ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1993.tb00095.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:Public health practice is in a transitory state, expanding considerably beyond medical and behavioural models of health and disease to encompass physical and social environmental health determinants. A new public health practice is emerging, apparent in initiatives like the international healthy cities/communities projects. This new public health practice must integrate the challenge of sustainable development, as defined by the 1987 World Commission on Environment and Development. The holosphere framework locates health as its central metaphor, and defines six interacting environmental spheres: a viable natural environment, a sustainable economic environment, a sufficient economy, an equitable social environment, a convivial community, and a livable built environment. There are five functional roles for local government: policy, legislation, education, partnerships and advocacy. Representative actions from each of the six environmental spheres of the holosphere framework are identified and discussed, using the five functional roles of local government. There is a need for new intersectoral forums to act upon the knowledge generated by integrative models such as the holosphere. Canadian Round Tables on Environment and Economy are encouraging examples of such intersectoralism.

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1993.tb00096.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:A survey was undertaken in Sydney in 1989 to identify factors associated with behaviour involving risk for human immunodeficiency virus infection. Self‐report data on needle‐sharing and sexual practices were collected from 91 heroin users entering a residential, drug‐free detoxification unit. Data were analysed using polytomous and ordinal logistic regressions. Heroin‐dependent subjects who also had a current alcohol problem were significantly more likely than others to report high risk needle‐sharing behaviour. Subjects with more than one sexual partner in the last three months were significantly more likely to use condoms while those with a current benzodiazepine problem were significantly less likely to use condoms. Qualitative data suggest that high risk needle‐sharing behaviour most often occurred around the time of relapse to injecting drug use and among homeless drug users occupying derelict buildings in inner

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1993.tb00097.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:Medication use and its correlates were examined in a randomly selected sample of 178 urban‐dwelling elderly people: 89 per cent were currently using medication and 44 per cent were using four or more medications concurrently. Forty percent were using at least one nonprescription medication, usually in combination with prescription medication. The treatment of hypertension was the most commonly given reason for medication use. Respondents demonstrated good knowledge of their medication and how to take it, and good compliance with prescribing instructions. Multiple medication use was associated with advanced age, living in supervised accommodation, and a range of measures indicative of reduced wellbeing. There was no association between cognitive functioning and multiple medication use. These findings suggest that stereotypical images of older people as being poor compilers and having little knowledge about their medication should be treated with caution. However, the extensive use of medication and of multiple medications and concerns about the appropriateness of use of some classes of medication highlight the need for more detailed study of medication use among the elderl

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1993.tb00098.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:Physical exercise is commonly promoted as a panacea. However many of the claimed benefits, in particular any positive effects on bone density, have not been scientifically proved. We assessed the effects of a twice‐weekly aerobic weight‐bearing exercise program on bone density in postmenopausal women. We tested bone density at the spine and hip in 19 exercisers with a mean age of 66.4 years (SEM ±1.2) before and after a two‐year exercise program, and in 11 controls, mean age 65.4 years (SEM ± 1.5). We also assessed risk factors for cardiovascular disease and tested wellbeing and cognitive function. The mean percentage change in lumbar bone mineral density was −0.8 in exercisers and −3.8 in controls (difference 3.0 per cent; 95 per cent confidence interval (CI) 0.3 to 5.7 per cent;P= 0.031). The mean percentage change in trochanteric bone mineral concentration was + 9.6 in exercisers and −4.4 in controls (difference 14.0 per cent; CI 4.6 to 23.5;P= 0.0049). The exercisers also had significantly higher wellbeing and diastolic blood pressure. This study adds strong evidence that twice‐weekly weight‐bearing aerobic exercise has a protective effect on bone density in postmenopausal women as well as being associated with other me

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1993.tb00099.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:This paper answers the questions: who is and is not tested for human immunodeficiency virus (HIV) antibodies, why, where are they tested, and what do they find difficult about the testing process? The data came from two samples of sexually active heterosexual, bisexual and gay men in Perth (N= 545). Bisexual and gay men were much more likely to be tested than heterosexual men, although the commonest reason for testing for all three groups was risky sex. The three groups differed on reasons for not having the HIV antibody test: heterosexual men most commonly claimed that they were not at risk; bisexual men explained that they had been meaning to go but kept putting it off; and gay men primarily feared a positive test result and lacked trust in the confidential treatment of results. Gay men were more likely to trust their regular doctors than were heterosexual and bisexual men who had more trust in state health clinics. Waiting for test results was the most difficult part of the testing process for all respondents. Few respondents agreed that employers and the police should be notified by a doctor of an antibody‐positive test result; nearly all agreed that those who had contracted HIV should be notified; notification of surgeons received moderate support. Knowing one's HIV infection status appears to be strongly associated with safer sex practices, and therefore the HIV antibody test could be promoted as part of a preventive health care progra

