Literatura académica sobre el tema "Self-perception. Sick Health behavior"

Introduction: Tuberculosis (Tb) is one of the 10 causes of death worldwide. Indonesia ranks third in the world . This indicates that the behavior of prevention of transmission by Tb patients is not effective yet. The purpose of this study is to identify behavioral factors for preventing TB transmission based on the Health Promotion Model theory.Method: This research was conducted by using descriptive analytic design with cross sectional approach. Population of this research was 150 patient with Tb. Sample on this research was 108 respondents which were chosen by using simple size calculator technique. Independent variables in this research were behavior before sickness, cognizance of patient of Tb, perceived of benefits, perceived of barriers, self-efficacy, attitudes related to transmission prevention activitie and environmental influences. Dependent variable in this research prevention behavior of TB transmission. The data colleting technique used in this research was questionnaire which was analysed by Spearman’s rho test with <0,05 significance. Result: The result showed that preventive behavior of TB transmission was correlated with behavior before sick (r=0.239), cognizance of patient of TB (r=0.261), perceived of benefits (r=0.371), and family support (r=0.284). There was no correlation between perceived of barriers (r=-.113), self-efficacy (r=0,160), attitudes related to transmission prevention activities (r=-.097) and environmental influences (r=0.034). With preventive behavior of TB transmission.Conclusion: Behavior of TB prevention is also influenced by behavioral factors before illness, knowledge of Tb, perception about the benefits of actions and family support. The Puskesmas was expected can improve Health Education by giving education about how to use mask well and shelter provision sputum in TB infection prevention behaviors in society.

A healthy lifestyle, including health behavior, illness behavior, as well as sick role behaviorplay a key role in managing type 2 diabetes mellitus (T2DM) as well as limiting its complications. This qualitative descriptive with case study research design utilized a type 2 diabetes mellitus patient who had good Self-Management Diabetes aims to describe the formation of health behavior in patients with type 2 diabetes mellitus reviewed by using Protection Motivation Theory (PMT). PMT consists of five components, namely the Severity, Vulnerability, Response Effectiveness, Self Efficacy, and Fear. Results suggest that the five components in PMT can be used to predict behavioral intentions that are highly related to one’s behavior, and the information either from the environment or intrapersonal plays a role in giving results in the formation of behavioral intentions to make changes in lifestyle, which leads to the emergence of health behaviors.

The Roma community (RC) has poor health indicators, and providing them with adequate healthcare requires understanding their culture and cultural differences. Our objective was to understand the concept of the health and sickness of the RC in Spain, and for this, a qualitative study was conducted. A content analysis utilizing an inductive approach was used to analyze the data. Twenty-three semi-structured interviews were performed, and four main categories were obtained after the analysis of the data: perception of the state of health, the value of health, what was observed, and causal attribution. The inter-relations between the categories shows that the RC have a dichotomous worldview split between non-sickness (health) and sickness mediated by causal attribution. Their worldview is polarized into two values: not sick/sick. When not sick, optimism is prioritized along with happiness, and these two emotions are highly valued, as they also play a physical and social function. When a person becomes noticeably sick, this is understood as being in a negative and severe state, and when there are visible physical implications, then the need to act is made clear. When faced with the need to act, the behavior of the RC is mediated by causal attributions, influenced by nature and religion, timing, concealment by not mentioning the disease, and the origin of the healthcare information. For the organization of an adequate health response for the RC, it is necessary for healthcare systems to be able to merge culture and health care.

Background. Poor, delayed, or inappropriate health seeking for a sick infant with acute childhood illness is associated with high morbidity/mortality. Delay in health seeking is implicated with fatal complications and prolonged hospital stay. Thus, caregivers ought to identify danger signs and promptly seek professional help for a sick infant. Objective. Establish determinants of health seeking behavior among caregivers of infants admitted with acute childhood illnesses in Kenyatta National Hospital. Methods. A mixed method cross-sectional study involving caregivers (n=130) of sick infants. Semistructured questionnaire and two focused group discussions were used to gather data on caregiver knowledge on danger signs, health care seeking options, and decision-making regarding health care seeking. Data was analyzed with SPSS V. 22. Results. Knowledge of danger signs of infancy was poor. Immediate health seeking was associated with tertiary [P=0.009] and secondary [P=0.030] education, knowledgeability on danger signs [P=0.002], and being married [P=0.019]. Respondents who resided in urban [P=0.034] or less than a kilometer [P=0.042] from a health facility sought care immediately. Those who rated services as excellent (P=0.005) and satisfactory (P=0.025) sought care promptly. Conclusion. Poor knowledge on danger signs of infancy was common among caregivers blurring the magnitude of acute illness resulting in delayed health seeking. Knowledgeability of danger signs of infancy, high educational level, and being married were associated with immediate health care seeking. Caregivers who resided in urban setting and/or near a health facility were linked to immediate health seeking. Additionally, satisfaction and perception of quality health care services were associated with immediate health seeking. Interventions with caregivers should involve capacity building through partnership with families and communities to raise awareness of danger signs of infancy. Strengthening of health care system to offer quality basic health services could improve health seeking behavior. Provision of a seamless supply system, infrastructural support, and technical support for soft skills minimize the turnaround time which is critical.

