Health promotion practices among physicians.

Personal belief concerning both the validity of health promotion and the physician's ability to influence patient behavior may affect how much effort a physician spends on health promotion strategies. We assessed these beliefs through a mail survey to physicians practicing in a predominantly rural southern state in 1987 (n = 83) and 1991 (n = 96). Response rates in both studies exceeded 75%. The instrument was obtained from similar studies conducted in Massachusetts in 1981 and Maryland in 1983. Between 1987 and 1991 we found slight improvements in the perceived importance of many health behaviors, but significant improvement was observed in the importance of reducing intake of dietary saturated fat (66% in 1987 to 80% in 1991; P < .05). Less than 10% of the physicians thought they could be "very successful" in modifying patients' behaviors. However, in 1991 physicians perceived that their ability to be "very successful" in helping patients to modify their behavior would increase threefold (8%-24% for exercise; 4%-18% for smoking) if given appropriate support. Although the type of appropriate support was not identified, the credibility of physician's advice in promoting health changes is important. These results suggest that efforts should be made to provide support to physicians who are inclined to discuss health behavior changes with their patients. Medical Subject Headings (MeSH): dietary fats, exercise, patient education, physician's practice patterns, smoking.

A model immunization demonstration for preschoolers in an inner-city barrio, San Diego, California, 1992-1994.

An immunization demonstration project was conducted in an inner-city Latino neighborhood in San Diego to address underimmunization of children of preschool age. The project attempted interventions on consumer, provider, and system levels to reduce barriers to immunization and raise immunization rates. Free walk-in immunization clinics with emphasis on cultural sensitivity and that incorporated computerized reminder/recall were established. An educational series was offered to community health center (CHC) providers, and extensive community-based outreach and education took place in schools, churches, a WIC site, etc. Evaluation activities included preintervention and postintervention provider knowledge, attitudes, and practice surveys, CHC chart audits, and household surveys in the intervention ZIP code area and a control ZIP code area. Immunization coverage for 4DPT, 3OPV, and 1MMR (4:3:1) among two-year-olds increased significantly from 37% to 50% overall, and to 59% in the 1991 birth cohort in the intervention area compared to a one percentage point overall increase in the control area. Coverage improved significantly and missed opportunities decreased in one intervention CHC that participated most actively in educational inservices. While the Year 2000 U.S. Public Health Service objective of 90% 4:3:1 coverage for two-year-olds was not achieved over the 21-month course of the project, the results approached the 1996 single-antigen objectives. This demonstration underscores the importance of multilevel interventions including low cost, no appointment, and culturally appropriate immunization services for the indigent; the use of computerized reminder systems; and provider assessment, education, and feedback in the effort to raise preschool immunization levels. Medical Subject Headings (MeSH): immunization, preschool-age children, health promotion, provider education, immunization monitoring and follow-up systems, pediatric immunization standards, household surveys.

Continuing education needs assessment: a brief report.

A needs assessment was conducted to quantify the need for, and the capacity to provide, public health continuing education in San Diego County, California. The study was conducted with the objective of developing public health continuing education courses to be offered by the San Diego State University Graduate School of Public Health (SDSU-GSPH) to address the unmet demands of local practitioners. Survey instruments were developed to separately assess the continuing education needs of public health practitioners and the capacity of SDSU-GSPH faculty to provide courses in San Diego County. The faculty survey was distributed to all full-time SDSU-GSPH faculty. Practitioner surveys were distributed to a systematic sample of divisions and subdivisions in the County of San Diego Department of Health Services. The overall survey response rates were 71% for faculty (22/31) and 40% for practitioners (190/470). Practitioners indicated a strong interest in several of the 64 specific course topics they were asked to rate. Reported faculty interest and capacity to teach continuing education courses appears to be limited. The analysis confirms a need to improve and increase SDSU-GSPH public health continuing education offerings. Further, our results suggest that external instructional resources will be needed to meet this educational demand.

Sedentary lifestyle and state variation in coronary heart disease mortality.