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1993.tb00100.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:Data were collected from 814 clients attending anonymously for counselling before tests for human immunodeficiency virus (HIV) infection at the Burnett Clinic in Auckland. Just over 10 per cent of clients (n= 83) reported ever having injected drugs. This group was matched according to age, gender, ethnicity and sexual orientation with an equal sized control group drawn from clients who had not injected drugs. The groups were compared in terms of their sexual practices, sexual partnerships, other drug use, current and past health status and their perception of HIV risk. The injecting drug users reported more sex partners than the nonusers, they were less likely to be in a relationship and they were less likely to be monogamous. Vaginal and oral sex were the most common practices in both groups but anal sex was more common among users than the nonusers. Regular condom use was reported by less than a quarter of each group. The health status of drug users was generally poorer than that of the nonusers. They reported greater use of alcohol and other drugs, more mental health problems, and more symptoms of ill health. They also had experienced more sexually‐transmitted diseases. Only 1 per cent of users and 2 per cent of nonusers tested positively for HIV, although users saw themselves and their partners as at greater risk of HIV infection than the nonuser

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1993.tb00101.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:During the 1989 Christmas holiday period, a large outbreak of gastroenteritis occurred among persons staying at a caravan park in southern New South Wales. Review of local hospital records found that 77 per cent of patients presenting with infective diarrhoea between 29 December and 3 January had stayed at the caravan park. In a retrospective cohort study we compared rates of illness among caravan park patrons exposed to different water sources. Stools were tested for pathogens and convalescent sera for viral antibodies. Rain and reticulated river water sampled from the caravan park were tested for bacteria and viruses. Of 351 persons interviewed at the caravan park, 305 (87 per cent) reported an illness characterised by diarrhoea, vomiting and abdominal pain. Of 196 persons who used reticulated river water for drinking or ablutions, 175 (89 per cent) became ill compared with 47 of 72 persons (65 per cent) who did not use this water (relative risk 1.4, 95 per cent confidence interval 1.2 to 1.6). The outbreak was probably caused by a 27–28 nm small round structured virus found in the stool from one ill person. High levels of faecal coliforms in the reticulated river water and enterovirus in sediment samples suggest that the outbreak was caused by sewage contaminating the reticulated river water through a break in the pipe directly over the underground water tanks. To prevent such outbreaks, poor water and sewerage system layouts should be avoided and nonpotable water should be clearly labelled. Where feasible, all camping‐ground water should stem from town suppl

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1993.tb00102.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:The purpose of this research was to estimate the cost‐effectiveness of mammographic screening to supplement the results of the National Evaluation of Breast Cancer Screening which identified the mortality benefit as the most sensitive parameter. This appraisal used a different computer model, MISCAN, which models the effects of introducing a national screening program into a previously unscreened population, rather than basing estimates on the assumption of a fully established program. For the 40 to 49 age group a mortality reduction of 8 per cent was assumed, rather than the 30 per cent estimate utilised in the National Evaluation. The revised estimate is based on the two Swedish trials (Malmo and WE). New estimates for treatment costs were also incorporated into the MISCAN model. The cost‐effectiveness of the policy recommended in the National Evaluation Report, $11 000 per life year saved with two‐yearly screening of women over 40, is estimated by the MISCAN model to be dollar;20 300. These differences arise partly from the difference in mortality effects for the 40 to 49 age group, but also from differences inherent in the steady‐state and dynamic population approaches to modelling premature deaths averted. The MISCAN results confirm that screening for women over 50 is more cost‐effective than screening women under 50. Screening all women aged 50 to 69 every two to three years is reasonable value for money. For women aged 40 to 49 the mortality benefit and cost‐effectiveness is less clear, and it would be prudent to allow screening in this group until further evidence i

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1993.tb00103.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:Making a special effort to gain health information has been associated with healthy behaviour. This paper identifies the information‐seeking dimension and the sources of information people use and examines whether there is an association between these and individual health status. In November 1989 a randomly selected sample of 2134 adults in the electorates of Maryborough, Toowoomba and Port Curtis (Gladstone) completed a self‐administered questionnaire which aimed to measure health‐related knowledge, attitudes and behaviour. Factor analysis identified clusters of items representing different dimensions of risky health behaviour as well as different perceived barriers to seeking preventive health care. Multiple regression analysis was then used to determine sociodemographic, attitudinal and behavioural variables related to a tendency not to seek health information and to be at risk for preventable diseases The findings have implications for the development of future health promotion programs in provincial Australian cities. Both age and sex were significant in predicting where people obtain information on health. Women were more likely than men to seek health information and their sources of information reflected this proactive attitude to health. While there was no significant difference between the perceived health status of males and females, reported behavioural risk factors were much more prevalent in males. Most respondents had consulted a general practitioner in the previous twelve months and stated that they would change their behaviour on the advice of a medical practitioner. However, few nominated medical practitioners as their main source of health inform

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1993.tb00104.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY