Efectividad de intervención basada en modelo de Nola Pender en promoción de estilos de vida saludables de universitarios peruanos / Effectiveness of an Intervention Based on the Nola Pender Model in Promoting Healthy Lifestyles in Peruvian Universities

Introducción: Los estilos de vida saludables previenen enfermedades y optimizan la salud del ser humano, mejor aún en los estudiantes universitarios quienes están vulnerables a cambiar actitudes, rutinas, hábitos y su estilo de vida. Objetivo: Determinar la efectividad de programa basado en modelo de Nola Pender para promover estilos de vida saludables en universitarios peruanos. Métodos: Estudio preexperimental con pretest y postest, en una universidad privada de Tarapoto, Perú, durante 2017. Participaron 869 estudiantes de siete carreras. Para conocer el estilo de vida de los universitarios, se utilizó el PESPS-I de Pender. La intervención tuvo una duración de ocho meses, se consideraron aspectos nutricionales, salud emocional y actividad física. En el análisis estadístico se realizó la prueba no paramétrica Wilcoxon, con nivel de significación de p = 0,05, además de la distribución de frecuencias absolutas, porcentajes, medias, rango promedio y desviación estándar. Resultados: Las medidas del postest fueron superiores a las del pretest demostrando la efectividad del programa para promover los estilos de vida saludables en el ejercicio, la responsabilidad en salud y el manejo del estrés (p < 0,05). Sin embargo, en las dimensiones: nutrición, soporte interpersonal y auto-actualización no se encontraron diferencias significativas (p > 0,05). Conclusiones: El programa para promover los estilos de vida saludables en universitarios peruanos de 16 a 22 años demostró ser efectivo para mejorar el ejercicio, la responsabilidad en salud y el manejo del estrés(AU)

ABSTRACT Introduction: Healthy lifestyles prevent diseases and optimize the health of the human being, even better among university students, who are vulnerable to changing attitudes, routines, habits, and their lifestyle. Objective: To determine the effectiveness of a program based on the Nola Pender model to promote healthy lifestyles in Peruvian university students. Methods: Pre-experimental study with pre-test and post-test, in a private university in Tarapoto, Peru, during 2017. 869 students from seven majors participated. To know the lifestyle of university students, the Pender PESPS-I was used. The intervention lasted eight months. Nutritional aspects, emotional health and physical activity were considered. In the statistical analysis, the non-parametric Wilcoxon test was performed, with a significance level of p=0.05, in addition to the distribution of absolute frequencies, percentages, means, average range and standard deviation. Results: The post-test measures were higher than to those of the pre-test, which demonstrated the effectiveness of the program to promote healthy lifestyles through exercising, health responsibility and stress management (p < 0.05). However, in the dimensions nutrition, interpersonal support and self-update, no significant differences were found (p >0.05). Conclusions: The program to promote healthy lifestyles in Peruvian university students aged 16 to 22 years proved to be effective in improving exercise, health responsibility and stress management(AU)

Prevalence and characteristics of universal depression screening in U.S. college health centers.

INTRODUCTION: Whereas universal depression screening has potential to increase identification of mental health concerns among college students, the prevalence of universal screening in college health centers is unknown. This study provides an estimate of the prevalence of universal depression screening at public, 4-year universities in the United States. It also documents systems-level facilitators and correlates of universal screening, as well as reasons for not screening. METHOD: Online cross-sectional survey of college health center directors and student health personnel of public 4-year universities. RESULTS: There were 131 participants who responded to the survey (25% response): 64.2% (54-74%; 95% confidence interval [CI]) of respondents reported that their clinics use universal depression screening. Characteristics associated with universal depression screening use clustered around systems-level resources, including larger student populations and health care staff, greater perceived financial resources, and shorter estimates of time required for screening. Universal screening use was also associated with respondents' awareness of the U.S. Preventive Services Task Force (USPSTF) recommendation, agreement with the evidence base supporting universal depression screening, and beliefs that codified standards support effective care. Leading reasons for not screening included: lack of mental health professionals, provider reluctance, liability concerns, and lack of clinic space. DISCUSSION: Universal depression screening is reasonably common among college health centers. Care planner discussions regarding depression screening initiatives should address resource concerns, awareness of the USPSTF recommendation and evidence base, and information about the average time it takes to screen. Future research should examine functional outcomes and implementation experiences of college health centers that have adopted universal depression screening. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Sexual violence screening practices of student health centers located on universities in Florida.

