The Journal of the Royal Society for the Promotion of Health最新文献

The HIV/AIDS pandemic has become one of the most important public health problems in recent times and it is having a profound impact on the lives of infected people and their families. There is an acknowledged burden of HIV/AIDS in Nigeria. As the prevalence of HIV/AIDS infection rises, health care professionals worldwide can expect greater clinical exposure to infected patients. The care of people living with AIDS presents a significant challenge to the health care sector. This study seeks to explore the relationship between sources of HIV/AIDS information and knowledge, and the relationship between knowledge of HIV/AIDS and care for people with AIDS among health care providers in three different levels of health care institutions in the southern region of Nigeria. Health care workers from two states in southern Nigeria completed a questionnaire that was designed to assess knowledge, attitudes and practices about HIV/AIDS. The sample was composed of 277 (65%) females and 135 (31.7%) males. The results showed a fair level of knowledge among all health care professionals, with the highest level of knowledge among the doctors and the lowest among laboratory workers. There was a significant gender difference in the level of knowledge but the data suggested that knowledge did not differ by hospital settings. There were generally negative feelings and views about the care of HIV/AIDS patients among the professionals, these views being worst at the community health centers and best at the government hospital. The greatest source of information for the majority of professionals was health talks/seminars, and those respondents who got their information from school scored the highest on the items on general knowledge of HIV/AIDS incidence, cause, transmission, and clinical treatment. This has important implications for future interventions designed for health care professionals including doctors, nurses and laboratory workers.

Aims: The role of statins in secondary prevention of cardiovascular disease is well established. However, there is debate about the most effective approach to primary prevention. This study simulated the effects of directed versus global approaches for intervention on coronary heart disease (CHD) event rates.

Methods: A primary prevention population was generated by computer simulation derived from data from the National Health Survey for England. The efficacy of reductions in cholesterol, treatment to cardiovascular risk targets and effects of phytosterols or statins were assessed.

Results: A 0.5 mmol/L reduction in population total cholesterol would result in a 10.4% reduction in CHD events, while 1.0 mmol/L, 1.5 mmol/L and 2.0 mmol/L reductions would achieve 21.0%, 30.6% and 41.9% reductions respectively. In statin-based cardiovascular risk targeted strategies, use of simvastatin 40 mg would result in 1.8% reduction by UK National Service Framework targets of 30%/decade CHD risk and 7.2% reduction in events for a 20%/decade target assuming perfect adherence. Similarly, aggressive primary prevention with 40 mg atorvastatin would result in a 2.5% or 10% reduction in events. Universal use of 10 mg simvastatin following an over-the-counter approach would result in a 25% reduction in CHD events. In contrast, whole population consumption of sitostanol/sitosterol products would result in 11.8% reduction.

Conclusion: Targeting and treating high-risk individuals may be beneficial for them and rewarding for medical practitioners. However, this approach has minimal effects on the population burden of atherosclerotic disease. This study suggests that universal therapy with phytosterols and/or wider availability of statins has the potential to dramatically decrease rates of CHD.

Health professionals face two complicated but contradictory epidemics: obesity and osteoporosis (OP). While obesity is obvious, OP progresses silently affecting one in two UK women. Both South Asian and Caucasian women are at OP risk. This study compared experiences of osteoporotic Caucasian and South Asian women in a purposive sample of 21 volunteers from south east England, aged 43 to 82 years. The women had been diagnosed for eight months to 40 years. Long disease duration was marked by complacent OP dialogue, although OP was objectionable and marked a loss of quality of life. Inductive content analysis of transcripts showed that 'uncertainty'--about one another and about what constituted helpful self-care--affected both GPs and patients. Instead, support groups and the media supported learning about OP care. Beyond providing drug prescriptions, women reported desiring, but rarely feeling, that GPs fully supported their preferences for self-care. Self-care often included specialist exercise classes. Some younger women led their GPs to better understand the range of self-care options. GPs were seen as being unsure about how and when to discuss physical activity (PA). In conclusion, women with OP in this sample are sensitive to their GP's hesitance about offering detailed PA recommendations. Regardless of ethnicity, younger women undertook PA based on personal initiative. Positive PA experiences stimulated an interest in discussing PA with GPs, and these dialogues broke the silence surrounding OP care. By providing important information regarding the OP patient experience, the findings highlight the unmet desire of OP sufferers for better and closer attention from GPs.