Family history (FH) is a risk factor for many diseases. Disease guidelines often include family history as important in assessing chronic disease risks, but the empirical evidence base to inform the routine use of family history in primary care in practice appears largely lacking. An environmental scan of how family history is represented in prevention guidelines for five conditions showed that, while family history is often included in guidelines, there is variation in the definition used, recommendation given and evidence cited. A dataset on cardiovascular health in women was analyzed to examine whether family history offers useful discrimination value above standard risk factors. Regression results showed that family history is an independent risk predictor for coronary heart disease which improves discrimination beyond classical clinical factors. However, the absolute amount of discriminatory ability alone or with other factors is moderate at best, raising issues regarding clinical utility.

Family history (FH) is a risk factor for many diseases. Disease guidelines often include family history as important in assessing chronic disease risks, but the empirical evidence base to inform the routine use of family history in primary care in practice appears largely lacking. An environmental scan of how family history is represented in prevention guidelines for five conditions showed that, while family history is often included in guidelines, there is variation in the definition used, recommendation given and evidence cited. A dataset on cardiovascular health in women was analyzed to examine whether family history offers useful discrimination value above standard risk factors. Regression results showed that family history is an independent risk predictor for coronary heart disease which improves discrimination beyond classical clinical factors. However, the absolute amount of discriminatory ability alone or with other factors is moderate at best, raising issues regarding clinical utility.

Thesis (doctoral)--Universität, Tübingen, 2000.

No description available.

The purpose of this capstone is to develop a program to address health literacy among African American adults. The social cognitive theory and the health belief model was used to create a model of an age appropriate, culturally sensitive program with a pre and post test to improve the health literacy in this population. The Community Health Literacy Improvement Program (CHIP) is a pilot program that will consist of a four week didactic intervention focused on combating prose, document, and quantitative health illiteracy. This program will be implemented through a community based nonprofit organization. Participants who complete the CHIP program will be able to identify risk factors for chronic diseases, assess their ability to avoid chronic diseases, and be able to locate community health resources. This proposed intervention will show that community based nonprofit organizations have an important role to play in building community buy in and establishing the agency necessary for community based, culturally sensitive programs such as CHIP to succeed.

Objective: Assess the effectiveness of an ecological approach to promote healthy food choices in early childhood education through an educational workshop series. Design: Utilizing play-based learning, the workshops emphasized an ecological approach to health and food choice by letting children explore and experience healthy foods through various play-based and experiential activities. Data were collected and analyzed using grounded theory of semi-structured interviews with children, parents, and early childhood educators (ECEs), thematic analysis of children’s drawings, and quantitative food preference and food categorization surveys conducted with the children. Setting: The work was undertaken in three YMCA child care centres located in the Greater Toronto Area: Newcastle, Unionville, and inner-city Toronto. Participants: Participants comprised of 19 children, 5 parents, and 9 ECEs. Conclusions: The ecological approach to the promotion of healthy food choices in early childhood education was demonstrated to be an effective health promotion strategy for children aged 3 to 5.

