Search

Issue Addressed: Ethical values underpin the health promotion discipline and profession, and competencies required for professional practice. Understanding how ethical values are translated into professional practice is critical. The aim of this exploratory sequential mixed methods study was to explore Australian health promotion stakeholder perspectives about ethical health promotion practice., Methods: A face-to-face group-based workshop (n = 15), online survey (n = 77) and in-depth individual interviews (n = 15) collected qualitative and quantitative data from health promotion stakeholders. Descriptive statistics were used to analyse quantitative and thematic analysis to analyse qualitative data., Results: Tensions emerged regarding the nomenclature of ethical health promotion practice, with ethics framed largely by participants as related to formal approval for research. A range of barriers and enablers to ethical practice were identified. Barriers related to obtaining ethical approvals and working with specific population groups and communities. Enablers included professional development opportunities, access to a specialised human research ethics committee and a better understanding of what is meant by 'ethical practice'., Conclusion: Findings suggest the need for an ethical health promotion practice framework and resources for practitioners and organisations throughout Australia. We propose a framework comprising two pillars: (a) developing critical practice; and (b) building the evidence-based for health promotion. SO WHAT?: This study recognises the need for increased dialogue about the ethical foundations of health promotion. The development of a health promotion ethics framework can better support the development of ethical practice in the Australian health promotion discipline and profession., (© 2021 Australian Health Promotion Association.)

Background: Drowning is a significant public health issue with more than 320,000 deaths globally every year. These numbers are greatly underestimated, however, due to factors such as inadequate data collection, inconsistent categorization and failure to report in certain regions and cultures.The objective of this study was to develop a standardised drowning dictionary using a consensus-based approach. Through creation of this resource, improved clarity amongst stakeholders will be achieved and, as a result, so will our understanding of the drowning issue., Methodology: A list of terms and their definitions were created and sent to 16 drowning experts with a broad range of backgrounds across four continents and six languages. A review was conducted using a modified Delphi process over five rounds. A sixth round was done by an external panel evaluating the terms' content validity., Results: The drowning dictionary included more than 350 terms. Of these, less than 10% had been previously published in peer review literature. On average, the external expert validity endorsing the dictionary shows a Scale Content Validity Index (S-CVI/Ave) of 0.91, exceeding the scientific recommended value. Ninety one percent of the items present an I-CVI (Level Content Validity Index) value considered acceptable (>0.78). The endorsement was not a universal agreement (S-CVI/UA: 0.44)., Conclusion: The drowning dictionary provides a common language, and the authors envisage that its use will facilitate collaboration and comparison across prevention sectors, education, research, policy and treatment. The dictionary will be open to readers for discussion and further review at www.idra.world., (© 2021 The Author(s).)

Issue Addressed: Since 1986, injury prevention and control has been classified as a National Health Priority. However, no reviews into the injury prevention workforce have been conducted in Australia since 2011 and to date; none has focused specifically on the injury prevention and safety promotion sector in Western Australia (WA). This research sought to review the scope of the injury prevention and safety promotion workforce in WA to gain a greater understanding of sector characteristics, work and needs., Methods: An online, cross-sectional survey was conducted between mid-January and mid-March 2018. Participants were required to be: (a) based in WA or have a program running within WA; and (b) working in injury prevention and safety promotion relating to programs, policy or legislation development, implementation and/or evaluation within intentional (eg interpersonal violence, suicide and self-harm) or unintentional injuries (eg transport, poisoning, falls, drowning, burns) or farm, child and community, occupational health and safety, sport and recreation and trauma., Results: The research found that participants were predominantly female (82%), aged 40 years or older (66.1%) and were employed full time (55.6%). The majority of participants worked in falls prevention (38.5%), alcohol and other drugs (38.0%), injury in general (31.8%) and community safety (30.7%)., Conclusions: Findings demonstrate significant heterogeneity with a core workforce supported by a range of non-core and indirect actors. Identifying characteristics and needs of the workforce supports coordinated capacity building to implement effective injury prevention and safety promotion initiatives. With this being the first review of the workforce in WA, this article highlights the need to more regularly audit the sector to determine its breadth and composition. SO WHAT?: In the light of the recent announcement by the Commonwealth for a new national Injury Prevention Strategy, this study provides timely insights into the injury prevention and safety promotion sector in WA., (© 2019 Australian Health Promotion Association.)

