. national policies have been developed to support evidence-based (EB) lifestyle programs for older adults, there has been limited research to determine the extent to which these programs actually reach local communities. This study sought to identify factors that impact the implementation of EB physical activity, nutrition, and chronic disease management programs at regional (Area Agencies on Aging [AAAs]) and community levels (senior Centers [SCs]). Interviews were conducted with directors of four AAAs and 12 SCs to understand their perspectives on EB program implementation. Narratives revealed differences between AAAs and SCs regarding knowledge about EB programs and reasons to promote and adopt these programs. The only agreement occurred when discussing concerns about funding and program inflexibility. Substantial gaps exist between how EB lifestyle programs are promoted and implemented at the regional and community levels.

Low-socioeconomic status workers: their health risks and how to reach them.

PubMed

Harris, Jeffrey R; Huang, Yi; Hannon, Peggy A; Williams, Barbara

2011-02-01

To help workplace health promotion practitioners reach low-socioeconomic status workers at high risk for chronic diseases. We describe low-socioeconomic status workers' diseases, health status, demographics, risk behaviors, and workplaces, using data from the Behavioral Risk Factor Surveillance System, Medical Expenditure Panel Survey, and Bureau of Labor Statistics. Workers with household annual incomes less than $35,000, or a high school education or less, report more chronic diseases and lower health status. They tend to be younger, nonwhite, and have much higher levels of smoking and missed cholesterol screening. They are concentrated in the smallest and largest workplaces and in three low-wage industries that employ one-quarter of the population. To decrease chronic diseases among low-socioeconomic status workers, we need to focus workplace health promotion programs on workers in low-wage industries and small workplaces.

Engagement in health and wellness: An online incentive-based program.

PubMed

Gibson, Teresa B; Maclean, J Ross; Carls, Ginger S; Moore, Brian J; Ehrlich, Emily D; Fener, Victoria; Goldberg, Jordan; Mechanic, Elaine; Baigel, Colin

2017-09-01

Increasingly, corporate health promotion programs are implementing wellness programs integrating principles of behavioral economics. Employees of a large firm were provided a customized online incentive program to design their own commitments to meet health goals. This study examines patterns of program participation and engagement in health promotion activities. Subjects were US-based employees of a large, nondurable goods manufacturing firm who were enrolled in corporate health benefits in 2010 and 2011. We assessed measures of engagement with the workplace health promotion program (e.g., incentive points earned, weight loss). To further examine behaviors indicating engagement in health promotion activities, we constructed an aggregate, employee-level engagement index. Regression models were employed to assess the association between employee characteristics and the engagement index, and the engagement index and spending. 4220 employees utilized the online program and made 25,716 commitments. Male employees age 18-34 had the highest level of engagement, and male employees age 55-64 had the lowest level of engagement overall. Prior year health status and prior year spending did not show a significant association with the level of engagement with the program ( p  > 0.05). Flexible, incentive-based behavioral health and lifestyle programs may reach the broader workforce including those with chronic conditions and higher levels of health spending.

A web-based training program to support chronic kidney disease screening by community pharmacists.

PubMed

Gheewala, Pankti A; Peterson, Gregory M; Zaidi, Syed Tabish R; Bereznicki, Luke; Jose, Matthew D; Castelino, Ronald L

2016-10-01

Background Community pharmacists' role in screening of several chronic diseases has been widely explored. The global health burden of chronic kidney disease is high; however, the progression and adverse outcomes can be prevented or delayed by detecting and treating the disease in its initial stages 1-3. Therefore, a web-based training program was developed to enhance pharmacists' knowledge and skills required to perform a chronic kidney disease screening service in a community setting. Objective The aim of this study was to evaluate the impact of a web-based training program on community pharmacists' knowledge and skills associated with chronic kidney disease screening. As secondary aim, pharmacists' satisfaction with the training program was assessed. Setting Community pharmacy practice. Method A web-based training program was developed by four pharmacists and a nephrologist. Quantitative data was collected by employing a self-administered, web-based questionnaire, which comprised a set of five multiple-choice knowledge questions and one clinical vignette to assess skills. A nine-item Likert scale was used to determine pharmacists' satisfaction with the training program. Main outcome measure Pharmacists' knowledge and skills scores at pre and post-training, reliability of the Likert scale, and the proportion of responses to the individual nine items of the satisfaction survey. Results Fifty pharmacists participated in the pre-questionnaire and 38 pharmacists completed the web-based training and post-questionnaire. Significant differences were observed in the knowledge scores (p < 0.001) and skills scores (p < 0.001) at pre- and post-training. Cronbach's alpha for the nine-item satisfaction scale was 0.73 and the majority pharmacists (92.1-100 %) were satisfied with the various aspects of the training program. Conclusion The web-based training program positively enhanced pharmacists' knowledge and skills associated with chronic kidney disease screening. These findings support further development and widespread implementation of the training program to facilitate health promotion and early identification of chronic kidney disease in a community setting.

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

PubMed

Stitzel, Kimberly F

2006-11-01

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

Factors Driving Local Health Departments' Partnerships With Other Organizations in Maternal and Child Health, Communicable Disease Prevention, and Chronic Disease Control.

PubMed

Luo, Huabin; Winterbauer, Nancy L; Shah, Gulzar; Tucker, Ashley; Xu, Lei

2016-01-01

To describe levels of partnership between local health departments (LHDs) and other community organizations in maternal and child health (MCH), communicable disease prevention, and chronic disease control and to assess LHD organizational characteristics and community factors that contribute to partnerships. Data were drawn from the National Association of County & City Health Officials' 2013 National Profile Study (Profile Study) and the Area Health Resources File. LHDs that received module 1 of the Profile Study were asked to describe the level of partnership in MCH, communicable disease prevention, and chronic disease control. Levels of partnership included "not involved," "networking," "coordinating," "cooperating," and "collaborating," with "collaborating" as the highest level of partnership. Covariates included both LHD organizational and community factors. Data analyses were conducted using Stata 13 SVY procedures to account for the Profile Study's survey design. About 82%, 92%, and 80% of LHDs partnered with other organizations in MCH, communicable disease prevention, and chronic disease control programs, respectively. LHDs having a public health physician on staff were more likely to partner in chronic disease control programs (adjusted odds ratio [AOR] = 2.33; 95% confidence interval [CI], 1.03-5.25). Larger per capita expenditure was also associated with partnerships in MCH (AOR = 2.43; 95% CI, 1.22-4.86) and chronic disease prevention programs (AOR = 1.76; 95% CI, 1.09-2.86). Completion of a community health assessment was associated with partnership in MCH (AOR = 7.26; 95% CI, 2.90-18.18), and chronic disease prevention (AOR = 5.10; 95% CI, 2.28-11.39). About 1 in 5 LHDs did not have any partnerships in chronic disease control. LHD partnerships should be promoted to improve care coordination and utilization of limited health care resources. Factors that might promote LHDs' partnerships include having a public health physician on staff, higher per capita expenditure, and completion of a community health assessment. Community context likely influences types and levels of partnerships. A better understanding of these contextual factors may lead to more complete and effective LHD partnerships.

Participatory research for chronic disease prevention in Inuit communities.

PubMed

Gittelsohn, Joel; Roache, Cindy; Kratzmann, Meredith; Reid, Rhonda; Ogina, Julia; Sharma, Sangita

2010-01-01

To develop a community-based chronic disease prevention program for Inuit in Nunavut, Canada. Stake-holders contributed to intervention development through formative research (in-depth interviews (n = 45), dietary recalls (n = 42)), community workshops, group feedback and implementation training. Key cultural themes included the perceived healthiness of country foods, food sharing, and importance of family. During community workshops, key problem foods for intervention were identified as well as healthier culturally and economically acceptable alternatives for these foods. Behaviors for promotion were identified and prioritized. This approach resulted in project acceptance, stakeholder collaboration, and a culturally appropriate program in stores, worksites, and other community venues.

Poison Prevention Program

Science.gov Websites

State Employees Chronic Disease Prevention and Health Promotion DHSS State of Alaska Home Divisions and Agencies Alaska Pioneer Homes Behavioral Health Office of Children's Services Office of the Commissioner Office of Substance Misuse and Addiction Prevention Finance & Management Services Health Care

Following the trend for a comprehensive healthy workplace in Taiwan.

PubMed

Chen, Ruey-Yu; Yu, Li-Hui

2016-03-01

To promote workers' health and boost corporate productivity and national competitiveness, workplace health promotion is an international trend and a vital part of national policies. Prior to 2000, Taiwan's workplace issues focused on industrial hygiene and safety improvements. Since 2003, the Health Promotion Administration (HPA) at the Ministry of Health and Welfare has established coaching centers for workplace health promotion and dispatched trained experts for teaching health promotion skills; including promoting the tobacco control program, preventing important chronic diseases, driving comprehensive programs, advocating workplace health promotion with the Ministry of Labor, establishing certification mechanisms for workplace health promotion, recognizing outstanding health-promoting workplaces, and conducting a nationwide survey for monitoring the practices of healthy behaviors and health conditions of workers. Through 2014, 12,439 workplaces have been accredited.Since 2003, the efforts of the HPA in workplace health promotion projects has shifted society's focus on workplace health from occupational diseases and injury prevention to workplace health promotion, resulting in the revision of the Occupational Safety and Health Act in 2013 by the Ministry of Labor to detail employers' responsibilities in protecting and promoting employees' health and well-being. © The Author(s) 2016.

A scoping review of the literature on benefits and challenges of participating in patient education programs aimed at promoting self-management for people living with chronic illness.

PubMed

Stenberg, Una; Haaland-Øverby, Mette; Fredriksen, Kari; Westermann, Karl Fredrik; Kvisvik, Toril

2016-11-01

To give a comprehensive overview of benefits and challenges from participating in group based patient education programs that are carried out by health care professionals and lay participants, aimed at promoting self-management for people living with chronic illness. We searched 8 literature databases. Full text articles meeting the inclusion criteria were retrieved and reviewed. Arksey and O'Malley's framework for scoping studies guided the review process and thematic analysis was undertaken to synthesize extracted data. Of the 5935 titles identified, 47 articles were included in this review. The participants experienced the programs as beneficial according to less symptom distress and greater awareness of their own health, improved self-management strategies, peer support, learning and hope. A substantial evidence base supports the conclusion that group based self-management patient education programs in different ways have been experienced as beneficial, but more research is needed. The insights gained from this review can enable researchers, health care professionals, and participants to understand the complexity in evaluating self-management patient education programs, and constitute a basis for a more standardized and systematic evaluation. The results may also encourage health care professionals in planning and carrying out programs in cooperation with lay participants. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Protocol for the "four steps to control your fatigue (4-STEPS)" randomised controlled trial: a self-regulation based physical activity intervention for patients with unexplained chronic fatigue

PubMed Central

2012-01-01

Background Unexplained Chronic Fatigue is a medical condition characterized by the presence of persistent, severe and debilitating medically unexplained fatigue, leading to impaired functioning and lower quality of life. Research suggests that physical activity can contribute to the reduction of fatigue and other somatic symptoms and can thus significantly improve physical functioning and quality of life in these patients. Based on the self-regulation (SR) theory of behaviour change, we developed a brief physical activity program for patients suffering from unexplained chronic fatigue which focuses on the training of self-regulation skills, the "4-STEPS to control your fatigue" program. Methods/Design This is a multi-centre, randomised controlled trial (RCT) that will be carried out in local primary care centres and at the Portuguese Fibromyalgia and Chronic Fatigue Syndrome Patients Association. Patients aged between 18 and 65 and fulfilling operationalized criteria for Idiopathic Chronic Fatigue (ICF) and Chronic Fatigue Syndrome (CFS) will be recruited and randomly allocated to standard care (SC) or standard care plus a self-regulation based physical activity program (4-STEPS). Patients will be assessed at baseline, after the intervention (3 months) and at 12 months follow-up. The primary outcome is fatigue severity. Discussion The results of the RCT will provide information about the effectiveness of a brief self-regulation intervention for promoting physical activity in patients with unexplained chronic fatigue. If the program proves to be effective, it may be considered as an adjunctive treatment for these patients. Trial Registration ISRCTN: ISRCTN70763996 PMID:22429404

Co-creating a Peer Education program to improve skin health in older people from diverse communities: An innovation in health promotion.

PubMed

Ogrin, Rajna; Brasher, Kathleen; Occleston, Jessica; Byrne, Jennifer

2017-06-01

Chronic wounds, debilitating and costly to manage, are more common in older people. Prevention is possible through improving skin health. We developed, implemented and evaluated an innovative health promotion program to improve skin health of older adults. A one-hour, peer education program was co-created and delivered to culturally diverse community-dwelling older people. A mixed-methods evaluation approach comprised objective measures of skin health and barrier function at commencement and six weeks posteducation, and focus groups posteducation. Seventy-three participants participated in the study (mean age 74.38 ± 11.80 years). Hydration significantly improved at follow-up for English speaking participants (t(27) = -2.90, P = 0.007). The majority of participants reported the education to be informative and useful in supporting behaviour changes. The peer education program improved skin hydration in older English speaking individuals. Peer education may effectively deliver health promotion information in some groups. © 2017 AJA Inc.

Development of a Rural Health Framework: Implications for Program Service Planning and Delivery

PubMed Central

White, Deanna

2013-01-01

Purpose: To describe the development and application of an evidence-based Rural Health Framework to guide rural health program, policy and service planning. Methods: A literature review of rural health programs, focusing on health promotion, chronic disease prevention and population health, was conducted using several bibliographic databases. Findings: Thirty papers met the criteria for review, describing chronic disease interventions and public health policies in rural settings. Twenty-one papers demonstrated effective intervention programs and highlighted potential good practices for rural health programs, which were used to define key elements of a Rural Health Framework. Conclusions: The Rural Health Framework was applied to an influenza immunization program to demonstrate its utility in assisting public health providers to increase uptake of the vaccine. This Rural Health Framework provides an opportunity for program planners to reflect on the key issues facing rural communities to ensure the development of policies and strategies that will prudently and effectively meet population health needs. PMID:23968625

76 FR 19995 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Funding...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-11

..., Extramural Research Program Office, National Center for Chronic Disease Prevention and Health Promotion, CDC... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Funding Opportunity Announcement...

A Double Whammy: Health Promotion Among Cancer Survivors with Pre-Existing Functional Limitations

PubMed Central

Volker, Deborah L.; Becker, Heather; Kang, Sook Jung; Kullberg, Vicki

2012-01-01

Purpose/Objectives To explore the experience of living with a cancer diagnosis within the context of a pre-existing functional disability and to identify strategies to promote health in this growing population of cancer survivors. Research Approach Qualitative descriptive Setting Four sites in the United States Participants 19 female cancer survivors with pre-existing disabling conditions Methodologic Approach Four focus groups were conducted. The audiotapes were transcribed and analyzed using content analysis techniques. Main Research Variables cancer survivor, disability, health promotion Findings Analytic categories included living with a cancer diagnosis, health promotion strategies, and wellness program development for survivors with pre-existing functional limitations. Participants described many challenges associated with managing a cancer diagnosis on top of living with a chronic disabling functional limitation. They identified strategies they used to maintain their health and topics to be included in health promotion programs tailored for this unique group of cancer survivors. Conclusions The “double whammy” of a cancer diagnosis for persons with pre-existing functional limitations requires modification of health promotion strategies and programs to promote wellness in this group of cancer survivors. Interpretation Nurses and other health care providers must attend to patients’ pre-existing conditions as well as the challenges of the physical, emotional, social, and economic sequelae of a cancer diagnosis. PMID:23269771

Act Healthy: promoting health behaviors and self-efficacy in the workplace.

PubMed

Schopp, Laura H; Bike, Denise H; Clark, Mary J; Minor, Marian A

2015-08-01

Chronic health conditions and multiple health risk factors afflict Americans and burden employers, but effective, affordable, workplace-based health promotion interventions have not been widely implemented. This is the first study to adapt the empirically validated Chronic Disease Self-Management Program for a general employee population in a workplace setting with an emphasis on disease prevention and health promotion. A quasi-experimental, wellness standard of care comparison, prospective cohort design was used among employee participants at a large University employer. Ninety-one individuals participated in the program. Participants reported significantly increased health behavior frequency and self-efficacy after the intervention, compared with their pre-intervention scores, and improvements were sustained at 3-month follow-up [self-rated abilities for health practices scale (SRA): F = 30.89, P < 0.001; health promoting lifestyle profile-II (HPLP-II): F = 36.30 P < 0.001]. Individuals in the intervention group reported improved self-efficacy and health behaviors compared with the wellness standard of care comparison group at post intervention (SRA: F = 12.45, P < 0.001; HPLP-II: F = 25.28, P < 0.001). Adapting lay-facilitated self-management for the workplace offers promise as a replicable, scalable, affordable model for culture change in organizations. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Peer support for people with chronic conditions in rural areas: a scoping review.

PubMed

Lauckner, Heidi M; Hutchinson, Susan L

2016-01-01

Chronic conditions are a growing healthcare concern. People living in rural regions are particularly affected because many barriers exist to accessing services and supports. Peer support for chronic condition self-management, where people living with chronic conditions learn about how to care for themselves and maintain their health from people also living with chronic conditions, is one approach gaining recognition. What remains unknown are the unique challenges and strategies associated with peer support for chronic condition self-management in rural contexts. In order to inform the development of peer supports in the authors' local context in rural eastern Canada, a scoping review was undertaken to discover community-based peer support initiatives for adults in rural settings living with chronic conditions. The authors followed established scoping review methods to answer the research question What is known from the existing literature about the key features and potential formats of community-based peer support initiatives for adults living with chronic conditions in rural settings? Six databases (CINAHL, PubMed, Sociological Abstracts, Embase, Cochrane Libraries and PsycInfo) were searched using the following concepts: chronic conditions, peer support, community-based and rural context. Two researchers reviewed the titles and/or abstracts of the 1978 articles retrieved from the initial search to include articles that were in English, published in 2000 to 2014, and that explicitly discussed rural programs/interventions with peers that were community-based. The initial screen excluded 1907 articles, leaving 71 articles, which were read by two research members in light of the inclusion/exclusion criteria. Thirteen articles representing 10 separate programs were included and analyzed using qualitative content analysis. Included programs were from the USA, Australia and Canada. A range of formats (telecommunications only, in-person meetings only, or a combination of both) were used. Peer leaders had varied experiences with chronic conditions and received training in content and facilitation skills. Peer leaders were provided with ongoing support. Program participants received training on chronic conditions, and programs provided opportunities for social support and the development of new skills. Programs focused on creating social connections, reducing stigma, ensuring relevance and promoting empowerment. Of the nine programs that reported outcomes, eight reported positive outcomes and one reported mixed results. Consistent with the extant literature, the programs identified unique issues faced by people with chronic conditions in rural areas that these programs addressed. The key findings of this scoping review are as follows: 1. A combination of telecommunications with some face-to-face meetings can support the accessibility of peer support programs in rural areas. 2. Core elements of these programs are the provision of social support and skill development. 3. Peer leaders benefit from skills training and ongoing support. 4. Sustainability of such programs is complex and requires multiple strategies. Cultural relevance, ongoing support and the use of telecommunications were key features of rural peer support programs. Guiding questions to facilitate a community consultation around these findings are provided. Peer support chronic condition self-management programs require further research.

The Hepatitis C Self-Management Program: Sustainability of Primary Outcomes at 1 Year

ERIC Educational Resources Information Center

Groessl, Erik J.; Ho, Samuel B.; Asch, Steven M.; Stepnowsky, Carl J.; Laurent, Diana; Gifford, Allen L.

2013-01-01

Objective: Chronic hepatitis C infection afflicts millions of people worldwide. Although antiviral treatments are increasingly effective, many hepatitis C virus (HCV) patients avoid treatment, do not complete or respond to treatment, or have contraindications. Self-management interventions are one option for promoting behavioral changes leading to…

Dietary factors during early life program bone formation in female rats

USDA-ARS?s Scientific Manuscript database

Nutritional status during intrauterine and early postnatal life impacts the risk of chronic diseases; however, evidence for an association between early life dietary factors and bone health in adults is limited. Soy protein isolate (SPI) may be one such dietary factor that promotes bone accretion du...

A new evaluation tool to obtain practice-based evidence of worksite health promotion programs.

PubMed

Dunet, Diane O; Sparling, Phillip B; Hersey, James; Williams-Piehota, Pamela; Hill, Mary D; Hanssen, Carl; Lawrenz, Frances; Reyes, Michele

2008-10-01

The Centers for Disease Control and Prevention developed the Swift Worksite Assessment and Translation (SWAT) evaluation method to identify promising practices in worksite health promotion programs. The new method complements research studies and evaluation studies of evidence-based practices that promote healthy weight in working adults. We used nationally recognized program evaluation standards of utility, feasibility, accuracy, and propriety as the foundation for our 5-step method: 1) site identification and selection, 2) site visit, 3) post-visit evaluation of promising practices, 4) evaluation capacity building, and 5) translation and dissemination. An independent, outside evaluation team conducted process and summative evaluations of SWAT to determine its efficacy in providing accurate, useful information and its compliance with evaluation standards. The SWAT evaluation approach is feasible in small and medium-sized workplace settings. The independent evaluation team judged SWAT favorably as an evaluation method, noting among its strengths its systematic and detailed procedures and service orientation. Experts in worksite health promotion evaluation concluded that the data obtained by using this evaluation method were sufficient to allow them to make judgments about promising practices. SWAT is a useful, business-friendly approach to systematic, yet rapid, evaluation that comports with program evaluation standards. The method provides a new tool to obtain practice-based evidence of worksite health promotion programs that help prevent obesity and, more broadly, may advance public health goals for chronic disease prevention and health promotion.

Exercise Training and Recreational Activities to Promote Executive Functions in Chronic Stroke: A Proof-of-Concept Study

PubMed Central

Liu-Ambrose, Teresa; Eng, Janice J

2015-01-01

Background Stroke survivors represent a target population in need of intervention strategies to promote cognitive function and prevent dementia. Both exercise and recreational activities are promising strategies. We assessed the effect of a six-month exercise and recreation program on executive functions in adults with chronic stroke. Methods A six-month ancillary study within a multi-centre randomized trial. Twenty-eight chronic stroke survivors (i.e., ≥ 12 months since an index stroke) were randomized to one of two experimental groups: intervention (INT; n=12) or delayed intervention (D-INT; n=16). Participants of the INT group received a six-month community-based structured program that included two sessions of exercise training and one session of recreation and leisure activities per week. Participants of the D-INT group received usual care. The primary outcome measure was the Stroop Test, a cognitive test of selective attention and conflict resolution. Secondary cognitive measures included set shifting and working memory. Mood, functional capacity, and general balance and mobility were additional secondary outcome measures. Results Compared with the D-INT group, the INT group significantly improved selective attention and conflict resolution (p=0.02), working memory (p=0.04), and functional capacity (p=0.02) at the end of the six-month intervention period. Improved selective attention and conflict resolution was significantly associated with functional capacity at six months (r=0.39; p=0.04). Conclusions This is the first randomized study to demonstrate that an exercise and recreation program can significantly benefit executive functions in community-dwelling chronic stroke survivors who are mildly cognitively impaired – a population at high-risk for dementia and functional decline. Thus, clinicians should consider prescribing exercise and recreational activities in the cognitive rehabilitation of chronic stroke survivors. Clinical Trial Registration http://clinicaltrials.gov. Unique identifier: NCT01085240. PMID:25440324

[Recommandation for patient engagement promotion in care and cure for chronic conditions.

PubMed

Graffigna, Guendalina; Barello, Serena; Riva, Giuseppe; Castelnuovo, Gianluca; Corbo, Massimo; Coppola, Liliana; Daverio, Giovanni; Fauci, Alice; Iannone, Primiano; Ricciardi, Walter; Bosio, Albino Claudio

2017-11-01

The concept of patient engagement is receiving a growing attention in the healthcare field. The last decades have seen a deep revision of care models in the aim of a greater acknowledge of the patient role, seen as an expert actor, in the healthcare process. On the other side, healthcare systems are facing a growing request for participation expressed by citizens and patients. People claim for being more involved in all the crucial turning point of their healthcare journey and of being better aware of their right and duties. They require a deeper knowledge about all the different therapeutic options with the related risks and advantages. However, although all the different stakeholders agree in considering patient engagement a pragmatic further then ethical priority, a shared consensus related to the strategies and instrument to promote has still to come. Patients and healthcare professional perspective about the factors that may hinder or sustain patient engagement still need to be further studied and at shared recommendations - about the programs better effective and efficient in promoting patient engagement - are still missed. Based on these premises, Università Cattolica of Milano and DG Welfare of Regione Lombardia, under the methodological supervision of the Istituto Superiore di Sanità, promoted a consesus conference entitled "Recommendation for promoting patient engagement in healthcare for chronic conditions". This consensus conferences constituted the occasion of sharing and discussion among experts belonging to different clinical and institutional contexts as well as with representative of patients associations in order to identify good practices and effective tools to promote patient engagement in the care and cure process for chronic conditions.

Peer relations of youth with pediatric conditions and health risks: promoting social support and healthy lifestyles.

PubMed

La Greca, Annette M; Bearman, Karen J; Moore, Hannah

2002-08-01

Peer relations and close friendships play important roles in youngsters' emotional development and take on special significance when a child or adolescent has a chronic disease. This article reviews the key ways that peer relations have been examined in youth with chronic pediatric conditions and specifically focuses on (1) the role of peers and close friends as a source of support, (2) friends' influence on treatment adherence, and (3) peers' and friends' impact on health-promoting and health-risk behaviors. In general, youngsters with chronic conditions do not have more problems in their peer relations than other youth, although children with medical conditions that are stigmatizing or that involve the central nervous system (CNS) may encounter peer difficulties. Social support from friends and classmates appears to facilitate youngsters' disease adaptation and may help with the lifestyle aspects of treatment regimens. Adolescent peer-crowd affiliations (e.g., "brains," "jocks") that are linked with health-promoting behaviors may prove beneficial to youngsters' disease management and health. The findings underscore the need for helping children and adolescents disclose their medical condition to peers in positive ways and for including youngsters' close friends in the treatment process and in school-reentry programs after extended medical care. Additional research is needed to develop strategies for incorporating youngsters' peers and friends into the medical management of youth with chronic pediatric conditions.

Promoting Integrated Approaches to Reducing Health Inequities among Low-Income Workers: Applying a Social Ecological Framework

PubMed Central

Baron, Sherry L; Beard, Sharon; Davis, Letitia K.; Delp, Linda; Forst, Linda; Kidd-Taylor, Andrea; Liebman, Amy K.; Linnan, Laura; Punnett, Laura; Welch, Laura S.

2013-01-01

Nearly one of every three workers in the United States is low-income. Low-income populations have a lower life expectancy and greater rates of chronic diseases compared to those with higher incomes. Low- income workers face hazards in their workplaces as well as in their communities. Developing integrated public health programs that address these combined health hazards, especially the interaction of occupational and non-occupational risk factors, can promote greater health equity. We apply a social-ecological perspective in considering ways to improve the health of the low-income working population through integrated health protection and health promotion programs initiated in four different settings: the worksite, state and local health departments, community health centers, and community-based organizations. An example of successful approaches to developing integrated programs in each of these settings is described. Recommendations for improved research, training, and coordination among health departments, health practitioners, worksites and community organizations are proposed. PMID:23532780

Predicting efficacy of robot-aided rehabilitation in chronic stroke patients using an MRI-compatible robotic device.

PubMed

Sergi, Fabrizio; Krebs, Hermano Igo; Groissier, Benjamin; Rykman, Avrielle; Guglielmelli, Eugenio; Volpe, Bruce T; Schaechter, Judith D

2011-01-01

We are investigating the neural correlates of motor recovery promoted by robot-mediated therapy in chronic stroke. This pilot study asked whether efficacy of robot-aided motor rehabilitation in chronic stroke could be predicted by a change in functional connectivity within the sensorimotor network in response to a bout of motor rehabilitation. To address this question, two stroke patients participated in a functional connectivity MRI study pre and post a 12-week robot-aided motor rehabilitation program. Functional connectivity was evaluated during three consecutive scans before the rehabilitation program: resting-state; point-to-point reaching movements executed by the paretic upper extremity (UE) using a newly developed MRI-compatible sensorized passive manipulandum; resting-state. A single resting-state scan was conducted after the rehabilitation program. Before the program, UE movement reduced functional connectivity between the ipsilesional and contralesional primary motor cortex. Reduced interhemispheric functional connectivity persisted during the second resting-state scan relative to the first and during the resting-state scan after the rehabilitation program. Greater reduction in interhemispheric functional connectivity during the resting-state was associated with greater gains in UE motor function induced by the 12-week robotic therapy program. These findings suggest that greater reduction in interhemispheric functional connectivity in response to a bout of motor rehabilitation may predict greater efficacy of the full rehabilitation program.

An Educational Intervention to Train Professional Nurses in Promoting Patient Engagement: A Pilot Feasibility Study.

PubMed

Barello, Serena; Graffigna, Guendalina; Pitacco, Giuliana; Mislej, Maila; Cortale, Maurizio; Provenzi, Livio

2016-01-01

Introduction: Growing evidence recognizes that patients who are motivated to take an active role in their care can experience a range of health benefits and reduced healthcare costs. Nurses play a critical role in the effort to make patients fully engaged in their disease management. Trainings devoted to increase nurses' skills and knowledge to assess and promote patient engagement are today a medical education priority. To address this goal, we developed a program of nurse education training in patient engagement strategies (NET-PES). This paper presents pilot feasibility study and preliminary participants outcomes for NET-PES. Methods: This is a pilot feasibility study of a 2-session program on patient engagement designed to improve professional nurses' ability to engage chronic patients in their medical journey; the training mainly focused on passing patient engagement assessment skills to clinicians as a crucial mean to improve care experience. A pre-post pilot evaluation of NET-PES included 46 nurses working with chronic conditions. A course specific competence test has been developed and validated to measure patient engagement skills. The design included self-report questionnaire completed before and after the training for evaluation purposes. Participants met in a large group for didactic presentations and then they were split into small groups in which they used role-play and case discussion to reflect upon the value of patient engagement measurement in relation to difficult cases from own practice. Results: Forty-six nurses participated in the training program. The satisfaction questionnaire showed that the program met the educational objectives and was considered to be useful and relevant by the participants. Results demonstrated changes on clinicians' attitudes and skills in promoting engagement. Moreover, practitioners demonstrated increases on confidence regarding their ability to support their patients' engagement in the care process. Conclusions: Learning programs teaching nurses about patient engagement strategies and assessment measures in clinical practice are key in supporting the realization of patient engagement in healthcare. Training nurses in this area is feasible and accepted and might have an impact on their ability to engage patients in the chronic care journey. Due to the limitation of the research design, further research is needed to assess the effectiveness of such a program and to verify if the benefits envisaged in this pilot are maintained on a long-term perspective and to test results by employing a randomized control study design.

Meeting the challenges of chronic illness: a nurse-led collaborative community care program in Thailand.

PubMed

Sindhu, Siriorn; Pholpet, Chennet; Puttapitukpol, Somjai

2010-01-01

Chronic illness is of concern to health care systems globally. Although a significant evidence base supports the concept of nurse-led interventions, less data is available to address unique features of health care systems in the developing world. The purpose of this study aimed to undertake preliminary testing of an intervention of nurse-led community care program, the Network Collaborative Action Plan (N-CAP), to assess the impact on disease severity and patient satisfaction. A quasi-experimental study, using historical controls, evaluated a collaborative nurse-led intervention to promote coordination and continuity of care for patients with chronic illness. Participants, diagnosed with chronic obstructive lung disease (COPD), coronary heart disease (CHD) and chronic heart failure (CHF) were recruited. Prospective consecutive patient meeting the study criteria (n=47) were assigned into the control group and following development and implementation of the intervention eligible consenting patients were enrolled in the experimental group (n=44). Participants in the experimental group had significantly tower scores on severity of disease measurements during the third week (F = 4.61, p = 0.035) and the eighth week hospital (F = 4.30, p = .041) following hospital discharge than those in the control group. Participants in the experimental group expressed significantly higher scores on satisfaction with community care than those in the control group. A nurse-led, collaboratively developed program has potential to improve satisfaction and decrease symptom development in people with chronic illnesses in Thailand.

Promoting the Health of Young Adults in Urban Public Universities: A Case Study from City University of New York

ERIC Educational Resources Information Center

Freudenberg, Nicholas; Manzo, Luis; Mongiello, Lorraine; Jones, Hollie; Boeri, Natascia; Lamberson, Patricia

2013-01-01

Changing demographics of college students and new insights into the developmental trajectory of chronic diseases present universities with opportunities to improve population health and reduce health inequalities. The reciprocal relationships between better health and improved educational achievement also offer university health programs a chance…

Changes in Social Support over Time in a Faith-Based Physical Activity Intervention

ERIC Educational Resources Information Center

Story, Chandra R.; Knutson, Douglas; Brown, Jameisha B.; Spears-Laniox, Erica; Harvey, Idethia Shevon; Gizlice, Ziya; Whitt-Glover, Melicia C.

2017-01-01

African-American women report higher levels of chronic conditions and church attendance relative to the overall US population. Therefore, efforts have increased over the past decade to design church-based health promotion programs. The present study compared changes in religiosity, religious social support and general social support across time…

A pilot study of Aboriginal health promotion from an ecological perspective

PubMed Central

2011-01-01

Background For health promotion to be effective in Aboriginal and Torres Strait Islander Communities, interventions (and their evaluation) need to work within a complex social environment and respect Indigenous knowledge, culture and social systems. At present, there is a lack of culturally appropriate evaluation methods available to practitioners that are capable of capturing this complexity. As an initial response to this problem, we used two non-invasive methods to evaluate a community-directed health promotion program, which aimed to improve nutrition and physical activity for members of the Aboriginal community of the Goulburn-Murray region of northern Victoria, Australia. The study addressed two main questions. First, for members of an Aboriginal sporting club, what changes were made to the nutrition environment in which they meet and how is this related to national guidelines for minimising the risk of chronic disease? Second, to what degree was the overall health promotion program aligned with an ecological model of health promotion that addresses physical, social and policy environments as well as individual knowledge and behaviour? Methods Rather than monitoring individual outcomes, evaluation methods reported on here assessed change in the nutrition environment (sports club food supply) as a facilitator of dietary change and the 'ecological' nature of the overall program (that is, its complexity with respect to numbers of targets, settings and strategies). Results There were favourable changes towards the provision of a food supply consistent with Australian guidelines at the sports club. The ecological analysis indicated that the design and implementation of the program were consistent with an ecological model of health promotion. Conclusions The evaluation was useful for assessing the impact of the program on the nutrition environment and for understanding the ecological nature of program activities. PMID:21961906

Relational coordination promotes quality of chronic care delivery in Dutch disease-management programs.

PubMed

Cramm, Jane Murray; Nieboer, Anna Petra

2012-01-01

Previous studies have shown that relational coordination is positively associated with the delivery of hospital care, acute care, emergency care, trauma care, and nursing home care. The effect of relational coordination in primary care settings, such as disease-management programs, remains unknown. This study examined relational coordination between general practitioners and other professionals in disease-management programs and assessed the impact of relational coordination on the delivery of chronic illness care. Professionals (n = 188; response rate = 57%) in 19 disease-management programs located throughout the Netherlands completed surveys that assessed relational coordination and chronic care delivery. We used a cross-sectional study design. Our study demonstrated that the delivery of chronic illness care was positively related to relational coordination. We found positive relationships with community linkages (r = .210, p < .01), self-management support (r = .217, p < .01), decision support (r = .190, p < .01), delivery system design (r = .278, p < .001), and clinical information systems (r = .193, p < .01). Organization of the health delivery system was not significantly related to relational coordination. The regression analyses showed that even after controlling for all background variables, relational coordination still significantly affected chronic care delivery (β = .212, p ≤ .01). As expected, our findings showed a lower degree of relational coordination among general practitioners than between general practitioners and other core disease-management team members: practice nurses (M = 2.69 vs. 3.73; p < .001), dieticians (M = 2.69 vs. 3.07; p < .01), physical therapists (M = 2.69 vs. 3.06; p < .01), medical specialists (M = 2.69 vs. 3.16; p < .01), and nurse practitioners (M = 2.69 vs. 3.19; p < .001). The enhancement of relational coordination among core disease-management professionals with different disciplines is expected to improve chronic illness care delivery.

Self-management of chronic low back pain and osteoarthritis.

PubMed

May, Stephen

2010-04-01

Chronic low back pain and osteoarthritis are two musculoskeletal problems that are highly prevalent in the general population, are frequently episodic and persistent, and are associated with high costs to society, both direct and indirect. This epidemiological picture provides the background that justifies the use of self-management strategies in managing these problems. For this Review, relevant systematic reviews were included that related to effectiveness; other study designs were included that addressed other aspects of the topic. The accepted definition of self-management includes liaison between health professionals and individuals with these problems, as well as independent health-promotion activities. Independent self-management strategies, such as exercise and self-medication, are practiced by individuals in the general population. Consistent evidence shows that self-management programs for osteoarthritis are effective in addressing pain and function, but effect sizes are small and might be clinically negligible. Educational programs for patients with back pain are effective in an occupational setting and if combined with an exercise program. Exercise is an effective strategy in the management of both chronic low back pain and osteoarthritis, although it is unclear what the optimum exercise is. Exercise, supported by advice and education, should be at the core of self-management strategies for chronic low back pain and osteoarthritis.

Community-Based Programs for Children and Youth: Our Experiences in Design, Implementation, and Evaluation

ERIC Educational Resources Information Center

O'Neil, Margaret E.; Fragala-Pinkham, Maria; Ideishi, Roger I.; Ideishi, Siobhan K.

2012-01-01

Pediatric physical and occupational therapists are in the unique position to provide therapeutic and health promotion interventions to children and youth with special health care needs (CYSHCN) including those with chronic conditions (such as overweight and obesity) in a variety of settings. In this commentary, the authors share their experiences…

Feasibility of a health promotion intervention for a group of predominantly African American women with type 2 diabetes.

PubMed

Rimmer, James H; Silverman, Katie; Braunschweig, Carol; Quinn, Laurie; Liu, Yang

2002-01-01

This feasibility study was undertaken to determine if a group of predominantly low-income, low-education, African American women with type 2 diabetes could achieve good compliance and improved health outcomes with a carefully structured health promotion intervention. The sample consisted of 30 participants from an urban setting who were diagnosed with type 2 diabetes but also had multiple chronic conditions (e.g., obesity, hypertension, joint pain, and depression). Participants attended a university-based health promotion program where they completed a 12-week intervention that addressed diet, nutrition, and health behavior. Transportation was provided at no cost to the participants. Compliance with the 12-week program was 72.5%. Participants made significant improvements in total cholesterol and LDL-cholesterol levels, cardiovascular fitness, muscular strength and endurance, and nutrition knowledge. African American women with type 2 diabetes residing in difficult living environments (i.e., poverty, high crime, and lack of family support) can achieve good compliance and health outcomes with a structured health promotion program provided that barriers to participation (e.g., transportation, cost, and commitment) are removed prior to and during the intervention.

The efficacy of using self-monitoring diaries in a weight loss program for chronically ill obese adults in a rural area.

PubMed

Wang, Chi-Jane; Fetzer, Susan J; Yang, Yi-Ching; Wang, Wen-Ling

2012-09-01

Self-monitoring is part of many weight-loss programs and is widely accepted as effective. However, there is a lack of research related to the efficacy of various self-monitoring instruments in meeting the needs of individuals with limited mobility or access to healthcare providers, especially those with limited education living in rural settings. This study examined the efficacy of using self-monitoring diaries in a weight loss program targeting chronically ill and obese rural-dwelling adults. A community-based intervention program using a pretest and posttest design examined the effect of using self-monitoring diaries on weight loss. Fifty participants were enrolled from the chronic disease clinic of a district health center with limited medical resources in a remote village in southwestern Taiwan. All participants were diagnosed with diabetes and/or hypertension, had body mass indices between 27 and 32 kg/m, and had a minimum educational level of junior high school. Mean participant age was 43.7 years. Participants were randomly assigned to the intervention or control group. All attended a mandatory 12-week weight loss program. The intervention group received instructions on how to record diet and exercise details in a structured, graphics-based diary provided by the researchers. Body weight and percentage of body fat were measured before and after the program, and data were analyzed by chi-square and ANCOVA. The intervention group significantly lost more weight than the control group (5.7 kg vs. 2.1 kg; p < .05). The participants of 88% in the intervention group lost 5% or more of their baseline weight greater than the 23% in the control group. Both groups achieved the mean of body fat reductions by comparing pretest and posttest. Self-monitoring diaries can have a significant impact on weight loss in individuals living in rural communities. Healthcare providers and health promotion agencies can use the suggested checklist method to improve weight loss promotion programs in isolated rural communities with limited medical resources.

The association between medical costs and participation in the vitality health promotion program among 948,974 members of a South African health insurance company.

PubMed

Patel, Deepak N; Lambert, Estelle V; da Silva, Roseanne; Greyling, Mike; Nossel, Craig; Noach, Adam; Derman, Wayne; Gaziano, Thomas

2010-01-01

Examine the association between the levels of participation in an incentive-based health promotion program (Vitality) and inpatient medical claims among members of a major health insurer. A 1-year, cross-sectional, correlational analyses of engagement with a health promotion program and hospital claims experience (admissions costs, days in hospital, and admission rate) of members of a national private health insurer. Adult members of South Africa's largest national private health insurer, Discovery Health. Insured members were also eligible for voluntary membership in an insurance-linked incentivized health promotion program, Vitality. The study sample included 948,974 adult members of the Discovery Health plan for the year 2006. Of these, 591,134 (62.3%) were also members of the Vitality health promotion program. The study sample was grouped based on registration and the level of engagement with the Vitality health promotion program into the following: not registered (37.5%), registered but not engaged with any health promotion activity (21.9%), low engagement (30.9%), and high engagement (9.5%). High engagement was defined a priori by the accumulation of an arbitrary number of points on the Vitality program, allocated against specific activities (knowledge, fitness-related activities, assessment and screening, and healthy choices). Hospital admission costs, the number of days in hospital, and hospital admission rates were compared among highly engaged members and those members who were not enrolled in the program, nonengaged, and lowly engaged. Data were normalized for age, gender, plan type, and chronic disease status. Highly engaged members had lower costs per patient, shorter stays in hospital, and fewer admissions compared with other groups (p < .001). Low or no engagement was not associated with lower hospital costs. Admission rates were also 7.4% lower for cardiovascular disease, 13.2% lower for cancers, and 20.7% lower for endocrine and metabolic diseases in the highly engaged group compared with any of the other groups (p < .01). Engagement in an incentive-based wellness program, offered by a health insurer, was associated with lower health care costs.

Avoiding Failure for Australia's Digital Health Record: The Findings from a Rural E-Health Participatory Research Project.

PubMed

Almond, H; Cummings, E; Turner, P

2016-01-01

Low adoption and use of Australia's digital health record has driven the Australian Government to trial 'opt-out' registration from mid-June 2016. The assumption that automatic registration will increase use and thereby deliver benefit requires further investigation especially amongst those sections of the population in rural, regional, remote Australia living with complex chronic conditions. This paper reports on findings from a community based participatory e-health research project based on an initiative where people with complex chronic conditions and their carers attended a rural health promotion and lifestyle modification program. Through co-operative enquiry, health promotion officers and their clients were actively supported to adopt and use Australia's digital health record as an intervention. Simultaneously they were encouraged to reflect on its design and their perceptions of its overall impact on their individual ability to self-manage complex chronic conditions. The findings, ultimately contributing to a conceptual implementation and evaluation framework for Australia's digital health record that could directly avoid failure of the new 'opt-out' approach being adopted.

[Laser therapy and famotidine in complex restorative treatment of primary chronic gastroduodenitis].

PubMed

Filimonov, R M; Musaeva, O M

2003-01-01

Primary chronic gastroduodenitis (PCG) is one of the most frequent diseases of the gastrointestinal tract. Timely and efficient treatment of patients with PCG promotes ulcer prevention. In this connection, an urgent problem of restorative medicine is to develop medical programs with active introduction of pharmacophysiotherapeutic complexes, in particular, laser therapy and anti-secretory preparation (famotidine) that increase therapeutic efficacy of treatment of this disease. To this end, we give results of treatment of 50 patients with primary chronic gastroduodenitis (26 having undergone laser therapy only, and 24 having had a combination of laser therapy and famotidine), which demonstrated that the complex action method has a more adequate effect on pathogenetic components in this disease than monotherapy.

[Health promotion and primary prevention strategies to fight chronic disease: a systematic review].

PubMed

da Silva, Luciana Saraiva; Cotta, Rosângela Minardi Mitre; Rosa, Carla de Oliveira Barbosa

2013-11-01

To analyze health promotion and primary prevention strategies in the global fight against chronic noncommunicable diseases (NCDs) and to reflect on the challenges of overcoming these diseases. In this systematic literature review, studies were analyzed on health programs identified by the Brazilian Health Ministry as the main global community intervention initiatives: the North Karelia Project, in Finland; the Stanford Three-Community Study, Stanford Five-City Project, Minnesota Heart Health and Pawtucket Heart Health Program, in the United States; the CINDI project, in Europe and Canada; CARMEN in South America; Mirame, in Chile; and Tianjin, in China. The LILACS, Medline, and SciELO databases were searched, as well as the Brazilian Health Ministry, Pan American Health Organization, and World Health Organization websites. Only original articles analyzing primary data were included. The outcomes evaluated in the studies were cholesterol, blood pressure, obesity, physical activity level, tobacco use, dietary habits, and other risk factors for NCDs. Seventeen studies were selected. The North Karelia Project, Three Community Study, and Five-City Multifactor Risk Reduction Project contributed to decrease tobacco use, cholesterol levels, and blood pressure levels. The Minnesota Heart Health Program and the Pawtucket Heart Health Program had moderate success in reducing the risk factors for NCD. The CINDI and CARMEN programs demonstrated the importance of integrated actions for decreasing the main risk factors. The Mirame project, which focused on educational interventions for school children, reached 30,000 students in 2001 without requiring a large financial investment. The Tianjin project was able to reduce salt intake, prevalence of arterial hypertension, and obesity by restructuring primary health care services. These successful experiences in community health improvement may serve as models for the implementation of more effective health policies, aiming at the development of actions that integrate health promotion and primary prevention of the main risk factors for NCDs.

Organizational capacity for chronic disease prevention: a survey of Canadian public health organizations.

PubMed

Hanusaik, Nancy; O'Loughlin, Jennifer L; Kishchuk, Natalie; Paradis, Gilles; Cameron, Roy

2010-04-01

There are no national data on levels of organizational capacity within the Canadian public health system to reduce the burden of chronic disease. Cross-sectional data were collected in a national survey (October 2004 to April 2005) of all 216 national, provincial and regional-level organizations engaged in chronic disease prevention through primary prevention or healthy lifestyle promotion. Levels of organizational capacity (defined as skills and resources to implement chronic disease prevention programmes), potential determinants of organizational capacity and involvement in chronic disease prevention programming were compared in western, central and eastern Canada and across three types of organizations (formal public health organizations, non-governmental organizations and grouped organizations). Forty percent of organizations were located in Central Canada. Approximately 50% were formal public health organizations. Levels of skill and involvement were highest for activities that addressed tobacco control and healthy eating; lowest for stress management, social determinants of health and programme evaluation. The few notable differences in skill levels by provincial grouping favoured Central Canada. Resource adequacy was rated low across the country; but was lowest in eastern Canada and among formal public health organizations. Determinants of organizational capacity (organizational supports and partnerships) were highest in central Canada and among grouped organizations. These data provide an evidence base to identify strengths and gaps in organizational capacity and involvement in chronic disease prevention programming in the organizations that comprise the Canadian public health system.

[Resource management: ICF-oriented exercise programs for patients with diabetes mellitus type 2. Chronic illnesses and biopsychosocial status].

PubMed

Pfeifer, K; Huber, G; Baldus, A; Pöthig, D; Schüle, K

2012-02-01

Common health problems are increasing due to the combination of decreased physical activity demands in everyday life and demographic changes; thus, the importance of exercise therapy is increasing. The incidence and prevalence of today's predominant chronic diseases are directly related to physical activity. However, daily clinical routine does not stay abreast with these changes. The education of physicians, and thus their scope of action, is dominated by biomedical therapy concepts, predominantly drug therapy concepts. Differential and consolidated findings of modern exercise and sport science are astonishingly rare in the counselling and treatment portfolio of medical care. The present disease management program for persons with diabetes mellitus type 2 is a good example. Referring to this background, the authors address the new approach of "ICF-oriented exercise programs and biopsychosocial status." They present resource-related interventional strategies and health care concepts for chronic health disorders like the metabolic syndrome or diabetes mellitus type 2. The relevance and use of active health promotion and care - due to lifestyle- and age-related health problems of the population - will increase in importance and be more commonly recommended.

Designing and pilot-testing a church-based community program to reduce obesity among African Americans.

PubMed

Cowart, Luvenia W; Biro, Diana J; Wasserman, Timothy; Stein, Ruth Federman; Reider, Lindsey R; Brown, Betty

2010-01-01

Obesity raises the risk for many chronic diseases and poor health outcomes. African Americans have the highest rates of excess weight in the nation, and standard weight management programs have not worked well with this population. The Genesis Health Project, a community-designed, culturally competent intervention to reduce obesity and promote healthy lifestyles, represents a successful partnership among Syracuse University, local Black churches, and several sponsors to empower families of color to adopt and sustain positive health practices across the lifespan. This article describes the Phase I design and pilot-testing of this demonstration project, and reports the results of the first-year nutrition education/exercise-fitness program. Participant feedback indicates notable shifts toward healthier food choices, cooking methods, and exercise habits, as well as increased motivation, improved health indicators, and revamped church menus. Lessons learned from this project can be helpful in developing other community/faith-based health promotion programs for African Americans.

Cigarette smoke condensate induces differential expression and promoter methylation profiles of critical genes involved in lung cancer in NL-20 lung cells in vitro: short-term and chronic exposure.

PubMed

Word, Beverly; Lyn-Cook, Lascelles E; Mwamba, Bibi; Wang, Honggang; Lyn-Cook, Beverly; Hammons, George

2013-01-01

Establishing early diagnostic markers of harm is critical for effective prevention programs and regulation of tobacco products. This study examined effects of cigarette smoke condensate (CSC) on expression and promoter methylation profile of critical genes (DAPK, ECAD, MGMT, and RASSF1A) involved in lung cancer development in different human lung cell lines. NL-20 cells were treated with 0.1-100 μg/ml of CSC for 24 to 72 hrs for short-term exposures. DAPK expression or methylation status was not significantly affected. However, CSC treatment resulted in changes in expression and promoter methylation profile of ECAD, MGMT, and RASSF1A. For chronic studies, cells were exposed to 1 or 10 μg/ml CSC up to 28 days. Cells showed morphological changes associated with transformation and changes in invasion capacities and global methylation status. This study provides critical data suggesting that epigenetic changes could serve as an early biomarker of harm due to exposure to cigarette smoke.

Childhood nutrition education in health promotion and disease prevention.

PubMed Central

Olson, C. M.

1989-01-01

In the last 10 to 15 years, nutrition has become a major component of health promotion and chronic disease prevention. Two widely recommended strategies for incorporating nutrition education directed toward children and youth into health promotion and disease prevention efforts are school-based nutrition education and the integration of nutritional care into health care. School-based nutrition education programs targeted toward very specific eating behaviors are showing very promising results in regard to behavior and attitude change of children and adolescents. Substantial changes in health care providers' attitudes and practices and in the funding and financing of health care will be needed if nutrition education delivered in the context of routine health care is to be a major force in health promotion and disease prevention for youth. PMID:2629968

The Promoting Effective Advance Care for Elders (PEACE) randomized pilot study: theoretical framework and study design.

PubMed

Allen, Kyle R; Hazelett, Susan E; Radwany, Steven; Ertle, Denise; Fosnight, Susan M; Moore, Pamela S

2012-04-01

Practice guidelines are available for hospice and palliative medicine specialists and geriatricians. However, these guidelines do not adequately address the needs of patients who straddle the 2 specialties: homebound chronically ill patients. The purpose of this article is to describe the theoretical basis for the Promoting Effective Advance Care for Elders (PEACE) randomized pilot study. PEACE is an ongoing 2-group randomized pilot study (n=80) to test an in-home interdisciplinary care management intervention that combines palliative care approaches to symptom management, psychosocial and emotional support, and advance care planning with geriatric medicine approaches to optimizing function and addressing polypharmacy. The population comprises new enrollees into PASSPORT, Ohio's community-based, long-term care Medicaid waiver program. All PASSPORT enrollees have geriatric/palliative care crossover needs because they are nursing home eligible. The intervention is based on Wagner's Chronic Care Model and includes comprehensive interdisciplinary care management for these low-income frail elders with chronic illnesses, uses evidence-based protocols, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. Our model, with its standardized, evidence-based medical and psychosocial intervention protocols, will transport easily to other sites that are interested in optimizing outcomes for community-based, chronically ill older adults. © Mary Ann Liebert, Inc.

An Educational Intervention to Train Professional Nurses in Promoting Patient Engagement: A Pilot Feasibility Study

PubMed Central

Barello, Serena; Graffigna, Guendalina; Pitacco, Giuliana; Mislej, Maila; Cortale, Maurizio; Provenzi, Livio

2017-01-01

Introduction: Growing evidence recognizes that patients who are motivated to take an active role in their care can experience a range of health benefits and reduced healthcare costs. Nurses play a critical role in the effort to make patients fully engaged in their disease management. Trainings devoted to increase nurses' skills and knowledge to assess and promote patient engagement are today a medical education priority. To address this goal, we developed a program of nurse education training in patient engagement strategies (NET-PES). This paper presents pilot feasibility study and preliminary participants outcomes for NET-PES. Methods: This is a pilot feasibility study of a 2-session program on patient engagement designed to improve professional nurses' ability to engage chronic patients in their medical journey; the training mainly focused on passing patient engagement assessment skills to clinicians as a crucial mean to improve care experience. A pre-post pilot evaluation of NET-PES included 46 nurses working with chronic conditions. A course specific competence test has been developed and validated to measure patient engagement skills. The design included self-report questionnaire completed before and after the training for evaluation purposes. Participants met in a large group for didactic presentations and then they were split into small groups in which they used role-play and case discussion to reflect upon the value of patient engagement measurement in relation to difficult cases from own practice. Results: Forty-six nurses participated in the training program. The satisfaction questionnaire showed that the program met the educational objectives and was considered to be useful and relevant by the participants. Results demonstrated changes on clinicians' attitudes and skills in promoting engagement. Moreover, practitioners demonstrated increases on confidence regarding their ability to support their patients' engagement in the care process. Conclusions: Learning programs teaching nurses about patient engagement strategies and assessment measures in clinical practice are key in supporting the realization of patient engagement in healthcare. Training nurses in this area is feasible and accepted and might have an impact on their ability to engage patients in the chronic care journey. Due to the limitation of the research design, further research is needed to assess the effectiveness of such a program and to verify if the benefits envisaged in this pilot are maintained on a long-term perspective and to test results by employing a randomized control study design. PMID:28119644

Can organizations benefit from worksite health promotion?

PubMed Central

Leviton, L C

1989-01-01

A decision-analytic model was developed to project the future effects of selected worksite health promotion activities on employees' likelihood of chronic disease and injury and on employer costs due to illness. The model employed a conservative set of assumptions and a limited five-year time frame. Under these assumptions, hypertension control and seat belt campaigns prevent a substantial amount of illness, injury, and death. Sensitivity analysis indicates that these two programs pay for themselves and under some conditions show a modest savings to the employer. Under some conditions, smoking cessation programs pay for themselves, preventing a modest amount of illness and death. Cholesterol reduction by behavioral means does not pay for itself under these assumptions. These findings imply priorities in prevention for employer and employee alike. PMID:2499556

Chronic disease prevention policy in British Columbia and Ontario in light of public health renewal: a comparative policy analysis

PubMed Central

2013-01-01

Background Public health strategies that focus on legislative and policy change involving chronic disease risk factors such as unhealthy diet and physical inactivity have the potential to prevent chronic diseases and improve quality of life as a whole. However, many public health policies introduced as part of public health reform have not yet been analyzed, such as in British Columbia and Ontario. The purpose of this paper is to present the results of a descriptive, comparative analysis of public health policies related to the Healthy Living Core Program in British Columbia and Chronic Disease Prevention Standard in Ontario that are intended to prevent a range of chronic diseases by promoting healthy eating and physical activity, among other things. Methods Policy documents were found through Internet search engines and Ministry websites, at the guidance of policy experts. These included government documents as well as documents from non-governmental organizations that were implementing policies and programs at a provincial level. Documents (n = 31) were then analysed using thematic content analysis to classify, describe and compare policies in a systematic fashion, using the software NVivo. Results Three main categories emerged from the analysis of documents: 1) goals for chronic disease prevention in British Columbia and Ontario, 2) components of chronic disease prevention policies, and 3) expected outputs of chronic disease prevention interventions. Although there were many similarities between the two provinces, they differed somewhat in terms of their approach to issues such as evidence, equity, and policy components. Some expected outputs were adoption of healthy behaviours, use of information, healthy environments and increased public awareness. Conclusions The two provincial policies present different approaches to support the implementation of related programs. Differences may be related to contextual factors such as program delivery structures and different philosophical approaches underlying the two frameworks. These differences and possible explanations for them are important to understand because they serve to contextualize the differences in health outcomes across the two provinces that might eventually be observed. This analysis informs future public health policy directions as the two provinces can learn from each other. PMID:24099140

Chronic disease prevention policy in British Columbia and Ontario in light of public health renewal: a comparative policy analysis.

PubMed

Kothari, Anita; Gore, Dana; MacDonald, Marjorie; Bursey, Gayle; Allan, Diane; Scarr, Jennifer

2013-10-08

Public health strategies that focus on legislative and policy change involving chronic disease risk factors such as unhealthy diet and physical inactivity have the potential to prevent chronic diseases and improve quality of life as a whole. However, many public health policies introduced as part of public health reform have not yet been analyzed, such as in British Columbia and Ontario. The purpose of this paper is to present the results of a descriptive, comparative analysis of public health policies related to the Healthy Living Core Program in British Columbia and Chronic Disease Prevention Standard in Ontario that are intended to prevent a range of chronic diseases by promoting healthy eating and physical activity, among other things. Policy documents were found through Internet search engines and Ministry websites, at the guidance of policy experts. These included government documents as well as documents from non-governmental organizations that were implementing policies and programs at a provincial level. Documents (n = 31) were then analysed using thematic content analysis to classify, describe and compare policies in a systematic fashion, using the software NVivo. Three main categories emerged from the analysis of documents: 1) goals for chronic disease prevention in British Columbia and Ontario, 2) components of chronic disease prevention policies, and 3) expected outputs of chronic disease prevention interventions. Although there were many similarities between the two provinces, they differed somewhat in terms of their approach to issues such as evidence, equity, and policy components. Some expected outputs were adoption of healthy behaviours, use of information, healthy environments and increased public awareness. The two provincial policies present different approaches to support the implementation of related programs. Differences may be related to contextual factors such as program delivery structures and different philosophical approaches underlying the two frameworks. These differences and possible explanations for them are important to understand because they serve to contextualize the differences in health outcomes across the two provinces that might eventually be observed. This analysis informs future public health policy directions as the two provinces can learn from each other.

A collaborative university model for employee wellness.

PubMed

Carter, Melondie R; Kelly, Rebecca C; Alexander, Chelley K; Holmes, Lauren M

2011-01-01

Universities are taking a more active approach in understanding and monitoring employees' modifiable health risk factors and chronic care conditions by developing strategies to encourage employees to start and sustain healthy behaviors. WellBama, the University of Alabama's signature health and wellness program, utilizes a collaborative model in partnership with select colleges and departments to implement strategies to improve employees' health status. The program provides onsite health screenings and assessments, timely health advising sessions, assistance in setting and monitoring individual health goals to promote improved health, and preventive examination referrals.

Health Promotion Behaviors and Chronic Diseases of Aging in the Elderly People of Iranshahr*- IR Iran.

PubMed

Pishkar Mofrad, Zahra; Jahantigh, Mozhgan; Arbabisarjou, Azizollah

2015-07-13

Aging is considered as the phenomenon of the day in the health arena of the world and Iran. It is anticipated that there will be an explosion of aging population in Iran in about 2031 and 20-25% of the population will be aged over 60 years. With aging, chronic diseases also increase and diminish the functional ability of older people. On the other hand, increased healthcare costs should be also added to this issue. Health promotion is a concept of process that continues throughout life. As much as health promotion is important in children and adults, it is equally important in older people. In fact, the elderlies, as a group, also acquire many benefits from health promotion behaviors. Due to the increasing elderly population, geriatric health promotion and enhancing the health level of older people is proposed as a health priority that should be properly planned. Hence, the present study has been conducted in this regard and aims to identify behaviors of health promotion and chronic diseases of aging in the elderly people of Iranshahr-Iran. The present research is a cross-sectional descriptive study whose population consists of 425 elderly people aged 60 years and over, who lived in the city of Iranshahr*, IR Iran. The random cluster sampling method has been used to select the research samples. The required information was collected using a questionnaire which was distributed among the older people through visiting their homes; then, the collected data was statistically analyzed using the statistical software of SPSS version 13. the research findings show that the mean age of older people is and the highest frequency belongs to the age group of 60 years and the maximum age is 92 years. 69.5% of the older people were in the age group of the young elderly (60-69 years) and 44% of them lived with their married children; also 55.8%, 81.9%, 70.5%, and 74.4% of them were respectively female, illiterate, married, and unemployed. The mean score of geriatric health promotion behaviors was in the range of 0-11 and 54.9% of them got the score of the inappropriate health promotion behavior. The most frequent chronic diseases of older people were respectively joint problems (78.9%), sensory problems (64.1%), and hypertension (56.6%). No significant relationship was observed between the score of health promotion behaviors and "the gender, lifestyle and marital status of the older people", but there was statistically a significant relationship between the score of health promotion behaviors and "the age, education, and job of the older people". Providing training programs for health promotion behaviors in elderly people can improve these behaviors and enhance their health and quality of life and reduce the incidence of chronic diseases in them. The goal of health promotion behaviors is to maintain performance, independence and quality of life; and many studies have demonstrated that the elderly people who aged 60 years and over benefit from health promotion behaviors more than middle-aged people.

Chronic alcohol intake promotes tumor growth in a diethylnitrosamine-induced hepatocarcinogenesis mouse model through increased Wnt/Beta-catenin signaling

USDA-ARS?s Scientific Manuscript database

Ethanol (EtOH) metabolism is involved in both initiating and promoting mechanisms in hepatocellular carcinoma progression in chronic alcoholics. In this study, we developed a mouse model to test the hypothesis that chronic EtOH consumption promotes tumor growth irrespective of EtOH-related initiati...

Promoting state health department evidence-based cancer and chronic disease prevention: a multi-phase dissemination study with a cluster randomized trial component

PubMed Central

2013-01-01

Background Cancer and other chronic diseases reduce quality and length of life and productivity, and represent a significant financial burden to society. Evidence-based public health approaches to prevent cancer and other chronic diseases have been identified in recent decades and have the potential for high impact. Yet, barriers to implement prevention approaches persist as a result of multiple factors including lack of organizational support, limited resources, competing emerging priorities and crises, and limited skill among the public health workforce. The purpose of this study is to learn how best to promote the adoption of evidence based public health practice related to chronic disease prevention. Methods/design This paper describes the methods for a multi-phase dissemination study with a cluster randomized trial component that will evaluate the dissemination of public health knowledge about evidence-based prevention of cancer and other chronic diseases. Phase one involves development of measures of practitioner views on and organizational supports for evidence-based public health and data collection using a national online survey involving state health department chronic disease practitioners. In phase two, a cluster randomized trial design will be conducted to test receptivity and usefulness of dissemination strategies directed toward state health department chronic disease practitioners to enhance capacity and organizational support for evidence-based chronic disease prevention. Twelve state health department chronic disease units will be randomly selected and assigned to intervention or control. State health department staff and the university-based study team will jointly identify, refine, and select dissemination strategies within intervention units. Intervention (dissemination) strategies may include multi-day in-person training workshops, electronic information exchange modalities, and remote technical assistance. Evaluation methods include pre-post surveys, structured qualitative phone interviews, and abstraction of state-level chronic disease prevention program plans and progress reports. Trial registration clinicaltrials.gov: NCT01978054. PMID:24330729

Process Evaluation of Baltimore Healthy Stores: A Pilot Health Intervention Program With Supermarkets and Corner Stores in Baltimore City

PubMed Central

Gittelsohn, Joel; Suratkar, Sonali; Song, Hee-Jung; Sacher, Suzanne; Rajan, Radha; Rasooly, Irit R.; Bednarek, Erin; Sharma, Sangita; Anliker, Jean A.

2011-01-01

Reduced access to affordable healthy foods is linked to higher rates of chronic diseases in low-income urban settings. The authors conduct a feasibility study of an environmental intervention (Baltimore Healthy Stores) in seven corner stores owned by Korean Americans and two supermarkets in low-income East Baltimore. The goal is to increase the availability of healthy food options and to promote them at the point of purchase. The process evaluation is conducted largely by external evaluators. Participating stores stock promoted foods, and print materials are displayed with moderate to high fidelity. Interactive consumer taste tests are implemented with high reach and dose. Materials developed specifically for Korean American corner store owners are implemented with moderate to high fidelity and dose. Results indicate that small food store–based intervention programs are feasible to implement and are a viable means of increasing healthy food availability and a good location for point-of-purchase promotions in low-income urban settings. PMID:19144859

"Here we're all in the same boat"--a qualitative study of group based rehabilitation for sick-listed citizens with chronic pain.

PubMed

Andersen, Lotte Nygaard; Kohberg, Maria; Herborg, Lene Gram; Søgaard, Karen; Roessler, Kirsten Kaya

2014-08-01

Musculoskeletal pain impacts upon everyday life. A degree of chronicity may pose an increased risk of sickness absence. One of two rehabilitative interventions, "Tailored Physical Activity" or "Chronic Pain Self-Management Program", was offered to sick-listed citizens who experienced pain. The objectives of this paper were to: (1) Assess what factors are experienced as problematic for sick-listed citizens in everyday life with chronic pain, and (2) Evaluate the significance of two distinct rehabilitative interventions on the future everyday lives of sick-listed citizens. Seven semi-structured interviews with sick-listed citizens were analyzed using a phenomenological-hermeneutical approach. Results were discussed by applying the theoretical framework of Antonovsky's salutogenetic model and Yaloms principles for group psychology. The potential for development of citizen's coping is evaluated based on Roessler's notion of progression. The analysis revealed four main themes: (1) Living with pain and unemployment; (2) "Putting my foot down" and "asking for help"; (3) Significance of the group, including instructors, and; (4) Aspects significant to progression. Unemployment is a major life event that promotes stress and can be accompanied by problems related to depressed mood, acceptance of the life situation, feelings of not being useful, feelings of losing control and identity conflicts. Group characteristics that gave a significant basis for progression in the self-management program are both emotional and instrumental, while the physical training program offers a "here-and-now"-experience and motivation to participate. This study indicates that the self-management program could potentially improve coping while the physical activity program revealed one example of a means of progression. © 2014 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

Psychosocial Stress and Ovarian Cancer Risk: Metabolomics and Perceived Stress

DTIC Science & Technology

2017-10-01

AWARD NUMBER: W81XWH-13-1-0493 TITLE: Psychosocial Stress and Ovarian Cancer Risk: Metabolomics and Perceived Stress PRINCIPAL INVESTIGATOR...CONTRACT NUMBER Psychosocial Stress and Ovarian Cancer Risk: Metabolomics and Perceived Stress 5b. GRANT NUMBER W81XWH-13-1-0493 5c. PROGRAM...Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Mouse models suggest that chronic stress promotes ovarian tumorigenesis, but the relationship

An Evaluation of the Navy’s Health Promotion Videotapes

DTIC Science & Technology

1990-04-30

has mainly occurred in hospitals, clinics, and patient education centers. However, as noted by Holm (1983), the broader intent of the patient ...Mitchell, M. (1977). Evaluation of a patient education program for chronic obstructive pulmonary disease. Mayo Clinic Proceedings, 52, 106-111...effectiveness of videotape in patient education on depression. Journal of Biocommunication, 1Q, 19-23. Cull, P. (1988). The production process of health

Systems approaches for chronic disease prevention: sound logic and empirical evidence, but is this view shared outside of academia?

PubMed

Wutzke, Sonia; Morrice, Emily; Benton, Murray; Wilson, Andrew

2016-07-15

There is a need and desire to improve chronic disease prevention efforts across Australia. Increasingly, scientists are urging the use of systems thinking and its methods to significantly shift the way we think about, and intervene in, chronic diseases. This research aimed to examine the convergence between the systems science literature and the views of those working in and advocating for prevention, in relation to the value of systems thinking and its methods for the prevention of chronic diseases. Individual and small-group semistructured interviews were undertaken with 29 individuals across Australia. The interviewees reflected a diverse cross-section of senior public health managers and program implementation staff from state and territory health departments, and senior thought leaders and public health advocates. Interviews were audio recorded and coded into key themes. Feedback from informants illustrated that, among those working in and advocating for prevention, there is a mix of support for systems thinking for chronic disease prevention, and some healthy scepticism. The lack of consistent confluence between those promoting the value of systems science, and those responsible for working in and advocating for prevention indicates a level of confusion about language and definitions. It also reflects a desire for published evidence about systems methods that have proven effectiveness. Systems thinking and its methods have a promising and important role to play in creating a robust, effective and sustainable strategy for prevention of chronic diseases throughout Australia. However, the method requires further development and refinement, and promotion of case studies of effectiveness. We also need to heed lessons learnt overseas.

Preserving mobility in older adults.

PubMed Central

Buchner, D M

1997-01-01

Age-related loss of strength contributes to impaired mobility and increases the risk of falls. Recent research has focused on 2 approaches to preventing age-related loss of strength--promoting physical activity and exercise (especially strength training) and using trophic factors to enhance muscle performance. Epidemiologic evidence strongly supports a role of regular physical activity in successful aging by preserving muscle performance, promoting mobility, and reducing fall risk. Randomized controlled trials provide convincing evidence that strength and endurance training improve muscle performance in older adults. Evidence is rapidly accumulating from randomized trials that endurance, strength, and balance training promote mobility and reduce fall risk, though exercise effects differ according to the type of exercise, details of the exercise program, and the target group of older adults. Because lifetime regular physical activity is recommended for all older adults, a reasonable strategy (especially for weak adults) is an activity program that includes strength training. In contrast, insufficient evidence exists to recommend the long-term use of trophic factors to preserve muscular performance. An intervention that merits additional study is avoiding the use of psychoactive drugs because drugs like benzodiazepines appear to be risk factors for inactivity and may have unrecognized direct effects on muscular performance. Because chronic illness is a risk factor for inactivity and disuse muscle atrophy, randomized trials comparing strength training with other interventions would be useful in understanding whether strength training has advantages in preserving muscle performance and improving health-related quality of life in a variety of chronic illnesses such as depressive illness. PMID:9348757

Health-promotion theories in nutritional interventions for community-dwelling older adults: a systematic review.

