Communicating with the community about grieving: A description and review of the foundations of a broken leg analogy of grieving

With loss permeating the lives of all people throughout the entire life span and its potential for serious long-term deleterious effects, providing effective care for those experiencing situations of loss would be an important element of any preventive community-based mental health promotion approach. The low use of mental health services by those confronted with loss, and the lack of such services in many areas, makes it imperative to enhance the competency of the broader community to provide appropriate care during times of loss. Contributory to such care is a sound knowledge of the literature concerning loss and grieving. The broken leg analogy of grief presented in this article integrates the traditional and emerging grief theories and empirical evidence into an analogy of grieving that can be easily communicated to the general community, is relevant to many losses. and vet upholds the differing positions concerning grieving held by various schools of psychiatric thought.

Beyond hearing aid fitting: improving communication for older adults

Many older adults with hearing impairment continue to have substantial communication difficulties after being fitted with hearing aids, and many do not choose to wear hearing aids. Two group communication education programs aimed at such older people are described. The 'Keep on Talking' program has a health promotion focus, and is aimed at maintaining communication for older adults living in the community. An experimental group (n=120) attended the program, and a control group (n=130) received a communication assessment but no intervention. Significant improvements were found in the experimental participants in terms of knowledge about communication changes with age and about strategies to maintain communication skills. At the follow-up evaluation at 1 year, 45% of the experimental group, compared to 10% of the control group, had acted to improve their communication skills. The 'Active Communication Education' program focuses on the development of problem-solving strategies to improve communication in everyday life situations. Preliminary outcomes have been assessed on a small scale (n=14) to date. It is concluded that communication programs represent an important adjunct to, or supplement for, the traditional approach that focuses on hearing aid fitting.

Sitting time and work patterns as indicators of overweight and obesity in Australian adults

BACKGROUND: Increasing levels of physical inactivity and sedentariness are contributing to the current overweight and obesity epidemic. In this paper, the findings of two recent studies are used to explore the relationships between sitting time ( in transport, work and leisure), physical activity and body mass index (BMI) in two contrasting samples of adult Australians. METHODS: Data on sitting time, physical activity, BMI and a number of demographic characteristics were compared for participants in two studies-529 women who were participants in a preschool health promotion project ('mothers'), and 185 men and women who were involved in a workplace pedometer study ('workers'). Relationships between age, number of children, physical activity, sitting time, BMI, gender and work patterns were explored. Logistic regression was used to predict the likelihood of being overweight or obese, among participants with different physical activity, sitting time and work patterns. RESULTS: The total reported time spent sitting per day ( across all domains) was almost 6 h less among the mothers than the workers (P

Life transitions and changing physical activity patterns in young women

Background: Physical activity (PA) patterns are likely to change in young adulthood in line with changes in lifestyle that occur in the transition from adolescence to adulthood. The aim of this study was to ascertain whether key life events experienced by young women in their early twenties are associated with increasing levels of inactivity. Methods: This was a 4-year follow-up of 7281 participants (aged 18 to 23 years at baseline) in the Australian Longitudinal Study of Women's Health, with self-reported measures of PA, life events, body mass index (BMI), and sociodemographic variables. Results: The cross-sectional data indicated no change in PA between baseline (57% active) and follow-up (56% active). However, for almost 40% of the sample, PA category changed between baseline and follow-up, with approximately 20% of the women changing from being active to inactive, and another 20% changing from being inactive to active. After adjustment for age, other sociodemographic variables, BMI, and PA at baseline, women who reported getting married, having a first or subsequent child, or beginning paid work were more likely to be inactive at follow-up than those who did not report these events. Conclusions: The results suggest that life events such as getting married, having children, and starting work are associated with decreased levels of PA in young adult women. Strategies are needed to promote maintenance of activity at the time when most women experience these key life-stage transitions.

