bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Accuracy of Capillary Blood Glucose Monitoring in Hospitalized Patients with Diabetes
Authors: Bustamante Mark A. , Hennessey James V. , Teter Martha L. , Stachler Richard J. , Warner Barry
Published: April 2008

This study evaluated the clinical accuracy of capillary blood glucose monitoring (CBGM) performed by nursing personnel on hospitalized patients with diabetes. We compared the results of 80 serum glucose samples obtained in a blinded fashion within 5 minutes of routine capillary glucose measurements performed during the course of clinical care. The CBGM results obtained by a diabetes nurse specialist during endocrine testing procedures were correlated with the serum results.

Correlation of CBGM to serum glucose ranged from.74 to .99 depending on the method used. Visual and manual interpretation yielded the lowest correlation and variable accuracy results, per error grid analysis, with 1 in 4 patients having errors of sufficient magnitude that could lead to inappropriate therapy. Monitoring with the AccuChek II® blood glucose meter produced the highest correlation and most accurate clinical readings. Bedside blood glucose monitoring of inpatients has a wide range of reliability depending on the method used.
A Comparison of Two Intravenous Insulin Regimens Among Surgical Patients With Insulin-Dependent Diabetes Mellitus
Authors: Simmons David , Morton Kimberley , Laughton Stephen J. , Scott David .J.
Published: April 2008

We compared two intravenous insulin regimens among 58 consecutive surgical patients who required perioperative insulin infusions. Patients were randomized to either a standard glucose-insulin-potassium (GIK) infusion or a more complex, tailored two-pump protocol. Both methods provided similar overall glycemic control. However, the two-pump regimen resulted in a significantly greater proportion of finger-prick results in the target range both preoperatively (47.4% vs 60.1 %) and postoperatively (52.0% vs 66.4%). The length of stay (15 vs 16 days), duration of infusion ( 15 vs 16 hours, and number of medical and nursing incidents (18% vs 20%) were similar: Although the two-punip protocol required more changes to the administration rate (2 vs 10), this method was preferred by the nursing staff over the GIK regimen, resulted in more stable glucose control, and is likely to be associated with fewer clinical errors.
The Feasibility of Recruiting Hospitalized Patients With Diabetes for a Smoking Cessation Program
Authors: Haire-Joshu Debra , Ziff Sheryl , Houston Cheryl
Published: April 2008

The aims of this study were to identify hospitalized smokers with diabetes, assess the severity of their physical condition, and determine their willingness to participate in a postdischarge smoking cessation program. Hospitalized smokers with diabetes were identified through referrals from the Dietetics Department. Smoking status was determined via medical charts, healthcare staff, and patient self-report. Among all patients with diabetes who were identified (n=314), smoking status was routinely recorded only for those with a primary cardiac diagnosis (41%). Smokers (n=59) were significantly younger and reported multiple but fewer concomitant diagnoses than nonsmokers. Ninety-one percent of the smokers who were contacted refused to participate in a postdischarge smoking cessation program. We conclude that accurate methods are needed for identifying all smokers to facilitate cessation efforts. The severity and chronicity of the physical condition of hospitalized smokers with diabetes may limit willingness to participate in a postdischarge smoking cessation intervention.
Continuous Monitoring of Health Status Outcomes: Experience With a Diabetes Education Program
Authors: Tilly Ken F. , Belton Anne B. , McLachlan John F.C.
Published: April 2008

A diabetes education program was evaluated using an outcomes management system. Data concerning health status outcomes, including glycemic control (HbA1c), diabetes-related quality of life, and general health-related quality of life, were collected over a 15-month period. This information was collected for each clinic patient at entry into the program and again at a 6-month follow-up session. Patients improved significantly in all categories of outcomes. Newly diagnosed patients showed significantly greater reduction in HbA1c than did patients with a history of diabetes. Health-related quality of life, as measured by symptoms and the SF-36, improved independent of glycemic control. Despite the difficulties of interpreting results from this one-group, pretest-posttest design, the study demonstrated the value of a multidimensional approach to outcome assessment and program evaluation.
Computer-Based Patient Education: Use By Diabetes Educators
Authors: Lewis Deborah
Published: April 2008

The purpose of this descriptive study was to identify the concerns and characteristics that distinguish diabetes educators who use computers for patient education from those who do not. Three hundred certified diabetes educators who were current members of the American Association of Diabetes Educators were surveyed using the Stages of Concern Questionnaire and a demographic questionnaire compiled by the author. Results indicated that diabetes educators are interested in computer-based patient education as an educational strategy, even though most diabetes educators are not currently using the computer for patient education. Primary barriers to using computers were identified as lack of computer availability for patients and limited financial resources.