PubMed

Raffaele, Barbara; Matarese, Maria; Alvaro, Rosaria; De Marinis, Maria Grazia

2017-01-01

To identify theories applied in interventions promoting healthy nutrition among community-dwelling older adults and determine the efficacy of theories in changing knowledge, attitudes, and behaviors. The PubMed, PsycINFO, Embase, and ERIC databases were searched for English articles from January 1990 to December 2015. Mono or multicomponent randomized controlled trial studies were included, whereas research on nutritional interventions related to acute or chronic diseases were excluded. Eight articles satisfied the inclusion criteria. Only three articles referred explicitly to health promotion theories. Nutritional programs varied in terms of contents, outcomes, lengths of interventions and follow-up. Pooling the results and identifying the most effective theories were therefore impossible. Although researchers and practitioners recognize the significance of theoretical models in guiding the health-promoting interventions, referring to a theoretical model for such interventions is still relatively recent.

Policies and health care financing issues for dialysis in Latin America: extracts from the roundtable discussion on the economics of dialysis and chronic kidney disease.

PubMed

Pecoits-Filho, Roberto; Campos, Camilo; Cerdas-Calderon, Manuel; Fortes, Paulo; Jarpa, Cecilia; Just, Paul; Luconi, Paulo; Lugon, Jocemir R; Pacheco, Alejandro; Paniagua, Ramon; Rodriguez, Konniev; Sanabria, Mauricio; Sciaraffia, Vito; Velasco, Carlos; De Arteaga, Javier

2009-02-01

During the 2008 Congress of the International Society for Peritoneal Dialysis, academic nephrologists, nephrology societies, and government officials from Colombia, Brazil, Argentina, Chile, Central America, Ecuador, and Mexico participated in a roundtable discussion on the Economics of Dialysis and Chronic Kidney Disease in Latin America. The main focus was policy and health care financing. The roundtable promoted open discussion between policymakers and clinicians on how to find viable solutions to contain spending on treatment for end-stage renal disease into the future. A number of options were proposed, including early medical intervention (disease management programs) to slow the progression of chronic kidney disease in high-risk patients, promotion of pre-emptive renal transplantation, and use of the most cost-effective dialysis therapy that can be offered to a patient without compromising outcome. It was concluded that the burden of treating more patients in the future could be alleviated by wider utilization of peritoneal dialysis (PD). However, important changes in health care reimbursement systems and realignment of incentives in the region are required to support wider PD penetration.

Effectiveness of self-management promotion educational program among diabetic patients based on health belief model

PubMed Central

Jalilian, Farzad; Motlagh, Fazel Zinat; Solhi, Mahnaz; Gharibnavaz, Hasan

2014-01-01

Introduction: Diabetes is a chronic disease; it can cause serious complications. Diabetes self-management is essential for prevention of disease complications. This study was conducted to evaluate self-management promotion educational program intervention efficiency among diabetic patients in Iran and health belief model (HBM) was applied as a theoretical framework. Materials and Methods: Overall, 120 Type 2 diabetic patients referred to rural health centers in Gachsaran, Iran participated in this study as randomly divided into intervention and control group. This was a longitudinal randomized pre- and post-test series control group design panel study to implement a behavior modification based intervention to promotion self-management among diabetic patients. Cross-tabulation and t-test by using SPSS statistical package, version 16 was used for the statistical analysis. Results: Mean age was 55.07 years (SD = 9.94, range: 30-70). Our result shows significant improvements in average response for susceptibility, severity, benefit and self-management among intervention group. Additionally, after intervention, average response of the barrier to self-management was decreased among intervention group. Conclusion: Our result showed education program based on HBM was improve of self-management and seems implementing these programs can be effective in the and prevention of diabetes complications. PMID:24741654

Daidzein Augments Cholesterol Homeostasis via ApoE to Promote Functional Recovery in Chronic Stroke

PubMed Central

Kim, Eunhee; Woo, Moon-Sook; Qin, Luye; Ma, Thong; Beltran, Cesar D.; Bao, Yi; Bailey, Jason A.; Corbett, Dale; Ratan, Rajiv R.; Lahiri, Debomoy K.

2015-01-01

Stroke is the world's leading cause of physiological disability, but there are currently no available agents that can be delivered early after stroke to enhance recovery. Daidzein, a soy isoflavone, is a clinically approved agent that has a neuroprotective effect in vitro, and it promotes axon growth in an animal model of optic nerve crush. The current study investigates the efficacy of daidzein on neuroprotection and functional recovery in a clinically relevant mouse model of stroke recovery. In light of the fact that cholesterols are essential lipid substrates in injury-induced synaptic remodeling, we found that daidzein enhanced the cholesterol homeostasis genetic program, including Lxr and downstream transporters, Apoe, Abca1, and Abcg1 genes in vitro. Daidzein also elevated the cholesterol homeostasis genes in the poststroke brain with Apoe, the highest expressing transporter, but did not affect infarct volume or hemispheric swelling. Despite the absence of neuroprotection, daidzein improved motor/gait function in chronic stroke and elevated synaptophysin expression. However, the daidzein-enhanced functional benefits and synaptophysin expression were abolished in Apoe-knock-out mice, suggesting the importance of daidzein-induced ApoE upregulation in fostering stroke recovery. Dissociation between daidzein-induced functional benefits and the absence of neuroprotection further suggest the presence of nonoverlapping mechanisms underlying recovery processes versus acute pathology. With its known safety in humans, early and chronic use of daidzein aimed at augmenting ApoE may serve as a novel, translatable strategy to promote functional recovery in stroke patients without adverse acute effect. SIGNIFICANCE STATEMENT There have been recurring translational failures in treatment strategies for stroke. One underlying issue is the disparity in outcome analysis between animal and clinical studies. The former mainly depends on acute infarct size, whereas long-term functional recovery is an important outcome in patients. In an attempt to identify agents that promote functional recovery, we discovered that an FDA-approved soy isoflavone, daidzein, improved stroke-induced behavioral deficits via enhancing cholesterol homeostasis in chronic stroke, and this occurs without causing adverse effects in the acute phase. With its known safety in humans, the study suggests that the early and chronic use of daidzein serves as a potential strategy to promote functional recovery in stroke patients. PMID:26558782

Daidzein Augments Cholesterol Homeostasis via ApoE to Promote Functional Recovery in Chronic Stroke.

PubMed

Kim, Eunhee; Woo, Moon-Sook; Qin, Luye; Ma, Thong; Beltran, Cesar D; Bao, Yi; Bailey, Jason A; Corbett, Dale; Ratan, Rajiv R; Lahiri, Debomoy K; Cho, Sunghee

2015-11-11

Stroke is the world's leading cause of physiological disability, but there are currently no available agents that can be delivered early after stroke to enhance recovery. Daidzein, a soy isoflavone, is a clinically approved agent that has a neuroprotective effect in vitro, and it promotes axon growth in an animal model of optic nerve crush. The current study investigates the efficacy of daidzein on neuroprotection and functional recovery in a clinically relevant mouse model of stroke recovery. In light of the fact that cholesterols are essential lipid substrates in injury-induced synaptic remodeling, we found that daidzein enhanced the cholesterol homeostasis genetic program, including Lxr and downstream transporters, Apoe, Abca1, and Abcg1 genes in vitro. Daidzein also elevated the cholesterol homeostasis genes in the poststroke brain with Apoe, the highest expressing transporter, but did not affect infarct volume or hemispheric swelling. Despite the absence of neuroprotection, daidzein improved motor/gait function in chronic stroke and elevated synaptophysin expression. However, the daidzein-enhanced functional benefits and synaptophysin expression were abolished in Apoe-knock-out mice, suggesting the importance of daidzein-induced ApoE upregulation in fostering stroke recovery. Dissociation between daidzein-induced functional benefits and the absence of neuroprotection further suggest the presence of nonoverlapping mechanisms underlying recovery processes versus acute pathology. With its known safety in humans, early and chronic use of daidzein aimed at augmenting ApoE may serve as a novel, translatable strategy to promote functional recovery in stroke patients without adverse acute effect. There have been recurring translational failures in treatment strategies for stroke. One underlying issue is the disparity in outcome analysis between animal and clinical studies. The former mainly depends on acute infarct size, whereas long-term functional recovery is an important outcome in patients. In an attempt to identify agents that promote functional recovery, we discovered that an FDA-approved soy isoflavone, daidzein, improved stroke-induced behavioral deficits via enhancing cholesterol homeostasis in chronic stroke, and this occurs without causing adverse effects in the acute phase. With its known safety in humans, the study suggests that the early and chronic use of daidzein serves as a potential strategy to promote functional recovery in stroke patients. Copyright © 2015 the authors 0270-6474/15/3515113-14$15.00/0.

Engaging the Underrepresented Sex: Male Participation in Chronic Disease Self-Management Education (CDSME) Programs.

PubMed

Smith, Matthew Lee; Bergeron, Caroline D; Ahn, SangNam; Towne, Samuel D; Mingo, Chivon A; Robinson, Kayin T; Mathis, Jamarcus; Meng, Lu; Ory, Marcia G

2018-01-01

Females are more likely than males to participate in evidence-based health promotion and disease prevention programs targeted for middle-aged and older adults. Despite the availability and benefits of Stanford's Chronic Disease Self-Management Education (CDSME) programs, male participation remains low. This study identifies personal characteristics of males who attended CDSME program workshops and identifies factors associated with successful intervention completion. Data were analyzed from 45,375 male CDSME program participants nationwide. Logistic regression was performed to examine factors associated with workshop attendance. Males who were aged 65-79 (OR = 1.27, p < .001), Hispanic (OR = 1.22, p < .001), African American (OR = 1.13, p < .001), Asian/Pacific Islander (OR = 1.26, p < .001), Native Hawaiian (OR = 3.14, p < .001), and residing in nonmetro areas (OR = 1.26, p < .001) were more likely to complete the intervention. Participants with 3+ chronic conditions were less likely to complete the intervention (OR = 0.87, p < .001). Compared to health-care organization participants, participants who attended workshops at senior centers (OR = 1.38, p < .001), community/multipurpose facilities (OR = 1.21, p < .001), and faith-based organizations (OR = 1.37, p < .001) were more likely to complete the intervention. Men who participated in workshops with more men were more likely to complete the intervention (OR = 2.14, p < .001). Once enrolled, a large proportion of males obtained an adequate intervention dose. Findings highlight potential strategies to retain men in CDSME programs, which include diversifying workshop locations, incorporating Session Zero before CDSME workshops, and using alternative delivery modalities (e.g., online).

Toward the prevention of childhood undernutrition: diet diversity strategies using locally produced food can overcome gaps in nutrient supply.

PubMed

Parlesak, Alexandr; Geelhoed, Diederike; Robertson, Aileen

2014-06-01

Chronic undernutrition is prevalent in Mozambique, where children suffer from stunting, vitamin A deficiency, anemia, and other nutrition-related disorders. Complete diet formulation products (CDFPs) are increasingly promoted to prevent chronic undernutrition. Using linear programming, to investigate whether diet diversification using local foods should be prioritized in order to reduce the prevalence of chronic undernutrition. Market prices of local foods were collected in Tete City, Mozambique. Linear programming was applied to calculate the cheapest possible fully nutritious food baskets (FNFB) by stepwise addition of micronutrient-dense localfoods. Only the top quintile of Mozambican households, using average expenditure data, could afford the FNFB that was designed using linear programming from a spectrum of local standard foods. The addition of beef heart or liver, dried fish and fresh moringa leaves, before applying linear programming decreased the price by a factor of up to 2.6. As a result, the top three quintiles could afford the FNFB optimized using both diversification strategy and linear programming. CDFPs, when added to the baskets, were unable to overcome the micronutrient gaps without greatly exceeding recommended energy intakes, due to their high ratio of energy to micronutrient density. Dietary diversification strategies using local, low-cost, nutrient-dense foods can meet all micronutrient recommendations and overcome all micronutrient gaps. The success of linear programming to identify a low-cost FNFB depends entirely on the investigators' ability to select appropriate micronutrient-dense foods. CDFPs added to food baskets are unable to overcome micronutrient gaps without greatly exceeding recommended energy intake.

A multilevel health promotion intervention in minority-owned workplaces

PubMed Central

Bowen, Deborah J.; Briant, Katherine J.; Harris, Jeffrey; Hannon, Peggy; Buchwald, Dedra

2015-01-01

Introduction Changing health behaviors and health-related environments is important in reducing chronic disease. Minority workplaces are potential venues to provide regular, effective health promotion opportunities to underserved individuals. The purpose of this study was to test the feasibility of changing workplace policy, programs, and practices in minority-owned workplaces. Methods Four minority Native American-owned businesses were recruited to participate in this study. The intervention was a set of recommended standards and guidelines gleaned from the US Preventive Task Force and The Community Guide relevant to workplaces. Each workplace selected between 4 and 6 target areas to improve over the year-long intervention period. The evaluation tool was a semi-structured survey conducted at baseline and at one-year follow-up, with workplace staff responsible for benefits and services to employees. Feasibility was evaluated by assessing the likelihood that the workplaces implemented health promotion activities in the year-long intervention. Results Several practices and policies changed significantly during the intervention in the four workplaces, including coverage for nicotine replacement therapy (NRT), elimination of out of pocket costs for screening and tobacco cessation, accountability systems for providers, posted stair use, cessation line availability that included NRT, offering weight loss programs, offering physical activity programs, and conducting targeted communication programs about health promotion. Other practices and polices changed in the expected direction, but were not significant. Conclusion Changing workplace programs, practices, and policies is feasible in minority workplaces, with support and tools provided by outside organizations. These findings could drive a full-scale test of the intervention in minority businesses in order to improve the health of disadvantaged workers. PMID:26693135

Milk--the promoter of chronic Western diseases.

PubMed

Melnik, Bodo C

2009-06-01

Common chronic diseases of Western societies, such as coronary heart disease, diabetes mellitus, cancer, hypertension, obesity, dementia, and allergic diseases are significantly influenced by dietary habits. Cow's milk and dairy products are nutritional staples in most Western societies. Milk and dairy product consumption is recommended by most nutritional societies because of their beneficial effects for calcium uptake and bone mineralization and as a source of valuable protein. However, the adverse long-term effects of milk and milk protein consumption on human health have been neglected. A hypothesis is presented, showing for the first time that milk protein consumption is an essential adverse environmental factor promoting most chronic diseases of Western societies. Milk protein consumption induces postprandial hyperinsulinaemia and shifts the growth hormone/insulin-like growth factor-1 (IGF-1) axis to permanently increased IGF-1 serum levels. Insulin/IGF-1 signalling is involved in the regulation of fetal growth, T-cell maturation in the thymus, linear growth, pathogenesis of acne, atherosclerosis, diabetes mellitus, obesity, cancer and neurodegenerative diseases, thus affecting most chronic diseases of Western societies. Of special concern is the possibility that milk intake during pregnancy adversely affects the early fetal programming of the IGF-1 axis which will influence health risks later in life. An accumulated body of evidence for the adverse effects of cow's milk consumption from fetal life to childhood, adolescence, adulthood and senescence will be provided which strengthens the presented hypothesis.

Anatomy of Culturally Sensitive Interventions Promoting Nutrition and Exercise in Hispanics: A Critical Examination of Existing Literature

PubMed Central

Mier, Nelda; Ory, Marcia G.; Medina, Alvaro A.

2013-01-01

Compared with non-Hispanic Whites, Hispanics experience a disproportionate burden of chronic diseases. Understanding the factors influencing the success of health programs in Hispanics requires a clearer examination of the principles and components of tailored interventions. This research comprises a comprehensive literature review of randomized controlled trials testing nutrition and exercise interventions tailored for Hispanics and an examination of how these interventions were constructed. The review of 18 interventions meeting study criteria suggests that most tailored programs promoting nutrition and exercise in Hispanics are theory driven and are informed by formative research. Also, the findings indicate that salient culturally sensitive intervention components are (a) bilingual and bicultural facilitators and materials, (b) family-based activities, (c) literacy-appropriate materials, and (d) social support. A clear understanding of Hispanic cultural values is also required. Further empirical examination is warranted to determine the factors mediating or predicting the efficacy of culturally sensitive health programs for Hispanics. PMID:19193933

Health Promotion and Substance Abuse Prevention among American Indian and Alaska Native Communities: Issues in Cultural Competence. Cultural Competence Series 9. Special Collaborative Edition.

ERIC Educational Resources Information Center

Trimble, Joseph E., Ed.; Beauvais, Fred, Ed.

Substance abuse continues to be one of the most damaging and chronic health problems faced by Indian people. American Indian and Alaska Native (AI/AN) substance abuse prevention and treatment programs must be framed within the broader context of the widening health disparities between AI/AN communities and the general population. Successful…

Maternal high fat diet promotion of mammary tumor risk in adult progeny is associated with early expansion of mammary cancer stem-like cells and increased maternal oxidative environment

USDA-ARS?s Scientific Manuscript database

Many adult chronic diseases might be programmed during early life by maternal nutritional history. Here, we evaluated effects of maternal high fat diet on mammary gland development and tumor formation in adult progeny. Female Wnt-1 transgenic mice exposed to high fat (HFD, 45% kcal fat) or control C...

Position of the American Dietetic Association, American Society for Nutrition, and Society for Nutrition Education: Food and nutrition programs for community-residing older adults.

PubMed

Kamp, Barbara J; Wellman, Nancy S; Russell, Carlene

2010-03-01

Given the federal cost-containment policy to rebalance long-term care away from nursing homes to home- and community-based services, it is the position of the American Dietetic Association, the American Society for Nutrition, and the Society for Nutrition Education that all older adults should have access to food and nutrition programs that ensure the availability of safe, adequate food to promote optimal nutritional status. Appropriate food and nutrition programs include adequately funded food assistance and meal programs, nutrition education, screening, assessment, counseling, therapy, monitoring, evaluation, and outcomes documentation to ensure more healthful aging. The growing number of older adults, the health care focus on prevention, and the global economic situation accentuate the fundamental need for these programs. Yet far too often food and nutrition programs are disregarded or taken for granted. Growing older generally increases nutritional risk. Illnesses and chronic diseases; physical, cognitive, and social challenges; racial, ethnic, and linguistic differences; and low socioeconomic status can further complicate a situation. The beneficial effects of nutrition for health promotion, risk reduction, and disease management need emphasis. Although many older adults are enjoying longer and more healthful lives in their own homes, others, especially those with health disparities and poor nutritional status, would benefit from greater access to food and nutrition programs and services. Food and nutrition practitioners can play a major role in promoting universal access and integrating food and nutrition programs and nutrition services into home- and community-based services.

Fifteen-month follow up of an assertive community treatment program for chronic patients with mental illness.

PubMed

Kim, Tae-Won; Jeong, Jong-Hyun; Kim, Young-Hee; Kim, Yura; Seo, Ho-Jun; Hong, Seung-Chul

2015-09-16

The aim of this study was to evaluate the effect of an Assertive Community Treatment (ACT) program on psychiatric symptoms, global functioning, life satisfaction, and recovery-promoting relationships among individuals with mental illness. Participants were patients at the Suwon Mental Health Center. Thirty-two patients were part of the ACT program and 32 patients matched for age, sex, and mental illness were in a standard case-management program and served as a control group. Follow-up with patients occurred every 3 months during the 15 months after a baseline interview. Participants completed the Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning (GAF) Scale, Life Satisfaction Scale, and Recovery-Promoting Relationship Scale (RPRS). No significant differences were noted in the sociodemographic characteristics of the ACT and the case-management group. According to the BPRS, the ACT group showed a significant reduction in symptom severity, but the ACT program was not significantly more effective at reducing psychiatric symptoms from baseline to the 15-month follow-up compared to the case-management approach. The ACT group showed more significant improvement than the control group in terms of the GAF Scale. Both groups showed no significant differences in the change of life satisfaction and in the change of recovery-promoting relationships. We observed a significant increase in recovery-promoting relationships in the control group, but the degree of change of recovery-promoting relationships through time flow between groups was not significantly different. In this study, we observed that ACT was significantly better at improving the GAF than case management and that participation in ACT was associated with a significant decrease in BPRS scores. However, ACT did not demonstrate an absolute superiority over the standard case-management approach in terms of the BPRS and the measures of life satisfaction and recovery-promoting relationships. ACT may have some advantages over a standard case management approach.

Register-Recall Systems: Tools for Chronic Disease Management in General Practice.

PubMed

Georgiou, Andrew; Burns, Joan; Penn, Danielle; Infante, Fernando; Harris, Mark

2004-09-01

The Divisions Diabetes and Cardiovascular Disease Quality Improvement Project (DDCQIP) is a national project that aims to promote quality improvement initiatives among Divisions of General Practice. DDCQIP has investigated the growth of Division-based diabetes and cardiovascular disease register-recall systems and the role they play in promoting evidence-based structured care within general practice. In the period 2000-2002, an increase in the number of GPs using register-recall systems and the rise in the number of active registered patients have made it possible to monitor quality of care and health outcome indicators, and contributed to the growth of a Division-based population health program.

Church-based health programs for mental disorders among African Americans: a review.

PubMed

Hankerson, Sidney H; Weissman, Myrna M

2012-03-01

African Americans underutilize traditional mental health services, compared with white Americans. The authors conducted a systematic review of studies involving church-based health promotion programs for mental disorders among African Americans to assess the feasibility of utilizing such programs to address racial disparities in mental health care. A literature review of MEDLINE, PsycINFO, CINAHL, and ATLA Religion databases was conducted to identify articles published between January 1, 1980, and December 31, 2009. Inclusion criteria were as follows: studies were conducted in a church; the primary objective involved assessment, perceptions and attitudes, education, prevention, group support, or treatment for DSM-IV mental disorders or their correlates; number of participants was reported; qualitative or quantitative data were reported; and African Americans were the target population. Of 1,451 studies identified, only eight met inclusion criteria. Five studies focused on substance-related disorders, six were designed to assess the effects of a specific intervention, and six targeted adults. One study focused on depression and was limited by a small sample size of seven participants. Although church-based health promotion programs have been successful in addressing racial disparities for several chronic medical conditions, the literature on such programs for mental disorders is extremely limited. More intensive research is needed to establish the feasibility and acceptability of utilizing church-based health promotion programs as a possible resource for screening and treatment to improve disparities in mental health care for African Americans.

Continuing medical education challenges in chronic fatigue syndrome.

PubMed

Brimmer, Dana J; McCleary, K Kimberly; Lupton, Teresa A; Faryna, Katherine M; Reeves, William C

2009-12-02

Chronic fatigue syndrome (CFS) affects at least 4 million people in the United States, yet only 16% of people with CFS have received a diagnosis or medical care for their illness. Educating health care professionals about the diagnosis and management of CFS may help to reduce population morbidity associated with CFS. This report presents findings over a 5-year period from May 2000 to June 2006 during which we developed and implemented a health care professional educational program. The objective of the program was to distribute CFS continuing education materials to providers at professional conferences, offer online continuing education credits in different formats (e.g., print, video, and online), and evaluate the number of accreditation certificates awarded. We found that smaller conference size (OR = 80.17; 95% CI 8.80, 730.25), CFS illness related target audiences (OR = 36.0; 95% CI 2.94, 436.34), and conferences in which CFS research was highlighted (OR = 4.15; 95% CI 1.16, 14.83) significantly contributed to higher dissemination levels, as measured by visit rates to the education booth. While print and online courses were equally requested for continuing education credit opportunities, the online course resulted in 84% of the overall award certificates, compared to 14% for the print course. This remained consistent across all provider occupations: physicians, nurses, physician assistants, and allied health professionals. These findings suggest that educational programs promoting materials at conferences may increase dissemination efforts by targeting audiences, examining conference characteristics, and promoting online continuing education forums.

Promoting Employee Health Through an American Cancer Society Program, The CEOs Challenge, Washington State, 2013-2015.

PubMed

Harris, Jeffrey R; Parrish, Amanda T; Kohn, Marlana; Hammerback, Kristen; McMillan, Becca; Hannon, Peggy A

2015-12-17

Evidence-based practices in the workplace can increase levels of healthy eating, cancer screening, physical activity, and tobacco cessation but are underused, even in large workplaces. This report summarizes an evaluation of the first year of The CEOs Challenge, a program developed by the American Cancer Society to promote implementation and maintenance of health-promoting, evidence-based workplace practices by large companies. Use of 17 evidence-based practices by 17 companies in the Washington State Chapter of the American Cancer Society's CEOs Against Cancer network was assessed via survey and scored from 0 to 100. Companies received a written report of their baseline performance, followed by at least quarterly consultations with American Cancer Society staff members trained to assist in implementation of these practices. Follow-up performance was measured at 1 year. At baseline, implementation scores were 54.8 for cancer screening, 46.5 for healthy eating, 59.8 for physical activity, and 68.2 for tobacco cessation. At follow-up, scores increased by 19.6 for cancer screening, 19.4 for healthy eating, 16.0 for physical activity, and 9.4 points for tobacco cessation. The CEOs Challenge is a promising approach to chronic disease prevention via the workplace. It brings together one of the nation's largest health-promoting voluntary agencies with the nation's largest employers to promote evidence-based practices targeted at the most common causes of disease and death. The program increased the adoption of these practices and was well-accepted.

A Smartphone-Based Intervention With Diaries and Therapist-Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain: Randomized Controlled Trial

PubMed Central

Fors, Egil A; Eide, Erlend; Finset, Arnstein; Stensrud, Tonje Lauritzen; van Dulmen, Sandra; Wigers, Sigrid Hørven; Eide, Hilde

2013-01-01

Background Internet-based interventions using cognitive behavioral approaches can be effective in promoting self-management of chronic pain conditions. Web-based programs delivered via smartphones are increasingly used to support the self-management of various health disorders, but research on smartphone interventions for persons with chronic pain is limited. Objective The aim of this trial was to study the efficacy of a 4-week smartphone-delivered intervention with written diaries and therapist feedback following an inpatient chronic pain rehabilitation program. Methods A total of 140 women with chronic widespread pain who participated in a 4-week inpatient rehabilitation program were randomized into 2 groups: with or without a smartphone intervention after the rehabilitation. The smartphone intervention consisted of 1 face-to-face session and 4 weeks of written communication via a smartphone. Participants received 3 smartphone diary entries daily to support their awareness of and reflection on pain-related thoughts, feelings, and activities. The registered diaries were immediately available to a therapist who submitted personalized written feedback daily based on cognitive behavioral principles. Both groups were given access to a noninteractive website after discharge to promote constructive self-management. Outcomes were measured with self-reported questionnaires. The primary outcome measure of catastrophizing was determined using the pain catastrophizing scale (score range 0-52). Secondary outcomes included acceptance of pain, emotional distress, functioning, and symptom levels. Results Of the 140 participants, 112 completed the study: 48 in the intervention group and 64 in the control group. Immediately after the intervention period, the intervention group reported less catastrophizing (mean 9.20, SD 5.85) than the control group (mean 15.71, SD 9.11, P<.001), yielding a large effect size (Cohen’s d=0.87) for study completers. At 5-month follow-up, the between-group effect sizes remained moderate for catastrophizing (Cohen’s d=0.74, P=.003), acceptance of pain (Cohen’s d=0.54, P=.02), and functioning and symptom levels (Cohen’s d=0.75, P=.001). Conclusions The results suggest that a smartphone-delivered intervention with diaries and personalized feedback can reduce catastrophizing and prevent increases in functional impairment and symptom levels in women with chronic widespread pain following inpatient rehabilitation. Trial Registration Clinicaltrials.gov NCT01236209; http://www.clinicaltrials.gov/ct2/show/NCT01236209 (Archived by WebCite at http://www.webcitation.org/6DUejLpPY) PMID:23291270

Position of the American Dietetic Association: child and adolescent food and nutrition programs.

PubMed

Stang, Jamie; Taft Bayerl, Cynthia; Flatt, Michelle M

2006-09-01

It is the position of the American Dietetic Association that all children and adolescents, regardless of age, sex, socioeconomic status, racial diversity, ethnic diversity, linguistic diversity, or health status, should have access to food and nutrition programs that ensure the availability of a safe and adequate food supply that promotes optimal physical, cognitive, social, and emotional growth and development. Appropriate food and nutrition programs include food assistance and meal programs, nutrition education initiatives, and nutrition screening and assessment followed by appropriate nutrition intervention and anticipatory guidance to promote optimal nutrition status. Food and nutrition programs create a safety net that ensures that children and adolescents at risk for poor nutritional intakes have access to a safe, adequate, and nutritious food supply and nutrition screening, assessment, and intervention. It is important that continued funding be provided for these programs, which consistently have been shown to have a positive impact on child and adolescent health and well-being. Food and nutrition programs serve as a means to prevent or reduce hunger and food insecurity, but also as a vehicle for nutrition education and promotion of physical activity designed to prevent or reduce overweight and prevent chronic disease. It is the role of the registered dietitian to support adequate and sustained funding for food and nutrition programs, universal health care reimbursement for nutrition services, and the use of research and surveillance programs to evaluate and improve these programs. In addition, the registered dietitian and dietetic technician, registered, are responsible for serving as a nutrition resource to all groups and individuals providing services to children and adolescents, acting as an advocate for the establishment of child-care, school, and community settings conducive to the development of good nutrition habits.

[Lumbar stabilization exercises].

PubMed

Vásquez-Ríos, Jorge Rodrigo; Nava-Bringas, Tania Inés

2014-01-01

Exercise is the intervention with the highest level of evidence on efficacy for treatment of chronic low back pain, with a higher benefit in terms of pain and function compared to any other intervention. A wide variety of exercises programs have been designed; however, "lumbar stabilization exercises" have become increasingly popular among clinicians who are in contact with spine diseases. However, there is controversy regarding the adequate prescription and there are multiple protocols. The aim of this literature review is to analyze the information about these exercises to promote better decision-making among clinicians and design the best program for each patient. We found the program an essential tool in the treatment of low back pain in both therapeutic and preventive phases.

Patterns of Food Consumption are Associated with Obesity, Self-Reported Diabetes and Cardiovascular Disease in Five American Indian Communities.

PubMed

Trude, Angela C B; Kharmats, Anna; Jock, Brittany; Liu, Debra; Lee, Katherine; Martins, Paula Andrea; Pardilla, Marla; Swartz, Jaqueline; Gittelsohn, Joel

2015-01-01

The relationship between dietary patterns and chronic disease is underexplored in indigenous populations. We assessed diets of 424 American Indian (AI) adults living in 5 rural AI communities. We identified four food patterns. Increased prevalence for cardiovascular disease was highly associated with the consumption of unhealthy snacks and high fat-food patterns (OR 3.6, CI=1.06, 12.3; and OR 6.0, CI=1.63, 22.1), respectively. Moreover, the food-consumption pattern appeared to be different by community setting (p<.05). We recommend culturally appropriate community-intervention programs to promote healthy behavior and to prevent diet-related chronic diseases in this high-risk population.

Mindfulness and motivational interviewing: two candidate methods for promoting self-management.

PubMed

Benzo, Roberto P

2013-08-01

There is no conclusive evidence about the way to a promote behavior change in self-management programs for patients with chronic obstructive pulmonary disease (COPD). The latter is a significant knowledge gap as there is a need to promote a sustained effect in interventions like Pulmonary Rehabilitation or Supporting Programs. Embracing patient's values seems to be a key ingredient to ignite genuine motivation for behavior change. This manuscript describes two pilot qualitative studies carried out in patients with severe COPD aimed to engage the patient inner experience and promote self-management: a trial testing motivational interviewing (MI) as one style of helping patients with severe COPD make changes in their behavior and second a trial testing a mindfulness-based intervention. The MI study consisted of a 3-month program of weekly coaching phone calls after one face-to-face visit. The following themes were outstanding: patients value the supportive communication with coach and believe the MI-based coaching created increased level of awareness and accountability. They perceived an increase in physical activity and reported "feeling better" or other benefits not directly related to exercise. The Mindfulness for Health Program was a mandatory 8-week program that consisted on 2-hour classes aimed to cultivate nonjudgmental attention in the moment (through different meditative practices and sharing) plus monthly face-to-face encounters aimed to sustain practice and sharing of life experiences for 1 year. The following themes (at 1 year) were outstanding: appreciating life by seeing hardships as opportunities, valuing the self through compassion and awareness, cultivating connectedness with others, acquiring joy, and adopting healthy behaviors. In the search for the "holy grail" for self-management programs that can promote a behavior change, mindfulness and MI seem promising for cultivating a way to live a life in which people are fully present and consciously agree with.

Health Promotion and Health Behaviors of Diverse Ethnic/Racial Women Cosmetologists: A Review

PubMed Central

Thelusma, Naomi; Ralston, Penny

2016-01-01

Women from diverse ethnic/racial backgrounds have higher chronic disease mortality rates when compared to White non-Hispanic women. Community-based programs, such as beauty salons, have been used to reach diverse ethnic/racial women, yet little is known about diverse ethnic/racial women cosmetologists’ involvement in health promotion and their health behaviors, which is the purpose of this review. The growing beauty salon health promotion literature indicates that their roles in these studies have been varied, not only as health promoters but also as recruiters, facilitators, and in general major catalysts for investigator-initiated studies. However, the review also identified a major void in the literature in that there were few studies on health behaviors of diverse ethnic/racial women cosmetologists, especially African American women cosmetologists. Recommendations include increasing the capacity of diverse ethnic/racial women cosmetologists as community health leaders and investigating their health status, knowledge, attitudes, and practices. PMID:27199580

Chronic Disease Self-Management Program in the Workplace: Opportunities for Health Improvement

PubMed Central

Smith, Matthew Lee; Wilson, Mark G.; DeJoy, David M.; Padilla, Heather; Zuercher, Heather; Corso, Phaedra; Vandenberg, Robert; Lorig, Kate; Ory, Marcia G.

2015-01-01

Disease management is becoming increasingly important in workplace health promotion given the aging workforce, rising chronic disease prevalence, and needs to maintain a productive and competitive American workforce. Despite the widespread availability of the Chronic Disease Self-Management Program (CDSMP), and its known health-related benefits, program adoption remains low in workplace settings. The primary purpose of this study is to compare personal and delivery characteristics of adults who attended CDSMP in the workplace relative to other settings (e.g., senior centers, healthcare organizations, residential facilities). This study also contrasts characteristics of CDSMP workplace participants to those of the greater United States workforce and provides recommendations for translating CDSMP for use in workplace settings. Data were analyzed from 25,664 adults collected during a national dissemination of CDSMP. Only states and territories that conducted workshops in workplace settings were included in analyses (n = 13 states and Puerto Rico). Chi-squared tests and t-tests were used to compare CDSMP participant characteristics by delivery site type. CDSMP workplace participant characteristics were then compared to reports from the United States Bureau of Labor Statistics. Of the 25,664 CDSMP participants in this study, 1.7% (n = 435) participated in workshops hosted in worksite settings. Compared to CDSMP participants in non-workplace settings, workplace setting participants were significantly younger and had fewer chronic conditions. Differences were also observed based on chronic disease types. On average, CDSMP workshops in workplace settings had smaller class sizes and workplace setting participants attended more workshop sessions. CDSMP participants in workplace settings were substantially older and a larger proportion were female than the general United States workforce. Findings indicate opportunities to translate CDSMP for use in the workplace to reach new target audiences. PMID:25964909

Alcohol-Induced Developmental Origins of Adult-Onset Diseases

PubMed Central

Lunde, Emilie R.; Washburn, Shannon E.; Golding, Michael C.; Bake, Shameena; Miranda, Rajesh C.; Ramadoss, Jayanth

2016-01-01

Fetal alcohol exposure may impair growth, development, and function of multiple organ systems, and is encompassed by the term Fetal Alcohol Spectrum Disorders (FASD). Research has so far focused on the mechanisms, prevention, and diagnosis of FASD, while the risk for adult-onset chronic diseases in individuals exposed to alcohol in utero is not well explored. David Barker’s hypothesis on Developmental Origins of Health and Disease (DOHaD) suggests that insults to the milieu of the developing fetus program it for adult-development of chronic diseases. In the 25 years since the introduction of this hypothesis, epidemiological and animal model studies have made significant advancements in identifying in utero developmental origins of chronic adult-onset diseases affecting cardiovascular, endocrine, musculoskeletal, and psycho-behavioral systems. Teratogen exposure is an established programming agent for adult diseases, and recent studies suggest that prenatal alcohol exposure correlates with adult-onset of neuro-behavioral deficits, cardiovascular disease, endocrine dysfunction, nutrient homeostasis instability, warranting additional investigation of alcohol-induced DOHaD, as well as patient follow-up well into adulthood for affected individuals. In utero epigenetic alterations during critical periods of methylation is a key potential mechanism for programming and susceptibility of adult-onset chronic diseases, with imprinted genes affecting metabolism being critical targets. Additional studies in epidemiology, phenotypic characterization in response to timing, dose and duration of exposure, as well as elucidation of mechanisms underlying FASD-DOHaD inter-relation are thus needed to clinically define chronic disease associated with prenatal alcohol exposure. These studies are critical to establish interventional strategies that decrease incidence of these adult-onset diseases and promote healthier aging among individuals affected with FASD. PMID:27254466

Alcohol-Induced Developmental Origins of Adult-Onset Diseases.

PubMed

Lunde, Emilie R; Washburn, Shannon E; Golding, Michael C; Bake, Shameena; Miranda, Rajesh C; Ramadoss, Jayanth

2016-07-01

Fetal alcohol exposure may impair growth, development, and function of multiple organ systems and is encompassed by the term fetal alcohol spectrum disorders (FASD). Research has so far focused on the mechanisms, prevention, and diagnosis of FASD, while the risk for adult-onset chronic diseases in individuals exposed to alcohol in utero is not well explored. David Barker's hypothesis on Developmental Origins of Health and Disease (DOHaD) suggests that insults to the milieu of the developing fetus program it for adult development of chronic diseases. In the 25 years since the introduction of this hypothesis, epidemiological and animal model studies have made significant advancements in identifying in utero developmental origins of chronic adult-onset diseases affecting cardiovascular, endocrine, musculoskeletal, and psychobehavioral systems. Teratogen exposure is an established programming agent for adult diseases, and recent studies suggest that prenatal alcohol exposure correlates with adult onset of neurobehavioral deficits, cardiovascular disease, endocrine dysfunction, and nutrient homeostasis instability, warranting additional investigation of alcohol-induced DOHaD, as well as patient follow-up well into adulthood for affected individuals. In utero epigenetic alterations during critical periods of methylation are a key potential mechanism for programming and susceptibility of adult-onset chronic diseases, with imprinted genes affecting metabolism being critical targets. Additional studies in epidemiology, phenotypic characterization in response to timing, dose, and duration of exposure, as well as elucidation of mechanisms underlying FASD-DOHaD inter relation, are thus needed to clinically define chronic disease associated with prenatal alcohol exposure. These studies are critical to establish interventional strategies that decrease incidence of these adult-onset diseases and promote healthier aging among individuals affected with FASD. Copyright © 2016 by the Research Society on Alcoholism.

Intermediate outcomes of a chronic disease self-management program for Spanish-speaking older adults in South Florida, 2008-2010.

PubMed

Melchior, Michael A; Seff, Laura R; Bastida, Elena; Albatineh, Ahmed N; Page, Timothy F; Palmer, Richard C

2013-08-29

The prevalence and negative health effects of chronic diseases are disproportionately high among Hispanics, the largest minority group in the United States. Self-management of chronic conditions by older adults is a public health priority. The objective of this study was to examine 6-week differences in self-efficacy, time spent performing physical activity, and perceived social and role activities limitations for participants in a chronic disease self-management program for Spanish-speaking older adults, Tomando Control de su Salud (TCDS). Through the Healthy Aging Regional Collaborative, 8 area agencies delivered 82 workshops in 62 locations throughout South Florida. Spanish-speaking participants who attended workshops from October 1, 2008, through December 31, 2010, were aged 55 years or older, had at least 1 chronic condition, and completed baseline and post-test surveys were included in analysis (N=682). Workshops consisted of six, 2.5-hour sessions offered once per week for 6 weeks. A self-report survey was administered at baseline and again at the end of program instruction. To assess differences in outcomes, a repeated measures general linear model was used, controlling for agency and baseline general health. All outcomes showed improvement at 6 weeks. Outcomes that improved significantly were self-efficacy to manage disease, perceived social and role activities limitations, time spent walking, and time spent performing other aerobic activities. Implementation of TCDS significantly improved 4 of 8 health promotion skills and behaviors of Spanish-speaking older adults in South Florida. A community-based implementation of TCDS has the potential to improve health outcomes for a diverse, Spanish-speaking, older adult population.

Individualising Chronic Care Management by Analysing Patients' Needs - A Mixed Method Approach.

PubMed

Timpel, P; Lang, C; Wens, J; Contel, J C; Gilis-Januszewska, A; Kemple, K; Schwarz, P E

2017-11-13

Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific unmet needs and their impact on health outcomes is limited, practical research is needed to tailor chronic care to individual needs of patients with diabetes. Qualitative approaches to describe professional and informal caregiving will support understanding the complexity of chronic care. Results are intended to provide practical recommendations to be used for systematic implementation of sustainable chronic care models. A mixed method study was conducted. A standardised survey (n = 92) of experts in chronic care using mail responses to open-ended questions was conducted to analyse existing chronic care programs focusing on effective, problematic and missing components. An expert workshop (n = 22) of professionals and scientists of a European funded research project MANAGE CARE was used to define a limited number of unmet needs and priorities of elderly patients with type 2 diabetes mellitus and comorbidities. This list was validated and ranked using a multilingual online survey (n = 650). Participants of the online survey included patients, health care professionals and other stakeholders from 56 countries. The survey indicated that current care models need to be improved in terms of financial support, case management and the consideration of social care. The expert workshop identified 150 patient needs which were summarised in 13 needs dimensions. The online survey of these pre-defined dimensions revealed that financial issues, education of both patients and professionals, availability of services as well as health promotion are the most important unmet needs for both patients and professionals. The study uncovered competing demands which are not limited to medical conditions. The findings emphasise that future care models need to focus stronger on individual patient needs and promote their active involvement in co-design and implementation. Future research is needed to develop new chronic care models providing evidence-based and practical implications for the regional care setting.

From the Paralympics to public health: increasing physical activity through legislative and policy initiatives.

PubMed

Blauwet, Cheri A; Iezzoni, Lisa I

2014-08-01

Individuals with disabilities experience a disproportionate rate of chronic disease and are more likely to lead sedentary lifestyles than the general population. Multiple complex factors likely contribute to these disparities, including structural, socioeconomic and attitudinal barriers that impede broad participation of individuals with disabilities in health and wellness promotion programs. Public health initiatives aimed at mitigating these health disparities emphasize improved access to physical activity and sports opportunities. Given its visibility, the Paralympic Movement provides an opportunity to transform how society conceptualizes the relationship of disability to physical fitness. The Paralympics also serve as a catalyst for public health education and program development. Already, public policies and governmental regulations are expanding grassroots sports opportunities for youth and adults with disabilities, thus promoting inclusive opportunities for participation in physical activity. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Outreach Strategies to Recruit Low-Income African American Men to Participate in Health Promotion Programs and Research: Lessons From the Men of Color Health Awareness (MOCHA) Project.

PubMed

Graham, Louis F; Scott, Lamont; Lopeyok, Erus; Douglas, Henry; Gubrium, Aline; Buchanan, David

2018-04-01

African American men continue to bear a disproportionate share of the burden of disease. Engaging these men in health research and health promotion programs-especially lower-income, African American men who are vulnerable to chronic disease conditions such as obesity and heart disease-has historically proven quite difficult for researchers and public health practitioners. The few effective outreach strategies identified in the literature to date are largely limited to recruiting through hospital clinics, churches, and barbershops. The Men of Color Health Awareness (MOCHA) project is a grassroots, community-driven initiative that has developed a number of innovative outreach strategies. After describing these strategies, we present data on the demographic and health characteristics of the population reached using these methods, which indicate that MOCHA has been highly effective in reaching this population of men.

Maternal obesity increases the risk of metabolic disease and impacts renal health in offspring

PubMed Central

Glastras, Sarah J.; Chen, Hui; Pollock, Carol A.; Saad, Sonia

2018-01-01

Obesity, together with insulin resistance, promotes multiple metabolic abnormalities and is strongly associated with an increased risk of chronic disease including type 2 diabetes (T2D), hypertension, cardiovascular disease, non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD). The incidence of obesity continues to rise in astronomical proportions throughout the world and affects all the different stages of the lifespan. Importantly, the proportion of women of reproductive age who are overweight or obese is increasing at an alarming rate and has potential ramifications for offspring health and disease risk. Evidence suggests a strong link between the intrauterine environment and disease programming. The current review will describe the importance of the intrauterine environment in the development of metabolic disease, including kidney disease. It will detail the known mechanisms of fetal programming, including the role of epigenetic modulation. The evidence for the role of maternal obesity in the developmental programming of CKD is derived mostly from our rodent models which will be described. The clinical implication of such findings will also be discussed. PMID:29483369

The chronic mental patient: the position of th Canadian Psychiatric Association.

PubMed

Watt, J A; el-Guebaly, N

1981-11-01

The Canadian Psychiatric Association recommends: 1. In this International Year of Disabled Persons, that the needs of the chronic neural patient be publicized with emphasis on the potential for improvement if these needs are adequately met. A working definition of the chronic mental patient refers to those members of society who suffer from a chronic mental illness and who demonstrate significant impairment of task performance and/or social performance. 2. A comprehensive network of services should be developed including provision for basic need with a range of housing options, inpatient and outpatient psychiatric evaluations and treatment, personal clinical support, living-skills training and vocational assessment and training. Aside from patient needs, the professional status of the caregivers involved is to be enhanced. Laudable efforts by self-help groups should be further encouraged. 3. Community resources should be enlisted following principles and practices identified as basic to successful programs already existing, for example: -- provision of economic stability -- presence of administrative leadership -- striving for continuity of care -- allowance for adequate manpower -- establishment of vocational supports -- respect for patients' rights -- provision of community education -- design of ongoing evaluation and research 4. A greater emphasis should be placed in undergraduate and postgraduate medical and psychiatric training programs on the treatment of the chronically ill. 5. The Canadian Council on Hospital Accreditation should continue to elaborate and publish criteria by which services to the chronically mentally ill would be evaluated both at the inpatient and outpatient levels. These criteria when available should be promoted in all relevant institutions.

Making the link between health and productivity at the workplace--a global perspective.

PubMed

Kirsten, Wolf

2010-01-01

This paper discusses the relationship between health and productivity at the workplace by providing a global perspective of the current status of the fields of workplace health promotion and health management. The prevailing chronic disease trends coupled with economic pressures have proven a significant challenge for employers and employees alike. While a global growth trend in workplace health promotion can be observed the number of companies which take a proactive and integrated approach to workplace health remains small. Workplace health promotion programs in the United States typically focus on the individual health risks of employees while their European counterparts target work-related hazards, physical and, more recently, psychosocial. A number of specific tools and programs for integrated health management are described, such as self-report instruments to measure presenteeism. The analysis suggests that existing occupational health services strategies are insufficient to address the current challenges. Improved employee health can only be achieved in a sustainable manner when integrating all health-related services within an enterprise and addressing psychosocial and organizational factors as well as individual health issues.

The impact of a mind-body program on multiple dimensions of resiliency among geographically diverse patients with neurofibromatosis.

PubMed

Zale, Emily L; Pierre-Louis, Catherine; Macklin, Eric A; Riklin, Eric; Vranceanu, Ana-Maria

2018-04-01

The neurofibromatoses (NF) are incurable genetic disorders that can cause nerve sheath tumors, chronic pain, and disfiguration. Patients with NF report lower quality of life and greater distress, and may benefit from programs that promote resiliency. To test effects of an 8-week mind-body program (Relaxation Response Resiliency Program for NF [3RP-NF]) on resiliency, using data derived from a larger randomized controlled trial of the 3RP-NF versus attention placebo control (Vranceanu et al. in Neurology 87:806-814, 2016). Participants (N = 63; 46 female; 52 White) were randomized to 3RP-NF (n = 32, M age = 42.86) or control (n = 31, M age = 39.90), completed intervention sessions via group videoconferencing, and provided self-report measures of resiliency (i.e., perceived coping abilities, perceived social support, gratitude, optimism, spiritual well-being, mindfulness) at baseline, post-intervention, and 6-month follow-up. All participants attended at least 6/8 sessions and 83% (N = 52) provided 6-month follow-up data. The 3RP-NF (vs. control) produced greater improvements from pre- to post-intervention in perceived coping abilities (M difference = 6.68; p = .008), perceived social support (M difference = 9.16; p = .032), and mindfulness (M difference = 2.23; p = .035), which were maintained at 6-month follow up. We did not observe group differences in spiritual well-being, optimism, or gratitude. The 3RP-NF produced sustained increases in multiple dimensions of resiliency (perceived coping abilities, perceived social support, and mindfulness). Promoting resiliency may be particularly important for a population that is underserved and living with a chronic, incurable illness.

Participation in fitness-related activities of an incentive-based health promotion program and hospital costs: a retrospective longitudinal study.

PubMed

Patel, Deepak; Lambert, Estelle V; da Silva, Roseanne; Greyling, Mike; Kolbe-Alexander, Tracy; Noach, Adam; Conradie, Jaco; Nossel, Craig; Borresen, Jill; Gaziano, Thomas

2011-01-01

A retrospective, longitudinal study examined changes in participation in fitness-related activities and hospital claims over 5 years amongst members of an incentivized health promotion program offered by a private health insurer. A 3-year retrospective observational analysis measuring gym visits and participation in documented fitness-related activities, probability of hospital admission, and associated costs of admission. A South African private health plan, Discovery Health and the Vitality health promotion program. 304,054 adult members of the Discovery medical plan, 192,467 of whom registered for the health promotion program and 111,587 members who were not on the program. Members were incentivised for fitness-related activities on the basis of the frequency of gym visits. Changes in electronically documented gym visits and registered participation in fitness-related activities over 3 years and measures of association between changes in participation (years 1-3) and subsequent probability and costs of hospital admission (years 4-5). Hospital admissions and associated costs are based on claims extracted from the health insurer database. The probability of a claim modeled by using linear logistic regression and costs of claims examined by using general linear models. Propensity scores were estimated and included age, gender, registration for chronic disease benefits, plan type, and the presence of a claim during the transition period, and these were used as covariates in the final model. There was a significant decrease in the prevalence of inactive members (76% to 68%) over 5 years. Members who remained highly active (years 1-3) had a lower probability (p < .05) of hospital admission in years 4 to 5 (20.7%) compared with those who remained inactive (22.2%). The odds of admission were 13% lower for two additional gym visits per week (odds ratio, .87; 95% confidence interval [CI], .801-.949). We observed an increase in fitness-related activities over time amongst members of this incentive-based health promotion program, which was associated with a lower probability of hospital admission and lower hospital costs in the subsequent 2 years. Copyright © 2011 by American Journal of Health Promotion, Inc.

A novel community-based model to enhance health promotion, risk factor management and chronic disease prevention.

PubMed

Carson, Shannon Ryan; Carr, Caroline; Kohler, Graeme; Edwards, Lynn; Gibson, Rick; Sampalli, Tara

2014-01-01

Chronic disease is a highly expensive but preventable problem to the healthcare system. Evidence suggests that impacting modifiable behaviours and risk management factors in the areas of physical inactivity, unhealthy diet, stress and obesity can alleviate the burden of chronic disease problem to a large extent. Despite this recognition, the challenge is embedding these recognized priorities into the community and in primary care in a sustainable and meaningful manner. Primary Health Care in Capital Health responded to this challenge by developing and implementing a free, interprofessional and community-based service, namely, the Community Health Teams (CHTs), that offers health and wellness, risk factor management, wellness navigation and behaviour-based programming. In this paper, the development and implementation of the CHTs are discussed. Preliminary outcomes for the model are significant and promising. Formal and large-scale studies are planned to validate these outcomes with additional research rigour. Copyright © 2014 Longwoods Publishing.

Chronic Conditions, Workplace Safety, And Job Demands Contribute To Absenteeism And Job Performance.

PubMed

Jinnett, Kimberly; Schwatka, Natalie; Tenney, Liliana; Brockbank, Claire V S; Newman, Lee S

2017-02-01

An aging workforce, increased prevalence of chronic health conditions, and the potential for longer working lives have both societal and economic implications. We analyzed the combined impact of workplace safety, employee health, and job demands (work task difficulty) on worker absence and job performance. The study sample consisted of 16,926 employees who participated in a worksite wellness program offered by a workers' compensation insurer to their employers-314 large, midsize, and small businesses in Colorado across multiple industries. We found that both workplace safety and employees' chronic health conditions contributed to absenteeism and job performance, but their impact was influenced by the physical and cognitive difficulty of the job. If employers want to reduce health-related productivity losses, they should take an integrated approach to mitigate job-related injuries, promote employee health, and improve the fit between a worker's duties and abilities. Project HOPE—The People-to-People Health Foundation, Inc.

Patients' self-efficacy within online health communities: facilitating chronic disease self-management behaviors through peer education.

PubMed

Willis, Erin

2016-01-01

In order to combat the growing burden of chronic disease, evidence-based self-management programs have been designed to teach patients about the disease and its affect on their lives. Self-efficacy is a key component in chronic disease self-management. This research used online ethnography and discourse analysis (N = 8,231) to examine self-efficacy within the computer-mediated communication (CMC) of four online health communities used by people with arthritis. Specifically, online opinion leaders were identified for examination. Across the four communities, there was a cyclical process that involved "disease veterans" sharing their experiences and gaining credibility within the community, new(er) members suffering from disease symptoms and sharing their experiences online, and finally, asking others for help with arthritis self-management behaviors. Three themes follow: (1) sharing disease experience, (2) suffering from disease symptoms, and (3) asking for help. Practical implications for health promotion and education are discussed.

Introduction to Health Promotion for People with Chronic Illness and Disability

ERIC Educational Resources Information Center

Chan, Fong; Chiu, Chung-Yi; Bezyak, Jill L.; Keegan, John

2012-01-01

Health promotion has received increasing attention in rehabilitation counseling research. Health promotion research contributes to theory building and provides the foundation for empirically supported interventions that can improve the health-related quality of life and employment outcomes of people with chronic illness and disability. In this…

KLF6 contributes to myeloid cell plasticity in the pathogenesis of intestinal inflammation

PubMed Central

Goodman, Wendy A.; Omenetti, Sara; Date, Dipali; Di Martino, Luca; De Salvo, Carlo; Kim, Gun-Dong; Chowdhry, Saleem; Bamias, Giorgos; Cominelli, Fabio; Pizarro, Theresa T.; Mahabeleshwar, Ganapati H.

2016-01-01

Inflammatory bowel disease (IBD) is associated with dysregulated macrophage responses, such that quiescent macrophages acquire a pro-inflammatory activation state and contribute to chronic intestinal inflammation. The transcriptional events governing macrophage activation and gene expression in the context of chronic inflammation such as IBD remain incompletely understood. Here, we identify Kruppel-like transcription factor-6 (KLF6) as a critical regulator of pathogenic myeloid cell activation in human and experimental IBD. We found that KLF6 was significantly upregulated in myeloid cells and intestinal tissue from IBD patients and experimental models of IBD, particularly in actively inflamed regions of the colon. Using complementary gain- and loss-of-function studies, we observed that KLF6 promotes pro-inflammatory gene expression through enhancement of NFκB signaling, while simultaneously suppressing anti-inflammatory gene expression through repression of STAT3 signaling. To study the in vivo role of myeloid KLF6, we treated myeloid-specific KLF6-knockout mice (Mac-KLF6-KO) with dextran sulfate-sodium (DSS) and found that Mac-KLF6-KO mice were protected against chemically-induced colitis; this highlights the central role of myeloid KLF6 in promoting intestinal inflammation. Collectively, our results point to a novel gene regulatory program underlying pathogenic, pro-inflammatory macrophage activation in the setting of chronic intestinal inflammation. PMID:26838049

Position of the American Dietetic Association, American Society for Nutrition, and Society for Nutrition Education: food and nutrition programs for community-residing older adults.

PubMed

Kamp, Barbara J; Wellman, Nancy S; Russell, Carlene

2010-01-01

Given the federal cost-containment policy to rebalance long-term care away from nursing homes to home- and community-based services, it is the position of the American Dietetic Association, the American Society for Nutrition, and the Society for Nutrition Education that all older adults should have access to food and nutrition programs that ensure the availability of safe, adequate food to promote optimal nutritional status. Appropriate food and nutrition programs include adequately funded food assistance and meal programs, nutrition education, screening, assessment, counseling, therapy, monitoring, evaluation, and outcomes documentation to ensure more healthful aging. The growing number of older adults, the health care focus on prevention, and the global economic situation accentuate the fundamental need for these programs. Yet far too often food and nutrition programs are disregarded or taken for granted. Growing older generally increases nutritional risk. Illnesses and chronic diseases; physical, cognitive, and social challenges; racial, ethnic, and linguistic differences; and low socioeconomic status can further complicate a situation. The beneficial effects of nutrition for health promotion, risk reduction, and disease management need emphasis. Although many older adults are enjoying longer and more healthful lives in their own homes, others, especially those with health disparities and poor nutritional status, would benefit from greater access to food and nutrition programs and services. Food and nutrition practitioners can play a major role in promoting universal access and integrating food and nutrition programs and nutrition services into home- and community-based services. Copyright 2010 The American Dietetic Association, the American Society for Nutrition, and the Society for Nutrition Education. Published by Elsevier Inc. All rights reserved.

Youth and Tobacco

MedlinePlus

... National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014. 2. Substance ... National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014. 4. U.S. ...

Buffer or amplifier? Longitudinal effects of social support for functional autonomy/dependence on older adults' chronic pain experiences.

PubMed

Matos, Marta; Bernardes, Sónia F; Goubert, Liesbet; Beyers, Wim

2017-12-01

This longitudinal study aimed to investigate (a) the moderating role of formal social support for functional autonomy versus dependence on the relationship between pain intensity and pain-related disability among older adults with chronic pain and (b) the mediating role of pain-related self-efficacy and pain-related fear in this moderation. One hundred and seventy older adults (Mage = 78.0; SD = 8.7) with chronic musculoskeletal pain participated in a 3-month prospective study, with 3 measurement moments. Participants filled out the Formal Social Support for Autonomy and Dependence in Pain Inventory, the Portuguese versions of the Brief Pain Inventory, the Pain Self-Efficacy Questionnaire, and the Tampa Scale of Kinesiophobia. Using structural equation modeling, it was found that perceived promotion of autonomy, at Time 1, moderated the relationship between pain intensity (T1) and pain-related disability (T2); this moderation was fully mediated by pain-related self-efficacy (T2). Perceived promotion of dependence was not a significant moderator. These findings highlight the importance of social support for functional autonomy in buffering the impact of pain intensity on older adults' pain-related disability. Also, they clarify the role of pain-related self-efficacy in this effect. Implications for the development of intervention programs, with formal caregivers, to reduce the impact of chronic pain on older adults' healthy ageing process, are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

[Research within the reach of Osakidetza professionals: Primary Health Care Research Program].

PubMed

Grandes, Gonzalo; Arce, Verónica; Arietaleanizbeaskoa, María Soledad

2014-04-01

To provide information about the process and results of the Primary Health Care Research Program 2010-2011 organised by the Primary Care Research Unit of Bizkaia. Descriptive study. Osakidetza primary care. The 107 health professionals who applied for the program from a total of 4,338 general practitioners, nurses and administrative staff who were informed about it. Application level, research topics classification, program evaluation by participants, projects funding and program costs. Percentage who applied, 2.47%; 95% CI 2.41-2.88%. Of the 28 who were selected and 19 completed. The research topics were mostly related to the more common chronic diseases (32%), and prevention and health promotion (18%). Over 90% of participants assessed the quality of the program as good or excellent, and half of them considered it as difficult or very difficult. Of the18 new projects generated, 12 received funding, with 16 grants, 10 from the Health Department of the Basque Government, 4 from the Carlos III Institute of Health of the Ministry of Health of Spain, and 2 from Kronikgune. A total of €500,000 was obtained for these projects. This program cost €198,327. This experience can be used by others interested in the promotion of research in primary care, as the program achieved its objectives, and was useful and productive. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Intersystem Implications of the Developmental Origins of Health and Disease: Advancing Health Promotion in the 21st Century.

PubMed

Barnes, Michael D; Heaton, Thomas L; Goates, Michael C; Packer, Justin M

2016-07-15

The developmental origins of health and disease (DOHaD) theory and life course theory (LCT) are emerging fields of research that have significant implications for the public health and health promotion professions. Using a DOHaD/LCT perspective, social determinants of health (SDH) take on new critical meaning by which health promotion professionals can implement DOHaD/LCT guided interventions, including recommended policies. Through these interventions, public health could further address the sources of worldwide chronic disease epidemics and reduce such disease rates substantially if related policy, programs, and interdisciplinary and multi-sector collaboration are emphasized. Additional characteristics of the most effective interventions involve context-specific adaptation and societal structures that impact upstream, early life environments on a broad scale, influencing multiple locations and/or diseases.

An Integrative Neuroscience Framework for the Treatment of Chronic Pain: From Cellular Alterations to Behavior.

PubMed

Greenwald, Jess D; Shafritz, Keith M

2018-01-01

Chronic pain can result from many pain syndromes including complex regional pain syndrome (CRPS), phantom limb pain and chronic low back pain, among others. On a molecular level, chronic pain syndromes arise from hypersensitization within the dorsal horn of the spinal cord, a process known as central sensitization. Central sensitization involves an upregulation of ionotropic and metabotropic glutamate receptors (mGluRs) similar to that of long-term potentiation (LTP). Regions of the brain in which LTP occurs, such as the amygdala and hippocampus, are implicated in fear- and memory-related brain circuity. Chronic pain dramatically influences patient quality of life. Individuals with chronic pain may develop pain-related anxiety and pain-related fear. The syndrome also alters functional connectivity in the default-mode network (DMN) and salience network. On a cellular/molecular level, central sensitization may be reversed through degradative glutamate receptor pathways. This, however, rarely happens. Instead, cortical brain regions may serve in a top-down regulatory capacity for the maintenance or alleviation of pain. Specifically, the medial prefrontal cortex (mPFC), which plays a critical role in fear-related brain circuits, the DMN, and salience network may be the driving forces in this process. On a cellular level, the mPFC may form new neural circuits through LTP that may cause extinction of pre-existing pain pathways found within fear-related brain circuits, the DMN, and salience network. In order to promote new LTP connections between the mPFC and other key brain structures, such as the amygdala and insula, we propose a holistic rehabilitation program including cognitive behavioral therapy (CBT) and revolving around: (1) cognitive reappraisals; (2) mindfulness meditation; and (3) functional rehabilitation. Unlike current medical interventions focusing upon pain-relieving medications, we do not believe that chronic pain treatment should focus on reversing the effects of central sensitization. Instead, we propose here that it is critical to focus on non-invasive efforts to promote new neural circuits originating from the mPFC.

Beating Obesity: Factors Associated with Interest in Workplace Weight Management Assistance in the Mining Industry.

PubMed

Street, Tamara D; Thomas, Drew L

2017-03-01

Rates of overweight and obese Australians are high and continue to rise, putting a large proportion of the population at risk of chronic illness. Examining characteristics associated with preference for a work-based weight-loss program will enable employers to better target programs to increase enrolment and benefit employees' health and fitness for work. A cross-sectional survey was undertaken at two Australian mining sites. The survey collected information on employee demographics, health characteristics, work characteristics, stages of behavior change, and preference for workplace assistance with reaching a healthy weight. A total of 897 employees participated; 73.7% were male, and 68% had a body mass index in the overweight or obese range. Employees at risk of developing obesity-related chronic illnesses (based on high body mass index) were more likely to report preference for weight management assistance than lower risk employees. This indicates that, even in the absence of workplace promotion for weight management, some at risk employees want workplace assistance. Employees who were not aware of a need to change their current nutrition or physical activity behaviors were less likely to seek assistance. This indicates that practitioners need to communicate the negative effects of excess weight and promote the benefits of a healthy lifestyle to increase the likelihood of weight management. Weight management programs should provide information, motivation. and trouble-shooting assistance to meet the needs of at-risk mining employees, including those who are attempting to change and maintain behaviors to achieve a healthy weight and be suitably fit for work.

Using Concept Mapping to Develop a Strategy for Self-Management Support for Underserved Populations Living With Chronic Conditions, British Columbia, August 2013-June 2014.

PubMed

Mills, Susan L; Bergeron, Kim; Pérez, Guillermina

2015-10-08

Self-management support (SMS) is an essential component of public health approaches to chronic conditions. Given increasing concerns about health equity, the needs of diverse populations must be considered. This study examined potential solutions for addressing the gaps in self-management support initiatives for underserved populations. Stakeholders representing government, nongovernment organizations, Aboriginal communities, health authorities, medical practices, and research institutions generated, sorted, and rated ideas on what could be done to improve self-management support for underserved populations. Concept mapping was used to facilitate the collection and organization of the data and to generate conceptual maps. Participants generated 92 ideas that were sorted into 11 clusters (foster partnerships, promote integrated community care, enhance health care provider training, shift government policy, support community development, increase community education, enable client engagement, incorporate client support systems, recognize client capacity, tailor self-management support programs, and develop client skills, training, and tools) and grouped into system, community, and individual levels within a partnership framework. The strategy can stimulate public health dialogue and be a roadmap for developing SMS initiatives. It has the potential to address SMS and chronic condition inequities in underserved populations in several ways: 1) by targeting populations that have greater inequities, 2) by advocating for shifts in government policies that create and perpetuate inequities, 3) by promoting partnerships that may increase the number of SMS initiatives for underserved groups, and 4) by promoting training and engagement that increase the relevance, uptake, and overall effectiveness of SMS.

Feasibility of virtual reality augmented cycling for health promotion of people poststroke.

PubMed

Deutsch, Judith E; Myslinski, Mary Jane; Kafri, Michal; Ranky, Richard; Sivak, Mark; Mavroidis, Constantinos; Lewis, Jeffrey A

2013-09-01

A virtual reality (VR) augmented cycling kit (VRACK) was developed to address motor control and fitness deficits of individuals with chronic stroke. In this article, we report on the safety, feasibility, and efficacy of using the VR augmented cycling kit to improve cardiorespiratory (CR) fitness of individuals in the chronic phase poststroke. Four individuals with chronic stroke (47-65 years old and ≥3 years poststroke), with residual lower extremity impairments (Fugl-Meyer 24-26/34), who were limited community ambulators (gait speed range 0.56-1.1 m/s) participated in this study. Safety was defined as the absence of adverse events. Feasibility was measured using attendance, total exercise time, and "involvement" measured with the presence questionnaire (PQ). Efficacy of CR fitness was evaluated using a submaximal bicycle ergometer test before and after an 8-week training program. The intervention was safe and feasible with participants having 1 adverse event, 100% adherence, achieving between 90 and 125 minutes of cycling each week, and a mean PQ score of 39 (SD 3.3). There was a statistically significant (13%; P = 0.035) improvement in peak VO(2), with a range of 6% to 24.5%. For these individuals, poststroke, VR augmented cycling, using their heart rate to set their avatar's speed, fostered training of sufficient duration and intensity to promote CR fitness. In addition, there was a transfer of training from the bicycle to walking endurance. VR augmented cycling may be an addition to the therapist's tools for concurrent training of mobility and health promotion of individuals poststroke.

Promoting the health of young adults in urban public universities: a case study from City University of New York.

PubMed

Freudenberg, Nicholas; Manzo, Luis; Mongiello, Lorraine; Jones, Hollie; Boeri, Natascia; Lamberson, Patricia

2013-01-01

Changing demographics of college students and new insights into the developmental trajectory of chronic diseases present universities with opportunities to improve population health and reduce health inequalities. The reciprocal relationships between better health and improved educational achievement also offer university health programs a chance to improve retention and graduation rates, a key objective for higher education. In 2007, City University of New York (CUNY), the nation's largest urban public university, launched Healthy CUNY, an initiative designed to offer life-time protection against chronic diseases and reduce health-related barriers to educational achievement. In its first 5 years, Healthy CUNY has shown that universities can mobilize students, faculty, and other constituencies to modify environments and policies that influence health. New policies on tobacco and campus food, enrollment of needy students in public food and housing assistance programs, and a dialogue on the role of health in academic achievement are first steps towards healthier universities.

ColoNav: patient navigation for colorectal cancer screening in deprived areas - Study protocol.

PubMed

Allary, C; Bourmaud, A; Tinquaut, F; Oriol, M; Kalecinski, J; Dutertre, V; Lechopier, N; Pommier, M; Benoist, Y; Rousseau, S; Regnier, V; Buthion, V; Chauvin, F

2016-07-07

The mass colorectal cancer screening program was implemented in 2008 in France, targeting 16 million French people aged between 50 and 74. The current adhesion is insufficient and the participation rate is even lower among the underserved population, increasing health inequalities within our health care system. Patient Navigation programs have proved their efficiency to promote the access to cancer screening and diagnosis. The purpose of the study is to assess the implementation of a patient navigation intervention that has been described in another cultural environment and another health care system. The main objective of the program is to increase the colorectal cancer screening participation rate among the deprived population through the intervention of a navigator to promote the Fecal Occult Blood Test (FOBT) and complementary exams. We performed a multisite cluster randomized controlled trial, with three groups (one experimental group and two control groups) for 18 months. The study attempts to give a better understanding of the adhesion barriers to colorectal cancer screening among underserved populations. If this project is cost-effective, it could create a dynamic based on peer approaches that could be developed for other cancer screening programs and other chronic diseases. NCT02369757.

Choose Health: Food, Fun, and Fitness Youth Curriculum Promotes Positive Behaviors.