Objective: This study aimed to determine changes in functional status, pain, and return to work/study (RTW/study) over 12 months post-injury in motorcyclists admitted to a large hospital in Ho Chi Minh City (HCMC), Vietnam., Methods: A prospective study was undertaken with adult motorcyclists who were injured due to a crash and were admitted to hospital for more than 24 h. Pain and functional status data were collected at baseline (time of injury), and follow-up at 6 and 12 months post-injury. RTW/study was collected at 6 and 12 months post-injury. Multilevel mixed models and multiple logistic regression models were used to determine the changes in outcomes and predictors of outcomes including age, sex, education, Injury Severity Score, length of stay in the hospital and health-related quality of life., Results: A total of 352 hospitalised motorcyclists were followed-up. The proportion of motorcyclist RTW/study was 60% (n = 165) at 6 months and 82% (n = 210) at 12 months post-injury. After adjusting for covariates, pain scores improved significantly at 6 months (β = -3.31, 95% CI: -3.61, -3.01) and 12 months post-injury (β = -3.62, 95% CI: -3.92, -3.32) compared to baseline. Functional status increased significantly by 2.89 points (95% CI: 2.64, 3.13) at 6 months and by 3.51 points (95% CI: 3.27, 3.75) at 12 months compared to baseline., Conclusions: The study found improvements in outcomes over the study period, although there was ongoing disability at 12 months post-injury (18% had not RTW/study). This study provides further evidence on the burden of motorcycle injuries in Vietnam and priorities for research, and further informs treatment and rehabilitation service planning., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Leavers Festivals have become an institution for Australian youth to celebrate the completion of secondary school. Reported hazardous consumption of alcohol by leavers has focused concern on risk-taking behaviour. In response to this, campaigns such as "Don't Drink and Drown" have targeted youth to reduce alcohol consumption during aquatic activities. This research investigated intended and actual alcohol consumption, particularly during aquatic activities at a Leavers Festival located in the coastal town of Dunsborough, southern Western Australia., Method: In November 2016, 549 leavers aged 17 or 18 years completed a paper-based survey over a four-day period during the Festival., Results: Overall, 90% of leavers reported intending to drink during the Festival, with expected average daily consumption being seven to nine standard drinks; reported daily consumption was five to six standard drinks (P < 0.001). Of the 29% of leavers who consumed alcohol around water during Leavers, 47% had done so while swimming. About 91% were aware of the campaign "Don't Drink and Drown.", Conclusion: Awareness of the "Don't Drink and Drown" campaign and knowledge of risks associated with alcohol consumption and swimming were relatively high. Intention and actual consumption of alcohol did not correlate, with daily consumption less than anticipated., So What: Leavers appear to have a reasonable level of awareness and knowledge of the risks associated with alcohol consumption and aquatic activities, which may reflect the impact of education campaigns. However, this knowledge is not always translated into nonrisky aquatic behaviour., (© 2018 Australian Health Promotion Association.)