Because computers are becoming more pervasive in disseminating information about diabetes and new educational software is being developed for patients, diabetes educators need to learn more about this educational methodology for teaching their patients about diabetes.
Self-Efficacy Theory as a Framework for Community Pharmacy-Based Diabetes Education Programs
Authors: Johnson Jeffrey A.
Published: April 2008

Pharmacists are the most accessible healthcare professional to many chronically ill patients and see patients vi,,ith diabetes up to five times more often than any other healthcare provider. Besides this high accessibility, pharmacists have a strong focus on counseling, health education, and interaction with patients, making them ideal providers of diabetes education and valuable members of a multidisciplinary diabetes care team. Health education programs in general often have been developed without a basic theoretical framework. These programs are more difficult to evaluate in terms of how behavioral change may be best accomplished. Self-efficacy theory has been used in the past to develop successful patient education programs for patients with diabetes. The purpose of this paper is to describe self-efficacy theory and its role in diabetes education, and to encourage its use as a framework for the development of community pharmacy-based diabetes education programs.
Into the Heart of Darkness: Reflections on Racism and Diabetes Care and The Healing Process: Reflections on African American History and Diabetes Care
Authors: Anderson Robert M. , Wisdom Kimberlydawn
Published: April 2008

These essays were adapted from a General Session presentation at the 25th Annual Meeting of the American Association of Diabetes Educators on August 22, 1998 in Minneapolis, Minnesota.
Long-Term Effects of One Year of Intensified Podiatric Activities on Foot-Care Knowledge and Self-Care Habits in Patients With Diabetes
Authors: Hämäläinen Helena , Rönnemaa Tapani , Toikka Tuula , Liukkonen Irmeli
Published: April 2008

The purpose of this study was to evaluate the effectiveness of the activities of a podiatrist in the outpatient foot care of patients with diabetes. Patients from southwestern Finland, ages 10 to 80 years, were selected from the national diabetes register. Those without a recent visit to a podiatrist and without any obvious need for foot care (n=530) were randomized into a podiatric care group (individual counseling and primary prevention measures, n=267) and a control group (written instructions only, n=263). Knowledge of foot care and self-care habits were evaluated by means of structured interviews, and a podiatric examination was performed at baseline and 1 and 7 years later. Compared with the baseline scores, the knowledge score was higher at the 7-year follow-up in both the podiatric and control group and similarly in men and women. Self-care score increased in men similarly in both treatment groups. The self-care score for women increased more in the podiatric group during the first year and the difference between the groups remained for up to 7 years. There were no significant differences between the groups in the podiatric findings.
A Summer Vacation From Diabetes: Evidence From a Clinical Trial
Authors: Boland Elizabeth A. , Grey Margaret , Mezger Jo Anne , Tamborlane William V.
Published: April 2008

PURPOSE

This study examined the metabolic trend and factors associated with an unexpected rise in HbA1c levels during the summer, with a return to baseline when school resumed, in 40 intensively treated adolescents with type 1 diabetes.

METHODS

Psychosocial data were collected using a variety of diabetes evaluation instruments. HbA1c was measured monthly.

RESULTS

HbA1C values increased by a mean of .73% from May to July and decreased by a mean of .75% from August to October. Lack of consistency in summer routines compared with school days was associated with a worsening in metabolic control during the summer months. Other factors associated with the summer increase in HbA1c included lower guidance scores on the Diabetes Family Behavior Scale, and higher impact and worry scores on the Diabetes Quality of Life for Youth Scale.

CONCLUSIONS

Interviews suggested that teenagers need to take a vacation from intensive diabetes care during the summer.
Nutritional Management of Hypoglycemia
Authors: Bell Stacey J. , Forse R. Armour
Published: April 2008

PURPOSE

People with type 1 diabetes who follow an intensive management program have an increased risk of hypoglycemia, particularly overnight. New strategies for the nutritional management of hypoglycemia are essential.

METHODS

The unique properties of foods that affect blood glucose are reviewed, with special attention to a new medical food bar designed to reduce the incidence of nocturnal hypoglycemia.

RESULTS

All carbohydrate-containing foods affect blood glucose, but each causes a different rise in concentration. Consuming a variety of conventional foods with different glycemic indices can help control hypoglycemia. A new medical food bar that provides a sequential triphasic release of glucose from sucrose, protein, and uncooked cornstarch can help control blood glucose levels.

CONCLUSIONS

Hypoglycemia can be avoided by consuming foods with varying glycemic indices. A new medical food bar that provides sequential release of glucose into the bloodstream may also help control blood glucose levels.
Participant Satisfaction With a Culturally Appropriate Diabetes Education Program: The Native American Diabetes Project
Authors: Griffin Julie A. , Gilliland Susan S. , Perez Georgia , Helitzer Deborah , Carter Janette S.
Published: April 2008

PURPOSE

the purpose of this paper is to report on participant satisfaction with the Native American Diabetes Project diabetes education program.