PubMed

Wolfe, Wendy S; Scott-Pierce, Michelle; Dollahite, Jamie

2017-11-20

Evaluate whether participation in Choose Health: Food, Fun, and Fitness (CHFFF), a hands-on, experiential curriculum aimed at third- to sixth-graders, resulted in improvements in the targeted obesity and chronic disease prevention behaviors. The researchers evaluated CHFFF in low-income youth participating in 2 federal programs in New York State during 2013-2015. Food and activity behaviors were assessed using the Expanded Food and Nutrition Education Program third- through fifth- and sixth- through eighth-grade pre-post surveys, along with 2 sets of added CHFFF-specific items completed by subsamples. Educators trained in CHFFF had youth complete the surveys as they delivered the curriculum, primarily in schools and after-school programs. Paired t tests showed significant (P < .01) positive changes before to after CHFFF education for consumption of vegetables, fruits, sweetened drinks, nutrition label reading, and other food and activity behaviors. Results provide practice-based evidence that CHFFF promotes positive behavior change in participating youth. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Statement on National WorkLife Priorities

PubMed Central

Cherniack, Martin; Henning, Rob; Merchant, James A.; Punnett, Laura; Sorensen, Glorian R.; Wagner, Gregory

2018-01-01

The National Institute for Occupational Safety and Health (NIOSH) WorkLife Initiative (WLI) [http://www.cdc.gov/niosh/worklife] seeks to promote workplace programs, policies, and practices that result in healthier, more productive employees through a focus simultaneously on disease prevention, health promotion, and accommodations to age, family, and life stage. The Initiative incorporates the Institute’s foundational commitment to workplaces free of recognized hazards into broader consideration of the factors that affect worker health and wellbeing. Workplace hazards, such as physical demands, chemical exposures, and work organization, often interact with non-work factors such as family demands and health behaviors to increase health and safety risks. New workplace interventions being tested by the first three NIOSH WLI Centers of WorkLife Excellence are exploring innovative models for employee health programs to reduce the human, social, and economic costs of compromised health and quality of life. Many parties in industry, labor, and government share the goals of improving employee health while controlling health care costs. NIOSH convened a workshop in 2008 with representatives of the three Centers of Excellence to develop a comprehensive, long-range strategy for advancing the WorkLife Initiative. The recommendations below fall into three areas: practice, research, and policy. Responding to these recommendations would permit the WorkLife Center system to establish a new infrastructure for workplace prevention programs by compiling and disseminating the innovative practices being developed and tested at the Centers, and elsewhere. The WLI would also extend the customary scope of NIOSH by engaging with multiple NIH Institutes that are already generating research-to-practice programs involving the working-age population, in areas such as chronic disease prevention and management. Research to Practice (r2p) is a concept focused on the translation of research findings, technologies, and information into evidence-based prevention practices and products that are adopted in the workplace or other “real-world” settings. NIOSH’s goal is to overcome the translational issues that now prevent state-of-the-art occupational health, health promotion, and chronic disease research findings from benefiting working age populations immediately, regardless of workplace size, work sector, or region of the country. PMID:20949545

Statement on national worklife priorities.

PubMed

Cherniack, Martin; Henning, Rob; Merchant, James A; Punnett, Laura; Sorensen, Glorian R; Wagner, Gregory

2011-01-01

The National Institute for Occupational Safety and Health (NIOSH) WorkLife Initiative (WLI) [http://www.cdc.gov/niosh/worklife] seeks to promote workplace programs, policies, and practices that result in healthier, more productive employees through a focus simultaneously on disease prevention, health promotion, and accommodations to age, family, and life stage. The Initiative incorporates the Institute's foundational commitment to workplaces free of recognized hazards into broader consideration of the factors that affect worker health and wellbeing. Workplace hazards, such as physical demands, chemical exposures, and work organization, often interact with non-work factors such as family demands and health behaviors to increase health and safety risks. New workplace interventions being tested by the first three NIOSH WLI Centers of WorkLife Excellence are exploring innovative models for employee health programs to reduce the human, social, and economic costs of compromised health and quality of life. Many parties in industry, labor, and government share the goals of improving employee health while controlling health care costs. NIOSH convened a workshop in 2008 with representatives of the three Centers of Excellence to develop a comprehensive, long-range strategy for advancing the WorkLife Initiative. The recommendations below fall into three areas: practice, research, and policy. Responding to these recommendations would permit the WorkLife Center system to establish a new infrastructure for workplace prevention programs by compiling and disseminating the innovative practices being developed and tested at the Centers, and elsewhere. The WLI would also extend the customary scope of NIOSH by engaging with multiple NIH Institutes that are already generating research-to-practice programs involving the working-age population, in areas such as chronic disease prevention and management. Research to Practice (r2p) is a concept focused on the translation of research findings, technologies, and information into evidence-based prevention practices and products that are adopted in the workplace or other "real-world" settings. NIOSH's goal is to overcome the translational issues that now prevent state-of-the-art occupational health, health promotion, and chronic disease research findings from benefiting working age populations immediately, regardless of workplace size, work sector, or region of the country. 2010 Wiley-Liss, Inc.

Design and implementation of a telecare information platform.

PubMed

Li, Shing-Han; Wang, Ching-Yao; Lu, Wen-Hui; Lin, Yuan-Yuan; Yen, David C

2012-06-01

For the aging population and for people with dominant chronic diseases, countries all over the world are promoting an "Aging in Place" program with its primary focus on the implementation of telecare. In 2009, Taiwan held a "Health Care Value-Added Platinum Program" with the goal of promoting the development of "Telecare" services by integrating medical treatment, healthcare, information communication, medical equipment and materials and by linking related cross-discipline professions to enable people to familiarize themselves with preventive healthcare services offered in their household and community environments. In addition, this program can be utilized to effectively provide diversified healthcare service benefitting society as a whole. This study aims to promote a diversified telecare service network in Taiwan's household and community environments, establish telecare information platforms, build an internal network of various healthcare service modes, standardize externally interfacing telecare information networks, effectively utilize related healthcare service resources, and complete reasonable service resource links forming an up-to-date health information exchange network. To this end, the telecare information platform based on service oriented architecture (SOA) is designed to promote an open telecare information interface and sharing environment to assist in such tasks as developing healthcare information exchange services, integrating service resources among various different healthcare service modes, accessing externally complex community affairs information, supporting remote physiological information transmissions, and providing diversified remote innovative services. Information system architecture and system monitoring indices of various types of healthcare service modes are used for system integrations for future development and/or expansions.

How People's Motivational System and Situational Motivation Influence Their Risky Financial Choices.

PubMed

Sekścińska, Katarzyna; Maison, Dominika Agnieszka; Trzcińska, Agata

2016-01-01

People's preferences for risks have been a subject of interest to researchers in both the economy and psychology fields over the last few years. This has given rise to many important findings about the role of psychological factors that influence people's choices. The presented studies focused on the role of motivational systems (described by Higgins in the Regulatory Focus Theory) in explaining people's financial choices. The main goal was to examine the relationship between people's chronic promotion and prevention motivational system and their propensity to (1) invest, (2) undertake investment risks, and (3) assume financial risks in gambling tasks in both the gain and loss decision-making frame. Moreover, we aimed to investigate how chronic motivational systems confronted with situationally induced promotion and prevention motivation would affect people's propensity to invest and embrace financial risks. Two CAWI studies on a Polish national representative sample (N 1 = 1093; N 2 = 1096) were conducted. The second study consisted of two waves with a 2-week break. The studies provided evidence of higher chronic promotion motivation as well as higher prevention motivation associated with the propensity to invest; however, induced promotion motivation results in a lower propensity to invest compared to induced prevention motivation. Participants with an activated promotion system built more risky portfolios than individuals with an induced prevention system. Moreover, participants with a low chronic promotion system built more risky portfolios than individuals with a high promotion motivation system as long as their prevention system was also low. In terms of gambling decisions in both the gain and loss frame, a higher level of chronic promotion motivation and situationally induced promotion motivation were related to the preference for the non-sure option over the sure one.

How People's Motivational System and Situational Motivation Influence Their Risky Financial Choices

PubMed Central

Sekścińska, Katarzyna; Maison, Dominika Agnieszka; Trzcińska, Agata

2016-01-01

People's preferences for risks have been a subject of interest to researchers in both the economy and psychology fields over the last few years. This has given rise to many important findings about the role of psychological factors that influence people's choices. The presented studies focused on the role of motivational systems (described by Higgins in the Regulatory Focus Theory) in explaining people's financial choices. The main goal was to examine the relationship between people's chronic promotion and prevention motivational system and their propensity to (1) invest, (2) undertake investment risks, and (3) assume financial risks in gambling tasks in both the gain and loss decision-making frame. Moreover, we aimed to investigate how chronic motivational systems confronted with situationally induced promotion and prevention motivation would affect people's propensity to invest and embrace financial risks. Two CAWI studies on a Polish national representative sample (N1 = 1093; N2 = 1096) were conducted. The second study consisted of two waves with a 2-week break. The studies provided evidence of higher chronic promotion motivation as well as higher prevention motivation associated with the propensity to invest; however, induced promotion motivation results in a lower propensity to invest compared to induced prevention motivation. Participants with an activated promotion system built more risky portfolios than individuals with an induced prevention system. Moreover, participants with a low chronic promotion system built more risky portfolios than individuals with a high promotion motivation system as long as their prevention system was also low. In terms of gambling decisions in both the gain and loss frame, a higher level of chronic promotion motivation and situationally induced promotion motivation were related to the preference for the non-sure option over the sure one. PMID:27630611

Model construction for the intention to use telecare in patients with chronic diseases.

PubMed

Huang, Jui-Chen; Lee, Yii-Ching

2013-01-01

Objective. This study chose patients with chronic diseases as study subjects to investigate their intention to use telecare. Methods. A large medical institute in Taiwan was used as the sample unit. Patients older than 20 years, who had chronic diseases, were sampled by convenience sampling and surveyed with a structural questionnaire, and a total of 500 valid questionnaires were collected. Model construction was based on the Health Belief Model. The reliability and validity of the measurement model were tested using confirmatory factor analysis (CFA), and the causal model was explained by structural equation modeling (SEM). Results. The priority should be on promoting the perceived benefits of telecare, with a secondary focus on the external cues to action, such as promoting the influences of important people on the patients. Conclusion. The findings demonstrated that patients with chronic diseases use telecare differently from the general public. To promote the use and acceptance of telecare in patients with chronic diseases, technology developers should prioritize the promotion of the usefulness of telecare. In addition, policy makers can strengthen the marketing from media and medical personnel, in order to increase the acceptance of telecare by patients with chronic diseases.

A health in all policies approach to promote active, healthy lifestyle in Israel

PubMed Central

2013-01-01

In December 2011, Israel launched the National Program to Promote Active, Healthy Lifestyle, an inter-ministerial, intersectoral effort to address obesity and its contribution to the country’s burden of chronic disease. This paper explores the National Program according to the “Health in All Policies” (HiAP) strategy for health governance, designed to engage social determinants of health and curb health challenges at the causal level. Our objective is twofold: to identify where Israel’s National Program both echoes and falls short of Health in All Policies, and to assess how the National Program can be utilized to enrich the Health in All Policies research-base. We review Health in All Policies’ evolution, why it developed and how it is diverges from other approaches to intersectoriality in health. We describe why obesity and related chronic diseases necessitate an intersectoral response, cite obstacles and gaps to implementation and list examples of HiAP-type initiatives from around the world. We then analyze Israel’s National Program as it relates to Health in All Policies, and propose directions through which the initiative may constitute a useful case study. We contend that joint planning, implementation and to a limited extent, budgeting, between the Ministries of Health, Education and Culture and Sport reflect an HiAP-approach, as does integrating health into the policymaking of other ministries. To further incorporate health in all Israeli policies, we suggest leveraging the Health Ministry’s presence on governmental and non-governmental committees in areas like building, land-use and urban planning, institutional food policy and environmental health, and focusing on knowledge translation according to the policy needs, strengths and limitations of other sectors. Finally, we suggest studying the National Program’s financing, decision-making and evaluation mechanisms in order to complement existing research on the implementation of Health in All Policies and intersectoral action for health. PMID:23607681

Translation of Fit & Strong! for Middle-Aged and Older Adults: Examining Implementation and Effectiveness of a Lay-Led Model in Central Texas

PubMed Central

Ory, Marcia G.; Lee, Shinduk; Zollinger, Alyson; Bhurtyal, Kiran; Jiang, Luohua; Smith, Matthew Lee

2015-01-01

The Fit & Strong! program is an evidence-based, multi-component program promoting physical activity among older adults, particularly those suffering from lower-extremity osteoarthritis. The primary purpose of the study is to examine if the Fit & Strong! program translated into a lay-leader model can produce comparable outcomes to the original program taught by physical therapists and/or certified exercise instructors. A single-group, pre–post study design was employed, and data were collected at the baseline (n = 136 participants) and the intervention conclusion (n = 71) with both baseline and post-intervention data. The measurements included socio-demographic information, health- and behavior-related information, and health-related quality of life. Various statistical tests were used for the program impact analysis and examination of the association between participant characteristics and program completion. As in the original study, there were statistically significant (p < 0.05) improvements in self-efficacy for exercise, aerobic capacity, joint stiffness, level of energy, and amount and intensity of physical activities. The odds of completing the program were significantly lower for the participants from rural areas and those having multiple chronic conditions. Successful adaptation of the Fit & Strong! program to a lay-leader model can increase the likelihood of program dissemination by broadening the selection pool of instructors and, hence, reducing the potential issue of resource limitation. However, high program attrition rates (54.1%) emphasize the importance of adopting evidence-based strategies for improving the retention of the participants from rural areas and those with multiple chronic conditions. PMID:25964912

Harnessing motivational forces in the promotion of physical activity: the Community Health Advice by Telephone (CHAT) project.

PubMed

King, Abby C; Friedman, Robert; Marcus, Bess; Castro, Cynthia; Forsyth, LeighAnn; Napolitano, Melissa; Pinto, Bernardine

2002-10-01

Physical inactivity among middle- and older-aged adults is pervasive, and is linked with numerous chronic conditions that diminish health and functioning. Counselor-directed physical activity programs may enhance extrinsic motivation (reflected in social influence theories, such as self-presentation theory) and, in turn, physical activity adherence, while the counselor is in charge of program delivery. However, external influences can undermine intrinsic motivation, making it more difficult to maintain physical activity once counselor-initiated contact ends. In contrast, programs that diminish the socially evaluative and controlling aspects of the counseling interchange may promote intrinsic motivation (described in cognitive evaluation theory), and, thus, physical activity maintenance, even when counselor-initiated contact ceases. The objective of the Community Health Advice by Telephone (CHAT) project is to compare these two theories by conducting a randomized controlled trial evaluating the effects of a telephone-administered counseling program delivered by a person (social influence enhancement) or computer (cognitive evaluation enhancement) on physical activity adoption and maintenance over 18 months. Healthy, sedentary adults (n = 225) aged 55 years and older are randomized to one of these programs or to a control arm. This study will contribute to advancing motivational theory as well as provide information on the sustained effectiveness of interventions with substantial public health applicability.

Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.

PubMed

Hwang, Rita; Bruning, Jared; Morris, Norman R; Mandrusiak, Allison; Russell, Trevor

2017-04-01

Is a 12-week, home-based telerehabilitation program conducted in small groups non-inferior to a traditional centre-based program in terms of the change in 6-minute walk distance? Is the telerehabilitation program also non-inferior to a centre-based program in terms of functional capacity, muscle strength, quality of life, urinary incontinence, patient satisfaction, attendance rates, and adverse events? Randomised, parallel, non-inferiority trial with concealed allocation, intention-to-treat analysis and assessor blinding. Patients with stable chronic heart failure (including heart failure with reduced or preserved ejection fraction) were recruited from two tertiary hospitals in Brisbane, Australia. The experimental group received a 12-week, real-time exercise and education intervention delivered into the participant's home twice weekly, using online videoconferencing software. The control group received a traditional hospital outpatient-based program of the same duration and frequency. Both groups received similar exercise prescription. Participants were assessed by independent assessors at baseline (Week 0), at the end of the intervention (Week 12) and at follow-up (Week 24). The primary outcome was a between-group comparison of the change in 6-minute walk distance, with a non-inferiority margin of 28m. Secondary outcomes included other functional measures, quality of life, patient satisfaction, program attendance rates and adverse events. In 53 participants (mean age 67 years, 75% males), there were no significant between-group differences on 6-minute walk distance gains, with a mean difference of 15m (95% CI -28 to 59) at Week 12. The confidence intervals were within the predetermined non-inferiority range. The secondary outcomes indicated that the experimental intervention was at least as effective as traditional rehabilitation. Significantly higher attendance rates were observed in the telerehabilitation group. Telerehabilitation was not inferior to a hospital outpatient-based rehabilitation program in patients with chronic heart failure. Telerehabilitation appears to be an appropriate alternative because it promotes greater attendance at the rehabilitation sessions. ACTRN12613000390785. [Hwang R, Bruning J, Morris NR, Mandrusiak A, Russell T (2017) Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial. Journal of Physiotherapy 63: 101-107]. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

Disease management and the Medicare Modernization Act: "It's the insurance, stupid".

PubMed

Sidorov, Jaan; Schlosberg, Claudia

2005-12-01

While definitions of "disease management" (DM) emphasize quality of care for populations with chronic illness, proponents argue it reduces healthcare costs. Buyers may find disease management organizations' (DMOs') use of clinical guidelines, physician collaboration, and promotion of patient self-management intuitively sound, but it is performance guarantees, combined with retrospective effectiveness cost studies, that have driven DMOs' penetration of the commercial insurance market with revenues that exceed $500 million per year. The success of DMOs contributed to the creation of the Chronic Care Improvement Program (CCIP), which is designed to prospectively test the impact of DM on both the quality and cost of care for fee-for-service Medicare beneficiaries with chronic illness. This may lead to an expansion of DM in Medicare, and even greater opportunities for DMOs beyond the $10 billion in 10- year projected growth. For community-based physicians caring for patients with chronic illness, the sharpened focus on chronic care and the growth of DMOs creates some potential advantages. These include more time to treat more patients with acute illness, lower practice costs, opportunities to collaborate over quality, and a greater ability to achieve quality targets set by pay-for-performance arrangements.

Implementation of a Worksite Wellness Program Targeting Small Businesses

PubMed Central

Stinson, Kaylan E.; Metcalf, Dianne; Fang, Hai; Brockbank, Claire vS.; Jinnett, Kimberly; Reynolds, Stephen; Trotter, Margo; Witter, Roxana; Tenney, Liliana; Atherly, Adam; Goetzel, Ron Z.

2015-01-01

Objective: To assess small business adoption and need for a worksite wellness program in a longitudinal study of health risks, productivity, workers' compensation rates, and claims costs. Methods: Health risk assessment data from 6507 employees in 260 companies were examined. Employer and employee data are reported as frequencies, with means and standard deviations reported when applicable. Results: Of the 260 companies enrolled in the health risk management program, 71% continued more than 1 year, with 97% reporting that worker wellness improves worker safety. Of 6507 participating employees, 34.3% were overweight and 25.6% obese. Approximately one in five participants reported depression. Potentially modifiable conditions affecting 15% or more of enrollees include chronic fatigue, sleeping problems, headaches, arthritis, hypercholesterolemia, and hypertension. Conclusions: Small businesses are a suitable target for the introduction of health promotion programs. PMID:25563536

What deserves our respect? Reexamination of respect for autonomy in the context of the management of chronic conditions.

PubMed

Enzo, Aya; Okita, Taketoshi; Asai, Atsushi

2018-05-29

The global increase in patients with chronic conditions has led to increased interest in ethical issues regarding such conditions. A basic biomedical principle-respect for autonomy-is being reexamined more critically in its clinical implications. New accounts of this basic principle are being proposed. While new accounts of respect for autonomy do underpin the design of many public programs and policies worldwide, addressing both chronic disease management and health promotion, the risk of applying such new accounts to clinical setting remain understudied. However, the application of new accounts of respect for autonomy to clinical settings could support disrespectful attitudes toward or undue interference with patients with chronic conditions. Reconsidering autonomy and respect using Kantian accounts, this paper proposes respect for persons as an alternative basic bioethical principle to respect for autonomy. Unlike the principle of respect for persons in the Belmont Report, our principle involves respecting any patient's decisions, behaviors, emotions, or life-style regardless of his or her "autonomous" capabilities. Thus, attitudes toward patients should be no different irrespective of the assessment of their decisional or executive capabilities.

Creating a pro-active health care system to combat chronic diseases in Sri Lanka: the central role of preventive medicine and healthy lifestyle behaviors.

PubMed

Sagner, Michael; Arena, Ross; McNeil, Amy; Brahmam, Ginnela N V; Hills, Andrew P; De Silva, H Janaka; Karunapema, R P Palitha; Wijeyaratne, Chandrika N; Arambepola, Carukshi; Puska, Pekka

2016-10-01

The current burden and future escalating threat of chronic diseases, constitutes the major global public health challenge. In Sri Lanka, cardiovascular diseases account for the majority of annual deaths. Data from Sri Lanka also indicate a high incidence and prevalence of pre-diabetes and diabetes; 1 in 5 adults have elevated blood sugar in Sri Lanka. It is well established that chronic diseases share four primary behavioral risk factors: 1) tobacco use; 2) unhealthy diet; 3) physical inactivity; and 4) harmful use of alcohol. Evidence has convincingly shown that replacing these behavioral risk factors with the converse, healthy lifestyle characteristics, decrease the risk of poor outcomes associated with chronic disease by 60 to 80%. In essence, prevention or reversal of these behavioral risk factors with effective healthy lifestyle programing and interventions is the solution to the current chronic disease crisis. Expert commentary: Healthy lifestyle is medicine with global applicability, including Sri Lanka and the rest of the South Asia region. This policy statement will discuss the chronic disease crisis in Sri Lanka, its current policies and action implemented to promote healthy lifestyles, and further recommendations on preventive medicine and healthy lifestyle initiatives that are needed to move forward.

Designing Culturally Relevant Physical Activity Programs for African-American Women: A Framework for Intervention Development.

PubMed

Joseph, Rodney P; Keller, Colleen; Affuso, Olivia; Ainsworth, Barbara E

2017-06-01

African-American women perform low levels of physical activity and are disproportionally burdened by associated cardiometabolic disease conditions (i.e., 57 % are obese, 49 % have cardiovascular disease). The marked health disparities among African-American women indicate the need for innovative strategies to promote physical activity to help attenuate the chronic disease health disparities in this high-risk population. Culturally tailoring physical activity programs to address the sociocultural norms, values, beliefs, and behaviors of African-American women is an advantageous strategy to enhance physical activity promotion efforts. The purpose of this article is to discuss critical aspects for researchers to consider when designing physical activity programs for African-American women and to present a conceptual framework to guide intervention development. Development of the framework was based on our previous physical activity research with African-American women, seminal literature on the topics of cultural adaptation and health promotion, sociological and theoretical perspectives on the role of women in African-American culture, and key determinants of physical activity engagement among African-American women. Three key concepts are discussed in the conceptual framework: (1) Developmental milestones and life stage transitions of African-American women; (2) Historical, social, and cultural influences associated with physical activity engagement; and (3) Intervention delivery strategies. Using the framework to guide intervention development has the potential to enhance the physical activity and health outcomes of a physical activity program for African-American women.

Designing Culturally Relevant Physical Activity Programs for African American Women: A Framework for Intervention Development

PubMed Central

Keller, Colleen; Affuso, Oliva; Ainsworth, Barbara E.

2016-01-01

Background African American women perform low levels of physical activity and are disproportionally burdened by associated cardiometabolic disease conditions (i.e. 57% are obese, 49% have cardiovascular disease) The marked health disparities among African American women indicate the need for innovative strategies to promote physical activity to help attenuate the chronic disease health disparities in this high-risk population. Culturally tailoring PA programs to address the sociocultural norms, values, beliefs, and behaviors of African American women is an advantageous strategy to enhance physical activity promotion efforts. The purpose of this article is to discuss critical aspects for researchers to consider when designing physical activity programs for African American women and to present a conceptual framework to guide intervention development. Methods Development of the framework was based on our previous physical activity research with African American women, seminal literature on the topics of cultural adaptation and health promotion, sociological and theoretical perspectives on the role of women in African American culture, and key determinants of physical activity engagement among African American women. Results Three key concepts are discussed in the conceptual framework: 1) Developmental milestones and life stage transitions of African American women, 2) Historical, social and cultural influences associated with physical activity engagement, and 3) Intervention delivery strategies. Discussion Using the framework to guide intervention development has the potential to enhance the physical activity and health outcomes of a physical activity program for African American women. PMID:27178447

[Training of institutional research networks as a strategy of improvement].

PubMed

Galván-Plata, María Eugenia; Almeida-Gutiérrez, Eduardo; Salamanca-Gómez, Fabio Abdel

2017-01-01

The Instituto Mexicano del Seguro Social (IMSS) through the Coordinación de Investigación en Salud (Health Research Council) has promoted a strong link between the generation of scientific knowledge and the clinical care through the program Redes Institucionales de Investigación (Institutional Research Network Program), whose main aim is to promote and generate collaborative research between clinical, basic, epidemiologic, educational, economic and health services researchers, seeking direct benefits for patients, as well as to generate a positive impact on institutional processes. All of these research lines have focused on high-priority health issues in Mexico. The IMSS internal structure, as well as the sufficient health services coverage, allows the integration of researchers at the three levels of health care into these networks. A few years after their creation, these networks have already generated significant results, and these are currently applied in the institutional regulations in diseases that represent a high burden to health care. Two examples are the National Health Care Program for Patients with Acute Myocardial Infarction "Código Infarto", and the Early Detection Program on Chronic Kidney Disease; another result is the generation of multiple scientific publications, and the promotion of training of human resources in research from the same members of our Research Networks. There is no doubt that the Coordinación de Investigación en Salud advances steadily implementing the translational research, which will keep being fruitful to the benefit of our patients, and of our own institution.

Increasing Resilience to Traumatic Stress: Understanding the Protective Role of Well-Being.

PubMed

Tory Toole, J; Rice, Mark A; Cargill, Jordan; Craddock, Travis J A; Nierenberg, Barry; Klimas, Nancy G; Fletcher, Mary Ann; Morris, Mariana; Zysman, Joel; Broderick, Gordon

2018-01-01

The brain maintains homeostasis in part through a network of feedback and feed-forward mechanisms, where neurochemicals and immune markers act as mediators. Using a previously constructed model of biobehavioral feedback, we found that in addition to healthy equilibrium another stable regulatory program supported chronic depression and anxiety. Exploring mechanisms that might underlie the contributions of subjective well-being to improved therapeutic outcomes in depression, we iteratively screened 288 candidate feedback patterns linking well-being to molecular signaling networks for those that maintained the original homeostatic regimes. Simulating stressful trigger events on each candidate network while maintaining high levels of subjective well-being isolated a specific feedback network where well-being was promoted by dopamine and acetylcholine, and itself promoted norepinephrine while inhibiting cortisol expression. This biobehavioral feedback mechanism was especially effective in reproducing well-being's clinically documented ability to promote resilience and protect against onset of depression and anxiety.

Nurses' health promoting lifestyle behaviors in a community hospital.

PubMed

Kurnat-Thoma, Emma; El-Banna, Majeda; Oakcrum, Monica; Tyroler, Jill

2017-06-01

To examine nurses' health-promoting lifestyle behaviors, describe their self-reported engagement in employee wellness program benefit options, and explore relationships between nurse demographic factors, health characteristics and lifestyle behaviors. Nurses adopting unhealthy lifestyle behaviors are at significantly higher risk for developing a number of chronic diseases and are at increased susceptibility to exhaustion, job dissatisfaction and turnover. Strengthening professional nurses' abilities to engage in healthy lifestyle behaviors could serve as a valuable tool in combating negative workplace stress, promote improved work-life balance and personal well-being, and help retain qualified health-care providers. In a 187-bed community hospital in the Washington D.C. metropolitan area, we conducted an IRB-approved exploratory descriptive study. We examined 127 nurses' demographic characteristics, self-reported employer wellness program use, and measured their healthy lifestyle behaviors using the 52-item Health-Promoting Lifestyle Profile-II (HPLP-II) survey instrument. Nurse demographic and HPLP-II scores were analyzed in SPSS v20.0. Inferential univariate statistical testing examined relationships between nurse demographic factors, health and job characteristics, and HPLP-II score outcomes. Nurses over 40years old were more likely to report participation in hospital wellness program options. Statistically significant age differences were identified in total HPLP-II score (p=0.005), and two subscale scores-spiritual growth (p=0.002) and interpersonal relations (p=0.000). Post-hoc testing identified nurse participants 40-49years old and ≥50years old experienced slightly lower total HPLP-II score, subscale scores in comparison to younger colleagues. Nurses ≥40years old may benefit from additional employer support and guidance to promote and maintain healthy lifestyles, personal well-being, and positive interpersonal relationships. Copyright © 2017 Elsevier Inc. All rights reserved.

Successful Reach and Adoption of a workplace health promotion RCT targeting a group of high-risk workers

PubMed Central

2010-01-01

Background Cleaners are rarely introduced to workplace health promotion programs. The study's objective was to evaluate the reach and adoption of a workplace randomized controlled trial (RCT) among cleaners in Denmark. Methods Cleaning businesses with at least 30 employees, that could offer a weekly 1-hour intervention during working hours, were invited to participate. Employees working at least 20 hours/week were invited to answer a screening questionnaire and consent to participate. Analyses determined the differences in health variables between responders and non-responders, consenters and non-consenters, participants and non-participants and between participants of the RCT's three groups: physical coordination training, cognitive-behavioural theory-based training and reference group. Results From 16 eligible workplaces, a representative sample of 50% adopted the trial. Of 758 eligible employees, 78% responded to the screening questionnaire and 49% consented to participate. Consenters and participants differed from non-consenters and non-participants by having higher BMI, more chronic diseases and poorer musculoskeletal health. Conclusions This study indicates that workplace health promotion programs directed at health risk factors among cleaners enable significant adoption and reach to a high-risk subgroup of the Danish workforce. Trial registration Trial registration ISRCTN96241850 PMID:20546592

Program prioritization to control chronic diseases in African-American faith-based communities.

PubMed

Hoyo, Cathrine; Reid, Laverne; Hatch, John; Sellers, Denethia B; Ellison, Arlinda; Hackney, Tara; Porterfield, Deborah; Page, Joyce; Parrish, Theodore

2004-04-01

In the last decade, African-American congregations have been inundated with requests to participate in health promotion activities; however, most are not equipped to effectively participate. We assessed the effect of providing congregation leaders with skills on identifying their own health needs, planning, and implementing their own interventions. At baseline, 21 congregational leaders from South East Raleigh, NC were taught methods for developing needs assessments, planning, and implementing health promotion activities tailored for their congregations. After approximately four years, 14 of the 21 congregations were successfully recontacted. At baseline, the congregation leadership ranked diabetes as the ninth (out of 10) most urgent health concern in their communities. However, at follow-up, not only was diabetes identified as the most serious health concern, but most congregations had taken advantage of available community and congregational resources to prevent it. Larger congregations were more likely than smaller ones to take advantage of available resources. Larger African-American congregations are an effective vehicle by which health promotion messages can diffuse; however, the leadership must be provided with skills to assess health needs before selecting programs most beneficial to their congregations. Mechanisms by which small congregation leaders can participate need development.

Program prioritization to control chronic diseases in African-American faith-based communities.

PubMed Central

Hoyo, Cathrine; Reid, Laverne; Hatch, John; Sellers, Denethia B.; Ellison, Arlinda; Hackney, Tara; Porterfield, Deborah; Page, Joyce; Parrish, Theodore

2004-01-01

OBJECTIVE: In the last decade, African-American congregations have been inundated with requests to participate in health promotion activities; however, most are not equipped to effectively participate. We assessed the effect of providing congregation leaders with skills on identifying their own health needs, planning, and implementing their own interventions. METHODS: At baseline, 21 congregational leaders from South East Raleigh, NC were taught methods for developing needs assessments, planning, and implementing health promotion activities tailored for their congregations. After approximately four years, 14 of the 21 congregations were successfully recontacted. RESULTS: At baseline, the congregation leadership ranked diabetes as the ninth (out of 10) most urgent health concern in their communities. However, at follow-up, not only was diabetes identified as the most serious health concern, but most congregations had taken advantage of available community and congregational resources to prevent it. Larger congregations were more likely than smaller ones to take advantage of available resources. CONCLUSIONS: Larger African-American congregations are an effective vehicle by which health promotion messages can diffuse; however, the leadership must be provided with skills to assess health needs before selecting programs most beneficial to their congregations. Mechanisms by which small congregation leaders can participate need development. PMID:15101672

Developing Occupation-Based Preventive Programs for Late-Middle-Aged Latino Patients in Safety-Net Health Systems

PubMed Central

Carlson, Mike; Martínez, Jenny; Guzmán, Laura; Mahajan, Anish; Clark, Florence

2015-01-01

Latino adults between ages 50 and 60 yr are at high risk for developing chronic conditions that can lead to early disability. We conducted a qualitative pilot study with 11 Latinos in this demographic group to develop a foundational schema for the design of health promotion programs that could be implemented by occupational therapy practitioners in primary care settings for this population. One-on-one interviews addressing routines and activities, health management, and health care utilization were conducted, audiotaped, and transcribed. Results of a content analysis of the qualitative data revealed the following six domains of most concern: Weight Management; Disease Management; Mental Health and Well-Being; Personal Finances; Family, Friends, and Community; and Stress Management. A typology of perceived health-actualizing strategies was derived for each domain. This schema can be used by occupational therapy practitioners to inform the development of health-promotion lifestyle interventions designed specifically for late-middle-aged Latinos. PMID:26565102

Developing Occupation-Based Preventive Programs for Late-Middle-Aged Latino Patients in Safety-Net Health Systems.

PubMed

Schepens Niemiec, Stacey L; Carlson, Mike; Martínez, Jenny; Guzmán, Laura; Mahajan, Anish; Clark, Florence

2015-01-01

Latino adults between ages 50 and 60 yr are at high risk for developing chronic conditions that can lead to early disability. We conducted a qualitative pilot study with 11 Latinos in this demographic group to develop a foundational schema for the design of health promotion programs that could be implemented by occupational therapy practitioners in primary care settings for this population. One-on-one interviews addressing routines and activities, health management, and health care utilization were conducted, audiotaped, and transcribed. Results of a content analysis of the qualitative data revealed the following six domains of most concern: Weight Management; Disease Management; Mental Health and Well-Being; Personal Finances; Family, Friends, and Community; and Stress Management. A typology of perceived health-actualizing strategies was derived for each domain. This schema can be used by occupational therapy practitioners to inform the development of health-promotion lifestyle interventions designed specifically for late-middle-aged Latinos. Copyright © 2015 by the American Occupational Therapy Association, Inc.

Family history of chronic disease and meeting public health guidelines for physical activity: the cooper center longitudinal study.

PubMed

Shuval, Kerem; Chiu, Chung-Yi; Barlow, Carolyn E; Gabriel, Kelley Pettee; Kendzor, Darla E; Businelle, Michael S; Skinner, Celette Sugg; Balasubramanian, Bijal A

2013-06-01

We aimed to assess whether a family history of coronary heart disease, diabetes, or cancer is linked to meeting public health guidelines for health-promoting physical activity. To achieve this objective, we analyzed data on 29,513 adults who came to the Cooper Clinic (Dallas, Texas) between January 1, 1990, and December 31, 2010, for a preventive medicine visit. Patients completed a comprehensive medical survey including information on family medical history, physical activity, and other lifestyle behaviors. Bivariate and multivariate logistic regression were used to examine the relationship between having a family history of chronic disease and meeting physical activity guidelines. The results indicated that individuals with a family history of disease had reduced odds for meeting or exceeding physical activity guidelines. For example, participants with a family history of 3 diseases were 36% less likely to meet or exceed physical activity guidelines than their counterparts without a family history of disease (odds ratio, 0.64; 95% CI, 0.58-0.72), while controlling for covariates. Among this large sample of adults, those with a family history of chronic disease were less inclined to regularly engage in physical activity. Thus, targeted programs encouraging adoption and maintenance of health-promoting physical activity might be warranted, specifically targeting individuals with familial history of disease. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Promoting Nature-Based Activity for People With Mental Illness Through the US “Exercise Is Medicine” Initiative

PubMed Central

Jette, Shannon

2016-01-01

Nature-based physical activity programming (e.g., countryside walks, hiking, horseback riding) has been found to be an effective way to help improve the health of people with mental illness. Exercise referral initiatives, whereby health practitioners prescribe exercise in an attempt to prevent or treat chronic illnesses, have helped make such nature-based activities accessible to this population in the United Kingdom and Australia; however, there is a dearth of research related to the most prominent exercise referral program in the United States: Exercise is Medicine. Taking into account the barriers to physical activity faced by people with mental illness, we explore how nature-based programming for this population might be mobilized in the United States through the growing Exercise is Medicine initiative. PMID:26985618

[Application of "disease management" to the organization and compensation of professionals in the U.S.A., Germany and England: prospects for France].

PubMed

Morin, Ludovic; Christian, Foury; Briot, Pascal; Perrocheau, Antonin; Pascal, Jean

2010-01-01

Disease management, developed in the U.S.A. in the 1990s, is a comprehensive integrated approach that aims to incorporate all phases of chronic disease management from prevention to health education. Its main objective is to optimize patient care services by making patients more responsible for the management of their chronic disease. The specificity of its implementation in different countries is reflected by its translation into various concepts, such as: in the United States by the concept of the "Medical Home", in Germany by establishing contracts that encourage GPs and social security funds to support patients with chronic diseases, and in the United Kingdom through programs with measures that support the delegation of tasks and cooperation between primary care professionals. Disease management is accompanied by the introduction of new forms of payment for doctors and primary care facilities that ensure the effective implementation of the underpinning principles of disease management programs. In France, the development of the disease management approach is being promoted and advocated for integration into primary care, as it is gradually becoming an integral part of the French National Health Insurance Fund's strategy to enhance and improve the quality of care.

Cell differentiation defines acute and chronic infection cell types in Staphylococcus aureus.

PubMed

García-Betancur, Juan-Carlos; Goñi-Moreno, Angel; Horger, Thomas; Schott, Melanie; Sharan, Malvika; Eikmeier, Julian; Wohlmuth, Barbara; Zernecke, Alma; Ohlsen, Knut; Kuttler, Christina; Lopez, Daniel

2017-09-12

A central question to biology is how pathogenic bacteria initiate acute or chronic infections. Here we describe a genetic program for cell-fate decision in the opportunistic human pathogen Staphylococcus aureus , which generates the phenotypic bifurcation of the cells into two genetically identical but different cell types during the course of an infection. Whereas one cell type promotes the formation of biofilms that contribute to chronic infections, the second type is planktonic and produces the toxins that contribute to acute bacteremia. We identified a bimodal switch in the agr quorum sensing system that antagonistically regulates the differentiation of these two physiologically distinct cell types. We found that extracellular signals affect the behavior of the agr bimodal switch and modify the size of the specialized subpopulations in specific colonization niches. For instance, magnesium-enriched colonization niches causes magnesium binding to S. aureus teichoic acids and increases bacterial cell wall rigidity. This signal triggers a genetic program that ultimately downregulates the agr bimodal switch. Colonization niches with different magnesium concentrations influence the bimodal system activity, which defines a distinct ratio between these subpopulations; this in turn leads to distinct infection outcomes in vitro and in an in vivo murine infection model. Cell differentiation generates physiological heterogeneity in clonal bacterial infections and helps to determine the distinct infection types.

Cell differentiation defines acute and chronic infection cell types in Staphylococcus aureus

PubMed Central

García-Betancur, Juan-Carlos; Goñi-Moreno, Angel; Horger, Thomas; Schott, Melanie; Sharan, Malvika; Eikmeier, Julian; Wohlmuth, Barbara; Zernecke, Alma; Ohlsen, Knut; Kuttler, Christina

2017-01-01

A central question to biology is how pathogenic bacteria initiate acute or chronic infections. Here we describe a genetic program for cell-fate decision in the opportunistic human pathogen Staphylococcus aureus, which generates the phenotypic bifurcation of the cells into two genetically identical but different cell types during the course of an infection. Whereas one cell type promotes the formation of biofilms that contribute to chronic infections, the second type is planktonic and produces the toxins that contribute to acute bacteremia. We identified a bimodal switch in the agr quorum sensing system that antagonistically regulates the differentiation of these two physiologically distinct cell types. We found that extracellular signals affect the behavior of the agr bimodal switch and modify the size of the specialized subpopulations in specific colonization niches. For instance, magnesium-enriched colonization niches causes magnesium binding to S. aureusteichoic acids and increases bacterial cell wall rigidity. This signal triggers a genetic program that ultimately downregulates the agr bimodal switch. Colonization niches with different magnesium concentrations influence the bimodal system activity, which defines a distinct ratio between these subpopulations; this in turn leads to distinct infection outcomes in vitro and in an in vivo murine infection model. Cell differentiation generates physiological heterogeneity in clonal bacterial infections and helps to determine the distinct infection types. PMID:28893374

Chronic periodontitis, inflammatory cytokines, and interrelationship with other chronic diseases.

PubMed

Cardoso, Elsa Maria; Reis, Cátia; Manzanares-Céspedes, Maria Cristina

2018-01-01

Periodontal diseases, such as chronic periodontitis, share common inflammatory risk factors with other systemic and chronic inflammatory disorders. Mucosal tissues, such as oral epithelia, are exposed to environmental stressors, such as tobacco and oral bacteria, that might be involved in promoting a systemic inflammatory state. Conversely, chronic disorders can also affect oral health. This review will summarize recent evidence for the interrelationship between chronic periodontitis and other prevalent chronic diseases such as cardiovascular diseases, diabetes, cancer and chronic respiratory diseases. The association with pregnancy is also included due to possible obstetric complications. We will focus on inflammatory cytokines such as TNF-alpha, IL-1, and IL-6, because they have been shown to be increased in patients with chronic periodontitis, in patients with chronic systemic diseases, and in patients with both chronic periodontitis and other chronic diseases. Therefore, an imbalance towards a proinflammatory immune response could underline a bidirectional link between chronic periodontitis and other chronic diseases. Finally, we highlight that a close coordination between dental and other health professionals could promote oral health and prevent or ameliorate other chronic diseases.

Karat, pulque, and gac: three shining stars in the traditional food galaxy.

PubMed

Kuhnlein, Harriet V

2004-11-01

Karat banana, pulque prepared from Agave species, and gac fruit are three traditional local food items recently studied intensively for their nutrition potential among traditional and indigenous peoples, and are examples of how local food-based strategies can be used to ensure micronutrient nutrition. Successful health promotion and intervention programs emphasizing traditional food systems are few in the international literature, but offer promise in understanding the potential of food-based strategies. Traditional food strategies could be used not only for alleviating malnutrition, but also for developing locally relevant programs for stemming the nutrition transition and preventing chronic disease, particularly among indigenous and traditional peoples who retain knowledge of using food species in their local ecosystems.

Feasibility of Virtual Reality Augmented Cycling for Health Promotion of People Post-Stroke

PubMed Central

Deutsch, Judith E; Myslinski, Mary Jane; Kafri, Michal; Ranky, Richard; Sivak, Mark; Mavroidis, Constantinos; Lewis, Jeffrey A

2013-01-01

Background and Purpose A virtual reality (VR) augmented cycling kit (VRACK) was developed to address motor control and fitness deficits of individuals with chronic stroke. In this paper we report on the safety, feasibility and efficacy of using the VRACK to train cardio-respiratory (CR) fitness of individuals in the chronic phase poststroke. Methods Four individuals with chronic stroke (47–65 years old and three or more years post-stroke), with residual lower extremity impairments (Fugl Meyer 24–26/34) who were limited community ambulators (gait speed range 0.56 to 1.1 m/s) participated in this study. Safety was defined as the absence of adverse events. Feasibility was measured using attendance, total exercise time, and “involvement” measured with the Presence Questionnaire (PQ). Efficacy of CR fitness was evaluated using a sub-maximal bicycle ergometer test before and after an 8-week training program. Results The intervention was safe and feasible with participants having 1 adverse event, 100% adherence, achieving between 90 and 125 minutes of cycling each week and a mean PQ score of 39 (SD 3.3). There was a statistically significant 13% (p = 0.035) improvement in peak VO2 with a range of 6–24.5 %. Discussion and Conclusion For these individuals post-stroke, VR augmented cycling, using their heart rate to set their avatar’s speed, fostered training of sufficient duration and intensity to promote CR fitness. In addition, there was a transfer of training from the bicycle to walking endurance. VR augmented cycling may be an addition to the therapist’s tools for concurrent training of mobility and health promotion of individuals post-stroke. Video Abstract available (see Video, Supplemental Digital Content 1) for more insights from the authors. PMID:23863828

Microglia activation due to obesity programs metabolic failure leading to type two diabetes.

PubMed

Maldonado-Ruiz, R; Montalvo-Martínez, L; Fuentes-Mera, L; Camacho, A

2017-03-20

Obesity is an energy metabolism disorder that increases susceptibility to the development of metabolic diseases. Recently, it has been described that obese subjects have a phenotype of chronic inflammation in organs that are metabolically relevant for glucose homeostasis and energy. Altered expression of immune system molecules such as interleukins IL-1, IL-6, IL-18, tumor necrosis factor alpha (TNF-α), serum amyloid A (SAA), and plasminogen activator inhibitor-1 (PAI-1), among others, has been associated with the development of chronic inflammation in obesity. Chronic inflammation modulates the development of metabolic-related comorbidities like metabolic syndrome (insulin resistance, glucose tolerance, hypertension and hyperlipidemia). Recent evidence suggests that microglia activation in the central nervous system (CNS) is a priority in the deregulation of energy homeostasis and promotes increased glucose levels. This review will cover the most significant advances that explore the molecular signals during microglia activation and inflammatory stage in the brain in the context of obesity, and its influence on the development of metabolic syndrome and type two diabetes.

The effect of health promotion on diagnosis and management of diabetes

PubMed Central

Lee, Jinkook; Smith, James P.

2013-01-01

Background Undiagnosed disease is one of the critical public health problems in the world. In 2002 South Korean introduced the nation’s first comprehensive public health promotion policy, Health Plan 2010. The first phase of Health Plan 2010 started in 2002, promoting early detection of diseases and preventative care and continued until 2005. Methods Using the 2001 and 2005 Korean National Health and Nutrition Examination Surveys that were fielded before and after the health promotion program, we investigate changes in health care utilization and its impacts on the prevalence of diagnosed and undiagnosed diabetes as well as the good management of the disease. Results A significant rise in diabetes diagnoses has occurred during this time period, especially for those with low education and older age. We find that, during this time period, the prevalence of undiagnosed diabetes was significantly reduced especially among older and less educated Koreans, the principal targets of the program. We also find that this health promotion had significant positive effects on good management of diabetes. Conclusions The increase of preventative health care through medical check-up among less-educated, older people suggests that the implementation of free medical check-ups for age 40 and older may have a positive impact on those who had not previously used preventative care. The positive experience in South Korea indicates that similarly designed public health campaigns in other countries have enormous potential in improving the detection and management of chronic disease. PMID:21282142

Long-term consequences of nutrition and growth in early childhood and possible preventive interventions.

PubMed

Adair, Linda S

2014-01-01

Maternal nutritional deficiencies and excesses during pregnancy, and faster infant weight gain in the first 2 years of life are associated with increased risk of noncommunicable diseases (NCDs) in adulthood. The first 1,000 days of life (from conception until the child reaches age 2 years) represent a vulnerable period for programming of NCD risk, and are an important target for prevention of adult disease. This paper takes a developmental perspective to identify periconception, pregnancy, and infancy nutritional stressors, and to discuss mechanisms through which they influence later disease risk with the goal of informing age-specific interventions. Low- and middle-income countries need to address the dual burden of under- and overnutrition by implementing interventions to promote growth and enhance survival and intellectual development without increasing chronic disease risk. In the absence of good evidence from long-term follow-up of early life interventions, current recommendations for early life prevention of adult disease presume that interventions designed to optimize pregnancy outcomes and promote healthy infant growth and development will also reduce chronic disease risk. These include an emphasis on optimizing maternal nutrition prior to pregnancy, micronutrient adequacy in the preconception period and during pregnancy, promotion of breastfeeding and high-quality complementary foods, and prevention of obesity in childhood and adolescence. © 2014 Nestec Ltd., Vevey/S. Karger AG, Basel.

Healthy Eating Strategies in the Workplace

PubMed Central

Quintiliani, Lisa; Poulsen, Signe; Sorensen, Glorian

2013-01-01

Purpose There is a clear link between dietary behavior and a range of chronic diseases, and overweight and obesity constitute an indirect risk in relation to these diseases. The worksite is a central venue for influencing dietary behavior. The purpose of this paper is to provide an overview of workplace influences on worker dietary patterns. Design/methodology/approach The paper reviews the evidence of the effectiveness of dietary health promotion, and provides a brief overview of appropriate theoretical frameworks to guide intervention design and evaluation. The findings are illustrated through research examples. Findings Through case studies and published research, it is found that workplace dietary interventions are generally effective, especially fruit and vegetable interventions. There is less consistent evidence on the long term effectiveness of workplace weight management interventions, underscoring the need for further research in this area. This paper also reports evidence that changes in the work environment, including through health and safety programs, may contribute to enhancing the effectiveness of workplace health promotion, including dietary interventions. Organizational factors such as work schedule may also influence dietary patterns. The social ecological model, the social contextual model and political process approach are presented as exemplar conceptual models that may be useful when designing or assessing the effects of workplace health promotion. Originality/value Using the worksite as setting for influencing health by influencing dietary patterns holds considerable promise and may be instrumental in reducing workers’ risk of chronic diseases. PMID:23935706

Use of market research data by state chronic disease programs, Illinois, 2012-2014.

PubMed

Amerson, Nancy L; Arbise, Benjamin S; Kelly, Nora K; Traore, Elizabeth

2014-09-25

Market research data complement traditional epidemiologic data by allowing users to examine health behavior and patterns by census block or census tract. Market research data can identify products and behaviors that align or do not align with public health program goals. Illinois is a recipient of an award from the Directors of Health Promotion and Education to use industry market research data collected by The Nielsen Company for public health purposes. Illinois creates customized community profiles using market research data on tobacco use characteristics to describe the demographics, habits, and media preferences of smokers in certain locations. Local agencies use profiles to plan and target marketing initiatives, reach disparate groups within overall community populations, and restructure program objectives and policy initiatives. Local market research data provide detailed information on the characteristics of smokers, allowing Illinois communities to design public health programs without having to collect data on their own.

Use of Market Research Data by State Chronic Disease Programs, Illinois, 2012–2014

PubMed Central

Arbise, Benjamin S.; Kelly, Nora K.; Traore, Elizabeth

2014-01-01

Market research data complement traditional epidemiologic data by allowing users to examine health behavior and patterns by census block or census tract. Market research data can identify products and behaviors that align or do not align with public health program goals. Illinois is a recipient of an award from the Directors of Health Promotion and Education to use industry market research data collected by The Nielsen Company for public health purposes. Illinois creates customized community profiles using market research data on tobacco use characteristics to describe the demographics, habits, and media preferences of smokers in certain locations. Local agencies use profiles to plan and target marketing initiatives, reach disparate groups within overall community populations, and restructure program objectives and policy initiatives. Local market research data provide detailed information on the characteristics of smokers, allowing Illinois communities to design public health programs without having to collect data on their own. PMID:25254983

How can research on plants contribute to promoting human health?

PubMed

Martin, Cathie; Butelli, Eugenio; Petroni, Katia; Tonelli, Chiara

2011-05-01

One of the most pressing challenges for the next 50 years is to reduce the impact of chronic disease. Unhealthy eating is an increasing problem and underlies much of the increase in mortality from chronic diseases that is occurring worldwide. Diets rich in plant-based foods are strongly associated with reduced risks of major chronic diseases, but the constituents in plants that promote health have proved difficult to identify with certainty. This, in turn, has confounded the precision of dietary recommendations. Plant biochemistry can make significant contributions to human health through the identification and measurement of the many metabolites in plant-based foods, particularly those known to promote health (phytonutrients). Plant genetics and metabolic engineering can be used to make foods that differ only in their content of specific phytonutrients. Such foods offer research tools that can provide significant insight into which metabolites promote health and how they work. Plant science can reduce some of the complexity of the diet-health relationship, and through building multidisciplinary interactions with researchers in nutrition and the pathology of chronic diseases, plant scientists can contribute novel insight into which foods reduce the risk of chronic disease and how these foods work to impact human health.

How Can Research on Plants Contribute to Promoting Human Health?[OA

PubMed Central

Martin, Cathie; Butelli, Eugenio; Petroni, Katia; Tonelli, Chiara

2011-01-01

One of the most pressing challenges for the next 50 years is to reduce the impact of chronic disease. Unhealthy eating is an increasing problem and underlies much of the increase in mortality from chronic diseases that is occurring worldwide. Diets rich in plant-based foods are strongly associated with reduced risks of major chronic diseases, but the constituents in plants that promote health have proved difficult to identify with certainty. This, in turn, has confounded the precision of dietary recommendations. Plant biochemistry can make significant contributions to human health through the identification and measurement of the many metabolites in plant-based foods, particularly those known to promote health (phytonutrients). Plant genetics and metabolic engineering can be used to make foods that differ only in their content of specific phytonutrients. Such foods offer research tools that can provide significant insight into which metabolites promote health and how they work. Plant science can reduce some of the complexity of the diet-health relationship, and through building multidisciplinary interactions with researchers in nutrition and the pathology of chronic diseases, plant scientists can contribute novel insight into which foods reduce the risk of chronic disease and how these foods work to impact human health. PMID:21586682

The VUKA Family Program: Piloting a family-based psychosocial intervention to promote health and mental health among HIV infected early adolescents in South Africa

PubMed Central

Bhana, Arvin; Mellins, Claude Ann; Petersen, Inge; Alicea, Stacey; Myeza, Nonhlahla; Holst, Helga; Abrams, Elaine; John, Sally; Chhagan, Meera; Nestadt, Danielle F; Leu, Cheng-Shiun; McKay, Mary

2013-01-01

An increasing number of adolescents born with HIV in South Africa are on antiretroviral treatment and have to confront complex issues related to coping with a chronic, stigmatizing and transmittable illness. Very few evidence-based mental health and health promotion programs for this population exist in South Africa. This study builds on a previous collaboratively designed and developmentally-timed family-based intervention for early adolescents (CHAMP). The study uses community-based participatory approach as part of formative research to evaluate a pilot randomized control trial at two hospitals. The paper reports on the development, feasibility and acceptability of the VUKA family-based program and its short-term impact on a range of psychosocial variables for HIV+ pre-adolescents and their caregivers. A ten session intervention of approximately 3 months duration was delivered to 65 pre-adolescents aged 10-13 years and their families. VUKA participants were noted to improve on all dimensions, including mental health, youth behaviour, HIV treatment knowledge, stigma, communication and adherence to medication. VUKA shows promise as a family-based mental and HIV prevention program for HIV+ pre-adolescents and which could be delivered by trained lay staff. PMID:23767772

Activating Patients for Sustained Chronic Disease Self-Management: Thinking Beyond Clinical Outcomes.

PubMed

Dye, Cheryl J; Williams, Joel E; Evatt, Janet H

2016-04-01

This article describes the impact of an 8-week community program implemented by trained volunteers on the hypertension self-management of 185 patients who were batch randomized to intervention or wait-list control groups. Compared with control group participants, a higher proportion of treatment group participants moved from the cognitive to behavioral stages of motivational readiness for being physically active (P < .001), practicing healthy eating habits (P = .001), handling stress well (P = .001), and living an overall healthy lifestyle (P = .003). They also demonstrated a greater average increase in perceived competence for self-management, F(1.134) = 4.957, P = .028, η2 = .036, and a greater increase in mean hypertension-related knowledge, F(1.160) = 16.571, P < .0005, η(2) = .094. Enduring lifestyle changes necessary for chronic disease self-management require that psychosocial determinants of health behavior are instilled, which is typically beyond standard medical practice. We recommend peer-led, community-based programs as a complement to clinical care and support the increasing health system interest in promoting population health beyond clinical walls. © The Author(s) 2016.

Can health care organizations improve health behavior and treatment adherence?

PubMed

Bender, Bruce G

2014-04-01

Many Americans are failing to engage in both the behaviors that prevent and those that effectively manage chronic health conditions, including pulmonary disorders, cardiovascular conditions, diabetes, and cancer. Expectations that health care providers are responsible for changing patients' health behaviors often do not stand up against the realities of clinical care that include large patient loads, limited time, increasing co-pays, and restricted access. Organizations and systems that might share a stake in changing health behavior include employers, insurance payers, health care delivery systems, and public sector programs. However, although the costs of unhealthy behaviors are evident, financial resources to address the problem are not readily available. For most health care organizations, the return on investment for developing behavior change programs appears highest when addressing treatment adherence and disease self-management, and lowest when promoting healthy lifestyles. Organizational strategies to improve adherence are identified in 4 categories: patient access, provider training and support, incentives, and information technology. Strategies in all 4 categories are currently under investigation in ongoing studies and have the potential to improve self-management of many chronic health conditions.

Preventing Chronic Disease in the Workplace: A Workshop Report and Recommendations

PubMed Central

Landsbergis, Paul; Hammer, Leslie; Amick, Benjamin C.; Linnan, Laura; Yancey, Antronette; Welch, Laura S.; Goetzel, Ron Z.; Flannery, Kelly M.; Pratt, Charlotte

2011-01-01

Chronic disease is the leading cause of death in the United States. Risk factors and work conditions can be addressed through health promotion aimed at improving individual health behaviors; health protection, including occupational safety and health interventions; and efforts to support the work–family interface. Responding to the need to address chronic disease at worksites, the National Institutes of Health and the Centers for Disease Control and Prevention convened a workshop to identify research priorities to advance knowledge and implementation of effective strategies to reduce chronic disease risk. Workshop participants outlined a conceptual framework and corresponding research agenda to address chronic disease prevention by integrating health promotion and health protection in the workplace. PMID:21778485

"I Love Fruit But I Can't Afford It": Using Participatory Action Research to Develop Community-Based Initiatives to Mitigate Challenges to Chronic Disease Management in an African American Community Living in Public Housing.

PubMed

Rogers, Courtney; Johnson, Joy; Nueslein, Brianne; Edmunds, David; Valdez, Rupa S

2018-03-12

As chronic conditions are on the rise in the USA, management initiatives outside of the inpatient setting should be explored to reduce associated cost and access disparities. Chronic conditions disproportionately affect African American public housing residents due to the effects of historical marginalization on the manifestation of economic and social problems exacerbating health disparities and outcomes. Informed by participatory research action tenets, this study focused on identifying the challenges to management of chronic conditions and developing community-envisioned initiatives to address these challenges in a predominantly African American public housing community. Two focus groups were conducted with former and current public housing residents and were analyzed using inductive content analysis. Physical activity, the cost associated with healthy eating, and lack of information were noted as challenges to chronic disease management. Initiatives discussed were the formation of a walking partner's program to promote physical activity, a shopper's club to exchange coupons and learn how to prepare healthy meals, and a natural remedy's book to share information intergenerationally about management tactics. Challenges identified existed predominantly on the individual and the system level, while the initiatives generated target engaging interpersonal and community relationships. These community-envisioned approaches should be explored to facilitate chronic disease management in public housing neighborhoods.

Under the same roof: co-location of practitioners within primary care is associated with specialized chronic care management.

PubMed

Rumball-Smith, Juliet; Wodchis, Walter P; Koné, Anna; Kenealy, Tim; Barnsley, Jan; Ashton, Toni

2014-09-02

International and national bodies promote interdisciplinary care in the management of people with chronic conditions. We examine one facilitative factor in this team-based approach - the co-location of non-physician disciplines within the primary care practice. We used survey data from 330 General Practices in Ontario, Canada and New Zealand, as a part of a multinational study using The Quality and Costs of Primary Care in Europe (QUALICOPC) surveys. Logistic and linear multivariable regression models were employed to examine the association between the number of disciplines working within the practice, and the capacity of the practice to offer specialized and preventive care for patients with chronic conditions. We found that as the number of non-physicians increased, so did the availability of special sessions/clinics for patients with diabetes (odds ratio 1.43, 1.25-1.65), hypertension (1.20, 1.03-1.39), and the elderly (1.22, 1.05-1.42). Co-location was also associated with the provision of disease management programs for chronic obstructive pulmonary disease, diabetes, and asthma; the equipment available in the centre; and the extent of nursing services. The care of people with chronic disease is the 'challenge of the century'. Co-location of practitioners may improve access to services and equipment that aid chronic disease management.

Development of a situation-specific theory for explaining health-related quality of life among older South Korean adults with type 2 diabetes.

PubMed

Chang, Sun Ju; Im, Eun-Ok

2014-01-01

The purpose of the study was to develop a situation-specific theory for explaining health-related quality of life (QOL) among older South Korean adults with type 2 diabetes. To develop a situation-specific theory, three sources were considered: (a) the conceptual model of health promotion and QOL for people with chronic and disabling conditions (an existing theory related to the QOL in patients with chronic diseases); (b) a literature review using multiple databases including Cumulative Index for Nursing and Allied Health Literature (CINAHL), PubMed, PsycINFO, and two Korean databases; and (c) findings from our structural equation modeling study on health-related QOL in older South Korean adults with type 2 diabetes. The proposed situation-specific theory is constructed with six major concepts including barriers, resources, perceptual factors, psychosocial factors, health-promoting behaviors, and health-related QOL. The theory also provides the interrelationships among concepts. Health care providers and nurses could incorporate the proposed situation-specific theory into development of diabetes education programs for improving health-related QOL in older South Korean adults with type 2 diabetes.

Sponsorship of physical activity programs by the sweetened beverages industry: public health or public relations?

PubMed

Gómez, Luis; Jacoby, Enrique; Ibarra, Lorena; Lucumí, Diego; Hernandez, Alexandra; Parra, Diana; Florindo, Alex; Hallal, Pedro

2011-04-01

The growing evidence on the association between consumption of sugar-sweetened beverages, obesity and other chronic diseases has highlighted the need to implement policy actions that go beyond programs exclusively focused on individual responsibility. In order to protect their commercial goals in Latin America, the sugar-sweetened beverage industry practices intense lobbying at high government levels in several countries across the region. This strategy is accompanied by corporate social responsibility programs that fund initiatives promoting physical activity. These efforts, although appearing altruistic, are intended to improve the industry's public image and increase political influence in order to block regulations counter to their interests. If this industry wants to contribute to human well being, as it has publicly stated, it should avoid blocking legislative actions intended to regulate the marketing, advertising and sale of their products.

Steps to a HealthierUS Cooperative Agreement Program: foundational elements for program evaluation planning, implementation, and use of findings.

PubMed

MacDonald, Goldie; Garcia, Danyael; Zaza, Stephanie; Schooley, Michael; Compton, Don; Bryant, Terry; Bagnol, Lulu; Edgerly, Cathy; Haverkate, Rick

2006-01-01

The Steps to a HealthierUS Cooperative Agreement Program (Steps Program) enables funded communities to implement chronic disease prevention and health promotion efforts to reduce the burden of diabetes, obesity, asthma, and related risk factors. At both the national and community levels, investment in surveillance and program evaluation is substantial. Public health practitioners engaged in program evaluation planning often identify desired outcomes, related indicators, and data collection methods but may pay only limited attention to an overarching vision for program evaluation among participating sites. We developed a set of foundational elements to provide a vision of program evaluation that informs the technical decisions made throughout the evaluation process. Given the diversity of activities across the Steps Program and the need for coordination between national- and community-level evaluation efforts, our recommendations to guide program evaluation practice are explicit yet leave room for site-specific context and needs. Staff across the Steps Program must consider these foundational elements to prepare a formal plan for program evaluation. Attention to each element moves the Steps Program closer to well-designed and complementary plans for program evaluation at the national, state, and community levels.

Process evaluation of a promotora de salud intervention for improving hypertension outcomes for Latinos living in a rural U.S.-Mexico border region.

PubMed

Sánchez, Victoria; Cacari Stone, Lisa; Moffett, Maurice L; Nguyen, PhoungGiang; Muhammad, Michael; Bruna-Lewis, Sean; Urias-Chauvin, Rita

2014-05-01

Hypertension is a growing public health problem for U.S.-Mexico border Latinos, who commonly experience low levels of awareness, treatment, and control. We report on a process evaluation that assessed the delivery of Corazón por la Vida, a 9-week promotora de salud-led curriculum to help Latinos manage and reduce hypertension risks in two rural/frontier counties in the New Mexico border region. Ninety-six adults participated in the program, delivered in three waves and in three communities. We assessed program delivery and quality, adherence, exposure, and participant responsiveness. Participant outcome measures included self-reported eating and physical activities and assessment of community resources. Findings suggest that the program was fully delivered (99%) and that most participants (81.7%) were very satisfied with the educational sessions. The average participant attendance for educational sessions was 77.47%. We found significant differences in self-reported behavioral changes depending on the number of sessions completed: The higher the dose of sessions, the better the self-reported outcomes. These findings suggest that a promotora-led curriculum may be useful for promoting self-management of chronic disease in rural/frontier border Latino populations. Future evaluation should focus on training and implementation adaptations within evidence-based chronic disease programs for diverse Latino communities.

10 CFR Appendix A to Part 850 - Chronic Beryllium Disease Prevention Program Informed Consent Form

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Chronic Beryllium Disease Prevention Program Informed Consent Form A Appendix A to Part 850 Energy DEPARTMENT OF ENERGY CHRONIC BERYLLIUM DISEASE PREVENTION PROGRAM Pt. 850, App. A Appendix A to Part 850—Chronic Beryllium Disease Prevention Program Informed...

10 CFR Appendix A to Part 850 - Chronic Beryllium Disease Prevention Program Informed Consent Form

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Chronic Beryllium Disease Prevention Program Informed Consent Form A Appendix A to Part 850 Energy DEPARTMENT OF ENERGY CHRONIC BERYLLIUM DISEASE PREVENTION PROGRAM Pt. 850, App. A Appendix A to Part 850—Chronic Beryllium Disease Prevention Program Informed...

10 CFR Appendix A to Part 850 - Chronic Beryllium Disease Prevention Program Informed Consent Form

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Chronic Beryllium Disease Prevention Program Informed Consent Form A Appendix A to Part 850 Energy DEPARTMENT OF ENERGY CHRONIC BERYLLIUM DISEASE PREVENTION PROGRAM Pt. 850, App. A Appendix A to Part 850—Chronic Beryllium Disease Prevention Program Informed...

10 CFR Appendix A to Part 850 - Chronic Beryllium Disease Prevention Program Informed Consent Form

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Chronic Beryllium Disease Prevention Program Informed Consent Form A Appendix A to Part 850 Energy DEPARTMENT OF ENERGY CHRONIC BERYLLIUM DISEASE PREVENTION PROGRAM Pt. 850, App. A Appendix A to Part 850—Chronic Beryllium Disease Prevention Program Informed...

10 CFR Appendix A to Part 850 - Chronic Beryllium Disease Prevention Program Informed Consent Form

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Chronic Beryllium Disease Prevention Program Informed Consent Form A Appendix A to Part 850 Energy DEPARTMENT OF ENERGY CHRONIC BERYLLIUM DISEASE PREVENTION PROGRAM Pt. 850, App. A Appendix A to Part 850—Chronic Beryllium Disease Prevention Program Informed...

Sensitivity to emotional ill health

NASA Technical Reports Server (NTRS)

Felton, J. S.

1969-01-01

The services of mental specialists, such as psychologists, psychiatrists, or psychiatric social workers are required to assure maximum human performance in Government facilities. Contemporary mental health programming covers emotionally generated problems at operational sites to complete disclaiming of the existence of such difficulties among workers. Frequent taking of sick leave or annual leave when work seems demanding or when a promotion does not materialize, chronic or repeated tardiness, requests for frequent transfers, work over-loading, accidental injuries, and alcoholism are all forms of stress responses and indicate a need for emotional counselling.

Development of the volunteer peer educator role in a community Cardiovascular Health Awareness Program (CHAP): a process evaluation in two communities.

PubMed

Karwalajtys, Tina; McDonough, Beatrice; Hall, Heather; Guirguis-Younger, Manal; Chambers, Larry W; Kaczorowski, Janusz; Lohfeld, Lynne; Hutchison, Brian

2009-08-01

Volunteers can support the delivery and sustainability of programs promoting chronic disease awareness to improve health at the community level. This paper describes the development of the peer education component of the Cardiovascular Health Awareness Program (CHAP) and assessment of the volunteer peer educator role in a community-wide demonstration project in two mid-sized Ontario communities. A case study approach was used incorporating process learning, a volunteer survey and debriefing discussions with volunteers. A post-program questionnaire was administered to 48 volunteers. Five debriefing discussions were conducted with 27 volunteers using a semi-structured interview guide. Discussions were audio-recorded and transcribed. Analysis used an editing approach to identify themes, taking into account the community-specific context. Volunteers reported an overall positive experience and identified rewarding aspects of their involvement. They felt well prepared but appreciated ongoing training and support and requested more refresher training. Understanding of program objectives increased volunteer satisfaction. Volunteers continued to develop their role during the program; however, organizational and logistical factors sometimes limited skill acquisition and contributions. The prospect of greater involvement in providing tailored health education resources addressing modifiable risk factors was acceptable to most volunteers. Continued refinement of strategies to recruit, train, retain and support volunteers strengthened the peer education component of CHAP. The experience and contributions of volunteers were influenced by the wider context of program delivery. Process evaluation allowed program planners to anticipate challenges, strengthen support for volunteer activities, and expand the peer educator role. This learning can inform similar peer-led health promotion initiatives.

Atrial arrhythmias and autonomic dysfunction in rats exposed to chronic intermittent hypoxia.

PubMed

Bober, Sara L; Ciriello, John; Jones, Douglas L

2018-06-01

Obstructive sleep apnea, which involves chronic intermittent hypoxia (CIH), is a major risk factor for developing atrial fibrillation (AF). Whether or not CIH alone alters cardiac mechanisms to support AF is unknown. This study investigated the effects of CIH on atrial electrophysiology and arrhythmia vulnerability and evaluated the role of autonomics in CIH promotion of AF. Adult male Sprague-Dawley rats were exposed to 8 h/day of CIH or normoxia for 7 days. After exposure, rats were anesthetized for intracardiac electrophysiological experiments. Atrial effective refractory periods (AERPs) and AF inducibility were determined using programmed electrical stimulation and burst pacing in the absence and presence of autonomic receptor agonists and antagonists. Western blot analysis measured atrial protein expression of muscarinic M2, M3, and β 1 -adrenergic receptors. Compared with normoxia-exposed control rats, CIH-exposed rats had enhanced AF vulnerability using both programmed electrical stimulation and burst pacing, accompanied by greater AERP responses to carbachol and propranolol, lesser responses to isoproterenol, and higher atrial M2 receptor protein levels. Enhanced atrial vulnerability was accentuated by carbachol and abolished by atropine, indicating that the AF-promoting effects of CIH depended principally on parasympathetic activation. Enhancement of atrial vulnerability and AERP shortening with cholinergic agonists in CIH-exposed rats is consistent with sensitivity to parasympathetic activation. Higher responses to adrenergic receptor blockade in CIH-exposed rats is consistent with sympathetic potentiation. These findings implicate CIH as an important mediator of enhanced AF susceptibility in obstructive sleep apnea and provide novel insights into the underlying mechanisms. NEW & NOTEWORTHY Our study demonstrates, for the first time, that chronic intermittent hypoxia alone enhances vulnerability to atrial arrhythmia induction, which depends principally on parasympathetic activation. Enhanced atrial vulnerability was accompanied by heightened electrophysiological responses of the atrial myocardium to carbachol and isoproterenol, dampened responses to propranolol, and increased atrial M2 receptor protein levels.

A multi-interface adaptive hypermedia system to promote consumer-provider partnership in chronic disease management.

PubMed

Lundström, Maria; Warren, Jim; Jones, Sara; Chung, Frank

2003-01-01

Much of chronic disease management depends on active partnership of consumer and provider. Our system promotes diabetes management through profiling and adaptive support of both consumer and provider. We use a University Podiatry Clinic and diabetes consumer information portal as inter-related contexts that share profile information.