Objective: This study is a systematic review of the peer-reviewed literature to identify the correlates of mobile screen media use among children aged 8 years and less., Setting: Home or community-based studies were included in this review while child care or school-based studies were excluded., Participants: Children aged 8 years or less were the study population. Studies that included larger age groups without subgroup analysis specific to the 0-8 years category were excluded. Eight electronic databases were searched for peer-reviewed English language primary research articles published or in press between January 2009 and March 2017 that have studied correlates of mobile screen media use in this age group., Outcome Measure: Mobile screen media use was the primary outcome measure. Mobile screen media use refers to children's use of mobile screens, such as mobile phones, electronic tablets, handheld computers or personal digital assistants., Results: Thirteen studies meeting the inclusion criteria were identified of which a total of 36 correlates were examined. Older children, children better skilled in using mobile screen media devices, those having greater access to such devices at home and whose parents had high mobile screen media use were more likely to have higher use of mobile screen media devices. No association existed with parent's age, sex and education., Conclusion: Limited research has been undertaken into young children's mobile screen media use and most of the variables have been studied too infrequently for robust conclusions to be reached. Future studies with objective assessment of mobile screen media use and frequent examination of the potential correlates across multiple studies and settings are recommended., Trial Registration Number: This review is registered with PROSPERO International Prospective Register of Ongoing Systematic Reviews (registration number: CRD42015028028)., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Office-based staff spend around three quarters of their work day sitting. People who sit for long periods while at work are at greater risk of adverse health outcomes., Objective: The pilot study aimed to determine the effect of sit-stand workstations on office-based staff sedentary and physical activity behaviors, work ability and self-reported physical and mental health outcomes., Methods: A two-group pre-post study design assessed changes in sedentary and physical activity behaviors (time spent sitting, standing and stepping and sit-stand transitions and number of steps taken) work ability and physical and mental health. Physical activity behaviors were measured using activPAL activity monitors and self-reported data on work ability and physical and mental health were collected using an online questionnaire., Results: Relative to the controls (n=19), the intervention group (n=18) significantly decreased time spent sitting by 100 minutes (p<0.001) and increased standing time by 99 minutes (p<0.001). There was a decrease in self-reported current work ability when compared to lifetime best (p=0.008). There were no significant differences for all other sedentary behavior, other workability outcomes, physical health or mental health outcomes at follow-up., Conclusions: The Uprising Study found that sit-stand workstations are an effective strategy to reduce occupational sitting time in office-based workers over a one month period.

Background: Office workers sit for more than 80% of the work day making them an important target for work site health promotion interventions to break up prolonged sitting time. Adjustable workstations are one strategy used to reduce prolonged sitting time. This study provides both an employees' and employers' perspective into the advantages, disadvantages, practicality and convenience of adjustable workstations and how movement in the office can be further supported by organisations., Methods: This qualitative study was part of the Uprising pilot study. Employees were from the intervention arm of a two group (intervention n = 18 and control n = 18) study. Employers were the immediate line-manager of the employee. Data were collected via employee focus groups (n = 17) and employer individual interviews (n = 12). The majority of participants were female (n = 18), had healthy weight, and had a post-graduate qualification. All focus group discussions and interviews were recorded, transcribed verbatim and the data coded according to the content. Qualitative content analysis was conducted., Results: Employee data identified four concepts: enhanced general wellbeing; workability and practicality; disadvantages of the retro-fit; and triggers to stand. Most employees (n = 12) reported enhanced general well-being, workability and practicality included less email exchange and positive interaction (n = 5), while the instability of the keyboard a commonly cited disadvantage. Triggers to stand included time and task based prompts. Employer data concepts included: general health and wellbeing; work engagement; flexibility; employee morale; and injury prevention. Over half of the employers (n = 7) emphasised back care and occupational health considerations as important, as well as increased level of staff engagement and strategies to break up prolonged periods of sitting., Discussion: The focus groups highlight the perceived general health benefits from this short intervention, including opportunity to sit less and interact in the workplace, creating an 'energised' work environment. The retro-fit workstation and keyboard platform provided challenges for some participants. Supervisors emphasised injury prevention and employee morale as two important by products of the adjustable workstation. These were not mentioned by employees. They called for champions to advocate for strategies to break up prolonged sitting., Implications: The findings of this novel research from both the employee and employer perspective may support installation of adjustable workstations as one component of a comprehensive approach to improve the long term health of employees., Competing Interests: Conflict of Interest: All authors declare no conflicts of interest in this paper.

