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A variety of health organizations, including the American Academy of Pediatrics and the American Dental Association, have employed the concept of anticipatory guidance to avert potential health risks among their patients. The application of anticipatory guidance with underclass collegiate athletes, however, has not been identified in the literature. The purpose of this mixed-methods, quasi-experimental study was to assess the eating disorder risk and nutrition knowledge of underclass Division I collegiate athletes at a Midwestern university and to determine the viability of using the theory of anticipatory guidance to identify the athletes' nutrition education needs related to six nutrition related key topics. Of the forty athletes who completed three assessments, results indicated a desire and a need for more nutrition information. The Sports Nutrition presentation significantly increased the sport nutrition knowledge among the collegiate athletes compared to the control group. Analysis of the EAT-26 survey indicated seven of the 40 athletes were at risk for an eating disorder; of these, almost half (43%) were female gymnasts. Applying anticipatory guidance early in an athlete’s career may potentially prevent future health problems and enhance performance. / Department of Family and Consumer Sciences

Bakgrund: Historiskt sett har fokus gällande hälsoinsatser främst handlat om förebyggande åtgärder samt att rehabilitera redan skadade och/eller sjuka. Denna syn på hälsa och hälsoarbete har på senare tid förändrats mot att nu ha en starkare tro på vikten av hälsofrämjande insatser. Vi tycker båda att förändringsarbeten är mycket intressanta och ville därför undersöka huruvida hälsoprofilsbedömningen är ett lämpligt verktyg för just friskvårdsinsatser i företagsmiljö. Syfte: Syftet med studien är att undersöka deltagarnas upplevelser under deltagande i en friskvårdssatsning med hälsoprofilsbedömning som metod samt om hälsoprofilsbedömningen kan motivera till en hälsosammare livsstil. Metod: Detta har undersökts med hjälp av en kvalitativt inriktad studie på ett företag med totalt tio anställda. Empirisk data har samlats in genom semistrukturerade intervjuer och sedan analyserats med inspiration från fenomenologisk analysmetod. Resultat: Deltagarna upplevde att hälsoprofilsbedömningen tillhandahöll ett nuläge att förhålla sig till då de ska påbörja eller fortsätta en livsstilsförändring mot ett hälsosammare liv. De ansåg att friskvårdsinsatsen vittnar om hur verksamhetscheferna värderar hälsa högt samt visar på en förståelse för sambandet mellan god medarbetarhälsa och framgångsrik verksamhet. Slutligen verkar det ha skett en positiv förändring i hur de tänker kring kost, träning och stress, där detta nu värderas högre än tidigare / Background: Historically health efforts mainly have been focusing on prevention and to rehabilitate already injured and/or sick people. This vision of health and health work has recently changed towards now having a stronger belief in the importance of health promotion actions. We both think that change management is very interesting and therefore wanted to investigate whether health profile assessment is an appropriate method for preventive health care in the organizational environment. Purpose: The purpose of the study is to investigate the participants experiences during a healthcare project with health profile assessment as method and if it can motivate to a healthy lifestyle. Method: This has been investigated with the help of a qualitatively oriented study on a corporation with a total of ten employees. Empirical data have been gathered through semi-structured interviews and been analyzed with inspiration from phenomenological analyze method. Result: The participants experienced that the health profile assessment provided a current state to relate to when they are going to start or continue a lifestyle change to a more healthy life. They believed that the wellness intervention is a sign of how the business managers highly value health and that it shows an understanding of the relationship between good employee health and business success. Finally it seems to have been a positive change in how they think about diet, exercise and stress, where it now has a higher value than before

The implementation of Electronic Medical Records (EMRs) may lead to improved quality of primary health care. To investigate this, we conducted a mixed methods study of eighteen Toronto family physicians who implemented EMRs in 2006 and nine comparison family physicians who continued to use paper records. We used a controlled before-after design and two focus groups. We examined five preventive services with Pay for Performance incentives: Pap smears, screening mammograms, fecal occult blood testing, influenza vaccinations and childhood vaccinations. There was no difference between the two groups: after adjustment, combined preventive services for the EMR group increased by 0.7% less than for the non-EMR group (p=0.55, 95% CI -2.8, 3.9). Physicians felt that EMR implementation was challenging.

The implementation of Electronic Medical Records (EMRs) may lead to improved quality of primary health care. To investigate this, we conducted a mixed methods study of eighteen Toronto family physicians who implemented EMRs in 2006 and nine comparison family physicians who continued to use paper records. We used a controlled before-after design and two focus groups. We examined five preventive services with Pay for Performance incentives: Pap smears, screening mammograms, fecal occult blood testing, influenza vaccinations and childhood vaccinations. There was no difference between the two groups: after adjustment, combined preventive services for the EMR group increased by 0.7% less than for the non-EMR group (p=0.55, 95% CI -2.8, 3.9). Physicians felt that EMR implementation was challenging.