METHODS

A questionnaire was designed to measure satisfaction among participants in the diabetes education program, which consisted of five sessions designed according to the Transtheoretical Model of Change and Social Action Theory with input from community members. Eight pueblo communities participated in the program. Sessions were taught by community mentors in three sites in New Mexico. One site taught sessions in a one-on-one format, and two sites taught sessions in a group format.

RESULTS

The results showed that participant satisfaction did not vary based on session delivery type or by session site. Overall, participants responded positively to sessions designed according to Social Action Theory and with cultural competency. Retention rates for the sessions were 81% for group sessions and 91% for one-on-one sessions.

CONCLUSIONS

Using a strong theoretical framework and community input to design diabetes education sessions may be important factors in participant satisfaction and retention in diabetes lifestyle education sessions.
Diabetes Knowledge and Its Determinants in a Mexican Population
Authors: Bautista-Martinez Silvia , Aguilar-Salinas Carlos Alberto , Lerman Israel , Velasco Ma.Luisa , Castellanos Rafael , Zenteno Elena , Guillen Luz E. , Murcio Rocio , Wong Bella , Pérez Francisco J Gómez , Rull-Rodrigo Juan A.
Published: April 2008

PURPOSE

the purpose of this study was to measure the level of diabetes knowledge in a representative group of Mexican individuals with diabetes and to identify the factors that influence it.

METHODS

A validated questionnaire was administered to 570 outpatients; 11.2% had Type 1 diabetes, 36.4% had Type 2 diabetes treated with insulin, and 52.2% had Type 2 diabetes treated with oral agents. Samples for HbAjC determination also were obtained.

RESULTS

The percentage of correct answers in each section of the questionnaire was low. Type 1 patients had the highest scores, followed by the insulin-treated Type 2 patients; those with chronic complications also had high scores. Educational background, attendance at diabetes courses, age, and HbAIC concentration were the main predictors of knowledge. Attendance at courses was influenced by the severity of the disease.

CONCLUSIONS

The amount of patient knowledge about diabetes-related issues was low in this representative Mexican population. The educational efforts were focused on those with the worst metabolic control and/or with diabetes complications.
Body Size and Body Shape: Perceptions of Black Women With Diabetes
Authors: Liburd Leandris C. , Anderson Lynda A. , Edgar Timothy , Jack Leonard
Published: April 2008

PURPOSE

this qualitative study was conducted to explore perceptions of body size and shape in a group of black women with Type 2 diabetes.

METHODS

Thirty-three black women with Type 2 diabetes participated in one of three focus groups to discuss perceptions about body size and body shape. Transcriptions of the discussion were analyzed for themes of participants' perceptions about their bodies, their ideas about body size and body shape, and personal and environmental influences on their preferences about size and shape.

RESULTS

Participants preferred a middle-to-small body size but indicated that a middle-to-large body size was healthier. They also said that a large body size did result in some untoward social consequences. Participants preferred a pear-shaped body (a figure without abdominal adiposity). The three major influences on body image perceptions were children, parents, and the media.

CONCLUSIONS

With these findings in mind, diabetes education programs that are geared for black women may benefit from the inclusion of key family members. Additionally, the importance of body image perceptions should be recognized in the design and implementation of weight-related diabetes education programs.
Perceived Control and Psychosocial/Physiological Functioning in African American Elders With Type 2 Diabetes
Authors: Wallhagen Margaret I , Lacson Magnolia
Published: April 2008

PURPOSE

The purpose of this pilot study was to assess (1) the reliability of the revised Wallhagen Perceived Control Questionnaire (PCQ-R), derived from a person-environment perspective, in a sample of elderly African Americans >60 years with Type 2 diabetes and (2) the relationship between the PCQ-R and psychosocial and physiological functioning.

METHODS

A descriptive, cross-sectional, pilot project was conducted with a convenience sample of 23 African Americans with Type 2 diabetes. Variables included health status, the PCQ-R, the Medical Outcomes Survey Short Form 36, and glycosylated hemoglobin.

RESULTS

The PCQ-R was reliable and significantly related to physical and social functioning, physical and emotional role involvement, mental health, vitality, and general health perception. No relationship was found with metabolic control.