OBJECTIVES/SPECIFIC AIMS: To access obesity risk perceptions, knowledge and behaviors of Hispanic taxi cab drivers and develop a better understanding of the factors that influence health outcomes in this population. METHODS/STUDY POPULATION: Focus groups were conducted at NYC H+H/Lincoln, where subjects were screened and recruited from taxi bases with the help of the local Federation of Taxi Drivers. This was done by utilizing flyers, messages through taxi-base radios, and referrals from livery cab drivers. Approval from the local Institutional Review Board was obtained. The research investigators, developed a structured focus group procedural protocol of open-ended interview questions related to cardiovascular disease. Participants for the focus groups were older than 18 years old and working as livery cab drivers in NYC for at least 6 months. Three focus groups were held with informed consent obtained from each participant in their primary language before the start of each session. After completion of the focus group, participants received a gift voucher for attending the approximately 1-hour session. Focus groups were moderated by trained research staff members at Lincoln. Three main categories of questions were organized based on perception, knowledge, and behavior. Participants were questioned on topics about obesity, CVD and diabetes knowledge; knowledge about etiology, risk perception, possible prevention and interventions. Responses were recorded using audiotapes and transcribed verbatim. If participants did not elaborate on the initial question, a probing question was asked to clarify. The transcript was translated from Spanish by trained bilingual staff and analyzed using standard qualitative techniques with open code method. Four research investigators read the transcript separately and formulated concepts, which were then categorized and formulated into dominant themes. These themes were then compared and analyzed with a group consensus to ensure representative data. Once recurring themes emerged and the saturation point was reached, the study concluded, after enrolling 25 participants. The Health Believe Model (HBM) was employed to understand and explain the perceptions and behaviors of taxi drivers. HBM is one of the most widely recognized models and is used to understand, predict and modify health behavior. HBM helps to identify perception of risks of unhealthy behavior, barriers for having healthy behavior, actions taken by patients to stay healthy, self-efficacy and commitment to goals [12]. RESULTS/ANTICIPATED RESULTS: Of the 25 Hispanic livery cab drivers, 92% were male. The majority of taxi drivers that participated in the study were immigrants (96%), with a mean age of 53 years (ranged 21–69), and 92%, were spoke Spanish. In total, 52% participants identified themselves as Hispanic, 20% White, 4% Black, and 20% did not identify their race. Mean body mass index (BMI) was 31 (22.8–38.7) kg/m2. In all, 56% were obese and another 40% were overweight. From this sample, 50% had been diagnosed with hypertension and 27% were living with diabetes. In all, 64% had a high school education or higher. Answers provided by the taxi drivers to focus group questions were recorded, reviewed and divided into 8 dominant themes based on concepts that emerged from the focus groups discussions. (a) Focus group study findings: Themes recorded during the focus group discussions, include poor diet, sedentary lifestyle, comorbidities/risk factors, stress, health not being a priority, discipline, education, and intervention. Participants shared their opinions in regards to these themes with minimal differences, making an emphasis on the fact that the nature of their profession was the root cause. Of the themes, the top 3 dominant themes include poor diet, sedentary/lifestyle and comorbidities/risk factors. (1) Diet: The theme “Poor diet” evolved from 151 related concepts that were described by participants. All 25 participants perceived their diet as bad due to eating high-fat meals associated with the cultural food and restaurant chains with lower food prices and ease of car parking. Drivers also reported that they did not have enough time to eat healthy foods based on their long working hours. They say: “comemos muy tarde por que preferimos montar un pasajero” … stating that they preferred to pick up passengers and delay their meals. However, they consider poor diet as the most decisive factor in their increased risk for obesity, diabetes, and hypertension. (2) Life Style: The theme “Sedentary lifestyle” was derived from 147 similar concepts described by participants. They believe that physical inactivity is another leading risk factor for obesity, diabetes, and CVD. The demands of the profession force them to drive more than 10 hours per day. They understand the importance of daily exercise but they admit that at the end of the workday they are too tired to exercise or “stop working” to participate in exercise as this means less money. They also understand that family history of obesity in addition to poor diet increases their risk of obesity, diabetes, and cardiovascular risks. (3) Comorbidity: The theme “Comorbidities” developed from 143 concepts grouped together. Taxi-drivers perceived that obesity complications directly affects