Background: Childhood is a crucial period for shaping healthy behaviours; however, it currently appears to be dominated by screen time. A large proportion of young children do not adhere to the screen time recommendations, with the use of mobile screen devices becoming more common than fixed screens. Existing systematic reviews on correlates of screen time have focused largely on the traditional fixed screen devices such as television. Reviews specially focused on mobile screen media are almost non-existent. This paper describes the protocol for conducting a systematic review of papers published between 2009 and 2015 to identify the correlates of mobile screen media use among children aged 0-8 years., Methods: A systematic literature search of electronic databases will be carried out using different combinations of keywords for papers published in English between January 2009 and December 2015. Additionally, a manual search of reference lists and citations will also be conducted. Papers that have examined correlates of screen time among children aged 0-8 will be included in the review. Studies must include at least one type of mobile screen media (mobile phones, electronic tablets or handheld computers) to be eligible for inclusion. This study will identify correlates of mobile screen-viewing among children in five categories: (i) child biological and demographic correlates, (ii) behavioural correlates, (iii) family biological and demographic correlates, (iv) family structure-related correlates and (v) socio-cultural and environmental correlates. PRISMA statement will be used for ensuring transparency and scientific reporting of the results., Discussion: This study will identify the correlates associated with increased mobile screen media use among young children through the systematic review of published peer-reviewed papers. This will contribute to addressing the knowledge gap in this area. The results will provide an evidence base to better understand correlates of mobile screen media use and potentially inform the development of recommendations to reduce screen time among those aged 0-8 years., Systematic Review Registration: PROSPERO CRD42015028028 .

Introduction: Worldwide, children under the age of 5 years are at particular risk of drowning. Responding to this need requires the development of evidence-informed drowning prevention strategies. Historically, drowning prevention strategies have included denying access, learning survival skills and providing supervision, as well as education and information which includes the use of mass media. Interventions underpinned by behavioural theory and formative evaluation tend to be more effective, yet few practical examples exist in the drowning and/or injury prevention literature. The Health Belief Model and Social Cognitive Theory will be used to explore participants' perspectives regarding proposed mass media messaging. This paper describes a qualitative protocol to undertake formative research to develop theory-based messages for a child drowning prevention campaign., Methods and Analysis: The primary data source will be focus group interviews with parents and caregivers of children under 5 years of age in metropolitan and regional Western Australia. Qualitative content analysis will be used to analyse the data., Ethics and Dissemination: This study will contribute to the drowning prevention literature to inform the development of future child drowning prevention mass media campaigns. Findings from the study will be disseminated to practitioners, policymakers and researchers via international conferences, peer and non-peer-reviewed journals and evidence summaries. The study was submitted and approved by the Curtin University Human Research Ethics Committee., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

This article presents a brief description of a longitudinal study of system-level change, offers observations about what has been learned about the evolution of systems of care from the unique and qualified perspectives of the group of site visitors who gathered the data for the study, and identifies a set of issues that needs to be addressed to advance the system of care model in community based care of children and youth with behavioral health needs and their families. The article describes the system of care assessment portion of the national evaluation of the Federal Children's Mental Health Initiative and presents a brief summary of accumulated findings from the assessments conducted in communities funded in six successive waves of awards to provide context for the site visitors' observations and the authors' recommendations. The authors draw upon the expert observations of the site visitors, who represent many different disciplines and backgrounds, which suggest that, as a set of guiding principles, the system of care philosophy and approach seem to have become accepted standards of program practice and system operation in the funded sites, although implementation is uneven across principles and sites. The article concludes with the authors' identification of high-level system issues that must be addressed more effectively if systems of care are to come to scale.