Using linear regression, the authors demonstrated a strong association between State-specific coronary heart disease mortality rates and State prevalence of sedentary lifestyle (r2 = 0.34; P = 0.0002) that remained significant after controlling for the prevalence of diagnosed hypertension, smoking, and overweight among the State's population. This ecologic analysis suggests that sedentary lifestyle may explain State variation in coronary heart disease mortality and reinforces the need to include physical activity promotion as a part of programs in the States to prevent heart disease.

Physical activity and health profiles of United States women.

Now that there is significant evidence to support the role of physical activity in the prevention of several chronic diseases and conditions, it is very important to encourage women to be active and to study the gender-specific benefits and risks of physical activity. The Year 2000 Objectives and the United States Preventive Services Task Force recommendations provide direction for clinical and public health efforts in the area of physical activity promotion. Evaluation of potential barriers for women to becoming more physically active is necessary to facilitate the design of physical activity promotion strategies and interventions. The medical and public health communities should collectively seek greater resources for additional research to better clarify the health benefits and risks of physical activity for women.

The female athlete triad. The inter-relatedness of disordered eating, amenorrhea, and osteoporosis.

This article examines the relationship between the female athlete triad of disordered eating, amenorrhea, and osteoporosis, disorders that may lead to significant morbidity, and even to a high rate of mortality.

Leisure-time physical activity and high-density lipoprotein cholesterol in a biracial community sample.

The purpose of this analysis was to describe the association of leisure-time physical activity and high-density lipoprotein cholesterol levels among a large community sample of African-American and white men and women. Physical assessment of high-density lipoprotein cholesterol, weight, height, waist, and hip measurements were obtained for 3121 randomly selected community participants (969 white men, 1409 white women, 205 African-American men, and 538 African-American women). Leisure-time physical activity was assessed from responses to a standard series of questions about participation in various leisure-time activities. We found an inverse relationship between leisure-time activities and high-density lipoprotein cholesterol levels in African Americans, in contrast to a positive association observed in whites; however, these associations failed to reach statistical significance after controlling for age and body composition. These results confirm a strong association of body composition with high-density lipoprotein cholesterol and support continued interventions designed to reduce overall body weight, particularly upper body weight. The results further suggest that the relationships between some life-style factors and HDL levels may be different among minorities.

Sensitivity and specificity of death certificate diagnoses for dementing illnesses, 1988-1990.

OBJECTIVE: To evaluate the extent to which mortality data, which is often used to track secular trends for specific diseases, underestimates the prevalence of dementia. DESIGN: Retrospective analysis of existing data. SETTING: Department of Mental Health inpatient facilities in South Carolina. SUBJECTS: Inpatients at Department of Mental Health facilities who were listed in the South Carolina Statewide Alzheimer's Disease and Related Disorders Registry and who died between 1988 and 1990 (n = 450). MAIN OUTCOME MEASURES: Sensitivity and specificity of dementia diagnoses on death certificates compared to medical record diagnoses for inpatients with a pre-mortem dementia diagnosis. RESULTS: Twenty-three percent of death certificates contained any dementia diagnosis (104/450). The sensitivity of death certificates varied by type of dementia (28 percent for Alzheimer's disease; 8 percent for multi-infarct dementia) as well as by race, sex, and age. CONCLUSIONS: Mortality statistics substantially underestimate the prevalence of dementing illnesses and do not fully represent the public health burden of dementia.

Diagnostic imaging approach to bone tumors of the foot.

The authors review various bone tumors in the foot. They use ten key points with respect to five levels of evaluation, in order to assist the clinician in rapid recognition of these maladies. The classification system relates to plain x-ray films, although the authors also illustrate other sophisticated radiologic techniques for increased accuracy.

Diagnostic imaging of bone tumors in the foot.

Many tumor and tumor-like lesions may involve bone. Bone tumors in the foot are, however, very rare. An accurate diagnosis relies on a cooperative clinical and imaging effort. The patient's age, sex, history, clinical findings, and presentation, in addition to the radiographic features, allow for proper diagnosis. Specialized imaging techniques may be helpful in certain instances. Aside from a biopsy, the radiograph is clearly the most important single approach to the diagnosis of bone tumors affecting the foot.