OBJECTIVE: The purpose of this study is to describe current sexual violence screening practices of student health centers located on universities in Florida. PARTICIPANTS: Institutional level data was collected from 33 student health centers from November 2015 through January 2016. The student health centers were located on public or private universities. METHODS: A cross-sectional descriptive study design was used. Data was collected from student health center representatives through use of a telephone administered survey. RESULTS: Findings reveal that the majority of student health centers screen for sexual violence. However, not all use effective screening strategies. Further, the majority of screening questions used are not specific to sexual violence. CONCLUSIONS: Findings can be used to assist universities with responding to campus sexual violence among the college population. Recommendations for strengthening sexual violence screening practices and future research are provided.

US college and university student health screening requirements for tuberculosis and vaccine-preventable diseases, 2012.

OBJECTIVE: Colleges are at risk for communicable disease outbreaks because of the high degree of person-to-person interactions and relatively crowded dormitory settings. This report describes the US college student health screening requirements among US resident and international students for tuberculosis (TB) and vaccine-preventable diseases (VPDs) as they relate to the American College Health Association (ACHA) guidelines. Methods/Participants: In April 2012, US college health administrators (N = 2,858) were sent online surveys to assess their respective school's TB screening and immunization requirements. RESULTS: Surveys were completed by 308 (11%) schools. Most schools were aware of the ACHA immunization (78%) and TB screening (76%) guidelines. Schools reported having policies related to immunization screening (80.4%), immunization compliance (93%), TB screening (55%), and TB compliance (87%). CONCLUSION: Most colleges were following ACHA guidelines. However, there are opportunities for improvement to fully utilize the recommendations and prevent outbreaks of communicable diseases among students in colleges.

Comprensión e implementación de la promoción de la salud en instituciones de educación superior en Colombia / The understanding and implementation of health promotion at higher education institutions in Colombia

Objetivo Caracterizar la implementación y la comprensión de la Promoción de la Salud en Instituciones de Educación Superior en Colombia. Métodos Se realiza un estudio cualitativo con enfoque etnográfico en once instituciones de cinco ciudades, usando una encuesta y una entrevista exploratoria, entrevistas a gestores, observación directa, así como revisión documental. La información se analiza a la luz de conceptualizaciones sobre promoción de la salud, entornos saludables y universidades promotoras de la salud. Resultados Las instituciones han desarrollado políticas, programas, así como acciones de educación, reorientación de los servicios de salud, participación, intervención sobre el ambiente, investigación y otras con alcance familiar y comunitario. Conclusión El desarrollo de la promoción de la salud en estas instituciones ha recorrido caminos distintos, coexisten el enfoque preventivo y abordajes intersectoriales con perspectivas amplias. Se presentan como desafíos la formación de los profesionales como gestores de cambio y la promoción como proceso de transformación organizacional.(AU)

Objective To characterize the implementation and understanding of health promotion at higher education institutions in Colombia. Methods A qualitative study with an ethnographic approach was carried out at eleven institutions selected in five cities. It was conducted through research tools such as an exploratory survey, interviews, direct observation and review of documents. The information was analyzed considering conceptualizations about health promotion, health settings, and health-promoting universities. Results These institutions have implemented policies and programs and have undertaken actions like education, reorientation of health services, participation and intervention on the environment, as well as research and activities with family and community outreach. Conclusion At these institutions, different scopes related to the development of health promotion were found, i.e. there was a preventive approach along with an inter-sectorial outlook with broad extent. Some of the main challenges for institutions are the training of professionals as agents of change, and fostering health promotion as a process of organizational change.(AU)

The effectiveness of screening with interferon-gamma release assays in a university health care setting with a diverse global population.

