Achieving 'best practice' in health promotion: improving the fit between research and practice.
This paper is based on the proposition that transfer of knowledge between researchers and practitioners concerning effective health promotion interventions is less than optimal. It considers how evidence concerning effectiveness in health promotion is established through research, and how such evidence is applied by practitioners and policy makers in deciding what to do and what to fund when addressing public health problems. From this examination it is concluded that there are too few rewards for researchers which encourage research with potential for widespread application and systematic development of promising interventions to a stage of field dissemination. Alternatively, practitioners often find themselves in the position of tackling a public health problem where evidence of efficacy is either lacking, or has to be considered alongside a desire to respond to expressed community needs, or the need to respond to political imperative. Several different approaches to improving the fit between research and practice are proposed, and they include improved education and training for practitioners, outcomes focussed program planning, and a more structured approach to rewarding research development and dissemination. (+info)
Fin-de-siecle Philadelphia and the founding of the Medical Library Association.
Philadelphia at the time of the founding of the Medical Library Association (MLA) is described. Several factors that promoted the birth of the association are discussed, including the rapid increase in the labor force and the rise of other health related professions, such as the American Hospital Association and the professionalization of nursing. The growth of the public hygiene movement in Philadelphia at the time of Sir William Osler's residency in the city is discussed. Finally, the rapid growth of the medical literature is considered a factor promoting the development of the association. This article continues the historical consideration of the MLA begun in the author's article on the three founders of the association. The background information is drawn from the items listed in the bibliography, and the conclusions are those of the author. (+info)
Cigarettes and suicide: a prospective study of 50,000 men.
OBJECTIVES: This study examined the relation between smoking and suicide, controlling for various confounders. METHODS: More than 50,000 predominantly White, middle-aged and elderly male health professionals were followed up prospectively with biennial questionnaires from 1986 through 1994. The primary end point was suicide. Characteristics controlled for included age, marital status, body mass index, physical activity, alcohol intake, coffee consumption, and history of cancer. RESULTS: Eighty-two members of the cohort committed suicide during the 8-year follow-up period. In age-adjusted analyses with never smokers as the comparison group, the relative risk of suicide was 1.4 (95% confidence interval [CI] = 0.8, 2.3) among former smokers, 2.6 (95% CI = 0.9, 7.5) for light smokers (< 15 cigarettes/day), and 4.5 (95% CI = 2.3, 8.8) among heavier smokers. After adjustment for potential confounders, the relative risks were 1.4 (95% CI = 0.9, 2.4), 2.5 (95% CI = 0.9, 7.3), and 4.3 (95% CI = 2.2, 8.5), respectively. CONCLUSION: We found a positive, dose-related association between smoking and suicide among White men. Although inference about causality is not justified, our findings indicate that the smoking-suicide connection is not entirely due to the greater tendency among smokers to be unmarried, to be sedentary, to drink heavily, or to develop cancers. (+info)
Integrating Healthy Communities concepts into health professions training.
To meet the demands of the evolving health care system, health professionals need skills that will allow them to anticipate and respond to the broader social determinants of health. To ensure that these skills are learned during their professional education and training, health professions institutions must look beyond the medical model of caring for communities. Models in Seattle and Roanoke demonstrate the curricular changes necessary to ensure that students in the health professions are adequately prepared to contribute to building Healthy Communities in the 21st century. In addition to these models, a number of resources are available to help promote the needed institutional changes. (+info)
Planning health care delivery systems.
The increasing concern and interest in the health delivery system in the United States has placed the health system planners in a difficult position. They are inadequately prepared, in many cases, to deal with the management techniques that have been designed for use with system problems. This situation has been compounded by the failure, until recently, of educational programs to train new health professionals in these techniques. Computer simulation is a technique that allows the planners dynamic feedback on his proposed plans. This same technique provides the planning student with a better understanding of the systems planning process. (+info)
Housework, paid work and psychiatric symptoms.
OBJECTIVE: To evaluate the hypothesis that work burden, the simultaneous engagement in paid work and unpaid family housework, is a potential risk factor for psychiatric symptoms among women. METHODS: A cross-sectional study was carried out with 460 women randomly selected from a poor area of the city of Salvador, Brazil. Women between 18 to 70 years old, who reported having a paid occupation or were involved in unpaid domestic activities for their families, were eligible. Work burden-related variables were defined as: a) double work shift, i.e., simultaneous engagement in a paid job plus unpaid housework; and b) daily working time. Psychiatric symptoms were collected through a validated questionnaire, the QMPA. RESULTS: Positive, statistically significant associations between high (>7 symptoms) QMPA scores and either double work shift (prevalence ratio - PR=2.04, 95% confidence interval - CI: 1.16, 2.29) or more than 10 hours of daily work time (PR=2.29, 95% CI: 1.96, 3.43) were found after adjustment for age, marital status and number of pre-school children. CONCLUSIONS: Major correlates of high QMPA scores are work burden variables. Being married or having pre-school children are also associated with high QMPA scores only when associated with work burden. (+info)
National health services and family planning: Thailand, a case study.(7/195)
Educational outcomes and leadership to meet the needs of modern health care.
If professionals are to be equipped better to meet the needs of modern health care systems and the standards of practice required, significant educational change is still required. Educational change requires leadership, and lack of educational leadership may have impeded change in the past. In practical terms standards refer to outcomes, and thus an outcome based approach to clinical education is advocated as the one most likely to provide an appropriate framework for organisational and system change. The provision of explicit statements of learning intent, an educational process enabling acquisition and demonstration of these, and criteria for ensuring their achievement are the key features of such a framework. The derivation of an appropriate outcome set should emphasise what the learners will be able to do following the learning experience, how they will subsequently approach these tasks, and what, as a professional, they will bring to their practice. Once defined, the learning outcomes should determine, in turn, the nature of the learning experience enabling their achievement and the assessment processes to certify that they have been met. Provision of the necessary educational environment requires an understanding of the close interrelationship between learning style, learning theory, and methods whereby active and deep learning may be fostered. If desired change is to prevail, a conducive educational culture which values learning as well as evaluation, review, and enhancement must be engendered. It is the responsibility of all who teach to foster such an environment and culture, for all practitioners involved in health care have a leadership role in education. (+info)