A continuing medical education program in chronic obstructive pulmonary diseases: design and outcome.

A continuing medical education course was developed to improve the care of patients with chronic bronchitis and emphysema (COPD); 44 primary care physicians completed the course. The physicians were randomly assigned to experimental and control groups, with 3 of the 4 experimental groups assisting in the selection of topics for the programs and/or receiving feedback on tests given during the course. The course's impact was assessed using written tests to measure knowledge and simulated patient visits to observe physician performance. Experimental groups retained significantly greater amounts of information 9 months after completing the program and used more program material during patient visits than did the control group (p < 0.05). The test scores and patient visits of the 3 experimental groups involved in determining the audiovisual topics and/or receiving feedback were not significantly different from one another nor from the fourth experimental group.

Evaluations of continuing medical education for chronic obstructive pulmonary diseases.

A continuing medical education program which linked primary care physicians to a source of needed appropriate clinical knowledge at a relatively low cost has been demonstrated. Chronic obstructive pulmonary disease was identified as the health problem; the reference patient population was comprised of coal miner health fund beneficiaries living in a 10-county region. Primary care physicians treating beneficiaries in this region were the eligible program participants. Content of the program was based on multiple sources of information about actual practice needs. Several educational techniques were used in combination to convey the knowledge identified as appropriate in the diagnostic stage. A quasi-experimental program evaluation indicated significant changes in physician knowledge, judgment, and self-reported behavior related to diagnosis and treatment of chronic obstructive pulmonary disease.

Attitudes toward obesity and the obese among professionals.

Negative attitudes toward obese patients by health professionals have been attributed to termination of weight reducing attempts. This study measured attitudes concerning the obese held by professional participants in a continuing education conference on causes and treatment of obesity. Substantial variation was found on items comprising obesity-related belief dimensions: (a) Disparaging image of the obese; (b) causes of obesity; and (c) ways to lose weight. Evidence is presented for the association among measures of these dimensions. While background and educational characteristics and conditions of practice were not related to such attitudes, the professional's personal experience with successful weight reduction was the best predictor of favorable attitudes.

Guidelines for health education in maternal and child health.

Guidelines are presented for specifying objectives, identifying resources, selecting methods and evaluating the health education component for maternal and child health programmes. Examples of the application of the principles are integrated with the Guidelines. Diagnostic, planning, organizational, administrative and evaluative procedures are presented around a model of health education which emphasizes: a) the careful delineation of the health problem; b) the specification of behaviours influencing the health problem; c) setting priorities among target behaviours on the basis of their relative epidemiological importance and their changeability; and d) the identification of factors that predispose, enable and reinforce the behaviour.

Social goals, health policy and the dynamics of development as bases for health education.

Among the most powerful social forces in this century is self determination of nations and of people. The relatively recent phenomenon of community participation in health decisions in some countries is but one aspect of the larger societal value. We can assume that self care, mutual care and collaborative involvement between providers and citizens flow from the concept of self determination. Although the pace is uneven and varies greatly among different communities and in different countries, there is a global movement towards health by the people. This is reflected in the decline of professional dominance of the health field as people in communities assume greater responsiblity for tasks previously monopolized by the health professionals. At the macro level, communities are making decisions in the allocation of resources for health and setting health priorities. At the macro level, health education is increasingly concerned in assisting consumers to develop skills in self diagnosis, self help and self care. However, if health is a human right, it must also be appropriated responsibly by those who claim it. Many healthy problems have their roots in community life. Today, major reductions in death and disability cannot be expected from curative services; instead, future progress will have to result from changes in the environment and lifestyle. Environmental changes will require in turn the cooperation of non-health sectors. Traditionally, professionals and others in these sectors have been reluctant to touch health planning and health policy due to medical dominance and a general attitude that health care belongs to the health professions. A primary task in health education is therefore to build stable linkages with other workers and the public in order that health status may be improved by finding areas of common concern and by institutionalizing joint efforts in seeking solutions through multipurpose planning. In-service training and continuing education for professionals and decision-makers are important strategies in this connection. The fostering of community capabilities for health planning and citizen responsibility in health matters is a priority in health education. This represents an investment in health resource development since the basic resources for collaboration in health improvement are people themselves, both professional and lay. Through community participation, all of us become both shapers of societal goals and governmental policies concerning health and health care, and recipients of the fruits of those goals and policies.

Application of social science theories to family planning health education in the People's Republic of China.

The transformation of the Chinese society was political and economic by revolution; it was also social and cultural through mass education. Group decisions have been used to induce social change in the Chinese society and applied extensively to the family planning program. The methods which Kurt Lewin developed to change food habits, have been perfected on a grand scale of myriad ways by the Chinese.

Food distribution as a guarantee for nutrition and health: China's experience.

In China, agriculture, health, education, and welfare are intricately woven as part of the development and its relationship to health programs, the strategy of food rationing and the "private plot" to improve nutrition and health, and the balance of food and population in the Chinese society. China's nutritional experience contributes significantly to understanding the role of "energy food" in the struggle against protein malnutrition and hunger. The author has outlined the implications for the developing countries.

The point of diminishing returns in nutrition education through home visits by aides: an evaluation of EFNEP.

