Good Health Practices Research Articles

Accessibility, knowledge and utilization of HIV/AIDS and sexual health information by female indoor sex workers in Ibadan metropolis of Nigeria

This study assessed accessibility knowledge and utilization of HIV/AIDS and sexual health information by female indoor sex workers in Ibadan metrotropolis of Nigeria. One hundred and eighty copies of questionnaires were administered to respondents, fifteen subjects representing a stratumwhile One hundred and forty-two were retrieved and valid for the study. Descriptive statistical method of analysis was used. Data were coded insimple percentages and presented in tables. Data obtained through the questionnaires, and interviews were discussed in relation to the researchquestions. T-test and ANOVA were used in testing the hypotheses.Findings of the study revealed that female indoor sex workers received information on HIV/AIDS and sexual health regularly. Also, their knowledge of the issue is adequate, because majority have full understanding. Findings of the study showed that the female sex workers have a positive perception of HIV/AIDS and sexual health information. Their knowledge and perception of the issue have influenced them to a great extent resulting in respondent’s adoption of good sexual healthpractices. It was recommended that Parents should talk and educate their children properly about life, be close to them and know the jobs their children are doing. Society should embrace them and show them some love in other to win them and get them out of what it frowns at. Finally, the government of Nigeria shouldsee the importance of the lives these sex workers as her citizens and come up with policies to rehabilitate them in other for to live more fulfilling lives.

Primary care for tinnitus: practice and opinion among GPs in England

Rationale, aim and objectiveEffective tinnitus management starts with appropriate general practitioner (GP) triage, which in England can be guided by the Department of Health's Good Practice Guide (GPG). Despite the prevalence of the condition, there has never been a systematic survey of its management in primary care in England. We aimed to evaluate how people with tinnitus are assessed and managed in general practice, noting variation in practice across GPs and health authorities, and evaluating how closely typical practice aligns to the GPG for tinnitus.MethodsA nine-item postal questionnaire was sent to 2000 GPs randomly selected to proportionally represent the number of primary care trusts and strategic health authorities in England.ResultsWe received 368 responses. Responses indicated a mix of frequent and infrequent practices, for example, 90% of GPs assessed the impact of tinnitus on quality of life, but fewer examined cranial nerves (38%) or assessed for a carotid bruit (26%) during a tinnitus consultation. In the management of tinnitus, 83% routinely removed earwax, and 87% provided information-based advice. In contrast, only 4% of responders would offer antidepressant drugs or psychological therapies. Thematic analysis revealed a desire for concise training on tinnitus management.ConclusionsGP assessment and management of tinnitus represents potential inequity of service for tinnitus patients. While the GPG aims to promote equity of care, it is only referred to by a minority of clinicians and so its utility for guiding service delivery is questionable. Although some GPs highlighted little demand for tinnitus management within their practice, many others expressed an unmet need for specific and concise GP training on tinnitus management. Further work should therefore evaluate current informational resources and propose effective modes of delivering educational updates.

Systematic review and meta‐analyses of randomized controlled trials examining tinnitus management

Objectives/HypothesisTo evaluate the existing level of evidence for tinnitus management strategies identified in the UK Department of Health's Good Practice Guideline.Study DesignSystematic review of peer-reviewed literature and meta-analyses.MethodsSearches were conducted in PubMed, Cambridge Scientific s, Web of Science, and EMBASE (earliest to August 2010), supplemented by hand searches in October 2010. Only randomized controlled trials that used validated questionnaire measures of symptoms (i.e., measures of tinnitus distress, anxiety, depression) were included.ResultsTwenty-eight randomized controlled trials met our inclusion criteria, most of which provide moderate levels of evidence for the effects they reported. Levels of evidence were generally limited by the lack of blinding, lack of power calculations, and incomplete data reporting in these studies. Only studies examining cognitive behavioral therapy were numerous and similar enough to perform meta-analysis, from which the efficacy of cognitive behavioral therapy (moderate effect size) appears to be reasonably established. Antidepressants were the only drug class to show any evidence of potential benefit.ConclusionsThe efficacy of most interventions for tinnitus benefit remains to be demonstrated conclusively. In particular, high-level assessment of the benefit derived from those interventions most commonly used in practice, namely hearing aids, maskers, and tinnitus retraining therapy needs to be performed.

