Health values最新文献

A model has been proposed to improve program development and management of behavior change programs with large-scale community impact. It can be applied to epidemiologic problems of which lifestyle is an important component, such as heart disease, adolescent pregnancy, hypertension, weight control, and cancer control and prevention programs. The model combines two previously existing models: one indicating that program development is an ongoing cyclical process which starts with uncertainty yet can progress to institutionalization with suitable testing; and the second model indicating that program management within each developmental cycle progresses through specific phases which can be hampered by plateaus and setbacks. Nine systems are essential for program development and operations: education (philosophy, objectives, and content), communications, reward, intervention, program process, program development, and program evaluation. These systems can be used as a guide to facilitate selection from the many guidelines recommended in the literature, and to ensure coordination of innovative program elements.

The Laredo-Webb County Health Department began planning a health promotion program for the prevention of chronic diseases during the late 1970s. After receiving a 4-year grant from the W.K. Kellogg Foundation, the Department initiated the program in 1983 by conducting an epidemiologic survey in Laredo, Texas, to determine the major risk factors for chronic disease. A comprehensive health education program was then initiated to reduce the prevalence of these factors in targeted low-income neighborhoods. Health information was disseminated among the population in small neighborhood groups using a variety of techniques to promote favorable changes in health behavior. An evaluation of the program in one neighborhood 1 year later showed an overall reduction in health risk practices of approximately 10%.

During the past 20 years there has been a wealth of literature on various aspects of ethical decision-making. The ethical dilemmas which confront health professionals become more and more complex as knowledge and technology expand. Professionals have more and more effect on human lives. As research provides professionals with more intervention tools, questions arise about "quality of life" and "who has the right to make life and death decisions." This paper examines the potential for ethical difficulties in long-term care settings for the elderly. Given the necessity for a multidisciplinary approach to geriatric care, a variety of professionals are involved in the delivery of services in multiple settings. For the purpose of this paper, these professionals are referred to as "health professionals" since we are defining health as physical, mental, and social well-being. Case examples will be used to illustrate potential issues when health professionals intervene with elderly persons who are in difficult situations. To provide a context, five codes of ethics (ie, health educators, social workers, physicians, clinical psychologists and nurses) will be examined. Each of these health profesionals is involved in service provision to an elderly client/patient or his family in the area of long-term care. These codes will be examined in light of their historic roots.

Content validity in the measurement of health status of individuals and population is a major problem in health needs assessment. This problem stems largely from the limited sampling inadequacy of the universe of empirical properties that represent the concept of health. In general, attempts to strengthen sensitivity of health status measures by defining health in very broad terms compromise specificity of measurement. Narrow definitions, on the other hand, may result in poor measurement validity and misclassification of subjects. This paper compares three basic paradigms of health: the medical model, the holistic model and the high-level wellness model, with respect to their content validity and therefore suitability for health status assessment.

The smoking cessation and prevention issue has not been addressed by nurses, the largest group of health care professionals in the nation (1.4 million currently licensed to practice). The World Health Organization and the Centers for Disease Control acknowledge smoking as the "single most preventable cause of poor health in the world," but not a solitary continuing medical education course of the 9,000 available in the United States in 1983 dealt with ways to resolve this issue. The women's movement has not addressed this cause, and nurses, a predominantly female population, continue to smoke in alarmingly large numbers, causing doubt as to nurses' effectiveness n teaching prevention or cessation. Nurses as role models could be crucial in effecting change in the smoking behavior of the general population, thereby eliminating or greatly reducing the health risk. There appears to be a significant need for more effective educational programs concerning the health hazards of smoking for all nurses and nursing students if the potential power of nursing leadership is to be realized in reducing mortality and morbidity from the number one killer in America.

Health care costs have increased so dramatically in the last 25 years that government, the health care industry, health insurance industry and most recently consumers are taking steps to counteract this progressing nemesis. Factors that have significantly influenced this increase in health care cost, such as third-party payments, advances in medical technology, increased profit motive, wasteful and insufficient care, and the growing population of older Americans are examined. Efforts by government, business, industry, and consumers to control health care costs and the resulting trends are identified.

An excess burden of disease and disability exists among minority populations in the United States. Health promotion strategies can be designed and implemented in a variety of settings to address the priority health needs of minorities and, in turn, contribute to the reduction of this burden. School-based health promotion presents an excellent opportunity for reaching minority and non-minority children and youth who are at risk for disease and disability due to lifestyle behaviors.

The purpose of this article is to provide a general overview of health promotion issues relevant to older Americans. As part of a national health promotion initiative for older people, sponsored by the US Public Health Service and the Administration on Aging, research was undertaken to study the health status, knowledge, attitudes and practices of this population. Six health behaviors identified in the study, entitled Aging and Health Promotion: Market Research for Public Education, which can positively influence the well-being of older people, will be briefly discussed: exercise, nutrition, injury prevention, safe use of medicines, use of preventive services and smoking cessation. Recommendations will be made for the development of health promotion messages focusing on these health habits.