Search

A thermal ionization mass spectrometric procedure was developed for determination of 240/239 ratios in subpicogram quantities of plutonium (Pu), and was applied to Pu extracted from Lake Ontario sediment. The detection limit was ∼ 4 fg of Pu and the precision of 240/239 ratio measurement was ∼ 7% in the 0.07-0.42 pg range. Results of sediment analyses at various depths showed in all cases 240/239 ratios near the mean global fallout value of 0.176 ± 0.014. The lack of variability of the ratios with depth negated the use of Pu, present in excess in the near-surface samples due to leakage from a nearby reprocessing plant, as a geochronological meter. The 240/239 ratio of the leakage Pu appeared to be very similar to that of fallout Pu.

This study utilized the diagnostic approach of the PRECEDE-PROCEED model. The constituents of this model were identified by utilizing participant observation field studies, traditionally applied by ethnographers to collect data describing the multiple facets of a culture, including linguistic patterns that capture and define characteristic semantics and viewpoints. The household study sample was randomly selected from a defined list of households known to have at least one child less than five years of age. An open-ended questionnaire format was used to interview the 115 mothers in the selected household sample. Kalama, the study community, is characteristically an agricultural village, situated in the Governorate of Kaliobia and located approximately 25 km (about 15.5 miles) from the capital, Cairo, Egypt. The latest 1986 census indicates a population size of about 13,328 people in 4,818 households. There were sixty-five deaths occurring among children less than five years in 1986. The causes of death were primarily related to diarrhea, followed by upper respiratory infections, congenital anomalies and birth injuries. This study outlines a) practices related to the management of diarrhea, including the administration of foods and drinks during such episodes; b) influences of governmental policies; and c) recommended strategies for overcoming barriers and promoting effective diarrhea intervention programs.

This article examines the issue of maintaining participation in workplace health promotion programs. The term "maintaining participation" is defined here as both continued program attendance and maintenance of recommended behaviors. The factors associated with participation and approaches to maintaining participation are reviewed. Evidence suggests that combinations of environmental and individual approaches are necessary to address the problem of maintenance. An approach to maintaining participation is suggested that utilizes a preprogram diagnostic interview model to identify and address environmental and individual factors that may cause an employee to drop out of a program or relapse into prior behavioral patterns.

Individual energy expenditure (kcal/kg/day) was calculated from a detailed set of questions from the Health Promotion and Disease Prevention Supplement of the 1985 National Health Interview Survey. Responses to three single-item, self-assessment questions were compared to the energy expenditure variable to test criterion validity. Spearman's correlation coefficient revealed moderate correlations between energy expenditure and corresponding levels of self-assessed leisure-time physical activity for each single-item question (r = 0.14 to 0.41). For purposes of measuring prevalence of physical activity, the energy expenditure variable was used to categorize individuals into activity levels. The single-item questions were found to have Spearman's correlations with the categorical measures ranging from 0.11 to 0.37 for leisure-time activities. Generally higher correlations were found for males and younger age groups (18-34 years). The relationships were interpreted as being weak relative to an expected correlation of 0.75 for criterion validation. However, the single-item questions show promise for obtaining proxy estimates of the degree of leisure-time physical activity in a population.

Three successive cross-sectional surveys were used to measure the impact of a restrictive smoking policy on employee smoking patterns, perceived exposure to environmental tobacco smoke, attitudes about the policy, and smoking-related norms in a large decentralized state agency. No significant change was detected in smoking prevalence, the proportion of smokers attempting to quit, or the total daily consumption of cigarettes by smokers. The daily consumption of cigarettes at work decreased significantly, from 16.9% to 4.9% smoking 15 or more cigarettes per day. The proportion of respondents bothered every day by coworkers' smoke dropped from 21.8% to 3.8%. Following policy implementation, the interaction between smokers and nonsmokers about smoking decreased. The findings suggest that restrictive work site smoking policies are effective at decreasing exposure to environmental tobacco smoke, but not, at least in the short run, at lowering smoking prevalence. Also, the decreased interaction regarding smoking may have the unintended consequence of reducing the perceived pressure on smokers to quit.

The relationships among social structure, stress, social support, life-style health behavior, and health status are explored in this multivariate analysis of data from the National Survey of Personal Health Practices and Consequences. Path analyses showed social structural factors to influence life-style practices both directly and indirectly through social network and negative life events. For women, social network and life events had direct relationships to health related life-style practices, while age and income acted both directly and indirectly through social network and, for income, through life events. Education was also directly related to life-style. For men, social network and education had the only direct effects on health practices, and age and income had indirect effects through network. We then examined the relative contributions of the social network index elements, life events, and demographic variables to each of the life-style practices. These analyses confirmed the importance of gender, education, age, and income to predicting life-style behaviors. Negative life events were associated with smoking for both men and women, sleep for women only, and physical activity and alcohol use for men, which suggests sex-specific norms for coping with stress. For both sexes, church attendance and marriage were associated with favorable smoking and alcoholic use, implicating cognitive social support or social control as a mediator of health promotion. Finally, analyses for each gender using health status as the outcome variable indicated that age, income, education, and life events affected health directly, while the effects of church attendance and marriage were likely mediated through smoking and alcohol behaviors.