Purpose: Dietary patterns offer an alternative method for analyzing dietary intakes that take into account the whole diet. We investigated empirical dietary patterns and prostate cancer risk in Western Australia (WA) using a population-based case-control study., Methods: Incident prostate cancer cases were identified via the WA Cancer Registry. Controls were sourced from the WA electoral roll, frequency matched on age. A food frequency questionnaire (FFQ) estimated usual dietary intake from 10 years earlier. Factor analysis identified dietary patterns in FFQ data. Effects of independent dietary patterns on prostate cancer risk were examined using unconditional logistic regression, adjusting for potential confounders., Results: A total of 546 cases and 447 controls provided data. Three distinct dietary patterns were identified, which we labeled vegetable, Western, and health-conscious. An increased risk for prostate cancer was observed with the Western pattern, which consisted of high intakes of red and processed meats, fried fish, hamburgers, chips, high-fat milk, and white bread. Men in the highest quartile for Western pattern score had an odds ratio of 1.82 (95% confidence interval 1.15-2.87, trend p = 0.02). Results were similar for aggressive cases and attenuated for non-aggressive cancers., Conclusions: A western style diet may lead to increased risks for prostate cancer, especially aggressive prostate cancer.

Objectives: To investigate dietary patterns and food intake as risk factors for surgically treated benign prostatic hyperplasia (BPH), as few risk factors have been established for BPH and recently there has been some interest in a role for diet in the development of BPH., Patients, Subjects and Methods: A case-control study was conducted in Western Australia (WA) during 2001 and 2002. BPH cases were men with a diagnosis of BPH hospitalized for their first prostatectomy. Controls were frequency matched for age and sex from the WA electoral roll. A previously evaluated food-frequency questionnaire (FFQ) collected information on usual dietary intake 10 years earlier. Factor analysis identified dietary patterns in the FFQ data. Effects of dietary patterns and food intakes on the risk of BPH were examined using unconditional logistic regression, adjusting for various confounders., Results: In all, 406 cases and 462 controls (aged 40-75 years) provided data. Three dietary patterns were identified, i.e. 'Vegetable', 'Western' and 'Health Conscious'. BPH risk was not associated with the 'Health Conscious' or 'Western' patterns, but there was a lower risk with an increasing score for the 'Vegetable' pattern (odds ratio 0.78, 95% confidence interval 0.63-0.98). BPH risk was significantly and inversely related to the intake of total vegetables, dark yellow vegetables, other vegetables, tofu and red meat. There was a higher risk of BPH with increasing intake of high-fat dairy products., Conclusions: These results indicate that vegetables, soy products, red meat and high-fat dairy foods might be important in the development of BPH.

The rationale for the development of effective programs for parents with serious mental illness and their children is compelling. Using qualitative methods and a grounded theory approach with data obtained in site visits, seven existing programs for parents with mental illness and their children in the United States are described and compared across core components: target population, theory and assumptions, funding, community and agency contexts, essential services and intervention strategies, moderators, and outcomes. The diversity across programs is strongly complemented by shared characteristics, the identification of which provides the foundation for future testing and the development of an evidence base. Challenges in program implementation and sustainability are identified. Qualitative methods are useful, particularly when studying existing programs, in taking steps toward building the evidence base for effective programs for parents with serious mental illness and their children.

Objective: To determine the relationship between personal, hormonal and lifestyle risk factors and surgically treated benign prostatic hyperplasia (BPH)., Materials and Methods: A population-based case-control study was conducted in Western Australia (WA) on men aged 40-75 years who were surgically treated at public and private hospitals for BPH during 2001-2002. Controls were recruited from the WA electoral roll. Cases and controls were compared with regard to demographic and lifestyle factors and proxy measures of hormonal status using logistic regression. Data were available for 398 cases and 471 controls., Results: No associations with BPH were found for family history of prostate cancer in father or brother, serving in the military in a combat area, pattern of baldness, smoking status, obesity, alcohol intake and occupational physical activity. The only inverse relationship was observed with heavy alcohol drinking (>30g/day), however, this was not statistically significant. An increased risk of BPH, not statistically significant, was observed for British-born men compared to Australian born and for history of vasectomy. The analysis was repeated after excluding 28% of controls with moderate and severe symptoms of BPH and 7% of cases with mild symptoms prior to surgery, and our results remained essentially unchanged., Conclusions: The results suggest that there are few risk factors for BPH although perhaps country of birth, vasectomy and heavy alcohol consumption may be considered further.