Prevent dental anxiety

Educating our yongest children on the benefits of good oral health practice cannot be overlooked. With proven links between gum disease, type 2 diabetes and heart disease, dental education must start early.

CURSO BIMODAL PRACTICA CLINICA DE ENFERMERIA BASADA EN LA EVIDENCIA: ALCANCES Y LIMITACIONES

Este artículo tiene como objetivo presentar el repertorio de entrada de los actuantes del curso bimodal, Práctica clínica basada en la evidencia, así como la evaluación final. Al inicio del curso, la población estuvo conformada por 23 personas de las cuales 20 correspondieron a enfermeras (os) de diferentes instituciones de salud públicas como privadas y tres estudiantes de quinto año de la carrera de Licenciatura en Enfermería de la Universidad de Costa Rica. Participaron 8 profesionales tutores. Sólo 16 participantes finalizaron el curso. Se utilizó la plataforma Dokeos complementada con una conferencia presencial mensual. El curso duró nueve meses. Se implementaron diversas estrategias de enseñanza. Resultado: La academia encargada de formar a los profesionales de la salud, en este caso a los enfermeros y enfermeras, consciente de planteamientos, no nuevos, pero sí novedosos para Costa Rica, los cuales pueden ayudar a subsanar la apatía investigativa, demostró que el investigar no solamente se hace para optar por una profesionalización, ya que es parte del quehacer diario profesional. Como insumo se construyó un proyecto en el cual todos (academia y servicio) tuvieron la oportunidad de mejorar sus prácticas clínicas basándolas en la evidencia científica. Además, se creó un proyecto en el que uno de sus objetivos fue capacitar a la mayor cantidad de profesionales en todo el país. Con esta estrategia de trabajo, se pretende disminuir el error práctico y brindar una atención más segura. Conclusión: La práctica clínica basada en la evidencia en una herramienta necesaria, cuya aplicación se justifica por los avances biotecnológicos acelerados en el área de la salud; tal adelanto obliga al profesional de Enfermería a mantenerse informado sobre las mejores prácticas en salud para responder a la población con responsabilidad mediante el desarrollo de una práctica actualizada y fiable que promueva la toma de las mejores decisiones en el quehacer profesional.

An instrument to assess health‐related advertising on college campuses

PurposeAdvertising can affect health‐related behaviors of young adults. However, little is known about this environmental influence on college campuses. The purpose of this paper is to create an inventory for assessing health‐related advertisements and use it to assess advertising on/near the campus of a major Northeastern university.Design/methodology/approachThe inventory was developed from existing instruments, input from experts, and data collected from student focus groups. The instrument was pilot tested, refined, and used by three trained data collectors (inter‐rater reliability =87.5 percent) to assess the advertising in academic buildings (n=10), residence halls (n=3), libraries (n=2), recreation centers (n=3), student centers (n=2), dining halls (n=3), bookstores (n=2), bus stops (n=4), campus student listserves, and retail stores adjacent to campus.FindingsOf the 130 advertisements, most common types were related to diet/nutrition (41.5 percent) and exercise/fitness (14.6 percent). An evaluation of advertising message polarity revealed 61.5 percent promoted positive health behaviors. Negative messages were mostly related to branded diet/nutrition ads (26 percent). Health‐related advertising on/near this university's campus mostly promoted good health practices in accordance to the university policies. However, improvements in developing university policies with regard to branded diet/nutrition ads on campus are warranted.Research limitations/implicationsThe study described in this paper was conducted at one time point at a single university. Future studies should examine seasonal variations and the usefulness of this instrument on other college campuses.Originality/valueThis valid data collection tool will be of benefit to other college campuses and policy makers who wish to identify how to improve campus‐related advertising policies to ensure they promote positive health behaviors.