OBJECTIVE: This analysis examined the effectiveness of utilizing interferon-gamma release assay (IGRA) technology in a TB (TB) screening program at a university. PARTICIPANTS: Participants were 2299 students at a Montana university who had presented to the university health center for TB screening during 2012 and 2013. METHODS: A retrospective study was conducted utilizing data from student health center medical records. Time and financial expenditures were determined, and the cost of the present screening process and 2 alternative scenarios was calculated. RESULTS: The current process is the most costly and time-consuming scenario for TB testing. Testing exclusively with IGRAs is the least labor-intensive for staff and creates revenue, whereas a dual method, utilizing IGRAs for high-risk students and skin tests for others, provides a solution that better responds to the demographic of the population. CONCLUSIONS: This assessment shows that IGRAs are a cost-effective tool for screening a global student population.

Screening and Counseling for Tobacco Use in Student Health Clinics: Reports of Health Care Providers.

PURPOSE: To assess tobacco screening and counseling in student health clinics, including facilitators, barriers, and associations with campus- and state-level variables. DESIGN: We conducted a mixed-methods study with an online survey and qualitative interviews. SETTING: Study setting was student health clinics on college campuses. SUBJECTS: Subjects included 71 clinic directors or designees from 10 Southeastern states (quantitative survey) and 8 directors or designees from 4 Southeastern states (qualitative interviews). MEASURES: Quantitative measures included demographics, screening and counseling practices, clinic-level supports for such practices, perceptions of tobacco on campus, institution size, public/private status, state tobacco farming revenue, and state tobacco control funding. Qualitative measures included barriers and facilitators of tobacco screening and counseling practices. ANALYSIS: Logistic and linear regression models assessed correlates of screening and counseling. Qualitative data were analyzed using multistage interpretive thematic analysis. RESULTS: A total of 55% of online survey respondents reported that their clinics screen for tobacco at every visit, whereas 80% reported their clinics offer counseling and pharmacotherapy. Barriers included lack of the following: time with patients, relevance to chief complaint, student self-identification as a tobacco user, access to pharmacotherapy, and interest in quitting among smokers. In multivariable models, more efforts to reduce tobacco use, student enrollment, and state-level cash receipts for tobacco were positively associated with clinic-level supports. CONCLUSION: This study highlights missed opportunities for screening. Although reports of counseling were higher, providers identified many barriers.

Implementation of universal behavioral health screening in a university health setting.

Universal screening at university health centers can facilitate early identification and treatment of behavioral health problems common among college students. This article describes the (a) process of implementing behavioral health screening at a university health center and (b) results of universal screening for depression, suicidal ideation, alcohol misuse, tobacco use, and sleep problems. We discuss the decision points involved in screening, including what to screen for, whom to screen, how to implement the screening measure, and how to deal with patients who screen positive. During the Spring and Fall 2010 academic semesters, 4,126 screening questionnaires were completed by students (62% female) accessing a university health center. Each semester, 9-13% of students screened positive for depression, 2.5-3% for suicidal ideation, and 33-38% for alcohol misuse, while 10% wanted help with smoking cessation and 12-13% with sleep problems. The results suggest that behavioral health screening in a university health center can help identify students with behavioral health concerns to increase access to care.

Web-based screening and brief intervention for student marijuana use in a university health center: pilot study to examine the implementation of eCHECKUP TO GO in different contexts.

This pilot study sought to test the feasibility of procedures to screen students for marijuana use in Student Health Services (SHS) and test the efficacy of a web-based intervention designed to reduce marijuana use and consequences. Students were asked to participate in voluntary screening of health behaviors upon arrival at SHS. One hundred and twenty-three students who used marijuana at least monthly completed assessments and were randomized to one of four intervention conditions in a 2 (intervention: Marijuana eCHECKUP TO GO vs. control)×2 (site of intervention: on-site vs. off-site) between-groups design. Follow-up assessments were conducted online at 3 and 6 months. Latent growth modeling was used to provide effect size estimates for the influence of intervention on outcomes. One thousand and eighty undergraduate students completed screening. The intervention did not influence marijuana use frequency. However, there was evidence of a small overall intervention effect on marijuana-related consequences and a medium effect in stratified analyses in the on-site condition. Analyses of psychological variables showed that the intervention significantly reduced perceived norms regarding peer marijuana use. These findings demonstrate that it is feasible to identify marijuana users in SHS and deliver an automated web-based intervention to these students in different contexts. Effect size estimates suggest that the intervention has some promise as a means of correcting misperceptions of marijuana use norms and reducing marijuana-related consequences. Future work should test the efficacy of this intervention in a full scale randomized controlled trial.