CONCLUSIONS

Findings support the reliability of the PCQ-R and the conceptualization of control. However, confirmation is needed in a larger sample, and questions that emerged require further exploration.
Cross-Regional Support for Gender Equality
Authors: Steel Gill , Kabashima Ikuo
Published: April 2008

Postmaterialists argue that citizens' values change when economic development expands educational opportunities. In modernized societies, people embrace postmaterialist values such as self-expression and the quality of life, including support for gender equality. We argue that the political processes that accompany modernization influence value formation. Since all societies do not modernize in the same way, citizens in different regions do not share an identical set of values at a particular stage in modernization. We compare East Asia with other regions, arguing that in East Asia, state-driven modernization processes incorporated gender inequality, and citizens' values reflect the norms disseminated by their governments. We use the underutilized Gallup International Millennium Survey, conducted in more than 60 countries in 2000.
Coordinated Community Response to Family Violence
Authors: Malik Neena M. , Ward Kristin , Janczewski Colleen
Published: April 2008

There is increasing awareness that domestic violence (DV) and child maltreatment often overlap and that there are significant negative consequences to women and children who are victims in the same families. The present study contains data from a participatory evaluation of a multisite national demonstration project on family violence (the Greenbook Initiative), funded jointly by the U.S. Departments of Health and Human Services and Justice. The goal of this initiative was to increase community capacity to assist dually victimized families. This article focuses on the DV service organizations in the demonstration with regard to collaborations with other agencies and work within the DV system to respond to dually victimized families. Findings suggest that DV agencies participated in leadership roles, cross-system collaborations, and cross-system trainings throughout the initiative. Within-agency practice changes were less apparent. Research and policy implications are discussed.
Evaluating health promotion in schools: a case study of design, implementation and results from the Hong Kong Healthy Schools Award Scheme
Authors: Lee Albert , St Leger Lawrence , Moon Alysoun
Published: April 2008

Health promoting schools (HPS) and Healthy Schools Award Schemes from a number of countries have demonstrated positive changes in children's health behaviours and the culture and organisation of the school. The Hong Kong Healthy Schools Award Scheme (HKHSA) aims to promote staff development, parental education, involvement of the whole school community, and linkage with different stakeholders to improve the health and well-being of the pupils, parents and staff, and the broader community, supported by a system to monitor the achievement. This concept is very much in line with the research literature on school effectiveness and improvement. The indicators examined to evaluate the success of the HKHSA reflect outcomes related to both health and education and are not limited to changes in population health status. The early results demonstrated significant improvements in various aspects of student health and also improvement in school culture and organisation. The evaluation framework described in this paper and data collected to assess how schools perform in the HKHSA scheme, provides insight into how HPSs could lead to better outcomes for both education and health.
An evidence-based approach to physical activity promotion and policy development in Europe: contrasting case studies
Authors: Cavill Nick , Foster Charlie , Oja Pekka , Martin Brian W.
Published: April 2008

Evidence-based public health takes many of the principles of evidence-based medicine and applies them to public health. This is a relatively young discipline however and is not universally applied to public health issues - especially such multi-disciplinary topics as physical activity. This paper sets out to provide guidance on this issue by characterising four 'key tasks' that form the basis of a systematic evidence-based approach to promoting physical activity. These tasks are based in part on the physical activity promotion model (Brownson et a1.,1999). These are illustrated with examples from work in three contrasting European countries: Finland, England and Switzerland.

'Task one' is concerned with using the evidence for the health benefits of physical activity to 'make the case' and increase action by policy makers. Here, all three countries took a similar approach, conducting academic reviews to draw together the existing evidence of the health benefits of physical activity.

'Task two' is concerned with conducting surveillance to collect evidence on the prevalence of physical activity. Here, Finland and Switzerland were careful to collect trend data and use them for advocacy, while in England continuous changes to questionnaires and survey methodologies have led to poor trend data.

'Task three' is to review evidence on 'what works' in increasing physical activity to influence practice. England appears to be taking a more systematic approach to this task, with a comprehensive approach to reviewing evidence on what works and disseminating this to influence good practice, while the other countries rely mainly on individual evaluation studies.

'Task four' is the evaluation of practice and it is clear that in all three countries this remains a significant challenge - one requiring additional training and dedicated funding. As a result much of current "good practice" is based upon experience (usually unevaluated) and not evidence.

This brief analysis shows that there are some common tasks that need to be undertaken as a central part of an evidence-based public health approach. However, cultural and political factors in each country studied have influenced the manner in which these tasks were undertaken, and the importance attached to each component.
Implementing national population based action on physical activity- for action and opportunities for international collaboration
Authors: Bull Fiona C. , Pratt Michael , Shepherd Roy J. , Lankenau Becky
Published: April 2008

This paper summarises recent past and current international developments on physical activity looking at the challenges and opportunities they pose. Key elements of the WHO's Global Strategy on Diet, Physical Activity and Health (GSDPAH) are summarised, focusing specifically on the physical activity components, and by drawing upon recent fora (Atlanta, October 2002; Miami, December 2004; Cascais, February 2005; Beijing, October 2005; Bogota, November 2005), we outline the barriers and areas of support required for successful development and implementation of national, population-based action on physical activity. These gatherings focused particularly on the needs of developing countries, where to date little has been done to augment physical activity at a population level. Unless swift action is taken, these countries will soon suffer significantly from an increased prevalence of non communicable diseases (NCD). Existing initiatives and opportunities for national and international action on physical activity are identified. Specific actions are proposed for advocacy, communication and dissemination, networks and partnerships, fundraising, policy development and implementation, programme implementation and evaluation, surveillance and capacity building. The development of the Global Alliance for Physical Activity (GAPA) provides a structure for international collaboration.
Empowered women from rural areas of Bolivia promote community development
Authors: Ríos Roxana , Olmedo Catón , Fernández Luis
Published: April 2008