Oral health status and behaviour of Mauritians visiting private dental clinics

PurposeThis paper seeks to assess the oral health status and behaviour of a sample of the Mauritian population visiting private dental clinics.Design/methodology/approachOral health status was determined using the World Health Organization (Decayed, Missing, Filled Teeth (DMFT) index indicating the prevalence of caries, and factors associated with oral health behaviour were investigated. Cross‐sectional data on oral health behaviour and demographic characteristics were collected through a structured 22‐item self‐designed survey questionnaire administered to a randomly selected sample of 250 Mauritians visiting private dental clinics. The data were statistically analysed to examine associations between oral health variables.FindingsAnalyses revealed significant correlations between DMFT scores, age and socioeconomic status. Over 80 per cent of the children below the age of 11 had DMFT scores higher than the acceptable WHO value of 3, and most adults older than 45 years had DMFT scores higher than 7. A large majority (85 per cent) reported using both fluoride toothpaste and tongue scrapers, but none reported using dental floss. Those who brushed teeth only once daily had high DMFT scores. Among males, smokers had significantly higher mean DMFT than non‐smokers. Females demonstrated better rates of good oral health behaviour than males. Respondents from higher socioeconomic classes were between three to five times more likely to visit dental clinics than those from lower classes.Practical implicationsThis study reveals the need for intervention programmes to raise awareness of good oral health practices among the Mauritian people.Originality/valueThe results identified the high risk groups and highlighted the need for dental education, taking into consideration socioeconomic status and sociodemographics in order to enable Mauritians to become oral‐hygiene‐conscious and active partners for the management of oral health and prevention of systemic diseases.

Organization of care practices in the health network

Objectives: to understand the organization of health care practices in the primary attention, considering it the coordinator of the health care network and to analyze in what way this network organization contributes to the development of best practices in health. Method: Grounded Theory collecting semi-structured interviews with health professionals, users and managers, constituting four sample groups. This article describes the results of the data analysis of the managers' group. Results: Construction of a theoretical model for the phenomenon: Framing the health care network: better care practices in the context of the public politics and for categories: Theoretical-conceptual referential for framing the health care network; Organization of care practices in the network perspective; Ordination of the attention: the primary attention role; Difficulties in the process of structuring the network; and, Characterizing better practices in the perspective of the health care network. Considerations: Health is a complex phenomenon resultant of the interactions experienced in the system of health care. The health care network, studied in these institutional contexts, reinforce the construction and development of best practices in health.

Participatory approach to improving safety, health and working conditions in informal economy workplaces in Cambodia

The present study aimed to improve safety and health in informal economy workplaces such as home workplaces, small construction sites, and rural farms in Cambodia by using "participatory" approach. The government, workers' and employers' organizations and NGOs jointly assisted informal economy workers in improving safety and health by using participatory training methodologies. The steps taken were: (1) to collect existing good practices in safety and health in Cambodia; (2) to develop new participatory training programmes for home workers and small construction sites referring to ILO's WISE training programme, and (3) to train government officers, workers, employers and NGOs as safety and health trainers. The participatory training programmes developed consisted of action-checklists associated with illustrations, good example photo sheets, and texts explaining practical, low-cost improvement measures. The established safety and health trainers reached many informal economy workers through their human networks, and trained them by using the developed participatory training programmes. More than 3,000 informal economy workers were trained and they implemented improvements by using low-cost methods. Participatory training methodologies and active cooperation between the government, workers, employers and NGOs made it possible to provide practical training for those involved in the informal economy workplaces.

Dangerous Pregnancies: Mothers, Disabilities, and Abortion in Modern America by Leslie J. Reagan (review)