The ability to assign patients to the most appropriate program of intervention would improve patient outcomes and reduce health care costs. This paper evaluates specific potentials of triaging patients into various combinations of health education treatments. Blood pressure improvement among hypertensive patients was measured and the associated treatment cost and savings were compared. Triaging rules were formed empirically from the relationship between patient characteristics selected before the study was conducted and their achieved blood pressure control within each combination of interventions. Patients randomly assigned to seven combinations of three interventions were studied in contrast to patients in a randomized control group. A combination of all three interventions was the most effective program for the undifferentiated (random) patient population, achieving a 49% increase over 18 months in patients with blood pressure under control. By triaging, 51-91% increases in patients with controlled blood pressure were achieved. Educational history of the patients which is a fairly reliable measure was the most efficient triaging variable, showing a 91% increase in patients with blood pressure under control and a relative cost saving of about 400%.

In a recent issue of Health Education Quarterly, Chen(1) reviewed the evaluations of worksite health promotion programs published in health education journals from 1980 through June 1983. He found few evaluations in the literature that used either quasi-experimental or experimental designs. This paper reviews the evaluations of stress reduction programs in the worksite, most of which were either published outside of health education journals or unpublished. Over one-half of the studies used either experimental or quasi-experimental designs in the evaluations. This suggests that reviews of worksite health promotion program evaluations must encompass journals from a variety of disciplines. Recommendations for improving the evaluations of stress reduction programs in the worksite are included.

This article examines the logic and evidence by which health education together with related organizational, economic, and environmental supports or interventions can result in more than superficial or transitory adjustments of behavior conductive to health. Most signs point to continuing development of the health promotion movement, as indicated by its grass roots origins, the long-range convergence of changes in health-related behaviors (e.g., smoking, diet, exercise, alcohol consumption, safety practices), public and private sector investment, and the growing interest of hospitals and medical practitioners in health promotion. To assess the durability of behavior changes accomplished through health promotion activities, the apparent discrepancy between improvements observed on the social level and high relapse rates reported in most experimental studies on individuals is analyzed, leading to the conclusion that the experimental studies have overstated the problem of relapse. There is a trade-off between expedient interventions that achieve short-term behavior changes and more difficult, slower-acting educational and lifestyle interventions that assure a greater congruence between the behavior and the values, beliefs, and circumstances of the individual.

Theoretical models and paradigms from the behavioral sciences which appear most frequently in the explanation and design of health education are reviewed and consolidated around a single classification of change processes. Kelman's definitions of internalization, identification, and compliance are used to subsume parallel classifications of motivational, sociological, cultural, organizational, and communication variables. The theorematic integration of these numerous variables presents a variety of new hypotheses and suggestions for educational diagnosis, health education planning and evaluation, and potential logistics for computer programming of decision models in health education.

Evaluation of health promotion programs' impact, rather than their outcome or process, currently is needed most.

Reliance on pharmaceuticals for medial therapy, especially for chronic conditions in an aging society, poses important questions regarding patient's understanding of and adherence to their drug regimens. Related policy issues have been debated chiefly in the context of regulations administered by the Food and Drug Administration (FDA), such as the once proposed 'patient package inserts'. A population-based analysis of the distribution of health risks and drug utilization errors--including errors of omission--identifies a set of allocation issues for improving use of medications for public health as well as medical and pharmacy practice. These issues center particularly on channels and targets of drug information, including mass media, community and private medical practices, age and sex groupings within the patient and non-patient populations, and selected diseases, conditions and drugs requiring more attention. A conceptual framework for determining information needs is developed with recommendations for a combined public health and patient education strategy for the reduction of drug errors and the enhancement of drug benefits.

This three-year evaluation of field work with poor, rural homemakers by nutrition aides employed by the Expanded Food and Nutrition Education Program (EFNEP) of the Maryland Cooperative Extension Service is based on successive annual interviews with 93 homemakers and a control group of 58 designated friends. The results suggest various points of diminishing returns beyond which behavioral and attitudinal changes brought about by the specific educational strategies are too small to justify continued visits to a homemaker. To sustain cost-effective home visits after the first year, more emphasis must be placed on reinforcement of first-year gains, and on expanding the scope of nutrition education to include more health education of other kinds.