Protective Connections and Educational Attainment among Young Adults with Childhood-Onset Chronic Illness

ERIC Educational Resources Information Center

Maslow, Gary; Haydon, Abigail A.; McRee, Annie-Laurie; Halpern, Carolyn T.

2012-01-01

Background: Youth with childhood-onset chronic illness (COCI) are at risk of poor educational attainment. Specific protective factors that promote college graduation in this population have not been studied previously. In this study, we examine the role protective factors during adolescence play in promoting college graduation among young adults…

Social psychogenic stress promotes the development of endometriosis in mouse.

PubMed

Guo, Sun-Wei; Zhang, Qi; Liu, Xishi

2017-03-01

Exposure to chronic stress before and well after the induction of endometriosis is reported to increase lesion sizes in rats, but it is unclear whether stress, exposed shortly after the induction of endometriosis, would also promote the development of endometriosis, nor is it clear what the underlying possible molecular mechanism is. This study was undertaken to test the hypothesis that chronic stress can promote the development of endometriosis. A prospective randomized mouse experiment was conducted that subjected mice with induced endometriosis to predator stress. In addition, a cross-sectional immunohistochemistry study was performed in ectopic and eutopic endometrial tissue samples from age- and roughly menstrual phase-matched women with ovarian endometriomas. It was found that the chronic psychogenic stress induced epigenetic changes in the hippocampus in mouse independent of endometriosis. It was also found that chronic psychogenic stress induced epigenetic changes in the hippocampus of mice with endometriosis, and seemingly activated the adrenergic signalling in ectopic endometrium, resulting in increased angiogenesis and accelerated growth of endometriotic lesions. Thus, chronic psychogenic stress promotes endometriosis development, raising the possibility that the use of anti-depressants in cases of prolonged and intense stress might forestall the negative impact of stress on the development of endometriosis. Copyright © 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Platelet-Derived Growth Factor Promotes Repair of Chronically Demyelinated White Matter

PubMed Central

Vana, Adam C.; Flint, Nicole C.; Harwood, Norah E.; Le, Tuan Q.; Fruttiger, Marcus; Armstrong, Regina C.

2009-01-01

In multiple sclerosis, remyelination becomes limited after repeated or prolonged episodes of demyelination. To test the effect of platelet-derived growth factor-A (PDGF-A) in recovery from chronic demyelination we induced corpus callosum demyelination using cuprizone treatment in hPDGF-A transgenic (tg) mice with the human PDGF-A gene under control of an astrocyte-specific promoter. After chronic demyelination and removal of cuprizone from the diet, remyelination and oligodendrocyte density improved significantly in hPDGF-A tg mice compared with wild-type mice. In hPDGF-A tg mice, oligodendrocyte progenitor density and proliferation values were increased in the corpus callosum during acute demyelination but not during chronic demyelination or the subsequent recovery period, compared with hPDGF-A tg mice without cuprizone or to treatment-matched wild-type mice. Proliferation within the subventricular zone and subcallosal zone was elevated throughout cuprizone treatment but was not different between hPDGF-A tg and wild-type mice. Importantly, hPDGF-A tg mice had reduced apoptosis in the corpus callosum during the recovery period after chronic demyelination. Therefore, PDGF-A may support oligodendrocyte generation and survival to promote remyelination of chronic lesions. Furthermore, preventing oligodendrocyte apoptosis may be important not only during active demyelination but also for supporting the generation of new oligodendrocytes to remyelinate chronic lesions. PMID:17984680

The USC Adult Twin Cohorts: International Twin Study and California Twin Program.

PubMed

Cozen, Wendy; Hwang, Amie E; Cockburn, Myles G; Hamilton, Ann S; Zadnick, John; Mack, Thomas M

2013-02-01

The study of twin subjects permits the documentation of crude heritability and may promote the identification of specific causal alleles. We believe that at the current time, the chief research advantage of twins as subjects, especially monozygotic twins, is that the commonality of their genetic and cultural identity simplifies the interpretation of biological associations. In order to study genetic and environmental determinants of cancer and chronic diseases, we developed two twin registries, maintained at the University of Southern California: The International Twin Study (ITS) and the California Twin Program (CTP). The ITS is a volunteer registry of twins with cancer and chronic disease consisting of 17,245 twin pairs affected by cancer and chronic disease, respectively, ascertained by advertising in periodicals from 1980-1991. The CTP is a population-based registry of California-born twin pairs ascertained by linking the California birth records to the State Department of Motor Vehicles. Over 51,000 individual California twins representing 36,965 pairs completed and returned 16-page questionnaires. Cancer diagnoses in the California twins are updated by regular linkage to the California Cancer Registry. Over 5,000 cancer patients are represented in the CTP. Twins from both registries have participated extensively in studies of breast cancer, melanoma, lymphoma, multiple sclerosis, systemic lupus erythematosus, diabetes mellitus type 1, mammographic density, smoking, and other traits and conditions.

Telehealth methods to deliver multifactorial dietary interventions in adults with chronic disease: a systematic review protocol.

PubMed

Kelly, Jaimon T; Reidlinger, Dianne P; Hoffmann, Tammy C; Campbell, Katrina L

2015-12-22

The long-term management of chronic diseases requires adoption of complex dietary recommendations, which can be facilitated by regular coaching to support sustained behaviour change. Telehealth interventions can overcome patient-centred barriers to accessing face-to-face programs and provide feasible delivery methods, ubiquitous and accessible regardless of geographic location. The protocol for this systematic review explains the methods that will be utilised to answer the review question of whether telehealth interventions are effective at promoting change in dietary intake and improving diet quality in people with chronic disease. A structured search of Medline, EMBASE, CINAHL, and PsychINFO, from their inception, will be conducted. We will consider randomised controlled trials which evaluate complex dietary interventions in adults with chronic disease. Studies must provide diet education in an intervention longer than 4 weeks in duration, and at least half of the intervention contact must be delivered via telehealth. Comparisons will be made against usual care or a non-telehealth intervention. The primary outcome of interest is dietary change with secondary outcomes relating to clinical markers pre-specified in the methodology. The process for selecting studies, extracting data, and resolving conflicts will follow a set protocol. Two authors will independently appraise the studies and extract the data, using specified methods. Meta-analyses will be conducted where appropriate, with parameters for determining statistical heterogeneity pre-specified. The GRADE tool will be used for determining the quality of evidence for analysed outcomes. To date, there has been a considerable variability in the strategies used to deliver dietary education, and the overall effectiveness of telehealth dietary interventions for facilitating dietary change has not been reviewed systematically in adults with chronic disease. A systematic synthesis of telehealth strategies will inform the development of evidence-based telehealth programs that can be tailored to deliver dietary interventions specific to chronic disease conditions. PROSPERO CRD42015026398.

[Cardiovascular disease prevention and health promotion in the French speaking community of Belgium].

PubMed

Coppieters, Y; Béduwé, C; Collignon, J L; Hubens, V; Levêque, A

2010-01-01

Cardiovascular diseases remain the first cause of mortality in Belgium and are a priority for the Five-year program of health promotion in the French speaking Community. It is declined in operational programs by priority thematics, including the heart health. With this framework, it appeared necessary to operationalize cardiovascular priorities. A process of systemic and participative planning was set up in order to seek operational strategies and actions, and to cover the whole population and actors concerned with these health problems. The various cardiovascular risk factors, which potentiate one another, are approached together and in a global way. Upstream to the risk factors, social health determinants play an important role in cardiovascular diseases and others diseases like cancers. Tracking cardiovascular risk factors among people 30 to 75 years is also proposed. It makes it possible to identify people at risk and to put forward individual and adapted measures. The plan integrates actions of health promotion (acting on the health determinants and factors which influence them) as well as actions aiming at improving tracking and the accompaniment of the patients in secondary and tertiary prevention. Actions on health determinants and the factors influencing them present moreover the advantage of being often common to many chronic diseases.

The role of indigenous health workers in promoting oral health during pregnancy: a scoping review.

PubMed

Villarosa, Ariana C; Villarosa, Amy R; Salamonson, Yenna; Ramjan, Lucie M; Sousa, Mariana S; Srinivas, Ravi; Jones, Nathan; George, Ajesh

2018-03-20

Early childhood caries is the most common chronic childhood disease worldwide. Australian Aboriginal and Torres Strait Islander children are twice more likely to develop dental decay, and contributing factors include poor maternal oral health and underutilisation of dental services. Globally, Indigenous health workers are in a unique position to deliver culturally competent oral healthcare because they have a contextual understanding of the needs of the community. This scoping review aimed to identify the role of Indigenous health workers in promoting maternal oral health globally. A systematic search was undertaken of six electronic databases for relevant published literature and grey literature, and expanded to include non-dental health professionals and other Indigenous populations across the lifespan when limited studies were identified. Twenty-two papers met the inclusion criteria, focussing on the role of Indigenous health workers in maternal oral healthcare, types of oral health training programs and screening tools to evaluate program effectiveness. There was a paucity of peer-reviewed evidence on the role of Indigenous health workers in promoting maternal oral health, with most studies focusing on other non-dental health professionals. Nevertheless, there were reports of Indigenous health workers supporting oral health in early childhood. Although some oral health screening tools and training programs were identified for non-dental health professionals during the antenatal period, no specific screening tool has been developed for use by Indigenous health workers. While the role of health workers from Indigenous communities in promoting maternal oral health is yet to be clearly defined, they have the potential to play a crucial role in 'driving' screening and education of maternal oral health especially when there is adequate organisational support, warranting further research.

Development and implementation of Baltimore Healthy Eating Zones: a youth-targeted intervention to improve the urban food environment.

PubMed

Gittelsohn, Joel; Dennisuk, Lauren A; Christiansen, Karina; Bhimani, Roshni; Johnson, Antoinette; Alexander, Eleanore; Lee, Matthew; Lee, Seung Hee; Rowan, Megan; Coutinho, Anastasia J

2013-08-01

Poor accessibility to affordable healthy foods is associated with higher rates of obesity and diet-related chronic diseases. We present our process evaluation of a youth-targeted environmental intervention (Baltimore Healthy Eating Zones) that aimed to increase the availability of healthy foods and promote these foods through signage, taste tests and other interactive activities in low-income Baltimore City. Trained peer educators reinforced program messages. Dose, fidelity and reach-as measured by food stocking, posting of print materials, distribution of giveaways and number of interactions with community members-were collected in six recreation centers and 21 nearby corner stores and carryouts. Participating stores stocked promoted foods and promotional print materials with moderate fidelity. Interactive sessions were implemented with high reach and dose among both adults and youth aged 10-14 years, with more than 4000 interactions. Recreation centers appear to be a promising location to interact with low-income youth and reinforce exposure to messages.

Exploring the process of capacity-building among community-based health promotion workers in Alberta, Canada.

PubMed

Montemurro, Genevieve R; Raine, Kim D; Nykiforuk, Candace I J; Mayan, Maria

2014-09-01

Community capacity-building is a central element to health promotion. While capacity-building features, domains and relationships to program sustainability have been well examined, information on the process of capacity-building as experienced by practitioners is needed. This study examined this process as experienced by coordinators working within a community-based chronic disease prevention project implemented in four communities in Alberta (Canada) from 2005-2010 using a case study approach with a mixed-method design. Data collection involved semi-structured interviews, a focus group and program documents tracking coordinator activity. Qualitative analysis followed the constant comparative method using open, axial and selective coding. Quantitative data were analyzed for frequency of major activity distribution. Capacity-building process involves distinct stages of networking, information exchange, partnering, prioritizing, planning/implementing and supporting/ sustaining. Stages are incremental though not always linear. Contextual factors exert a great influence on the process. Implications for research, practice and policy are discussed. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A Multi-interface Adaptive Hypermedia System to Promote Consumer-Provider Partnership in Chronic Disease Management

PubMed Central

Lundström, Maria; Warren, Jim; Jones, Sara; Chung, Frank

2003-01-01

Much of chronic disease management depends on active partnership of consumer and provider. Our system promotes diabetes management through profiling and adaptive support of both consumer and provider. We use a University Podiatry Clinic and diabetes consumer information portal as inter-related contexts that share profile information. PMID:14728425

Functional significance of SPINK1 promoter variants in chronic pancreatitis.

PubMed

Derikx, Monique H M; Geisz, Andrea; Kereszturi, Éva; Sahin-Tóth, Miklós

2015-05-01

Chronic pancreatitis is a progressive inflammatory disorder of the pancreas, which often develops as a result of genetic predisposition. Some of the most frequently identified risk factors affect the serine protease inhibitor Kazal type 1 (SPINK1) gene, which encodes a trypsin inhibitor responsible for protecting the pancreas from premature trypsinogen activation. Recent genetic and functional studies indicated that promoter variants in the SPINK1 gene might contribute to disease risk in carriers. Here, we investigated the functional effects of 17 SPINK1 promoter variants using luciferase reporter gene expression assay in four different cell lines, including three pancreatic acinar cell lines (rat AR42J with or without dexamethasone-induced differentiation and mouse 266-6) and human embryonic kidney 293T cells. We found that most variants caused relatively small changes in promoter activity. Surprisingly, however, we observed significant variations in the effects of the promoter variants in the different cell lines. Only four variants exhibited consistently reduced promoter activity in all acinar cell lines, confirming previous reports that variants c.-108G>T, c.-142T>C, and c.-147A>G are risk factors for chronic pancreatitis and identifying c.-52G>T as a novel risk variant. In contrast, variant c.-215G>A, which is linked with the disease-associated splice-site mutation c.194 + 2T>C, caused increased promoter activity, which may mitigate the overall effect of the pathogenic haplotype. Our study lends further support to the notion that sequence evaluation of the SPINK1 promoter region in patients with chronic pancreatitis is justified as part of the etiological investigation. Copyright © 2015 the American Physiological Society.

Costs of implementing and maintaining comprehensive school health: the case of the Annapolis Valley Health Promoting Schools program.

PubMed

Ohinmaa, Arto; Langille, Jessie-Lee; Jamieson, Stuart; Whitby, Caroline; Veugelers, Paul J

2011-01-01

Comprehensive school health (CSH) is increasingly receiving renewed interest as a strategy to improve health and learning. The present study estimates the costs associated with implementing and maintaining CSH. We reviewed the accounting information of all schools in the Annapolis Valley Health Promoting Schools (AVHPS) program in 2008/2009. We considered support for nutrition and physical activity programs by the public system, grants, donations, fundraising and volunteers. The annual public funding to AVHPS to implement and maintain CSH totaled $344,514, which translates, on average, to $7,830 per school and $22.67 per student. Of the public funding, $140,500 was for CSH, $86,250 for breakfast programs, $28,750 for school food policy programs, and the remainder for other subsidized programs. Grants, donations and fundraising were mostly locally acquired. They totaled $127,235, which translates, on average, to $2,892 per school or $8.37 per student. The value of volunteer support was estimated to be equivalent to the value of grants, donations and fundraising combined. Of all grants, donations, fundraising and volunteers, 20% was directed to physical activity programs and 80% to nutrition programs. The public costs to implement and maintain CSH are modest. They leveraged substantial local funding and in-kind contributions, underlining community support for healthy eating and active living. Where CSH is effective in preventing childhood overweight, it is most likely cost-effective too, as costs for future chronic diseases are mounting. CSH programs that are proven effective and cost-effective have enormous potential for broad implementation and for reducing the public health burden associated with obesity.

Selling health lifestyles: using social marketing to promote change and prevent disease.

PubMed

Langill, Donna

2004-11-01

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) brought together grantmakers, researchers, and public health professionals on May 20, 2004 to discuss the application of social marketing principles to health promotion and chronic disease prevention. As a behavior change technique, social marketing has proven effective in motivating people to make the complex and difficult behavior changes that can improve health and reduce the risk of chronic diseases such as cardiovascular disease, cancer, and diabetes. The Issue Dialogue used the lens of tobacco prevention and cessation, physical activity, and healthy eating to examine how health grantmakers can use social marketing principles and techniques to encourage and support the adoption of healthier behaviors across the lifespan. This Issue Brief incorporates the information and ideas shared at the meeting with a background paper on social marketing that was prepared for participants who attended the Issue Dialogue. It starts with an introduction of social marketing concepts and provides a framework for assessing whether social marketing is an appropriate approach to use in addressing a particular issue. Subsequent sections: (1) describe both the social marketing communications process and techniques, using examples from campaigns developed by health grantmakers and others; (2) describe how social marketing can be used to promote policy change; (3) provide information on communication strategies that can complement social marketing; and (4) present opportunities for grantmakers.

Microglia activation due to obesity programs metabolic failure leading to type two diabetes

PubMed Central

Maldonado-Ruiz, R; Montalvo-Martínez, L; Fuentes-Mera, L; Camacho, A

2017-01-01

Obesity is an energy metabolism disorder that increases susceptibility to the development of metabolic diseases. Recently, it has been described that obese subjects have a phenotype of chronic inflammation in organs that are metabolically relevant for glucose homeostasis and energy. Altered expression of immune system molecules such as interleukins IL-1, IL-6, IL-18, tumor necrosis factor alpha (TNF-α), serum amyloid A (SAA), and plasminogen activator inhibitor-1 (PAI-1), among others, has been associated with the development of chronic inflammation in obesity. Chronic inflammation modulates the development of metabolic-related comorbidities like metabolic syndrome (insulin resistance, glucose tolerance, hypertension and hyperlipidemia). Recent evidence suggests that microglia activation in the central nervous system (CNS) is a priority in the deregulation of energy homeostasis and promotes increased glucose levels. This review will cover the most significant advances that explore the molecular signals during microglia activation and inflammatory stage in the brain in the context of obesity, and its influence on the development of metabolic syndrome and type two diabetes. PMID:28319103

A national survey of organizational transfer practices in chronic disease prevention in Canada.

PubMed

Hanusaik, Nancy; O'Loughlin, Jennifer L; Paradis, Gilles; Kishchuk, Natalie

2011-08-01

Underuse of best practices in chronic disease prevention (CDP) represents missed opportunities to promote healthy living and prevent chronic disease. Better understanding of how CDP programs, practices and policies (PPPs) are transferred from 'resource' organizations that develop them to 'user' organizations that implement them is crucial. The objectives of this work were to develop psychometrically sound measures of transfer practices occurring within resource organizations; describe the use of these transfer practices and identify correlates of the transfer process. Cross-sectional data were collected in structured telephone interviews with the person most knowledgeable about PPP transfer in 77 Canadian organizations that develop PPPs. Independent correlates of transfer were identified using multiple linear regression. The transfer practices most commonly used included: identification of barriers to PPP adoption/implementation, tailoring transfer strategies and designing a transfer plan. Skill at planning/implementing transfer, external sources of funding specifically allocated for transfer, type of resource organization, attitude toward process of collaboration and user-centeredness were all positively associated with the transfer process. These factors represent possible targets for interventions to improve transfer of CDP PPPs.

PD-1 immune checkpoint blockade promotes brain leukocyte infiltration and diminishes cyst burden in a mouse model of Toxoplasma infection.

PubMed

Xiao, Jianchun; Li, Ye; Yolken, Robert H; Viscidi, Raphael P

2018-06-15

Tissue cysts, the hallmark of chronic Toxoplasma gondii infection, are predominantly located in the brain making clearance of the parasite difficult. Currently available anti-T. gondii drugs are ineffective on cysts and fail to prevent reactivation of latent toxoplasmosis. We examined whether abrogation of inhibitory signaling pathways that maintain T cells in an exhausted state can be exploited for treating T. gondii tissue cysts. By using a mouse model of chronic toxoplasmosis, we showed immune checkpoint blockade directed against the programmed death-1 (PD-1) pathway results in a significant reduction in brain cyst number (77% lower). We showed leukocyte infiltration (CD3+ T cells, CD8+ T cells, and CD11b + cells) in the leptomeninges, choroid plexus, and subependymal tissue, which are known routes of entry of immune cells into the brain, and in proximal brain parenchyma. Our study provides proof of concept for blockade of immune checkpoint inhibitors as a therapy for chronic toxoplasmosis and potentially for other brain pathogens. Copyright © 2018 Elsevier B.V. All rights reserved.

Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory - use of the Chronic Care Model.

PubMed

Si, Damin; Bailie, Ross; Cunningham, Joan; Robinson, Gary; Dowden, Michelle; Stewart, Allison; Connors, Christine; Weeramanthri, Tarun

2008-05-28

Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from chronic illness such as diabetes, renal disease and cardiovascular disease. Improving the understanding of how Indigenous primary care systems are organised to deliver chronic illness care will inform efforts to improve the quality of care for Indigenous people. This cross-sectional study was conducted in 12 Indigenous communities in Australia's Northern Territory. Using the Chronic Care Model as a framework, we carried out a mail-out survey to collect information on material, financial and human resources relating to chronic illness care in participating health centres. Follow up face-to-face interviews with health centre staff were conducted to identify successes and difficulties in the systems in relation to providing chronic illness care to community members. Participating health centres had distinct areas of strength and weakness in each component of systems: 1) organisational influence - strengthened by inclusion of chronic illness goals in business plans, appointment of designated chronic disease coordinators and introduction of external clinical audits, but weakened by lack of training in disease prevention and health promotion and limited access to Medicare funding; 2) community linkages - facilitated by working together with community organisations (e.g. local stores) and running community-based programs (e.g. "health week"), but detracted by a shortage of staff especially of Aboriginal health workers working in the community; 3) self management - promoted through patient education and goal setting with clients, but impeded by limited focus on family and community-based activities due to understaffing; 4) decision support - facilitated by distribution of clinical guidelines and their integration with daily care, but limited by inadequate access to and support from specialists; 5) delivery system design - strengthened by provision of transport for clients to health centres, separate men's and women's clinic rooms, specific roles of primary care team members in relation to chronic illness care, effective teamwork, and functional pathology and pharmacy systems, but weakened by staff shortage (particularly doctors and Aboriginal health workers) and high staff turnover; and 6) clinical information systems - facilitated by wide adoption of computerised information systems, but weakened by the systems' complexity and lack of IT maintenance and upgrade support. Using concrete examples, this study translates the concept of the Chronic Care Model (and associated systems view) into practical application in Australian Indigenous primary care settings. This approach proved to be useful in understanding the quality of primary care systems for prevention and management of chronic illness. Further refinement of the systems should focus on both increasing human and financial resources and improving management practice.

Reducing chronic obstructive pulmonary disease readmissions: the role of the durable medical equipment provider.

PubMed

Messenger, Robert W

2012-01-01

Exacerbation and frequent rehospitalization in chronic obstructive pulmonary disease exacts a heavy toll on the US health care system. To address these issues, new initiatives have been proposed that are largely based on financial penalties to promote patient education and postdischarge care. However, as laudable as these goals are, improving outcomes in the chronic obstructive pulmonary disease population is more confounding than it may first appear. Chronic hypoxia, cognitive dysfunction, poor nutrition, and economic disadvantage are just a few of the challenges that require creative solutions and ongoing support. Case managers need to utilize all the potential products and services that can assist in improving outcomes for these patients. Durable medical equipment providers are often viewed as purveyors of medical equipment that offer little in the form of clinical support. However, in many cases these providers represent an overlooked resource that provides individualized, highly structured patient education and ongoing support programs. The challenge is in identifying those durable medical equipment providers that offer patients contemporary technology, and have both the resources and the commitment to provide patient support that is amenable to the goals of the hospital. This article reviews many of the confounding issues that contribute to the frequent rehospitalization of chronic obstructive pulmonary disease patients. Recommendations to improve patient education and oxygen therapy outcomes are provided along with suggestions to aid in the vetting of durable medical equipment providers. Acute care hospitals, long-term acute care hospitals, extended care facilities, integrated delivery systems. 1. An understanding of the complex variables that play in the management of chronic obstructive pulmonary disease will help the case manager to plan an effective course of care. 2. Case managers need to ensure that patients receive long-term oxygen technology that supports their lifestyle, promotes compliance, and ultimately achieves the desired outcomes. 3. Case managers must advocate for coordinated, ongoing patient education and stress the need for continuing reinforcement. 4. Case managers must ensure that patients under their care be matched with durable medical equipment providers that provide the technology and support that favors positive clinical outcomes.

Building Resiliency in a Palliative Care Team: A Pilot Study.

PubMed

Mehta, Darshan H; Perez, Giselle K; Traeger, Lara; Park, Elyse R; Goldman, Roberta E; Haime, Vivian; Chittenden, Eva H; Denninger, John W; Jackson, Vicki A

2016-03-01

Palliative care clinicians (PCCs) are vulnerable to burnout as a result of chronic stress related to working with seriously ill patients. Burnout can lead to absenteeism, ineffective communication, medical errors, and job turnover. Interventions that promote better coping with stress are needed in this population. This pilot study tested the feasibility of the Relaxation Response Resiliency Program for Palliative Care Clinicians, a program targeted to decrease stress and increase resiliency, in a multidisciplinary cohort of PCCs (N = 16) at a major academic medical center. A physician delivered the intervention over two months in five sessions (12 hours total). Data were collected the week before the program start and two months after completion. The main outcome was feasibility of the program. Changes in perceived stress, positive and negative affect, perspective taking, optimism, satisfaction with life, and self-efficacy were examined using nonparametric statistical tests. Effect size was quantified using Cohen's d. The intervention was feasible; all participants attended at least four of the five sessions, and there was no attrition. After the intervention, participants showed reductions in perceived stress and improvements in perspective taking. Our findings suggest that a novel team-based resiliency intervention based on elicitation of the relaxation response was feasible and may help promote resiliency and protect against the negative consequences of stress for PCCs. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Promoting health in response to global tourism expansion in Cuba.

PubMed

Spiegel, J M; Gonzalez, M; Cabrera, G J; Catasus, S; Vidal, C; Yassi, A

2008-03-01

The ability of communities to respond to the pressures of globalization is an important determinant of community health. Tourism is a rapidly growing industry and there is an increasing concern about its health impact on local communities. Nonetheless, little research has been conducted to identify potential mitigating measures. We therefore took advantage of the 'natural experiment' provided by the expansion of tourism in Cuba, and conducted four focus groups and key informants interviews in each of two coastal communities. Participants expressed concerns about psycho-social impacts as well as occupational and environmental concerns, and both infectious and chronic diseases. A wide array of programs that had been developed to mitigate potential negative were described. Some of the programs were national in scope and others were locally developed. The programs particularly targeted youth as the most vulnerable population at risk of addictions and sexually transmitted infections. Occupational health concerns for workers in the tourism sector were also addressed, with many of the measures implemented protecting tourists as well. The health promotion and various other participatory action initiatives implemented showed a strong commitment to address the impacts of tourism and also contributed to building capacity in the two communities. Although longitudinal studies are needed to assess the sustainability of these programs and to evaluate their long-term impact in protecting health, other communities can learn from the initiatives taken.

The Decisional Balance Sheet to Promote Healthy Behavior Among Ethnically Diverse Older Adults

PubMed Central

Geller, Karly S.; Mendoza, Ilora D.; Timbobolan, Jasah; Montjoy, Holly L.; Nigg, Claudio R.

2012-01-01

Objective The rising health care costs and increasing older adult population in the United States make preventive medicine for this age group especially crucial. Regular physical activity and fruit and vegetable consumption may prevent or delay the onset of many chronic conditions that are common among older adults. The decisional balance sheet is a promotional tool targeting the perceived pros and cons of behavior adoption. The current study tested the efficiency and effectiveness of a single-day decisional balance sheet program, targeting increased physical activity and fruit and vegetable intake among older adults. Design and Sample Participating adults (N = 21, age = 72.2) who represented a diverse population in Hawaii (Japanese = 5, Filipino = 4, Caucasian = 4, Native American = 1, Native Hawaiian = 1, Hispanic = 1, and Others = 5) were recruited from housing communities and randomized to a decisional balance sheet program adapted for physical activity or fruit and vegetable consumption. Measures Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) short form, and daily fruit and vegetable intake with the National Health and Nutrition Examination Survey single item instrument. Baseline and follow-up data were collected. Results Both programs were implemented efficiently, and participants in both groups improved their daily physical activity. The decisional balance sheet for fruit and vegetable consumption appeared less effective. Conclusions Specific suggestions for similar programs are reported. PMID:22512425

Interactive Games for Home Delivery of Exercise and Rehabilitation Interventions for Older Adults: An Australian Perspective.

PubMed

Smith, Stuart Trevor; Bird, Marie-Louise

2016-01-01

Over the past few decades there has been a wealth of published scientific evidence for the physical, cognitive and social health-related benefits of increased physical activity, especially in older adults and people living with chronic disease. Despite the clear evidence base demonstrating the health-related benefits of physical activity, uptake and adherence is often disappointing. Therefore, methods for remote delivery of guided exercise programs are required, both to maximise the reach of physical activity promotion initiatives and programs across the older community and to minimise attrition once people begin to be physically active. One method by which we can increase understanding of the importance of, and compliance with, exercise programs involves the use of fun and engaging videogames. In the following we outline two ways in which we are using games technology in an Australian context.

A beta1-adrenergic receptor CaM kinase II-dependent pathway mediates cardiac myocyte fetal gene induction.

PubMed

Sucharov, Carmen C; Mariner, Peter D; Nunley, Karin R; Long, Carlin; Leinwand, Leslie; Bristow, Michael R

2006-09-01

Beta-adrenergic signaling plays an important role in the natural history of dilated cardiomyopathies. Chronic activation of beta-adrenergic receptors (beta1-AR and beta2-AR) during periods of cardiac stress ultimately harms the failing heart by mechanisms that include alterations in gene expression. Here, we show that stimulation of beta-ARs with isoproterenol in neonate rat ventricular myocytes causes a "fetal" response in the relative activities of the human cardiac fetal and/or adult gene promoters that includes repression of the human and rat alpha-myosin heavy chain (alpha-MyHC) promoters with simultaneous activation of the human atrial natriuretic peptide (ANP) and rat beta-MyHC promoters. We also show that the promoter changes correlate with changes in endogenous gene expression as measured by mRNA expression. Furthermore, we show that these changes are specifically mediated by the beta1-AR, but not the beta2-AR, and are independent of alpha1-AR stimulation. We also demonstrate that the fetal gene response is independent of cAMP and protein kinase A, whereas inhibition of Ca2+/calmodulin-dependent protein kinase (CaMK) pathway blocks isoproterenol-mediated fetal gene program induction. Finally, we show that induction of the fetal program is dependent on activation of the L-type Ca2+ channel. We conclude that in neonatal rat cardiac myocytes, agonist-occupied beta1-AR mobilizes Ca2+ stores to activate fetal gene induction through cAMP independent pathways that involve CaMK.

Patient engagement and patient-centred care in the management of advanced chronic kidney disease and chronic kidney failure.

PubMed

Bear, Robert Allan; Stockie, Suzanne

2014-01-01

The purpose of this article is to review the current status of patient-centred care (PCC) and patient engagement (PE) in the management of patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD), to identify some of the barriers that exist to the achievement of PCC and PE, and to describe how these barriers can be overcome. The review is based on the professional experience of one of the authors (RB) as a Nephrologist and health care consultant, on the MBA thesis of one of the authors (SS) and on a review of pertinent internet-based information and published literature. Evidence exists that, currently, the care of patients with advanced CKD and ESRD is not fully patient-centred or fully supportive of PE. A number of barriers exist, including: conflict with other priorities; lack of training and fear of change; the unequal balance of power between patients and providers; physician culture and behaviour; the fee-for-service model of physician compensation; slow implementation of electronic health records; and, fear of accountability. These barriers can be overcome by committed leadership and the development of an information-based implementation plan. Established Renal Agencies in Canada appear interested in facilitating this work by collaborating in the development of a toolkit of recommended educational resources and preferred implementation practices for use by ESRD Programs. A limitation of this review is the absence of a substantial pre-existing literature on this topic. Receiving care that is patient-centred and that promotes PE benefits patients with serious chronic diseases such as advanced CKD and ESRD. Considerable work is required by ESRD Programs to ensure that such care is provided. Canadian Renal Agencies can play an important role by ensuring that ESRD Programs have access to essential educational material and proven implementation approaches and that implementation successes are celebrated. In this area, enabling policies are required, as are clinical research studies focusing on the measurement of outcomes.

PPARγ-mediated increase in glucose availability sustains chronic Brucella abortus infection in alternatively activated macrophages

PubMed Central

Xavier, Mariana N.; Winter, Maria G.; Spees, Alanna M.; den Hartigh, Andreas B.; Nguyen, Kim; Roux, Christelle M.; Silva, Teane M. A.; Atluri, Vidya L.; Kerrinnes, Tobias; Keestra, A. Marijke; Monack, Denise M.; Luciw, Paul A.; Eigenheer, Richard A.; Bäumler, Andreas J.; Santos, Renato L.; Tsolis, Renée M.

2013-01-01

SUMMARY Eradication of persistent intracellular bacterial pathogens with antibiotic therapy is often slow or incomplete. However, strategies to augment antibiotics are hampered by our poor understanding of the nutritional environment that sustains chronic infection. Here we show that the intracellular pathogen Brucella abortus survives and replicates preferentially in alternatively activated macrophages (AAM), which are more abundant during chronic infection. A metabolic shift induced by peroxisome proliferator activated receptor γ (PPARγ), which increases intracellular glucose availability, is identified as a causal mechanism promoting enhanced bacterial survival in AAM. Glucose uptake was crucial for increased replication of B. abortus in AAM, and chronic infection, as inactivation of the bacterial glucose transporter gluP reduced both intracellular survival in AAM and persistence in mice. Thus, a shift in intracellular nutrient availability induced by PPARγ promotes chronic persistence of B. abortus within AAM and targeting this pathway may aid in eradicating chronic infection. PMID:23954155

Quantitative Evaluation of MMP-9 and TIMP-1 Promoter Methylation in Chronic Periodontitis.

PubMed

Li, Xiting; Lu, Jiaxuan; Teng, Wei; Zhao, Chuanjiang; Ye, Xiaolei

2018-03-01

In this study, we investigated the promoter DNA methylation (DNAm) status of the MMP-9 and TIMP-1 genes in patients with chronic periodontitis to evaluate disease progression. Using pyrosequencing technology, DNAm levels of MMP-9 and TIMP-1 CpG islands were measured in 88 chronic periodontitis patients and 15 healthy controls. We found a positive correlation between methylation levels of MMP-9 CpG islands and the severity of chronic periodontitis. Methylated CpG islands were also closely associated with the duration of chronic periodontitis. Moreover, female patients exhibited lower methylation levels of MMP-9 but higher methylation levels of TIMP-1 compared with male patients, and the methylation levels of TIMP-1 gradually decreased with age. The findings of gender disparity in the DNAm of MMP-9 and TIMP-1 genes provide novel insights into chronic periodontitis.

[The Utilization of Health-Related Applications in Chronic Disease Self-Management].

PubMed

Kao, Chi-Wen; Chuang, Hui-Wan; Chen, Ting-Yu

2017-08-01

The dramatic increase in smartphone usage has spurred the development of many health-related mobile applications (apps). On the other hand, population aging and the associated rise in the incidence of chronic disease is increasing the demand for long-term care. Effective chronic disease self-management has been shown to help patients improve their health condition. Numerous smartphone applications currently support patient self-management of chronic disease, facilitating health management and health promotion. The purpose of the present article was to introduce the definition, contents, and types of health-related apps; to discuss the effectiveness of self-management health-related apps in promoting chronic disease management; and to assess and evaluate these apps. We hope that the present article helps give to healthcare professionals and patients who are willing to manage their diseases a general understanding of health-related apps and their potential to facilitate the self-management of chronic diseases.

The relationship between perceived promotion of autonomy/dependence and pain-related disability in older adults with chronic pain: the mediating role of self-reported physical functioning.

PubMed

Matos, Marta; Bernardes, Sónia F; Goubert, Liesbet

2016-08-01

Chronic pain is prevalent among older adults and is usually associated with high levels of functional disability. Social support for the promotion of functional autonomy and dependence has been associated with pain-related disability and self-reported physical functioning. Nevertheless, these relationships need further inquiry. Our aims were to investigate: (1) the relationship between perceived promotion of autonomy/dependence and pain-related disability and (2) the extent to which self-reported physical functioning mediated these relationships. 118 older adults (Mage = 81.0) with musculoskeletal chronic pain completed the Portuguese versions of the revised formal social support for Autonomy and Dependence in Pain Inventory, the pain severity and interference scales of the Brief Pain Inventory, and the physical functioning scale of the Medical Outcomes Study-Short-Form 36 v2. Higher levels of perceived promotion of autonomy were associated with lower pain-related disability; this relationship was partially mediated by self-reported physical functioning (B = -.767, p < .001 decreasing to B' = -.485, p < .01). Higher perceived promotion of dependence was associated with higher pain-related disability; this effect was also partially accounted for by self-reported physical functioning (B = .889, p < .01 decreasing to B' = .597, p < .05). These results highlight the importance of perceived promotion of autonomy and dependence for managing older adults' experience of chronic pain.

Venetoclax: Bcl-2 inhibition for the treatment of chronic lymphocytic leukemia.

PubMed

Del Poeta, G; Postorino, M; Pupo, L; Del Principe, M I; Dal Bo, M; Bittolo, T; Buccisano, F; Mariotti, B; Iannella, E; Maurillo, L; Venditti, A; Gattei, V; de Fabritiis, P; Cantonetti, M; Amadori, S

2016-04-01

Venetoclax (ABT-199) is a small-molecule selective oral inhibitor of the antiapoptotic protein Bcl-2 that promotes programmed cell death of chronic lymphocytic leukemia (CLL) cells regulating the release of proapoptotic factors, such as Smac/Diablo, apoptosis-inducing factor (AIF) and cytochrome c. In April 2016, the U.S. Food and Drug Administration (FDA) granted accelerated approval to venetoclax for patients diagnosed with CLL with 17p deletion, as detected by an FDA-approved test, who have received at least one prior therapy. This review will focus on the mechanism of action, preclinical studies and clinical development of venetoclax both as a monotherapy and in combination with other drugs for CLL in the current milieu of therapy dominated by novel tyrosine kinase inhibitors such as ibrutinib and idelalisib. Copyright 2016 Prous Science, S.A.U. or its licensors. All rights reserved.

Overview of Substance Use and Mental Health Among the "Baby Boomers" Generation.

PubMed

Cleary, Michelle; Sayers, Jan; Bramble, Marguerite; Jackson, Debra; Lopez, Violeta

2017-01-01

As the population ages, risk factors commonly shared by chronic degenerative disease can be exacerbated by behaviours and lifestyle choices. There is increasing evidence that those affected by chronic disease (and associated symptoms such as pain), depression and adverse behavioural and lifestyle patterns are at risk of substance misuse. This paper overviews substance use in Baby Boomers, which are defined as people aged between 52-70 years old, and the implications this may have on their mental health and well-being. We provide an overview of the characteristics of the Baby Boomer generation, their health status and what is currently known about their substance use and misuse. A strengthening of older adult mental health outpatient services is recommended to prevent and address substance use among older adults. Further research examining factors that influence substance use among this group could better inform health promotion programs targeting Baby Boomers.

The potential of 1018 ISS adjuvant in hepatitis B vaccines: HEPLISAV™ review.

PubMed

Eng, Nelson F; Bhardwaj, Nitin; Mulligan, Rebecca; Diaz-Mitoma, Francisco

2013-08-01

Hepatitis B (HBV) virus infects the liver, and upon chronic infection, can cause liver cirrhosis and hepatocellular carcinoma. Despite universal vaccination programs against the virus, HBV still affects over 2 billion people worldwide, with over 240 million developing a chronic infection. While current alum-adjuvanted vaccines have shown efficacy in promoting seroprotection in healthy adults, 5-10% of immune-competent populations fail to achieve long-lasting seroprotection from these formulations. Furthermore, a large proportion of immunocompromised patients fail to achieve seroprotective antibody titers after receiving these vaccines. A novel vaccine candidate, HEPLISAV™, uses immunostimulatory sequences (ISS), in its formulation that helps induce a robust humoral and cell mediated immunity against HBV. In Phase III clinical trials, HEPLISAV™ has been shown to elicit seroprotective antibody titers with fewer immunizations. Similar safety profiles are demonstrated when compared with current HBV vaccines. For these reasons, HEPLISAV™ is an attractive vaccine to combat this global disease.

Physical activity: exploring views of older Russian-speaking slavic immigrants.

PubMed

Purath, Janet; Van Son, Catherine; Corbett, Cynthia F

2011-01-01

Many of the 1.3 million Russian-speaking immigrants in the US have chronic conditions such as cardiovascular disease, diabetes, obesity, and depression. They engage in physical activity less often than other groups, and little is known about their views of physical activity. This qualitative study explored physical activity attitudes, beliefs, motivators, and barriers among older Russian-speaking immigrants. In four focus group interviews, 23 participants discussed physical activity. "Movement is life" was a theme throughout all interviews. Walking was the most frequently mentioned activity. Increased energy and decreased pain were described as health benefits. Motivators for physical activity were maintaining function, improved health, and the support of God and family. Barriers included poor health and environmental safety concerns. Participants suggested community walking groups and church-supported programs as useful methods to promote physical activity. Future research includes developing culturally appropriate interventions that utilize physical activity to prevent and manage chronic illness with ethnic minority older adults.

Association of matrix metalloproteinase-7 (-181A/G) promoter polymorphism in chronic pancreatitis.

PubMed

Manjari, K Sri; Jyothy, A; Kumar, P Shravan; Prabhakar, B; Nallari, Pratibha; Venkateshwari, A

2014-11-01

Chronic pancreatitis is progressive and irreversible destruction of the pancreas. Matrix metalloproteinase-7 (MMP-7) is a secreted matrilysin, which contributes to angiogenesis and breakdown of basement membranes of pancreatic tissues. The present study was aimed to investigate the association of MMP-7 -181A/G (rs11568818) gene promoter polymorphism in patients with chronic pancreatitis. A total of 100 chronic pancreatitis patients and 150 unrelated healthy individuals were included in this case control study. The genotyping of the MMP-7 gene (- 181 A/G) (rs11568818) was carried out based on PCR-RFLP. The serum levels of MMP-7 were determined by ELISA. Association between genotypes and chronic pancreatitis was examined by odds ratio (OR) with 95% confidence interval (CI). The frequencies of the genotypes in promoter of MMP-7 were AA 49 per cent, AG 25 per cent and GG 26 per cent in chronic pancreatitis patients and AA 53 per cent, AG 38 per cent and GG 9 per cent in control subjects. Frequency of MMP-7 -181GG genotype and - 181G allele was significantly associated with chronic pancreatitis compared to healthy subjects [OR = 1.58 (95% CI: 1.06 -2.36), p =0.019]. There was no significant difference in the serum MMP-7 levels in the patients compared to control subjects. The present study revealed a significant association of MMP-7 -181A/G (rs11568818) GG genotype with chronic pancreatitis patients, indicating its possible association with the disease.

The present and future of Mexican health promotion.

PubMed

Acosta-Mendez, María; Mariscal-Servitje, Lorenza; Santos-Burgoa, Carlos

2007-01-01

Mexico, with a 92 percent literacy, 62 native languages and 12.7 million indigenous people, has entered a new era of macroeconomic stability. Nevertheless 40 percent of the population live below the poverty line. The burden of disease includes malnutrition, infectious diseases, reproductive health problems, as well as chronic diseases. Addressing the social determinants of health has been a priority. This can be seen in two of the most successful Mexican programs. The National Healthy Communities Program that uses a setting approach to establish a link between socioeconomic development and health levels and the Opportunities Program that has become an international model and which is a comprehensive, poverty alleviation program that uses education, fiscal measures and health education to improve population health. Both have been implemented throughout all the states in an intersectorial manner, since 1997 and 2000 respectively. Health promotion in Mexico has evolved in many positive ways during the past 20 years. Development of healthy environments and community actions are the strongest components. Evidence and evaluation, health services reorientation, and building personal skills and empowerment are the weakest. The paradox between low empowerment and high community action results in a superficial community participation that lacks a real commitment towards health. The newest Mexican health promotion policy is named National Alliance for Health and it aims to involve all members of society. Its value is to be independent of any international recommendation; its weakness is that it lacks a deep analysis of the health issues that it is supposed to solve. Consequently valid evaluations are not feasible, and without real evidence the impact of these kinds of policies will remain unknown.

Design and methods for a cluster-controlled trial conducted at sixty-eight daycare facilities evaluating the impact of "JolinchenKids - Fit and Healthy in Daycare", a program for health promotion in 3- to 6-year-old children.

PubMed

Steenbock, Berit; Zeeb, Hajo; Rach, Stefan; Pohlabeln, Hermann; Pischke, Claudia R

2017-07-11

The prevention of overweight and obesity during infancy is a highly relevant public health topic given the significant impact of childhood obesity on acute and chronic diseases, general health, and well-being in later stages of life. Apart from the family setting, daycare facilities (DFs) represent a key setting for health promotion among children under the age of six years. "JolinchenKids - Fit and Healthy in Daycare" is a multi-component program promoting physical activity (PA), healthy eating, and mental well-being in 3- to 6-year-old preschoolers at DFs, originally designed by the German health insurance AOK. To evaluate program effectiveness, a cluster-controlled trial involving 68 DFs is currently conducted. The objective of this article is to describe the background, study design, and aims of this trial. Sixty-eight DFs across Germany will be recruited to take part in the study, half of them serving as intervention DFs and half of them as delayed intervention control DFs (which receive the program upon completion of the study). At each DF, height, weight, and body composition, as well as motor skills, will be assessed in twenty 3- to 6-year-old children. Children's eating and PA habits, and mental well-being will be assessed via parental questionnaires. A subsample of children (i.e., at 24 DFs which are randomly selected within a geographic region) will be asked to wear accelerometers at their wrists to objectively measure PA over the course of seven days. To compare changes in body composition, motor skills, eating and PA habits, and mental well-being of children at intervention DFs with those observed among children at delayed intervention control DFs over one year, all measurements will take place at baseline and twelve months after the launch of the program at all DFs. This study investigates the influence of a health promotion program in the daycare setting on various outcomes, including body composition and objectively measured PA, in a nationwide sample of 3- to 6-year-old preschoolers. This study will provide evidence regarding the effectiveness of a multi-component program for health promotion in this setting and may provide insights into new strategies for preventing obesity in early life. German Clinical Trials Register DRKS00011065 (Date of registration 16-09-2016).

Increasing Physical Activity in Patients with Arthritis: A Tailored Health Promotion Program

PubMed Central

Ehrlich-Jones, Linda; Mallinson, Trudy; Fischer, Heidi; Bateman, Jillian; Semanik, Pamela A.; Spring, Bonnie; Ruderman, Eric; Chang, Rowland W.

2010-01-01

Objective Despite recent studies showing the benefit of physical activity for people with arthritis, the vast majority of persons with arthritis are not sufficiently physically active. The purpose of this report is to describe a tailored health promotion intervention aimed at increasing physical activity among persons with arthritis. The intervention is designed to be useful for health systems and insurers interested in a chronic disease management program that could be disseminated to large populations of arthritis patients. Methods The intervention is carried out by a clinician who is designated as the client’s physical activity advocate. The approach emphasizes motivational interviewing, individualized goal setting, tailored strategies for increasing physical activity and for monitoring progress, and a plan of 2 years of follow-up. The intervention includes a standardized assessment of barriers to and strengths supporting increased lifestyle physical activity. A randomized, controlled trial is underway to evaluate the efficacy and cost-effectiveness of this intervention. Conclusion This intervention is unique in that it implements a program tailored to the individual that focuses on lifestyle physical activity and long-term monitoring. The approach recognizes that persons with arthritis present with varying levels of motivation for change in physical activity and that behavior change can take a long time to become habitual. PMID:20696695

Outcome based state budget allocation for diabetes prevention programs using multi-criteria optimization with robust weights.

PubMed

Mehrotra, Sanjay; Kim, Kibaek

2011-12-01

We consider the problem of outcomes based budget allocations to chronic disease prevention programs across the United States (US) to achieve greater geographical healthcare equity. We use Diabetes Prevention and Control Programs (DPCP) by the Center for Disease Control and Prevention (CDC) as an example. We present a multi-criteria robust weighted sum model for such multi-criteria decision making in a group decision setting. The principal component analysis and an inverse linear programming techniques are presented and used to study the actual 2009 budget allocation by CDC. Our results show that the CDC budget allocation process for the DPCPs is not likely model based. In our empirical study, the relative weights for different prevalence and comorbidity factors and the corresponding budgets obtained under different weight regions are discussed. Parametric analysis suggests that money should be allocated to states to promote diabetes education and to increase patient-healthcare provider interactions to reduce disparity across the US.

PROMOTING CANCER PREVENTION AND CONTROL IN COMMUNITY-BASED HIV/AIDS SERVICE ORGANIZATIONS: ARE THEY READY?

PubMed Central

Guidry, John A.; Lubetkin, Erica I.; Corner, Geoffrey W.; Lord-Bessen, Jennifer; Kornegay, Mark; Burkhalter, Jack E.

2015-01-01

Community-based organizations (CBOs) serving persons living with HIV or AIDS face the challenge of an aging population with more chronic diseases. This study assessed cancer programming needs of AIDS service organizations (ASOs) in New York, New Jersey, and Connecticut by conducting a community needs assessment. Sixty (58%) of 103 organizations completed the survey. ASOs conduct activities most related to early steps along the cancer care continuum, but they also express great interest in expanding cancer-focused programming into new areas. ASOs have resources or capacities in assisting HIV+ clients with mental health or substance abuse problems, but there exists a need for funding in undertaking or expanding cancer-focused programs. ASOs are receptive to collaborating with researchers on disseminating cancer prevention and control knowledge in their settings. Community-academic research partnerships enable resonant training and technical assistance methods to be explored that will enhance the abilities of ASOs to bring cancer-related programming to their clients. PMID:24450277

Promoting cancer prevention and control in community-based HIV/AIDS service organizations: are they ready?

PubMed

Guidry, John A; Lubetkin, Erica; Corner, Geoffrey; Lord-Bessen, Jennifer; Kornegay, Mark; Burkhalter, Jack E

2014-02-01

Community-based organizations (CBOs) serving persons living with HIV or AIDS face the challenge of an aging population with more chronic diseases. This study assessed cancer programming needs of AIDS service organizations (ASOs) in New York, New Jersey, and Connecticut by conducting a community needs assessment. Sixty (58%) of 103 organizations completed the survey. ASOs conduct activities most related to early steps along the cancer care continuum, but they also express great interest in expanding cancer-focused programming into new areas. ASOs have resources or capacities in assisting HIV+ clients with mental health or substance abuse problems, but there exists a need for funding in undertaking or expanding cancer-focused programs. ASOs are receptive to collaborating with researchers on disseminating cancer prevention and control knowledge in their settings. Community-academic research partnerships enable resonant training and technical assistance methods to be explored that will enhance the abilities of ASOs to bring cancer-related programming to their clients.

Attrition in Chronic Disease Self-Management Programs and Self-Efficacy at Enrollment

ERIC Educational Resources Information Center

Verevkina, Nina; Shi, Yunfeng; Fuentes-Caceres, Veronica Alejandra; Scanlon, Dennis Patrick

2014-01-01

Among other goals, the Chronic Disease Self-Management Program (CDSMP) is designed to improve self-efficacy of the chronically ill. However, a substantial proportion of the enrollees often leave CDSMPs before completing the program curriculum. This study examines factors associated with program attrition in a CDSMP implemented in a community…

The Impact of a Telephone-Based Chronic Disease Management Program on Medical Expenditures.

PubMed

Avery, George; Cook, David; Talens, Sheila

2016-06-01

The impact of a payer-provided telephone-based chronic disease management program on medical expenditures was evaluated using claims data from 126,245 members in employer self-ensured health plans (16,224 with a chronic disease in a group enrolled in the self-management program, 13,509 with a chronic disease in a group not participating in the program). A random effects regression model controlling for retrospective risk, age, sex, and diagnosis with a chronic disease was used to determine the impact of program participation on market-adjusted health care expenditures. Further confirmation of results was obtained by an ordinary least squares model comparing market- and risk-adjusted costs to the length of participation in the program. Participation in the program is associated with an average annual savings of $1157.91 per enrolled member in health care expenditures. Savings increase with the length of participation in the program. The results support the use of telephone-based patient self-management of chronic disease as a cost-effective means to reduce health care expenditures in the working-age population. (Population Health Management 2016;19:156-162).

The development of a community and home-based chronic care management program for older adults.

PubMed

Cooper, Jennifer; McCarter, Kathryn A

2014-01-01

The objective of this paper was to evaluate a chronic care management program piloted by a visiting nurses association. Desired outcomes were to increase nurses' knowledge of self-management of chronic conditions and improve patient self-efficacy and clinical measures. The program provided educational development for nurses and piloted encounters with patients with chronic conditions targeting community health nurses for a chronic care professional (CCP) certification and invited 300 faith community nurses to an education program on chronic condition(s). Thirteen patients with chronic condition(s) were enrolled. Chronic care professional modules were used to increase nurses' knowledge and were measured by successful completion of a certification exam. Faith community nurses participated in an education program and completed a posttest to measure knowledge of content. Patient improvement in self-management was measured by pre- and postintervention self-efficacy scores and clinical measures. Seventeen nurses successfully completed the exam, and 38 faith community nurses participated in the program and completed the posttest. Three patients showed improvement in self-efficacy scores and eight in clinical measures. The educational development of community nurses prepared them to provide effective encounters to improve self-efficacy and clinical outcomes for older adults with chronic conditions. © 2013 Wiley Periodicals, Inc.

Chronic administration of ethanol leads to an increased incidence of hepatocellular adenoma by promoting H-ras-mutated cells

PubMed Central

Jeannot, Emmanuelle; Pogribny, Igor P.; Beland, Frederick A.; Rusyn, Ivan

2010-01-01

This study used tissue samples from male B6C3F1 mice treated with ethanol in drinking water (0, 2.5, or 5%) for 4 or 104 weeks. We tested whether chronic alcohol drinking promotes oxidative stress in the liver and characterized the mutation profile of spontaneous and ethanol-induced tumors. We show that ethanol does not cause detectable oxidative stress in the liver at any time point and acts by promoting H-ras mutated cells. PMID:21168264

Chronic disease management for recently homeless veterans: a clinical practice improvement program to apply home telehealth technology to a vulnerable population.

PubMed

Gabrielian, Sonya; Yuan, Anita; Andersen, Ronald M; McGuire, James; Rubenstein, Lisa; Sapir, Negar; Gelberg, Lillian

2013-03-01

Although vulnerable populations may benefit from in-home health information technologies (HIT) that promote disease self-management, there is a "digital divide" in which these groups are often unlikely to use such programs. We describe the early phases of applying and testing an existing Veterans Affairs (VA) HIT-care management program, Care Coordination Home Telehealth (CCHT), to recently homeless Veterans in the US Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program. Peers were used to support patient participation. CCHT uses in-home messaging devices to provide health education and daily questions about clinical indicators from chronic illness care guidelines, with patient responses reviewed by VHA nurses. Patients could also receive adjunctive peer support. We used medical record review, Veteran interviews, and staff surveys to "diagnose" barriers to CCHT use, assess program acceptability, explore the role of peer support, and inform future quality improvement. Fourteen eligible Veterans in HUD-VASH agreed to CCHT participation. Ten of these Veterans opted to have adjunctive peer support and the other 4 enrolled in CCHT usual care. Although barriers to enrollment/engagement must be addressed, this subset of Veterans in HUD-VASH was satisfied with CCHT. Most Veterans did not require support from peers to engage in CCHT but valued peer social assistance amidst the isolation felt in their scattered-site homes. HIT tools hold promise for in-home care management for recently housed Veterans. Patient-level barriers to enrollment must be addressed in the next steps of quality improvement, testing and evaluating peer-driven CCHT recruitment.

NASA light emitting diode medical applications from deep space to deep sea

NASA Astrophysics Data System (ADS)

Whelan, Harry T.; Buchmann, Ellen V.; Whelan, Noel T.; Turner, Scott G.; Cevenini, Vita; Stinson, Helen; Ignatius, Ron; Martin, Todd; Cwiklinski, Joan; Meyer, Glenn A.; Hodgson, Brian; Gould, Lisa; Kane, Mary; Chen, Gina; Caviness, James

2001-02-01

This work is supported and managed through the NASA Marshall Space Flight Center-SBIR Program. LED-technology developed for NASA plant growth experiments in space shows promise for delivering light deep into tissues of the body to promote wound healing and human tissue growth. We present the results of LED-treatment of cells grown in culture and the effects of LEDs on patients' chronic and acute wounds. LED-technology is also biologically optimal for photodynamic therapy of cancer and we discuss our successes using LEDs in conjunction with light-activated chemotherapeutic drugs. .

Can We Foster a Culture of Peer Support and Promote Mental Health in Adolescence Using a Web-Based App? A Control Group Study

PubMed Central

Crameri, Aureliano; Eich-Stierli, Brigitte; Telesko, Rainer; von Wyl, Agnes

2016-01-01

Background Adolescence with its many transitions is a vulnerable period for the development of mental illnesses. Establishing effective mental health promotion programs for this age group is a challenge crucial to societal health. Programs must account for the specific developmental tasks that adolescents face. Considering peer influence and fostering adolescent autonomy strivings is essential. Participation in a program should be compelling to young people, and their affinity to new technologies offers unprecedented opportunities in this respect. Objective The Companion App was developed as a Web-based app giving adolescents access to a peer mentoring system and interactive, health-relevant content to foster a positive peer culture among adolescents and thereby strengthen social support and reduce stress. Methods In a control group study design, a group of employed (n=546) and unemployed (n=73) adolescents had access to the Companion App during a 10-month period. The intervention was evaluated using a combination of quantitative and qualitative approaches. Linear mixed effects models were used to analyze changes in chronic stress levels and perception of social support. Monthly feedback on the app and qualitative interviews at the end of the study allowed for an in-depth exploration of the adolescents’ perception of the intervention. Results Adolescents in the intervention group did not use the Companion App consistently. The intervention had no significant effect on chronic stress levels or the perception of social support. Adolescents reported endorsing the concept of the app and the implementation of a peer mentoring system in particular. However, technical difficulties and insufficiently obvious benefits of using the app impeded more frequent usage. Conclusions The Companion Project implemented a theory-driven and innovative approach to mental health promotion in adolescence, taking into account the specifics of this developmental phase. Particularities of the implementation context, technical aspects of the app, and insufficient incentives may have played considerable roles concerning the difficulties of the Companion Project to establish commitment. However, adopting peer mentoring as a strategy and using an app still seems to us a promising approach in mental health promotion in adolescents. Future projects should be careful to invest enough resources into the technical development of an app and consider a large use of incentives to establish commitment. When targeting risk groups, such as unemployed adolescents, it may be expedient to use more structured approaches including face-to-face support. PMID:27663691

The effect of an anger management program for family members of patients with alcohol use disorders.

PubMed

Son, Ju-Young; Choi, Yun-Jung

2010-02-01

This study was aimed to test the structured anger management nursing program for the family members of patients with alcohol use disorders (AUDs). Families with the AUDs suffer from the dysfunctional family dynamic caused by the patients' deteriorative disease processes of alcohol dependence. Family members of AUDs feel bitter and angry about the uncontrolled behaviors and relapses of the patients in spite of great effort for a long time. This chronic anger threatens the optimal function of the family as well as obstructs the family to help the patients who are suffering from AUDs. Sixty three subjects were participated who were referred from community mental health centers, alcohol consultation centers, and an alcohol hospital in Korea. Pre-post scores of the Korean Anger Expression Inventory were used to test the program. An anger management program was developed and implemented to promote anger expression and anger management for the family members of the patients with AUDs. The total anger expression score of the experimental group was significantly more reduced as compared with that of the control group. Subjects in the experimental group reported after the program that they felt more comfortable and their life was changed in a better way. The anger management program was effective to promote anger expression and anger management for family members of AUDs. Nurses need to include family members in their nursing process as well as to care of patients with AUDs to maximize nursing outcome and patient satisfaction. 2010 Elsevier Inc. All rights reserved.

Factors Supporting Implementation among CDSMP Organizations

PubMed Central

Paone, Deborah

2015-01-01

Reaching individuals who can benefit from evidence-based health promotion and disability prevention programs is a goal of federal, state, and local agencies as well as researchers, providers, community agencies, and other stakeholders. Implementation effectiveness at the organizational level must be achieved in order to reach these individuals and sustain the program. This mixed methods study examined eight organizations within two states that successfully implemented the Chronic Disease Self-Management Program (CDSMP) and sustained it from 4 to 10 years. There were two types of organizations: aging services and health care. Internal and external implementation factors and influences were explored. Additional examination of state activities (as a key external agent supporting CDSMP implementation) was conducted. The examination found agreement among the eight organizations regarding why they had adopted the CDSMP – citing the alignment between the program and their organizations’ mission and purpose to improve health status and promote better self-care, and the demonstrated value (benefits) of the program. Organizations were also alike in that they described the importance of an internal champion and supportive senior leader. Organizations differed in how they experienced and valued peer support and collaborative networks. Organizations also differed in how they filled their CDSMP workshops. Internal drivers and capability were more often discussed as facilitating successful implementation than external factors. However, state activities and external support enabled successful adoption – particularly funding and training. The primary challenges identified by this set of organizations included difficulty in recruiting participants (filling workshops) and irregular or insufficient funding sources. These challenges were identified as significant and represented barriers to sustaining the program. PMID:25964928

Factors Supporting Implementation among CDSMP Organizations.

PubMed

Paone, Deborah

2014-01-01

Reaching individuals who can benefit from evidence-based health promotion and disability prevention programs is a goal of federal, state, and local agencies as well as researchers, providers, community agencies, and other stakeholders. Implementation effectiveness at the organizational level must be achieved in order to reach these individuals and sustain the program. This mixed methods study examined eight organizations within two states that successfully implemented the Chronic Disease Self-Management Program (CDSMP) and sustained it from 4 to 10 years. There were two types of organizations: aging services and health care. Internal and external implementation factors and influences were explored. Additional examination of state activities (as a key external agent supporting CDSMP implementation) was conducted. The examination found agreement among the eight organizations regarding why they had adopted the CDSMP - citing the alignment between the program and their organizations' mission and purpose to improve health status and promote better self-care, and the demonstrated value (benefits) of the program. Organizations were also alike in that they described the importance of an internal champion and supportive senior leader. Organizations differed in how they experienced and valued peer support and collaborative networks. Organizations also differed in how they filled their CDSMP workshops. Internal drivers and capability were more often discussed as facilitating successful implementation than external factors. However, state activities and external support enabled successful adoption - particularly funding and training. The primary challenges identified by this set of organizations included difficulty in recruiting participants (filling workshops) and irregular or insufficient funding sources. These challenges were identified as significant and represented barriers to sustaining the program.

Fatty acid oxidation is required for active and quiescent brown adipose tissue maintenance and thermogenic programing.

PubMed

Gonzalez-Hurtado, Elsie; Lee, Jieun; Choi, Joseph; Wolfgang, Michael J

2018-01-01

To determine the role of fatty acid oxidation on the cellular, molecular, and physiologic response of brown adipose tissue to disparate paradigms of chronic thermogenic stimulation. Mice with an adipose-specific loss of Carnitine Palmitoyltransferase 2 (Cpt2 A-/- ), that lack mitochondrial long chain fatty acid β-oxidation, were subjected to environmental and pharmacologic interventions known to promote thermogenic programming in adipose tissue. Chronic administration of β3-adrenergic (CL-316243) or thyroid hormone (GC-1) agonists induced a loss of BAT morphology and UCP1 expression in Cpt2 A-/- mice. Fatty acid oxidation was also required for the browning of white adipose tissue (WAT) and the induction of UCP1 in WAT. In contrast, chronic cold (15 °C) stimulation induced UCP1 and thermogenic programming in both control and Cpt2 A-/- adipose tissue albeit to a lesser extent in Cpt2 A-/- mice. However, thermoneutral housing also induced the loss of UCP1 and BAT morphology in Cpt2 A-/- mice. Therefore, adipose fatty acid oxidation is required for both the acute agonist-induced activation of BAT and the maintenance of quiescent BAT. Consistent with this data, Cpt2 A-/- BAT exhibited increased macrophage infiltration, inflammation and fibrosis irrespective of BAT activation. Finally, obese Cpt2 A-/- mice housed at thermoneutrality exhibited a loss of interscapular BAT and were refractory to β3-adrenergic-induced energy expenditure and weight loss. Mitochondrial long chain fatty acid β-oxidation is critical for the maintenance of the brown adipocyte phenotype both during times of activation and quiescence. Copyright © 2017 The Authors. Published by Elsevier GmbH.. All rights reserved.

Promoting healthy behaviors to prevent chronic disease in Panama and Trinidad & Tobago: results of the women as agents of change project.

PubMed

White, Sarah C; Agurto, Irene; Araguas, Nuria

2006-10-01

In order to address the growing burden of chronic diseases in the Americas, the Pan American Health Organization implemented the Women as Agents of Change project in Panama and Trinidad & Tobago. The project focused on low income, middle aged women and promoted increased physical activity, intake of 5 servings of fruits and vegetables daily, and yearly screening for cervical cancer. One hundred women per country participated in the 6 week program which consisted of weekly meetings and participation in a behavior change curriculum. Gollwitzer's theory of implementation intentions and the theory of social support provided the methodology for the design of the curriculum. At baseline, end of project, and at 6 months, participants completed physical activity and fruit and vegetable consumption surveys. Results show an increase in consumption in Panama between the pre and post-tests, though the increase was not maintained at the 6 month period. Physical activity decreased in both countries over the intervention period, likely due to misreporting on the pretest. Notably, most participants reported on the 6 month follow up survey that they had continued or intensified the behavior changes they undertook during the project. The paper describes barriers identified by the participants as well as strategies they devised to overcome them.

Evaluation of a Psychological Intervention for Patients with Chronic Pain in Primary Care.

PubMed

Cano-García, Francisco J; González-Ortega, María Del Carmen; Sanduvete-Chaves, Susana; Chacón-Moscoso, Salvador; Moreno-Borrego, Roberto

2017-01-01

According to evidence from recent decades, multicomponent programs of psychological intervention in people with chronic pain have reached the highest levels of efficacy. However, there are still many questions left to answer since efficacy has mainly been shown among upper-middle class patients in English-speaking countries and in controlled studies, with expert professionals guiding the intervention and with a limited number of domains of painful experience evaluated. For this study, a program of multicomponent psychological intervention was implemented: (a) based on techniques with empirical evidence, but developed in Spain; (b) at a public primary care center; (c) among patients with limited financial resources and lower education; (d) by a novice psychologist; and (e) evaluating all domains of painful experience using the instruments recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). The aim of this study was to evaluate this program. We selected a consecutive sample of 40 patients treated for chronic non-cancer pain at a primary care center in Utrera (Seville, Spain), adults who were not in any employment dispute, not suffering from psychopathology, and not receiving psychological treatment. The patients participated in 10 psychological intervention sessions, one per week, in groups of 13-14 people, which addressed psychoeducation for pain; breathing and relaxation; attention management; cognitive restructuring; problem-solving; emotional management; social skills; life values and goal setting; time organization and behavioral activation; physical exercise promotion; postural and sleep hygiene; and relapse prevention. In addition to the initial assessment, measures were taken after the intervention and at a 6-month follow-up. We assessed the program throughout the process: before, during and after the implementation. Results were analyzed statistically (significance and effect size) and from a clinical perspective (clinical significance according to IMMPACT standards). According to this analysis, the intervention was successful, although improvement tended to decline at follow-up, and the detailed design gave the program assessment a high degree of standardization and specification. Finally, suggestions for improvement are presented for upcoming applications of the program.

Evaluation of a Psychological Intervention for Patients with Chronic Pain in Primary Care

PubMed Central

Cano-García, Francisco J.; González-Ortega, María del Carmen; Sanduvete-Chaves, Susana; Chacón-Moscoso, Salvador; Moreno-Borrego, Roberto

2017-01-01

According to evidence from recent decades, multicomponent programs of psychological intervention in people with chronic pain have reached the highest levels of efficacy. However, there are still many questions left to answer since efficacy has mainly been shown among upper-middle class patients in English-speaking countries and in controlled studies, with expert professionals guiding the intervention and with a limited number of domains of painful experience evaluated. For this study, a program of multicomponent psychological intervention was implemented: (a) based on techniques with empirical evidence, but developed in Spain; (b) at a public primary care center; (c) among patients with limited financial resources and lower education; (d) by a novice psychologist; and (e) evaluating all domains of painful experience using the instruments recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). The aim of this study was to evaluate this program. We selected a consecutive sample of 40 patients treated for chronic non-cancer pain at a primary care center in Utrera (Seville, Spain), adults who were not in any employment dispute, not suffering from psychopathology, and not receiving psychological treatment. The patients participated in 10 psychological intervention sessions, one per week, in groups of 13–14 people, which addressed psychoeducation for pain; breathing and relaxation; attention management; cognitive restructuring; problem-solving; emotional management; social skills; life values and goal setting; time organization and behavioral activation; physical exercise promotion; postural and sleep hygiene; and relapse prevention. In addition to the initial assessment, measures were taken after the intervention and at a 6-month follow-up. We assessed the program throughout the process: before, during and after the implementation. Results were analyzed statistically (significance and effect size) and from a clinical perspective (clinical significance according to IMMPACT standards). According to this analysis, the intervention was successful, although improvement tended to decline at follow-up, and the detailed design gave the program assessment a high degree of standardization and specification. Finally, suggestions for improvement are presented for upcoming applications of the program. PMID:28386242

The Burden of Hypertension and Kidney Disease in Northeast India: The Institute for Indian Mother and Child Noncommunicable Diseases Project

PubMed Central

Aiello, Angela; Tucci, Benedetta; Sala, Valeria; Brahmochary Mandal, Sujit K.; Doneda, Anna; Genovesi, Simonetta

2014-01-01

Chronic noncommunicable diseases (NCDs) such as hypertension, atherosclerosis, acute myocardial infarction, stroke, diabetes, obesity, and chronic kidney disease are the major cause of death not only in high income, but also in medium and low income countries. Hypertension and diabetes, the most common causes of chronic kidney disease, are particularly common in southeast Asian Countries. Because early intervention can markedly slow the progression of these two killer diseases, assessment of their presence through screening and intervention program is a priority. We summarize here results of the screening activities and the perspectives of a noncommunicable diseases project started in West Bengal, India, in collaboration with the Institute for Indian Mother and Child (IIMC), a nongovernmental voluntary organization committed to promoting child and maternal health. We started investigating hypertension and chronic kidney disease with screen in school-age children and in adults >30 years old. We found a remarkable prevalence of hypertension, even in underweight subjects, in both children and adult populations. A glomerular filtration rate <60 mL/min was found in 4.1% of adult subjects significantly higher than that of 0.8% to 1.4% reported 10 years ago. Increased awareness and intervention projects to identify NCDs and block their progression are necessary in all countries. PMID:24616621

Silica-induced Chronic Inflammation Promotes Lung Carcinogenesis in the Context of an Immunosuppressive Microenvironment12

PubMed Central

Freire, Javier; Ajona, Daniel; de Biurrun, Gabriel; Agorreta, Jackeline; Segura, Victor; Guruceaga, Elizabeth; Bleau, Anne-Marie; Pio, Ruben; Blanco, David; Montuenga, Luis M

2013-01-01

The association between inflammation and lung tumor development has been clearly demonstrated. However, little is known concerning the molecular events preceding the development of lung cancer. In this study, we characterize a chemically induced lung cancer mouse model in which lung cancer developed in the presence of silicotic chronic inflammation. Silica-induced lung inflammation increased the incidence and multiplicity of lung cancer in mice treated with N-nitrosodimethylamine, a carcinogen found in tobacco smoke. Histologic and molecular analysis revealed that concomitant chronic inflammation contributed to lung tumorigenesis through induction of preneoplastic changes in lung epithelial cells. In addition, silica-mediated inflammation generated an immunosuppressive microenvironment in which we observed increased expression of programmed cell death protein 1 (PD-1), transforming growth factor-β1, monocyte chemotactic protein 1 (MCP-1), lymphocyte-activation gene 3 (LAG3), and forkhead box P3 (FOXP3), as well as the presence of regulatory T cells. Finally, the K-RAS mutational profile of the tumors changed from Q61R to G12D mutations in the inflammatory milieu. In summary, we describe some of the early molecular changes associated to lung carcinogenesis in a chronic inflammatory microenvironment and provide novel information concerning the mechanisms underlying the formation and the fate of preneoplastic lesions in the silicotic lung. PMID:23908592

Challenges to establishing successful partnerships in community health promotion programs: local experiences from the national implementation of healthy eating activity and lifestyle (HEAL™) program.

