School health activities have been very important in improving adolescent health in Sweden for almost 200 years. In the 1800s, emphasis was on medical services. Vaccination programs and medical examinations became the key issues. Deterioration of adolescent health in the 1960s changed the objectives of both school education and health services to health promotion. Important members of the community followed suit and involvement of the local community has remained a hallmark, even though the extent and direction varies. The subsequent period was characterized by substantial improvement in adolescent health behavior. The latter years of the 1980s and the 1990s saw deterioration of adolescent health behavior. Less emphasis on health promotion, decentralization of school health responsibility from physicians to administrators, and heavy savings directed toward schools were important mediators. Adolescents were also more engaged in international youth cultures with liberal practices, such as drug use. Community surveys of adolescent health behaviors have proven to be important in mobilizing broad local involvement in adolescent health promotion. The lesson learned is that health promotion has to involve as many community members as possible. Coordinating resources and having unified objectives is cost efficient
"Au coeur de la vie" is a research project which aims to evaluate the impact of a heart health dissemination program on primary and secondary prevention practices in local community clinics in the province of Quebec, Canada. Because the project starts in 2001 and no data has been collected to date this paper presents the theoretical model, the objectives of the program, the description of the dissemination procedures, and a brief overview of the evaluation.
The purpose of this paper is to report on the capacity building efforts that took place during the dissemination research phase of Heart Health Nova Scotia (HHNS). HHNS, a health promotion research team, is funded by Health Canada and the Nova Scotia Department of Health. It is located in Halifax, Nova Scotia, a province of 937,000 people situated on the east coast of Canada. It has been a member of the Canadian Heart Health Initiative since its inception in 1989. The first phase of the program, Demonstration, was successfully completed in December 1995 (Heart Health Nova Scotia, 1995). In 1996, HHNS entered its second phase, Dissemination Research, which was conducted between April 1996 and March 2001 in the Western Health Region of Nova Scotia. This was completed in collaboration with organizations, community groups, and government agencies who joined HHNS to form the Heart Health Partnership (HHP) (Heart Health Nova Scotia, 2001). The main aim of this phase of the initiative was to build and research organizational capacity for health promotion and chronic disease prevention.
To report an exploration of the multidimensionality of safety in cardiac rehabilitation programmes as perceived by women who were enrolled in the Women's Cardiovascular Health Initiative in Toronto, Canada.
Cardiovascular disease is the leading cause of death among women. Although cardiac rehabilitation is clinically effective, significantly fewer women than men participate in available programmes. The literature identifies factors affecting women's cardiac rehabilitation participation, and provides possible explanations for this gender disparity. Although safety is mentioned among the barriers to women's cardiac rehabilitation participation, the extent to which safety contributes to programme participation, completion, and maintenance remains under-explored in the cardiac rehabilitation literature.
We conducted an exploratory qualitative study to examine the role safety and place play for women engaged in cardiac prevention and rehabilitation at the Women's Cardiovascular Health Initiative. Methods. From 2005-2006, 14 participants engaged in semi-structured, qualitative interviews lasting 30-90 minutes. Discussions addressed women's experiences at the Women's Cardiovascular Health Initiative. Interview transcripts were analysed using thematic analysis.
Three themes were developed: 'Safety', which was sub-categorized according to physical, social, and symbolic interpretations of safety, 'searching for a sense of place', and 'confidence and empowerment'.
Feeling physically, socially, and symbolically safe in one's cardiac rehabilitation environment may contribute to programme adherence and exercise maintenance for women. Focusing on comprehensive notions of safety in future cardiac rehabilitation research could offer insight into why many women do not maintain an exercise regimen in currently structured cardiac rehabilitation and community programmes.
Tertiary care referral centre specialising in respiratory diseases.
Chest radiography is a major screening and diagnostic tool for tuberculosis (TB). We evaluated the reproducibility of a radiographic classification system for screening for active TB of immigration applicants to Canada. We also evaluated the validity of this classification system for detection of prevalent active TB among the screened applicants, as well as tuberculin-positive close contacts and symptomatic patients.
Reproducibility was assessed by re-reading a randomly selected 10% sample of screening chest films. Validity was estimated from the final clinical and microbiologic diagnosis of patients undergoing detailed clinical evaluation.
Inter-reader agreement using five broad categories was moderate (kappas of 0.44-0.56), while intra-reader agreement was substantial (kappas of 0.59-0.72). After adjustment for age and patient group, the adjusted odds of active tuberculosis, relative to normal or minor findings or granulomas, for fibronodular changes was 10.2 (95% confidence interval [CI] 3.2-33), for mass or pleural effusion it was 11.6 (95%CI 3.6-37), and for parenchymal infiltrate it was 46.1 (95%CI 18-117). Among tuberculin-positive close contacts, the probability of active tuberculosis was more than 50% if the radiographs showed any mass, pleural disease, or parenchymal infiltrates.
A simple classification of TB-related chest radiographic abnormalities into five broad categories had moderate to substantial reproducibility of readings, with reasonable validity.