As part of a statewide effort to coordinate existing resources for high blood pressure (HBP) control, a public health HPB control program was planned and implemented in two high-risk communities in Maryland. The selection of the two communities was based on epidemiologic data. The planning of the educational intervention program in these communities (urban and rural) was guided by organizational theory and health education principles. The framework for development, implementation, and evaluation of the program utilizes an educational assessment model which identified factors that predispose, reinforce, and enable individual persons to practice positive health behavior. Multiple data sources were used in assessing the extent of the problem and relevant approaches in the development of the coordinated HPB control program. These include statewide vital statistics and a random statewide household survey to assess the prevalence rates of awareness, treatment, and control of HPB. To supplement these data, telephone surveys were carried out in the two communities to assess knowledge, beliefs, and practices related to HPB control. Medical record reviews provided baseline information on appointment keeping behavior and BP correlates of hypertensive patients. The planning and implementation of the program was carried out under the direction of representatives of the health care systems, community leaders, and residents, and representatives of communitywide organizations involved in HPB control.

Because the elderly are viewed as having more difficulty in complying with therapy, this analysis was directed at the effects of a health education program on their control of primary hypertension when compared with a younger population. The program consisted of three sequential interventions introduced in a randomized factorial design. Depsite the fact that elderly patients had more chronic disease, more complications from hypertension, and were receiving more complex drug therapies than younger patients exposed to the same experimental interventions, they demonstrated significantly higher levels of compliance with drug therapy, significantly higher levels of appointment keeping, and no difference in the proportion having their BP under control at two-year-follow-up. Longitudinal data collected at five-year follow-up indicate no decay effect. These results indicate such programs can be successfully implemented and equally effective for an elderly population.

Although the medical management of epilepsy is possible with effective therapeutics, such management is complicated by patient errors of self-medication. Efforts to improve adherence to prescribed regimens of anticonvulsant medication have not been extensively studied, although several promising results have been obtained. Research on adherence to medication regimens has been more extensive in other chronic conditions, such as hypertension, that have similarities to epilepsy in their demand for long-term treatment, often in the absence of symptoms, with drugs that may produce side effects. From the combined research on factors associated with drug errors, we have analyzed characteristics of the patient, of the regimen, of the illness, and of the patient - provider relationship. The most promising areas for improving compliance appear to be the influence of family and friends, the complexity of the treatment regimen, the patient's belief in severity of the illness, and the patient - provider relationship. Strategies to improve compliance can target 3 sets of factors: predisposing factors including patients' motivation and perception, factors that enable patients to comply more easily, and factors that reinforce compliance. Physician-directed interventions tailored to each of these categories of factors, taken together, can make up a comprehensive health education program. A model for the interventions and their evaluations is presented.

To examine the relative cost-effectiveness of single versus multiple patient education strategies to reduce hypertension, we assigned patients to seven intervention groups and to a usual-care control group using a randomized factorial design. We compared cost-effectiveness measures for single, double, and triple combinations of (a) a clinic exit interview with patients to clarify their medical regimens, (b) an educational meeting with a member of the patient's family to aid in management at home, and (c) a series of small group sessions to help patients overcome personal barriers to management. We observed consistent results for six different effectiveness measures under a variety of decision-making rules. Our results suggest that in the absence of targeting of multiple interventions to systematically selected high-risk patients, multiple intervention combinations are not more cost-effective than single interventions.

A prospective experimental design evaluated the ability of a series of educational and motivational interventions to enhance self-treatment by adult asthmatics and to reduce use of emergency department services for asthma attacks. After treatment for an asthma attack, subjects were randomly assigned to the following sequential interventions: (1) reinforcement by interpersonal similarity at the time of the emergency visit, (2) recepit of positive written appeals, and (3) follow-up telephone reinforcement. The asthmatic nurse educator was generally more effective in achieving short-term reduction of emergency department visits. Although the usefulness of the positive written appeal increased when employed by the asthmatic nurse, there were no substantive independent effects of the written message on emergency department use.

Health policy in the United States has paid scant notice to physical activity until recently. This current policy focus on physical activity has revealed not only that there is less than adequate data about it but also that the single survey questions used for the purpose of measuring its prevalence should be interpreted carefully. A case in point is the example presented in this article, which gives estimates of physical activity prevalence levels for women of child-bearing ages from several National Center for Health Statistics (NCHS) surveys. The amount of physical activity reported, and thus the proportion of women at risk for various diseases due to limited activity, depends on how the question is asked and the type of responses offered as options. Various questions used in three different NCHS surveys produced prevalence estimates of limited physical activity levels ranging from 3.9 to 39.1%. These findings have important implications for survey assessments of physical activity at all policy levels.