PubMed

Dennis, Sarah; Hetherington, Sharon A; Borodzicz, Jerrad A; Hermiz, Oshana; Zwar, Nicholas A

2015-04-01

Community-based programs to address physical activity and diet are seen as a valuable strategy to reduce risk factors for chronic disease. Community partnerships are important for successful local implementation of these programs but little is published to describe the challenges of developing partnerships to implement health promotion programs. The aim of this study was to explore the experiences and opinions of key stakeholders on the development and maintenance of partnerships during their implementation of the HEAL™ program. Semi-structured interviews with key stakeholders involved in implementation of HEAL™ in four local government areas. The interviews were transcribed verbatim and analysed thematically. Partnerships were vital to the success of the local implementation. Successful partnerships occurred where the program met the needs of the partnering organisation, or could be adapted to do so. Partnerships took time to develop and were often dependent on key people. Partnering with organisations that had a strong influence in the community could strengthen existing relationships and success. In remote areas partnerships took longer to develop because of fewer opportunities to meet face to face and workforce shortages and this has implications for program funding in these areas. Partnerships are important for the successful implementation of community preventive health programs. They take time to develop, are dependent on the needs of the stakeholders and are facilitated by stable leadership. SO WHAT?: An understanding of the role of partnerships in the implementation of community health programs is important to inform several aspects of program delivery, including flexibility in funding arrangements to allow effective and mutually beneficial partnerships to develop before the implementation phase of the program. It is important that policy makers have an understanding of the time it takes for partnerships to develop and to take this into consideration when programs are funded and implemented in the community.

Dying dangerously: Necrotic cell death and chronic inflammation promote tumor growth.

PubMed

Lotze, Michael T; Demarco, Richard A

2004-12-01

Extract: We all shudder about untimely deaths or those that we were not prepared for. As such we perceive such "unscheduled" deaths as dangerous. Similarly, apoptotic death (literally falling leaves) or the programmed cell death of cells in multicellular organisms ranging from slime mold and simple worms through to mammals, has a level of tidiness and well-orchestrated activities with literally hundreds if not thousands of gene products employed with either the primary or secondary purpose of coordinating the orderly death of cells throughout life. During inflammation of any sort, driven by tissue damage or injury or infection by pathogens (virus, bacteria, and parasites), apoptotic death similarly serves to quickly rid the host of damaged cells, promote removal and digestion of the infected cell, and prepare the way for tissue remodeling and repair. When this goes awry, for example during periods of chronic inflammation, tissues are subjected to the contrasting needs of driving apoptotic death whilst maintaining the barrier function of the epithelia (such as skin cells) as well as the selective permeability of mucosal sites (i.e., areas where mucus is secreted to protect the cells from their surroundings, such as gut cells protecting themselves from the gastric acids). Prudently, they need to limit and husband local resources sufficiently for the maintenance of tissue integrity and renewal. It is our provocative and novel contention that cancer in adults (and not children) most often arises in a setting of chronic inflammation and disordered cell death rather than one associated primarily with disordered cell growth as it is popularly imagined by scientists, clinicians, and the general public.

Short and long term improvements in quality of chronic care delivery predict program sustainability.

PubMed

Cramm, Jane Murray; Nieboer, Anna Petra

2014-01-01

Empirical evidence on sustainability of programs that improve the quality of care delivery over time is lacking. Therefore, this study aims to identify the predictive role of short and long term improvements in quality of chronic care delivery on program sustainability. In this longitudinal study, professionals [2010 (T0): n=218, 55% response rate; 2011 (T1): n=300, 68% response rate; 2012 (T2): n=265, 63% response rate] from 22 Dutch disease-management programs completed surveys assessing quality of care and program sustainability. Our study findings indicated that quality of chronic care delivery improved significantly in the first 2 years after implementation of the disease-management programs. At T1, overall quality, self-management support, delivery system design, and integration of chronic care components, as well as health care delivery and clinical information systems and decision support, had improved. At T2, overall quality again improved significantly, as did community linkages, delivery system design, clinical information systems, decision support and integration of chronic care components, and self-management support. Multilevel regression analysis revealed that quality of chronic care delivery at T0 (p<0.001) and quality changes in the first (p<0.001) and second (p<0.01) years predicted program sustainability. In conclusion this study showed that disease-management programs based on the chronic care model improved the quality of chronic care delivery over time and that short and long term changes in the quality of chronic care delivery predicted the sustainability of the projects. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Use of Health Information and Communication Technologies to Promote Health and Manage Behavioral Risk Factors Associated with Chronic Disease: Applications in the Field of Health Education

ERIC Educational Resources Information Center

Stellefson, Michael; Alber, Julia M.; Wang, Min Qi; Eddy, James M.; Chaney, Beth H.; Chaney, J. Don

2015-01-01

This special issue provides real-world examples of the diverse methods health education researchers are using to expand existing applications of information and communication technologies (ICTs) for health promotion and chronic disease management. The original and review articles presented in this special issue investigate eHealth, mHealth, and…

Strategies for Worksite Health Interventions to Employees with Elevated Risk of Chronic Diseases.

PubMed

Meng, Lu; Wolff, Marilyn B; Mattick, Kelly A; DeJoy, David M; Wilson, Mark G; Smith, Matthew Lee

2017-06-01

Chronic disease rates have become more prevalent in the modern American workforce, which has negative implications for workplace productivity and healthcare costs. Offering workplace health interventions is recognized as an effective strategy to reduce chronic disease progression, absenteeism, and healthcare costs as well as improve population health. This review documents intervention and evaluation strategies used for health promotion programs delivered in workplaces. Using predetermined search terms in five online databases, we identified 1,131 published items from 1995 to 2014. Of these items, 27 peer-reviewed articles met the inclusion criteria; reporting data from completed United States-based workplace interventions that recruited at-risk employees based on their disease or disease-related risk factors. A content rubric was developed and used to catalogue these 27 published field studies. Selected workplace interventions targeted obesity ( n   =  13), cardiovascular diseases ( n   =  8), and diabetes ( n   =  6). Intervention strategies included instructional education/counseling ( n   =  20), workplace environmental change ( n   =  6), physical activity ( n   =  10), use of technology ( n   =  10), and incentives ( n   =  13). Self-reported data ( n   =  21), anthropometric measurements ( n   =  17), and laboratory tests ( n   =  14) were used most often in studies with outcome evaluation. This is the first literature review to focus on interventions for employees with elevated risk for chronic diseases. The review has the potential to inform future workplace health interventions by presenting strategies related to implementation and evaluation strategies in workplace settings. These strategies can help determine optimal worksite health programs based on the unique characteristics of work settings and the health risk factors of their employee populations.

Transcription Factor IRF4 Promotes CD8+ T Cell Exhaustion and Limits the Development of Memory-like T Cells during Chronic Infection.

PubMed

Man, Kevin; Gabriel, Sarah S; Liao, Yang; Gloury, Renee; Preston, Simon; Henstridge, Darren C; Pellegrini, Marc; Zehn, Dietmar; Berberich-Siebelt, Friederike; Febbraio, Mark A; Shi, Wei; Kallies, Axel

2017-12-19

During chronic stimulation, CD8 + T cells acquire an exhausted phenotype characterized by expression of inhibitory receptors, down-modulation of effector function, and metabolic impairments. T cell exhaustion protects from excessive immunopathology but limits clearance of virus-infected or tumor cells. We transcriptionally profiled antigen-specific T cells from mice infected with lymphocytic choriomeningitis virus strains that cause acute or chronic disease. T cell exhaustion during chronic infection was driven by high amounts of T cell receptor (TCR)-induced transcription factors IRF4, BATF, and NFATc1. These regulators promoted expression of inhibitory receptors, including PD-1, and mediated impaired cellular metabolism. Furthermore, they repressed the expression of TCF1, a transcription factor required for memory T cell differentiation. Reducing IRF4 expression restored the functional and metabolic properties of antigen-specific T cells and promoted memory-like T cell development. These findings indicate that IRF4 functions as a central node in a TCR-responsive transcriptional circuit that establishes and sustains T cell exhaustion during chronic infection. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

77 FR 43092 - Agency Information Collection Activities; Proposed Collection; Comment Request; Chronic Disease...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-23

... Collection Activities; Proposed Collection; Comment Request; Chronic Disease Self-Management Education... through Chronic Disease Self-Management Education (CDSME) Programs'' cooperative agreement program is... solicits comments on the information collection requirements relating to the Chronic Disease Self...

Promoting youth physical activity in rural southern communities: practitioner perceptions of environmental opportunities and barriers.

PubMed

Edwards, Michael B; Theriault, Daniel S; Shores, Kindal A; Melton, Karen M

2014-01-01

Research on youth physical activity has focused on urban areas. Rural adolescents are more likely to be physically inactive than urban youth, contributing to higher risk of obesity and chronic diseases. Study objectives were to: (1) identify perceived opportunities and barriers to youth physical activity within a rural area and (2) identify rural community characteristics that facilitate or inhibit efforts to promote youth physical activity. Thirty in-depth interviews were conducted with expert informants in 2 rural southern US counties. Interviewees were recruited from diverse positions across multiple sectors based on their expert knowledge of community policies and programs for youth physical activity. Informants saw ball fields, natural amenities, and school sports as primary resources for youth physical activity, but they were divided on whether opportunities were abundant or scarce. Physical distance, social isolation, lack of community offerings, and transportation were identified as key barriers. Local social networks facilitated political action and volunteer recruitment to support programs. However, communities often lacked human capital to sustain initiatives. Racial divisions influenced perceptions of opportunities. Despite divisions, there were also examples of pooling resources to create and sustain physical activity opportunities. Developing partnerships and leveraging local resources may be essential to overcoming barriers for physical activity promotion in rural areas. Involvement of church leaders, school officials, health care workers, and cooperative extension is likely needed to establish and sustain youth rural physical activity programs. Allocating resources to existing community personnel and volunteers for continuing education may be valuable. © 2014 National Rural Health Association.

Lessons Learned in Promoting Evidence-Based Public Health: Perspectives from Managers in State Public Health Departments.

PubMed

Allen, Peg; Jacob, Rebekah R; Lakshman, Meenakshi; Best, Leslie A; Bass, Kathryn; Brownson, Ross C

2018-03-02

Evidence-based public health (EBPH) practice, also called evidence-informed public health, can improve population health and reduce disease burden in populations. Organizational structures and processes can facilitate capacity-building for EBPH in public health agencies. This study involved 51 structured interviews with leaders and program managers in 12 state health department chronic disease prevention units to identify factors that facilitate the implementation of EBPH. Verbatim transcripts of the de-identified interviews were consensus coded in NVIVO qualitative software. Content analyses of coded texts were used to identify themes and illustrative quotes. Facilitator themes included leadership support within the chronic disease prevention unit and division, unit processes to enhance information sharing across program areas and recruitment and retention of qualified personnel, training and technical assistance to build skills, and the ability to provide support to external partners. Chronic disease prevention leaders' role modeling of EBPH processes and expectations for staff to justify proposed plans and approaches were key aspects of leadership support. Leaders protected staff time in order to identify and digest evidence to address the common barrier of lack of time for EBPH. Funding uncertainties or budget cuts, lack of political will for EBPH, and staff turnover remained challenges. In conclusion, leadership support is a key facilitator of EBPH capacity building and practice. Section and division leaders in public health agencies with authority and skills can institute management practices to help staff learn and apply EBPH processes and spread EBPH with partners.

Fifty communities putting prevention to work: accelerating chronic disease prevention through policy, systems and environmental change.

PubMed

Bunnell, Rebecca; O'Neil, Dara; Soler, Robin; Payne, Rebecca; Giles, Wayne H; Collins, Janet; Bauer, Ursula

2012-10-01

The burden of preventable chronic diseases is straining our nation's health and economy. Diseases caused by obesity and tobacco use account for the largest portions of this preventable burden. CDC funded 50 communities in 2010 to implement policy, systems, and environmental (PSE) interventions in a 2-year initiative. Funded communities developed PSE plans to reduce obesity, tobacco use, and second-hand smoke exposure for their combined 55 million residents. Community outcome objectives and milestones were categorized by PSE interventions as they related to media, access, promotion, pricing, and social support. Communities estimated population reach based on their jurisdiction's census data and target populations. The average proportion of each community's population that was reached was calculated for each intervention category. Outcome objectives that were achieved within 12 months of program initiation were identified from routine program records. The average proportion of a community's jurisdictional population reached by a specific intervention varied across interventions. Mean population reach for obesity-prevention interventions was estimated at 35%, with 14 (26%) interventions covering over 50% of the jurisdictional populations. For tobacco prevention, mean population reach was estimated at 67%, with 16 (84%) interventions covering more than 50% of the jurisdictional populations. Within 12 months, communities advanced over one-third of their obesity and tobacco-use prevention strategies. Tobacco interventions appeared to have higher potential population reach than obesity interventions within this initiative. Findings on the progress and potential reach of this major initiative may help inform future chronic disease prevention efforts.

[Adherence to a stability exercise program in patients with chronic low back pain].

PubMed

Nava-Bringas, Tania Inés; Roeniger-Desatnik, Antje; Arellano-Hernández, Aurelia; Cruz-Medina, Eva

2016-01-01

Chronic low back pain is a major cause of disability. The most effective intervention is exercise, with higher benefits in terms of pain and function. Knowing the level of adherence to therapeutic exercise is essential to assess the effectiveness of health services, for planning strategies, optimising resources, and promoting the full recovery of patients in less time. A prospective, observational study with 6 months follow-up was performed on 31 patients with chronic low back pain who underwent a lumbar stability program. Rating scales for pain, function, anxiety, depression and fear of avoidance were applied. Adherence was recorded using daily therapy diary. Parametric tests were performed to determine correlations of interest, and to evaluate the changes presented over time. The percentage of adherence was 82-84% during the 3 trimesters. There were no correlations between adherence and socio-demographic variables, depression, anxiety, or fear of avoidance. Patients categorised as adherent showed faster and more significant improvements in pain and function (p > 0.05). At the end of the study all patients had a significant improvement in pain and function. Depressed patients showed higher scores on scales of pain and disability at the beginning and end of the study. However, neither depression, anxiety, nor fear of running activity were predictors of non-adherence to the therapy. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Process Evaluation of a Comprehensive Supermarket Intervention in a Low-Income Baltimore Community.

PubMed

Lee, Ryan M; Rothstein, Jessica D; Gergen, Jessica; Zachary, Drew A; Smith, Joyce C; Palmer, Anne M; Gittelsohn, Joel; Surkan, Pamela J

2015-11-01

Supermarket-based interventions are one approach to improving the local food environment and reducing obesity and chronic disease in low-income populations. We implemented a multicomponent intervention that aimed to reduce environmental barriers to healthy food purchasing in a supermarket in Southwest Baltimore. The intervention, Eat Right-Live Well! used: shelf labels and in-store displays promoting healthy foods, sales and promotions on healthy foods, in-store taste tests, increasing healthy food products, community outreach events to promote the intervention, and employee training. We evaluated program implementation through store environment, taste test session, and community event evaluation forms as well as an Employee Impact Questionnaire. The stocking, labeling, and advertising of promoted foods were implemented with high and moderate fidelity. Taste test sessions were implemented with moderate reach and low dose. Community outreach events were implemented with high reach and dose. Supermarket employee training had no significant impact on employees' knowledge, self-efficacy, or behavioral intention for helping customers with healthy purchasing or related topics of nutrition and food safety. In summary, components of this intervention to promote healthy eating were implemented with varying success within a large supermarket. Greater participation from management and employees could improve implementation. © 2015 Society for Public Health Education.

School health guidelines to promote healthy eating and physical activity.

PubMed

2011-09-16

During the last 3 decades, the prevalence of obesity has tripled among persons aged 6--19 years. Multiple chronic disease risk factors, such as high blood pressure, high cholesterol levels, and high blood glucose levels are related to obesity. Schools have a responsibility to help prevent obesity and promote physical activity and healthy eating through policies, practices, and supportive environments. This report describes school health guidelines for promoting healthy eating and physical activity, including coordination of school policies and practices; supportive environments; school nutrition services; physical education and physical activity programs; health education; health, mental health, and social services; family and community involvement; school employee wellness; and professional development for school staff members. These guidelines, developed in collaboration with specialists from universities and from national, federal, state, local, and voluntary agencies and organizations, are based on an in-depth review of research, theory, and best practices in healthy eating and physical activity promotion in school health, public health, and education. Because every guideline might not be appropriate or feasible for every school to implement, individual schools should determine which guidelines have the highest priority based on the needs of the school and available resources.

Influence of the Bolsa Família program on nutritional status and food frequency of schoolchildren.

PubMed

do Carmo, Ariene Silva; de Almeida, Lorena Magalhães; de Oliveira, Daniela Rodrigues; Dos Santos, Luana Caroline

2016-01-01

To evaluate the food frequency and nutritional status among students according to participation in the Bolsa Família program funded by the government. Cross-sectional study carried out with students from the fourth grade of elementary school in the municipal capital of the southeastern region of Brazil. Food consumption and anthropometry were investigated by a questionnaire administered in school, while participation in the Bolsa Família program and other socio-economic information was obtained through a protocol applied to mothers/guardians. Statistical analysis included the Mann-Whitney test, the chi-squared test, and Poisson regression with robust variance, and the 5% significance level was adopted. There were 319 children evaluated; 56.4% were male, with a median of 9.4 (8.6-11.9) years, and 37.0% were beneficiaries of Bolsa Família program. Between the two groups, there was high prevalence of regular soda consumption (34.3%), artificial juice (49.5%), and sweets (40.3%), while only 54.3% and 51.7% consumed fruits and vegetables regularly, respectively. Among participants of Bolsa Família program, a prevalence 1.24 times higher in the regular consumption of soft drinks (95% CI: 1.10-1.39) was identified compared to non-beneficiaries. The prevalence of overweight was higher in the sample (32.9%), with no difference according to participation in the program. The study found increased consumption of soft drinks among BFP participants. The high rate of overweight and poor eating habits denote the need to develop actions to promote healthy eating, especially for the beneficiaries of the Bolsa Família program, to promote improvements in nutritional status and prevent chronic diseases throughout life. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Promoting physical activity in Iranian women: A qualitative study using social marketing

PubMed Central

Tabatabaei, Seyed Vahid Ahmadi; Ardabili, Hassan Eftekhar; Haghdoost, Ali Akbar; Nakhaee, Nouzar; Shams, Mohsen

2017-01-01

Background and aim In social marketing, at the center of the program is consumer perception. The objective of this study was to explore the viewpoints of Iranian women for tailoring interventions so as to increase physical activity. Methods The social marketing model served as the framework of the study. Qualitative data were collected via six semi-structured focus group discussions (FGDs), in 2014 in Iran. Participants were 51 women, 20 to 60 years old, selected by purposive sampling, with a maximum diversity. Qualitative content analysis of the data was conducted by researchers. Results After data analysis and extracting initial codes, they were all categorized in four predefined categories of social marketing model (product, price, place and promotion) and related sub-categories. Most of the participants were inactive. Price was addressed by women as the dominant category of this study. The majority of participants emphasized the benefits of prevention of chronic diseases, fitness, staying young, and improving family relations. Most women preferred to do physical activity in a secure and enclosed female environment. And the majority of participants considered radio, television, face to face training, texting, and advertising billboards as promotional strategies. Conclusion This study provides a unique insight into consumers’ values and motivations that affect consumers’ decisions to adopt physical activity, in Iran. It could also help researchers to design and implement intervention programs to increase physical activity. PMID:29038710

Promoting physical activity in Iranian women: A qualitative study using social marketing.

PubMed

Tabatabaei, Seyed Vahid Ahmadi; Ardabili, Hassan Eftekhar; Haghdoost, Ali Akbar; Nakhaee, Nouzar; Shams, Mohsen

2017-09-01

In social marketing, at the center of the program is consumer perception. The objective of this study was to explore the viewpoints of Iranian women for tailoring interventions so as to increase physical activity. The social marketing model served as the framework of the study. Qualitative data were collected via six semi-structured focus group discussions (FGDs), in 2014 in Iran. Participants were 51 women, 20 to 60 years old, selected by purposive sampling, with a maximum diversity. Qualitative content analysis of the data was conducted by researchers. After data analysis and extracting initial codes, they were all categorized in four predefined categories of social marketing model (product, price, place and promotion) and related sub-categories. Most of the participants were inactive. Price was addressed by women as the dominant category of this study. The majority of participants emphasized the benefits of prevention of chronic diseases, fitness, staying young, and improving family relations. Most women preferred to do physical activity in a secure and enclosed female environment. And the majority of participants considered radio, television, face to face training, texting, and advertising billboards as promotional strategies. This study provides a unique insight into consumers' values and motivations that affect consumers' decisions to adopt physical activity, in Iran. It could also help researchers to design and implement intervention programs to increase physical activity.

Self care programs and multiple sclerosis: physical therapeutics treatment - literature review.

PubMed

Demaille-Wlodyka, S; Donze, C; Givron, P; Gallien, P

2011-03-01

To clarify the therapeutic education program impact with multiple sclerosis patients, literature review. Highlight contents and efficacy. A non-systematic review on Medline, PubMed and Cochrane library databases from 1966 to 2010 using the following keywords: "multiple sclerosis", "self-care", "self-management" and specific symptoms keywords. Clinical trials and randomized clinical trials, as well as literature reviews published in English, French and German will be analyzed. Counseling is a part of the non-pharmacological management of chronic illnesses such as multiple sclerosis. Symptoms' diversity and the different clinical forms limit standardized programs of self-care management, applicable to patients. In the literature review, counseling programs have often low metrology. A behavior change with patients and medical staff could exist. To empower the patient, to reduce symptoms' impact and to improve treatment access are the aims of educational therapy. Therapeutic education program for multiple sclerosis patients could progress with their standardization and assessment, for each sign. To promote the educational therapy of multiple sclerosis patients, a specific training for medical staff, as specific financing are necessary. 2011 Elsevier Masson SAS. All rights reserved.

Impact of a Translated Disease Self-Management Program on Employee Health and Productivity: Six-Month Findings from a Randomized Controlled Trial.

PubMed

Smith, Matthew Lee; Wilson, Mark G; Robertson, Melissa M; Padilla, Heather M; Zuercher, Heather; Vandenberg, Robert; Corso, Phaedra; Lorig, Kate; Laurent, Diana D; DeJoy, David M

2018-04-25

Disease management is gaining importance in workplace health promotion given the aging workforce and rising chronic disease prevalence. The Chronic Disease Self-Management Program (CDSMP) is an effective intervention widely offered in diverse community settings; however, adoption remains low in workplace settings. As part of a larger NIH-funded randomized controlled trial, this study examines the effectiveness of a worksite-tailored version of CDSMP (wCDSMP [ n = 72]) relative to CDSMP (‘Usual Care’ [ n = 109]) to improve health and work performance among employees with one or more chronic conditions. Multiple-group latent-difference score models with sandwich estimators were fitted to identify changes from baseline to 6-month follow-up. Overall, participants were primarily female (87%), non-Hispanic white (62%), and obese (73%). On average, participants were age 48 (range: 23⁻72) and self-reported 3.25 chronic conditions (range: 1⁻16). The most commonly reported conditions were high cholesterol (45%), high blood pressure (45%), anxiety/emotional/mental health condition (26%), and diabetes (25%). Among wCDSMP participants, significant improvements were observed for physically unhealthy days (uΔ = −2.07, p = 0.018), fatigue (uΔ = −2.88, p = 0.002), sedentary behavior (uΔ = −4.49, p = 0.018), soda/sugar beverage consumption (uΔ = −0.78, p = 0.028), and fast food intake (uΔ = −0.76, p = 0.009) from baseline to follow-up. Significant improvements in patient⁻provider communication (uΔ = 0.46, p = 0.031) and mental work limitations (uΔ = −8.89, p = 0.010) were also observed from baseline to follow-up. Relative to Usual Care, wCDSMP participants reported significantly larger improvements in fatigue, physical activity, soda/sugar beverage consumption, and mental work limitations ( p < 0.05). The translation of Usual Care (content and format) has potential to improve health among employees with chronic conditions and increase uptake in workplace settings.

Impact of a Translated Disease Self-Management Program on Employee Health and Productivity: Six-Month Findings from a Randomized Controlled Trial

PubMed Central

Smith, Matthew Lee; Wilson, Mark G.; Robertson, Melissa M.; Padilla, Heather M.; Zuercher, Heather; Vandenberg, Robert; Corso, Phaedra; Lorig, Kate; Laurent, Diana D.; DeJoy, David M.

2018-01-01

Disease management is gaining importance in workplace health promotion given the aging workforce and rising chronic disease prevalence. The Chronic Disease Self-Management Program (CDSMP) is an effective intervention widely offered in diverse community settings; however, adoption remains low in workplace settings. As part of a larger NIH-funded randomized controlled trial, this study examines the effectiveness of a worksite-tailored version of CDSMP (wCDSMP [n = 72]) relative to CDSMP (‘Usual Care’ [n = 109]) to improve health and work performance among employees with one or more chronic conditions. Multiple-group latent-difference score models with sandwich estimators were fitted to identify changes from baseline to 6-month follow-up. Overall, participants were primarily female (87%), non-Hispanic white (62%), and obese (73%). On average, participants were age 48 (range: 23–72) and self-reported 3.25 chronic conditions (range: 1–16). The most commonly reported conditions were high cholesterol (45%), high blood pressure (45%), anxiety/emotional/mental health condition (26%), and diabetes (25%). Among wCDSMP participants, significant improvements were observed for physically unhealthy days (uΔ = −2.07, p = 0.018), fatigue (uΔ = −2.88, p = 0.002), sedentary behavior (uΔ = −4.49, p = 0.018), soda/sugar beverage consumption (uΔ = −0.78, p = 0.028), and fast food intake (uΔ = −0.76, p = 0.009) from baseline to follow-up. Significant improvements in patient–provider communication (uΔ = 0.46, p = 0.031) and mental work limitations (uΔ = −8.89, p = 0.010) were also observed from baseline to follow-up. Relative to Usual Care, wCDSMP participants reported significantly larger improvements in fatigue, physical activity, soda/sugar beverage consumption, and mental work limitations (p < 0.05). The translation of Usual Care (content and format) has potential to improve health among employees with chronic conditions and increase uptake in workplace settings. PMID:29693605

Negotiating Access to Health Information to Promote Students' Health.

PubMed

Radis, Molly E; Updegrove, Stephen C; Somsel, Anne; Crowley, Angela A

2016-04-01

Access to student health information, such as immunizations, screenings, and care plans for chronic conditions, is essential for school nurses to fulfill their role in promoting students' health. School nurses typically encounter barriers to accessing health records and spend many hours attempting to retrieve health information. As a result, nurses' time is poorly utilized and students may suffer adverse outcomes including delayed school entry. In response to this pressing public health issue, a school medical advisor and director of school nurses in a local health department successfully negotiated access for school nurses to three health record systems: a state immunization tracking system, an electronic lead surveillance program, and an electronic health record system. This negotiation process is presented within a framework of the Theory of Diffusion of Innovation and provides a strategy for other school nurses seeking access to student health information. © The Author(s) 2015.

Strengthening Chronic Disease Prevention Programming: the Toward Evidence-Informed Practice (TEIP) Program Assessment Tool

PubMed Central

Albert, Dayna; Fortin, Rebecca; Lessio, Anne; Herrera, Christine; Hanning, Rhona; Rush, Brian

2013-01-01

Best practices identified solely on the strength of research evidence may not be entirely relevant or practical for use in community-based public health and the practice of chronic disease prevention. Aiming to bridge the gap between best practices literature and local knowledge and expertise, the Ontario Public Health Association, through the Toward Evidence-Informed Practice initiative, developed a set of resources to strengthen evidence-informed decision making in chronic disease prevention programs. A Program Assessment Tool, described in this article, emphasizes better processes by incorporating review criteria into the program planning and implementation process. In a companion paper, “Strengthening Chronic Disease Prevention Programming: The Toward Evidence-Informed Practice (TEIP) Program Evidence Tool,” we describe another tool, which emphasizes better evidence by providing guidelines and worksheets to identify, synthesize, and incorporate evidence from a range of sources (eg, peer-reviewed literature, gray literature, local expertise) to strengthen local programs. The Program Assessment Tool uses 19 criteria derived from literature on best and promising practices to assess and strengthen program planning and implementation. We describe the benefits, strengths, and challenges in implementing the tool in 22 community-based chronic disease prevention projects in Ontario, Canada. The Program Assessment Tool helps put best processes into operation to complement adoption and adaptation of evidence-informed practices for chronic disease prevention. PMID:23721789

When do chronic differences in self-regulation count? Regulatory focus effects in easy and difficult soccer tasks.

PubMed

Vogel, Tobias; Genschow, Oliver

2013-04-01

Research on regulatory focus theory (Higgins, 1997) suggests that performance increases if instructions fit with sportspersons' dispositions. Sportspersons who chronically focus on wins (i.e., promotion-oriented individuals) perform best if instructions frame the objective as a promotion goal (e.g., "Try to hit!"). By contrast, sportspersons who chronically focus on losses (i.e., prevention-oriented individuals) perform best if instructions frame the objective as a prevention goal (e.g., "Try not to miss!"). Recent theorizing also suggests that regulatory focus interacts with task difficulty. In an experiment, we assessed soccer performance as a function of chronic focus, instructional focus, and task difficulty. Results support that task difficulty moderates the effects of fit on performance; fitting instructions to match the sportsperson's chronic regulatory focus improved performance in the easy rather than the difficult task. Findings are discussed regarding the role of regulatory fit in altering subjective pressure during sports performance.

Evaluation of the Centers for Disease Control and Prevention's chronic disease state-based epidemiology for public health program support (STEPPS) program.

PubMed

Frey, Catherine A; Remington, Patrick L; Lengerich, Eugene

2003-01-01

To identify effective strategies for improving epidemiology capacity in state chronic disease programs, staff epidemiologists and program directors from 25 states were interviewed using a structured questionnaire by phone or in person. Respondents reported three chief barriers to chronic disease epidemiology capacity: lack of institutional commitment and support for chronic disease epidemiology; lack of professional opportunities to engage with peers, colleagues, and scientists; and lack of trained epidemiology staff and resources to support chronic disease functions and activities. Epidemiology capacity in states would be improved by expanding the role and scope of staff placement programs; assisting states in establishing formal collaborations with academic institutions; and providing technical assistance to staff currently employed in states through training, consultation, and networking.

Upstream Disaster Management to Support People Experiencing Homelessness.

PubMed

Sundareswaran, Madura; Ghazzawi, Andrea; O'Sullivan, Tracey L

2015-08-18

The unique context of day-to-day living for people who are chronically homeless or living with housing insecurity puts them at high risk during community disasters. The impacts of extreme events, such as flooding, storms, riots, and other sources of community disruption, underscore the importance of preparedness efforts and fostering community resilience. This study is part of larger initiative focused on enhancing resilience and preparedness among high risk populations. The purpose of this study was to explore critical issues and strategies to promote resilience and disaster preparedness among people who are homeless in Canada. A sample of interviews (n=21) from key informants across Canada was analyzed to explore existing programs and supports for homeless populations. The data was selected from a larger sample of (n=43) interviews focused on programs and supports for people who are at heightened risk for negative impacts during disasters. Qualitative content analysis was used to extract emergent themes and develop a model of multi-level collaboration to support disaster resilience among people who are homeless. The results indicate there is a need for more upstream continuity planning, collaboration and communication between the emergency management sector and community service organizations that support people who are homeless. Prioritization and investment in the social determinants of health and community supports is necessary to promote resilience among this high-risk population. The findings from this study highlight the importance of acknowledging community support organizations as assets in disaster preparedness. Day-to-day resilience is an ongoing theme for people who are chronically homeless or living with housing insecurity. Upstream investment to build adaptive capacity and collaborate with community organizations is an important strategy to enhance community resilience.

Chronic Mycobacterium marinum Infection Acts as a Tumor Promoter in Japanese Medaka (Oryzias latipes)

EPA Science Inventory

An accumulating body of research indicates there is an increased cancer risk associated with chronic infections. The genus Mycobacterium contains a number of species, including M tuberculosis, which mount chronic infections and have been implicated in higher cancer risk. Several ...

Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review.

PubMed

Lee, Jung-Ah; Choi, Mona; Lee, Sang A; Jiang, Natalie

2018-02-20

Mobile health (mHealth) has continuously been used as a method in behavioral research to improve self-management in patients with chronic diseases. However, the evidence of its effectiveness in chronic disease management in the adult population is still lacking. We conducted a systematic review to examine the effectiveness of mHealth interventions on process measures as well as health outcomes in randomized controlled trials (RCTs) to improve chronic disease management. Relevant randomized controlled studies that were published between January 2005 and March 2016 were searched in six databases: PubMed, CINAHL, EMBASE, the Cochrane Library, PsycINFO, and Web of Science. The inclusion criteria were RCTs that conducted an intervention using mobile devices such as smartphones or tablets for adult patients with chronic diseases to examine disease management or health promotion. Of the 12 RCTs reviewed, 10 of the mHealth interventions demonstrated statistically significant improvement in some health outcomes. The most common features of mHealth systems used in the reviewed RCTs were real-time or regular basis symptom assessments, pre-programed reminders, or feedbacks tailored specifically to the data provided by participants via mHealth devices. Most studies developed their own mHealth systems including mobile apps. Training of mHealth systems was provided to participants in person or through paper-based instructions. None of the studies reported the relationship between health outcomes and patient engagement levels on the mHealth system. Findings from mHealth intervention studies for chronic disease management have shown promising aspects, particularly in improving self-management and some health outcomes.

The decisional balance sheet to promote healthy behavior among ethnically diverse older adults.

PubMed

Geller, Karly S; Mendoza, Ilora D; Timbobolan, Jasah; Montjoy, Holly L; Nigg, Claudio R

2012-01-01

The rising health care costs and increasing older adult population in the United States make preventive medicine for this age group especially crucial. Regular physical activity and fruit and vegetable consumption may prevent or delay the onset of many chronic conditions that are common among older adults. The decisional balance sheet is a promotional tool targeting the perceived pros and cons of behavior adoption. The current study tested the efficiency and effectiveness of a single-day decisional balance sheet program, targeting increased physical activity and fruit and vegetable intake among older adults. Participating adults (N = 21, age = 72.2) who represented a diverse population in Hawaii (Japanese = 5, Filipino = 4, Caucasian = 4, Native American = 1, Native Hawaiian = 1, Hispanic = 1, and Others = 5) were recruited from housing communities and randomized to a decisional balance sheet program adapted for physical activity or fruit and vegetable consumption. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) short form, and daily fruit and vegetable intake with the National Health and Nutrition Examination Survey single item instrument. Baseline and follow-up data were collected. Both programs were implemented efficiently, and participants in both groups improved their daily physical activity. The decisional balance sheet for fruit and vegetable consumption appeared less effective. Specific suggestions for similar programs are reported. © 2011 Wiley Periodicals, Inc.

Promoting health in schools through a board game.

PubMed

Bartfay, W J; Bartfay, E

1994-08-01

Primary prevention and health promotion have become salient topics in Canadian society and in nursing during the past two decades. The noncommunicable chronic diseases, such as heart disease and cancer, have been linked to specific lifestyle behaviors or habits, which often develop early in life. The success of public health efforts to improve the health status of all Canadians depends substantially on the success of educational programs directed toward children. Effective teaching strategies that seek to promote health and wellness in children need to be developed and empirically evaluated. Educational games may provide an efficient vehicle for carrying out developmentally specific nursing interventions in school settings. This article begins with a brief overview of the historical origins of games, along with their advantages and disadvantages as educational strategies. The results of a pretest-posttest control group design study that evaluated the effectiveness of a board game as a primary prevention teaching strategy with 23 sixth grade children in Winnipeg, Manitoba are presented. The experimental group had significant gains in knowledge related to anatomy and physiology, diet, and lifestyle risk factors associated with the development of heart disease and cancer.

Exercise behavior and related factors in career women - the case of a bank in Taipei City.

PubMed

Chen, Chen-Mei; Chang, Mei

2004-09-01

With the trend of premature aging of physiological functions on the rise and a variety of chronic diseases continuing to spread, health promotion has become the top concern among public health experts. Regular exercise plays a pivotal role in both health promotion and disease prevention. This study aims to investigate the exercise behavior of career women and related factors. The samples were drawn from the female employees of a bank in Taipei, totaling 361 persons, all aged between 20 and 56. The result shows that only 8.6 % of the respondents exercise regularly and that among the reasons for not doing any exercise, " Don ' t have time for it " tops the list. Self-efficacy in exercise is found to be the common factor for predicting both exercise regularity and total exercise amount. Exercise intervention programs thus must be developed on the basis of female self-efficacy with a " family-oriented " activity design. It is therefore suggested that employers promote exercise and encourage exercise behaviors to help enhance employee self-efficacy as well as employee health.

77 FR 42625 - Chronic Wasting Disease Herd Certification Program and Interstate Movement of Farmed or Captive...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-20

... No. 00-108-9] Chronic Wasting Disease Herd Certification Program and Interstate Movement of Farmed or... final rule that will establish a herd certification program to control chronic wasting disease (CWD) in..., elk, and moose that are otherwise eligible for interstate movement. This action will allow interested...

Seizing opportunities under the Affordable Care Act for transforming the mental and behavioral health system.

PubMed

Mechanic, David

2012-02-01

The Affordable Care Act, along with Medicaid expansions, offers the opportunity to redesign the nation's highly flawed mental health system. It promotes new programs and tools, such as health homes, interdisciplinary care teams, the broadening of the Medicaid Home and Community-Based Services option, co-location of physical health and behavioral services, and collaborative care. Provisions of the act offer extraordinary opportunities, for instance, to insure many more people, reimburse previously unreimbursed services, integrate care using new information technology tools and treatment teams, confront complex chronic comorbidities, and adopt underused evidence-based interventions. The Centers for Medicare and Medicaid Services and its Center for Medicare and Medicaid Innovation should work intensively with the states to implement these new programs and other arrangements and begin to fulfill the many unmet promises of community mental health care.

Students With Asthma and Its Impacts.

PubMed

Isik, Elif; Isik, Ismet S

2017-07-01

Asthma is a common chronic disease in children. Uncontrolled asthma is a significant contributor to school absenteeism, emergency room visits, and hospitalization, all of which can lead to low school performance, financial burdens, and emotional problems for children and their parents. Asthma in children restricts the activities of school-aged children, such as participating in before- and after-school activity and extracurricular activities such as sports. Uncontrolled asthma has the potential to impact a student's self-confidence and social interactions. This article reviews the physical, emotional, and social burden of asthma on school-aged children/parents as well as recounting school asthma intervention programs. One of the roles of the school nurse is to be the leader of the intervention programs, manage asthma, and provide education for the students, parents, and school community to promote knowledge about asthma and its management.

Patient and Nurse Experiences in a Rural Chronic Disease Management Program: A Qualitative Evaluation.

PubMed

Davisson, Erica A; Swanson, Elizabeth A

Rural status confounds chronic disease self-management. The purpose of this qualitative, descriptive study was to evaluate the nurse-led "Living Well" chronic disease management program reporting patient recruitment and retention issues since program initiation in 2013. The Chronic Care Model (CCM) was the guiding framework used to reinforce that interdisciplinary teams must have productive patient interactions for their program(s) to be sustainable. A rural, Midwest county clinic's chronic disease management program. Observations, interviews, and within- and across-case coding were used. Patients' responses were analyzed to identify (1) reasons for recruitment and retention problems and (2) program elements that were viewed as successful or needing improvement. A convenience sample of 6 rural, English-speaking adults (65 years or older, with no severe cognitive impairment) with at least one chronic condition was recruited and interviewed. Themes emerged related to nurse knowledge, availability, and value; peer support; overcoming barriers; adherence enhancement; and family/friends' involvement. Patients reported engagement in self-management activities because of program elements such as support groups and productive nurse-patient interactions. Interdisciplinary communication, commitment, and patient referral processes were identified as reasons for recruitment and retention issues. Findings substantiated that certain elements must be present and improved upon for future rural programs to be successful. Interdisciplinary communication may need to be improved to address recruitment and retention problems. It was clear from patient interviews that the nurse coordinators played a major role in patients' self-management adherence and overall satisfaction with the program. This is important to case management because results revealed the need for programs of this nature that incorporate the vital role of nurse coordinators and align with the CCM value of providing a supportive community health care resource for patients with chronic disease.

A customizable model for chronic disease coordination: Lessons learned from the coordinated chronic disease program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Voetsch, Karen; Sequeira, Sonia; Chavez, Amy Holmes

In 2012, the Centers for Disease Control and Prevention provided funding and technical assistance to all states and territories to implement the Coordinated Chronic Disease Program, marking the first time that all state health departments had federal resources to coordinate chronic disease prevention and control programs. This article describes lessons learned from this initiative and identifies key elements of a coordinated approach. We analyzed 80 programmatic documents from 21 states and conducted semistructured interviews with 7 chronic disease directors. Six overarching themes emerged: 1) focused agenda, 2) identification of functions, 3) comprehensive planning, 4) collaborative leadership and expertise, 5) managedmore » resources, and 6) relationship building. Furthermore, these elements supported 4 essential activities: 1) evidence-based interventions, 2) strategic use of staff, 3) consistent communication, and 4) strong program infrastructure. On the basis of these elements and activities, we propose a conceptual model that frames overarching concepts, skills, and strategies needed to coordinate state chronic disease prevention and control programs.« less

A customizable model for chronic disease coordination: Lessons learned from the coordinated chronic disease program

DOE PAGES

Voetsch, Karen; Sequeira, Sonia; Chavez, Amy Holmes

2016-03-31

In 2012, the Centers for Disease Control and Prevention provided funding and technical assistance to all states and territories to implement the Coordinated Chronic Disease Program, marking the first time that all state health departments had federal resources to coordinate chronic disease prevention and control programs. This article describes lessons learned from this initiative and identifies key elements of a coordinated approach. We analyzed 80 programmatic documents from 21 states and conducted semistructured interviews with 7 chronic disease directors. Six overarching themes emerged: 1) focused agenda, 2) identification of functions, 3) comprehensive planning, 4) collaborative leadership and expertise, 5) managedmore » resources, and 6) relationship building. Furthermore, these elements supported 4 essential activities: 1) evidence-based interventions, 2) strategic use of staff, 3) consistent communication, and 4) strong program infrastructure. On the basis of these elements and activities, we propose a conceptual model that frames overarching concepts, skills, and strategies needed to coordinate state chronic disease prevention and control programs.« less

Negotiating health and chronic illness in Filipino-Australians: a qualitative study with implications for health promotion.

PubMed

Maneze, Della; Ramjan, Lucie; DiGiacomo, Michelle; Everett, Bronwyn; Davidson, Patricia Mary; Salamonson, Yenna

2018-08-01

In spite of the healthy immigrant effect, the prevalence of lifestyle-related chronic diseases among migrants is reported to approximate that of the host country with longer duration of stay. For example, higher rates of chronic diseases such as Type 2 diabetes and hypertension have been observed among Filipino migrants and these have been linked to acculturation. The aim of this study was to explore the experiences of Filipino-Australian migrants in managing their chronic health conditions in a Western host country. This paper reports on qualitative findings of a mixed methods study that used an explanatory sequential design. Nine focus group discussions were undertaken with 58 Filipino-Australian migrants with chronic disease. Thematic analysis was undertaken using a five-stage general purpose thematic framework ensuring that themes closely identified key participants' experiences . Findings revealed that health benefits provided by the health system in Australia were considered advantageous. However, a lack of social and instrumental support compounded isolation and disempowerment, limiting self-management strategies for chronic illnesses. Cultural beliefs and practices influenced their knowledge, attitude to and management of chronic disease, which health service providers overlooked because of perceived acculturation and English language skills. Overall this study has clearly identified recognition of cultural beliefs, language needs and support as three core needs of Filipino-Australian migrants with the elderly the most vulnerable. This paper highlights that self-management of chronic disease among elderly Filipino immigrants may be adversely affected by host language difficulties, a lack of social support and cultural issues, impacting on access to services, health-seeking behaviours and participation in health promotion initiatives. Language, culture-specific health interventions and resources and enhancing social support are likely important strategies in promoting chronic disease self-management among the elderly. These interventions have the potential to empower and encourage individuals to take control and better manage their chronic disease.

Chronic disease management for recently homeless Veterans: a clinical practice improvement program to apply home telehealth technology to a vulnerable population

PubMed Central

Gabrielian, Sonya; Yuan, Anita; Andersen, Ronald M.; McGuire, James; Rubenstein, Lisa; Sapir, Negar; Gelberg, Lillian

2013-01-01

Background Though vulnerable populations may benefit from in-home health information technologies (HIT) that promote disease self-management, there is a “digital divide” in which these groups are often unlikely to use such programs. We describe the early phases of applying and testing an existing Veterans Administration (VA) HIT care management program, Care Coordination Home Telehealth (CCHT), to recently homeless Veterans in the U.S. Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program. Peers were used to support patient participation. Methods CCHT uses in-home messaging devices to provide health education and daily questions about clinical indicators from chronic illness care guidelines, with patient responses reviewed by VA nurses. Patients could also receive adjunctive peer support. We used medical record review, Veteran interviews, and staff surveys to “diagnose” barriers to CCHT use, assess program acceptability, explore the role of peer support, and inform future quality improvement. Subjects Fourteen eligible Veterans in HUD-VASH agreed to CCHT participation. Ten of these Veterans opted to have adjunctive peer support and the other four enrolled in CCHT usual care. Results Though barriers to enrollment/engagement must be addressed, this subset of Veterans in HUD-VASH was satisfied with CCHT. Most Veterans did not require support from peers to engage in CCHT but valued peer social assistance amidst the isolation felt in their scattered-site homes. Conclusions HIT tools hold promise for in-home care management for recently housed Veterans. Patient-level barriers to enrollment must be addressed in the next steps of quality improvement, testing and evaluating peer-driven CCHT recruitment. PMID:23407011

Promoting dietary change among state health employees in Arkansas through a worksite wellness program: the Healthy Employee Lifestyle Program (HELP).

PubMed

Perez, Amanda Philyaw; Phillips, Martha M; Cornell, Carol E; Mays, Glen; Adams, Becky

2009-10-01

Maintaining a healthy and productive workforce is essential for employers in public and private sectors. Poor nutrition and obesity contribute to chronic diseases and influence health care costs and productivity. Research indicates that eating a healthy diet is associated with lower body mass index and reduced risk for developing chronic disease. The Arkansas Department of Health implemented the Healthy Employee Lifestyle Program to encourage wellness among state health employees. During the pilot year, participants completed a health risk assessment at baseline and again after 1 year that assessed diet and physical activity, other health risk factors, and readiness to make behavioral changes. Participants were encouraged to eat healthfully, participate in regular exercise, report health behaviors using a Web-based reporting system, accumulate points for healthy behaviors, and redeem points for incentives. Differences in participants' (n = 214) reported dietary behaviors between baseline and follow-up were assessed using chi2 analyses and tests of symmetry. Consumption of sweets/desserts, fats, protein, grains, processed meats, and dairy did not differ significantly from baseline to follow-up. However, at follow-up more participants reported eating 3 or more fruits and vegetables per day than at baseline and being in the action and maintenance stages of readiness to change for eating 5 or more fruits and vegetables per day and for eating a diet low in fat. Further study is needed to examine physical activity and other health risk factors to determine whether the program merits a broader dissemination.

A training program for nurse scientists to promote intervention translation.

PubMed

Santacroce, Sheila Judge; Leeman, Jennifer; Song, Mi-Kyung

To reduce the burden of chronic illness, prevention and management interventions must be efficacious, adopted and implemented with fidelity, and reach those at greatest risk. Yet, many research-tested interventions are slow to translate into practice. This paper describes how The University of North Carolina at Chapel Hill School of Nursing's NINR-funded institutional pre- and postdoctoral research-training program is addressing the imperative to speed knowledge translation across the research cycle. The training emphasizes six research methods ("catalysts") to speed translation: stakeholder engagement, patient-centered outcomes, intervention optimization and sequential multiple randomized trials (SMART), pragmatic trials, mixed methods approaches, and dissemination and implementation science strategies. Catalysts are integrated into required coursework, biweekly scientific and integrative seminars, and experiential research training. Trainee and program success is evaluated based on benchmarks applicable to all PhD program students, supplemented by indicators specific to the catalysts. Trainees must also demonstrate proficiency in at least two of the six catalysts in their scholarly products. Proficiency is assessed through their works in progress presentations and peer reviews at T32 integrative seminars. While maintaining the emphasis on theory-based interventions, we have integrated six catalysts into our ongoing research training to expedite the dynamic process of intervention development, testing, dissemination and implementation. Through a variety of training activities, our research training focused on theory-based interventions and the six catalysts will generate future nurse scientists who speed translation of theory-based interventions into practice to maximize health outcomes for patients, families, communities and populations affected by chronic illness. Copyright © 2017 Elsevier Inc. All rights reserved.

Longitudinal Model Predicting Self-Concept in Pediatric Chronic Illness.

PubMed

Emerson, Natacha D; Morrell, Holly E R; Neece, Cameron; Tapanes, Daniel; Distelberg, Brian

2018-04-16

Although self-concept has been identified as salient to the psychosocial adjustment of adolescents dealing with a chronic illness (CI), little research has focused on its predictors it. Given that depression and parent-child attachment have been linked to self-concept in the population at large, the goal of this study was to evaluate these relationships longitudinally in a sample of adolescents with CI. Using participant data from the Mastering Each New Direction (MEND) program, a 3-month psychosocial, family based intensive outpatient program for adolescents with CI, we employed multilevel modeling to test longitudinal changes in self-concept, as predicted by depressive symptoms and parent-child attachment, in a sample of 50 youths (M age  = 14.56, SD age  = 1.82) participating in MEND. Both "time spent in the program" and decreases in depressive symptoms were associated with increases in self-concept over time. Higher baseline levels of avoidant attachment to both mother and father were also associated with greater initial levels of self-concept. Targeting depressive symptoms and supporting adaptive changes in attachment may be key to promoting a healthy self-concept in pediatric CI populations. The association between avoidant attachment and higher baseline self-concept scores may reflect differences in participants' autonomy, self-confidence, or depression. Limitations of the study include variability in the amount of time spent in the program, attrition in final time point measures, and the inability to fully examine and model all potential covariates due to a small sample size (e.g. power). © 2018 Family Process Institute.

Cardiovascular disease prevention in low resource settings: lessons from the Heartfile experience in Pakistan.

PubMed

Nishtar, Sania

2003-01-01

This paper outlines activities of the Heartfile Program in Pakistan (http://heartfile.org). The program focuses on cardiovascular disease prevention and health promotion, and includes several initiatives that encompass building policy, reorienting health services, and developing community interventions that utilize the print and electronic media and outreach at the grass-root level to incorporate social marketing approaches. Initiated by the nonprofit private sector, the program now links with major public sector primary healthcare programs, and is currently spearheading formulation of the National Action Plan on Noncommunicable Disease Prevention and Control in Pakistan. In addition, the program is being refined, validated, and packaged as a replicable model for other developing countries and in low resource settings, utilizing appropriate principles of franchising with inbuilt components sensitive to cultural and social adaptations. A review of the planning process, implementation strategy, and fund-raising experience is presented. Strategies unique to low resource settings, such as the development of cost- and time-efficient strategic alliances and partnerships, have also been highlighted. In addition, specific caveats are identified as being helpful to private sector development of chronic disease prevention programs in resource-constrained settings, and a road map to a sustainable public-private sector partnership is provided.

Mentoring the Next Generation of Social Workers in Palliative and End-of-Life Care: The Zelda Foster Studies Program.

PubMed

Gardner, Daniel S; Gerbino, Susan; Walls, Jocelyn Warner; Chachkes, Esther; Doherty, Meredith J

2015-01-01

As Americans live longer with chronic illnesses, there is a growing need for social workers with the knowledge and skills to deliver quality palliative care to older adults and their families. Nevertheless, there remains a critical shortage of social workers prepared to provide quality palliative and end-of-life care (PELC) and to maintain the field into the next generation. Formal mentorship programs represent an innovative approach to enhancing practice, providing support and guidance, and promoting social work leadership in the field. This article reviews the literature on mentorship as an approach to professional and leadership development for emerging social workers in PELC. The Zelda Foster Studies Program in Palliative and End-of-Life Care bolsters competencies and mentors social workers in PELC over the trajectory of their careers, and enhances the capacity in the field. Findings from the first six years of two components of the ZF Program are examined to illustrate the feasibility, benefits, and challenges of formal mentorship programs. The authors describe the background, structure, and evaluation of the initiative's mentorship programs, and discuss the implications of mentorship in PELC for social work education, practice, and research.

Hypothalamic inflammation and the central nervous system control of energy homeostasis.

PubMed

Pimentel, Gustavo D; Ganeshan, Kirthana; Carvalheira, José B C

2014-11-01

The control of energy homeostasis relies on robust neuronal circuits that regulate food intake and energy expenditure. Although the physiology of these circuits is well understood, the molecular and cellular response of this program to chronic diseases is still largely unclear. Hypothalamic inflammation has emerged as a major driver of energy homeostasis dysfunction in both obesity and anorexia. Importantly, this inflammation disrupts the action of metabolic signals promoting anabolism or supporting catabolism. In this review, we address the evidence that favors hypothalamic inflammation as a factor that resets energy homeostasis in pathological states. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study

PubMed Central

2013-01-01

Background The number of chronically ill patients increases every year. This is partly due to an unhealthy lifestyle. However, the frequency and quality of (evidence-based) health promotion activities conducted by Dutch general practitioners (GPs) and practice nurses (PNs) are limited. The aim of this pilot study was to explore which lifestyle interventions Dutch GPs and PNs carry out in primary care, which barriers and facilitators can be identified and what main topics are with respect to attitudes towards health promoting activities. These topic areas will be identified for a future, larger scale study. Method This qualitative study consisted of 25 semi-structured interviews with sixteen GPs and nine PNs. ATLAS.ti was used to analyse the transcripts of the interviews. Results All GPs and PNs said they discuss lifestyle with their patients. Next to this, GPs and PNs counsel patients, and/or refer them to other disciplines. Only few said they refer patients to specific lifestyle programs or interventions in their own practice or in the neighbourhood. Several barriers and facilitators were identified. The main topics as barriers are: a lack of patients’ motivation to make lifestyle changes, insufficient reimbursement, a lack of proven effectiveness of interventions and a lack of overview of health promoting programs in their neighbourhood. The most cited facilitators are availability of a PN, collaboration with other disciplines and availability of interventions in their own practice. With respect to attitudes, six different types of GPs were identified reflecting the main topics that relate to attitudes, varying from ‘ignorer’ to ‘nurturer’. The topics relating to PNs attitudes towards health promotion activities, were almost unanimously positive. Conclusion GPs and PNs all say they discuss lifestyle issues with their patients, but the health promotion activities that are organized in their practice vary. Main topics that hinder or facilitate implementation are identified, including those that relate to attitudes of GPs and PNs. PMID:23394162

Obstructive sleep apnoea in adults: a common chronic condition in need of a comprehensive chronic condition management approach.

PubMed

Heatley, Emer M; Harris, Melanie; Battersby, Malcolm; McEvoy, R Doug; Chai-Coetzer, Ching Li; Antic, Nicholas A

2013-10-01

Obstructive sleep apnoea (OSA) is a common disorder that has all the characteristics of a chronic condition. As with other chronic conditions, OSA requires ongoing management of treatments and problems, such as residual symptoms, deficits and co-morbidities. Also, many OSA patients have modifiable lifestyle factors that contribute to their disease, which could be improved with intervention. As health systems are in the process of developing more comprehensive chronic care structures and supports, tools such as chronic condition management programs are available to enable OSA patients and their health care providers to further engage and collaborate in health management. This review explains why the OSA patient group requires a more comprehensive approach to disease management, describes the chronic care model as a platform for management of chronic conditions, and assesses the suitability of particular chronic disease management programs in relation to the needs of the OSA population. Implementation of an evidence-based health-professional-led chronic condition management program into OSA patient care is likely to provide a context in which health risks are properly acknowledged and addressed. Such programs present an important opportunity to enable more optimal health outcomes than is possible by device-focused management alone. Copyright © 2012 Elsevier Ltd. All rights reserved.

MGMT and MLH1 methylation in Helicobacter pylori-infected children and adults.

PubMed

Alvarez, Marisa C; Santos, Juliana C; Maniezzo, Nathália; Ladeira, Marcelo S; da Silva, Artur L C; Scaletsky, Isabel C A; Pedrazzoli, José; Ribeiro, Marcelo L

2013-05-28

To evaluate the association between Helicobacter pylori (H. pylori) infection and MLH1 and MGMT methylation and its relationship with microsatellite instability (MSI). The methylation status of the MLH1 and MGMT promoter region was analysed by methylation specific methylation-polymerase chain reaction (MSP-PCR) in gastric biopsy samples from uninfected or H. pylori-infected children (n = 50), from adults with chronic gastritis (n = 97) and from adults with gastric cancer (n = 92). MLH1 and MGMT mRNA expression were measured by real-time PCR and normalised to a constitutive gene (β actin). MSI analysis was performed by screening MSI markers at 4 loci (Bat-25, Bat-26, D17S250 and D2S123) with PCR; PCR products were analysed by single strand conformation polymorphism followed by silver staining. Statistical analyses were performed with either the χ(2) test with Yates continuity correction or Fisher's exact test, and statistical significance for expression analysis was assessed using an unpaired Student's t-test. Methylation was not detected in the promoter regions of MLH1 and MGMT in gastric biopsy samples from children, regardless of H. pylori infection status. The MGMT promoter was methylated in 51% of chronic gastritis adult patients and was associated with H. pylori infection (P < 0.05); this region was methylated in 66% of gastric cancer patients, and the difference in the percentage of methylated samples between these patients and those from H. pylori-infected chronic gastritis patients was statistically significant (P < 0.05). MLH1 methylation frequencies among H. pylori-infected and non-infected chronic gastritis adult patients were 13% and 7%, respectively. We observed methylation of the MLH1 promoter (39%) and increased MSI levels (68%) in samples from gastric cancer patients in comparison to samples from H. pylori-infected adult chronic gastritis patients (P < 0.001 and P < 0.01, respectively). The frequency of promoter methylation for both genes was higher in gastric cancer samples than in H. pylori-positive chronic gastritis samples (P < 0.05). The levels of MLH1 and MGMT mRNA were significantly reduced in chronic gastritis samples that were also hypermethylated (P < 0.01). In summary, MGMT and MLH1 methylation did not occur in earlier-stage H. pylori infections and thus might depend on the duration of infection.

Exercise program adherence using a 5-kilometer (5K) event as an achievable goal in people with schizophrenia.

PubMed

Warren, Kimberly R; Ball, M Patricia; Feldman, Stephanie; Liu, Fang; McMahon, Robert P; Kelly, Deanna L

2011-10-01

People with schizophrenia have a higher prevalence of obesity than the general population. Many people with this illness struggle with weight gain, due, in part, to medications and other factors that act as obstacles to exercise and healthy eating. Several studies have shown the benefits of behavioral weight loss programs targeting eating and/or exercise in people with schizophrenia. Fewer studies have used competitive events as a goal for an exercise program. The current study tested the feasibility of preparing, using an exercise program, for a 5-kilometer (5K) event in people with schizophrenia. The exercise program was a 10-week training program consisting of three supervised walking/jogging sessions per week and a weekly educational meeting on healthy behaviors. Almost 65% (11/17) of the subjects participated in all of the training sessions, and 82% (14/17) participated in the 5K event. Participants did not gain a significant amount of weight during the exercise program (median weight change = 0.7 kg; 25th percentile 0.5, 75th percentile 3.9, p = .10). This study suggests that using an achievable goal, such as a 5K event, promotes adherence to an exercise program and is feasible in a population of people with chronic schizophrenia.

Theory in Chronic Disease Prevention and Health Promotion

ERIC Educational Resources Information Center

Hall, Michael; Elise, Eifert

2016-01-01

Morbidity and mortality related to chronic diseases are a primary concern of health professionals, including Health Educators. According to the Centers for Disease Control and Prevention, over one half of the adult population in the United States suffer from one or more chronic conditions. Understanding the health risk behaviors that contribute to…

Chronic Spinal Injury Repair by Olfactory Bulb Ensheathing Glia and Feasibility for Autologous Therapy

PubMed Central

Muñoz-Quiles, Cintia; Santos-Benito, Fernando F.; Llamusí, M. Beatriz; Ramón-Cueto, Almudena

2009-01-01

Olfactory bulb ensheathing glia (OB-OEG) promote repair of spinal cord injury (SCI) in rats after transplantation at acute or subacute (up to 45 days) stages. The most relevant clinical scenario in humans, however, is chronic SCI, in which no more major cellular or molecular changes occur at the injury site; this occurs after the third month in rodents. Whether adult OB-OEG grafts promote repair of severe chronic SCI has not been previously addressed. Rats with complete SCI that were transplanted with OB-OEG 4 months after injury exhibited progressive improvement in motor function and axonal regeneration from different brainstem nuclei across and beyond the SCI site. A positive correlation between motor outcome and axonal regeneration suggested a role for brainstem neurons in the recovery. Functional and histological outcomes did not differ at subacute or chronic stages. Thus, autologous transplantation is a feasible approach as there is time for patient stabilization and OEG preparation in human chronic SCI; the healing effects of OB-OEG on established injuries may offer new therapeutic opportunities for chronic SCI patients. PMID:19915486

Is "disease management" the answer to our problems? No! Population health management and (disease) prevention require "management of overall well-being".

PubMed

Cramm, Jane Murray; Nieboer, Anna Petra

2016-09-21

Disease management programs based on the chronic care model have achieved successful and long-term improvement in the quality of chronic care delivery and patients' health behaviors and physical quality of life. However, such programs have not been able to maintain or improve broader self-management abilities or social well-being, which decline over time in chronically ill patients. Disease management efforts, population health management initiatives and innovative primary care solutions are still mainly focused on clinical and functional outcomes and health behaviors (e.g., smoking cessation, exercise, and diet) failing to address individuals' overall quality of life and well-being. Individuals' ability to achieve well-being can be assessed with great specificity through the application of social production function (SPF) theory. This theory asserts that people produce their own well-being by trying to optimize the achievement of instrumental goals (stimulation, comfort, status, behavioral confirmation, affection) that provide the means to achieve the larger, universal goals of physical and social well-being. A shift in focus from the management of physical function, disease limitations, and lifestyle behaviors alone to an approach that fosters self-management abilities such as self-efficacy and resource investment as well as overall quality of life, is urgently needed. Disease management interventions should be aimed at adequately addressing all difficulties chronically ill patients face in life, such as the effects of pain and fatigue on the ability to maintain a job and social life and to participate in activities promoting physical and social well-being. Patients' ability to maintain engagement in stimulating work and social activities with the people who are important to them may be even more important than aspects of disease self-management such as blood pressure or glycemic control. Interventions should aim to make chronically ill patients capable of managing their own well-being and adequately addressing their needs in a broader sense. So, is disease management the answer to our problems in the time of aging populations and increased prevalence of unhealthy lifestyles, chronic illnesses, and comorbidity? No! Effective (disease) prevention, disease management, patient-centered care, and high-quality chronic care and/or population health management calls for management of overall well-being.

Innovation in survivor care: group visits.

PubMed

Trotter, Kathryn; Frazier, Alana; Hendricks, Colleen K; Scarsella, Heidi

2011-04-01

The Centering Cancer Survivorship (CCS) follow-up care program is an innovation in healthcare delivery that meets the needs of cancer survivors and cancer centers. Piloted in a breast cancer clinic, the program provides an avenue for provision of psychological support and health-promotion activities, as well as surveillance for recurrence or late effects. The program empowers each survivor by enlisting her to produce a written breast cancer survivorship care plan for personal use and to share with her primary care provider. Concurrently, this innovation should enhance the viability of the primary cancer center by freeing appointment slots for oncologists who provide expensive therapies to newly diagnosed patients. The CCS program's central feature is the implementation of a multidisciplinary clinic designated specifically for breast cancer survivors in which follow-up care is provided through a group visit medical model. This model of care provides opportunities for health assessment, patient empowerment, and patient education within a framework of social support from peers with similar issues. The group visit model may be well suited to addressing the unique chronic healthcare needs of breast cancer survivors. Further evaluation is needed to verify cost-benefit analysis.

Understanding social forces involved in diabetes outcomes: a systems science approach to quality-of-life research.

PubMed

Lounsbury, David W; Hirsch, Gary B; Vega, Chawntel; Schwartz, Carolyn E

2014-04-01

The field of quality-of-life (QOL) research would benefit from learning about and integrating systems science approaches that model how social forces interact dynamically with health and affect the course of chronic illnesses. Our purpose is to describe the systems science mindset and to illustrate the utility of a system dynamics approach to promoting QOL research in chronic disease, using diabetes as an example. We build a series of causal loop diagrams incrementally, introducing new variables and their dynamic relationships at each stage. These causal loop diagrams demonstrate how a common set of relationships among these variables can generate different disease and QOL trajectories for people with diabetes and also lead to a consideration of non-clinical (psychosocial and behavioral) factors that can have implications for program design and policy formulation. The policy implications of the causal loop diagrams are discussed, and empirical next steps to validate the diagrams and quantify the relationships are described.

Mentorship and competencies for applied chronic disease epidemiology.

PubMed

Lengerich, Eugene J; Siedlecki, Jennifer C; Brownson, Ross; Aldrich, Tim E; Hedberg, Katrina; Remington, Patrick; Siegel, Paul Z

2003-01-01

To understand the potential and establish a framework for mentoring as a method to develop professional competencies of state-level applied chronic disease epidemiologists, model mentorship programs were reviewed, specific competencies were identified, and competencies were then matched to essential public health services. Although few existing mentorship programs in public health were identified, common themes in other professional mentorship programs support the potential of mentoring as an effective means to develop capacity for applied chronic disease epidemiology. Proposed competencies for chronic disease epidemiologists in a mentorship program include planning, analysis, communication, basic public health, informatics and computer knowledge, and cultural diversity. Mentoring may constitute a viable strategy to build chronic disease epidemiology capacity, especially in public health agencies where resource and personnel system constraints limit opportunities to recruit and hire new staff.

Inventory and perspectives of chronic disease management programs in Switzerland: an exploratory survey.

PubMed

Peytremann-Bridevaux, Isabelle; Burnand, Bernard

2009-10-07

To describe chronic disease management programs active in Switzerland in 2007, using an exploratory survey. We searched the internet (Swiss official websites and Swiss web-pages, using Google), a medical electronic database (Medline), reference lists of pertinent articles, and contacted key informants. Programs met our operational definition of chronic disease management if their interventions targeted a chronic disease, included a multidisciplinary team (>/=2 healthcare professionals), lasted at least six months, and had already been implemented and were active in December 2007. We developed an extraction grid and collected data pertaining to eight domains (patient population, intervention recipient, intervention content, delivery personnel, method of communication, intensity and complexity, environment, clinical outcomes). We identified seven programs fulfilling our operational definition of chronic disease management. Programs targeted patients with diabetes, hypertension, heart failure, obesity, psychosis and breast cancer. Interventions were multifaceted; all included education and half considered planned follow-ups. The recipients of the interventions were patients, and healthcare professionals involved were physicians, nurses, social workers, psychologists and case managers of various backgrounds. In Switzerland, a country with universal healthcare insurance coverage and little incentive to develop new healthcare strategies, chronic disease management programs are scarce. For future developments, appropriate evaluations of existing programs, involvement of all healthcare stakeholders, strong leadership and political will are, at least, desirable.

Nutrition knowledge of rural older populations: can congregate meal site participants manage their own diets?

PubMed

Thomas, Lionel; Almanza, Barbara; Ghiselli, Richard

2010-07-01

Congregate meal sites were funded to assist socioeconomically disadvantaged, rural older individuals in improving their health-related practices. Although the participants in the program are largely female, the meals are designed to meet one third of the daily caloric intake of a 70-year-old male, and to satisfy his recommended dietary allowances for total fat, fiber, calcium, and sodium. The actual percentage of the required nutrient intake contributed by meals served at congregate sites is indefinite. Moreover, the ability of congregate meal participants to manage their diets and their receptiveness to helpful nutrition information in that regard is unknown. Our objective was to promote nutritional knowledge in economically disadvantaged, rural older participants by studying its impact on their ability to benefit from congregate meal programs. We used a test, intervention, retest methodology to examine the effect of short-term nutrition interventions on congregate meal site participants' nutrition knowledge. The objective was to determine the participants' potential for managing their own diets (e.g., their ability to determine what diet behaviors are appropriate for specific chronic conditions). We found that while congregate meal site participants have knowledge of nutrition recommendations, their ability to apply this information in helping themselves to prevent or control their chronic conditions remains in question.

Potential Savings of Harmonising Hospital and Community Formularies for Chronic Disease Medications Initiated in Hospital

PubMed Central

Lapointe-Shaw, Lauren; Fischer, Hadas D.; Newman, Alice; John-Baptiste, Ava; Anderson, Geoffrey M.; Rochon, Paula A.; Bell, Chaim M.

2012-01-01

Background Hospitals in Canada manage their formularies independently, yet many inpatients are discharged on medications which will be purchased through publicly-funded programs. We sought to determine how much public money could be saved on chronic medications if hospitals promoted the initiation of agents with the lowest outpatient formulary prices. Methods We used administrative databases for the province of Ontario to identify patients initiated on a proton pump inhibitor (PPI), angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) following hospital admission from April 1st 2008-March 31st 2009. We assessed the cost to the Ontario Drug Benefit Program (ODB) over the year following initiation and determined the cost savings if prescriptions were substituted with the least expensive agent in each class. Results The cost for filling all PPI, ACE inhibitor and ARB prescriptions was $ 2.48 million, $968 thousand and $325 thousand respectively. Substituting the least expensive agent could have saved $1.16 million (47%) for PPIs, $162 thousand (17%) for ACE inhibitors and $14 thousand (4%) for ARBs over the year following discharge. Interpretation In a setting where outpatient prescriptions are publicly funded, harmonising outpatient formularies with inpatient therapeutic substitution resulted in modest cost savings and may be one way to control rising pharmaceutical costs. PMID:22761882

Potential savings of harmonising hospital and community formularies for chronic disease medications initiated in hospital.