A longitudinal analysis of sex differences in bone mineral accrual in healthy 8-19-year-old boys and girls

Background: Although early in life there is little discernible difference in bone mass between boys and girls, at puberty sex differences are observed. It is uncertain if these differences represent differences in bone mass or just differences in anthropometric dimensions. Aim: The study aimed to identify whether sex independently affects bone mineral content (BMC) accrual in growing boys and girls. Three sites are investigated: total body (TB), femoral neck (FN) and lumbar spine (LS). Subjects and methods: 85 boys and 67 girls were assessed annually for seven consecutive years. BMC was assessed by dual energy X-ray absorptiometry (DXA). Biological age was defined as years from age at peak height velocity (PHV). Data were analysed using a hierarchical (random effects) modelling approach. Results: When biological age, body size and body composition were controlled, boys had statistically significantly higher TB and FN BMC at all maturity levels (p < 0.05). No independent sex differences were found at the LS (p > 0.05). Conclusion: Although a statistical significant sex effect is observed, it is less than the error of the measurement, and thus sex difference are debatable. In general, sex difference are explained by anthropometric difference

Environmental conditions and variation in levels of sun exposure among children in child care

Sun exposure in childhood is I of the risk factors for developing skin cancer, yet little is known about levels of exposure at this age. This is particularly important in countries with high levels of ultraviolet radiation. (UVR) such as Australia. Among 49 children 3 to 5 years of age attending child care centers, UVR exposure was studied under 4 conditions in a repeated measures design; sunny days, cloudy days, teacher's instruction to stay in the shade, and a health professionals instruction to apply sunscreen. Three different data collection methods were employed: (a) completion of questionnaire or diary by parents and researcher, (b) polysulphone dosimeter readings, and (c) observational audits (video recording). Results of this study indicated that more than half the children had been sunburnt (pink or red) and more than a third had experienced painful sunburn (sore or tender) in the last summer. Most wore short sleeve shirts, short skirts or shorts and cap, that do not provide optimal levels of skin protection. However, sunscreen was applied to all exposed parts before the children went out to the playground. Over the period of I hr (9-10 a.m.) the average amount of time children spent in full sun was 22 min. On sunny days there was more variation across children in the amount of sun exposure received. While the potential amount of UVR exposure for young children during the hour they were outside on a sunny day was 1.45 MED (Minimum Erythemal Dose), they received on average 0.35 MED, which is an insufficient amount to result in an erythemal response on fair skin even without the use of sunscreen.

The effectiveness of personalized smoking cessation strategies for callers to a Quitline service

Aim To assess the effectiveness of a program of computer-generated tailored advice for callers to a telephone helpline, and to assess whether it enhanced a series of callback telephone counselling sessions in aiding smoking cessation. Design Randomized controlled trial comparing: (1) untailored self-help materials; (2) computer-generated tailored advice only, and (3) computer-generated tailored advice plus callback telephone counselling. Assessment surveys were conducted at baseline, 3, 6 and 12 months. Setting Victoria, Australia. Participants A total of 1578 smokers who called the Quitline service and agreed to participate. Measurements Smoking status at follow-up; duration of cessation, if quit; use of nicotine replacement therapy; and extent of participation in the callback service. Findings At the 3-month follow-up, significantly more (chi(2)(2) = 16.9; P < 0.001) participants in the computer-generated tailored advice plus telephone counselling condition were not smoking (21%) than in either the computer-generated advice only (12%) or the control condition (12%). Proportions reporting not smoking at the 12-month follow-up were 26%, 23% and 22%, respectively (NS) for point prevalence, and for 9 months sustained abstinence; 8.2, 6.0, and 5.0 (NS). In the telephone counselling group, those receiving callbacks were more likely than those who did not to have sustained abstinence at 12 months (10.2 compared with 4.0, P < 0.05). Logistic regression on 3-month data showed significant independent effects on cessation of telephone counselling and use of NRT, but not of computer-generated tailored advice. Conclusion Computer-generated tailored advice did not enhance telephone counselling, nor have any independent effect on cessation. This may be due to poor timing of the computer-generated tailored advice and poor integration of the two modes of advice.