Reviewed by: Dangerous Pregnancies: Mothers, Disabilities, and Abortion in Modern America by Leslie J. Reagan Carol Mason Dangerous Pregnancies: Mothers, Disabilities, and Abortion in Modern America. By Leslie J. Reagan. Berkeley: University of California Press. 2010. In this year of extensive proposals to regulate reproduction, Dangerous Pregnancies could not be more needed. This book will jostle the national memory of how abortion became so important by providing details long forgotten and revealing how we came to see, on an unprecedented scale, the future of the nation in terms [End Page 222] of protecting future children. While other scholars detail how abortion opponents deploy a rationale of protecting the unborn, Reagan shows culturally how this idea of future children became part of the national consciousness regardless of people’s opinion about abortion. She does so with an innovative combination of archival research on German measles and thalidomide, which resulted in grave birth defects, and perspectives borrowed from disabilities studies. The result is a book that explains how the abortion rights and disability rights movements shared an origin and shaped American law. Reagan begins with women in the 1940s facing the new scare of German measles, aka rubella or CRS. In the introduction and first chapter, she charts the shift away from superstitious ideas of “maternal marking” (which supposed, for example, that looking at a misshapen infant would result in delivering a malformed baby) toward modern ideas that resulted in “standardization of knowledge across regions, languages, sciences and individuals” and, ultimately, “a single unifying name for [the] disease” (25). In this way she explains how mothers were “coworkers in the production of scientific knowledge” about the mysterious rash (23). Chapter two intensifies the focus on mothers as physicians’ collaborators with an in-depth analysis of the role Sherri Finkbine, host of TV’s Romper Room, played in readjusting popular understandings to present abortion as something that responsible, middle-class white mothers did. Coupled with astute readings of contemporary magazines, Reagan’s account of mothers like Finkbine is a sorely needed response to current scornful attitudes that suggest bourgeois women who were panicked by potential birth defects sought abortion because they wanted perfect babies. Chapter three, which focuses on the legal “torts first articulated during the German measles epidemic” that “later came to be known as ‘wrongful birth’ and ‘wrongful life’ suits,” is a must-read for anyone concerned with recent “conscience clauses” that seek to indemnify doctors who withhold medical information due to their religious convictions and political beliefs about abortion (106). In excavating the details of pivotal legal battles in California (the Beilenson reform bill) and Minnesota (the case of Dr. Jane Hodgson), chapter four challenges conservative assumptions and popular knowledge to show that “the earliest efforts to change the nation’s criminal abortion laws came not out of sexual liberation but out of the anxieties and responsibilities felt by married mothers” (178). Chapter five demonstrates how immunization campaigns in the 1960s and 1970s did the cultural work of instilling across class and race a new responsibility for future children. In her epilogue, Reagan sketches the cultural logic about preventing damaged children through the “crack baby” scare of the 1980s and today’s prosecutions of women who suffer stillbirths to show how, yet again, the “work of women to convince other women to follow good health practices on behalf of their future children” is “too easily not only forgotten but also misrepresented” (234). Powerfully moving, historically precise, and politically relevant, Dangerous Pregnancies combats the misogynist implications underlying currently proposed policies—implications that women terminate pregnancies without cognizance of their own physical and mental health or that of their fetus. Reagan’s impeccable scholarship shows why “the idea that pregnant women are uninterested in their own health and [End Page 223] in the health of their developing fetuses and future children is wrongheaded” and historically impossible to defend (233). Carol Mason University of Kentucky Copyright © 2011 Mid-America American Studies Association

Can Reform's Prevention Incentives Help to Bend the Cost Curve?

On my various trips to Boston for conferences and meetings, I make a point of having dinner with a close cousin. Our conversations invariably turn to the issue of health care and its reform. While hardly an advocate of comprehensive health reform, my cousin has taken the position that reform would be unnecessary if people took care of themselves. More specifically, he sees much of our current health care spending crisis as emanating from our sedentary lifestyles, poor health habits, lack of discipline regarding exercise and food consumption, and failure to follow recommendations for annual physical exams and other periodic preventive care. body is like a car, I recall him saying. You need to maintain it and every once in a while you have to look under the hood. My cousin does have a point regarding our reluctance to comply with good health practices and recommended preventive care, and I suspect that many others feel the same. Indeed, there can be ample personal rewards for such behavior as well as rewards to society at large. In the context of health reform, promoting preventive care and health-enhancing behaviors are part of the arsenal of cost-containment strategies in the Patient Protection and Affordable Care Act (PPACA), and a recent study sees the use of recommended preventive services as having the potential to reduce loss of life and achieve cost savings (Maciosek et al. 2010). However, in light of the fanfare and push for preventive care and other health-related practices, a critical issue is whether we can expect individuals to respond to reform's incentives for preventive activities, whether the vagaries of human behavior will impede such responses, and most importantly, whether such care can indeed be expected to reliably yield cost savings. In what follows, I explore the issue of whether we should expect incentives for more preventive care to yield substantive savings, and thus to what extent we can expect prevention and good health behaviors to make a meaningful contribution to bending the cost curve. The PPACA and Incentives for Prevention The PPACA includes a variety of provisions directed toward the use of preventive health services and wellness activities. number of these measures entail administration and information gathering: creating administrative bodies to coordinate federal prevention efforts, establishing a national prevention strategy, expanding funds for public health programs, developing evidence-based recommendations for using clinical and community preventive services, and devising outreach campaigns for preventive benefits, among others (this and the following summary are drawn from the Kaiser Family Foundation 2010). The law also includes provisions to eliminate out-of-pocket costs for 41 preventive services rated A or by the U.S. Preventive Services Task Force (2010). It does so by eliminating cost sharing for such services covered by Medicare, and by increasing federal medical assistance to states (by one percentage point) that offer and B preventive services under Medicaid and also remove cost sharing. Additionally, the law authorizes Medicare coverage for personalized prevention plan services, provides incentives for Medicare and Medicaid beneficiaries to enroll in and complete behavior modification programs, and requires Medicaid to cover tobacco cessation programs for pregnant women. Finally, consistent with cost-containment goals, the PPACA permits the Secretary of the Department of Health and Human Services (DHHS) to modify or eliminate Medicare coverage of preventive services as recommended by the task force. Reform also eliminates out-of-pocket costs for and B preventive services for enrollees in qualified private health plans (beginning in September), and such plans are also required to provide, with no out-of-pocket costs, recommended immunizations, preventive care for children and adolescents, and additional preventive care and screening for women. …

Salud de la Mujer: Using Fotonovelas to Increase Health Literacy Among Latinas

There is an identified need for health literacy strategies to be culturally sensitive and linguistically appropriate. The goal of our community-based participatory research (CBPR) project related to health and nutrition is to demonstrate that active community involvement in the creation of health education fotonovelas that are relevant to culture, ethnicity, gender, social class, and language can increase the health literacy of women in a disadvantaged community. We recruited 12 women to take part in our pilot fotonovela intervention about healthy eating and nutrition. Pre- and post-test assessments of knowledge, attitudes, and behavior around nutrition were given at baseline and will be collected after the completion of the project. We hypothesize that post-test assessments of our participants will reveal increased nutrition knowledge as well as positive changes in attitudes and behavior toward healthy eating. We believe that our fotonovelas will represent experiences of community members and encourage good health practices by increasing knowledge and cooperation among community members.

Abstract ED05-03: Global tobacco control: Preventing 10 million cancer deaths by 2030

Abstract Tobacco use is responsible for one in three cancer-related deaths. Thanks to 50 years of aggressive public education efforts, tobacco use is declining in most industrialized countries. However, worldwide, tobacco consumption is actually increasing, driven in part by population growth and economic development in China, India, Indonesia, and parts of Africa and the Middle East. There are now approximately 1.3 billion smokers in the world, and 84% of them reside in the developing world. Tobacco use is the world's leading cause of preventable death, directly causing 30% of the 11.5 million annual cancer predicted by 2030 deaths. In recognition of this enormous threat, the member countries of the WHO adopted the Framework Convention on Tobacco Control [FCTC], the first international treaty devoted to health. The FCTC has been ratified by over 160 countries, but some large countries such as the United States and Russia have yet to ratify the treaty. Ratification obligates countries to implement a comprehensive set of common sense policies intended to reduce the demand for tobacco use. These policies include measures to: keep the price of tobacco high; protect nonsmokers from exposure to tobacco smoke; regulate products; control packaging and labeling of tobacco products; ban tobacco product marketing; educate the public; promote and assist tobacco cessation and prevention; prevent sales to minors; and promote alternative uses for tobacco croplands. Estimates indicate that aggressive implementation of FCTC policies could prevent 10 million excess cancer deaths anticipated over the next 20 years. The policies included in the FCTC were selected on the basis of scientific evidence. However, as the FCTC continues with its critical implementation phase in the next 5 years, and as nations that have ratified the treaty decide what specific policies will be implemented to meet their treaty obligations, it will become increasingly important that scientific evidence continue to guide the adoption of policies that will work effectively. There is already evidence that the tobacco industry is working to undermine the FCTC by encouraging countries to adopt policies that, although compliant with the FCTC, are suboptimal. As in clinical medicine, good public health practice demands that rigorously evaluated evidence guide the adoption of new tobacco control interventions. Thus, in the next few years, amassing a strong body of evidence from a methodologically sound evaluation of FCTC policies will be critical. This can then be used to guide governmental policymakers in the future. Citation Information: Cancer Prev Res 2010;3(1 Suppl):ED05-03.