The United States Agency for Development in Bolivia (USAID/Bolivia) created in 2002 PROSALUD- Partners for Development Project (PfD) with the aim of improving the population's well-being. The project used three components: small grant scheme, technical assistance and database system management. Through the small grants scheme, the PfD supported a Community Participation Strategy (CPS) project over a three year period. The project involved the rural areas of six Bolivian departments and suburban areas of three Bolivian cities. The main objective was to increase health service utilization with a particular emphasis on empowerment of women, strengthening of local organizations and increasing the demand for health services. Women from both the urban and rural areas, and from different indigenous groups, were trained in project management, health promotion, reproductive health and family planning, advocacy and community participation. Participatory methodologies have allowed empowering women in decision making and capacity building throughout the entire project process. The experience shows that it is important to work with formally established grass-root community organizations and strengthen leadership within them. Additionally, the sub-projects demonstrated that interventions are more successful when promoters speak and write native languages, women are more motivated and empowered, projects are designed to be responsive to daily necessities identified by the communities and health services are culturally suitable. A preliminary evaluation, in both quantitative and qualitative terms, shows an overall improvement in health knowledge and practice, and utilization of health services. ( Promotion & Education, 2007, (2): pp 83-84)
Advocacy for appropriate health policy and effective governance of the health system
Authors: Mukhopadhyay Alok
Published: April 2008

Health policies supported by sustained advocacy efforts need to continually grow and develop to respond to the increasing pressures of macro-economic policies of globalization, liberalization and privatization. VHAI, the largest network of voluntary agencies in health sector is playing a critical role at both macro and micro levels. Its health advocacy efforts emerge from the grassroots with an understanding of their health and development problems as well as the strategies adopted to address them. The process, of strengthening an upward mobilization of information, towards formulation of an effective health policy, is backed by serious macro research on various policy dimensions of health, done by the Independent Commission on Health and Development in India (ICDHI), set up in 1995 by VHAI. These key policy documents are both reflective and prescriptive and are presented to the highest state authorities along with a discussion at various levels with varies groups. One of the recent successes was at getting the giant tobacco companies withdraw from Cricket sponsorship with an association in the formulation of a comprehensive Bill by the Union Government to prevent this in future. Various well-researched policy documents have been put together by the organisation based on its micro and macro level work and persistent advocacy. Appropriate public health and development policies with their effective implementation are the cornerstones to realize the fundamental values of Alma-Ata. The health care system needs to be removed from the current bio-medical model and closer to a socio-political and spiritual model where health care again becomes an organic part of community care as it once was in the traditional society. ( Promotion & Education, 2007, (2): pp 88-89)
Cracking the nut of health equity: top down and bottom up pressure for action on the social determinants of health
Authors: Baum Fran
Published: April 2008

The Commission on the Social Determinants of Health (CSDH) was established to advise on ways in which understanding of the social determinants of health can affect practical action to improve population health equitably. This paper considers the factors that are necessary to encourage governments to adopt policies that aim at doing this. It argues that knowledge, while essential, is insufficient. Governments need a commitment to the values of fairness and justice and an ability to cope with the complexity of responding to social determinants beyond exhorting individuals to change their behaviour. The role of civil society is crucial in advocating for governments to do this. The presence of linking social capital is also crucial to creating a social and political environment in which fairness is promoted. A case study of the poor health status of the Aboriginal peoples in Australia is used to illustrate the importance of social capital. ( Promotion & Education, 2007, (2): pp 90-95)
Health promotion in Canada: 1986 to 2006
Authors: Jackson Suzanne F. , Riley Barbara L.
Published: April 2008