PubMed

Lapointe-Shaw, Lauren; Fischer, Hadas D; Newman, Alice; John-Baptiste, Ava; Anderson, Geoffrey M; Rochon, Paula A; Bell, Chaim M

2012-01-01

Hospitals in Canada manage their formularies independently, yet many inpatients are discharged on medications which will be purchased through publicly-funded programs. We sought to determine how much public money could be saved on chronic medications if hospitals promoted the initiation of agents with the lowest outpatient formulary prices. We used administrative databases for the province of Ontario to identify patients initiated on a proton pump inhibitor (PPI), angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) following hospital admission from April 1(st) 2008-March 31(st) 2009. We assessed the cost to the Ontario Drug Benefit Program (ODB) over the year following initiation and determined the cost savings if prescriptions were substituted with the least expensive agent in each class. The cost for filling all PPI, ACE inhibitor and ARB prescriptions was $ 2.48 million, $968 thousand and $325 thousand respectively. Substituting the least expensive agent could have saved $1.16 million (47%) for PPIs, $162 thousand (17%) for ACE inhibitors and $14 thousand (4%) for ARBs over the year following discharge. In a setting where outpatient prescriptions are publicly funded, harmonising outpatient formularies with inpatient therapeutic substitution resulted in modest cost savings and may be one way to control rising pharmaceutical costs.

Integrating physical activity into mental health services for persons with serious mental illness.

PubMed

Richardson, Caroline R; Faulkner, Guy; McDevitt, Judith; Skrinar, Gary S; Hutchinson, Dori S; Piette, John D

2005-03-01

This article reviews evidence supporting the need for interventions to promote physical activity among persons with serious mental illness. Principles of designing effective physical activity interventions are discussed along with ways to adapt such interventions for this population. Individuals with serious mental illness are at high risk of chronic diseases associated with sedentary behavior, including diabetes and cardiovascular disease. The effects of lifestyle modification on chronic disease outcomes are large and consistent across multiple studies. Evidence for the psychological benefits for clinical populations comes from two meta-analyses of outcomes of depressed patients that showed that effects of exercise were similar to those of psychotherapeutic interventions. Exercise can also alleviate secondary symptoms such as low self-esteem and social withdrawal. Although structured group programs can be effective for persons with serious mental illness, especially walking programs, lifestyle changes that focus on accumulation of moderate-intensity activity throughout the day may be most appropriate. Research suggests that exercise is well accepted by people with serious mental illness and is often considered one of the most valued components of treatment. Adherence to physical activity interventions appears comparable to that in the general population. Mental health service providers can provide effective, evidence-based physical activity interventions for individuals with serious mental illness.

The efficacy of a senior outreach program in the reduction of hospital readmissions and emergency department visits among chronically ill seniors.

PubMed

Prior, Michael K; Bahret, Beverly A; Allen, Reva I; Pasupuleti, Sudershan

2012-01-01

This study reports on the effectiveness of a community-based senior outreach program in decreasing rehospitalizations and emergency department visits among chronically ill seniors. Participants had been repeatedly hospitalized with chronic illnesses and were subsequently served in an in-home program designed to address their psychosocial and medical needs. Participation in the program was found to be related to lower hospital readmission rates and emergency department usage. Clients also reported decreased financial concerns and depression and anxiety and increased social support. The study adds to the growing body of work supporting community-based programs as effective strategies for decreasing health care usage and improving quality of life for chronically ill seniors.

Conserved region C functions to regulate PD-1 expression and subsequent CD8 T cell memory1

PubMed Central

Bally, Alexander P. R.; Tang, Yan; Lee, Joshua T.; Barwick, Benjamin G.; Martinez, Ryan; Evavold, Brian D.; Boss, Jeremy M.

2016-01-01

Expression of programmed death 1 (PD-1) on CD8 T cells promotes T cell exhaustion during chronic antigen exposure. During acute infections, PD-1 is transiently expressed and has the potential to modulate CD8 T cell memory formation. Conserved Region C (CR-C), a promoter proximal cis-regulatory element that is critical to PD-1 expression in vitro, responds to NFATc1, FoxO1, and/or NF-κB signaling pathways. Here, a CR-C knockout mouse (CRC−) was established to determine its role on PD-1 expression and corresponding effects on T cell function in vivo. Deletion of CR-C decreased PD-1 expression on CD4 T cells and antigen-specific CD8 T cells during acute and chronic lymphocytic choriomeningitis virus (LCMV) challenges, but did not affect the ability to clear an infection. Following acute LCMV infection, memory CD8 T cells in the CRC− mouse were formed in greater numbers, were more functional, and were more effective at responding to a melanoma tumor than wild-type memory cells. These data implicate a critical role for CR-C in governing PD-1 expression, and a subsequent role in guiding CD8 T cell differentiation. The data suggest the possibility that titrating PD-1 expression during CD8 T cell activation could have important ramifications in vaccine development and clinical care. PMID:27895178

Autoreactive T Cells and Chronic Fungal Infection Drive Esophageal Carcinogenesis

PubMed Central

Zhu, Feng; Willette-Brown, Jami; Song, Na-Young; Lomada, Dakshayani; Song, Yongmei; Xue, Liyan; Gray, Zane; Zhao, Zitong; Davis, Sean R.; Sun, Zhonghe; Zhang, Peilin; Wu, Xiaolin; Zhan, Qimin; Richie, Ellen R.; Hu, Yinling

2018-01-01

SUMMARY Humans with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED), a T cell–driven autoimmune disease caused by impaired central tolerance, are susceptible to developing chronic fungal infection and esophageal squamous cell carcinoma (ESCC). However, the relationship between autoreactive T cells and chronic fungal infection in ESCC development remains unclear. We find that kinase-dead Ikkα knockin mice develop phenotypes reminiscent of APECED, including impaired central tolerance, autoreactive T cells, chronic fungal infection, and ESCCs expressing specific human ESCC markers. Using this model, we investigated the potential link between ESCC and fungal infection. Autoreactive CD4 T cells permit fungal infection and incite tissue injury and inflammation. Antifungal treatment or depletion of autoreactive CD4 T cells rescues, whereas oral fungal administration promotes, ESCC development. Inhibition of inflammation or EGFR activity decreases fungal burden. Importantly, fungal infection is highly associated with ESCCs in non-autoimmune human patients. Therefore, autoreactive T cells and chronic fungal infection, fostered by inflammation and epithelial injury, promote ESCC development. PMID:28407484

Food Insecurity and Chronic Disease123

PubMed Central

Laraia, Barbara A.

2013-01-01

Household food insecurity has been previously hypothesized to promote dependence on inexpensive, highly palatable foods that are energy dense. Such dependence, and the cyclical nature of having enough food in the beginning of the month followed by food scarcity at the end of the month, could lead to weight gain over a short period of time. Such dependence on energy-dense foods and weight gain may play a direct role in the development of chronic conditions. Other compounding factors that result from exposure to household food insecurity have been well described, including pathways by which stress promotes visceral fat accumulation and chronic disease. This symposium review paper summarizes the literature on the link between food insecurity and the following: 1) diet, 2) weight gain, and 3) chronic disease, especially among women. This paper also proposes a framework for considering how the lived experience of household food insecurity may potentiate the development of chronic disease by activating the stress response among individuals at critical developmental periods in a food-impoverished environment. PMID:23493536

MCP-1-mediated activation of microglia promotes white matter lesions and cognitive deficits by chronic cerebral hypoperfusion in mice.

PubMed

Yuan, Bangqing; Shi, Hui; Zheng, Kuang; Su, Zulu; Su, Hai; Zhong, Ming; He, Xuenong; Zhou, Changlong; Chen, Hao; Xiong, Qijiang; Zhang, Yi; Yang, Zhao

2017-01-01

Microglia activation played a vital role in the pathogenesis of white matter lesions (WMLs) by chronic cerebral hypoperfusion. In addition, hypoxia induced up-regulated expression of MCP-1, promotes the activation of microglia. However, the role of MCP-1-mediated microglia activation in chronic cerebral ischemia is still unknown. To explore that, chronic cerebral hypoperfusion model was established by permanent stenosis of bilateral common carotid artery in mice. The activation of microglia and the related signal pathway p38MAPK/PKC in white matter, and working memory of mice were observed. We found that stenosis of common carotid arteries could induce MCP-1-mediated activation of microglia through p38MAPK/PKC pathway and white matter lesions. Taken together, our findings represent a novel mechanism of MCP-1 involved in activation of microglia and provide a novel therapeutical strategy for chronic cerebral hypoperfusion. Copyright © 2016 Elsevier Inc. All rights reserved.

[Influence Mildrocard on the morfo-functional condition of cardio-respiratory system at patients with chronic heart failure with concomitant chronic obstructive pulmonary disease].

PubMed

Ignatenko, G A; Mukhin, I V; Faierman, A O; Pola, M K; Taktashov, G S; Goncharov, O M; Rybalko, G S; Volodkina, N O

2011-01-01

In paper influence of a cytoprotective drug "Mildrocard" on morfo-functional condition of cardiorespiratory system at patients with chronic heart failure with concomitant chronic obstructive pulmonary disease is estimated. It is established, that joining "Mildrocard" to complex therapy associated to pathology promotes reduction clinical display of heart failure, shows cardioprotective and pulmoprotective effects.

Nursing Activities for Patients With Chronic Disease in Primary Care Settings: A Practice Analysis.

PubMed

Poitras, Marie-Eve; Chouinard, Maud-Christine; Gallagher, Frances; Fortin, Martin

Nurses in primary care organizations play a central role for patients with chronic disease. Lack of clarity in role description may be associated with underutilization of nurse competencies that could benefit the growing population of patients with chronic disease. The purpose of the research was to describe nursing activities in primary care settings with patients with chronic disease. A Web-based survey was sent to nurses practicing in Family Medicine Groups in the Canadian Province of Québec. Participants rated the frequency with which they carried out nursing activities in five domains: (a) global assessment, (b) care and case management, (c) health promotion, (d) nurse-physician collaboration, and (e) planning services for patients with chronic disease. Findings were summarized with descriptive statistics (means, standard deviations, and ranges). The survey was completed by 266 of the 322 nurses who received the survey (82.6%). Activities in the health promotion and global assessment of the patient domains were carried out most frequently. Planning services for patients with chronic disease were least frequently performed. This study provides a broad description of nursing activities with patients with chronic disease in primary care. The findings provide a baseline for clinicians and researchers to document and improve nursing activities for optimal practice for patients with chronic disease.

7 CFR 1210.331 - Programs and projects.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., effectuation and administration of appropriate programs or projects for advertising and other sales promotion...; (d) A prohibition on advertising or other promotion programs that make any reference to private brand... PROMOTION PLAN Watermelon Research and Promotion Plan Research and Promotion § 1210.331 Programs and...

Program for the Chronically Ill.

ERIC Educational Resources Information Center

Schoenherr, Arline; Schnarr, Barbara

The program for chronically ill students in the Detroit public schools is described. Forms are presented listing needed information and implications for teachers of the following conditions: diabetes, sickle cell anemia, chronic renal failure, congenital heart disease, hemophilia, rheumatoid arthritis, asthma, leukemia, and cystic fibrosis. The…

Adenovirus-mediated HIF-1α gene transfer promotes repair of mouse airway allograft microvasculature and attenuates chronic rejection

PubMed Central

Jiang, Xinguo; Khan, Mohammad A.; Tian, Wen; Beilke, Joshua; Natarajan, Ramesh; Kosek, Jon; Yoder, Mervin C.; Semenza, Gregg L.; Nicolls, Mark R.

2011-01-01

Chronic rejection, manifested as small airway fibrosis (obliterative bronchiolitis [OB]), is the main obstacle to long-term survival in lung transplantation. Recent studies demonstrate that the airways involved in a lung transplant are relatively hypoxic at baseline and that OB pathogenesis may be linked to ischemia induced by a transient loss of airway microvasculature. Here, we show that HIF-1α mediates airway microvascular repair in a model of orthotopic tracheal transplantation. Grafts with a conditional knockout of Hif1a demonstrated diminished recruitment of recipient-derived Tie2+ angiogenic cells to the allograft, impaired repair of damaged microvasculature, accelerated loss of microvascular perfusion, and hastened denudation of epithelial cells. In contrast, graft HIF-1α overexpression induced via an adenoviral vector prolonged airway microvascular perfusion, preserved epithelial integrity, extended the time window for the graft to be rescued from chronic rejection, and attenuated airway fibrotic remodeling. HIF-1α overexpression induced the expression of proangiogenic factors such as Sdf1, Plgf, and Vegf, and promoted the recruitment of vasoreparative Tie2+ cells. This study demonstrates that a therapy that enhances vascular integrity during acute rejection may promote graft health and prevent chronic rejection. PMID:21606594

The Role of Macrophages in Acute and Chronic Wound Healing and Interventions to Promote Pro-wound Healing Phenotypes

PubMed Central

Krzyszczyk, Paulina; Schloss, Rene; Palmer, Andre; Berthiaume, François

2018-01-01

Macrophages play key roles in all phases of adult wound healing, which are inflammation, proliferation, and remodeling. As wounds heal, the local macrophage population transitions from predominantly pro-inflammatory (M1-like phenotypes) to anti-inflammatory (M2-like phenotypes). Non-healing chronic wounds, such as pressure, arterial, venous, and diabetic ulcers indefinitely remain in inflammation—the first stage of wound healing. Thus, local macrophages retain pro-inflammatory characteristics. This review discusses the physiology of monocytes and macrophages in acute wound healing and the different phenotypes described in the literature for both in vitro and in vivo models. We also discuss aberrations that occur in macrophage populations in chronic wounds, and attempts to restore macrophage function by therapeutic approaches. These include endogenous M1 attenuation, exogenous M2 supplementation and endogenous macrophage modulation/M2 promotion via mesenchymal stem cells, growth factors, biomaterials, heme oxygenase-1 (HO-1) expression, and oxygen therapy. We recognize the challenges and controversies that exist in this field, such as standardization of macrophage phenotype nomenclature, definition of their distinct roles and understanding which phenotype is optimal in order to promote healing in chronic wounds. PMID:29765329

77 FR 47394 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-08

...--New-- National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for... and Health Promotion, Division of Cancer Prevention and Control (DCPC). Through NCCCP, CDC supports... environmental changes to guide sustainable cancer control; (5) promote health equity as it relates to cancer...

75 FR 80734 - Chronic Beryllium Disease Prevention Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-23

... Disease Prevention Program AGENCY: Office of Health, Safety and Security, Department of Energy. ACTION... and comments on issues related to its current chronic beryllium disease prevention program. The... disease prevention program. DATES: All comments on the issues presented in this document must be received...

Chronic Alcohol Ingestion in Rats Alters Lung Metabolism, Promotes Lipid Accumulation, and Impairs Alveolar Macrophage Functions

PubMed Central

Romero, Freddy; Shah, Dilip; Duong, Michelle; Stafstrom, William; Hoek, Jan B.; Kallen, Caleb B.; Lang, Charles H.

2014-01-01

Chronic alcoholism impairs pulmonary immune homeostasis and predisposes to inflammatory lung diseases, including infectious pneumonia and acute respiratory distress syndrome. Although alcoholism has been shown to alter hepatic metabolism, leading to lipid accumulation, hepatitis, and, eventually, cirrhosis, the effects of alcohol on pulmonary metabolism remain largely unknown. Because both the lung and the liver actively engage in lipid synthesis, we hypothesized that chronic alcoholism would impair pulmonary metabolic homeostasis in ways similar to its effects in the liver. We reasoned that perturbations in lipid metabolism might contribute to the impaired pulmonary immunity observed in people who chronically consume alcohol. We studied the metabolic consequences of chronic alcohol consumption in rat lungs in vivo and in alveolar epithelial type II cells and alveolar macrophages (AMs) in vitro. We found that chronic alcohol ingestion significantly alters lung metabolic homeostasis, inhibiting AMP-activated protein kinase, increasing lipid synthesis, and suppressing the expression of genes essential to metabolizing fatty acids (FAs). Furthermore, we show that these metabolic alterations promoted a lung phenotype that is reminiscent of alcoholic fatty liver and is characterized by marked accumulation of triglycerides and free FAs within distal airspaces, AMs, and, to a lesser extent, alveolar epithelial type II cells. We provide evidence that the metabolic alterations in alcohol-exposed rats are mechanistically linked to immune impairments in the alcoholic lung: the elevations in FAs alter AM phenotypes and suppress both phagocytic functions and agonist-induced inflammatory responses. In summary, our work demonstrates that chronic alcohol ingestion impairs lung metabolic homeostasis and promotes pulmonary immune dysfunction. These findings suggest that therapies aimed at reversing alcohol-related metabolic alterations might be effective for preventing and/or treating alcohol-related pulmonary disorders. PMID:24940828

The Eating and Cooking Healthy (TEACH) Kitchen: A Research Protocol

PubMed Central

White, Sashia; Alva-Ruiz, Roberto; Chen, Lucia; Conger, Jason; Kuang, Christopher; Murphy, Cameron; Okashah, Najeah; Ollila, Eric; Smith, Selina A.; Ansa, Benjamin E.

2016-01-01

Background Diet-related chronic diseases, such as diabetes mellitus, hypertension, and hyperlipidemia have affected millions of individuals, resulting in disease-related complications and mortality. Strategies that may improve the outcome of chronic disease management include modification of lifestyle risk factors such as unhealthy diets. TEACH Kitchen is an experiential education program related to community nutrition, the goal of which is to teach patients management of chronic disease through dietary change. Methods Adults (n=144) ≥18 years old and their children (n=144) 7–17 years old will complete four 2-hour sessions. Components of each session will include brief nutrition education (20 min), an interactive cooking session (1 hr), and after-dinner discussion (40 min). Pre- and post-session questionnaires will be administered to all participants for self-reported demographics, knowledge, attitude, and beliefs about healthy nutrition. Medical records will be used to collect information about adult participants’ demographics and clinical indicators (hemoglobin A1c, lipid profile, blood pressure, weight, height, and body mass index [BMI]). Descriptive analyses will be performed to determine socio-demographic characteristics using frequencies and proportions for all categorical data, and means for continuous variables. T-tests and multiple logistic regression analysis will be accomplished to compare the differences in means. Results Differences in the pre- and post-session knowledge, attitude, and beliefs related to healthy eating will be evaluated for adults and children. The anticipated outcomes include enhanced education promoting healthy eating in the community, prevention of chronic disease complications related to poor diet, and prevention of obesity-related chronic diseases in children. Conclusions Enhancement of chronic disease management among patients, and the prevention of obesity among children, can be accomplished through healthy cooking and diet. PMID:28066831

Inflammatory stress promotes the development of obesity-related chronic kidney disease via CD36 in mice.

PubMed

Yang, Ping; Xiao, Yayun; Luo, Xuan; Zhao, Yunfei; Zhao, Lei; Wang, Yan; Wu, Tingting; Wei, Li; Chen, Yaxi

2017-07-01

Ectopic fat located in the kidney has emerged as a novel cause of obesity-related chronic kidney disease (CKD). In this study, we aimed to investigate whether inflammatory stress promotes ectopic lipid deposition in the kidney and causes renal injury in obese mice and whether the pathological process is mediated by the fatty acid translocase, CD36. High-fat diet (HFD) feeding alone resulted in obesity, hyperlipidemia, and slight renal lipid accumulation in mice, which nevertheless had normal kidney function. HFD-fed mice with chronic inflammation had severe renal steatosis and obvious glomerular and tubular damage, which was accompanied by increased CD36 expression. Interestingly, CD36 deficiency in HFD-fed mice eliminated renal lipid accumulation and pathological changes induced by chronic inflammation. In both human mesangial cells (HMCs) and human kidney 2 (HK2) cells, inflammatory stress increased the efficiency of CD36 protein incorporation into membrane lipid rafts, promoting FFA uptake and intracellular lipid accumulation. Silencing of CD36 in vitro markedly attenuated FFA uptake, lipid accumulation, and cellular stress induced by inflammatory stress. We conclude that inflammatory stress aggravates renal injury by activation of the CD36 pathway, suggesting that this mechanism may operate in obese individuals with chronic inflammation, making them prone to CKD. Copyright © 2017 by the American Society for Biochemistry and Molecular Biology, Inc.

Multidisciplinary management of heart failure just beginning in Japan.

PubMed

Sato, Yukihito

2015-09-01

The mortality associated with end-stage heart failure (HF) is high despite the development of new and increasingly effective drugs and non-pharmacological therapies. Repetitive hospitalizations predict fatal outcomes and each hospitalization should prompt individual conversations with the patient, the family, and the caregivers. A multidisciplinary disease management program promotes the education of patients and their families and modifies their behavior, with a view to ultimately improve the prognosis and quality of life. From the early to the late stages of HF, a multidisciplinary disease management program should be implemented. In Western societies this multidisciplinary management has long been debated and endorsed, in contrast to Japan, where it has just begun. In 2012, the Japanese Nursing Association launched a certification in chronic HF nursing. A Japanese version of HF disease management should soon be developed in its own social environment. Copyright © 2015. Published by Elsevier Ltd.

Mentoring new nurse practitioners to accelerate their development as primary care providers: a literature review.

PubMed

Harrington, Susan

2011-04-01

To provide a review of the literature regarding programs for mentoring new nurse practitioners (NPs) to accelerate their development as primary care providers. A search was conducted in PubMed, Ovid, CINAHL, and Cochrane Database of Systematic Reviews. There is currently a critical shortage of primary care providers and an aging population requiring management of chronic medical conditions. Although NPs are trained in health promotion, disease prevention, and medical management and are well equipped to treat patients in primary care, the work can be overwhelming to the novice NP. A mentoring program could help the new NP further develop competencies and capabilities as a provider. However, there is a gap in the literature concerning any mentoring programs for novice NPs. Nonetheless, the literature review has provided a mentoring definition, program models, desired characteristics of nurse mentors, and barriers to mentoring programs. It has also described the benefits, goals and outcomes of a mentoring relationship. These insights from the literature provide a foundation for future mentoring program development. A mentoring program for new NPs working in primary care could accelerate productivity, increase job satisfaction, and provide longevity in the primary care setting. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

Health benefits achieved through the Seventh-Day Adventist Wellness Challenge program.

PubMed

Kamieneski, R; Brown, C M; Mitchell, C; Perrin, K M; Dindial, K

2000-11-01

The Wellness Challenge program introduces the philosophy of the healing power of God and stresses the importance of developing a sense of spirituality in conjunction with the promotion of good health. To employ scientific rigor to the outcome measures of the Seventh-Day Adventist Wellness Challenge program. A 2-tailed, paired sample t test. East Pasco Medical Center in Zephyrhills, Fla. 165 participants. Presurvey, 21-day outpatient wellness intervention; postsurvey, 6 weeks after completion of the program. Changes in behaviors related to cigarette smoking, alcohol use, eating patterns, exercise, water consumption, rest, relaxation, and time spent outdoors, as well as demographic data. Statistically significant differences were found between the pre- and postprogram clinical and laboratory test results for the participants' blood pressure, weight, glucose levels, and cholesterol at .05 alpha. Furthermore, self-health improvements measured by a pre- and postsurvey response confirmed statistically significant improvement in participants' willingness to improve their lifestyle behaviors for a potentially greater quality of life. The Wellness Challenge program offers ways to reduce risk factors related to chronic disease while improving the quality of life within an adult population by allowing people to slowly incorporate newly acquired tools into their everyday life.

Association of Childhood Chronic Physical Aggression with a DNA Methylation Signature in Adult Human T Cells

PubMed Central

Guillemin, Claire; Vitaro, Frank; Côté, Sylvana M.; Hallett, Michael; Tremblay, Richard E.; Szyf, Moshe

2014-01-01

Background Chronic physical aggression (CPA) is characterized by frequent use of physical aggression from early childhood to adolescence. Observed in approximately 5% of males, CPA is associated with early childhood adverse environments and long-term negative consequences. Alterations in DNA methylation, a covalent modification of DNA that regulates genome function, have been associated with early childhood adversity. Aims To test the hypothesis that a trajectory of chronic physical aggression during childhood is associated with a distinct DNA methylation profile during adulthood. Methods We analyzed genome-wide promoter DNA methylation profiles of T cells from two groups of adult males assessed annually for frequency of physical aggression between 6 and 15 years of age: a group with CPA and a control group. Methylation profiles covering the promoter regions of 20 000 genes and 400 microRNAs were generated using MeDIP followed by hybridization to microarrays. Results In total, 448 distinct gene promoters were differentially methylated in CPA. Functionally, many of these genes have previously been shown to play a role in aggression and were enriched in biological pathways affected by behavior. Their locations in the genome tended to form clusters spanning millions of bases in the genome. Conclusions This study provides evidence of clustered and genome-wide variation in promoter DNA methylation in young adults that associates with a history of chronic physical aggression from 6 to 15 years of age. However, longitudinal studies of methylation during early childhood will be necessary to determine if and how this methylation variation in T cells DNA plays a role in early development of chronic physical aggression. PMID:24691403

Reward and motivation in pain and pain relief

PubMed Central

Navratilova, Edita; Porreca, Frank

2015-01-01

Pain is fundamentally unpleasant, a feature that protects the organism by promoting motivation and learning. Relief of aversive states, including pain, is rewarding. The aversiveness of pain, as well as the reward from relief of pain, is encoded by brain reward/motivational mesocorticolimbic circuitry. In this Review, we describe current knowledge of the impact of acute and chronic pain on reward/motivation circuits gained from preclinical models and from human neuroimaging. We highlight emerging clinical evidence suggesting that anatomical and functional changes in these circuits contribute to the transition from acute to chronic pain. We propose that assessing activity in these conserved circuits can offer new outcome measures for preclinical evaluation of analgesic efficacy to improve translation and speed drug discovery. We further suggest that targeting reward/motivation circuits may provide a path for normalizing the consequences of chronic pain to the brain, surpassing symptomatic management to promote recovery from chronic pain. PMID:25254980

Implications of Extracellular Matrix Production by Adipose Tissue-Derived Stem Cells for Development of Wound Healing Therapies.

PubMed

Hyldig, Kathrine; Riis, Simone; Pennisi, Cristian Pablo; Zachar, Vladimir; Fink, Trine

2017-05-31

The synthesis and deposition of extracellular matrix (ECM) plays an important role in the healing of acute and chronic wounds. Consequently, the use of ECM as treatment for chronic wounds has been of special interest-both in terms of inducing ECM production by resident cells and applying ex vivo produced ECM. For these purposes, using adipose tissue-derived stem cells (ASCs) could be of use. ASCs are recognized to promote wound healing of otherwise chronic wounds, possibly through the reduction of inflammation, induction of angiogenesis, and promotion of fibroblast and keratinocyte growth. However, little is known regarding the importance of ASC-produced ECM for wound healing. In this review, we describe the importance of ECM for wound healing, and how ECM production by ASCs may be exploited in developing new therapies for the treatment of chronic wounds.

Healthy and wellbeing activities' promotion using a Big Data approach.

PubMed

Gachet Páez, Diego; de Buenaga Rodríguez, Manuel; Puertas Sánz, Enrique; Villalba, María Teresa; Muñoz Gil, Rafael

2018-06-01

The aging population and economic crisis specially in developed countries have as a consequence the reduction in funds dedicated to health care; it is then desirable to optimize the costs of public and private healthcare systems, reducing the affluence of chronic and dependent people to care centers; promoting healthy lifestyle and activities can allow people to avoid chronic diseases as for example hypertension. In this article, we describe a system for promoting an active and healthy lifestyle for people and to recommend with guidelines and valuable information about their habits. The proposed system is being developed around the Big Data paradigm using bio-signal sensors and machine-learning algorithms for recommendations.

Small sustainable monetary incentives versus charitable donations to promote exercise: Rationale, design, and baseline data from a randomized pilot study.

PubMed

Williams, David M; Lee, Harold H; Connell, Lauren; Boyle, Holly; Emerson, Jessica; Strohacker, Kelley; Galárraga, Omar

2018-03-01

Regular physical activity (PA) enhances weight-loss and reduces risk of chronic disease. However, as few as 10% of U.S. adults engage in regular PA. Incentive programs to promote PA have shown some promise, but have typically used incentives that are too large to sustain over time and have not demonstrated habit formation or been tested in community settings. This report presents the rationale and design of a randomized pilot study testing the feasibility and preliminary efficacy of small monetary incentives for PA (n=25) versus charitable donations in the same amount (n=25) versus control (n=25) over 12months among 75 low-active but otherwise healthy adults at a local YMCA. Incentives are based on YMCA attendance, which is verified by electronic swipe card data and is the primary study outcome, with self-reported minutes/week of PA assessed as a secondary outcome. Incentives are intentionally small enough-$1/session, maximum of $5/week-such that they could be indefinitely sustained by community organizations, privately-owned health clubs, healthcare organizations, or employers (e.g., employer fitness facilities). Costs of the incentive program for the sponsoring organization may be partially offset by increases in membership resulting from the appeal of the program. Moreover, if efficacious, the charitable donation incentive program may have the added benefit of building social capital for the sponsoring organization and potentially serving as a tax write-off, thus further offsetting the cost of the incentives. Findings will also have implications for the use of financially sustainable community-based incentive programs for other health-related behaviors (e.g., weight loss, smoking). Copyright © 2018 Elsevier Inc. All rights reserved.

Effect of the adapted Virtual Reality cognitive training program among Chinese older adults with chronic schizophrenia: a pilot study.

PubMed

Chan, Christopher L F; Ngai, Elena K Y; Leung, Paul K H; Wong, Stephen

2010-06-01

To examine the effect of the adapted virtual reality cognitive training program in older adults with chronic schizophrenia. Older adults with chronic schizophrenia were recruited from a long-stay care setting and were randomly assigned into intervention (n = 12) and control group (n = 15). The intervention group received 10-session of VR program that consisted of 2 VR activities using IREX. The control group attended the usual programs in the setting. After the 10-session intervention, older adults with chronic schizophrenia preformed significantly better than control in overall cognitive function (p .000), and in two cognitive subscales: repetition (p .001) and memory (p .040). These participants engaged in the VR activities volitionally. No problem of cybersickness was observed. The results of the current study indicate that engaging in the adapted virtual reality cognitive training program offers the potential for significant gains in cognitive function of the older adults with chronic schizophrenia.

The effect of a telephone-based health coaching disease management program on Medicaid members with chronic conditions.

PubMed

Lin, Wen-Chieh; Chien, Hung-Lun; Willis, Georgianna; O'Connell, Elizabeth; Rennie, Kate Staunton; Bottella, Heather M; Ferris, Timothy G

2012-01-01

Despite the growing popularity of disease management programs for chronic conditions, evidence regarding the effect of these programs has been mixed. In addition, few peer-reviewed studies have examined the effect of these programs on publicly insured populations. To examine the effect of a telephone-based health coaching disease management program on healthcare utilization and expenditures in Medicaid members with chronic conditions. Using a difference-in-differences analysis, we examined changes in hospitalizations, emergency department (ED) visits, ambulatory care visits, and Medicaid expenditures among program members for 1 year before and 2 years after their enrollment compared with a matched comparison group. Medicaid members aged 18 to 64 with a diagnosis of qualifying chronic conditions and 2 acute health service events of hospitalizations and/or ED visits within a 12-month period. Changes in acute hospitalizations, ambulatory care visits, and Medicaid expenditures before and after program enrollment were similar between the 2 study groups. However, during the second year after enrollment, program members had a significantly smaller decrease in ED visits than the comparisons (8% in program members and 23% in comparisons, P value=0.03). Compared with a matched comparison group, the telephone-based health coaching disease management program did not demonstrate significant effects on healthcare utilization and expenditures in Medicaid members with chronic conditions.

Association Between IL-10 Gene Promoter Polymorphisms (-592 A/C, -819 T/C, -1082 A/G) and Susceptibility to HBV Infection in an Iranian Population.

PubMed

Moudi, Bita; Heidari, Zahra; Mahmoudzadeh-Sagheb, Hamidreza; Hashemi, Mohammad; Metanat, Malihe; Khosravi, Soheila; Farrokh, Parisa

2016-02-01

IL-10 can play a vital role in immune response against HBV. Three biallelic SNPs from the transcription start site control the transcription of the IL-10 gene. An association between susceptibility to HBV and IL-10 polymorphisms has been suggested in patients with HBV infection. The present study was designed to study the association between polymorphisms in interleukin-10 (-1082 A/G, -819 T/C and -592 A/C) promoter gene and chronic hepatitis B virus (HBV) infection. 221 chronically infected patients and 200 healthy control subjects were enrolled in the study. Three biallelic (-1082 A/G, -819 T/C and -592 A/C) polymorphisms in the IL-10 promoter gene were determined by PCR-RFLP method. Persistent HBV infection was associated with IL-10-1082 AG (P = 0.001) and GG (P = 0.004) genotypes and G (P = 0.000) allele. IL-10-819 T/C and -592 A/C genotype and allele frequencies did not show any correlation with the risk of chronic hepatitis B infection. These results suggest that polymorphisms in interleukin-10 gene promoter influence clinical outcome of HBV infection and susceptibility to HBV infection.

Interleukin-10 Overexpression Promotes Fas-Ligand-Dependent Chronic Macrophage-Mediated Demyelinating Polyneuropathy

PubMed Central

Dace, Dru S.; Khan, Aslam A.; Stark, Jennifer L.; Kelly, Jennifer; Cross, Anne H.; Apte, Rajendra S.

2009-01-01

Background Demyelinating polyneuropathy is a debilitating, poorly understood disease that can exist in acute (Guillain-Barré syndrome) or chronic forms. Interleukin-10 (IL-10), although traditionally considered an anti-inflammatory cytokine, has also been implicated in promoting abnormal angiogenesis in the eye and in the pathobiology of autoimmune diseases such as lupus and encephalomyelitis. Principal Findings Overexpression of IL-10 in a transgenic mouse model leads to macrophage-mediated demyelinating polyneuropathy. IL-10 upregulates ICAM-1 within neural tissues, promoting massive macrophage influx, inflammation-induced demyelination, and subsequent loss of neural tissue resulting in muscle weakness and paralysis. The primary insult is to perineural myelin followed by secondary axonal loss. Infiltrating macrophages within the peripheral nerves demonstrate a highly pro-inflammatory signature. Macrophages are central players in the pathophysiology, as in vivo depletion of macrophages using clodronate liposomes reverses the phenotype, including progressive nerve loss and paralysis. Macrophage-mediate demyelination is dependent on Fas-ligand (FasL)-mediated Schwann cell death. Significance These findings mimic the human disease chronic idiopathic demyelinating polyneuropathy (CIDP) and may also promote further understanding of the pathobiology of related conditions such as acute idiopathic demyelinating polyneuropathy (AIDP) or Guillain-Barré syndrome. PMID:19771172

Social stress induces neurovascular pathology promoting depression

PubMed Central

Menard, Caroline; Pfau, Madeline L.; Hodes, Georgia E.; Kana, Veronika; Wang, Victoria X.; Bouchard, Sylvain; Takahashi, Aki; Flanigan, Meghan E.; Aleyasin, Hossein; LeClair, Katherine B.; Janssen, William G.; Labonté, Benoit; Parise, Eric M.; Lorsch, Zachary S.; Golden, Sam A.; Heshmati, Mitra; Tamminga, Carol; Turecki, Gustavo; Campbell, Matthew; Fayad, Zahi; Tang, Cheuk Ying; Merad, Miriam; Russo, Scott J.

2017-01-01

Studies suggest that heightened peripheral inflammation contributes to the pathogenesis of major depressive disorder. We investigated the effect of chronic social defeat stress, a mouse model of depression, on blood-brain barrier (BBB) permeability and infiltration of peripheral immune signals. We found reduced expression of endothelial cell tight junction protein claudin-5 (cldn5) and abnormal blood vessel morphology in nucleus accumbens (NAc) of stress-susceptible but not resilient mice. CLDN5 expression was also decreased in NAc of depressed patients. Cldn5 down-regulation was sufficient to induce depression-like behaviors following subthreshold social stress while chronic antidepressant treatment rescued cldn5 loss and promoted resilience. Reduced BBB integrity in NAc of stress-susceptible or AAV-shRNA-cldn5-injected mice caused infiltration of peripheral cytokine interleukin-6 (IL-6) into brain parenchyma and subsequent expression of depression-like behaviors. These findings suggest that chronic social stress alters BBB integrity through loss of tight junction protein cldn5, promoting peripheral IL-6 passage across the BBB and depression. PMID:29184215

Sucralose Promotes Food Intake through NPY and a Neuronal Fasting Response.

PubMed

Wang, Qiao-Ping; Lin, Yong Qi; Zhang, Lei; Wilson, Yana A; Oyston, Lisa J; Cotterell, James; Qi, Yue; Khuong, Thang M; Bakhshi, Noman; Planchenault, Yoann; Browman, Duncan T; Lau, Man Tat; Cole, Tiffany A; Wong, Adam C N; Simpson, Stephen J; Cole, Adam R; Penninger, Josef M; Herzog, Herbert; Neely, G Gregory

2016-07-12

Non-nutritive sweeteners like sucralose are consumed by billions of people. While animal and human studies have demonstrated a link between synthetic sweetener consumption and metabolic dysregulation, the mechanisms responsible remain unknown. Here we use a diet supplemented with sucralose to investigate the long-term effects of sweet/energy imbalance. In flies, chronic sweet/energy imbalance promoted hyperactivity, insomnia, glucose intolerance, enhanced sweet taste perception, and a sustained increase in food and calories consumed, effects that are reversed upon sucralose removal. Mechanistically, this response was mapped to the ancient insulin, catecholamine, and NPF/NPY systems and the energy sensor AMPK, which together comprise a novel neuronal starvation response pathway. Interestingly, chronic sweet/energy imbalance promoted increased food intake in mammals as well, and this also occurs through an NPY-dependent mechanism. Together, our data show that chronic consumption of a sweet/energy imbalanced diet triggers a conserved neuronal fasting response and increases the motivation to eat. Copyright © 2016 Elsevier Inc. All rights reserved.

Disability management: organizational diversity and Dutch employment policy.

PubMed

Kopnina, Helen; Haafkens, Joke A

2010-06-01

While Human Resource Managers (HRM) and line managers could play a significant role in the prevention of job-related problems and in promotion of early job-continuation, it is not clear wether the chronically ill workers are recognized as a group. Unlike some other groups, distinguished by gender, age or ethnicity, those with chronic illness are less distinct and may not be included in diversity management programs. The aim of this research is to address theory and evidence in literature about the topic, as well as to inquire whether chronic illness of the employees is 'visible' in practice. For desk research, we used a systematic search strategy involving medical, statistical, management, and social science databases (Web of Science, MedLine, Pub Med, Psych Info, etc.). Research results are based on case studies conducted with the managers and HRM of government and commercial organizations between March 2007 and October 2008 and between October 2008 and April 2009. These case studies were based on open interviews and focus group sessions (for human resource departments) which were consequently analyzed using thematical analysis. For group sessions, we used concept mapping to collect information from two groups of HRM professionals and managers. Secondary analysis included thematic and content analysis of 'best practice' organizations carried out by the Dutch organization Gatekeeper. We have discovered that the chronically ill employees are largely invisible to HRM practitioners, line managers who do not always have the right instruments for implementation of the European or national frameworks. Most practitioners are unaware of the impact of chronic illness in their organizations and in employees work life.

Interferon-gamma promoter hypomethylation and increased expression in chronic periodontitis

PubMed Central

Zhang, Shaoping; Crivello, Antonino; Offenbacher, Steven; Moretti, Antonio; Paquette, David W.; Barros, Silvana P.

2011-01-01

Aim The goal of this investigation was to determine whether epigenetic modifications in the IFNG promoter are associated with an increase of IFNG transcription in different stages of periodontal diseases. Materials and Methods DNA was extracted from gingival biopsy samples collected from 47 total sites from 47 different subjects: 23 periodontally healthy sites, 12 experimentally induced gingivitis sites and 12 chronic periodontitis sites. Levels of DNA methylation within the IFNG promoter containing six CpG dinucleotides were determined using pyrosequencing technology. Interferon gamma mRNA expression was analysed by quantitative polymerase chain reactions using isolated RNA from part of the biological samples mentioned above. Results The methylation level of all six analysed CpG sites within the IFNG promoter region in the periodontitis biopsies {52% [interquartile range, IQR (43.8%, 63%)]} was significantly lower than periodontally healthy samples {62% [IQR (51.3%, 74%)], p =0.007} and gingivitis biopsies {63% [IQR (55%, 74%)], p =0.02}. The transcriptional level of IFNG in periodontitis biopsies was 1.96-fold and significantly higher than tissues with periodontal health (p =0.04). Although the mRNA level from experimental gingivitis samples exhibited an 8.5-fold increase as compared with periodontally healthy samples, no significant methylation difference was observed in experimental gingivitis sample. Conclusions A hypomethylation profile within IFNG promoter region is related to an increase of IFNG transcription present in the chronic periodontitis biopsies, while such an increase of IFNG in experimentally induced gingivitis seems independent of promoter methylation alteration. PMID:20958339

Cationic Antimicrobial Peptides Promote Microbial Mutagenesis and Pathoadaptation in Chronic Infections

PubMed Central

Limoli, Dominique H.; Rockel, Andrea B.; Host, Kurtis M.; Jha, Anuvrat; Kopp, Benjamin T.; Hollis, Thomas; Wozniak, Daniel J.

2014-01-01

Acquisition of adaptive mutations is essential for microbial persistence during chronic infections. This is particularly evident during chronic Pseudomonas aeruginosa lung infections in cystic fibrosis (CF) patients. Thus far, mutagenesis has been attributed to the generation of reactive species by polymorphonucleocytes (PMN) and antibiotic treatment. However, our current studies of mutagenesis leading to P. aeruginosa mucoid conversion have revealed a potential new mutagen. Our findings confirmed the current view that reactive oxygen species can promote mucoidy in vitro, but revealed PMNs are proficient at inducing mucoid conversion in the absence of an oxidative burst. This led to the discovery that cationic antimicrobial peptides can be mutagenic and promote mucoidy. Of specific interest was the human cathelicidin LL-37, canonically known to disrupt bacterial membranes leading to cell death. An alternative role was revealed at sub-inhibitory concentrations, where LL-37 was found to induce mutations within the mucA gene encoding a negative regulator of mucoidy and to promote rifampin resistance in both P. aeruginosa and Escherichia coli. The mechanism of mutagenesis was found to be dependent upon sub-inhibitory concentrations of LL-37 entering the bacterial cytosol and binding to DNA. LL-37/DNA interactions then promote translesion DNA synthesis by the polymerase DinB, whose error-prone replication potentiates the mutations. A model of LL-37 bound to DNA was generated, which reveals amino termini α-helices of dimerized LL-37 bind the major groove of DNA, with numerous DNA contacts made by LL-37 basic residues. This demonstrates a mutagenic role for antimicrobials previously thought to be insusceptible to resistance by mutation, highlighting a need to further investigate their role in evolution and pathoadaptation in chronic infections. PMID:24763694

Aberrant GSTP1 promoter methylation predicts short-term prognosis in acute-on-chronic hepatitis B liver failure.

PubMed

Gao, S; Sun, F-K; Fan, Y-C; Shi, C-H; Zhang, Z-H; Wang, L-Y; Wang, K

2015-08-01

Glutathione-S-transferase P1 (GSTP1) methylation has been demonstrated to be associated with oxidative stress induced liver damage in acute-on-chronic hepatitis B liver failure (ACHBLF). To evaluate the methylation level of GSTP1 promoter in acute-on-chronic hepatitis B liver failure and determine its predictive value for prognosis. One hundred and five patients with acute-on-chronic hepatitis B liver failure, 86 with chronic hepatitis B (CHB) and 30 healthy controls (HC) were retrospectively enrolled. GSTP1 methylation level in peripheral mononuclear cells (PBMC) was detected by MethyLight. Clinical and laboratory parameters were obtained. GSTP1 methylation levels were significantly higher in patients with acute-on-chronic hepatitis B liver failure (median 16.84%, interquartile range 1.83-59.05%) than those with CHB (median 1.25%, interquartile range 0.48-2.47%; P < 0.01) and HC (median 0.80%, interquartile range 0.67-1.27%; P < 0.01). In acute-on-chronic hepatitis B liver failure group, nonsurvivors showed significantly higher GSTP1 methylation levels (P < 0.05) than survivors. GSTP1 methylation level was significantly correlated with total bilirubin (r = 0.29, P < 0.01), prothrombin time activity (r = -0.24, P = 0.01) and model for end-stage liver disease (MELD) score (r = 0.26, P = 0.01). When used to predict 1- or 2-month mortality of acute-on-chronic hepatitis B liver failure, GSTP1 methylation showed significantly better predictive value than MELD score [area under the receiver operating characteristic curve (AUC) 0.89 vs. 0.72, P < 0.01; AUC 0.83 vs. 0.70, P < 0.05 respectively]. Meanwhile, patients with GSTP1 methylation levels above the cut-off points showed significantly poorer survival than those below (P < 0.05). Aberrant GSTP1 promoter methylation exists in acute-on-chronic hepatitis B liver failure and shows high predictive value for short-term mortality. It might serve as a potential prognostic marker for acute-on-chronic hepatitis B liver failure. © 2015 John Wiley & Sons Ltd.

Combining balneotherapy and health promotion to promote active and healthy ageing: the Balaruc-MACVIA-LR® approach.

PubMed

Blain, H; Bernard, P L; Canovas, G; Raffort, N; Desfour, H; Soriteau, L; Noguès, M; Camuzat, T; Mercier, J; Dupeyron, A; Quéré, I; Laffont, I; Hérisson, C; Solimene, H; Bousquet, J

2016-12-01

Scaling up and replication of successful innovative integrated care models for chronic diseases is one of the targets of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). MACVIA-LR ® (MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon) is a Reference Site of the EIP on AHA. The main objective of MACVIA-LR ® is to develop innovative solutions in order to (1) improve the care of patients affected by chronic diseases, (2) reduce avoidable hospitalization and (3) scale up the innovation to regions of Europe. The MACVIA-LR ® project also aims to assess all possible aspects of medicine-including non-pharmacologic approaches-in order to maintain health and prevent chronic diseases. These approaches include hydrotherapy and balneotherapy which can be of great importance if health promotion strategies are considered. Balneotherapy at Balaruc-les-Bains focusses on musculoskeletal diseases and chronic venous insufficiency of the lower limbs. Each year, over 46,000 people attend an 18-day course related to a new falls prevention initiative combining balneotherapy and education. On arrival, each person receives a flyer providing information on the risk of fall and, depending on this risk, a course is proposed combining education and physical activity. A pilot study assesses the impact of the course 6 and 12 months later. This health promotion strategy for active and healthy ageing follows the FEMTEC (World Federation of Hydrotherapy and Climatotherapy) concept.

Changes in health indicators related to health promotion and microcredit programs in the Dominican Republic.

PubMed

Dohn, Anita L; Chávez, Andrea; Dohn, Michael N; Saturria, Luis; Pimentel, Carlos

2004-03-01

To assess the impact of health promotion programs and microcredit programs on three communities in the Dominican Republic. One community had only the health promotion program, one community had only the microcredit program, and one community had both a health promotion program and a microcredit program. This pilot project examined the hypothesis that the largest changes in 11 health indicators that were studied would be in the community with both a health promotion program and a microcredit program, that there would be intermediate changes in the community with only a health promotion program, and that the smallest changes would be in the community with only a microcredit program. The health promotion programs used community volunteers to address two major concerns: (1) the prevalent causes of mortality among children under 5 years of age and (2) women's health (specifically breast and cervical cancer screening). The microcredit program made small loans to individuals to start or expand small businesses. Outcome measures were based on comparisons for 11 health indicators from baseline community surveys (27 households surveyed in each of the three communities, done in December 2000 and January 2001) and from follow-up surveys (also 27 households surveyed in each of the three communities, in June and July 2002, after the health promotion program had been operating for about 13 months). Households were randomly chosen during both the baseline and follow-up surveys, without regard to their involvement in the microcredit or health promotion programs. The health indicators improved in all three communities. However, the degree of change was different among the communities (P < 0.001). The community with parallel microcredit and health promotion programs had the largest changes for 10 of the 11 health indicators. Multisector development is known to be important on a macroeconomic scale. The results of this pilot project support the view that multisector development is also important on a microeconomic level, given that the parallel microcredit and health promotion programs resulted in greater change in the measured health indicators than either program alone. As far as we authors know, this is the first published study to quantify changes in health indicators related to parallel health promotion and microcredit programs as compared to control communities with only a health promotion program or a microcredit program.

A novel comparative pattern count analysis reveals a chronic ethanol-induced dynamic shift in immediate early NF-κB genome-wide promoter binding during liver regeneration.

PubMed

Kuttippurathu, Lakshmi; Patra, Biswanath; Hoek, Jan B; Vadigepalli, Rajanikanth

2016-03-01

Liver regeneration after partial hepatectomy is a clinically important process that is impaired by adaptation to chronic alcohol intake. We focused on the initial time points following partial hepatectomy (PHx) to analyze the genome-wide binding activity of NF-κB, a key immediate early regulator. We investigated the effect of chronic alcohol intake on immediate early NF-κB genome-wide localization, in the adapted state as well as in response to partial hepatectomy, using chromatin immunoprecipitation followed by promoter microarray analysis. We found many ethanol-specific NF-κB binding target promoters in the ethanol-adapted state, corresponding to the regulation of biosynthetic processes, oxidation-reduction and apoptosis. Partial hepatectomy induced a diet-independent shift in NF-κB binding loci relative to the transcription start sites. We employed a novel pattern count analysis to exhaustively enumerate and compare the number of promoters corresponding to the temporal binding patterns in ethanol and pair-fed control groups. The highest pattern count corresponded to promoters with NF-κB binding exclusively in the ethanol group at 1 h post PHx. This set was associated with the regulation of cell death, response to oxidative stress, histone modification, mitochondrial function, and metabolic processes. Integration with the global gene expression profiles to identify putative transcriptional consequences of NF-κB binding patterns revealed that several of ethanol-specific 1 h binding targets showed ethanol-specific differential expression through 6 h post PHx. Motif analysis yielded co-incident binding loci for STAT3, AP-1, CREB, C/EBP-β, PPAR-γ and C/EBP-α, likely participating in co-regulatory modules with NF-κB in shaping the immediate early response to PHx. We conclude that adaptation to chronic ethanol intake disrupts the NF-κB promoter binding landscape with consequences for the immediate early gene regulatory response to the acute challenge of PHx.

Health promotion through primary care: enhancing self-management with activity prescription and mHealth.

PubMed

Knight, Emily; Stuckey, Melanie I; Petrella, Robert J

2014-09-01

It is well established in the literature that regular participation in physical activity is effective for chronic disease management and prevention. Remote monitoring technologies (ie, mHealth) hold promise for engaging patients in self-management of many chronic diseases. The purpose of this study was to test the effectiveness of an mHealth study with tailored physical activity prescription targeting changes in various intensities of physical activity (eg, exercise, sedentary behavior, or both) for improving physiological and behavioral markers of lifestyle-related disease risk. Forty-five older adults (aged 55-75 years; mean age 63 ± 5 years) were randomly assigned to receive a personal activity program targeting changes to either daily exercise, sedentary behavior, or both. All participants received an mHealth technology kit including smartphone, blood pressure monitor, glucometer, and pedometer. Participants engaged in physical activity programming at home during the 12-week intervention period and submitted physical activity (steps/day), blood pressure (mm Hg), body weight (kg), and blood glucose (mmol/L) measures remotely using study-provided devices. There were no differences between groups at baseline (P > 0.05). The intervention had a significant effect (F(10 488) = 2.947, P = 0.001, ηP² = 0.057), with similar changes across all groups for physical activity, body weight, and blood pressure (P > 0.05). Changes in blood glucose were significantly different between groups, with groups prescribed high-intensity activity (ie, exercise) demonstrating greater reductions in blood glucose than the group prescribed changes to sedentary behavior alone (P < 0.05). Findings demonstrate the utility of pairing mHealth technologies with activity prescription for prevention of lifestyle-related chronic diseases among an at-risk group of older men and women. RESULTS support the novel approach of prescribing changes to sedentary behaviors (alone, and in conjunction with exercise) to reduce risk of developing lifestyle-related chronic conditions.

A Theoretical Framework for a Virtual Diabetes Self-Management Community Intervention

PubMed Central

Vorderstrasse, Allison; Shaw, Ryan J.; Blascovich, Jim; Johnson, Constance M.

2015-01-01

Due to its high prevalence, chronic nature, potential complications, and self-management challenges for patients, diabetes presents significant health education and support issues. We developed and pilot-tested a virtual community for adults with type 2 diabetes to promote self-management education and provide social support. Although digital-based programs such as virtual environments can address significant barriers to reaching patients (i.e., child care, transportation, location), they must be strongly grounded in a theoretical basis to be well-developed and effective. In this article, we discuss how we synthesized behavioral and virtual environment theoretical frameworks to guide the development of SLIDES (Second Life Impacts Diabetes Education and Support). PMID:24451083

[Information technologies: new partners in treating diabetes].

PubMed

Colombet, I; Chatellier, G

2001-10-15

The management of chronic diseases such as diabetes is becoming a crucial issue in developed countries. Innovative communication technologies should now be included as new partners in the health care system. These technologies can help both in managing patients and measuring quality of care. Internet-based health promotion programs may improve compliance with treatment. Decision systems are available on the Net to help patients monitoring their diet and insulin doses. The use of electronic medical record shared on Internet may help both physicians and patients to monitor on the long term the effect of interventions. It is now time to perform appropriate trials to determine, beside other interventions, the precise role of innovative communication technologies in diabetes management.

A theoretical framework for a virtual diabetes self-management community intervention.

PubMed

Vorderstrasse, Allison; Shaw, Ryan J; Blascovich, Jim; Johnson, Constance M

2014-10-01

Due to its high prevalence, chronic nature, potential complications, and self-management challenges for patients, diabetes presents significant health education and support issues. We developed and pilot-tested a virtual community for adults with type 2 diabetes to promote self-management education and provide social support. Although digital-based programs such as virtual environments can address significant barriers to reaching patients (i.e., child care, transportation, location), they must be strongly grounded in a theoretical basis to be well-developed and effective. In this article, we discuss how we synthesized behavioral and virtual environment theoretical frameworks to guide the development of SLIDES (Second Life Impacts Diabetes Education and Support). © The Author(s) 2014.

HealtheSteps™ Study Protocol: a pragmatic randomized controlled trial promoting active living and healthy lifestyles in at-risk Canadian adults delivered in primary care and community-based clinics.

PubMed

Gill, Dawn P; Blunt, Wendy; Bartol, Cassandra; Pulford, Roseanne W; De Cruz, Ashleigh; Simmavong, P Karen; Gavarkovs, Adam; Newhouse, Ian; Pearson, Erin; Ostenfeldt, Bayley; Law, Barbi; Karvinen, Kristina; Moffit, Pertice; Jones, Gareth; Watson, Cori; Zou, Guangyong; Petrella, Robert J

2017-02-07

Physical inactivity is one of the leading causes of chronic disease in Canadian adults. With less than 50% of Canadian adults reaching the recommended amount of daily physical activity, there is an urgent need for effective programs targeting this risk factor. HealtheSteps™ is a healthy lifestyle prescription program, developed from an extensive research base to address risk factors for chronic disease such as physical inactivity, sedentary behaviour and poor eating habits. HealtheSteps™ participants are provided with in-person lifestyle coaching and access to eHealth technologies delivered in community-based primary care clinics and health care organizations. To determine the effectiveness of Healthesteps™, we will conduct a 6-month pragmatic randomized controlled trial with integrated process and economic evaluations of HealtheSteps™ in 5 clinic settings in Southwestern Ontario. 110 participants will be individually randomized (1:1; stratified by site) to either the intervention (HealtheSteps™ program) or comparator (Wait-list control). There are 3 phases of the HealtheSteps™ program, lasting 6 months each. The active phase consists of bi-monthly in-person coaching with access to a full suite of eHealth technology supports. During the maintenance phase I, the in-person coaching will be removed, but participants will still have access to the full suite of eHealth technology supports. In the final stage, maintenance phase II, access to the full suite of eHealth technology supports is removed and participants only have access to publicly available resources and tools. This trial aims to determine the effectiveness of the program in increasing physical activity levels and improving other health behaviours and indicators, the acceptability of the HealtheSteps™ program, and the direct cost for each person participating in the program as well as the costs associated with delivering the program at the different community sites. These results will inform future optimization and scaling up of the program into additional community-based primary care sites. NCT02413385 (Clinicaltrials.gov). Date Registered: April 6, 2015.

Differential response to targeted recruitment strategies to fitness promotion research by African-American women of varying body mass index.

PubMed

Yancey, A K; Miles, O L; McCarthy, W J; Sandoval, G; Hill, J; Leslie, J J; Harrison, G G

2001-01-01

To assess patterns of recruitment into a community-based NCI-funded physical activity and dietary lifestyle change program targeting African-American women. Acquisition of a convenience sample to be screened for participation in a randomized, controlled prevention intervention. African-American-owned and -operated health club located in an area of Los Angeles in which African Americans are concentrated. 893 African-American women. RECRUITMENT STRATEGIES: Social networking/word-of-mouth, staff presentations, mass and targeted media, and physician referral. Completion of screening questionnaire indicating a desire to enroll in the study. Screening questionnaire domains included self-reported height and weight, recent participation in organized weight loss programs, ability to walk one mile unassisted, current medication use, smoking status, personal medical history of cancer, sociodemographic variables, and recruitment source. Sociodemographic and anthropometric characteristics distinguished between respondents obtained through different recruitment strategies. In particular, women with a higher body mass index (BMI) were more likely than those with lower BMIs (P = .014) to be recruited through more personalized methods (eg, social networking). Culturally tailored recruitment strategies are critical in securing the participation of members of "hard-to-reach" populations, who are both under-represented in health promotion research and at high risk for chronic diseases.

Definition, aims, and implementation of GA(2) LEN Urticaria Centers of Reference and Excellence.

PubMed

Maurer, M; Metz, M; Bindslev-Jensen, C; Bousquet, J; Canonica, G W; Church, M K; Godse, K V; Grattan, C E; Hide, M; Kocatürk, E; Magerl, M; Makris, M; Meshkova, R; Saini, S S; Sussman, G; Toubi, E; Zhao, Z; Zuberbier, T; Gimenez-Arnau, A

2016-08-01

GA²LEN, the Global Allergy and Asthma European Network, has recently launched a program for the development, interaction, and accreditation of centers of reference and excellence in special areas of allergy embedded in its overall quality management of allergy centers of excellence. The first area chosen is urticaria. Urticaria is a common and debilitating condition and can be a challenge for both patients and treating physicians, especially when chronic. Centers of reference and excellence in urticaria (UCAREs) can help to improve the management of hard-to-treat conditions such as urticaria. Here, we describe the aims, the requirements and deliverables, the application process, and the audit and accreditation protocol for GA²LEN UCAREs. The main aims of GA²LEN UCAREs are to provide excellence in urticaria management, to increase the knowledge of urticaria by research and education, and to promote the awareness of urticaria by advocacy activities. To become a certified GA²LEN UCARE, urticaria centers have to apply and fulfill 32 requirements, defined by specific deliverables that are assessed during an audit visit. The GA²LEN UCARE program will result in a strong network of urticaria specialists, promote urticaria research, and harmonize and improve urticaria management globally. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Self-efficacy: a useful construct to promote physical activity in people with stable chronic heart failure.

PubMed

Du, HuiYun; Everett, Bronwyn; Newton, Phillip J; Salamonson, Yenna; Davidson, Patricia M

2012-02-01

To explore the conceptual underpinnings of self-efficacy to address the barriers to participating in physical activity and propose a model of intervention. The benefits of physical activity in reducing cardiovascular risk have led to evidence-based recommendations for patients with heart disease, including those with chronic heart failure. However, adherence to best practice recommendations is often suboptimal, particularly in those individuals who experience high symptom burden and feel less confident to undertake physical activity. Self-efficacy is the degree of confidence an individual has in his/her ability to perform behaviour under several specific circumstances. Four factors influence an individual's level of self-efficacy: (1) past performance, (2) vicarious experience, (3) verbal persuasion and (4) physiological arousal. Discursive. Using the method of a discursive paper, this article seeks to explore the conceptual underpinnings of self-efficacy to address the barriers to participating in physical activity and proposes a model of intervention, the Home-Heart-Walk, to promote physical activity and monitor functional status. Implementing effective interventions to promote physical activities require appreciation of factors impacting on behaviour change. Addressing concepts relating to self-efficacy in physical activity interventions may promote participation and adherence in the longer term. The increasing burden of chronic disease and the emphasis on self-management strategies underscore the importance of promoting adherence to recommendations, such as physical activity. © 2011 Blackwell Publishing Ltd.

Incorporating physical activity measures into environmental monitoring of national parks: an example from Yosemite.

PubMed

Walden-Schreiner, Chelsey; Leung, Yu-Fai; Floyd, Myron F

2014-09-01

To address increasing prevalence of obesity and associated chronic disease, recent national initiatives have called upon federal agencies to promote healthy lifestyles and provide opportunities for physical activity. In response, the U.S. National Park Service has developed strategies promoting health through physical activity in addition to its well-established biodiversity and landscape conservation mission. Incorporating physical activity measures with routine environmental monitoring would help identify areas where parks can promote active pursuits with minimal environmental impact. This study provides one example of how protocols developed for visitor and environmental monitoring can generate data to evaluate physical activity. Researchers implemented an observational study in high-use meadows of Yosemite National Park during the summer of 2011. Variables measured include the spatial location of visitors and activity type. Metabolic equivalents (METs) were assigned to activity categories and analyzed for average energy expenditure. Mean METs values indicated sedentary to light physical activity across the meadows, with greater means in areas with boardwalks or paved pathways. Data leveraged in this study provide park managers an example of adapting existing monitoring programs to incorporate indicators relevant to physical activity evaluation and how physical activity may impact resource conditions in national parks.

7 CFR 1206.50 - Programs, plans, and projects.

Code of Federal Regulations, 2010 CFR

2010-01-01

... PROMOTION, RESEARCH, AND INFORMATION Mango Promotion, Research, and Information Order Definitions Promotion... establishment, issuance, effectuation, and administration of appropriate programs for promotion, research, and... the Board to ensure that it contributes to an effective program of promotion, research, or information...

[Integrating patient education in your oncology practice].

PubMed

Thariat, Juliette; Creisson, Anne; Chamignon, Blandine; Dejode, Magali; Gastineau, Marie; Hébert, Christophe; Boissin, Fabienne; Topfer, Christelle; Gilbert, Elise; Grondin, Benoit; Guennoc, Helène; Mari, Veronique; Buzzo, Solange; Saja, Dominique; Duboue, Nathalie; Boulahssass, Rabia; Tosi, Alexia; Verne, Suzanne; Ducray, Julie; Benard-Thiery, Isabelle; Ferrero, Jean Marc

2016-01-01

Patient education is the process by which health professionals impart information to patients and their caregivers that will alter their health behaviors; improve their health status to better manage their lives with a chronic disease. Patient education implies a profound paradigm shift in the conception of care among health professionals, and should result in structural care changes. Patient education has been promoted by the French Health system for 30years, including in the 2009 HPST law and Cancer Plan 2014-2019. A patient education program was designed in our hospital for breast cancer patients. A multidisciplinary and transversal team of health professionals and resource patients was trained before grant application for funding of the program by the regional health care agency. Management of the project required that a functional unit be built for recording of all patient education related activities. A customized patient education program process was built under the leadership of a coordinator and several patient education project managers during bimonthly meetings, using an accurate timeline and a communication strategy to ensure full institutional support and team engagement. The grant was prepared in four months and the program started within the next four months with the aim to include 120 patients during year 1. The program includes a diagnosis of patient abilities and well-being resources, followed by collective and individual workshops undertaken in 4months for each patient. Patient education is positively evaluated by all participants and may contribute to better health care management in the long term but the financial and human resources allocated to such programs currently underestimate the needs. Sustainability of patient education programs requires that specific tools and more commitment be developed to support health care professionals and to promote patient coping and empowerment in the long term. Copyright © 2016 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Physical activity and health-related quality of life in pediatric cancer patients following a 4-week inpatient rehabilitation program.

PubMed

Müller, Carsten; Krauth, Konstantin A; Gerß, Joachim; Rosenbaum, Dieter

2016-09-01

Chronic health conditions and impaired quality of life are commonly experienced in childhood cancer survivors. While rehabilitation clinics support patients in coping with the disease, studies evaluating an inpatient rehabilitation program on promoting physical activity (PA) and health-related quality of life (HRQoL) are missing. A 4-week inpatient rehabilitation program was prospectively evaluated. One hundred fifty patients with leukemia or lymphoma (N = 86), brain tumors (N = 38), and sarcomas (N = 26) were enrolled on average 17 months after cessation of acute medical treatment. PA amount and cadence (indicating the intensity of walking activity) using the StepWatch™ 3 Activity Monitor and HRQoL global and physical well-being scores using the KINDL(®) questionnaire were assessed before, immediately after, and 6 and 12 months following the program and analyzed using multiple linear mixed models. Significant effects on PA were only found at 12-month follow-up for amount and cadence variables (all p < 0.05). While leukemia and lymphoma patients revealed the highest PA level throughout the study, rehabilitation effects were more pronounced for cadence variables in brain tumor and sarcoma patients. The rehabilitation program had immediate (t = 4.56, p < 0.001) and sustainable effects on HRQoL global scores (6-month follow-up, t = 4.08, p < 0.001; 12-month follow-up, t = 3.13, p < 0.006). Immediate and sustainable increases in HRQoL indicate that a 4-week rehabilitation program is beneficial for improving psychosocial well-being, while the significant increase in PA levels could be related to general recovery as well. The lack of a control group hampers the evaluation of the rehabilitation program on promoting PA levels in pediatric cancer patients.

[Integrated delivery systems and other examples of collaboration among providers. SESPAS report, 2012].

PubMed

Vázquez, M Luisa; Vargas, Ingrid; Nuño, Roberto; Toro, Nuria

2012-03-01

Because of the steady increase in healthcare complexity, due to high specialization and the involvement of a number of services, as well as the increase in patients with chronic diseases and pluripathology, coordination has become a high-priority need in healthcare systems. The distinct regional services that comprise the decentralized Spanish National Health System have developed a number of experiences to improve collaboration among the providers involved in the healthcare process. The present article aims to analyze the experiences with integrated healthcare providers in Catalonia and the Basque Country and the chronic diseases programs of the latter. In Catalonia, which promoted the purchaser-provider split and maintained diversity in providers' ownership, organizations were slowly created that manage the provision of the healthcare continuum, known as integrated healthcare organizations (IHO). These organizations have evolved and, despite some common characteristics, they also show some differences, such as the emphasis on formal instruments or on coordination mechanisms and organic structures. This is also reflected in their results regarding culture and perceived coordination across the organization. In the Basque Country, in addition to the establishment of an IHO, a variety of integration experiences have been developed to improve the care of chronic diseases. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

Primary health care as a philosophical and practical framework for nursing education: rhetoric or reality?

PubMed

Mackey, Sandra; Hatcher, Deborah; Happell, Brenda; Cleary, Michelle

2013-08-01

At least three decades after primary health care (PHC) took nursing by storm it is time to re-examine the philosophical shift to a PHC framework in pre-registration nursing curricula and overview factors which may hinder or promote full integration of PHC as a course philosophy and a contemporary approach to professional practice. Whilst nurse education has traditionally focused on preparing graduates for practice in the acute care setting, there is continuing emphasis on preparing nurses for community based primary health roles, with a focus on illness prevention and health promotion. This is driven by growing evidence that health systems are not responding adequately to the needs and challenges of diverse populations, as well as economic imperatives to reduce the burden of disease associated with the growth of chronic and complex diseases and to reduce the costs associated with the provision of health care. Nursing pre-registration programs in Australia and internationally have philosophically adopted PHC as a curriculum model for preparing graduates with the necessary competencies to function effectively across a range of settings. Anecdotal evidence, however, suggests that when adopted as a program philosophy PHC is not always well integrated across the curriculum. In order to develop a strong and resilient contemporary nursing workforce prepared for practice in both acute and community settings, pre-registration nursing programs need to comprehensively consider and address the factors impacting on the curricula integration of PHC philosophy.

[Correlation between interleukin-10 polymorphisms and susceptibility to chronic periodontitis among Uygur adults in the Moyu area].

PubMed

Yuhui, Zhang; Ping, Huang; Jing, Lin; Jin, Zhao

2017-10-01

This study aims to investigate the association between interleukin (IL)-10-597 (C/A) single-nucleotide polymorphisms and chronic periodontitis of Moyu Uygur population in Xinjiang Uygur Autonomous Region of China. In accordance with the inclusion and exclusion criteria, the buccal swabs of 300 subjects were randomly selected from the epidemiological investigation of Uygur adults in Moyu county on April and May 2013. The study was conducted on a healthy control group, a mild chronic periodontitis group, and a moderate-to-severe chronic periodontitis group, with each comprising 100 samples. The IL-10-597(C/A) site in the promoter sequences was analyzed using the tetra-primer amplification refractory mutation system-polymerase chain reaction method to test the genotype and allele distributions. Statistical analysis was performed using Chi-squared test and ordinal classification Logistic regression analysis. The genotype and allele frequencies of the IL-10-597(C/A) site in the healthy control group, mild chronic periodontitis group, and moderate-to-severe chronic periodontitis group exhibited no significant difference (P>0.05). The age of all the samples was associated with chronic periodontitis. The risk of chronic periodontitis in the people of 55-65 years old was 25 times in the people under the age of 35 (OR=25.56, P<0.001). The IL-10-597 (C/A) single-nucleotide polymorphisms in the gene promoter are not associated with chronic periodontitis in Uygur adult population.

Using organization theory to understand the determinants of effective implementation of worksite health promotion programs.

PubMed

Weiner, Bryan J; Lewis, Megan A; Linnan, Laura A

2009-04-01

The field of worksite health promotion has moved toward the development and testing of comprehensive programs that target health behaviors with interventions operating at multiple levels of influence. Yet, observational and process evaluation studies indicate that such programs are challenging for worksites to implement effectively. Research has identified several organizational factors that promote or inhibit effective implementation of comprehensive worksite health promotion programs. However, no integrated theory of implementation has emerged from this research. This article describes a theory of the organizational determinants of effective implementation of comprehensive worksite health promotion programs. The model is adapted from theory and research on the implementation of complex innovations in manufacturing, education and health care settings. The article uses the Working Well Trial to illustrate the model's theoretical constructs. Although the article focuses on comprehensive worksite health promotion programs, the conceptual model may also apply to other types of complex health promotion programs. An organization-level theory of the determinants of effective implementation of worksite health promotion programs.

