To provide updated, evidence-based recommendations for the assessment of the diagnosis, cardiovascular risk and identifiable causes for adults with high blood pressure.
For persons in whom a high blood pressure value is recorded, the assignment of a diagnosis of hypertension is dependent on the appropriate measurement of blood pressure, the level of the blood pressure elevation and the duration of follow-up. In addition, the presence of concomitant vascular risk factors, target organ damage and established atherosclerotic diseases should be assessed to determine the urgency, intensity and type of treatment. For persons diagnosed as having hypertension, defining overall risk of adverse cardiovascular outcomes requires an assessment of concomitant vascular risk factors, including laboratory testing, a search for target organ damage and an assessment for modifiable causes of hypertension. Home and ambulatory blood pressure assessment and echocardiography are options for selected patients.
The identification of persons at increased risk of adverse cardiovascular outcomes; the quantification of overall cardiovascular risk; and the identification of persons with potentially modifiable causes of hypertension.
Medline searches were conducted from November 2001, one year before the period of the last revision of the Canadian recommendations for the management of hypertension, to October 2003. Reference lists were scanned, experts were polled, and the personal files of subgroup members and authors were used to identify other studies. Identified articles were reviewed and appraised using prespecified levels of evidence by content experts and methodological experts.
A high value was placed on the identification of persons at increased risk of cardiovascular morbidity and mortality, and persons with identifiable and potentially modifiable causes of hypertension.
The identification of persons at higher risk of cardiovascular disease will permit counselling for lifestyle maneuvers and introduction of antihypertensive drugs to reduce blood pressure for patients with sustained hypertension. The identification of specific causes of hypertension may permit the use of cause-specific interventions. For certain subgroups of patients and specific classes of drugs, blood pressure lowering has been associated with reduced cardiovascular morbidity and/or mortality.
The document contains recommendations for blood pressure measurement, diagnosis of hypertension and assessment of cardiovascular risk for adults with high blood pressure. These include the accurate measurement of blood pressure, criteria for diagnosis of hypertension, and recommendations for follow-up, assessment of overall cardiovascular risk, routine and optional laboratory testing, assessment for renovascular and endocrine causes, home and ambulatory blood pressure monitoring, and the role of echocardiography for those with hypertension.
All recommendations were graded according to strength of evidence and voted on by the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. Only the recommendations that achieved high levels of consensus are reported. These guidelines will be updated annually.
Childhood physical inactivity and obesity are serious public health threats. Socioecological approaches to addressing these threats have been proposed. The school is a critical environment for promoting children's health and provides the opportunity to explore the impact of a socioecological approach.
Thirty percent of children in British Columbia, Canada, are overweight or obese, and 50% of youths are not physically active enough to yield health benefits.
Action Schools! BC, a socioecological model, was developed to create 1) an elementary school environment where students are provided with more opportunities to make healthy choices and 2) a supportive community and provincial environment to facilitate change at the school and individual levels.
The environment in British Columbia for school- and provincial-level action on health behaviors improved. Focus group and project tracking results indicated that the Action Schools! BC model enhanced the conceptual use of knowledge and was an influencing factor. Political will and public interest were also cited as influential factors.
The Action Schools! BC model required substantial and demanding changes in the approach of the researchers, policy makers, and support team toward health promotion. Despite challenges, Action Schools! BC provides a good example of how to enhance knowledge exchange and multilevel intersectoral action in chronic disease prevention.
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Department of Social and Preventive Medicine, Centre de recherche Léa-Roback sur les inégalités sociales de santé de Montréal & IRSPUM, Université de Montréal Public Health Research Institute, Québec, Canada. Sherri.Bisset@criucpq.ulaval.ca
To describe how and why nutritionists implement and strategize particular program operations across school contexts.
Instrumental case study with empirical propositions from Actor-Network Theory (ANT). Data derived from interviews with interventionists and observations of their practices.
Seven primary schools from disadvantaged Montreal neighborhoods.
Six nutritionists implementing the nutrition intervention in grades 4 and 5. From 133 nutrition workshops held in 2005/06, 31 workshops were observed with audio-recordings.
Little Cooks--Parental Networks aims to promote healthy eating behaviors through engagement in food preparation and promotion of nutrition knowledge.
The program-context interface where interventionists' practices form interactively within a given social context.
Coding inspired by ANT. Interview analysis involved construction of collective implementation strategies. Observations and audio-recordings were used to qualify and quantify nutritionists' practices against variations in implementation.
Nutritionists privileged intervention strategies according to particularities of the setting. Some such variation was accounted for by school-level social conditions, individual preferences and nutritionists' past experiences.
Implementation practices are strategic and aim to engage educational actors to achieve intervention goals. These results challenge implementation frameworks centered on purely technical considerations that exclude the social and interpretive nature of practice.
To evaluate the effect of previous AIDS education on AIDS knowledge and sex behaviour among Danish adolescents, a survey was carried out in April-May 1988 amongst 15-16 year-old school children of 9th grade elementary school. Through a cluster-sampling procedure, 45 school classes in nine geographical areas around the country were selected representing various degrees of urbanisation. A questionnaire was handed out and collected by the local school physician during a class session. The 728 pupils responding corresponded to a response rate of 89% of the pupils enlisted and 99% of the pupils present. The results demonstrate that AIDS education has been widely introduced in Danish schools and is well accepted. However, school health services have only rarely been involved. The educational activities seem to have a positive effect on knowledge about HIV-transmission and AIDS, attitudes towards the use of condoms and actual sexual behaviour, although risk-behaviour is still prevalent. The respondents express positive attitudes towards more AIDS education--especially among those with very little or no previous educational experiences.