The evolution of health promotion in Canada between 1986 and 2006 is characterized by three major eras: Health Promotion in the Limelight, 1986-1992, Health Promotion Behind the Scenes, 1993-2003, and Health Promotion Restaged, 2003-2006. These eras are illustrated using the Canadian Heart Health Initiative as an example. The first era, backed by strong federal government leadership and support, was a progressive time of developing concepts, collaborations and infrastructure for health promotion across the country. Despite significant progress, by the end of this era, health promotion was neither sufficiently developed nor funded to make it a cornerstone of the health system. In addition, the emphasis was heavily biased towards changing individual behaviour. In the second era, health promotion continued to develop in pockets across the country and debates within the field intensified. However, these events went largely unnoticed and massive overall cuts at federal and provincial levels of government made acute care a much higher priority than health promotion. The third era, mostly shaped by fears linked to public health threats, saw a restaging of health promotion through efforts to strengthen public health infrastructure. Nevertheless, at the end of this era, the necessary intersectoral partnerships (such as in health, housing, education, food, income) remained scarce, and little progress was made to decrease health inequalities. The Canadian Heart Health Initiative was implemented over the same time period as the three eras. Its legacy includes collegial relationships across various levels of government and with non-government organizations, a culture that values pan-Canadian initiatives, and support for integration of research, evaluation, surveillance, policy and practice. It remains to be seen how quickly it will be possible to advance the vision of health promotion conceived during the Limelight Era in Canada. ( Promotion & Education, 2007, XIV (4): pp 214-218)
Transforming Ottawa Charter health promotion concepts into Swedish public health policy
Authors: Pettersson Bosse
Published: April 2008

Swedish public health policy clearly illustrates how the concept of the Ottawa Charter for health promotion can be utilized at a national level. The impact has been more implicit than explicit. Public health has a long history in Sweden and much of the present and future is, and will be, linked to traditional values and structures. International input, however, has been essential to prompt new approaches and change. Health inequalities remain the major shortcoming. The Swedish system offers universal access to healthcare in a decentralized system. Still, primary healthcare, and the health services as a whole have not yet sufficiently embraced the idea of health promotion. Political attention to modern public health at the Prime Minister level was established in late 1980s. Since, continuous initiatives in terms of organization, infrastructure and funding have taken place. With regard to funding, a vast majority of the resources allocated to health promotion will be found outside the health sector. An interesting observation is that the Swedish public health policy with its 11 objective domains remains the same, also after a change of government. Future challenges include maintaining and developing an intersectoral mechanism for implementation, allocating more resources for intervention research to strengthen knowledge-based health promotion, and developing tools for coping better with the challenges of globalisation identified in the Bangkok Charter. ( Promotion & Education, 2007, XIV (4): pp 244-249)
Suicidal ideation and suicide attempts among adult Danes
Authors: Kjøler Mette , Helweg-Larsen Marie
Published: April 2008

This study describes the prevalence of suicidal ideation and attempted suicide in a representative survey among adults in Denmark and gives the proportion of people reporting a suicide attempt that results in contact with the health care system. The data for the 1994 Danish national health interview survey were collected by personal interview and a self-administered questionnaire. A subsample of 1362 individuals participated in the part of the survey that addressed suicidal behaviour (64% of the random sample). The results show that 6.9% reported having had suicidal thoughts within the past year. Averaging across all age groups the overall prevalence of people reporting ever having made a suicide attempt was 3.4% and the one-year prevalence was 0.5%. Suicidal ideation was more prevalent among young people than among older people, whereas ever-attempted suicide showed no age gradient. Both suicidal ideation and ever-attempted suicide were more prevalent among economically inactive people (e.g. unemployed) and among unmarried or divorced people. We estimate that 50-60% of suicide attempts reported in a representative, national survey become known to the healthcare system.
Social support and physical and psychological recovery one year after myocardial infarction or coronary artery bypass surgery
Authors: Hämäläinen Helena , Smith Richard , Puukka Pauli , Lind Jouko , Kallio Veikko , Kuttila Kari , Ronnemaa Tapani
Published: April 2008

The aim of this study was to evaluate the role of different support factors supposed to explain physical and psychological recovery after myocardial infarction (MI) or coronary artery bypass surgery (CABS). The subjects comprised 147 MI patients and 159 CABS patients. Support factors included formal services, semi-formal assistance, and informal social support. The outcome measures used for analysis were functional activities level (Duke Activity Status Index, DASI), physical working capacity, anxiety, and depression one year after MI or CABS. In general, support factors had a limited role in this study. The patient's functional and psychological status at three months was the main determinant to recovery at one year. The outcome factors measured at three months explained 36-56% of their variance at one year, and the support factors increased the explanatory power by 0 -10%. The support model employed in this study revealed that some single factors may have a positive or negative role in the recovery after MI or CABS.
Women's health: issues and prospects
Authors: Riska Elianne
Published: April 2008

An overview is presented of the research and theorizing on women's health accomplished over the past 25 years. This research is represented by two parallel strands regarding women's health: the first strand concerns the feminist and sociological research tradition, and the other focuses on the public health and epidemiological tradition. The conclusion is that Nordic research can offer new knowledge on women's health in both the quantitative and the qualitative research traditions when researchers adopt a gender-sensitive perspective.
Effects of performance-based reimbursement in healthcare
Authors: Forsberg Ewa , Axelsson Runo , Arnetz Bengt
Published: April 2008

