Health Promotion Advice Research Articles

Observations of sexually transmitted disease consultations in India

Objectives: To assess the quality of sexually transmitted disease (STD) case management provided in public and private health facilities in selected areas of Madras, Tamil Nadu, India, in order to make recommendations for improving the quality of care and promote the syndromic approach to STD treatment. Methods: Structured observations of consultations for STDs in health care facilities. Scoring of the observations according to standards for history taking, examination, treatment and provision of basic health promotion advice allows evaluation of STD case management. Results: With STD treatment adequacy scored against Indian national guidelines (which recommend aetiologic treatment), history taking, examination and treatment were satisfactory in 76 out of 108 (70%) of observed consultations. However, if STD treatment adequacy is scored with respect to the syndromic approach towards selected STD (male urethritis and non herpetic genital ulcer for both sexes), only 8 out of 81 (10%) of the patients were satisfactorily managed. During 32 out of 108 (30%) of the consultations, advice on the use of condoms in order to prevent STD or HIV/AIDS was given. Instructions regarding how to use condoms were offered to seven (6%) patients and condoms were only provided to one patient (1%). Patients were urged to refer their partner(s) for treatment during 29 (27%) of consultations. A criterion of adequate use of the STD consultation for health promotion, requiring both promotion of condoms and encouragement to refer partner(s) for treatment, was met during 13 (12%) of consultations. Conclusions: Monitoring and improving the standards of care at facilities at which STDs are treated have become key roles of STD/HIV/AIDS programmes. The present report suggests that in Madras the activities of medical practitioners who treat STD patients are far from ideal at present. Improvements would involve simplifying existing treatment guidelines by promoting the syndromic approach to STD management, continuing education programmes for health care providers in the public and private sectors and repeat assessments and feedback of the quality of STD care.

‘Sorted’

Each year in Accident and Emergency an increasing number of young people present with acute problems related to social drugs. These problems range from mild symptoms to life-threatening conditions, many of which can be extremely difficult and time consuming for staff to manage. It has become apparent that as with sex the experimental age for taking drugs is getting younger as youths are now far more ‘streetwise’ than their predecessors. This is one of the main reasons for this paper being written; it is imperative that staff are equipped with the appropriate knowledge to deal with the challenge and are educated about the problems associated with current drug trends. This potentially improves the quality of care and, in turn, good communication improves relationships. Ecstacy is once again becoming increasingly popular within mainstream clubs, as recently highlighted in the media, and with it reappear its problems. This article discusses the historical aspects of Ecstasy and aims to educate staff about its use and effects and provides health promotion advice for those who are involved in the care of people who take Ecstasy.

Receipt of recommended prenatal interventions and birth weight among African-American women: analysis of data from the 1988 National Maternal and Infant Health Survey.

While the importance of exploring and better measuring elements of prenatal care have been noted in the public health literature, the components and timing of such services have been poorly examined for the overall pregnant population and specifically for African-Americans, who traditionally have had higher rates of low birth weight and premature delivery. This study explores the association between patient receipt of selected recommended prenatal care interventions and infant birth weight in a nationally representative sample of African-American women, while controlling for the influence of low birth weight risk indicators. This is a retrospective case-control analysis using survey data of women who delivered normal birth weight, moderate low birth weight, and very low birth weight newborns in 1988. A sample of 3905 African-American women who responded to the 1988 National Maternal and Infant Health Survey is examined based on maternal recall of receipt of six clinical screening procedures and seven health-promotion recommendations. Birth weight measures were obtained from linked 1988 birth certificate data. The initial results indicated that women who do not receive all of the recommended health-promotion advice are more likely to deliver very low birth weight infants than women who receive all of the advice in the content of their prenatal care, after controlling for low birth weight risks (OR = 1.28; 95% CI = 1.01, 1.7). However, when breast-feeding advice is removed from the aggregation of health-promotion advice, the significant effect of advice on very low birth weight is negated. No other significant group variations in the receipt of clinical screening procedures or health-promotion advice for women who gave birth in the remaining birth weight categories are observed. Nationally recommended initial clinical screening procedures and health-promotion advice in prenatal care content do not appear to be associated with a reduction in low birth weight for African-American women. More research is needed to better assess the impact of other antenatal interventions, particularly those given to women with a higher prevalence of poor birth outcomes.

Health promotion advice in the private sector

EDITOR, - An 86 year old female patient of mine was given a cardiovascular risk assessment as a Christmas present by her family. This was done at a local private hospital and …

Diffusion of the U.S. preventive services task force recommendations into practice

The U.S. Preventive Services Task Force's "Guide to Clinical Preventive Services" summarizes the results of a critical review of the literature pertaining to the effectiveness of 169 interventions in modifying 60 risk factors or conditions. The ultimate impact of the guide depends on the diffusion into clinical practice of its recommendations. This report reviews the factors influencing the diffusion process. Three categories of behavioral influence--predisposing, enabling, and reinforcing factors--apply to this diffusion process. Predisposing factors include knowledge and attitudes, personal health behaviors, confidence, and beliefs about patients' interests in health-promotion advice. Enabling factors include competence to perform preventive services, reimbursement for preventive services, organization of the practice setting, time to provide preventive services, a reminder system, and a coherent set of guidelines that are perceived as scientific and unambiguous. Reinforcing factors include peer support, feedback, evidence of results, and an enhanced sense of self-efficacy in fulfilling one's role as a healer. Recommendations are given for using these factors to increase the diffusion of preventive services into clinical practice.

Juvenile justice as a system: Law enforcement to rehabilitation : Alan R. Coffey Prentice-Hall, Inc. (Englewood Cliffs, New Jersey 07632), 1974, 152 pp., hardcover—$10.95

Each year in Accident and Emergency an increasing number of young people present with acute problems related to social drugs. These problems range from mild symptoms to life-threatening conditions, many of which can be extremely difficult and time consuming for staff to manage. It has become apparent that as with sex the experimental age for taking drugs is getting younger as youths are now far more ‘streetwise’ than their predecessors. This is one of the main reasons for this paper being written; it is imperative that staff are equipped with the appropriate knowledge to deal with the challenge and are educated about the problems associated with current drug trends. This potentially improves the quality of care and, in turn, good communication improves relationships. Ecstacy is once again becoming increasingly popular within mainstream clubs, as recently highlighted in the media, and with it reappear its problems. This article discusses the historical aspects of Ecstasy and aims to educate staff about its use and effects and provides health promotion advice for those who are involved in the care of people who take Ecstasy.