Background: Three decades after US and Australian forces withdrew from Vietnam, there has been much public interest in the health consequences of service in Vietnam. One controversial question is whether the risk of prostate cancer amongst Vietnam veterans is increased. This paper examines relationships between military history, family history and risk of prostate cancer in a population-based case control study., Methods: Cases were selected from the Cancer Registry of Western Australia as incident cases of histologically-confirmed prostate cancer, and controls were age-matched and selected from the Western Australian electoral roll. Study participants were asked to report any military service history and details about that service., Results: Between January 2001 and September 2002, 606 cases and 471 controls aged between 40-75 years were recruited. An increased prostate cancer risk was observed in men reporting they were deployed in Vietnam although this was not statistically significant (OR = 2.12; 95% CI 0.88-5.06). An increased risk was also observed in men reporting prostate cancer in fathers (OR = 1.90; 95% CI 1.20-3.00) or brothers (OR = 2.05; 95% CI 1.20-3.50) diagnosed with prostate cancer., Conclusion: These findings support a positive association between prostate cancer and military service history in the Vietnam war and a first degree relative family history of prostate cancer.

Little is known about the effectiveness of interventions for families living with parental mental illness. Existing interventions offer information about successfully implemented treatments, which may demonstrate effectiveness in research. In the current study, directors of programs for parents with mental illness and their families were interviewed. Qualitative analyses revealed noteworthy similarities with respect to target population; funding; community context; agency context; mission, theoretical orientation, and assumptions; locus of care and essential services; desired outcomes; and moderators. Program similarities were identified to provide parameters for research, and to contribute to the development of testable hypotheses. Family-centered, strengths-based approaches were identified across program directors as critical to intervention success.

This article discusses a number of issues related to the diagnosis and treatment of children with attention-deficit hyperactivity disorder (ADHD), with specific implications for preschoolers. A brief review of diagnostic and treatment issues for young children is followed by a discussion of developmental issues that contextualize the preschool years and have an impact on cognitive and emotional development underlying self-regulation. The characteristics of the high numbers of children with ADHD receiving services within community-based systems of care and symptom outcomes are reported, as well as a description of the components of the systems of care approach. Recent federal initiatives that impact the care of children with ADHD within community settings are highlighted. It is concluded that the identification and management of preschool children with ADHD can be effective within the context of fully integrated service system approaches.

The aim of this study was to review the indication, source of referral and findings at hysterosalpingocontrastsonography (HyCoSy) of the first 100 patients referred for this new service in the gynaecological outpatients department of the Coombe Women's Hospital, Dublin. Of the first 100 women referred for HyCoSy, the indication for referral was investigation of infertility in 72%, recurrent miscarriage in 22% and other reasons in 6%. Sixty-four women were referred from general gynaecological clinics, 29 from the specialised infertility clinic and seven women were referred from other hospitals. The procedure was completed in 97% of cases and tubal patency successfully assessed in 95%. Saline hysterosonography was performed in 96 cases. Tubal assessment with Echovistt showed bilateral tubal patency in 73%, bilateral occlusion in 10% and unilateral patency in 12%. All women were discharged within 30 minutes of the procedure. We concluded that hysterosalpingocontrastsonography is an easily introduced, successful outpatient technique, which is well tolerated by women and provides clinically relevant information in women with infertility or recurrent miscarriage.

In this study of six greyhound mandibles, 24 implants were placed into extraction sockets. Eighteen of the implants were connected with abutments and immediately placed into normal function, and the remaining six submerged implants served as controls. At placement, dehiscence areas were created adjacent to 12 of the implants to study bone regeneration in extended membrane-protected defects. Six of the defects were covered with expanded polytetrafluoroethylene membranes, and six of the defects were augmented with autologous bone grafts and covered with expanded polytetrafluoroethylene material. The clinical and radiographic evaluations demonstrated that all implants achieved functional osseointegration and no implants were lost. Implant sites where membranes were used to regenerate bone over dehiscence defects demonstrated a high rate of membrane exposure and variable response to treatment. On completion of the study at 16 weeks, histomorphometric analysis demonstrated osseointegration with direct bone-to-implant contact for all implants, although the percentage of contact varied considerably. Histomorphometry indicates that the quality of osseointegration may be less favorable than the clinical and radiographic result would suggest.