The aim of this study was to assess changes in attitudes and behaviour related to efficiency and quality of care after introduction of performance-based reimbursement. The study consisted of two parts. Part One was performed in 1992-94 as a repeated cross-sectional study of physicians in Stockholm County Council working with a newly introduced performance-based reimbursement system. Part Two was a similar study conducted in 1994 in 11 Swedish councils without performance-based reimbursement. The results show a significant difference between the two groups of physicians in attitudes concerning changes in quality of care and premature discharge from hospital. Despite concern about quality and premature discharge, physicians in Stockholm were found to have changed their behaviour in that the average length of stay in 1994 was about one day shorter in Stockholm than in the other 11 county councils. This indicates that the performance-based reimbursement system may strengthen the incentive to increase efficiency.
Surveys on attitudes to active euthanasia and the difficulty of drawing normative conclusions
Authors: Nilstun Tore , Melltorp Gunilla , Hermerén Göran
Published: April 2008

Purpose: To present surveys on active euthanasia and to discuss what normative conclusions can be drawn. Methods: Two summary articles and 30 recent surveys on attitudes to active euthanasia are discussed. Results: According to the first summary article, acceptance of active euthanasia among the public has stabilized around 65%; according to the second, almost 60% of physicians are in favour of legalizing active euthanasia. As for the 30 recent surveys, physicians are most often respondents, while the general public is surveyed in only three. The differences in attitudes are striking: 21-78% answered that active euthanasia should be legalized, and 14-51% rejected this idea. The core of the general problem of drawing normative conclusions from empirical data is first addressed; then we discuss the principles of autonomy and beneficence, which are often referred to in arguments for and against euthanasia.
Effects of job characteristics, team climate, and attitudes towards clinical guidelines
Authors: Elovainio Marko , Mäkelä Marjukka , Sinervo Timo , Kivimäki Mika , Eccles Martin , Kahan James
Published: April 2008

The aim of this study was to form and test a model of the antecedents and possible moderators of the use of clinical guidelines among healthcare professionals. A postal questionnaire survey of all workers in six health centres around Finland. was carried out in April 1996. The health centres were selected to represent all different areas of Finland. A total of 748 (65.5%) of the healthcare workers completed and returned the questionnaire. Of the respondents 95% were women, 16% physicians or dentists, 31% registered nurses, and 27% practical nurses. It was hypothesized that besides positive attitudes towards guidelines, job characteristics and team climate affect the use of guidelines. Three alternative models of possible main and moderating effects of attitudes, job characteristics, and team climate were formed and tested. These models were tested using hierarchical regression analysis and structural equation modelling (LISREL8). All of the hypothesized main effects and the moderating effect of job characteristics between attitudes towards and the use of guidelines were supported. According to our results important factors behind the general positive or negative attitudes towards guidelines are the usefulness, reliability, practicality, and availability of the guidelines. Also, the overall individual, team, and organizational competence to follow the procedures recommended, seemed to be vital. Moreover, those whose job motivation potential was high were more ready to use clinical guidelines even when their attitudes towards guidelines were the same.
Sleep problems: a predictor of long-term work disability?
Authors: Eriksen Willy , Natvig Bard , Bruusgaard Dag
Published: April 2008

Aims: This study investigates sleep problems as a predictor of long-term work disability. Methods: Data from a community-based four-year prospective study were used. In 1990, all inhabitants of the municipality of Ullensaker, Norway, belonging to six age cohorts (20-22, 30-32, 40-42, 50-52, 60-62, and 70-72 years), were mailed a questionnaire .Of the 1,788 responders who were working and not older than 62 years, 1,426 ( 80%) returned a second questionnaire four years later ( 1994) . Results: Reporting mediocre or poor sleep ( in contrast to good) in 1990 was significantly related to long-term work disability ( > 8 weeks) during the previous 12 months in 1994 ( odds ratio=2.16; 95% confidence interval=1.26-3.72) , after adjustments for age, gender, civil status, body mass index, emotional symptoms, musculoskeletal pain, self-evaluated health, smoking, physical exercise, job satisfaction, and work characteristics . Conclusion: The study indicates that sleep problems are a predictor of long-term work disability.
Socioeconomic status and trends in alcohol drinking in the Danish MONICA population, 1982- 92
Authors: Osler Merete , Jørgensen Torben , Davidsen Michael , Grønbæk Morten , Brønnum-Hansen Henrik , Madsen Mette , Gerdes Ulrik , Schroll Marianne
Published: April 2008

Aims: To examine trends in alcohol drinking in different educational groups.

Methods: Data from three cross-sectional WHO MONICA surveys conducted in 1982-84, 1987, and 1991-92 were analysed to estimate trends in abstention, moderate, heavy, and sporadic heavy alcohol use in relation to level of education, age and smoking. In total, 6,695 Danish men and women aged 30, 40, 50, and 60 years were included.