Healthy active living: a residence community-based intervention to increase physical activity and healthy eating during the transition to first-year university.

OBJECTIVE: To examine the effects of a Healthy Active Living (HAL) community intervention on moderate-to-vigorous physical activity (MVPA), fruit and vegetable consumption (FVC), and psychosocial mediators of physical activity among students transitioning into university. METHODS: Sixty undergraduate students were assigned to reside in either the HAL community or no-treatment control residence and completed questionnaire measures at the beginning and end of the academic year. RESULTS: Students living in the HAL community reported significantly more MVPA (F[1, 58]=19.93, p<.001, ηp2=.26) and greater FVC (F[1, 56]=3.12, p=.08, ηp2=.05) compared with controls. Participants in the HAL condition also scored significantly higher in action planning (F[1, 58]=4.79, p<.05, ηp2=.08), partially mediating the effect of the intervention on MVPA. CONCLUSION: A peer-delivered healthy lifestyles intervention targeting first-year university students appears to be effective in preserving or enhancing health behaviors and cognitions during their transition into university life.

Care of the college student.

There are approximately 20 million students in U.S. colleges and universities. Although this population is characterized as having good health, 600,000 students report some form of disability or some type of medical problem, including attention-deficit/hyperactivity disorder, learning disabilities, psychiatric disorders, and chronic illnesses, among others. Physicians can enhance youth transition to an adult model of health care; the use of self-care skills checklists is one recommended method to assist with the transition. Stimulant medications are effective for treating adults with attention-deficit/hyperactivity disorder, but physicians should use caution when prescribing stimulants to college students because of the high rates of medication diversion in this population. Depression, anxiety, posttraumatic stress disorder, sleep problems, and eating disorders are common in college students and can significantly impact performance. Emphasis on immunization of students for influenza, meningococcus, and pertussis is necessary because of the low rates of compliance. Screening and interventions for obesity, tobacco use, and substance abuse are important because of the high prevalence of these problems in college students. Screening for alcohol abuse facilitates identification of students with problem drinking behaviors. Students who are war veterans should be monitored for suicidal ideation and posttraumatic stress disorder. Lesbian, gay, bisexual, transgender, and questioning students are at risk of harassment and discrimination. Caution should be exercised when prescribing medications to college athletes to avoid violation of National Collegiate Athletic Association eligibility rules.

SBIRT goes to college: interdisciplinary screening for alcohol use.

Although risky/harmful drinking, in the form of binge drinking, remains a national problem, only recently have health services in universities systematically screened for drinking, drug use, and smoking. This article recounts "lessons learned" in two nurse-directed, interdisciplinary health services, which adapted the National College Depression Partnership model to include screening and brief intervention (SBIRT) for risky/harmful alcohol use in the form of binge drinking. Using a planned change model, nurse leaders worked with university administrators, providers, and health service staff to screen all students seeking health services for risky drinking. The outcomes suggest that this process may increase staff and student awareness of the importance of alcohol consumption to health, show the ease of using SBIRT screening along with standard screening tools, and yield information on the normalization of high-risk drinking in collegiate settings. Project findings indicate that common perceptions in college students minimize negative outcomes and stress the importance of additional quality assurance initiatives that review the efficacy of combinations of standardized screening tools.

Patient-centered medical home: developing, expanding, and sustaining a role for pharmacists.