In 1982, Jane Knitzer's Unclaimed Children described continued nationwide failure to provide services for children and adolescents with serious emotional disturbances. Since 1982, there has been considerable change in the philosophy, administration, and operation of services for this population. The current study compared state child and adolescent (C/A) mental health systems to those described in Unclaimed Children. Present findings are based on surveys of State Mental Health Representatives for Children and Youth in 1988/89 and 1993. Results indicated a marked increase in the number of state administrative offices and staff for C/A mental health. Much pertinent legislation had been passed. States developed a target population definition and largely officially embraced the Child and Adolescent Services System Program (CASSP) principles of an ideal system of care. Out-of-state placements were high, and placements on adult wards still existed. Counts of these placements were often unavailable to mental health officials.

Lack of adequate insurance coverage is one reason that the percentage of children who currently utilize mental health services is significantly lower than the estimated percentage of children with serious mental disorders. Principles of a reformed health care system with particular relevance for children's mental health services include coverage of a broad array of home- and community-based services, provision of organized systems of care for children with serious and persistent mental illness, mechanisms to ensure appropriate utilization of services, and provision of mental health services on the same terms and conditions as other health services. The Clinton Administration's proposed Health Security Act embodied many of these principles. In addition, its call for universal coverage and for elimination of insurance exclusions for preexisting conditions would extend mental health coverage to children who are currently uninsured or underinsured; the plan would also expand the range of services covered to include state-of-the-art approaches such as intensive nonresidential services and other alternatives to hospitalization. Implementation of the proposed plan would require developing the service and workforce capacity to provide a full continuum of services, ensuring availability of existing services, integrating existing and new systems of care, guarding against underserving children with serious mental illness, and planning for the role of Medicaid funding in the reformed health care system.

Background and Methods: Physicians have long believed that the erythrocyte sedimentation rate is low in patients with congestive heart failure, but this concept is based on a misinterpretation of the results in a single report published in 1936. To reevaluate this concept in the modern era, we measured the sedimentation rate in 242 patients who were referred for treatment of chronic heart failure., Results: The sedimentation rate was low (less than 5 mm per hour) in only 24 patients (10 percent) but was increased (above 25 mm per hour) in 50 percent. Patients with low or normal sedimentation rates (less than or equal to 25 mm per hour) had more severe hemodynamic abnormalities than patients with elevated rates: lower cardiac index (mean +/- SEM, 1.7 +/- 0.1 vs. 2.0 +/- 0.1 liters per minute per square meter of body-surface area) and higher mean right atrial pressure (mean +/- SEM, 12 +/- 1 vs. 9 +/- 1 mm Hg) (both P less than 0.0001). New York Heart Association functional class IV symptoms were present in 66 percent of the patients with a low or normal sedimentation rate, as compared with 42 percent of those with elevated rates (P less than 0.0001). After one to three months of therapy, patients whose sedimentation rates decreased showed little hemodynamic or clinical response to treatment, whereas both cardiac performance and functional status improved in patients whose rates increased (P less than 0.02 for the comparison between groups). The sedimentation rate was correlated with the plasma fibrinogen level (r = 0.64, P = 0.0025), and changes in the sedimentation rate during treatment were correlated inversely with changes in mean right atrial pressure (r = -0.57, P = 0.0002). During long-term follow-up, patients with low or normal sedimentation rates had a worse one-year survival than patients with elevated rates (41 vs. 66 percent, P = 0.01)., Conclusions: These data indicate that the erythrocyte sedimentation rate is correlated with the severity of illness in patients with chronic heart failure. Because of its lack of discriminatory power, however, the test is of limited value in the clinical management of this disorder.