Results: Alcohol drinking decreased in both men and women during the study period, but changes were only significant among the highest educated. In the highest educated men the prevalence of moderate alcohol use increased from 77 to 82%, while heavy alcohol use declined from 19 to 12%. In the highest educated women the prevalence of abstention increased from 15 to 22%, while moderate alcohol use declined from 78 to 68%.

Conclusion: During the 1980s, alcohol drinking decreased among the highest educated men and women and an educational gradient in alcohol drinking widened in men and attenuated in women.
Psychosomatic complaints in schoolchildren: a Nordic comparison
Authors: Berntsson Leeni T. , Köehler Lennart , Gustafsson Jan-Eric
Published: April 2008

Aims: This study investigates the association between psychosomatic complaints ( PSC) and background factors from children in the five Nordic countries, their families, and their social context in a model using proximal ( child) , intermediate ( family) , and distal ( society) levels. Similarities and differences between the countries were compared. Methods: A questionnaire was sent to the parents of a representative sample of 3,760 Nordic children aged seven to 12 years. The relationship between PSC and background factors was analysed using structural equation modelling. Results: Headaches and stomach complaints were most common. The prevalence was higher in girls than in boys. A LISREL analysis showed that determinants of PSC varied little between countries. The most important factors associated with PSC were the mother's health and well-being, the child's mental stability and social competence, and the family's socioeconomic status. Families with low education, blue-collar work, low income, and unemployed fathers were found to be most vulnerable . High risk factors could be infl uenced by other intervening protective factors. The greatest country differences were found on the distal level, where macroeconomic, legislative, and social factors dominated . Conclusions: The pattern of PSC was quite similar between the Nordic countries, although there were some small differences. The results also confirm that the determinants of PSC are multidimensional . Longitudinal studies are needed to clarify the complex reality.
Structural changes and social inequalities in health in Finland, 1986- 1994
Authors: Manderbacka Kristiina , Lahelma Eero , Rahkonen Ossi
Published: April 2008

Background: This paper seeks to examine changes in health inequalities in Finland from the mid-1980s to the mid-1990s. To improve our understanding of the contribution of employment status changes to class and educational differences in health within the context of changing labour market conditions, we examined the differences in ill health among social classes, educational groups, and employment status groups.

Methods: The data was derived from nation-wide Finnish Surveys on Living Conditions from 1986 and 1994. Analyses included the age range 25- 64 years. Health was measured using limiting long-standing illness and perceived health as below good. Results are presented as age-standardized prevalence percentages and odds ratios from logistic regression analyses.

Results: The pattern and size of relative social inequalities in ill health have remained generally stable during the eight-year study period in Finland. Differences between social classes have changed only slightly. Differences between educational groups have declined somewhat among men, but have remained stable among women. Compared with the employed, health among the unemployed, housewives, and pensioners has improved for both men and women. Analysing social class differences within both the employed and the non-employed showed only negligible changes.

Conclusions: Changes in social inequalities in health as indicated by class and educational differentials among Finnish men and women have mostly been negligible. The observed changes are likely to have been affected by the 1990s' labour market crisis in Finland. The rapidly increasing mass unemployment is unlikely to have been very individually selective in the short run. However, in the longer run, to the extent that unemployment remains high, this trend can be expected to change as re-entry to paid employment is likely to be more individually selective.
Risk factors for coronary heart disease in different socioeconomic groups of Lithuania and Sweden — the LiVicordia study
Authors: Kristenson Margareta , Kucinskiene Zita , Bergdahl Björn , Orth-Gomér Kristina
Published: April 2008

Aims: Lithuanian middle-aged men have a fourfold higher risk for coronary heart disease (CHD) mortality compared with Swedish men. In Sweden, CHD mortality is twice as high in blue- compared with white-collar workers. Whether the same risk factors that characterized Lithuanian men, compared with Swedish men, could be found in low socioeconomic groups within the cities was investigated. Methods : The LiVicordia study compared both traditional and new possible risk factors for CHD among 150 50-year-old men in Linköping, Sweden and Vilnius, Lithuania. A comparison was made of the prevalence of these risk factors in high and low socioeconomic groups within the cities and, after controlling for the city, variations across socioeconomic groups in the total sample. Results: Small differences were found in traditional risk factors between cities. However, Vilnius men were shorter, had lower serum levels of antioxidant vitamins, more psychosocial strain, and lower cortisol response to a standardized laboratory stress test. These characteristics were also found among men in low social classes in both cities. In linear regression models, short stature, low serum β-carotene, low social integration, coping and self-esteem, high vital exhaustion, high baseline and low cortisol response to stress were related to low social class. Conclusions: The same set of risk factors, mainly relating to oxidative and psychosocial stress, that characterized Vilnius men was also found in men in low social classes within the cities. The results suggest that a common set of risk factors may help to explain health differences both between and within countries.