Evaluation of an internet-based physical activity intervention: A preliminary investigation

The Internet has the potential for delivering innovative, interactive physical activity (PA) interventions to large numbers of people. This study was designed to test the efficacy. of ant Internet intervention that consisted of a Web site plus 12 weekly e-mail tip sheets, compared with a waiting list control group. The Internet intervention was theory based and emphasized clear, graphical presentation of PA information. Sixty-five (30 intervention and 35 control) sedentary adult employees of several large hospitals (9 men and 56 women) were randomly assigned to 1 of the 2 study arms. Of the 65 participants, 57 completed the 1-month follow-up, and 52 completed the 3-month follow-up. At both 1 and 3 months, those in the intervention group were significantly more likely to have progressed, in stage of motivational readiness for PA than participants in the control group: 1 month, chi(2)(1, N = 52) = 4.05, p

Sa??de do trabalhador p??blico: quest??o para a gest??o de pessoas - a experi??ncia na Prefeitura de S??o Paulo

O artigo trata de quest??es da sa??de do servidor p??blico nos aspectos relacionados ?? per??cia m??dica, ?? assist??ncia e ?? promo????o da sa??de. Discute-se a sa??de do servidor como um problema da ??rea de gest??o de pessoas e fazem-se considera????es sobre o papel e a gest??o da per??cia m??dica realizada nos ??rg??os p??blicos, respons??vel por avaliar nexo entre patologia e capacidade laboral para fins de admiss??o, licen??a m??dica, aposentadoria por invalidez, readapta????o funcional, acidente e doen??as relacionadas ao trabalho. Ressalta-se a import??ncia da rela????o entre os servi??os de per??cia, a assist??ncia m??dica e a promo????o ?? sa??de. Apresenta-se, por fim, a experi??ncia de sa??de do trabalhador p??blico realizada na Prefeitura do Munic??pio de S??o Paulo, que trabalhou com os projetos de humaniza????o, agiliza????o e transpar??ncia da atividade pericial, de descentraliza????o de atividades e processos, de forma????o e capacita????o em sa??de do trabalhador e de implementa????o de atividades de promo????o ?? sa??de.

Acessibilidade e longitudinalidade no pr��-natal : an��lise de um grupo de pu��rperas atendidas no Hospital Universit��rio Cassiano Ant��nio de Moraes

A aten����o prim��ria visa garantir cobertura e acesso a cuidados de sa��de abrangentes e aceit��veis pela popula����o enfatizando a preven����o e a educa����o (STARFIELD, 2004). No Brasil a Estrat��gia Sa��de da Fam��lia (ESF) �� o modelo implantado pelo Minist��rio da Sa��de (MS) com a finalidade de reestrutura����o da aten����o prim��ria e j�� abrange cerca de 50% da popula����o. Segundo Starfield (2004) a aten����o prim��ria pode ser avaliada atrav��s de seus atributos essenciais: aten����o de primeiro contato (utiliza����o e acessibilidade), longitudinalidade, integralidade e coordena����o de cuidados. No contexto da aten����o �� sa��de brasileira, a mortalidade infantil �� fato preocupante, principalmente a mortalidade que ocorre nos primeiros dias de vida. Este componente da mortalidade �� intimamente relacionado �� qualidade da aten����o recebida no per��odo gestacional. A aten����o pr��-natal deve incluir a����es organizadas, amplas, integradas e com cobertura abrangente de promo����o e preven����o da sa��de, al��m de diagn��stico e tratamento adequado dos problemas que possam vir a ocorrer nesse per��odo. O objetivo do presente estudo foi analisar o pr��-natal de um grupo de pu��rperas quanto aos atributos da aten����o prim��ria acessibilidade e longitudinalidade. Para alcan��ar este objetivo foram realizadas 80 entrevistas com mulheres que realizaram pr��-natal na aten����o prim��ria e 19 mulheres que realizaram pr��-natal no Hospital Universit��rio Cassiano Ant��nio de Moraes (HUCAM). Utilizou-se parcialmente o question��rio de avalia����o da aten����o prim��ria PCATool. As pu��rperas tamb��m foram questionadas quanto �� percep����o da adequa����o do pr��-natal realizado. A acessibilidade foi baixa para a maioria das entrevistadas. Nas pu��rperas que realizaram o pr��-natal na Aten����o prim��ria a acessibilidade foi estatisticamente maior naquelas que realizaram pr��-natal na ESF e naquelas que utilizaram as unidades de sa��de do munic��pio de Vit��ria (ES). A longitudinalidade se relacionou ao tipo de unidade de sa��de do pr��-natal, ao n��mero de consultas realizadas e ao ��ndice de ��pgar no primeiro minuto. A percep����o de um pr��-natal adequado se relacionou com a utiliza����o da ESF como servi��o de pr��-natal e �� realiza����o de seis ou mais consultas. Apesar de as pu��rperas do grupo que realizou o pr��-natal no HUCAM perceberem o atendimento pr��-natal como adequado, algumas quest��es revelaram fragilidades na assist��ncia, principalmente quanto ao acesso ao servi��o. A impossibilidade de receber atendimento pela equipe fora dos hor��rios de funcionamento do ambulat��rio, a falta de um n��mero de telefone no qual possam sanar d��vidas ou falar com o m��dico respons��vel pelo pr��-natal, a percep����o de dificuldade na marca����o de consultas e a espera prolongada no dia do atendimento s��o pontos que devem ser melhorados nessa assist��ncia.