Background Many trials in the USA, Canada, Europe and Australia have attempted to evaluate the effectiveness of preventive in-home health assessment and home care programs for older people. Trials have differed widely in their processes, including the dependence levels of subjects, assessment components and locations (clinic/home), intensity of case management (frequency of contact, length of follow-up period, scope of interventions) and methods of case management (telephone/visits). Preventive programs use valuable health resources and, although there has been inconclusive evidence of their effectiveness, programs combining preventive in-home health assessment and home care for older people have been introduced into public policy in Australia and internationally. Ongoing research is therefore essential in order to identify the positive benefits for older people, and establish their effectiveness with regard to health resource utilisation. Purpose The purpose of the study was to maintain the health status of older people living alone in the community by implementing a preventive health assessment and follow-up home care program. Research Design An experimental group was compared with a control group using a cluster randomised controlled trial methodology. Health outcomes were measured pre and post intervention, including health perception, functional ability, psychosocial status, client satisfaction, and health resource utilisation. Population and Sample The population for this study consisted of people aged 75 years and over who lived alone in Independent Living Units within managed retirement facilities, and who were highly independent in their activities of daily living. The final sample totalled 124, comprising of an experimental group (n=61) and a control group (n=63). The sample resided in South East Queensland. Intervention The intervention for the study "A Community Preventive Health Model for over 75s Living Alone" comprised of five major elements: 1) targeting before health and/or social crisis, and while community care needs were low; 2) linking clients with a community nurse; 3) comprehensive health assessments and identification of needs; 4) introduction of basic health care and community services and referrals if required; and 5) case management by three-monthly telephone contact. Assessments and case management were carried out by experienced community care registered nurses, and case management was performed for a one year period. The control group received health assessments and phone calls similar to the experimental group for data collection purposes, and to balance the risk of a Hawthorne effect due to regular contacts with participants. However all aspects of case management were omitted from all episodes of contact with the control group. For ethical reasons control group participants were supplied with a summary of their health assessment results to share with their GP if they wished. Data Collection and Instruments Measures of health perception, functional ability and psychosocial status occurred at two points (baseline and after 12 months). Measures of health resource utilisation, mortality and client satisfaction were measured after twelve months. A combination of several widely-used, valid and reliable instruments, as well as some newly developed data collection tools, were used to measure health outcomes. Data Analysis Independent group t-tests and Chi-square tests were used to examine for baseline differences between the experimental and control groups, and also to analyse health resource utilisation data at Time 2. A series of ANCOVA tests were applied to test the remaining hypotheses, so that the effects of Time 1 scores and potential confounding variables could be incorporated into the analyses. Results The experimental group and control group were homogenous at baseline for all demographic variables and all major outcome variables. The intervention model was applied for one year, with 66% (n = 40) in the experimental group having at least one unmet need identified and appropriate interventions undertaken. Only a small proportion of interventions (16%) were recorded as not being followed through by clients, and the majority (59%) resulted in needs being met or problems resolved. Results showed no benefits were gained from the program after one year for experimental group participants for the outcomes of health perception, functional ability, psychosocial status, health resource utilisation and mortality. However, the experimental group did show a statistically significantly higher level of satisfaction with care. Conclusions Comprehensive assessments performed by Registered Nurses with expertise in gerontology resulted in the identification of previously undetected unmet needs. When comprehensive assessment was combined with low intensity case management for a one year period, higher levels of client satisfaction with care were achieved. Therefore a model involving Registered Nurses with advanced knowledge and experience in aged care, working in collaboration with General Practitioners and community service organisations, could have considerable benefits in identifying unmet needs and improving client satisfaction. However, no client benefit was detected for quality of life outcomes, nor was a reduction in health resource utilisation found. This result from an Australian cohort is consistent with findings from many other international trials (Van Haastregt et al., 2000). It is possible that methodological issues are masking the effect of the intervention. Are we measuring appropriate outcomes? Are we expecting long-term outcomes in short time frames? Are we applying the model appropriately across a diverse older population? Further research to explore these questions is recommended for the future.

Objective: To examine the impact on dental utilisation following the introduction of a participating provider scheme (Regional and Rural Oral Health Program {RROHP)). In this model dentists receive higher third party payments from a private health insurance fund for delivering an agreed range of preventive and diagnostic benefits at no out-ofpocket cost to insured patients. Data source/Study setting: Hospitals Contribution Fund of Australia (HCF) dental claims for all members resident in New South Wales over the six financial years from l99811999 to 200312004. Study design: This cohort study involves before and after analyses of dental claims experience over a six year period for approximately 81,000 individuals in the intervention group (HCF members resident in regional and rural New South Wales, Australia) and 267,000 in the control group (HCF members resident in the Sydney area). Only claims for individuals who were members of HCF at 31 December 1997 were included. The analysis groups claims into the three years prior to the establishment of the RROHP and the three years subsequent to implementation. Data collection/Extraction methods: The analysis is based on all claims submitted by users of services for visits between 1 July 1988 and 30 June 2004. In these data approximately 1,000,000 services were provided to the intervention group and approximately 4,900,000 in the control group. Principal findings: Using Statistical Process Control (SPC) charts, special cause variation was identified in total utilisation rate of private dental services in the intervention group post implementation. No such variation was present in the control group. On average in the three years after implementation of the program the utilisation rate of dental services by regional and rural residents of New South Wales who where members of HCF grew by 12.6%, over eight times the growth rate of 1.5% observed in the control group (HCF members who were Sydney residents). The differences were even more pronounced in the areas of service that were the focus of the program: diagnostic and preventive services. Conclusion: The implementation of a benefit design change, a participating provider scheme, that involved the removal of CO-payments on a defined range of preventive and diagnostic dental services combined with the establishment and promotion of a network of dentists, appears to have had a marked impact on HCF members' utilisation of dental services in regional and rural New South Wales, Australia.

Otitis media and consequent hearing loss are known to be high in Koori communities. Previous research on otitis media in Koori communities has focused on its identification, treatment and management. Little research has focused on the prevention of otitis media. Victorian Aboriginal communities often have small populations which result in small sample sizes for research projects. Consequently use of traditional quantitative methods to measure of change arising from health interventions can be problematic. The aim of the research was to describe Koori children’s otitis media risk factors using a Koori research method in order to develop, implement and evaluate preventative interventions.

Thesis (Ph.D.)--Duquesne University, 2007. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 127-138).

Thesis (M.P.H.M.(Primary Health Care Management))--Mahidol University, 2005.