<p>Chronic diseases of lifestyle (CDL) are on a raising trend in the world regardless of age, economic class or geographical location of a population. The mortality rate associated with CDL is alarmingly among the highest globally. Tanzania is not exempted from this development. Literature indicates that physical activity is a health practice that can prevent CDL. It is recommended that medical practitioners should hold the responsibility of counselling patients on physical activity. Some studies outside Africa found an association between doctors&rsquo / physical activity patterns and their counselling practices on the same. This study therefore sought to establish whether physical inactivity among medical&nbsp / doctors in Tanzania significantly influenced their counselling practices on physical activity. A cross sectional quantitative survey at the Muhimbili National Hospital and Muhimbili Orthopedic Institute was conducted to derive the required information. A self administered structured questionnaire was voluntarily answered by 144 medical doctors. The Statistical Package for Social Sciences (SPSS) version 17 was used for data capturing and analysis. Descriptive statistics were employed to summarize data and was expressed as means, standard deviation, frequencies and percentages. The students&rsquo / t-test was used to compare mean physical activity between different groups. Furthermore students&rsquo / t-test and analysis of variance tests were used to examine association between different variables. Chisquare tests were used to test for associations between categorical variables. Alpha level was set at p&lt / 0.05. Most of the participants in this study were sedentary in their leisure time and only active at work. When their quality of&nbsp / physical activity counselling was assessed, the majority of them were found to be poor physical activity counsellors. A significant association was found between physical activity and age, as well as physical activity and counselling practice (p&lt / 0.05). Participants mostly informed their patients about the intensity and duration of exercising more than any other idea of physical activity such as types of exercises, issuing of a written prescription and planning for a follow up. Lack of knowledge and experience about details of physical activity were reasons offered for failure to counsel. Participants also reported the inconvenience of physical activity facility&rsquo / s schedules, fatigue and tiredness to be their&nbsp / barriers to physical activity participation. Doctors in Tanzania lacked personal initiative to participate in physical activity and consequently lacked the motivation to counsel.&nbsp / Measures around enhancing this health practice should be enhanced by all stakeholders including medical doctors, physiotherapists and patients. The need for short term and&nbsp / long term training in matters related to physical activity are therefore necessary among the practicing doctors and those undergoing training in medical schools. Physiotherapists who are trained in movement science can offer valuable advice/information to medical doctors to ensure that medical doctors acquire physical activity prescription and&nbsp / counselling knowledge. Collaboration between stakeholders in campaigning against sedentary lifestyles should be enhanced. Further reasons for failure to counsel, hindrances to physical activity participation and modern approaches to counselling should be explored.<br /> &nbsp / </p>

The purpose of the study was to analyze the process of facilitating collaboration between traditional healers and western trained health care workers in the management of chronic illnesses, hypertension and diabetes. This process was facilitated through qualitative participatory action research which utilized the principles of Action Science Enquiry. This was a qualitative research. Two phases were as followed: phase one was the analysis of the problem of collaboration while phase two was the implementation of strategy one and two. Strategy one was the development of the constitution of traditional healers towards the establishment of the Swaziland traditional Healers' Council and a traditional healers' department within the Ministry of Health and Social Welfare. Strategy two was a small comparative survey into the safety and efficacy of traditional medicine. The survey compared clients who utilized only traditional medicines and those who utilized only western medicines to control their hypertension. Data was collected through interviews, meetings, observations and clinical measurements. Audio-taped and field notes were transcribed, carefully studied and analyzed. The editing analysis described by Crabtree and Williams (1992) was utilized in the analysis of data. The results of phase one was a descriptive profile of traditional healers and the way hypertension and diabetes were managed by the traditional healers and the western trained health care workers, with the aim of finding out how they could collaborate. A number of barriers for collaboration were identified such as the lack of a legal body of traditional healers, negative attitudes of western trained health care workers towards clients and traditional healers, ethical issues, perceptions of illnesses and payments as well as the lack of transparency. Enhancers for collaboration were also identified. Consequences of a successful collaborative process were established by the participants. Strategies to solving the problems of collaboration were identified and two of the strategies were implemented. A traditional collaborative model was identified and compared to an existing modem collaborative model. Phase two, strategy one, the legalizing of traditional healers in Swaziland, was decided upon during one of the meetings held between traditional healers, clients and western trained health care workers. Barriers to successfully organize this strategy were also identified, such as organization and exclusion, leadership style, traditional and cultural structures, lack of resources, poor communication and different traditional healers' categories. Action plans to solve those problems were developed and progress was made. The end result was that a draft of the traditional healers' constitution content was developed. Stakeholders who would be part of the development of the constitution were contacted. The stakeholders included the Ministry of Health and Social Welfare, the Ministry of Natural Resources and Agriculture, the Swaziland World Health Organization, the Ministry of Justice and the University of Swaziland. The traditional healers managed to form an interim committee called the Traditional Healers' Constitution Development Committee. This committee was still in a process of involving all traditional healers in Swaziland to furnish their views and opinions to the committee concerning the constitution. The target date for the constitution to be completed was set to be around April, 2001. The researcher will still be working with the committee until the legalizing process is completed. This would take another one year to complete. Phase two : strategy two, establishing the efficacy of traditional healers' medicines to control hypertension was established to enhance trust between the traditional healers and the western trained health care personnel. From the small sample, it would seem that fluctuations of blood pressure levels were similar between the two groups. This showed that traditional healers medicines to control hypertension in Swaziland is effective. Though it was difficult to establish the safety of those clients who utilized only the traditional medicines, there were no abnormalities discovered to be associated with the use of the traditional medicines. / Thesis (Ph.D.)-University of Natal, Durban, 2001.