This three-year evaluation of field work with poor, rural homemakers by nutrition aides employed by the Expanded Food and Nutrition Education Program (EFNEP) of the Maryland Cooperative Extension Service is based on successive annual interviews with 93 homemakers and a control group of 58 designated friends. The results suggest various points of diminishing returns beyond which behavioral and attitudinal changes brought about by the specific educational strategies are too small to justify continued visits to a homemaker. To sustain cost-effective home visits after the first year, more emphasis must be placed on reinforcement of first-year gains, and on expanding the scope of nutrition education to include more health education of other kinds.

Training of the barefoot doctor in the People's Republic of China: from prevention to curative service.

Among the changes that have been brought about in health delivery in the People's Republic of China, the introduction of the barefoot doctor has been one of the most important and effective ways that the government has devised to radically alter the concept of health care. Through close identification with the community in terms of recruitment, training, and practice, the barefoot doctor is a concrete manifestation of the ideological principles of following the mass line and being self-reliant. The paper focuses on the building of rural health services, with special reference to the training of the barefoot doctor as the first-level contact person in primary care in the communes. It describes the training programs in a school of public health and the career mobility possible to the barefoot doctor in joining the ranks of medical practitioners.

Motivating the masses for family planning in the People's Republic of China.

China's family planning efforts give the appearance of being substantial and effective, though in terms of hard data the precise degree of success achieved is hard to gauge. The author's five-week tour of China, upon which this article is based, showed a country that seemed capable of controlling its rate of population growth, but it was unclear whether the desired level of growth had in fact been attained. What was clear is that several unusual ingredients are primarily responsible for the marked progress made to date. Foremost among them is a public attitude of strict adherence to a moral code which effectively limits sexual relations to married couples and which encourages delay of marriage well beyond the teenage years. Enhancing this, a wide-ranging State publicity campaign promotes birth control through public address systems, brochures given newlyweds, classes and information provided to expectant parents, discussion groups designed to elicit "voluntary" adoption of birth control methods, and other means. To complement this, the Government provides a nationwide network of free or nearly free family planning services organized down to the local level and fully equipped to assist with contraception, sterilization, or termination of pregnancy upon request. Although general statistics have not been made available, it seems obvious that a substantial reduction in China's potential rate of population growth has been achieved.

PIP: The People's Republic of China has developed a mass culture which em phasizes correct thinking and action and allows little room for self-ind ulgence. Sex is not publicly commercialized or exploited and in the crowded Chinese household sex is viewed as a normal bodily function in which parents can engage. It is inconceivable that there are cultures in which a woman would be so shameless as to ask for the pill before she was married. Mass media reinforce the desirability of late marriage so that the young person can acquire education and self-development. A student who is selected to attend college is sent off as a "hero" of the community and he has tremendous social pressure upon him to remain single and finish school. Married students are forced to drop-out. The state Family Planning Commission, working through the network of barefoot doctors, promotes the ideal of a small family. Most of the barefoot doctors interviewed came from families of 5 or 6 children and spoke feelingly about the need for a woman to limit and space her children for the good of the community and her development. Family planning is included in the schools at all levels but sex education is t aught only at upper school levels via courses in biology, anatomy, and physiology. Young couples receive information on contraception at marriage. In some communities couples are not targets of family planning information until after the birth of the 1st child while in others they receive a family planning booklet along with the marriage certificate. Everyone contacted vigorously denies that grain or clothing rations are withheld from a 3rd or 4th child but there is no doubt that parents are subject to continual social harassment in the name of persuasion. Both 22-day pills containing norethindrone and ethinyl estradiol and an experimental once-a-month pill are very popular. Sometimes a "Number 3 pill" containing ethinyl estradiol with .005 mg estrogen is dispensed to counter side effects. IUDs, which are called 70-90% effective, are also popular. Tubal ligation is preferred by older women with 3 children or more. Acceptance of vasectomy varies, but appears less than other contraceptive measures. Abortion does not have the emotional overtones it does in Western societies and is done freely. However, consent of both parents and sometimes the community is required. This community consent is designed to discourage promiscuity and encourage contraception. Statistical data show birth rates ranging from 20/100 to 8/1000. Vital statistics are incomplete but area hospital records, school figures, and other records indicate China's family planning is having an impact.

Motivating the masses for family planning in the People's Republic of China

China's family planning efforts give the appearance of being substantial and effective, though in terms of hard data the precise degree of success achieved is hard to gauge. The author's five-week tour of China, upon which this article is based, showed a country that seemed capable of controlling its rate of population growth, but it was unclear whether the desired level of growth had in fact been attained. What was clear is that several unusual ingredients are primarily responsible for the marked progress made to date. Foremost among them is a public attitude of strict adherence to a moral code which effectively limits sexual relations to married couples and which encourages delay of marriage well beyond the teenage years. Enhancing this, a wide-ranging State publicity campaign promotes birth control through public address systems, brochures given newlyweds, classes and information provided to expectant parents, discussion groups designed to elicit «voluntary» adoption of birth control methods, and other means. To complement this, the Government provides a nationwide network of free or nearly free family planning services organized down to the local level and fully equipped to assist with contraception, sterilization, or termination of pregnancy upon request. Although general statistics have not been made available, it seems obvious that a substantial reduction in China's potential rate of population growth has been achieved (Au)