The Preventive Health Behaviors of Long-Term Survivors of Cancer and Hematopoietic Stem Cell Transplantation Compared with Matched Controls

Little is known about the health promotion, prevention, and disease screening behaviors of cancer survivors treated with hematopoietic cell transplantation (HCT), who undergo arduous treatment and may be at particular risk for late effects and secondary malignancies. The purposes of this study were to examine the current health and secondary prevention behaviors of long-term HCT survivors compared with matched controls without cancer, and to identify sociodemographic and clinical factors associated with appropriate preventive practices. HCT survivors (n = 662) were drawn from 40 North American transplantation centers. Peer-nominated acquaintances of survivors matched on sex, age, education, and marital status served as controls (n = 158). Data were collected a mean of 6.7 years post-HCT (range, 1.8-22.6 years). Despite a greater frequency of physical exams, the HCT survivors had similar health and screening behaviors as the matched controls. Sociodemographic factors were associated with health prevention behaviors in expected ways. Some differences between disease group and type of transplant were found, with survivors of acute leukemia less likely to report regular exercise, autologous transplant survivors more likely than allogeneic transplant survivors to report screenings for breast and cervical cancer, and allogeneic transplant survivors more likely than autologous transplant survivors to report undergoing a skin exam in the previous year. Despite higher levels of engagement with health care providers, HCT survivors had similar health behaviors as matched controls and comparable to those reported by cancer survivors who did not undergo HCT. There remains considerable room for improvement. These findings support the need for further education of both HCT survivors and health practitioners.

Eating as a Cultural Expression of Caring among Afro-Caribbean and African American Women: Understanding the Cultural Dimensions of Obesity

Previous studies focused on obesity and weight management have ignored the cultural uniqueness of Afro-Caribbean individuals. The purpose of this study was to examine the cultural context for notions of good health and health practices, and perception of obesity and weight management, among African American and Caribbean American women. Four focus groups of Afro-Caribbean and African American women (age 40 and older) were conducted between May and July of 2007 to explore cultural factors related to physical activity, healthy eating and weight management. Cultural variation was observed among Afro-Caribbean and African American woman in terms of indigenous traditions of food and food preparation, and perceptions of obesity. In the development of community-based interventions to counter trends towards obesity among people of African descent, it may be important not to assume that 'one size fits all' cultures.

Youth Assets and Delayed Coitarche Across Developmental Age Groups

Cross-sectional studies suggest that assets are associated with youth abstinence, but whether these relationships are constant across developmental age groups has not been shown. Data for this study were obtained from two independent datasets collected across a 2-year period using in-person, in-home interviews of youth (52% female; 44% Caucasian, 23% Hispanic, 23% African-American, 10% other) and their parents (N = 2163 youth/parent pairs). Eighty-eight percent of teens aged 12-14 and 58% of teens aged 15-17 reported no sexual intercourse. Individual logistic regression models for assets and abstinence found 5 youth assets with significant adjusted odds ratios for both age groups: Non-Parental Adult Role models; Family Communication; Use of Time (Religion); Responsible Choices; and Peer Role Models. Community Involvement was associated with abstinence for young teens only and Aspirations for the Future and Good Health Practices only for middle teens. These findings can inform policies and programs targeting youth sexual decision-making.

School Closure to Reduce Influenza Transmission

We agree with Koonin and Cetron (1) that early application of any intervention during an influenza epidemic or pandemic is critical in maximizing population health benefits. Further, the longer an intervention is sustained, the greater the likely benefit. Whether surveillance data can inform public health interventions may depend on the timeliness of the data as well as the length of the epidemic. In tropical and subtropical settings, influenza tends to circulate longer. Although duration of the epidemic could enable delayed interventions a chance of success, social distancing interventions may need to be sustained to ensure that the epidemic does not revive when the intervention period ends. One important study not mentioned by Koonin and Cetron is a natural experiment in France where the staggering of school holiday periods in different regions enabled Cauchemez et al. to estimate that school holidays prevent 16%–18% of seasonal influenza cases (2). In contrast to our study of a single school closure event in response to 1 seasonal outbreak, the French study considered preplanned holiday periods spanning many years. Although pandemic plans often describe action to be taken depending on features in the epidemic curve (e.g., the acceleration interval as the upslope of the epidemic curve), we would argue that more focus should be given to underlying transmission dynamics. In our analysis of the effect of school closures in Hong Kong, we used a simple statistical technique (3) to estimate the underlying reproductive number. Changes in the epidemic curve may lag behind changes in the underlying transmission dynamics by at least 1 serial interval, as has previously been shown for severe acute respiratory syndrome (3–5). Public health practitioners must be encouraged to use these methods routinely. Finally, we concur that a multipronged, targeted, layered approach will likely provide the best mitigation strategy in the event of a pandemic. However, we caution against conflating good public health practice of “pulling out all the stops” in the event of a pandemic with good scientific practice of evaluating the independent effect of school closures, which was the object of our article.