The relationships of serum cholesterol, blood pressure and cigarette smoking with certain chronic diseases were investigated in a prospective study among more than 9,000 middle-aged adults in urban Shanghai. At baseline, the mean serum cholesterol was 4.2 mmol/l, 14 per cent of the participants had definite hypertension, and 61 per cent of males and 7 per cent of females were regular smokers. During 8-13 years of follow-up, 620 deaths were recorded. 231 (37%) of the deaths were ascribed to cardiovascular disease, including 44 (7%) from CHD and 152 (25%) from stroke. Cancer caused 274 deaths (44%), of which 66 deaths (11%) were from lung cancer, 63 (10%) from stomach cancer and 54 deaths (9%) from liver cancer. Other causes accounted for 115 deaths (19%), 29 (5%) of which were from chronic liver disease, and 31 (5%) from chronic obstructive pulmonary disease. In this study, there was a strong positive and apparently independent relationship of serum cholesterol level to CHD death (z=3.47, 2P<0.001). Within the range of usual serum cholesterol studied (about 3.8-4.7 mmol/l), there was no evidence of any apparent "threshold". After appropriate adjustment for the "regression dilution" bias, a 4% difference in usual cholesterol was associated with a 21% (95% confidence interval 9-35%) difference in the risk of CHD death. There was no significant relationship of serum cholesterol with total stroke mortality, or with total cancer mortality. The 79 deaths due to liver cancer or other chronic liver diseases were inversely related to cholesterol concentration at baseline. This inverse association appears to be secondary to prolonged hepatitis B virus infection, which accounts for most of the deaths from liver disease in China and which chronically lowers blood cholesterol. There was a strong positive relationship between blood pressure and risk of death from stroke and CHD. Within the range of usual blood pressure studied (SBP: 117-161 mmHg; DBP:75-101 mmHg), there was no evidence of any apparent threshold. After appropriate adjustment for the "regression dilution" bias, a 10 mmHg difference in usual SBP was associated with a 67% (95% Cl 52-83%) difference in the risk of stroke deaths, and with a 44% (95% confidence interval 21- 73%) difference in the risk of CHD death; a 7 mmHg difference in usual DBP was associated with a 124% (95% Cl 96-155%) difference in the risk of stroke deaths, and with a 58% (95% Cl 22-105%) difference in the risk of CHD deaths. Cigarette smoking was significantly associated with deaths from any disease. There was a strong positive relationship between cigarette smoking and risk of all cancer deaths, and specifically cancer of the lung and cancer of the upper aerodigestive tract. The relative risk of lung cancer for a current smoker was 3.5 (95% Cl 1.8-7.0; 2P<0.001), and among the male population 63% of lung cancers were directly attributed to the smoking. The relative risk of upper aero-digestive cancer death for regular smokers was 3.4 (95% Cl 1.1-10.5; 2P<0.05). The risk of chronic obstructive lung disease was also significantly related to smoking, with a relative risk in a smoker of 2.2 (95% Cl 1.1-4.4; 2P<0.05). In the present population, smokers had a 60% excess risk of deaths from total stroke compared with nonsmokers (z=2.40, 2P<0.05).

Family history (FH) is a risk factor for many diseases. Disease guidelines often include family history as important in assessing chronic disease risks, but the empirical evidence base to inform the routine use of family history in primary care in practice appears largely lacking. An environmental scan of how family history is represented in prevention guidelines for five conditions showed that, while family history is often included in guidelines, there is variation in the definition used, recommendation given and evidence cited. A dataset on cardiovascular health in women was analyzed to examine whether family history offers useful discrimination value above standard risk factors. Regression results showed that family history is an independent risk predictor for coronary heart disease which improves discrimination beyond classical clinical factors. However, the absolute amount of discriminatory ability alone or with other factors is moderate at best, raising issues regarding clinical utility.