7 CFR 1210.311 - Programs and projects.

Code of Federal Regulations, 2010 CFR

2010-01-01

... PROMOTION PLAN Watermelon Research and Promotion Plan Definitions § 1210.311 Programs and projects. Programs and projects mean those research, development, advertising, or promotion programs or projects...

Importance of exercise immunology in health promotion.

PubMed

Neto, J C Rosa; Lira, F S; de Mello, M T; Santos, Ronaldo Vagner T

2011-11-01

Chronic physical exercise with adequate intensity and volume associated with sufficient recovery promotes adaptations in several physiological systems. While intense and exhaustive exercise is considered an important immunosuppressor agent and increases the incidence of upper respiratory tract infections (URTI), moderate regular exercise has been associated with significant disease protection and is a complementary treatment of many chronic diseases. The effects of chronic exercise occur because physical training can induce several physiological, biochemical and psychological adaptations. More recently, the effect of acute exercise and training on the immunological system has been discussed, and many studies suggest the importance of the immune system in prevention and partial recovery in pathophysiological situations. Currently, there are two important hypotheses that may explain the effects of exercise and training on the immune system. These hypotheses including (1) the effect of exercise upon hormones and cytokines (2) because exercise can modulate glutamine concentration. In this review, we discuss the hypothesis that exercise may modulate immune functions and the importance of exercise immunology in respect to chronic illnesses, chronic heart failure, malnutrition and inflammation.

7 CFR 1221.121 - Programs, plans, and projects.

Code of Federal Regulations, 2010 CFR

2010-01-01

... PROMOTION, RESEARCH, AND INFORMATION ORDER Sorghum Promotion, Research, and Information Order Promotion... establishment, issuance, effectuation, and administration of appropriate programs for promotion, research, and... contributes to an effective program of promotion, research, or information. If it is found by the Board that...

Results from a national survey on chronic care management by health plans.

PubMed

Mattke, Soeren; Higgins, Aparna; Brook, Robert

2015-05-01

The growing burden of chronic disease necessitates innovative approaches to help patients and to ensure the sustainability of our healthcare system. Health plans have introduced chronic care management models, but systematic data on the type and prevalence of different approaches are lacking. Our goal was to conduct a systematic examination of chronic care management programs offered by health plans in the commercial market (ie, in products sold to employers and individuals. We undertook a national survey of a representative sample of health plans (70 plans, 36% response rate) and 6 case studies on health plans' programs to improve chronic care in the commercial market. The data underwent descriptive and bivariate analyses. All plans, regardless of size, location, and ownership, offer chronic care management programs, which identify eligible members from claims data and match them to interventions based on overall risk and specific care gaps. Plans then report information on care gaps to providers and offer self-management support to their members. While internal evaluations suggest that the interventions improve care and reduce cost, plans report difficulties in engaging members and providers. To overcome those obstacles, plans are integrating their programs into provider work flow, collaborating with providers on care redesign and leveraging patient support technologies. Our study shows that chronic care management programs have become a standard component of the overall approach used by health plans to manage the health of their members.

7 CFR 1150.109 - Qualified program.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGREEMENTS AND ORDERS; MILK), DEPARTMENT OF AGRICULTURE DAIRY PROMOTION PROGRAM Dairy Promotion and Research Order Definitions § 1150.109 Qualified program. Qualified program means any dairy product promotion, research or nutrition education program which is certified as a qualified program pursuant to § 1150.153...

7 CFR 1150.109 - Qualified program.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Agreements and Orders; Milk), DEPARTMENT OF AGRICULTURE DAIRY PROMOTION PROGRAM Dairy Promotion and Research Order Definitions § 1150.109 Qualified program. Qualified program means any dairy product promotion, research or nutrition education program which is certified as a qualified program pursuant to § 1150.153...

7 CFR 1150.109 - Qualified program.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGREEMENTS AND ORDERS; MILK), DEPARTMENT OF AGRICULTURE DAIRY PROMOTION PROGRAM Dairy Promotion and Research Order Definitions § 1150.109 Qualified program. Qualified program means any dairy product promotion, research or nutrition education program which is certified as a qualified program pursuant to § 1150.153...

Assessment of the Sustainability Capacity of a Coordinated Approach to Chronic Disease Prevention.

PubMed

Moreland-Russell, Sarah; Combs, Todd; Polk, LaShaun; Dexter, Sarah

This article outlines some factors that influenced the sustainability capacity of a coordinated approach to chronic disease prevention in state and territory health departments. This study involved a cross-sectional design and mixed-methods approach. Quantitative data were collected using the Program Sustainability Assessment Tool (PSAT), a 40-item multiple-choice instrument that assesses 8 domains of sustainability capacity (environmental support, funding stability, partnerships, organizational capacity, program evaluation, program adaptation, communications, and strategic planning). Qualitative data were collected via phone interviews. The PSAT was administered to staff and stakeholders from public health departments in 50 US states, District of Columbia, and Puerto Rico, who were involved in the implementation of coordinated chronic disease programs. Phone interviews were conducted with program coordinators in each state. Sustainability score patterns and state-level categorical results, as well as strengths and opportunities for improvement across the 8 program sustainability domains, were explored. On average, programs reported the strongest sustainability capacity in the domains of program adaptation, environmental support, and organizational capacity, while funding stability, strategic planning, and communications yielded lowest scores, indicating weakest capacity. Scores varied the most by state in environmental support and strategic planning. The PSAT results highlight the process through which states approached the sustainability of coordinated chronic disease initiatives. This process included an initial focus on program evaluation and partnerships with transfer of priority to long-term strategic planning, communications, and funding stability to further establish coordinated chronic disease efforts. Qualitative interviews provided further context to PSAT results, indicating that leadership, communications, partnerships, funding stability, and policy change were perceived as keys to success of the transition. Integrating these findings into future efforts may help those in transition establish greater sustainability capacity. The PSAT results and interviews provide insight into the capacity for sustainability for programs transitioning from traditional siloed programs to coordinated chronic disease programs.

Comparing effectiveness of generic and disease-specific self-management interventions for people with diabetes in a practice context.

PubMed

Ghahari, Setareh; Packer, Tanya; Boldy, Duncan; Melling, Lauren; Parsons, Richard

2015-10-01

The effectiveness of self-management interventions has been demonstrated. However, the benefits of generic vs. disease-specific programs are unclear, and their efficacy within a practice setting has yet to be fully explored. To compare the outcomes of the diabetes-specific self-management program (Diabetes) and the generic chronic disease Self-management Program (Chronic Condition) and to explore whether program characteristics, evaluated using the Quality Self-Management Assessment Framework (Q-SAF), provide insight into the results of the outcome evaluation. A pragmatic pretest, post-test design with 12-week follow up was used to compare the 2 self-management interventions. Outcomes were quality of life, self-efficacy, loneliness, self-management skills, depression, and health behaviours. People with diabetes self-selected attendance at the Diabetes or Chronic Condition program offered as part of routine practice. Participants with diabetes in the 2 programs (Diabetes=200; Chronic Condition=90) differed significantly in almost all demographic and clinical characteristics. Both programs yielded positive outcomes. Controlling for baseline and demographic characteristics, random effects modelling showed an interaction between time and program for 1 outcome: self-efficacy (p=0.029). Participants in the Chronic Condition group experienced greater improvements over time than did those in the Diabetes group. The Q-SAF analysis showed differences in program content, delivery and workforce capacity. People with diabetes benefited from both programs, but participation in the generic program resulted in greater improvements in self-efficacy for participants who had self-selected that program. Both programs in routine care led to health-related improvements. The Q-SAF can be used to assess the quality of programs. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

The South Australia Health Chronic Disease Self-Management Internet Trial

ERIC Educational Resources Information Center

Lorig, Kate; Ritter, Philip L.; Plant, Kathryn; Laurent, Diana D.; Kelly, Pauline; Rowe, Sally

2013-01-01

Objectives: To evaluate the effectiveness of an online chronic disease self-management program for South Australia residents. Method: Data were collected online at baseline, 6 months, and 12 months. The intervention was an asynchronous 6-week chronic disease self-management program offered online. The authors measured eight health status measures,…

[Using telemedicine to improve chronic disease monitoring].

PubMed

Lamothe, Lise; Paquette, Marie-Andrée; Fortin, Jean-Paul; Labbé, Françoise; Messikhs, Djamel; Duplantie, Julie

2013-01-01

The purpose of this study was to understand how home telecare technologies can be used to improve services for people with chronic diseases. Canadian elders with at least one of the targeted chronic diseases (COPD, heart failure, hypertension, diabetes) were asked to use telehomecare equipment. The data needed to assess the implementation process and to monitor outcomes were collected through participatory observation, documentary analysis and interviews. The study found that the technology has a number of benefits for patients, particularly in terms of access to health services. By enabling patients to access more information about their health, the use of the technology, combined with an educational program, contributes to increasing their capacity for self-management. The results also indicate that the telehomecare equipment had a positive impact on clinical decision-making. By facilitating health professionals' access to information and expertise, it was found to promote interprofessional practice. The study found that telehomecare technology has an organizational impact on practice and requires organizational adaptation, the form of which will depend on local organizational and clinical settings. The results suggest that telehomecare technology helps to create conditions that need to be met by health care organizations in order to improve service delivery to people with chronic diseases, particularly with regard to interprofessional collaboration, health professionals' access to information and expertise and active patient participation. However, the successful implementation of the technology requires a detailed analysis of the settings in which it is used.

Evaluation of a family systems intervention for managing pediatric chronic illness: Mastering Each New Direction (MEND).

PubMed

Distelberg, Brian; Williams-Reade, Jackie; Tapanes, Daniel; Montgomery, Susanne; Pandit, Mayuri

2014-06-01

Family systems play a crucial, albeit complex, role in pediatric chronic illness. Unfortunately, very few psychosocial interventions are available to help these stressed families navigate the developmental steps of chronic illness. A new intervention (MEND) addresses the needs of these families and applies to a broad range of chronic illnesses. This article presents this family systems intervention as well as includes preliminary program evaluation data on 22 families that graduated from the program. Results show consistently strong effects across an array of psychosocial measures. Conclusions from this preliminary study suggest that families entering MEND present with high levels of stress due to the child's chronic illness, but after MEND, the level of stress and other functioning measures are comparable to those seen in healthy families, suggesting that the program offers a significant benefit to families with pediatric chronic illness. © 2014 FPI, Inc.

Evaluation of a Family Systems Intervention for Managing Pediatric Chronic Illness: Mastering Each New Direction (MEND)

PubMed Central

Distelberg, Brian; Williams-Reade, Jackie; Tapanes, Daniel; Montgomery, Susanne; Pandit, Mayuri

2015-01-01

Family systems play a crucial, albeit complex, role in pediatric chronic illness. Unfortunately, very few psychosocial interventions are available to help these stressed families navigate the developmental steps of chronic illness. A new intervention (MEND) addresses the needs of these families and applies to a broad range of chronic illnesses. This article presents this family systems intervention as well as includes preliminary program evaluation data on 22 families that graduated from the program. Results show consistently strong effects across an array of psychosocial measures. Conclusions from this preliminary study suggest that families entering MEND present with high levels of stress due to the child's chronic illness, but after MEND, the level of stress and other functioning measures are comparable to those seen in healthy families, suggesting that the program offers a significant benefit to families with pediatric chronic illness. PMID:24635346

The effect of message framing on self-management of chronic pain: a new perspective on intervention?

PubMed

Janke, E Amy; Spring, Bonnie; Weaver, Frances

2011-07-01

This study examines framed messages as a novel approach to promote self-management of chronic pain. Primary care patients reporting chronic pain (pain rated ≥ 4 on 0-10 NRS-I for ≥3 months) were randomly assigned to receive a gain- or loss-framed message promoting self-management of pain. Impact of the framed message on behavioural self-management (including communicating with providers, relaxation, activity pacing, pleasant activities and healthy lifestyle) was assessed. Post-message, individuals in the loss-frame condition reported significantly greater interest in and more knowledge gained from the information presented in the message (p≤0.03). Loss-frame participants were significantly more likely to express confidence that they would practice relaxation (p≤0.03). Pain readiness to change, pain self-efficacy and message frame independently influenced motivation to engage in relaxation as a self-management strategy. Across all behaviours assessed, there were no observed interactions between message frame and either pain self-efficacy or pain readiness to change (p>0.05). Framing may be useful to promote pain self-management; larger trials are needed to fully evaluate its potential and to further assess the applicability of framed communication to impact a broader range of chronic conditions. © 2011 Taylor & Francis

Chronic exposure to the cytolethal distending toxins of Gram-negative bacteria promotes genomic instability and altered DNA damage response

PubMed Central

Guidi, Riccardo; Guerra, Lina; Levi, Laura; Stenerlöw, Bo; Fox, James G.; Josenhans, Christine; Masucci, Maria G.; Frisan, Teresa

2014-01-01

Summary Epidemiological evidence links chronic bacterial infections to the increased incidence of certain types of cancer but the molecular mechanisms by which bacteria contribute to tumour initiation and progression are still poorly characterized. Here we show that chronic exposure to the genotoxin cytolethal distending toxin (CDT) of Gram-negative bacteria promotes genomic instability and acquisition of phenotypic properties of malignancy in fibroblasts and colon epithelial cells. Cells grown for more than 30 weeks in the presence of sublethal doses of CDT showed increased mutation frequency, and accumulation of chromatin and chromosomal aberrations in the absence of significant alterations of cell cycle distribution, decreased viability or senescence. Cell survival was dependent on sustained activity of the p38 MAP kinase. The ongoing genomic instability was associated with impaired activation of the DNA damage response and failure to efficiently activate cell cycle checkpoints upon exposure to genotoxic stress. Independently selected sublines showed enhanced anchorage-independent growth as assessed by the formation of colonies in semisolid agarose. These findings support the notion that chronic infection by CDT-producing bacteria may promote malignant transformation, and point to the impairment of cellular control mechanisms associated with the detection and repair of DNA damage as critical events in the process. PMID:22998585

Change in health-related quality of life amongst participants in a 4-month pedometer-based workplace health program.

PubMed

Harding, Jessica; Freak-Poli, Rosanne Laura Armida; Backholer, Kathryn; Peeters, Anna

2013-05-01

Regular physical activity (PA) is associated with a reduced risk for chronic health conditions and improved health-related quality of life (HRQoL). Efforts to increase PA have included workplace health promotion. Currently, little is known about the effect of these programs on overall HRQoL. To evaluate whether participation in a pedometer-based PA program in the workplace was associated with changes in HRQoL. 487 voluntary employees enrolled in a health program completed the SF-12 Health Survey at baseline and 4 months. Change in Physical and Mental component summary scores (PCS; MCS) was assessed with multivariable regression analysis, adjusting for covariates. Participation in the program was associated with an increase of 1.5 MCS units (95% CI: 0.76, -2.09). Greater improvements in MCS were observed in those reporting an increased level of PA during the program [1.9 (CI: 0.78, 2.92) versus 0.9 (CI: -0.12, 2.03)] and a lower baseline MCS score [6.3 (CI: 4.80, 7.62) versus -1.5 (CI: -2.21, -0.80)]. No change in PCS was observed. Participation in this workplace PA program was associated with improvements in the mental component of HRQoL. We recommend the use of a broad perspective of health be used in both the implementation and evaluation of workplace PA programs.

Development of a chronic care ostomy self-management program.

PubMed

Grant, Marcia; McCorkle, Ruth; Hornbrook, Mark C; Wendel, Christopher S; Krouse, Robert

2013-03-01

Each year a percentage of the 1.2 million men and women in the United States with a new diagnosis of colorectal cancer join the 700,000 people who have an ostomy. Education targeting the long-term, chronic care of this population is lacking. This report describes the development of a Chronic Care Ostomy Self-Management Program, which was informed by (1) evidence on published quality-of-life changes for cancer patients with ostomies, (2) educational suggestions from patients with ostomies, and (3) examination of the usual care of new ostomates to illustrate areas for continued educational emphases and areas for needed education and support. Using these materials, the Chronic Care Ostomy Self-Management Program was developed by a team of multi-disciplinary researchers accompanied by experienced ostomy nurses. Testing of the program is in process. Pilot study participants reported high satisfaction with the program syllabus, ostomy nurse leaders, and ostomate peer buddies.

Development of a Chronic Care Ostomy Self Management Program

PubMed Central

Grant, Marcia; McCorkle, Ruth; Hornbrook, Mark C.; Wendel, Christopher S.; Krouse, Robert

2012-01-01

Each year a percentage of the 1.2 million men and women in the United States with a new diagnosis of colorectal cancer join the 700,000 people who have an ostomy. Education targeting the long term, chronic care of this population is lacking. This report describes the development of a Chronic Care Ostomy Self Management Program, which was informed by (1) evidence on published quality of life changes for cancer patients with ostomies, (2) educational suggestions from patients with ostomies, and (3) examination of the usual care of new ostomates to illustrate areas for continued educational emphases and areas for needed education and support. Using these materials, the Chronic Care Ostomy Self Management Program was developed by a team of multi-disciplinary researchers accompanied by experienced ostomy nurses. Testing of the program is in process. Pilot study participants reported high satisfaction with the program syllabus, ostomy nurse leaders, and ostomate peer buddies. PMID:23104143

Barriers to care and service needs among chronically homeless persons in a housing first program.

PubMed

Parker, R David; Albrecht, Helmut A

2012-01-01

In 2010, more than 600,000 people in the United States experienced homelessness. Efficient and cost-effective housing methods that reduce homelessness need to be implemented. Housing Ready programs are the standard method that often has set requirements including earned income and sobriety, among others. These programs enable a subset of the homeless to become housed. However, chronically homeless persons, who use the most resources, are often not successful at enrollment or maintaining enrollment. Housing First (H1) is a method focusing on chronically homeless persons. Housing First places a client in housing and provides services after stabilization. This article assessed differences between chronically homeless persons in a H1 program and chronically homeless persons who are not in H1. A case-control study imbedded within a homeless service program collected sociodemographic and service variables, including access and barriers to care. Although the sample was 100% native English speaking, 22% of homeless persons reported that their providers do not speak their same language. All (100%) of participants had a disabling condition under HUD guidelines, but only 17.78% of homeless controls reported having a disabling condition. There were no differences on housing status based on income, gender, race, or age. The lack of differences between these groups indicates that a H1 program can be a clear derivation from the more common Housing Ready programs that have specific requirements for participation. Provider communication may negatively impact an individual's ability to transition from homelessness. Furthermore, chronically homeless persons not in intensive case management are less likely to understand the eligibility requirements for housing and, therefore, self-disqualify because of this lack of knowledge. Intentional communication and education for chronically homeless persons are 2 examples where case managers could improve the ability of the chronically homeless to obtain housing.

Engaging Men in Chronic Disease Prevention and Management Programs: A Scoping Review.

PubMed

Gavarkovs, Adam Gregory; Burke, Shauna M; Petrella, Robert J

2016-11-01

Chronic disease has become one of the largest health burdens facing the developed world. Men are at a higher risk of being diagnosed with chronic disease than women. Although lifestyle interventions have been shown to reduce the risk of chronic disease in participants, men are often underrepresented in such programs. The purpose of this study was to explore the individual-level and program-specific factors that affect male participation rates in chronic disease prevention and management (CDPM) programs. A scoping review methodology was selected, and 25 studies met the criteria for inclusion in the review. Results showed that traditional group-based programs that focused on topics such as nutrition and physical activity were often seen by men as inherently feminine, which served as a barrier for participation. Program-specific factors that attracted men to participate in interventions included a group component with like-minded men, the use of humor in the delivery of health information, the inclusion of both nutrition and physical activity components, and the presence of some manner of competition. A past negative health event, personal concern for health status, and motivation to improve physical appearance were cited by men as facilitators to CDPM program participation. Gaps in the research are identified, and results of this study can be used to inform the development of CDPM programs that will improve the engagement and participation of men. © The Author(s) 2015.

20 CFR 30.220 - What are the criteria for eligibility for benefits relating to chronic silicosis?

Code of Federal Regulations, 2010 CFR

2010-04-01

...' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000 CLAIMS FOR COMPENSATION UNDER THE ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT... disease that arose as a consequence of the accepted chronic silicosis. ...

Aging and chronic alcohol consumption are determinants of p16 gene expression, genomic DNA methylation and p16 promoter methylation in the mouse colon

USDA-ARS?s Scientific Manuscript database

Elder age and chronic alcohol consumption are important risk factors for the development of colon cancer. Each factor can alter genomic and gene-specific DNA methylation. This study examined the effects of aging and chronic alcohol consumption on genomic and p16-specific methylation, and p16 express...

Ageing, chronic alcohol consumption and folate are determinants of genomic DNA methylation, p16 promoter methylation and the expression of p16 in the mouse colon

USDA-ARS?s Scientific Manuscript database

Elder age and chronic alcohol consumption are important risk factors for the development of colon cancer. Each factor can alter genomic and gene-specific DNA methylation. This study examined the effects of aging and chronic alcohol consumption on genomic and p16-specific methylation, and p16 express...

An eHealth Intervention to Promote Physical Activity and Social Network of Single, Chronically Impaired Older Adults: Adaptation of an Existing Intervention Using Intervention Mapping

PubMed Central

Peels, Denise A; Berendsen, Brenda AJ; Bolman, Catherine AW; Lechner, Lilian

2017-01-01

Background Especially for single older adults with chronic diseases, physical inactivity and a poor social network are regarded as serious threats to their health and independence. The Active Plus intervention is an automated computer-tailored eHealth intervention that has been proven effective to promote physical activity (PA) in the general population of adults older than 50 years. Objective The aim of this study was to report on the methods and results of the systematic adaptation of Active Plus to the wishes and needs of the subgroup of single people older than 65 years who have one or more chronic diseases, as this specific target population may encounter specific challenges regarding PA and social network. Methods The Intervention Mapping (IM) protocol was used to systematically adapt the existing intervention to optimally suit this specific target population. A literature study was performed, and quantitative as well as qualitative data were derived from health care professionals (by questionnaires, n=10) and the target population (by focus group interviews, n=14), which were then systematically integrated into the adapted intervention. Results As the health problems and the targeted behavior are largely the same in the original and adapted intervention, the outcome of the needs assessment was that the performance objectives remained the same. As found in the literature study and in data derived from health professionals and focus groups, the relative importance and operationalization of the relevant psychosocial determinants related to these objectives are different from the original intervention, resulting in a refinement of the change objectives to optimally fit the specific target population. This refinement also resulted in changes in the practical applications, program components, intervention materials, and the evaluation and implementation strategy for the subgroup of single, chronically impaired older adults. Conclusions This study demonstrates that the adaptation of an existing intervention is an intensive process in which adopting the IM protocol is an invaluable tool. The study provides a broad insight in adapting interventions aimed at single older adults with a chronic disease. It is concluded that even when the new target population is a sizable segment of the original target population, the adapted intervention still needs considerable changes to optimally fit the needs and situational differences of the narrower target population. PMID:29170146

[Use of decamethoxine in the complex treatment of chronic bronchitis].

PubMed

Iukhimets, V A; Pilipchuk, V N

1990-02-01

Seventy-two patients with chronic bronchitis were examined and divided into 3 groups. Group I consisted of patients with chronic catarrhal bronchitis (CCB) group II of those with chronic purulent bronchitis (CPB), group III of subjects with bronchitis associated with purulent destructive pulmonary diseases. All the patients received combined treatment with decamethoxin as an antibacterial modality. It was found that decamethoxin promotes elimination of the infection of the bronchial secretion in 60% of chronic bronchitis suffers, the incidence of microorganisms resistent to several antibiotics reduced 2-fold. Local use of decamethoxin as an antibacterial and antiinflammatory drug in multimodality treatment of chronic purulent bronchitis proved highly effective.

A cognitive-behavioral program for parents of children with chronic musculoskeletal pain; A feasibility study.

PubMed

Wiertz, C; Goossens, M; Spek, E M; Verbunt, J A

2017-10-01

The purpose of the study is to evaluate the feasibility of a newly developed parent program for parents of children with non-specific chronic musculoskeletal pain. This program is part of the child's interdisciplinary outpatient pain rehabilitation treatment. The goal of the parent program is to change parent's thoughts/behaviour regarding pain with the ultimate intention to further improve their child's functioning. There were two main objectives in the study: First, to evaluate the feasibility of the parent program. Second, to evaluate changing in parental behavioral factors pre- and posttreatment. Participants were parents of adolescents, who underwent a interdisciplinary outpatient pain program for non-specific chronic musculoskeletal pain. Parents participated in a parent program as part of their child's treatment. Adolescents reported their level of disability, pain intensity, fear of pain and pain catastrophizing by filling out questionnaires. Parents reported catastrophic thinking about their child's pain, fear of pain and disabilities of their child. In addition, they evaluated the parent program. Sixty five parents (36 mothers and 29 fathers) of 44 adolescents filled in the baseline questionnaires. Result showed significant and clinically relevant improvements for both parents as well for adolescents. Parents were positive about the content of the parent program, they evaluated the program as supportive and informative. Adding a parent program to a interdisciplinary outpatient pain program for adolescent with chronic musculoskeletal pain, seems to be feasible in daily life of the parents and results in positive behavioural changes for both parents and adolescents. A parent program, designed to change cognition and behaviour of parents of children with chronic musculoskeletal pain is feasible. © 2017 European Pain Federation - EFIC®.

Precore and core promoter mutations of hepatitis B virus and hepatitis B e antigen-negative chronic hepatitis B in Korea.

PubMed

Yoo, Byung Chul; Park, Joong-Won; Kim, Hyung Joon; Lee, Dong Ho; Cha, Young Ju; Park, Sill Moo

2003-01-01

The aims of this study were to determine the frequency of precore/core promoter mutations and hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (e-CHB) in Korea. Patients with chronic hepatitis B virus (HBV) infection were tested for HBeAg, anti-HBe, liver profile and HBV-DNA by a branched DNA (bDNA) assay. Serum HBV-DNA was amplified by a polymerase chain reaction and the precore/core promoter sequence was determined. Among the 413 consecutive HBeAg-negative patients, 19.6% were bDNA-positive. Evidence of liver disease was found in 90.1% of bDNA-positive and 41.7% of bDNA-negative patients. Overall, 17.7% of HBeAg-negative patients had e-CHB. Precore mutation (A1896) was detected in 93.7% of HBeAg-negative bDNA-positive and 93.9% of HBeAg-negative bDNA-negative patients. In 59 HBeAg-positive patients, 78% had wild-type and 22% had a mixture of wild-type and A1896 mutant. Core promoter TA mutation was detected in 89.9% of HBeAg-negative bDNA-positive patients, 89.8% of HBeAg-negative bDNA-negative patients, and 74.6% of HBeAg-positive patients. No correlation was found between the presence of precore/core promoter mutations and HBV-DNA levels or disease severity. In Korean patients infected with HBV genotype C, precore mutation occurred almost invariably along with HBeAg seroconversion and core promoter TA mutation was frequent irrespective of viral replication levels or disease severity.

Establishment of an innovative specialist cardiac indigenous outreach service in rural and remote Queensland.

PubMed

Tibby, David; Corpus, Rohan; Walters, Darren L

2010-01-01

Cardiovascular diseases are the leading cause of mortality in Indigenous Australians. Indigneous Australians present at a younger age and have a greater incidence of cardiac risk including smoking and diabetes than non-Indigenous Australians. Access to specialist health services is an important determinant of health care outcomes for these patients. We describe an innovative and successful for model for providing Outreach Cardiac Specialist services to Indigenous communities in rural and remote locations. The approach involves a step-wise process of a) community engagement, b) delivering recovery interventions to improve health outcomes, c) building community capacity to self manage chronic illness and promoting health and well being with the aim of d) community self governance of chronic disease and health promotion. Key elements to this process are community participation in the program, disease self-management led by local health care workers, open access that is all-inclusive utilising community-generated referral, and the translation of scientific knowledge of disease processes into community understanding and making culturally relevant connections. Specialist cardiac services and point of care diagnostics have been provided to 18 sites across rural and remote Queensland. More than 1400 episodes of care have been provided to Indigenous Australians with rheumatic heart disease, ischaemic heart disease and congenital heart conditions. Traditional values can work harmoniously with an inclusive medical approach in this relational model. Crown Copyright 2010. Published by Elsevier B.V. All rights reserved.

Conserved Region C Functions To Regulate PD-1 Expression and Subsequent CD8 T Cell Memory.

PubMed

Bally, Alexander P R; Tang, Yan; Lee, Joshua T; Barwick, Benjamin G; Martinez, Ryan; Evavold, Brian D; Boss, Jeremy M

2017-01-01

Expression of programmed death 1 (PD-1) on CD8 T cells promotes T cell exhaustion during chronic Ag exposure. During acute infections, PD-1 is transiently expressed and has the potential to modulate CD8 T cell memory formation. Conserved region C (CR-C), a promoter proximal cis-regulatory element that is critical to PD-1 expression in vitro, responds to NFATc1, FoxO1, and/or NF-κB signaling pathways. Here, a CR-C knockout mouse was established to determine its role on PD-1 expression and the corresponding effects on T cell function in vivo. Deletion of CR-C decreased PD-1 expression on CD4 T cells and Ag-specific CD8 T cells during acute and chronic lymphocytic choriomeningitis virus challenges, but did not affect the ability to clear an infection. Following acute lymphocytic choriomeningitis virus infection, memory CD8 T cells in the CR-C knockout mouse were formed in greater numbers, were more functional, and were more effective at responding to a melanoma tumor than wild-type memory cells. These data implicate a critical role for CR-C in governing PD-1 expression, and a subsequent role in guiding CD8 T cell differentiation. The data suggest the possibility that titrating PD-1 expression during CD8 T cell activation could have important ramifications in vaccine development and clinical care. Copyright © 2016 by The American Association of Immunologists, Inc.

Combined Transcranial Direct Current Stimulation and Virtual Reality-Based Paradigm for Upper Limb Rehabilitation in Individuals with Restricted Movements. A Feasibility Study with a Chronic Stroke Survivor with Severe Hemiparesis.

PubMed

Fuentes, María Antonia; Borrego, Adrián; Latorre, Jorge; Colomer, Carolina; Alcañiz, Mariano; Sánchez-Ledesma, María José; Noé, Enrique; Llorens, Roberto

2018-04-02

Impairments of the upper limb function are a major cause of disability and rehabilitation. Most of the available therapeutic options are based on active exercises and on motor and attentional inclusion of the affected arm in task oriented movements. However, active movements may not be possible after severe impairment of the upper limbs. Different techniques, such as mirror therapy, motor imagery, and non-invasive brain stimulation have been shown to elicit cortical activity in absence of movements, which could be used to preserve the available neural circuits and promote motor learning. We present a virtual reality-based paradigm for upper limb rehabilitation that allows for interaction of individuals with restricted movements from active responses triggered when they attempt to perform a movement. The experimental system also provides multisensory stimulation in the visual, auditory, and tactile channels, and transcranial direct current stimulation coherent to the observed movements. A feasibility study with a chronic stroke survivor with severe hemiparesis who seemed to reach a rehabilitation plateau after two years of its inclusion in a physical therapy program showed clinically meaningful improvement of the upper limb function after the experimental intervention and maintenance of gains in both the body function and activity. The experimental intervention also was reported to be usable and motivating. Although very preliminary, these results could highlight the potential of this intervention to promote functional recovery in severe impairments of the upper limb.

Chronic liver injury promotes hepatocarcinoma cells seeding and growth, associated with the infiltration by macrophages.

PubMed

Delire, Bénédicte; Henriet, Patrick; Lemoine, Pascale; Leclercq, Isabelle A; Stärkel, Peter

2018-05-04

Ninety percent of hepatocarcinoma (HCC) develop in a chronically damaged liver. The interactions between non tumor stromal components, especially macrophages, and the cancer cells are still incompletely understood. Our aim was to determine whether a chronically injured liver represents a favorable environment for the seeding and growth of HCC cells, and to evaluate the potential roles of macrophages infiltrated within the tumor. HCC cells were injected into the liver in healthy mice (healthy liver group-HL) and in mice chronically treated with CCl 4 for 7 weeks (CCl 4 7w group). Livers were examined for the presence of tumor 2 weeks post injection. Tumor and non tumor tissues were analyzed for macrophages infiltration, origin (monocytes-derived vs resident macrophages) and polarization state, and matrix metalloproteinases (MMPs) production. Fifty-three percent of mice developed neoplastic lesion in the HL group while a tumor lesion was found in all livers in the CCl 4 7w group. Macrophages infiltrated more deeply the tumors of the CCl 4 7weeks group. Evaluation of factors involved in the recruitment of macrophages and of markers of their polarization state was in favor of prominent infiltration of M2 pro-tumor monocytes-derived macrophages inside the tumors developing in a chronically injured liver. MMP-2 and -9 production, attributed to M2 pro-tumor macrophages, was significantly higher in the tumors of the CCl 4 7w group. Chronic liver damage promotes cancer development in our model. Our results suggest that an injured background favors the infiltration of M2 pro-tumor monocytes-derived macrophages. These secrete MMP-2 and MMP-9 that promote tumor progression. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Comparative and Experimental Studies on the Genes Altered by Chronic Hypoxia in Human Brain Microendothelial Cells

PubMed Central

Mata-Greenwood, Eugenia; Goyal, Dipali; Goyal, Ravi

2017-01-01

Background : Hypoxia inducible factor 1 alpha (HIF1A) is a master regulator of acute hypoxia; however, with chronic hypoxia, HIF1A levels return to the normoxic levels. Importantly, the genes that are involved in the cell survival and viability under chronic hypoxia are not known. Therefore, we tested the hypothesis that chronic hypoxia leads to the upregulation of a core group of genes with associated changes in the promoter DNA methylation that mediates the cell survival under hypoxia. Results : We examined the effect of chronic hypoxia (3 days; 0.5% oxygen) on human brain micro endothelial cells (HBMEC) viability and apoptosis. Hypoxia caused a significant reduction in cell viability and an increase in apoptosis. Next, we examined chronic hypoxia associated changes in transcriptome and genome-wide promoter methylation. The data obtained was compared with 16 other microarray studies on chronic hypoxia. Nine genes were altered in response to chronic hypoxia in all 17 studies. Interestingly, HIF1A was not altered with chronic hypoxia in any of the studies. Furthermore, we compared our data to three other studies that identified HIF-responsive genes by various approaches. Only two genes were found to be HIF dependent. We silenced each of these 9 genes using CRISPR/Cas9 system. Downregulation of EGLN3 significantly increased the cell death under chronic hypoxia, whereas downregulation of ERO1L, ENO2, adrenomedullin, and spag4 reduced the cell death under hypoxia. Conclusions : We provide a core group of genes that regulates cellular acclimatization under chronic hypoxic stress, and most of them are HIF independent. PMID:28620317

A telephonic intervention for promoting occupational re-integration in work-disabled individuals with musculoskeletal pain.

PubMed

Sullivan, Michael J L; Simon, Gregory

2012-06-01

The purpose of the present research was to examine the feasibility of a telephonic occupational rehabilitation program. A sample of 23 individuals with chronic musculoskeletal pain was enrolled in the telephonic version of the Progressive Goal Attainment Program (PGAP-Tel). The PGAP-Tel is a risk-targeted intervention designed to reduce pain-related disability consequent to musculoskeletal injury. Treatment outcomes of PGAP-Tel were compared to a group of individuals with chronic musculoskeletal pain, who participated in the face-to-face format of the PGAP. Results showed that PGAP-Tel was acceptable to the majority of participants (76%) to whom it was offered. There were indications that engagement and adherence issues were more problematic in PGAP-Tel than in the face-to-face intervention. Both groups showed comparable reductions in pain, depression, fear of symptom exacerbation, and self-reported disability. Participants in the face-to-face intervention showed greater reduction in catastrophic thinking than participants in PGAP-Tel. Finally, 26% of participants in PGAP-Tel had resumed some form of employment at treatment termination compared to 56% of the participants in the face-to-face intervention. Given the low cost of the PGAP-Tel intervention and the accessibility advantages of a telephonic delivery, this type of intervention might be an important resource for targeting occupational disability in rural or remote communities when face-to-face services are not available.

The Emergence and Unfolding of Telemonitoring Practices in Different Healthcare Organizations

PubMed Central

2018-01-01

Telemonitoring, a sub-category of telemedicine, is promoted as a solution to meet the challenges in Western healthcare systems in terms of an increasing population of people with chronic conditions and fragmentation issues. Recent findings from large-scale telemonitoring programs reveal that these promises are difficult to meet in complex real-life settings which may be explained by concentrating on the practices that emerge when telemonitoring is used to treat patients with chronic conditions. This paper explores the emergence and unfolding of telemonitoring practices in relation to a large-scale, inter-organizational home telemonitoring program which involved 5 local health centers, 10 district nurse units, four hospitals, and 225 general practice clinics in Denmark. Twenty-eight interviews and 28 h of observations of health professionals and administrative staff were conducted over a 12-month period from 2014 to 2015. This study’s findings reveal how telemonitoring practices emerged and unfolded differently among various healthcare organizations. This study suggests that the emergence and unfolding of novel practices is the result of complex interplay between existing work practices, alterations of core tasks, inscriptions in the technology, and the power to either adopt or ignore such novel practices. The study enhances our understanding of how novel technology like telemonitoring impacts various types of healthcare organizations when implemented in a complex inter-organizational context. PMID:29301384

A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation

PubMed Central

Rosenkranz, Melissa A.; Davidson, Richard J.; MacCoon, Donal G.; Sheridan, John F.; Kalin, Ned H.; Lutz, Antoine

2012-01-01

Psychological stress is a major provocative factor of symptoms in chronic inflammatory conditions. In recent years, interest in addressing stress responsivity through meditation training in health-related domains has increased astoundingly, despite a paucity of evidence that reported benefits are specific to meditation practice. We designed the present study to rigorously compare an 8-week Mindfulness-Based Stress Reduction (MBSR) intervention to a well-matched active control intervention, the Health Enhancement Program (HEP) in ability to reduce psychological stress and experimentally-induced inflammation. The Trier Social Stress Test (TSST) was used to induce psychological stress and inflammation was produced using topical application of capsaicin cream to forearm skin. Immune and endocrine measures of inflammation and stress were collected both before and after MBSR training. Results show those randomized to MBSR and HEP training had comparable post-training stress-evoked cortisol responses, as well as equivalent reductions in self-reported psychological distress and physical symptoms. However, MBSR training resulted in a significantly smaller post-stress inflammatory response compared to HEP, despite equivalent levels of stress hormones. These results suggest behavioral interventions designed to reduce emotional reactivity may be of therapeutic benefit in chronic inflammatory conditions. Moreover, mindfulness practice, in particular, may be more efficacious in symptom relief than the well-being promoting activities cultivated in the HEP program. PMID:23092711

Impaired Kidney Function and Associated Factors Among Rural Adults With Disabilities in Taiwan.

PubMed

Chen, Chu-Yeh; Chiu, Wen-Nan; Lin, Yu-Chen; Jane, Sui-Hwi; Chiang, Hsin-Hung; Chen, Mei-Yen

2017-04-01

The results of numerous studies indicate that people with disabilities seek more healthcare than those who are not disabled, particularly for conditions such as chronic kidney disease, cardiovascular disease, and obesity. However, little is known about the incidence of impaired kidney function and its associated factors among adults with disabilities in Taiwan. The aim of this study was to explore the prevalence and factors associated with impaired kidney function among adults with disabilities. This descriptive study was nurse led and was conducted as part of a health promotion program for disadvantaged rural adults with disabilities in Chiayi County, Taiwan. Health screening and a health needs survey were conducted between July and December 2013. Kidney function, physiological biomarkers, health-related behaviors, and demographic characteristics were examined. Eight hundred ten rural adults with disabilities were enrolled. The most common disabilities included physical-related disability (33.1%), intellectual-related disability (26.7%), and hearing and vision impairment (18.6%). The prevalence of impaired kidney function in this population was 85%. According to classification for chronic kidney disease, 68.6% were in Stages 1-2, and 16.8% were in Stages 3-4. Univariate analysis showed that impaired kidney function was significantly associated with lower educational level (p < .001), hearing or vision impairment (p < .001), being overweight or obese (p < .05), high systolic blood pressure (p < .01), fasting blood glucose (p < .001), total cholesterol (p < .001), total triglyceride (p < .05), older age (p < .001), smoking (p < .05), chewing betel nuts (p = .001), and low levels of participation in social activities (p < .05). The final logistic regression model showed that residents with disabilities who were older or had less education, high fasting blood glucose, and high total cholesterol tended to have impaired kidney function after adjustment for other potential confounding variables. Most participants showed impaired kidney function. The factors that were found to relate significantly to this impairment include being overweight, having hyperlipidemia, having hypertension, having high fasting blood glucose, and having an unhealthy lifestyle. Because of the lack of symptoms during the early stages of chronic kidney disease, a community-based health promotion program for these factors is an important element in health advocacy for this vulnerable population.

How can a change in the operating system of the mental health review board promote the discharge of long-term hospitalized psychiatric patients? A case study of Seoul city.

PubMed

Lee, Myung-Soo; Lim, Hee-Young; Kim, Youngki; Lee, Yong-Suk

2014-01-01

One of the most typical and chronic problem in Korean mental health system is the prolonged length of hospital stay. In contrast to there are many components which leads to long length of stay of psychiatric patients in Korean situation such as low and fixed medical fee for psychiatric inpatient treatment, shortage of community resources, lack of care-givers' awareness and so on, there are just few mechanisms to handle this issue such as Mental Health Review Board (MHRB) which is based on Mental Health Act since 1995. However, the discharge order rate was very low and there community care system after discharge order is still very weak. The Korean government has revised the Mental Health Act in 2008 and changed the operating principals of the MHRB from a regional level to a local level to strengthen the function of MHRB. However, the discharge order rate versus the whole evaluation requests still remains at a very low level or less than 5%. And it is still very difficult to execute a discharge order against a patient whose symptoms and conditions become psychiatrically stabilized enough for discharge, due to a shortage of community care facilities and a lack of social support system. These results are exactly same with former studies. Any policies to promote psychiatric discharge including MHRB are needed to take the comprehensive factors into consideration, such as payment program, community infrastructure, increasing care-givers' acceptance and so on. Despite of the political trial of Korean government to reduce length of stay of chronic psychiatric patients, it was not successful. Still it had failed to propose a detailed policy measure in terms of the above-mentioned prerequisites. Therefore, new system and program developments including reform of payment system which reflect prior studies' recommendations are essential.

Analysis of cellular response by exposure to acute or chronic radiation in human lymphoblastoid TK-6 cells

NASA Astrophysics Data System (ADS)

Ohnishi, T.; Yasumoto, J.; Takahashi, A.; Ohnishi, K.

To clarify the biological effects of low-dose rate radiation on human health for long-term stay in space, we analyzed the induction of apoptosis and apoptosis-related gene expression after irradiation with different dose-rate in human lymphoblastoid TK-6 cells harboring wild-type p53 gene. We irradiated TK-6 cells by X-ray at 1.5 Gy (1 Gy/min) and then sampled at 25 hr after culturing. We also irradiated by gamma-ray at 1.5 Gy (1 mGy/min) and then sampled immediately or 25 hr after irradiation. For DNA ladder analysis, we extracted DNA from these samples and electrophoresed with 2% agarose gel. In addition, we extracted mRNA from these samples for DNA-array analysis. mRNA from non-irradiated cells was used as a control. After labeling the cDNA against mRNA with [α -33P]-dCTP and hybridizing onto DNA array (Human Apoptosis Expression Array, R&D Systems), we scanned the profiles of the spots by a phosphorimager (BAS5000, FUJI FILM) and calculated using a NIH Image program. The data of each DNA-array were normalized with eight kinds of house keeping genes. We analyzed the expression level of apoptosis-related genes such as p53-related, Bcl-2 family, Caspase family and Fas-related genes. DNA ladders were obviously detected in the cells exposed to a high dose-rate radiation. We detected the induction of the gene expression of apoptosis-promotive genes. In contrast, almost no apoptosis was observed in the cells exposed to the chronic radiation at a low dose-rate. In addition, we detected the induction of the gene expression of apoptosis-suppressive genes as compared with apoptosis promotive-genes immediately after chronic irradiation. These results lead the importance of biological meaning of exposure to radiation at low dose-rate from an aspect of carcinogenesis. Finally, the effects of chronic irradiation become a highly important issue in space radiation biology for human health.

Medicare's chronic care improvement pilot program: what is its potential?

PubMed

Super, Nora

2004-05-10

This paper describes the voluntary chronic care improvement program under traditional fee-for-service Medicare as authorized by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (Public Law 108-173; section 721). This brief analyzes the emerging issues raised by this new program, including which chronic conditions and regional areas will be targeted, the types of entities that may participate, the physician's role in care management, and the adoption and use of health information technology and evidence-based clinical guidelines.

Association Between IL-10 Gene Promoter Polymorphisms (-592 A/C, -819 T/C, -1082 A/G) and Susceptibility to HBV Infection in an Iranian Population

PubMed Central

Moudi, Bita; Heidari, Zahra; Mahmoudzadeh-Sagheb, Hamidreza; Hashemi, Mohammad; Metanat, Malihe; Khosravi, Soheila; Farrokh, Parisa

2016-01-01

Background IL-10 can play a vital role in immune response against HBV. Three biallelic SNPs from the transcription start site control the transcription of the IL-10 gene. An association between susceptibility to HBV and IL-10 polymorphisms has been suggested in patients with HBV infection. Objectives The present study was designed to study the association between polymorphisms in interleukin-10 (-1082 A/G, -819 T/C and -592 A/C) promoter gene and chronic hepatitis B virus (HBV) infection. Patients and Methods 221 chronically infected patients and 200 healthy control subjects were enrolled in the study. Three biallelic (-1082 A/G, -819 T/C and -592 A/C) polymorphisms in the IL-10 promoter gene were determined by PCR-RFLP method. Results Persistent HBV infection was associated with IL-10-1082 AG (P = 0.001) and GG (P = 0.004) genotypes and G (P = 0.000) allele. IL-10-819 T/C and -592 A/C genotype and allele frequencies did not show any correlation with the risk of chronic hepatitis B infection. Conclusions These results suggest that polymorphisms in interleukin-10 gene promoter influence clinical outcome of HBV infection and susceptibility to HBV infection. PMID:27148384

5 a day Achievement Badge for African-American Boy Scouts: pilot outcome results.

PubMed

Baranowski, Tom; Baranowski, Janice; Cullen, Karen W; deMoor, Carl; Rittenberry, LaTroy; Hebert, David; Jones, Lovell

2002-03-01

Boy Scouts are an important channel to complement school-based programs to enable boys to eat more fruit, 100% juice, and vegetables (FJV) for chronic disease prevention. The "5 a Day Achievement Badge" program was presented on a pilot study basis to African-American Boy Scout troops in Houston. Troops were the unit of recruitment and random assignment to treatment and control groups. The badge program was presented in Fall 1997 by trained dietitians and included activities to increase availability and accessibility of fruit and vegetables at scouts' homes, increase preferences for vegetables, and train in the preparation of FaSST (fast, simple, safe, and tasty) recipes. Weekly comic books demonstrated and reinforced what scouts were expected to do at home. A weekly newsletter with recipes was sent to parents. The program was revised and presented to the control group in Winter 1998. Two 24-h recalls were the primary assessment tools. Telephone interviews were conducted with parents. The intervention resulted in a 0.8 FJV serving difference (post values of treatment versus control groups with pre value covaried). The changes obtained suggest that the intervention was effective in promoting dietary change. (C)2002 American Health Foundation and Elsevier Science (USA).

A controlled trial of the SibworkS group program for siblings of children with special needs.

PubMed

Roberts, Rachel M; Ejova, Anastasia; Giallo, Rebecca; Strohm, Kate; Lillie, Meredith; Fuss, Belinda

2015-01-01

Siblings of children with a disability are an at risk group for emotional and behavioral problems. This study evaluated an intervention to promote the emotional and behavioral functioning of siblings of children with disabilities and chronic health conditions. SibworkS is a six-week manual-based, cognitive-behavioral group support program focussed on strengthening siblings' perceived social support, self-esteem, problem-solving skills, adaptive coping behaviors and positive sibling relationships. Fifty-six children aged 7-12 were allocated to either the SibworkS program (n=30) or waitlist control (n=26) in alternating sequence. The primary outcome was siblings' emotional and behavioral functioning. Additional outcomes were self-esteem, perceived social support, the sibling relationship and coping behaviors. Siblings were followed-up immediately after the intervention and at 3-months. Siblings participating in the SibworkS intervention were reported to have fewer emotional and behavioral difficulties than siblings in the control group immediately following the intervention and at the 3-month follow-up. Participation in SibworkS was associated with fewer emotional and behavioral difficulties for siblings. Implications for practice and future research include recommendations for improving program participation. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Renal Tubule Repair: Is Wnt/β-Catenin a Friend or Foe?

PubMed

Gewin, Leslie S

2018-01-24

Wnt/β-catenin signaling is extremely important for proper kidney development. This pathway is also upregulated in injured renal tubular epithelia, both in acute kidney injury and chronic kidney disease. The renal tubular epithelium is an important target of kidney injury, and its response (repair versus persistent injury) is critical for determining whether tubulointerstitial fibrosis, the hallmark of chronic kidney disease, develops. This review discusses how Wnt/β-catenin signaling in the injured tubular epithelia promotes either repair or fibrosis after kidney injury. There is data suggesting that epithelial Wnt/β-catenin signaling is beneficial in acute kidney injury and important in tubular progenitors responsible for epithelial repair. The role of Wnt/β-catenin signaling in chronically injured epithelia is less clear. There is convincing data that Wnt/β-catenin signaling in interstitial fibroblasts and pericytes contributes to the extracellular matrix accumulation that defines fibrosis. However, some recent studies question whether Wnt/β-catenin signaling in chronically injured epithelia actually promotes fibrosis or repair.

Granulocyte Macrophage Colony-Stimulating Factor-Activated Eosinophils Promote Interleukin-23 Driven Chronic Colitis

PubMed Central

Griseri, Thibault; Arnold, Isabelle C.; Pearson, Claire; Krausgruber, Thomas; Schiering, Chris; Franchini, Fanny; Schulthess, Julie; McKenzie, Brent S.; Crocker, Paul R.; Powrie, Fiona

2015-01-01

Summary The role of intestinal eosinophils in immune homeostasis is enigmatic and the molecular signals that drive them from protective to tissue damaging are unknown. Most commonly associated with Th2 cell-mediated diseases, we describe a role for eosinophils as crucial effectors of the interleukin-23 (IL-23)-granulocyte macrophage colony-stimulating factor (GM-CSF) axis in colitis. Chronic intestinal inflammation was characterized by increased bone marrow eosinopoiesis and accumulation of activated intestinal eosinophils. IL-5 blockade or eosinophil depletion ameliorated colitis, implicating eosinophils in disease pathogenesis. GM-CSF was a potent activator of eosinophil effector functions and intestinal accumulation, and GM-CSF blockade inhibited chronic colitis. By contrast neutrophil accumulation was GM-CSF independent and dispensable for colitis. In addition to TNF secretion, release of eosinophil peroxidase promoted colitis identifying direct tissue-toxic mechanisms. Thus, eosinophils are key perpetrators of chronic inflammation and tissue damage in IL-23-mediated immune diseases and it suggests the GM-CSF-eosinophil axis as an attractive therapeutic target. PMID:26200014

Genetic and metabolic signals during acute enteric bacterial infection alter the microbiota and drive progression to chronic inflammatory disease

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kamdar, Karishma; Khakpour, Samira; Chen, Jingyu

Chronic inflammatory disorders are thought to arise due to an interplay between predisposing host genetics and environmental factors. For example, the onset of inflammatory bowel disease is associated with enteric proteobacterial infection, yet the mechanistic basis for this association is unclear. We have shown previously that genetic defiency in TLR1 promotes acute enteric infection by the proteobacteria Yersinia enterocolitica. Examining that model further, we uncovered an altered cellular immune response that promotes the recruitment of neutrophils which in turn increases metabolism of the respiratory electron acceptor tetrathionate by Yersinia. These events drive permanent alterations in anti-commensal immunity, microbiota composition, andmore » chronic inflammation, which persist long after Yersinia clearence. Deletion of the bacterial genes involved in tetrathionate respiration or treatment using targeted probiotics could prevent microbiota alterations and inflammation. Thus, acute infection can drive long term immune and microbiota alterations leading to chronic inflammatory disease in genetically predisposed individuals.« less

Self-management programs for Aboriginal and Torres Strait Islander Peoples with chronic conditions: A rapid review.

PubMed

Moore, Ellie; Lawn, Sharon; Oster, Candice; Morello, Andrea

2017-01-01

Objectives Review the evidence for the effectiveness of chronic condition self-management programs applied to Aboriginal and Torres Strait Islander Peoples. Methods A rapid review methodology was followed to develop an evidence summary from peer-reviewed and grey literature. Results Only seven peer-reviewed studies were identified. The evidence indicated that group programs, particularly the Stanford Program, and structured individual chronic condition self-management programs were of good quality for Aboriginal and Torres Strait Islander Peoples, although these need to be integrated into practice in order to see the greatest benefits. The Flinders Program showed promise as a standardised program with content designed specifically with and for these populations. Numerous grey literature sources were identified, many using strong participatory approaches developed locally within Aboriginal and Torres Strait Islander Peoples. However, few of these programs have been subject to rigorous evaluation. Discussion Despite the significant focus on chronic condition self-management programs to help address the burden of disease for Aboriginal and Torres Strait Islander Peoples, few studies exist that have been properly evaluated. The Closing the Gap Principles developed by the Australian Institute of Health and Welfare offer important guidance for how to proceed to maximise engagement, cultural appropriateness and ownership of program initiatives.

Perceived benefits and challenges of coordinated approaches to chronic disease prevention in state health departments.

PubMed

Allen, Peg; Sequeira, Sonia; Best, Leslie; Jones, Ellen; Baker, Elizabeth A; Brownson, Ross C

2014-05-08

Chronic disease prevention efforts have historically been funded categorically according to disease or risk factor. Federal agencies are now progressively starting to fund combined programs to address common risk. The purpose of this study was to inform transitions to coordinated chronic disease prevention by learning views on perceived benefits and challenges of a coordinated approach to funding. A national survey on evidence-based public health was conducted from March through May 2013 among state health department employees working in chronic disease prevention (N = 865). Participants were asked to rank the top 3 benefits and top 3 challenges in coordinating chronic disease approaches from provided lists and could provide additional responses. Descriptive analyses, χ(2) tests, and analysis of variance were conducted. The most common perceived benefits of coordinated approaches to chronic disease prevention were improved health outcomes, common risk factors better addressed, and reduced duplication of program efforts. The most common perceived challenges were funding restrictions, such as disease-specific performance measures; competing priorities; lack of communication across programs; funding might be reduced; agency not structured for program coordination; and loss of disease-specific partner support. Rankings of benefits and challenges were similar across states and participant roles; the perceived challenges "lack of communication across programs" (P = .02) and "funding might be reduced" differed by program area (P < .001). Findings can be used by funding agencies and state health departments for planning, training, and technical assistance. The information on perceived challenges demonstrates the need to improve communication across programs, enhance organizational support for coordinated approaches, and create benefits for organizational partners.

Lenalidomide interferes with tumor-promoting properties of nurse-like cells in chronic lymphocytic leukemia

PubMed Central

Fiorcari, Stefania; Martinelli, Silvia; Bulgarelli, Jenny; Audrito, Valentina; Zucchini, Patrizia; Colaci, Elisabetta; Potenza, Leonardo; Narni, Franco; Luppi, Mario; Deaglio, Silvia; Marasca, Roberto; Maffei, Rossana

2015-01-01

Lenalidomide is an immunomodulatory agent clinically active in chronic lymphocytic leukemia patients. The specific mechanism of action is still undefined, but includes modulation of the microenvironment. In chronic lymphocytic leukemia patients, nurse-like cells differentiate from CD14+ mononuclear cells and protect chronic lymphocytic leukemia cells from apoptosis. Nurse-like cells resemble M2 macrophages with potent immunosuppressive functions. Here, we examined the effect of lenalidomide on the monocyte/macrophage population in chronic lymphocytic leukemia patients. We found that lenalidomide induces high actin polymerization on CD14+ monocytes through activation of small GTPases, RhoA, Rac1 and Rap1 that correlated with increased adhesion and impaired monocyte migration in response to CCL2, CCL3 and CXCL12. We observed that lenalidomide increases the number of nurse-like cells that lost the ability to nurture chronic lymphocytic leukemia cells, acquired properties of phagocytosis and promoted T-cell proliferation. Gene expression signature, induced by lenalidomide in nurse-like cells, indicated a reduction of pivotal pro-survival signals for chronic lymphocytic leukemia, such as CCL2, IGF1, CXCL12, HGF1, and supported a modulation towards M1 phenotype with high IL2 and low IL10, IL8 and CD163. Our data provide new insights into the mechanism of action of lenalidomide that mediates a pro-inflammatory switch of nurse-like cells affecting the protective microenvironment generated by chronic lymphocytic leukemia into tissues. PMID:25398834

A School Reentry Program for Chronically Ill Children.

ERIC Educational Resources Information Center

Worchel-Prevatt, Frances F.; Heffer, Robert W.; Prevatt, Bruce C.; Miner, Jennifer; Young-Saleme, Tammi; Horgan, Daniel; Lopez, Molly A.; Frankel, Lawrence; Rae, William A.

1998-01-01

Describes a school reintegration program aimed at overcoming the numerous psychological, physical, environmental, and family-based deterrents to school reentry for chronically ill children. The program uses a systems approach to children's mental health with an emphasis on multiple aspects of the child's environment (i.e., family, medical…

MAPP: A Multimedia Instructional Program for Youths with Chronic Illness.

ERIC Educational Resources Information Center

Murdock, Peggy O'Hara; McClure, Christopher; Lage, Onelia G.; Sarkar, Dilip; Shaw, Kimberly

The Multimedia Approach to Pregnancy Prevention (MAPP) is an expert intelligence multimedia program administered in outpatient and inpatient clinics in the University of Miami/Jackson Children's Hospital (Florida). The target population for the MAPP program is youths aged 9-14 years, diagnosed with chronic illnesses (asthma, diabetes, and sickle…

Disability Management: Organizational Diversity and Dutch Employment Policy

PubMed Central

Haafkens, Joke A.

2010-01-01

Introduction While Human Resource Managers (HRM) and line managers could play a significant role in the prevention of job-related problems and in promotion of early job-continuation, it is not clear wether the chronically ill workers are recognized as a group. Unlike some other groups, distinguished by gender, age or ethnicity, those with chronic illness are less distinct and may not be included in diversity management programs. The aim of this research is to address theory and evidence in literature about the topic, as well as to inquire whether chronic illness of the employees is ‘visible’ in practice. Methods For desk research, we used a systematic search strategy involving medical, statistical, management, and social science databases (Web of Science, MedLine, Pub Med, Psych Info, etc.). Research results are based on case studies conducted with the managers and HRM of government and commercial organizations between March 2007 and October 2008 and between October 2008 and April 2009. These case studies were based on open interviews and focus group sessions (for human resource departments) which were consequently analyzed using thematical analysis. For group sessions, we used concept mapping to collect information from two groups of HRM professionals and managers. Secondary analysis included thematic and content analysis of ‘best practice’ organizations carried out by the Dutch organization Gatekeeper. Conclusions We have discovered that the chronically ill employees are largely invisible to HRM practitioners, line managers who do not always have the right instruments for implementation of the European or national frameworks. Most practitioners are unaware of the impact of chronic illness in their organizations and in employees work life. PMID:20383740

Awareness Status of Chronic Disabling Neurological Diseases among Elderly Veterans.

PubMed

Tan, Ji-Ping; Zhu, Lin-Qi; Zhang, Jun; Zhang, Shi-Min; Lan, Xiao-Yang; Cui, Bo; Deng, Yu-Cheng; Li, Ying-Hao; Ye, Guang-Hua; Wang, Lu-Ning

2015-05-20

The awareness, treatment and prevention of chronic diseases are generally poor among the elderly population of China, whereas the prevention and control of chronic diseases in elderly veteran communities have been ongoing for more than 30 years. Therefore, investigating the awareness status of chronic disabling neurological diseases (CDND) and common chronic diseases (CCD) among elderly veterans may provide references for related programs among the elderly in the general population. A cross-sectional survey was conducted among veterans ≥60 years old in veteran communities in Beijing. The awareness of preventive strategies against dementia, Alzheimer's disease (AD), Parkinson's disease (PD), sleep disorders, cerebrovascular disease (CVD) and CCD such as hypertension, and the approaches used to access this information, including media, word of mouth (verbal communication among the elderly) and health care professionals, were investigated via face-to-face interviews. The awareness rates for CCD and CVD were approximately 100%, but that for AD was the lowest at <10%. The awareness rates for sleep disorders, PD and dementia, were 51.0-89.4%. Media was the most commonly selected mode of communication by which veterans acquired knowledge about CCD and CVD. Media was used by approximately 80% of veterans. Both health care professionals and word of mouth were used by approximately 50% of veterans. With respect to the source of information about CDND excluding AD, the rates of the use of health care professionals, word of mouth and media were 10.6-28.2%, 56.5-76.5%, and approximately 50%, respectively. The awareness of CDND among elderly veterans was significantly lower than that of CCD. More information about CDND should be disseminated by health care professionals. Appropriate guidance will promote the rapid and extensive dissemination of information about the prevention of CDND by media and word-of-mouth peer education.

Personalized Telehealth in the Future: A Global Research Agenda

PubMed Central

2016-01-01

As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that can lead to scalable and sustainable telehealth programs. This paper has two aims: (1) to describe the challenges of promoting telehealth implementation to advance adoption and (2) to present a global research agenda for personalized telehealth within chronic disease management. Using evidence from the United States and the European Union, this paper provides a global overview of the current state of telehealth services and benefits, presents fundamental principles that must be addressed to advance the status quo, and provides a framework for current and future research initiatives within telehealth for personalized care, treatment, and prevention. A broad, multinational research agenda can provide a uniform framework for identifying and rapidly replicating best practices, while concurrently fostering global collaboration in the development and rigorous testing of new and emerging telehealth technologies. In this paper, the members of the Transatlantic Telehealth Research Network offer a 12-point research agenda for future telehealth applications within chronic disease management. PMID:26932229

Personalized Telehealth in the Future: A Global Research Agenda.

PubMed

Dinesen, Birthe; Nonnecke, Brandie; Lindeman, David; Toft, Egon; Kidholm, Kristian; Jethwani, Kamal; Young, Heather M; Spindler, Helle; Oestergaard, Claus Ugilt; Southard, Jeffrey A; Gutierrez, Mario; Anderson, Nick; Albert, Nancy M; Han, Jay J; Nesbitt, Thomas

2016-03-01

As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that can lead to scalable and sustainable telehealth programs. This paper has two aims: (1) to describe the challenges of promoting telehealth implementation to advance adoption and (2) to present a global research agenda for personalized telehealth within chronic disease management. Using evidence from the United States and the European Union, this paper provides a global overview of the current state of telehealth services and benefits, presents fundamental principles that must be addressed to advance the status quo, and provides a framework for current and future research initiatives within telehealth for personalized care, treatment, and prevention. A broad, multinational research agenda can provide a uniform framework for identifying and rapidly replicating best practices, while concurrently fostering global collaboration in the development and rigorous testing of new and emerging telehealth technologies. In this paper, the members of the Transatlantic Telehealth Research Network offer a 12-point research agenda for future telehealth applications within chronic disease management.

7 CFR 1206.50 - Programs, plans, and projects.

Code of Federal Regulations, 2011 CFR

2011-01-01

... PROMOTION, RESEARCH, AND INFORMATION Mango Promotion, Research, and Information Order Definitions Promotion, Research, and Information § 1206.50 Programs, plans, and projects. (a) The Board shall receive and evaluate... establishment, issuance, effectuation, and administration of appropriate programs for promotion, research, and...

7 CFR 1221.121 - Programs, plans, and projects.

Code of Federal Regulations, 2011 CFR

2011-01-01

... PROMOTION, RESEARCH, AND INFORMATION ORDER Sorghum Promotion, Research, and Information Order Promotion, Research, and Information § 1221.121 Programs, plans, and projects. (a) The Board shall receive and... establishment, issuance, effectuation, and administration of appropriate programs for promotion, research, and...

Selecting and Training Community Promoters in Latin America. Studies and Evaluation Papers 13.

ERIC Educational Resources Information Center

Brouwer, Jani; Martinic, Sergio

Community promoters are community members who are selected and trained to perform specific tasks in a project or program. Promoters have worked in education projects throughout Latin American since the 1960s, and their use in programs has shown to boost program success. Whether promoters work in externally directed programs or in more autonomous…

Do Program Implementation Factors or Fidelity Affect Chronic Disease Self-Management Education Programs' Outcomes?

PubMed

Brady, Teresa J; Murphy, Louise B; O'Colmain, Benita J; Hobson, Reeti Desai

2017-09-01

To evaluate whether implementation factors or fidelity moderate chronic disease self-management education program outcomes. Meta-analysis of 34 Arthritis Self-Management Program and Chronic Disease Self-Management Program studies. Community. N = 10 792. Twelve implementation factors: program delivery fidelity and setting and leader and participant characteristics. Eighteen program outcomes: self-reported health behaviors, physical health status, psychological health status, and health-care utilization. Meta-analysis using pooled effect sizes. Modest to moderate statistically significant differences for 4 of 6 implementation factors; these findings were counterintuitive with better outcomes when leaders and participants were unpaid, leaders had less than minimum training, and implementation did not meet fidelity requirements. Exploratory study findings suggest that these interventions tolerate some variability in implementation factors. Further work is needed to identify key elements where fidelity is essential for intervention effectiveness.

Evaluation of a Digital Behavioral Counseling Program for Reducing Risk Factors for Chronic Disease in a Workforce.

PubMed

Wilson, Mark G; Castro Sweet, Cynthia M; Edge, Michael D; Madero, Erica N; McGuire, Megan; Pilsmaker, Megan; Carpenter, Dan; Kirschner, Scott

2017-08-01

To evaluate a digitally delivered, intensive behavioral counseling program for a workforce at risk for obesity-related chronic disease. Employees were offered a digital health program modeled after the diabetes prevention program (DPP). Annual workforce health assessments were used to examine changes in chronic disease risk factors between participants (n = 634) relative to a matched comparison group (n = 1268). Overall, employees were gaining an average of 3.5 pounds annually before program inception. Program engagement was positive; 83% completed the majority of the curriculum and 31% lost at least 5% of their starting weight. Compared with non-participating peers, participants demonstrated reduced weight, improved fasting blood glucose, and improved nutritional intake after a year. The digital health program was effective for engaging employees in health behavior change. Digital options facilitate widespread implementation.

Yoga for Youth in Pain

PubMed Central

Evans, Subhadra; Moieni, Mona; Sternlieb, Beth; Tsao, Jennie C.I; Zeltzer, Lonnie K.

2012-01-01

Children, adolescents, and young adults do not typically feature in clinics, studies, and mainstream notions of chronic pain. Yet many young people experience debilitating pain for extended periods of time. Chronic pain in these formative years may be especially important to treat in order for young patients to maintain life tasks and to prevent protracted disability. The Pediatric Pain Program at the University of California, Los Angeles, is a multidisciplinary treatment program designed for young people with chronic pain and their families. We offer both conventional and complementary medicine to treat the whole individual. This article describes the work undertaken in the clinic and our newly developed Yoga for Youth Research Program. The clinical and research programs fill a critical need to provide service to youth with chronic pain and to scientifically study one of the more popular complementary treatments we offer, Iyengar yoga. PMID:22864296

Chronic Sublethal Effects of San Francisco Bay Sediments on Nereis (Neanthes) arenaceodentata; Effect of Storage Time on Sediment Toxicity

DTIC Science & Technology

1994-04-01

Operations Program Chronic Sublethal Effects of San Francisco Bay Sediments on Nereis (Neanthes) arenaceodentata; Effect of Storage Time on Sediment...Dredging Miscellaneous Paper D-94-2 Operations Program April 1994 Chronic Sublethal Effects of San Francisco Bay Sediments on Nereis (Neanthes...tWatelrway EnD A2AIM a MI F~YRA • rI~WATIMA. •7 WATCH Moore, David W. Chronic sublethal effects of San Francisco Bay sediments on Nerels (Neanthes

Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA.

PubMed

Bauer, Ursula E; Briss, Peter A; Goodman, Richard A; Bowman, Barbara A

2014-07-05

With non-communicable conditions accounting for nearly two-thirds of deaths worldwide, the emergence of chronic diseases as the predominant challenge to global health is undisputed. In the USA, chronic diseases are the main causes of poor health, disability, and death, and account for most of health-care expenditures. The chronic disease burden in the USA largely results from a short list of risk factors--including tobacco use, poor diet and physical inactivity (both strongly associated with obesity), excessive alcohol consumption, uncontrolled high blood pressure, and hyperlipidaemia--that can be effectively addressed for individuals and populations. Increases in the burden of chronic diseases are attributable to incidence and prevalence of leading chronic conditions and risk factors (which occur individually and in combination), and population demographics, including ageing and health disparities. To effectively and equitably address the chronic disease burden, public health and health-care systems need to deploy integrated approaches that bundle strategies and interventions, address many risk factors and conditions simultaneously, create population-wide changes, help the population subgroups most affected, and rely on implementation by many sectors, including public-private partnerships and involvement from all stakeholders. To help to meet the chronic disease burden, the US Centers for Disease Control and Prevention (CDC) uses four cross-cutting strategies: (1) epidemiology and surveillance to monitor trends and inform programmes; (2) environmental approaches that promote health and support healthy behaviours; (3) health system interventions to improve the effective use of clinical and other preventive services; and (4) community resources linked to clinical services that sustain improved management of chronic conditions. Establishment of community conditions to support healthy behaviours and promote effective management of chronic conditions will deliver healthier students to schools, healthier workers to employers and businesses, and a healthier population to the health-care system. Collectively, these four strategies will prevent the occurrence of chronic diseases, foster early detection and slow disease progression in people with chronic conditions, reduce complications, support an improved quality of life, and reduce demand on the health-care system. Of crucial importance, with strengthened collaboration between the public health and health-care sectors, the health-care system better uses prevention and early detection services, and population health is improved and sustained by solidifying collaborations between communities and health-care providers. This collaborative approach will improve health equity by building communities that promote health rather than disease, have more accessible and direct care, and focus the health-care system on improving population health. Copyright © 2014 Elsevier Ltd. All rights reserved.

Informing the development of an Internet-based chronic pain self-management program.