Fatores relacionados �� cronologia de erup����o da denti����o dec��dua

O objetivo deste estudo foi estimar a cronologia e sequ��ncia de erup����o da denti����o dec��dua e seus fatores relacionados em amostra de crian��as de duas regi��es do munic��pio de Vit��ria, ES. Os dados utilizados no estudo s��o provenientes de um estudo longitudinal realizado entre 2003 e 2006 com 86 rec��m-nascidos que foram acompanhados at�� a idade de 36 meses de vida, cuja coleta de dados foi obtida por meio da aplica����o de um formul��rio as m��es e da realiza����o de um exame cl��nico nas crian��as. Um total de 67 crian��as permaneceram at�� o final do estudo. Calculou-se a idade m��dia de erup����o dos dentes dec��duos de cada crian��a e foram aplicados o teste de kappa, McNemar e kappa ajustado pela preval��ncia. Em seguida realizou-se a An��lise de Sobreviv��ncia. Os resultados mostraram que a m��dia de erup����o dos dentes dec��duos variou de oito a 29 meses de vida no arco inferior, e de 11 a 30 meses no arco superior e que os maiores n��veis de concord��ncia foram para os tempos de erup����o dos incisivos e caninos dec��duos (71/81, kappa = 0,82; IC95% = 0,72-0,93; 53/63, kappa = 0,76; IC95% = 0,62-0,88) do que para os molares dec��duos. Dos fatores relacionados a cronologia de erup����o da denti����o dec��dua, foi identificado na Regress��o de Cox que os h��bitos alimentares infantis podem influenciar, acelerando e retardando esse processo eruptivo. Recomenda-se o conhecimento do perfil de erup����o dec��dua de cada popula����o para que tais evid��ncias sirvam de base para a implementa����o de medidas de preven����o e controle da sa��de dessa popula����o e auxilie na elabora����o de estrat��gias, com a����es de prote����o e promo����o da sa��de. As a����es tem como finalidade a preven����o de poss��veis altera����es bucais e gerais durante o crescimento e desenvolvimento infantil e melhoria da qualidade de vida dessa popula����o.

Cuidar do corpo para melhor cuidar da casa

Objectivo: O objectivo deste estudo foi avaliar a implementa����o de um projecto comunit��rio na sintomatologia neuro-m��sculo-esquel��tica de dom��sticas. Metodologia: Realizou-se um estudo experimental que incluiu 30 dom��sticas (20 no grupo experimental e 10 no grupo de controlo) aleatoriamente seleccionadas. Foram utilizados como instrumentos de avalia����o o Question��rio de Avalia����o de Risco, a Escala de Borg da Percep����o Subjectiva do Esfor��o e o Question��rio N��rdico M��sculo-Esquel��tico. O projecto comunit��rio englobou uma ac����o de educa����o para a sa��de e um programa de exerc��cios espec��ficos. Resultados: A implementa����o do projecto comunit��rio diminuiu significativamente (p<0,05) a sintomatologia neuro-m��sculo-esquel��tica, a percep����o subjectiva de esfor��o e a intensidade m��dia de dor reportada pelas dom��sticas durante a realiza����o de v��rias tarefas. As dom��sticas melhoraram significativamente (p<0,05) os seus conhecimentos em rela����o aos factores de risco e modificaram significativamente (p<0,05) os seus comportamentos, adoptando posturas mais adequadas. Conclus��es: O servi��o dom��stico propicia o aparecimento de sintomatologia neuro-m��sculo-esquel��tica e, como tal, a implementa����o de uma ac����o de educa����o para a sa��de e um programa de exerc��cios espec��ficos tornam-se eficazes como projecto de promo����o de sa��de.