PURPOSE: The development of a patient-centered medical home (PCMH) health care model and the role of pharmacists in PCMHs at the University of Michigan are described. SUMMARY: In 2009, Blue Cross Blue Shield of Michigan (BCBSM) provided financial incentives to physician groups to implement PCMH principles. A partnership was formed among the department of pharmacy, college of pharmacy, and faculty group practice at the University of Michigan Health System (UMHS) to integrate clinical pharmacists into the PCMH model at eight general medicine practices. The rationale was that PCMH pharmacists could assist in managing chronic conditions by substituting or augmenting physician care, help achieve quality indicators, and increase revenue by billing for their services. At the University of Michigan, PCMH pharmacists currently provide direct patient care services at eight general medicine health centers for patients with diabetes, hypertension, hyperlipidemia, and polypharmacy, which are billable using T codes, which are payable to UMHS by most BCBSM plans. In the first year, the number of PCMH pharmacist half-day clinics varied from one to six per health center, and the mean number of patients per half-day clinic ranged from 2.2 to 6. Pharmacists in four PCMHs made more medication changes per visit than the other four, particularly for patients with diabetes. CONCLUSION: At the University of Michigan, PCMH pharmacists currently provide direct patient care services at eight general medicine health centers for patients with diabetes, hypertension, hyperlipidemia, and polypharmacy via referral from physicians.

Screening services for alcohol misuse and abuse at four-year colleges in the U.S.

We examine the prevalence of screening for student alcohol misuse/abuse among 333 U.S. colleges via a survey of campus leaders. We also use latent class modeling to identify classes of colleges based on screening practices. We found that most colleges conduct screening after a student is involved in an alcohol-related incident, and about 50% of colleges screen students at regular health care visits. Legal, health care, and housing staff are trained in screening at nearly all colleges; other key personnel were trained at about one third of colleges. We identified four classes of colleges: 62% of colleges fit in a class that had many screening components in place, 9% in a class with very limited services, and the remainder (29%) fit in 2 middle classes. Although most colleges had many alcohol misuse/abuse screening components in place, more than one third show need for improvement in how, where, and when screening is conducted.

Screening and brief intervention for tobacco use by student health providers on college campuses.

OBJECTIVE: This study assessed college students' reports of tobacco screening and brief intervention by student health center providers. PARTICIPANTS: Participants were 3,800 students from 8 universities in North Carolina. METHODS: Web-based survey of a stratified random sample of undergraduates. RESULTS: Fifty-three percent reported ever visiting their student health center. Of those, 62% reported being screened for tobacco use. Logistic regression revealed screening was higher among females and smokers, compared to nonsmokers. Among students who were screened and who reported tobacco use, 50% reported being advised to quit or reduce use. Brief intervention was more likely among current daily smokers compared to current nondaily smokers, as well as at schools with higher smoking rates. Screening and brief intervention were more likely at schools with lower clinic caseloads. CONCLUSIONS: Results highlight the need to encourage college health providers to screen every patient at every visit and to provide brief intervention for tobacco users.

Brief physician advice for heavy drinking college students: a randomized controlled trial in college health clinics.

OBJECTIVE: The aim of this study was to test the efficacy of brief physician advice in reducing alcohol use and related harm in college students. METHOD: The College Health Intervention Projects (CHIPs) is a randomized, controlled clinical trial with 12-month follow-up conducted in five college health clinics in Wisconsin; Washington state; and Vancouver, Canada. Of the 12,900 students screened for high-risk drinking, 484 men and 502 women met inclusion criteria and were randomized into a control (n = 493) or intervention (n = 493) group. Ninety-six percent of students participated in the follow-up procedures. The intervention consisted of two 15-minute counseling visits and two follow-up phone calls, and used motivational interviewing, contracting, diary cards, and take-home exercises. RESULTS: No significant differences were found between groups at baseline on alcohol use, age, socioeconomic or smoking status, rates of depression, or measures of alcohol-related harm. At 12 months, the experimental subjects reduced their 28-day drinking totals by 27.2%, and the control group reduced their totals by 21%. A mixed effects repeated measures model found a statistical difference in favor of the brief-intervention group (beta = 4.7, SE = 2.0, p = .018) in 28-day drinking totals. The total Rutgers Alcohol Problem Index score was also significantly different during the 12-month follow-up period (beta = 0.8, SE = 0.4, p = .033). There was no difference on the other outcome measures of interest, such as frequency of excessive heavy drinking, health care utilization, injuries, drunk driving, depression, or tobacco use. CONCLUSIONS: The study supports resource allocation and implementation of alcohol screening and brief physician advice in primary care-based college health clinics.