PubMed

Gogovor, Amédé; Visca, Regina; Auger, Claudine; Bouvrette-Leblanc, Lucie; Symeonidis, Iphigenia; Poissant, Lise; Ware, Mark A; Shir, Yoram; Viens, Natacha; Ahmed, Sara

2017-01-01

Self-management can optimize health outcomes for individuals with chronic pain (CP), an increasing fiscal and social burden in Canada. However, self-management is rarely integrated into the regular care (team activities and medical treatment) patients receive. Health information technology offers an opportunity to provide regular monitoring and exchange of information between patient and care team. To identify information needs and gaps in chronic pain management as well as technology features to inform the development of an Internet-based self-management program. Two methods were used. First was a structured literature review: electronic databases were searched up to 2015 with combinations of MeSH terms and text-words such as chronic pain, self-management, self-efficacy, technology, Internet-based, patient portal, and e-health. A narrative synthesis of the characteristics and content of Internet-based pain management programs emerging from the literature review and how they relate to gaps in chronic pain management were completed. Second, four audiotaped focus group sessions were conducted with individuals with chronic pain and caregivers (n=9) and health professionals (n=7) recruited from three multidisciplinary tertiary and rehabilitation centres. A thematic analysis of the focus group transcripts was conducted. Thirty-nine primary articles related to 20 patient-oriented Internet-based programs were selected. Gaps in CP management included lack of knowledge, limited access to health care, suboptimal care, and lack of self-management support. Overall, 14 themes related to information needs and gaps in care were identified by both health professionals and patients, three were exclusive to patients and five to health professionals. Common themes from the focus groups included patient education on chronic pain care, attitude-belief-culture, financial and legal issues, end-of-program crash, and motivational content. Internet-based programs contain automated, communication and decision support features that can address information and care gaps reported by patients and clinicians. However, focus groups identified functionalities not reported in the literature, non-medical and condition- and context-specific information, integration of personal health records, and the role of the different health professionals in chronic pain management were not identified. These gaps need to be considered in the future development of Internet-based programs. While the association between the mechanisms of Internet-based programs' features and outcomes is not clearly established, the results of this study indicate that interactivity, personalization and tailored messages, combined with therapist contact will maximize the effectiveness of an Internet-based chronic pain program in enhancing self-management. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Emerging Models for Mobilizing Family Support for Chronic Disease Management: A Structured Review

PubMed Central

Rosland, Ann-Marie; Piette, John D.

2015-01-01

Objectives We identify recent models for programs aiming to increase effective family support for chronic illness management and self-care among adult patients without significant physical or cognitive disabilities. We then summarize evidence regarding the efficacy for each model identified. Methods Structured review of studies published in medical and psychology databases from 1990 to the present, reference review, general Web searches, and conversations with family intervention experts. Review was limited to studies on conditions that require ongoing self-management, such as diabetes, chronic heart disease, and rheumatologic disease. Results Programs with three separate foci were identified: 1) Programs that guide family members in setting goals for supporting patient self-care behaviors have led to improved implementation of family support roles, but have mixed success improving patient outcomes. 2) Programs that train family in supportive communication techniques, such as prompting patient coping techniques or use of autonomy supportive statements, have successfully improved patient symptom management and health behaviors. 3) Programs that give families tools and infrastructure to assist in monitoring clinical symptoms and medications are being conducted, with no evidence to date on their impact on patient outcomes. Discussion The next generation of programs to improve family support for chronic disease management incorporate a variety of strategies. Future research can define optimal clinical situations for family support programs, the most effective combinations of support strategies, and how best to integrate family support programs into comprehensive models of chronic disease care. PMID:20308347

7 CFR 1218.54 - Programs, plans, and projects.

Code of Federal Regulations, 2010 CFR

2010-01-01

... PROMOTION, RESEARCH, AND INFORMATION ORDER Blueberry Promotion, Research, and Information Order Expenses and..., effectuation, and administration of appropriate programs for promotion, research, and information, including... ensure that it contributes to an effective program of promotion, research, or information. If it is found...

Chronic disease management in rural and underserved populations: innovation and system improvement help lead to success.

PubMed

Bolin, Jane; Gamm, Larry; Kash, Bita; Peck, Mitchell

2005-03-01

Successful implementation of disease management (DM) is based on the ability of an organization to overcome a variety of barriers to deliver timely, appropriate care of chronic illnesses. Such programs initiate DM services to patient populations while initiating self-management education among medication-resistant patients who are chronically ill. Despite formidable challenges, rural health care providers have been successful in initiating DM programs and have discovered several ways in which these programs benefit their organizations. This research reports on six DM programs that serve large rural and underserved populations and have demonstrated that DM can be successfully implemented in such areas.

Complex adaptive chronic care.

PubMed

Martin, Carmel; Sturmberg, Joachim

2009-06-01

The Chronic Care Model (CCM) is widely taken up as the universal operational framework for redesigning health systems to address the increasing chronic disease burden of an ageing population. Chronic care encompasses health promotion, prevention, self management, disease control, treatment and palliation to address 'chronicity' of long journeys through disease, illness and care in the varying contexts of complex health systems. Yet at an operational level, CCM activities are predominantly based on an evidence-base of discreet chronic disease interventions in specific settings; and their demonstrable impact is limited to processes of select disease management such as diabetes in specific disease management programs. This paper proposes a framework that makes sense of the nature of chronicity and its multiple dimensions beyond disease and argues for a set of building blocks and leverage points that should constitute the starting points for 'redesign'? Complex Adaptive Chronic Care is proposed as an idea for an explanatory and implementation framework for addressing chronicity in existing and future chronic care models. Chronicity is overtly conceptualized to encompass the phenomena of an individual journey, with simple and complicated, complex and chaotic phases, through long term asymptomatic disease to bodily dysfunction and illness, located in family and communities. Chronicity encompasses trajectories of self-care and health care, as health, illness and disease co-exist and co-evolve in the setting of primary care, local care networks and at times institutions. A systems approach to individuals in their multi-layered networks making sense of and optimizing experiences of their chronic illness would build on core values and agency around a local vision of health, empowerment of individuals and adaptive leadership, and it responds in line with the local values inherent in the community's disease-based knowledge and the local service's history and dynamics. Complex Adaptive Chronic Care exceeds the current notions of disease management as an endpoint. Primary care team members are system adaptors in partnership with individuals constructing their care and system leadership in response to chronic illness, and enable healthy resilience as well as personal healing and support. Outcomes of complex adaptive chronic care are the emergence of health in individuals and communities through adaptability, self-organization and empowerment. Chronic care reform from within a complex adaptive system framework is bottom up and emergent and stands in stark contrast to (but has to co-exist with) the prevailing protocol based disease care rewarding selective surrogate indicators of disease control. Frameworks such as the Chronic Care Model provide guidance, but do not replace individual experience, local adaptive leadership and responsiveness. The awareness of complexity means opening up problems to a different reality demanding different set of questions and approaches to answer them.

75 FR 41392 - Sorghum Promotion and Research Program: Procedures for the Conduct of Referenda

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-16

... Programs Branch, Livestock and Seed Program, AMS, USDA, Room 2628-S, STOP 0251, 1400 Independence Avenue... to consider industry proposals for generic programs of promotion, research, and information for... through industry-funded, Government-supervised, commodity promotion programs. Section 518 of the Act...

[Children and bankers in Bangladesh].

PubMed

Hartmann, B

1991-06-01

This critique of the World Bank's role in developing country population programs begins with a description of a 1987 case in which an 80-year- old Bangladeshi man was persuaded to undergo vasectomy and then robbed of his incentive payment by the health agent. For over 20 years, the World Bank has pressured 3rd World governments to implement population control programs. Although there are divergent opinions within the World Bank, the most dominant is the neomalthusian view that the poor through their high fertility help perpetuate their own poverty. This view hides the real source of poverty in the Third World: the unequal distribution of resources within these countries and between the developed and developing countries. The World Bank has always been blind to the inequalities, and has associated with the elites of developing countries who monopolize the resources of their countries and thereby impede authentic development. Furthermore, the emphasis on population control distorts social policy and hinders the implementation of safe and voluntary family planning services. In many countries the World Bank has required governments to give greater priority to population control than to basic health services. It has pressured them to relax contraceptive prescription norms and has promoted the more effective methods without regard to proper use or side effects. In Bangladesh the World Bank has sponsored sterilization programs that rely on coercion and incentives. In that country of enormous inequities, 10% of landowners control over 50% of lands, while nearly half the population is landless and chronically underemployed. Political power is concentrated in the military government, which annually receives over 1.5 billion dollars in external aid. External aid primarily benefits the wealthy. 3/4 of the population are undernourished and less than 1/3 are literate or have access to basic health care. The poor of Bangladesh, as in many other countries, feel that their only source of security is to have many children, a significant proportion of whom will not survive. In rural Bangladesh, where chronic hunger and unemployment are rife, the incentives and the pressures of family planning and health workers were sufficient to persuade many persons to undergo sterilization. Payment of commissions to workers to promote sterilization has discouraged them from supplying adequate information about sterilization for fear of losing clients. Population from other donors and wide publicity about the abuses in the sterilization program and the high rates of regret among women undergoing sterilization only for the incentives have led to some modifications, but the World Bank has continued to exert pressure on the Bangladeshi government to develop fertility-control programs. The damaging effects of World Bank population programs can also be seen in Indonesia, Nepal, and other developing countries.

76 FR 3046 - Farmers' Market Promotion Program Regulation; Notice of Request for Approval of a New Information...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-19

... Service 7 CFR Part 185 [Document No. AMS-TM-10-0088; TM-08-07] RIN 0581-AC83 Farmers' Market Promotion... Promotion Program (FMPP). The FMPP is a competitive grant program that makes funds available to eligible... information collection OMB 0581-0235, entitled Farmers' Market Promotion Program. DATES: Comments received by...

Using robot fully assisted functional movements in upper-limb rehabilitation of chronic stroke patients: preliminary results.

PubMed

Caimmi, Marco; Chiavenna, Andrea; Scano, Alessandro; Gasperini, Giulio; Giovanzana, Chiara; Molinari Tosatti, Lorenzo; Molteni, Franco

2017-06-01

Robotic rehabilitation is promising to promote function in stroke patients. The assist as needed training paradigm has shown to stimulate neuroplasticity but often cannot be used because stroke patients are too impaired to actively control the robot against gravity. To verify whether a rehabilitation intervention based on robot fully assisted reaching against gravity (RCH) and hand-to-mouth (HTM) can promote upper-limb function in chronic stroke. Cohort study. Chronic stroke outpatients referring to the robotic rehabilitation lab of a rehabilitation centre. Ten chronic stroke patients with mild to moderate upper-limb hemiparesis. Patients underwent 12 sessions (3 per week) of robotic treatment using an end-effector robot Every session consisted of 20 minutes each of RCH and HtM; movements were fully assisted, but patients were asked to try to actively participate. The Fugl-Meyer Assessment (FMA) was the primary outcome measure; Medical Research Council and Modified Ashworth Scale were the secondary outcome measures. All patients, but one, show functional improvements (FMA section A-D, mean increment 7.2±3.9 points, P<0.008). This preliminary study shows that a robotic intervention based on functional movements, fully assisted, can be effective in promoting function in chronic stroke patients. These results are promising considering the short time of the intervention (1 month) and the time from the stroke event, which was large (27±20 months). A larger study, comprehensive of objective instrumental measures, is necessary to confirm the results. This intervention could be extended even to subacute stroke and other neurological disorders.

The Value of College Health Promotion: A Critical Population and Setting for Improving the Public's Health

ERIC Educational Resources Information Center

Lederer, Alyssa M.; Oswalt, Sara B.

2017-01-01

College students are an important priority population, and higher education is an opportune setting for chronic disease prevention and health promotion. Yet many people do not understand why enhancing the well-being of college students is of value. In this commentary, we address 3 common misperceptions about college health promotion: (1) College…

7 CFR 1207.311 - Programs and projects.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN Potato Research and Promotion Plan Definitions § 1207.311 Programs and projects. Programs and projects mean those research, development, advertising or promotion programs or projects developed by the...

[Development of Empowerment Program for Persons with Chronic Mental Illness and Evaluation of Impact].

PubMed

Kim, Mijung; Lee, Kyunghee

2015-12-01

This study was done to develop an empowerment program for people with chronic mental illness and to analyze effects of the program on level of empowerment. The research was conducted using a nonequivalent control group pretest-posttest design. Participants were 37 people with chronic mental illness (experimental group: 18, control group: 19). The empowerment program was provided for 8 weeks (15 sessions). Data were collected between July 21 and October 17, 2014. Data were analyzed using Chi-square, Fisher's exact test, Sapiro-Wilk test, and Repeated measure ANOVA with SPSS/WIN 18.0. Quantitative results show that self-efficacy, interpersonal relationships, attitudes in the workplace, occupational performance capacity, and levels of empowered execute were significantly better in the experimental group compared to the control group. Study findings indicate that this empowerment program for persons with chronic mental illness is effective for improving self efficacy, interpersonal skills, attitudes in the workplace, occupational performance capacity, levels of empowered execute.

[Efficiency of etiologic correction of concomitant ascaridosis in the complex treatment of chronic pancreatitis].

PubMed

Babinets', L S; Droniak, Iu V; Pliashko, K O; Babinets', A I

2014-11-01

The of antihelmintic preparation albendazole using in the complex treatment of patients with chronic pancreatitis with the concomitant ascaridosis was promote regression of clinical demonstration of basic and concomitant diseases (P < 0.05). Options of coprogram and the structural state of pancreas from data of ultrasonography in marks by Marseille-Cambridge classification of chronic pancreatitis, after the conducted treatment became the better (P < 0.05), that established expedience of the use of albendazole in complex treatment of patients with a chronic pancreatitis with a concomitant ascaridosis.

Beta-adrenergic signaling promotes tumor angiogenesis and prostate cancer progression through HDAC2-mediated suppression of thrombospondin-1.

PubMed

Hulsurkar, M; Li, Z; Zhang, Y; Li, X; Zheng, D; Li, W

2017-03-01

Chronic behavioral stress and beta-adrenergic signaling have been shown to promote cancer progression, whose underlying mechanisms are largely unclear, especially the involvement of epigenetic regulation. Histone deacetylase-2 (HDAC2), an epigenetic regulator, is critical for stress-induced cardiac hypertrophy. It is unknown whether it is necessary for beta-adrenergic signaling-promoted cancer progression. Using xenograft models, we showed that chronic behavioral stress and beta-adrenergic signaling promote angiogenesis and prostate cancer progression. HDAC2 was induced by beta-adrenergic signaling in vitro and in mouse xenografts. We next uncovered that HDAC2 is a direct target of cAMP response element-binding protein (CREB) that is activated by beta-adrenergic signaling. Notably, HDAC2 is necessary for beta-adrenergic signaling to induce angiogenesis. We further demonstrated that, upon CREB activation, HDAC2 represses thrombospondin-1 (TSP1), a potent angiogenesis inhibitor, through epigenetic regulation. Together, these data establish a novel pathway that HDAC2 and TSP1 act downstream of CREB activation in beta-adrenergic signaling to promote cancer progression.

Increasing Neuroplasticity to Bolster Chronic Pain Treatment: A Role for Intermittent Fasting and Glucose Administration?

PubMed Central

Sibille, KT; Bartsch, F; Reddy, D; Fillingim, RB; Keil, A

2016-01-01

Neuroplastic changes in brain structure and function are not only a consequence of chronic pain but are involved in the maintenance of pain symptoms. Thus, promoting adaptive, treatment responsive neuroplasticity represents a promising clinical target. Emerging evidence about the human brain’s response to an array of behavioral and environmental interventions may assist in identifying targets to facilitate increased neurobiological receptivity, promoting healthy neuroplastic changes. Specifically, strategies to maximize neuroplastic responsiveness to chronic pain treatment could enhance treatment gains by optimizing learning and positive central nervous system (CNS) adaptation. Periods of heightened plasticity have been traditionally identified with the early years of development. More recent research however has identified a wide spectrum of methods that can be used to “re-open” and enhance plasticity and learning in adults. In addition to transcranial direct current stimulation and transcranial magnetic stimulation, behavioral and pharmacological interventions have been investigated. Intermittent fasting and glucose administration are two propitious strategies, which are non-invasive, inexpensive to administer, implementable in numerous settings, and may be applicable across differing chronic pain treatments. Key findings and neurophysiological mechanisms are summarized, providing evidence for the potential clinical contributions of these two strategies toward ameliorating chronic pain. PMID:26848123

Course content related to chronic wounds in nursing degree programs in Spain.

PubMed

Romero-Collado, Angel; Raurell-Torreda, Marta; Zabaleta-del-Olmo, Edurne; Homs-Romero, Erica; Bertran-Noguer, Carme

2015-01-01

To analyze content related to chronic wounds in nursing degree programs in Spain. Cross-sectional descriptive study. Course descriptions available for online access during June and July of 2012 were reviewed for the 114 centers in Spain that offer a nursing degree, according to the official Registry of Universities, Centers, and Titles. Of the 114 centers with degree programs, 95 (83.3%) post course content online, which make it possible to analyze 2,258 courses. In 60 (63.1%) of these centers, none of the courses included the concept of pressure ulcer prevention, and the course content posted by 36 (37.9%) centers made no mention of their treatment. None of the course descriptions contained any reference to pain management in patients with chronic wounds. Of the 728 elective courses analyzed, only one was related to chronic wounds. This review of available information about nursing degree programs in Spain indicates that pain management in patients with chronic wounds is not addressed in any course, and more courses consider the treatment of pressure ulcers than their prevention. Degree programs responsible for the training of future nurses should be reviewed and revised as needed to ensure that graduates have acquired minimum basic competencies in the prevention and treatment of chronic wounds that help to decrease the theory-practice gap in this field. © 2014 Sigma Theta Tau International.

Evaluation of a Digital Behavioral Counseling Program for Reducing Risk Factors for Chronic Disease in a Workforce

PubMed Central

Wilson, Mark G.; Castro Sweet, Cynthia M.; Edge, Michael D.; Madero, Erica N.; McGuire, Megan; Pilsmaker, Megan; Carpenter, Dan; Kirschner, Scott

2017-01-01

Objective: To evaluate a digitally delivered, intensive behavioral counseling program for a workforce at risk for obesity-related chronic disease. Methods: Employees were offered a digital health program modeled after the diabetes prevention program (DPP). Annual workforce health assessments were used to examine changes in chronic disease risk factors between participants (n = 634) relative to a matched comparison group (n = 1268). Results: Overall, employees were gaining an average of 3.5 pounds annually before program inception. Program engagement was positive; 83% completed the majority of the curriculum and 31% lost at least 5% of their starting weight. Compared with non-participating peers, participants demonstrated reduced weight, improved fasting blood glucose, and improved nutritional intake after a year. Conclusions: The digital health program was effective for engaging employees in health behavior change. Digital options facilitate widespread implementation. PMID:28650899

A Health Promotion Program for School Personnel.

ERIC Educational Resources Information Center

Flack, Vilma T.; Kilcoyne, Martha E., Jr.

1984-01-01

Programs that provide support for the health and well-being of school employees are rare. A health promotion program focusing on self-help is discussed in this article. Methods of program development and implementation are presented. Results indicate that school employees can be trained to facilitate a health promotion program in the school…

The chronic care model versus disease management programs: a transaction cost analysis approach.

PubMed

Leeman, Jennifer; Mark, Barbara

2006-01-01

The present article applies transaction cost analysis as a framework for better understanding health plans' decisions to improve chronic illness management by using disease management programs versus redesigning care within physician practices.

Community-based exercise programs as a strategy to optimize function in chronic disease: a systematic review.

PubMed

Desveaux, Laura; Beauchamp, Marla; Goldstein, Roger; Brooks, Dina

2014-03-01

Chronic diseases are the leading cause of death and disability worldwide. Preliminary evidence suggests that community-based exercise (CBE) improves functional capacity (FC) and health-related quality of life (HRQL). To describe the structure and delivery of CBE programs for chronic disease populations and compare their impact on FC and HRQL to standard care. Randomized trials examining CBE programs for individuals with stroke, chronic obstructive pulmonary disease, osteoarthritis, diabetes, and cardiovascular disease were identified. Quality was assessed using the Cochrane risk of bias tool. Meta-analyses were conducted using Review Manager 5.1. The protocol was registered on PROSPERO (CRD42012002786). Sixteen studies (2198 individuals, mean age 66.8±4.9 y) were included to describe program structures, which were comparable in their design and components, irrespective of the chronic disease. Aerobic exercise and resistance training were the primary interventions in 85% of studies. Nine studies were included in the meta-analysis. The weighted mean difference for FC, evaluated using the 6-minute walk test, was 41.7 m (95% confidence interval [CI], 20.5-62.8). The standardized mean difference for all FC measures was 0.18 (95% CI, 0.05-0.3). The standardized mean difference for the physical component of HRQL measures was 0.21 (95% CI, 0.05-0.4) and 0.38 (95% CI, 0.04-0.7) for the total score. CBE programs across chronic disease populations have similar structures. These programs appear superior to standard care with respect to optimizing FC and HRQL in individuals with osteoarthritis; however, the effect beyond this population is unknown. Long-term sustainability of these programs remains to be established.

Promoting normal development and self-efficacy in school-age children managing chronic conditions.

PubMed

Mickley, Kristyn L; Burkhart, Patricia V; Sigler, April N

2013-06-01

Chronic conditions can affect school-age children in more ways than just physically. Normal childhood maturation is critical at this age, yet daily management of chronic symptoms can be challenging. This article describes 4 common childhood chronic illnesses (asthma, seizure disorders, diabetes, and cystic fibrosis), and the impact these conditions have on the developing child. Self-efficacy, the belief that one can effectively perform necessary skills, is essential to self-management of chronic conditions and contributes in a positive way to the child's normal development. Implications for clinical practice and future research are discussed. Copyright © 2013 Elsevier Inc. All rights reserved.

Using Technology To Promote Your Guidance and Counseling Program among Stake Holders.

ERIC Educational Resources Information Center

Sabella, Russell A.; Booker, Beverly L.

2003-01-01

Focuses on the use of technology to promote guidance and counseling programs among stakeholders. Details the significance of promoting comprehensive guidance and counseling programs and examples of technology tools used for persuasive communication. Discusses the advantages and disadvantages of using technology to promote a school counseling…

Promoting healthy diets and tackling obesity and diet-related chronic diseases: what are the agricultural policy levers?

PubMed

Hawkes, Corinna

2007-06-01

Diet-related chronic diseases are now a serious global public health problem. Public health groups are calling for the agricultural sector to play a greater role in tackling the threat. To identify potential points of policy intervention in the agricultural sector that could be leveraged to promote healthy diets and tackle obesity and diet-related chronic diseases. A review of the literature on the dietary implications of agriculture, a conceptual analysis of the issues, and the identification of relevant examples. There are two main potential points of intervention in the agricultural sector that could be leveraged to promote healthy diets: agricultural policies and agricultural production practices. Agricultural policies and practices affect diet through their influence on food availability, price, and nutrient quality, which in turn affects food choices available to consumers. Agricultural policies amenable to intervention include input, production, and trade policies; agricultural production practices amenable to intervention include crop breeding, crop fertilization practices, livestock-feeding practices, and crop systems diversity. It is well-known that agricultural policies and production practices influence what farmers choose to grow. Agricultural policies and production practices could also play a role in influencing what consumers choose to eat. To identify how agricultural policies and practices can usefully contribute toward promoting healthy diets and tackling obesity and diet-related chronic diseases, health policymakers need to examine whether current agricultural policies and production practices are contributing to-or detracting from-efforts to attain dietary goals; where and how could agricultural intervention help achieve dietary goals; and whether there are trade-offs between these interventions and other important concerns, such as undernutrition and the livelihoods of agricultural producers. Given the potential of agriculture to contribute to large-scale, population-level dietary improvements, these questions warrant closer attention from health policymakers.

Worse cardiac remodeling in response to pressure overload in type 2 diabetes mellitus.

PubMed

Gonçalves, N; Gomes-Ferreira, C; Moura, C; Roncon-Albuquerque, R; Leite-Moreira, A F; Falcão-Pires, I

2016-08-15

Diabetic cardiomyopathy is characterized by cardiac structural and functional abnormalities. Additionally, chronic pressure overload conditions are highly prevalent amongst diabetic population and this association leads to a more severe myocardial impairment. The differences in myocardial pathophysiology between type 1 and type 2 diabetes mellitus (DM) still remain to be clarified. Thus, we aimed to investigate biventricular structural and functional changes promoted by the two types of DM and the impact of concomitant chronic pressure overload. Wistar rats were injected with streptozotocin (Type 1 DM, T1DM) or fed with a hypercaloric diet (Type 2 DM, T2DM). Pressure overload was imposed in DM animals by aortic constriction and after 5weeks of DM the cardiac function and structure were evaluated. Both types of DM promoted hypertrophy, increased fibrosis and advanced glycation end-products deposition, in the two ventricles. Interestingly, the induced myocardial alterations were distinct. While T1DM stimulated a pronounced hypertrophy and extracellular matrix remodeling, T2DM induced functional impairment. The negative impact of the association of DM with aortic constriction was more pronounced in T2DM, promoting impaired function and increased stiffness, particularly in the right ventricle. Our study demonstrated that the two types of diabetes induce distinct cardiac alterations per se or when combined with chronic pressure overload. T1DM promoted a more extensive remodeling in cardiac structure while T2DM significantly impaired ventricular function. The impact of pressure overload was more notorious in T2DM as observed by worse myocardial remodeling, suggesting a higher susceptibility to the deleterious effects of chronic pressure overload, namely hypertension, among this diabetic population. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Increasing the effectiveness of the Diabetes Prevention Program through if-then plans: study protocol for the randomized controlled trial of the McGill CHIP Healthy Weight Program.

PubMed

Knäuper, Bärbel; Ivanova, Elena; Xu, Zhen; Chamandy, Melodie; Lowensteyn, Ilka; Joseph, Lawrence; Luszczynska, Aleksandra; Grover, Steven

2014-05-18

The Diabetes Prevention Program (DPP) is highly effective in promoting weight loss in overweight and obese individuals. However, one-on-one DPP sessions are costly. As a cost-saving alternative, a group version of the DPP, called Group Lifestyle Balance program (GLB), has been developed but has been shown to be less effective. The aim of this two-arm parallel randomized controlled trial is to increase the effectiveness of the GLB by integrating habit formation techniques, namely if-then plans and their mental practice, into the program. A total of 154 participants will be randomized to a standard or enriched GLB program. For the enriched GLB program, if-then plans and their mental practice will be integrated into the standard GLB program. Participants will be overweight or obese men and women (BMI of 28 to 45 kg/m2, waist circumference ≥ 88 for women, ≥ 102 for men, 18 to 75 years of age) who do less than 200 minutes of self-reported moderate or vigorous exercise per week. Measures will be completed at baseline, 3 months, post-intervention (12 months), and 12 months post-intervention (24 months). The primary outcome measure is weight loss at 3, 12, and 24 months. Secondary outcomes include percent reaching weight loss goal, physical activity at 3, 12, and 24 months, and weight-related risk factors (waist circumference, hemoglobin A1c, systolic/diastolic blood pressure, total cholesterol/HDL ratio). Standardized training of the life-style coaches, use of standardized manuals, and audio taping and reviewing of the sessions will ensure intervention fidelity. The study will provide evidence-based data on the effectiveness of an enhanced GLB intervention in promoting weight loss and in reducing weight-related risk factors for chronic health problems. Ethical clearance has been received from the Research Ethics and Compliance Board of the Faculty of Medicine Research and Graduate Studies Office at McGill University (Montreal, Canada). ClinicalTrials.gov Identifier: NCT02008435. Registered 6 December 2013.

HIV treatment as prevention in Jamaica and Barbados: magic bullet or sustainable response?

PubMed

Barrow, Geoffrey; Barrow, Christine

2015-01-01

This discursive article introduces HIV treatment as prevention (TasP) and identifies various models for its extrapolation to wider population levels. Drawing on HIV surveillance data for Jamaica and Barbados, the article identifies significant gaps in HIV response programming in relation to testing, antiretroviral treatment coverage, and treatment adherence, thereby highlighting the disparity between assumptions and prerequisites for TasP success. These gaps are attributable, in large part, to sociocultural impediments and structural barriers, severe resource constraints, declining political will, and the redefinition of HIV as a manageable, chronic health issue. Antiretroviral treatment and TasP can realize success only within a combination prevention frame that addresses structural factors, including stigma and discrimination, gender inequality and gender-based violence, social inequality, and poverty. The remedicalization of the response compromises outcomes and undermines the continued potential of HIV programming as an entry point for the promotion of sexual, health, and human rights. © The Author(s) 2013.

The role of the community health nurse in military humanitarian operations: lessons from operation sea signal--Guantanamo Bay, Cuba.

PubMed

Samuels, G L; Sommer, M D

1997-01-01

The military humanitarian mission is an "Operation-Other-Than-War" with a goal of restoring or promoting the ability of a population to care for themselves (U.S. Army, 1990b). One of the primary foci of these operations is the medical care of the target populace. The elements and techniques of primary health care have been used for this purpose, especially as the situation of a population stabilizes and demands a community base for health care programs (Downing, 1989). The knowledge and expertise of a community health nurse is indispensable in both acute and chronic humanitarian situations in performing a comprehensive community needs assessment for the formulation of a community base for health care programs while facilitating a health care system that meets the overall needs of the population. The contributions of community health nurses assigned to Joint Task Force 160, during Operation Sea Signal, bear testimony as to the efficacy of such a "specialized" role in the care of displaced populations.

The contribution of the programmed cell death machinery in innate immune cells to lupus nephritis.

PubMed

Tsai, FuNien; Perlman, Harris; Cuda, Carla M

2017-12-01

Systemic lupus erythematosus (SLE) is a chronic multi-factorial autoimmune disease initiated by genetic and environmental factors, which in combination trigger disease onset in susceptible individuals. Damage to the kidney as a consequence of lupus nephritis (LN) is one of the most prevalent and severe outcomes, as LN affects up to 60% of SLE patients and accounts for much of SLE-associated morbidity and mortality. As remarkable strides have been made in unlocking new inflammatory mechanisms associated with signaling molecules of programmed cell death pathways, this review explores the available evidence implicating the action of these pathways specifically within dendritic cells and macrophages in the control of kidney disease. Although advancements into the underlying mechanisms responsible for inducing cell death inflammatory pathways have been made, there still exist areas of unmet need. By understanding the molecular mechanisms by which dendritic cells and macrophages contribute to LN pathogenesis, we can improve their viability as potential therapeutic targets to promote remission. Copyright © 2016 Elsevier Inc. All rights reserved.

The transcriptional coregulator GRIP1 controls macrophage polarization and metabolic homeostasis

PubMed Central

Coppo, Maddalena; Chinenov, Yurii; Sacta, Maria A.; Rogatsky, Inez

2016-01-01

Diet-induced obesity causes chronic macrophage-driven inflammation in white adipose tissue (WAT) leading to insulin resistance. WAT macrophages, however, differ in their origin, gene expression and activities: unlike infiltrating monocyte-derived inflammatory macrophages, WAT-resident macrophages counteract inflammation and insulin resistance, yet, the mechanisms underlying their transcriptional programming remain poorly understood. We recently reported that a nuclear receptor cofactor—glucocorticoid receptor (GR)-interacting protein (GRIP)1—cooperates with GR to repress inflammatory genes. Here, we show that GRIP1 facilitates macrophage programming in response to IL4 via a GR-independent pathway by serving as a coactivator for Kruppel-like factor (KLF)4—a driver of tissue-resident macrophage differentiation. Moreover, obese mice conditionally lacking GRIP1 in macrophages develop massive macrophage infiltration and inflammation in metabolic tissues, fatty livers, hyperglycaemia and insulin resistance recapitulating metabolic disease. Thus, GRIP1 is a critical regulator of immunometabolism, which engages distinct transcriptional mechanisms to coordinate the balance between macrophage populations and ultimately promote metabolic homeostasis. PMID:27464507

Empowerment and Social Support: Implications for Practice and Programming Among Minority Women with Substance Abuse and Criminal Justice Histories.

PubMed

Barringer, Alexandra; Hunter, Bronwyn A; Salina, Doreen D; Jason, Leonard A

2017-01-01

Programs for women with substance abuse and criminal justice histories often incorporate empowerment and social support into service delivery systems. Women's empowerment research has focused on the relationship between women's personal identities and the larger sociopolitical context, with an emphasis on how community-based resources are critical for promoting well-being. Social support often protects against negative outcomes for individuals who live with chronic stress. However, few studies have evaluated community resource knowledge and empowerment among marginalized women or how social support might strengthen or weaken this relationship. This study investigated resource knowledge, social support, and empowerment among 200 minority women in substance abuse recovery who had recent criminal justice involvement. Results indicated that resource knowledge was related to empowerment and belonging social support marginally moderated this relationship. In addition, education level increased and current involvement in the criminal justice system decreased empowerment. Implications for research, practice, and policy are discussed.

Empowerment and Social Support: Implications for Practice and Programming among Minority Women with Substance Abuse and Criminal Justice Histories

PubMed Central

Barringer, Alexandra; Hunter, Bronwyn A.; Salina, Doreen; Jason, Leonard A.

2016-01-01

Programs for women with substance abuse and criminal justice histories often incorporate empowerment and social support into service delivery systems. Women’s empowerment research has focused on the relationship between women’s personal identities and the larger sociopolitical context, with an emphasis on how community based resources are critical for promoting well-being. Social support often protects against negative outcomes for individuals who live with chronic stress. However, few studies have evaluated community resource knowledge and empowerment among marginalized women or how social support might strengthen or weaken this relationship. This study investigated resource knowledge, social support and empowerment among 200 minority women in substance abuse recovery who had recent criminal justice involvement. Results indicated that resource knowledge was related to empowerment and belonging social support marginally moderated this relationship. In addition, education level increased and current involvement in the criminal justice system decreased empowerment. Implications for research, practice and policy are discussed. PMID:27084362

Long term effects of a health promotion intervention in low socioeconomic Arab- Israeli kindergartens

PubMed Central

2013-01-01

Background Obesity is the most common chronic pediatric disease in westernized, especially low socioeconomic societies. We previously demonstrated the beneficial effects of a randomized prospective school-based health education program for low socioeconomic status Arab-Israeli kindergarten children. Methods To examine whether the effects of our program on nutrition and physical activity knowledge and preferences, anthropometric measures, and fitness persisted one year after the end of intervention. We were able to perform the one year follow-up in 203 kindergarten children (59% of our 342 original cohort; 85 control, 118 intervention). Results At one year following the intervention BMI and BMI percentiles approached baseline level in both the intervention (16.4±0.2 kg/m2 and 61.5±2.4%, respectively) and control group participants (16.5±0.2 kg/m2 and 58.5±3.3%, respectively). Yet, a year after the end of the intervention, the decrease in BMI%ile from baseline was significantly greater in the intervention group (-7.8±1.5 vs. -1.9±1.9, p<0.012). Nutritional and physical activity knowledge and preferences, and physical fitness remained significantly elevated in the intervention compared to the control group participants. Conclusions The beneficial effects of a kindergarten dietary-physical activity intervention applied by the kindergarten teachers, on nutrition and physical activity knowledge and preferences, fitness, and BMI percentile were evident one year after the end of intervention. This promising program may play a role in health promotion, prevention and treatment of childhood obesity. PMID:23547765

Addressing Obesity in the Workplace: The Role of Employers

PubMed Central

Heinen, Luann; Darling, Helen

2009-01-01

Context: Employers have pursued many strategies over the years to control health care costs and improve care. Disappointed by efforts to manage costs through the use of insurance-related techniques (e.g., prior authorization, restricted provider networks), employers have also begun to try to manage health by addressing their employees' key lifestyle risks. Reducing obesity (along with tobacco use and inactivity) is a priority for employers seeking to lower the incidence and severity of chronic illness and the associated demand for health services. Methods: This article describes the employer's perspective on the cost impact of obesity, discusses current practices in employer-sponsored wellness and weight management programs, provides examples from U.S. companies illustrating key points of employers' leverage and opportunities, and suggests policy directions to support the expansion of employers' initiatives, especially for smaller employers. Findings: Researchers and policymakers often overlook the extensive efforts and considerable impact of employer-sponsored wellness and health improvement programs. Greater focus on opportunities in the workplace is merited, however, for the evidence base supporting the economic and health impacts of employer-sponsored health promotion and wellness is growing, although not as quickly as the experience base of large employers. Conclusions: Public and private employers can serve their own economic interests by addressing obesity. Health care organizations, particularly hospitals, as well as public employers can be important role models. Policy development is needed to accelerate change, especially for smaller employers (those with fewer than 500 employees), which represent the majority of U.S. employers and are far less likely to offer health promotion programs. PMID:19298417

Addressing obesity in the workplace: the role of employers.

PubMed

Heinen, LuAnn; Darling, Helen

2009-03-01

Employers have pursued many strategies over the years to control health care costs and improve care. Disappointed by efforts to manage costs through the use of insurance-related techniques (e.g., prior authorization, restricted provider networks), employers have also begun to try to manage health by addressing their employees' key lifestyle risks. Reducing obesity (along with tobacco use and inactivity) is a priority for employers seeking to lower the incidence and severity of chronic illness and the associated demand for health services. This article describes the employer's perspective on the cost impact of obesity, discusses current practices in employer-sponsored wellness and weight management programs, provides examples from U.S. companies illustrating key points of employers' leverage and opportunities, and suggests policy directions to support the expansion of employers' initiatives, especially for smaller employers. Researchers and policymakers often overlook the extensive efforts and considerable impact of employer-sponsored wellness and health improvement programs. Greater focus on opportunities in the workplace is merited, however, for the evidence base supporting the economic and health impacts of employer-sponsored health promotion and wellness is growing, although not as quickly as the experience base of large employers. Public and private employers can serve their own economic interests by addressing obesity. Health care organizations, particularly hospitals, as well as public employers can be important role models. Policy development is needed to accelerate change, especially for smaller employers (those with fewer than 500 employees), which represent the majority of U.S. employers and are far less likely to offer health promotion programs.

The prevention and management of chronic disease in primary care: recommendations from a knowledge translation meeting.

PubMed

Ahmed, Sara; Ware, Patrick; Visca, Regina; Bareil, Celine; Chouinard, Maud-Christine; Desforges, Johanne; Finlayson, Roderick; Fortin, Martin; Gauthier, Josée; Grimard, Dominique; Guay, Maryse; Hudon, Catherine; Lalonde, Lyne; Lévesque, Lise; Michaud, Cecile; Provost, Sylvie; Sutton, Tim; Tousignant, Pierre; Travers, Stella; Ware, Mark; Gogovor, Amede

2015-10-15

Seven chronic disease prevention and management programs were implemented across Quebec with funding support from a provincial-private industry funding initiative. Given the complexity of implementing integrated primary care chronic disease management programs, a knowledge transfer meeting was held to share experiences across programs and synthesize common challenges and success factors for implementation. The knowledge translation meeting was held in February 2014 in Montreal, Canada. Seventy-five participants consisting of 15 clinicians, 14 researchers, 31 knowledge users, and 15 representatives from the funding agencies were broken up into groups of 10 or 11 and conducted a strengths, weaknesses, opportunities, and threats analysis on either the implementation or the evaluation of these chronic disease management programs. Results were reported back to the larger group during a plenary and recorded. Audiotapes were transcribed and summarized using pragmatic thematic analysis. Strengths to leverage for the implementation of the seven programs include: (1) synergy between clinical and research teams; (2) stakeholders working together; (3) motivation of clinicians; and (4) the fact that the programs are evidence-based. Weaknesses to address include: (1) insufficient resources; (2) organizational change within the clinical sites; (3) lack of referrals from primary care physicians; and (4) lack of access to programs. Strengths to leverage for the evaluation of these programs include: (1) engagement of stakeholders and (2) sharing of knowledge between clinical sites. Weaknesses to address include: (1) lack of referrals; (2) difficulties with data collection; and (3) difficulties in identifying indicators and control groups. Opportunities for both themes include: (1) fostering new and existing partnerships and stakeholder relations; (2) seizing funding opportunities; (3) knowledge transfer; (4) supporting the transformation of professional roles; (5) expand the use of health information technology; and (6) conduct cost evaluations. Fifteen recommendations related to mobilisation of primary care physicians, support for the transformation of professional roles, and strategies aimed at facilitating the implementation and evaluation of chronic disease management programs were formulated based on the discussions at this knowledge translation event. The results from this knowledge translation day will help inform the sustainability of these seven chronic disease management programs in Quebec and the implementation and evaluation of similar programs elsewhere.

PDGFRα promoter polymorphisms and expression patterns influence risk of development of imatinib-induced thrombocytopenia in chronic myeloid leukemia: A study from India.

PubMed

Guru, Sameer Ahmad; Mir, Rashid; Bhat, Musadiq; Najar, Imtiyaz; Zuberi, Mariyam; Sumi, Mamta; Masroor, Mirza; Gupta, Naresh; Saxena, Alpana

2017-10-01

Platelet-derived growth factor receptor has been implicated in many malignant and non-malignant diseases. Platelet-derived growth factor receptor-α is a tyrosine kinase and a side target for imatinib, a revolutionary drug for the treatment of chronic myeloid leukemia that has dramatically improved the survival of chronic myeloid leukemia patients. Given the importance of platelet-derived growth factor receptor in platelet development and its inhibition by imatinib, it was intriguing to analyze the role of platelet-derived growth factor receptor-α in relation to imatinib treatment in the development of imatinib-induced thrombocytopenia in chronic myeloid leukemia patients. We hypothesized that two known functional polymorphisms, +68GA insertion/deletion and -909C/A, in the promoter region of the platelet-derived growth factor receptor-α gene may affect the susceptibility of chronic myeloid leukemia patients receiving imatinib treatment to the development of thrombocytopenia. A case-control study was conducted among a cohort of chronic myeloid leukemia patients admitted to the Lok Nayak Hospital, New Delhi, India. A set of 100 patients of chronic myeloid leukemia in chronic phase and 100 age- and sex-matched healthy controls were studied. After initiation of imatinib treatment, the hematological response of chronic myeloid leukemia patients was monitored regularly for 2 years, in which the development of thrombocytopenia was the primary end point. Platelet-derived growth factor receptor-α promoter polymorphisms +68GA ins/del and -909C/A were studied by allele-specific polymerase chain reaction. Platelet-derived growth factor receptor-α messenger RNA expression was evaluated by quantitative real-time polymerase chain reaction. The messenger RNA expression results were expressed as 2 -Δct ± standard deviation. The distribution of +68GA ins/del promoter polymorphism genotypes differed significantly between the thrombocytopenic and non-thrombocytopenic chronic myeloid leukemia patient groups (p < 0.0001). Moreover, +68GA del/del and ins/del genotypes in imatinib-treated chronic myeloid leukemia patients were associated with an increased risk of developing thrombocytopenia, with odds ratios 6.5 (95% confidence interval = 2.02-0.89, p = 0.001) and 6.0 (95% confidence interval = 2.26-15.91, p = 0.0002), respectively. Similarly, -909C/A promoter polymorphism genotype distribution also differed significantly between thrombocytopenic and non-thrombocytopenic chronic myeloid leukemia patient groups (p = 0.02), and a significantly increased risk of imatinib-induced thrombocytopenia was associated with -909C/A polymorphism mutant homozygous (AA) genotypes the odds ratio being 7.7 (95% confidence interval 1.50 to 39.91, p = 0.009). However, no significant risk of imatinib-induced thrombocytopenia was found to be associated with heterozygous genotype (-909C/A) with odds ratio 1.9 (95% confidence interval = 0.86-4.56, p = 1.14). Platelet-derived growth factor receptor-α messenger RNA expression was significantly higher in chronic myeloid leukemia patients compared to controls (p = 0.008). Moreover, patients with imatinib-induced thrombocytopenia had a significantly lower platelet-derived growth factor receptor-α messenger RNA expression, compared to patients without thrombocytopenia (p = 0.01). A differential expression of platelet-derived growth factor receptor-α messenger RNA was observed with respect to different +68 GA ins/del and -909C/A polymorphism genotypes. The +68GA deletion allele and -909A allele were significantly associated with lower expression of platelet-derived growth factor receptor-α messenger RNA. The platelet-derived growth factor receptor-α +68GA del/del, +68GA ins/del, and -909AA genotypes are associated with an increased risk of developing thrombocytopenia in imatinib-treated chronic myeloid leukemia patients. A significantly lower platelet-derived growth factor receptor-α messenger RNA expression accompanies the +68GA deletion allele in an allele dose-dependent manner. Platelet-derived growth factor receptor-α -909AA genotype is also associated with lower expression of platelet-derived growth factor receptor-α. The downregulation of platelet-derived growth factor receptor-α expression may play a causative role in imatinib-induced thrombocytopenia, a common side effect, in the subset of chronic myeloid leukemia patients with platelet-derived growth factor receptor-α +68 GA ins/del, +68 GA del/del, and -909C/A genotypes.

Social network analysis of public health programs to measure partnership.

PubMed

Schoen, Martin W; Moreland-Russell, Sarah; Prewitt, Kim; Carothers, Bobbi J

2014-12-01

In order to prevent chronic diseases, community-based programs are encouraged to take an ecological approach to public health promotion and involve many diverse partners. Little is known about measuring partnership in implementing public health strategies. We collected data from 23 Missouri communities in early 2012 that received funding from three separate programs to prevent obesity and/or reduce tobacco use. While all of these funding programs encourage partnership, only the Social Innovation for Missouri (SIM) program included a focus on building community capacity and enhancing collaboration. Social network analysis techniques were used to understand contact and collaboration networks in community organizations. Measurements of average degree, density, degree centralization, and betweenness centralization were calculated for each network. Because of the various sizes of the networks, we conducted comparative analyses with and without adjustment for network size. SIM programs had increased measurements of average degree for partner collaboration and larger networks. When controlling for network size, SIM groups had higher measures of network density and lower measures of degree centralization and betweenness centralization. SIM collaboration networks were more dense and less centralized, indicating increased partnership. The methods described in this paper can be used to compare partnership in community networks of various sizes. Further research is necessary to define causal mechanisms of partnership development and their relationship to public health outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.

A randomized controlled trial of water-based exercise for cardiovascular fitness in individuals with chronic stroke

PubMed Central

Chu, Kelly S; Eng, Janice J; Dawson, Andrew S; Harris, Jocelyn E.; Ozkaplan, Atila; Gylfadóttir, Sif

2011-01-01

Objective To evaluate the effect of an 8-week water-based exercise program (experimental group) over an upper extremity function program (control group) to increase cardiovascular fitness within a community setting for individuals with stroke. Design Single-blind randomized controlled trial Setting Public community centre Participants 12 community-dwelling individuals who have had a stroke with mild to moderate motor deficits; volunteer sample Intervention Experimental and control groups participated in group exercise programs undertaken in one hour sessions, three times per week for 8 weeks. The experimental group undertook chest deep water exercises at targeted heart rates. The control group performed arm and hand exercises while sitting. Main Outcome Measures The primary outcome measure was cardiovascular fitness (VO2max). Secondary measures were maximal workload, muscle strength, gait speed, and the Berg Balance Score. Results The experimental group attained significant improvements over the control group in cardiovascular fitness, maximal workload, gait speed, and paretic lower extremity muscle strength. The relatively short program (8 weeks) of water-based exercise resulted in a large improvement (22%) in cardiovascular fitness in a small group of individuals with stroke with relatively high function. Conclusions A water-based exercise program can be undertaken in the community as a group program and may be an effective means to promote fitness in individuals with stroke. PMID:15179638

African American Men’s Perspectives on Promoting Physical Activity: “We’re Not That Difficult to Figure out!”

PubMed Central

Friedman, Daniela B.; Hooker, Steven P.; Wilcox, Sara; Burroughs, Ericka L.; Rheaume, Carol E.

2012-01-01

African American men report poorer health than do White men and have significantly greater odds for developing chronic diseases partly because of limited physical activity. Understanding how to encourage healthy behaviors among African American men will be critical in the development of effective physical activity messages and programs. Guided by principles of cultural sensitivity and social marketing, this research examined middle-aged and older African American men’s recommended strategies for promoting physical activity to African American men of their age. The authors report results from. 49 interviews conducted with middle-aged (45–64 years) and older (65–84 years) African American men in South Carolina. Four groups of African American men were recruited; middle-aged active men (n = 17), middle-aged inactive men (n = 12), older active men (n = 10), older inactive men (n = 10). Themes related to marketing and recruitment strategies, message content, and spokesperson characteristics emerged and differed by age and physical activity level. Recommended marketing strategies included word of mouth; use of mass media; partnering with churches, businesses, and fraternities; strategic placement of messages; culturally appropriate message framing; and careful attention to selection of program spokespersons. Findings will help in the marketing, design, implementation, and evaluation of culturally appropriate interventions to encourage physical activity among middle-aged and older African American men in the South. PMID:22808914

Reimbursement for school nursing health care services: position statement.

PubMed

Lowe, Janet; Cagginello, Joan; Compton, Linda

2014-09-01

Children come to school with a variety of health conditions, varying from moderate health issues to multiple, severe chronic health illnesses that have a profound and direct impact on their ability to learn. The registered professional school nurse (hereinafter referred to as school nurse) provides medically necessary services in the school setting to improve health outcomes and promote academic achievement. The nursing services provided are reimbursable services in other health care settings, such as hospitals, clinics, and home care settings. The National Association of School Nurses (NASN) believes that school nursing services that are reimbursable nursing services in other health care systems should also be reimbursable services in the school setting, while maintaining the same high quality care delivery standards. Traditionally, local and state tax revenues targeted to fund education programs have paid for school nursing health services. School nurses are in a strategic position to advocate for improving clinical processes to better fit with community health care providers and to align reimbursements with proposed changes. Restructuring reimbursement programs will enable health care funding streams to assist in paying for school nursing services delivered to students in the school setting. Developing new innovative health financing opportunities will help to increase access, improve quality, and reduce costs. The goal is to promote a comprehensive and cost-effective health care delivery model that integrates schools, families, providers, and communities.

Gilz-Activin A as a Novel Signaling Axis Orchestrating Mesenchymal Stem Cell and Th17 Cell Interplay

PubMed Central

Luz-Crawford, Patricia; Espinosa-Carrasco, Gabriel; Ipseiz, Natacha; Contreras, Rafael; Tejedor, Gautier; Medina, Daniel A.; Vega-Letter, Ana-Maria; Ngo, Devi; Morand, Eric F.; Pène, Jérôme; Hernandez, Javier; Jorgensen, Christian; Djouad, Farida

2018-01-01

Mesenchymal stem cells (MSC) are highly immunosuppressive cells able to reduce chronic inflammation through the active release of mediators. Recently, we showed that glucocorticoid-induced leucine zipper (Gilz) expression by MSC is involved in their therapeutic effect by promoting the generation of regulatory T cells. However, the mechanisms underlying this pivotal role of Gilz remain elusive. Methods and Results In this study, we have uncovered evidence that Gilz modulates the phenotype and function of Th1 and Th17 cells likely by upregulating the level of Activin A and NO2 secreted by MSC. Adoptive transfer experiments sustained this Gilz-dependent suppressive effect of MSC on Th1 and Th17 cell functions. In immunoregulatory MSC, obtained by priming with IFN-γ and TNF-α, Gilz was translocated to the nucleus and bound to the promoters of inos and Activin βA to induce their expression. The increased expression of Activin A directly impacted on Th17 cells fate by repressing their differentiation program through the activation of Smad3/2 and enhancing IL-10 production. Conclusion Our results reveal how Gilz controls inos and Activin βA gene expression to ultimately assign immunoregulatory status to MSC able to repress the pathogenic Th17 cell differentiation program and uncover Activin A as a novel mediator of MSC in this process. PMID:29344311

Gilz-Activin A as a Novel Signaling Axis Orchestrating Mesenchymal Stem Cell and Th17 Cell Interplay.

PubMed

Luz-Crawford, Patricia; Espinosa-Carrasco, Gabriel; Ipseiz, Natacha; Contreras, Rafael; Tejedor, Gautier; Medina, Daniel A; Vega-Letter, Ana-Maria; Ngo, Devi; Morand, Eric F; Pène, Jérôme; Hernandez, Javier; Jorgensen, Christian; Djouad, Farida

2018-01-01

Mesenchymal stem cells (MSC) are highly immunosuppressive cells able to reduce chronic inflammation through the active release of mediators. Recently, we showed that glucocorticoid-induced leucine zipper (Gilz) expression by MSC is involved in their therapeutic effect by promoting the generation of regulatory T cells. However, the mechanisms underlying this pivotal role of Gilz remain elusive. Methods and Results In this study, we have uncovered evidence that Gilz modulates the phenotype and function of Th1 and Th17 cells likely by upregulating the level of Activin A and NO 2 secreted by MSC. Adoptive transfer experiments sustained this Gilz-dependent suppressive effect of MSC on Th1 and Th17 cell functions. In immunoregulatory MSC, obtained by priming with IFN-γ and TNF-α, Gilz was translocated to the nucleus and bound to the promoters of inos and Activin βA to induce their expression. The increased expression of Activin A directly impacted on Th17 cells fate by repressing their differentiation program through the activation of Smad3/2 and enhancing IL-10 production. Conclusion Our results reveal how Gilz controls inos and Activin βA gene expression to ultimately assign immunoregulatory status to MSC able to repress the pathogenic Th17 cell differentiation program and uncover Activin A as a novel mediator of MSC in this process.

An urban food store intervention positively affects food-related psychosocial variables and food behaviors.

PubMed

Gittelsohn, Joel; Song, Hee-Jung; Suratkar, Sonali; Kumar, Mohan B; Henry, Elizabeth G; Sharma, Sangita; Mattingly, Megan; Anliker, Jean A

2010-06-01

Obesity and other diet-related chronic diseases are more prevalent in low-income urban areas, which commonly have limited access to healthy foods. The authors implemented an intervention trial in nine food stores, including two supermarkets and seven corner stores, in a low-income, predominantly African American area of Baltimore City, with a comparison group of eight stores in another low-income area of the city. The intervention (Baltimore Healthy Stores; BHS) included an environmental component to increase stocks of more nutritious foods and provided point-of-purchase promotions including signage for healthy choices and interactive nutrition education sessions. Using pre- and postassessments, the authors evaluated the impact of the program on 84 respondents sampled from the intervention and comparison areas. Exposure to intervention materials was modest in the intervention area, and overall healthy food purchasing scores, food knowledge, and self-efficacy did not show significant improvements associated with intervention status. However, based on adjusted multivariate regression results, the BHS program had a positive impact on healthfulness of food preparation methods and showed a trend toward improved intentions to make healthy food choices. Respondents in the intervention areas were significantly more likely to report purchasing promoted foods because of the presence of a BHS shelf label. This is the first food store intervention trial in low-income urban communities to show positive impacts at the consumer level.

African American men's perspectives on promoting physical activity: "We're not that difficult to figure out!".

PubMed

Friedman, Daniela B; Hooker, Steven P; Wilcox, Sara; Burroughs, Ericka L; Rheaume, Carol E

2012-01-01

African American men report poorer health than do White men and have significantly greater odds for developing chronic diseases partly because of limited physical activity. Understanding how to encourage healthy behaviors among African American men will be critical in the development of effective physical activity messages and programs. Guided by principles of cultural sensitivity and social marketing, this research examined middle-aged and older African American men's recommended strategies for promoting physical activity to African American men of their age. The authors report results from 49 interviews conducted with middle-aged (45-64 years) and older (65-84 years) African American men in South Carolina. Four groups of African American men were recruited: middle-aged active men (n = 17), middle-aged inactive men (n = 12), older active men (n = 10), older inactive men (n = 10). Themes related to marketing and recruitment strategies, message content, and spokesperson characteristics emerged and differed by age and physical activity level. Recommended marketing strategies included word of mouth; use of mass media; partnering with churches, businesses, and fraternities; strategic placement of messages; culturally appropriate message framing; and careful attention to selection of program spokespersons. Findings will help in the marketing, design, implementation, and evaluation of culturally appropriate interventions to encourage physical activity among middle-aged and older African American men in the South.

The efficacy of a multidisciplinary group program for patients with refractory chronic pain

PubMed Central

Inoue, Masayuki; Inoue, Shinsuke; Ikemoto, Tatsunori; Arai, Young-Chang P; Nakata, Masatoshi; Miyazaki, Atsuko; Nishihara, Makoto; Kawai, Takashi; Hatakeyama, Noboru; Yamaguchi, Setsuko; Shimo, Kazuhiro; Miyagawa, Hirofumi; Hasegawa, Tomomi; Sakurai, Hiroki; Hasegawa, Yoshinobu; Ohmichi, Yusuke; Ushida, Takahiro

2014-01-01

BACKGROUND: Chronic pain is a major problem because it can result in not only a reduction in activities of daily living and quality of life but also requires initiation of social assistance. Seeking only to eliminate pain itself would appear to be too narrow an objective, in addition to often being unachievable; therefore, a multifaceted, comprehensive approach with multiple objectives is needed. OBJECTIVE: To describe the effects of a program (the ‘Chronic Pain Class’) offering cognitive behavioural therapy to small groups of individuals with refractory chronic pain in Japan. Exercise was an important feature of the program. METHODS: A total of 46 patients who were experiencing treatment difficulties and decreased activity participated in the program. The programs were conducted in groups of five to seven patients who met weekly for nine weeks. Weekly sessions, which were approximately 2 h in duration, combined lectures with exercise. Several measures related to pain and physical function were administered at the beginning and the conclusion of the program. RESULTS: Nine patients dropped out during the program. A number of measures (eg, pain intensity, disability, catastrophizing thoughts) showed significant improvements after intervention (P<0.002 after Bonferroni correction). Furthermore, most measures of physical function showed substantial improvement, especially seated forward bends, zig-zag walking, self-care and 6 min walk test (P<0.001). CONCLUSION: The results of the present study provide evidence that a combination of cognitive behavioural therapy and exercise should be recommended to patients with refractory chronic pain. PMID:24992454

Chronic disease management systems registries in rural health care.

PubMed

Skinner, Anne; Fraser-Maginn, Roslyn; Mueller, Keith J

2006-05-01

Health care quality is being addressed from a variety of policy perspectives. The 2001 Institute of Medicine report, Crossing the Quality Chasm, calls for sweeping action involving a five-part strategy for change in the U.S. health care system. This agenda for change includes use of evidence-based approaches to address common conditions, the majority of which are chronic. A Chronic Disease Management System (CDMS), or registry, is a tool that helps providers efficiently collect and analyze patient information to promote quality care for the rural population. CDMSs can provide a technological entry point for the impending use of Electronic Medical Records. A CDMS is a patient-centered electronic database tool that helps providers diagnose, treat, and manage chronic diseases. The purpose of this brief is to discuss the different types of CDMSs used by a sample of 14 state organizations and 19 local rural clinics in Maine, Nebraska, New Mexico, South Carolina, Washington, and Wisconsin. As part of a larger study examining the challenges and innovations in implementing disease management programs in rural areas, we conducted interviews with national, state, and local contacts. During interviews, respondents helped us understand the usefulness and functionalities of commonly used CDMSs in rural facilities. Our focus was on the use of CDMSs in the management of diabetes, a disease prevalent in rural populations. (1) CDMSs are readily available to rural clinics and are being implemented and maintained by clinic staff with minimal expenditures for technology. (2) Use of a standardized system in a collaborative helps provide data comparisons and share costs involved with technical assistance services across the group.

Hypoxia, hypoxia-inducible factors and fibrogenesis in chronic liver diseases.

PubMed

Cannito, Stefania; Paternostro, Claudia; Busletta, Chiara; Bocca, Claudia; Colombatto, Sebastiano; Miglietta, Antonella; Novo, Erica; Parola, Maurizio

2014-01-01

Fibrogenic progression of chronic liver diseases (CLDs) towards the end-point of cirrhosis is currently regarded, whatever the aetiology, as a dynamic and highly integrated cellular response to chronic liver injury. Liver fibrogenesis (i.e., the process) is sustained by hepatic populations of highly proliferative, pro-fibrogenic and contractile myofibroblast-like cells (MFs) that mainly originate from hepatic stellate cells (HSC) or, to a less extent, from portal fibroblasts or bone marrow-derived cells. As is well known, liver fibrosis (i.e., the result) is accompanied by perpetuation of liver injury, chronic hepatitis and persisting activation of tissue repair mechanisms, leading eventually to excess deposition of extracellular matrix (ECM) components. In this scenario, hypoxic areas represent a very common and major feature of fibrotic and cirrhotic liver during the progression of CLDs. Cells exposed to hypoxia respond by means of heterodimeric hypoxia-inducible factors (HIFs) that translocate into the nucleus and binds to a specific core sequence defined hypoxia-responsive element (HRE), present in the promoter on several genes which are considered as hypoxia-regulated target genes. HIFs transcription factors can activate a complex genetic program designed to sustain several changes necessary to efficiently counteract the decrease in oxygen tension. Accordingly, hypoxia, through up-regulation of angiogenesis, is currently believed to significantly contribute to fibrogenic progression of CLDs, mostly by affecting the pro-fibrogenic and pro-angiogenic behaviour of hepatic MFs. In addition, experimental and clinical evidence generated in the last decade also indicates that angiogenesis and fibrogenesis in CLDs may also be sustained by HIF-dependent but hypoxia-independent mediators.

Program Evaluation and Replications of School-Based Mental Health Services and Family-Community Interventions with Chronically Disruptive Students

ERIC Educational Resources Information Center

Carpenter-Aeby, Tracy; Aeby, Victor G.

2005-01-01

Although outcomes for alternative schools may be mixed, it is generally agreed that counseling, therapy, group work, case management, and family-community involvement have been credited in some effective programs. This study examined program evaluations from 1994-1999 for an alternative school for chronically disruptive students (599 students,…

Characterization of Mouse Models of Early Pancreatic Lesions Induced by Alcohol and Chronic Pancreatitis.

PubMed

Xu, Shiping; Chheda, Chintan; Ouhaddi, Yassine; Benhaddou, Hajar; Bourhim, Mouloud; Grippo, Paul J; Principe, Daniel R; Mascariñas, Emman; DeCant, Brian; Tsukamoto, Hidekazu; Pandol, Stephen J; Edderkaoui, Mouad

2015-08-01

We describe the first mouse model of pancreatic intraepithelial neoplasia (PanIN) lesions induced by alcohol in the presence and absence of chronic pancreatitis. Pdx1-Cre;LSL-K-ras mice were exposed to Lieber-DeCarli alcohol diet for 6 weeks with cerulein injections. The PanIN lesions and markers of fibrosis, inflammation, histone deacetylation, epithelial-to-mesenchymal transition (EMT), and cancer stemness were measured by immunohistochemistry and Western. Exposure of Pdx1-Cre;LSL-K-ras mice to an alcohol diet significantly stimulated fibrosis and slightly but not significantly increased the level of PanIN lesions associated with an increase in tumor-promoting M2 macrophages. Importantly, the alcohol diet did not increase activation of stellate cells. Alcohol diet and cerulein injections resulted in synergistic and additive effects on PanIN lesion and M2 macrophage phenotype induction, respectively. Cerulein pancreatitis caused stellate cell activation, EMT, and cancer stemness in the pancreas. Pancreatitis caused histone deacetylation, which was promoted by the alcohol diet. Pancreatitis increased EMT and cancer stemness markers, which were not further affected by the alcohol diet. The results suggest that alcohol has independent effects on promotion of PDAC associated with fibrosis formed through a stellate cell-independent mechanism and that it further promotes early PDAC and M2 macrophage induction in the context of chronic pancreatitis.

[The Spanish strategy for nutrition, physical activity and the prevention of obesity (NAOS Strategy)].

PubMed

Ballesteros Arribas, Juan Manuel; Dal-Re Saavedra, Marián; Pérez-Farinós, Napoleón; Villar Villalba, Carmen

2007-01-01

Obesity, the prevalence of which is still on the rise, is related to the main chronic diseases affecting the health of the population. Therefore, in 2004, the World Health Assembly approved the Global Strategy on Diet, Physical Activity and Health with the aim of reducing the risk factors of nontransmittable diseases related to unhealthy diets and physical inactivity. Along this same line, the Spanish Ministry of Health and Consumer Affairs began implementing the NAOS Strategy in 2005 as a platform from which to include and promote all those initiatives contributing to achieving the necessary social change in the promotion of healthy eating and the prevention of a sedentary lifestyle by meeting certain specific challenges within different scopes of action. The NAOS Strategy extends far beyond the healthcare and educational areas, by combining actions in all those sectors of society playing a role in preventing obesity. Informative campaigns, agreements with public and private institutions, voluntary working agreements, educational programs and supporting health promotion initiatives are some of the activities being carried out as part of the NAOS Strategy. Carrying out these activities and incorporating yet others, in conjunction with the work of evaluating and monitoring all of these activities, will be what is going to make it possible to maintain a high degree of effectiveness in preventing obesity.

7 CFR 1150.153 - Qualified dairy product promotion, research or nutrition education programs.

Code of Federal Regulations, 2012 CFR

2012-01-01

... nutrition education programs. 1150.153 Section 1150.153 Agriculture Regulations of the Department of... Qualified dairy product promotion, research or nutrition education programs. (a) Any producer organization that conducts a State or regional dairy product promotion, research or nutrition education program...

7 CFR 1150.153 - Qualified dairy product promotion, research or nutrition education programs.

Code of Federal Regulations, 2013 CFR

2013-01-01

... nutrition education programs. 1150.153 Section 1150.153 Agriculture Regulations of the Department of... Qualified dairy product promotion, research or nutrition education programs. (a) Any producer organization that conducts a State or regional dairy product promotion, research or nutrition education program...

7 CFR 1150.153 - Qualified dairy product promotion, research or nutrition education programs.

Code of Federal Regulations, 2014 CFR

2014-01-01

... nutrition education programs. 1150.153 Section 1150.153 Agriculture Regulations of the Department of... Qualified dairy product promotion, research or nutrition education programs. (a) Any producer organization that conducts a State or regional dairy product promotion, research or nutrition education program...

[SOCIAL IMPACT BONDS FOR HEALTH PROMOTION AND PREVENTIVE MEDICINE].

PubMed

Moran, Roni S; Moran, Daniel S; Fire, Gil

2018-01-01

The World Health Organization (WHO) has declared obesity a global epidemic. WHO sheds much light on this matter in its publications on health promotion and preventative medicine. Lack of physical activity, an unbalanced diet and an unhealthy lifestyle are the leading causes of developing obesity and chronic diseases. In Israel, the growing rate of obesity is a reason for concern. About 500,000 diabetics, mainly as a result of obesity, live in Israel today and by 2030 the number is expected to rise to 2,000,000. Every third child born is expected to develop diabetes by the time they reach the age of 40 unless a profound change is made in health policy. The State of Israel recognizes its responsibility in promoting awareness against obesity as well as its role in prevention. In spite of the country's recognition of the problem, it still has not managed to implement long term solutions which address the issue. Therefore, creative and innovative solutions are called for. The social impact bond (SIB), a newly developed financial model is a possible solution. This model suggests the entry of private investors into the public sector, a field which is within the responsibility of the government. The private investor will be in charge of running a social program on a topic which will be finalized with the government. The private investor and the government will have a contract outlining the program and the criteria for the evaluation and the success of the program. To note, the private investor will only be paid according to the success of the program. Thus the purpose of SIB is in motion processes and is set to serve as a model for several years, and then the authorities will take over the responsibility and continue with the program that the SIB handled. In March 2016, a new SIB was launched in Israel to prevent Type 2 diabetes. This involves 2250 pre-diabetic adults who are at risk to develop Type 2 diabetes and will be identified by their Health Maintenance Organizations (HMOs, Clalit and Leumit) through blood tests. The participants will take part in an intensive intervention wellness program during 3 years. This SIB aims to prevent the onset of diabetes. If successful, and a significant reduction in Type 2 diabetes is found, there will be substantial savings for the HMOs and the National Insurance Institute, which will in turn repay the investors for their expenses, according to the signed contract. This SIB will serve as a pilot project for diabetes prevention and if successful, this model can be adopted for other projects in preventive medicine and health promotion. Thereby, we may be facing a dramatic change in the paradigm of funding national health services in Israel.

A randomized controlled trial of qigong exercise on fatigue symptoms, functioning, and telomerase activity in persons with chronic fatigue or chronic fatigue syndrome.

PubMed

Ho, Rainbow T H; Chan, Jessie S M; Wang, Chong-Wen; Lau, Benson W M; So, Kwok Fai; Yuen, Li Ping; Sham, Jonathan S T; Chan, Cecilia L W

2012-10-01

Chronic fatigue is common in the general population. Complementary therapies are often used by patients with chronic fatigue or chronic fatigue syndrome to manage their symptoms. This study aimed to assess the effect of a 4-month qigong intervention program among patients with chronic fatigue or chronic fatigue syndrome. Sixty-four participants were randomly assigned to either an intervention group or a wait list control group. Outcome measures included fatigue symptoms, physical functioning, mental functioning, and telomerase activity. Fatigue symptoms and mental functioning were significantly improved in the qigong group compared to controls. Telomerase activity increased in the qigong group from 0.102 to 0.178 arbitrary units (p < 0.05). The change was statistically significant when compared to the control group (p < 0.05). Qigong exercise may be used as an alternative and complementary therapy or rehabilitative program for chronic fatigue and chronic fatigue syndrome.

A Systematic Review of Health-Promotion Programs in NCAA Division III Institutions

ERIC Educational Resources Information Center

Hanson, Matthew

2011-01-01

Health-promotion in the workplace has existed for numerous years. However, the availability of health-promotion programs offered in institutions of higher education has seemed to lag behind other industries such as business. The purpose of this survey research project was to identify specific components of health-promotion programs within NCAA…

76 FR 53844 - National Dairy Promotion and Research Program; Invitation To Submit Comments on Proposed...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-30

... Stabilization Act of 1983 authorizes a national program for dairy product promotion, research and nutrition...-0007; DA-11-02] National Dairy Promotion and Research Program; Invitation To Submit Comments on.... SUMMARY: This document invites comments on a proposed amendment to the Dairy Promotion and Research Order...

Kansas Primary Care Weighs In: A Pilot Randomized Trial of a Chronic Care Model Program for Obesity in 3 Rural Kansas Primary Care Practices

ERIC Educational Resources Information Center

Ely, Andrea C.; Banitt, Angela; Befort, Christie; Hou, Qing; Rhode, Paula C.; Grund, Chrysanne; Greiner, Allen; Jeffries, Shawn; Ellerbeck, Edward

2008-01-01

Context: Obesity is a chronic disease of epidemic proportions in the United States. Primary care providers are critical to timely diagnosis and treatment of obesity, and need better tools to deliver effective obesity care. Purpose: To conduct a pilot randomized trial of a chronic care model (CCM) program for obesity care in rural Kansas primary…

Health Promotion and Wellness Programs: An Insight into the Fortune 500.

ERIC Educational Resources Information Center

Forouzesh, Mohammed Reza; Ratzker, Leslie E.

1985-01-01

Employee health promotion and wellness programs have become a popular method of decreasing employee health care costs. The characteristics of worksite health-promotion programs were surveyed in a study of Fortune 500 companies. This study also served to examine the extent of activities offered in these programs. (DF)

77 FR 20400 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-04

.../ 2012)--Extension--National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP... to $92 billion annually in lost worker productivity, and die an average of 14 years earlier than...) the elimination of nonsmokers' exposure to secondhand smoke, (3) the promotion of quitting among...

78 FR 43886 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-22

... Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC). Background and... annually in direct medical expenses and lost productivity. The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) provides funding to health departments in States, territories, and...