小規模事業場において良好実践を行っている事業者の産業保健ニーズに関する質的調査

The purpose of this study was to identify what motivates employers to promote good occupational health and safety practices in small-scale enterprises. Previous studies have shown that small-scale enterprises generally pay insufficient attention to issues of occupational health and safety. These findings were mainly derived from questionnaire based surveys. Nevertheless, some small-scale enterprises in which employers exercise good leadership do take a progressive approach to occupational health and safety. Although good practices can be identified in small-scale enterprises, it remains unclear what motivates employers in small-scale enterprises to actively implement occupational health and safety practices. We speculated that identifying employer motivations in promoting occupational health would help to spread good practices among small-scale enterprises. Using a qualitative approach based on the KJ methods, we interviewed ten employers who actively promote occupational health and safety in the workplace. The employers were asked to discuss their views of occupational health and safety in their own words. A semi-structured interview format was used, and transcripts were made of the interviews. Each transcript was independently coded by two or more researchers. These transcripts and codes were integrated and then the research group members discussed the heading titles and structural relationships between them according to the KJ method. Qualitative analysis revealed that all the employers expressed a strong interest in a "good company" and "good management". They emphasized four elements of "good management", namely "securing human resources", "trust of business partners", "social responsibility" and "employer's health condition itself", and considered that addressing occupational health and safety was essential to the achievement of these four elements. Consistent with previous findings, the results showed that implementation of occupational health and safety activities depended on "cost", "human resources", "time to perform", and "advisory organization". These results suggest that employer awareness of the relationship between good management and occupational health is essential to the implementation of occupational health and safety practices in small-scale enterprises.

Prevalence of Multiple Health-Related Behaviors in Adolescents With Cancer

This preliminary study investigated prevalence rates of multiple health-related behaviors (ie, tobacco, alcohol, and other drug use; sexual risk-taking; nutrition/physical activity; overweight and dietary behaviors; sun safety) among 42 adolescents on active treatment for cancer, as compared with healthy adolescent norms. Health-related behaviors were assessed using the 2005 National Youth Risk Behavior Survey, for which healthy adolescent norms were publicly available. Adolescents with cancer reported significantly lower current and lifetime rates of tobacco, alcohol, and other drug use; fruit/vegetable consumption; physical activity; and dietary behavior, in addition to lower rates of lifetime sexual intercourse, early-onset sexual intercourse, and alcohol/drug use before last sexual intercourse, compared with healthy peers. Among those who have previously engaged in sexual intercourse, there appeared to be a trend toward increased partners, current sexual activity, and lack of protection at last episode of sexual intercourse. Adolescents with cancer also reported significantly higher rates of television watching compared with healthy peers. Adolescents on active treatment for cancer are engaging in multiple health-risk behaviors, including sedentary behavior, poor nutrition, lack of sun safety, and sexual risk-taking (eg, multiple partners, lack of protection at last sexual intercourse). Health promotion interventions are needed during active treatment to facilitate the acquisition of good health practices as adolescents transition into survivorship.

Governing Masses

The aim of this article is to critically discuss routine HIV testing policy in the United States by locating its origins within health promotion efforts to govern masses and the neoliberal construction of the individual as free, autonomous, responsible, and empowered. Basing our approach on the work of the late French philosopher Michel Foucault, we describe routine HIV testing as a bio-political intervention that redefines the norms and social practices pertaining to HIV testing with the goal of regulating the population's health. From a neoliberalist perspective, routine HIV testing is also introduced as a practice of self-care that should be undertaken by any rational person who performs good health practices around HIV/AIDS. The objective of this article is to situate routine HIV testing policy in relation to nursing practice and, most important, to demonstrate how this policy should not be considered in isolation from the political context in which it was created.