Alcohol screening and brief intervention in a college student health center: a randomized controlled trial.

OBJECTIVE: This study tested the effectiveness of brief primary care provider interventions delivered in a college student health center to a sample of college students who screened positive for high-risk drinking. METHOD: Between November 2005 and August 2006, 8,753 students who presented as new patients to the health service at a large public university were screened for high-risk drinking, and 2,484 students (28%) screened positive on the 5/4 gender-specific high-risk drinking question (i.e., five or more drinks per occasion for men and four or more for women). Students who screened positive for high-risk drinking and consented to participate (N= 363; 52% female) were randomly assigned either to a control group (n = 182) or to an experimental group (n = 181). Participants in the experimental group received two brief intervention sessions that were founded in motivational interviewing techniques and delivered by four specially trained providers within the student health center. Data on alcohol use and related harms were obtained from a Web-based Healthy Lifestyle Questionnaire, 30-day Timeline Followback alcohol-use diaries, the Rutgers Alcohol Problem Index (RAPI), and eight items from the Drinker Inventory of Consequences-2L. RESULTS: Repeated measures analysis showed that, compared with the control group (C), the intervention group (I) had significant reductions in typical estimated blood alcohol concentration (BAC) (C = .071 vs I = .057 at 3 months; C = .073 vs I = .057 at 6 months), peak BAC (C = . 142 vs I = .112 at 3 months; C = .145 vs I = .108 at 6 months), peak number of drinks per sitting (C = 8.03 vs I = 6.87 at 3 months; C = 7.98 vs I = 6.52 at 6 months), average number of drinks per week (C = 9.47 vs I = 7.33 at 3 months; C = 8.90 vs I = 6.16 at 6 months), number of drunk episodes in a typical week (C = 1.24 vs I = 0.85 at 3 months; C = 1.10 vs I = 0.71 at 6 months), number of times taken foolish risks (C = 2.24 vs I = 1.12 at 3 months), and RAPI sum scores (C = 6.55 vs I = 4.96 at 6 months; C = 6.17 vs I = 4.58 at 9 months). CONCLUSIONS: Brief interventions delivered by primary care providers in a student health center to high-risk-drinking students may result in significantly decreased alcohol consumption, high-risk drinking, and alcohol-related harms.

Tuberculosis screening on a health science campus: use of QuantiFERON-TB Gold Test for students and employees.

Detecting and managing Mycobacterium tuberculosis (TB) infection in a health-science center population is a clinical dilemma. Tuberculin skin tests are still the preferred method for detecting present or past infection of TB. The authors discuss the performance of whole blood interferon gamma release assay test commercially known as QuantiFERON-TB Gold Test (QFT-G) as an additional tool for a TB surveillance program for the students and employees at an academic medical center. QFT-G was successfully implemented as a confirmatory test for screening of TB infection.

Computerised screening for hazardous drinking in primary care.

INTRODUCTION: Brief interventions undertaken in primary care settings have been shown consistently to reduce hazardous drinking, but they are not commonly offered in practice. The aims were to determine the uptake by young people of an offer of screening in a primary care setting; to identify patients' drinking risk levels; and to estimate the proportion who would consent to computerised brief intervention and follow-up. METHODS: Participants were 1120 patients attending a university student health service that were invited for screening while in the waiting room. Participants were also asked for their consent to be contacted for follow-up assessment 1, 6, and 12 months later. RESULTS: 1,010 patients (90%) accepted the invitation for screening. Of these, 35 (4%) failed to complete screening, thus leaving 975 with complete Alcohol Use Disorders Identification Test (AUDIT) data. Sixty percent of women and 73% of men screened positive. Twenty-three patients (4%) eligible for intervention declined follow-up assessments. DISCUSSION: The study demonstrates that the primary care setting can be used to facilitate access via computer to a large number of individuals whose drinking is hazardous. Limitations of the study include the use of an educated segment of the population who may be more receptive to computerised screening than other groups. Strengths of the study include the high rate of participation and the naturalistic setting in which the data were collected.