many vital organs, such as the kidneys, the heart, and vasculature. Participants perceive obesity as important risk factor for high blood sugar and cholesterol levels. Taxi drivers see an association between their health condition and their work as a taxi driver. However, taxi-drivers reported that they are more concerned about the economic well-being of their families than themselves. Taxi-drivers begin to intervene in their own health only when more serious health conditions related to obesity, diabetes, and hypertension developed. (4) Work Stress: The theme “Stress/other risk factors” was derived from 141 concepts. Taxi-drivers perceive their profession with lack of organization and high-stress levels as one of the leading risk factors contributing to obesity, diabetes, and cardiovascular disease. They also attribute a combination of stressful lifestyle, poor diet, lack of exercise, consumption of alcohol and cigarettes as determining factors in developing negative health outcomes. “One participant says; Tenemos el paquete completo” … we have the entire package. (5) Health as a priority: The theme “Health is not a priority” was derived from 120 concepts based on the cab drivers’ responses. Taxi drivers prioritize their work while their health takes a back seat. They work long shifts as they feel the pressures of financial responsibilities of their family. They admitted lack of intentions to change their behavior and they consider themselves as “hard headed.” Drivers changed their behavior only when serious health conditions develop that require professional medical attention. Taxi drivers explain that the lack of time as being a big factor in pursuing preventative care. (6) Personal Discipline: The theme “Discipline” evolved from 80 concepts derived from the driver’s transcripts. Taxi drivers are aware of their lack of organizational skills in general, especially when it comes to the balance between work and a healthy lifestyle. Taxi drivers recognize that not being disciplined results in the development of their obesity and chronic health conditions. Drivers admit that they do not have a fixed schedule, with no direct supervision, and cannot find the time to go to the doctor or change their behavior. (7) Health Education: The theme “Education” was derived from79 concepts noted from the focus group discussion. Taxi drivers know that their lack of health education is affecting them. With little understanding about the severity of the disease process it is difficult to take proactive measures. They are interested in the development of programs that will educate them about obesity, diabetes and CVD prevention. They want to attend programs that can educate them about prevention of obesity, diabetes, and CVD prevention with strong focus on healthy eating. They understand that this would increase their ability to change their unhealthy behavior. (8) Health interventions: The last major theme “Intervention” was derived out of 71 concepts. When asked about possible interventions that might help them towards healthy behaviors, taxi drivers think that the use of technology as a means of education is very effective. They understand the most direct route to reach them is by cellphone, email, and social media such as Facebook. They also feel that it would be good to use this type of communication to not only to inform them about health issues, but to also educate them directly. (b) Application of Health Behavior Model: We employed the HBM, one of the most utilized and easy to understand health models (18, 20–22) to explain the knowledge, perception, and health behaviors of our study participants. The HBM consist of 6 posits: (1) risk susceptibility, (2) risk severity, (3) benefits of action, and (4) barriers to action, (5) self-efficacy, and (6) cues to action [23]. According to the HBM, people’s beliefs about their risk and their perception of the benefits of taking action to avoid it, influence their readiness to take action [15, 21–22, 24]. Using the HBM, health behavior can be modified positively if the 6 posits are perceived by the person [23]. According to the results of our study, taxi drivers that participated in our study, do not perceive the severity of their risk. Participants admitted that they go to the doctor and start paying attention to their health condition only when they get seriously sick. Another posit of the HBM, understanding benefit of actions, is also not perceived by taxi drivers. Participants understand that they should be involved in physical activity, but do not pursue physical activity. They stated that they are too busy and tired to exercise daily without realizing the benefits of having a healthy life style. Findings from the focus groups also demonstrate that taxi drivers do not possess self-efficacy, as they are not confident that they are able to change their own health behavior. They openly admitted to having poor discipline, lack of organizational skills, and lack of time management skills. But, they expressed their wish to get information about time management, healthy snacks, places where they can get affordable and healthy food, learn more about different physical activities, and places where they can exercise. The sixth posit of the HBM model is the cues for action which should trigger the action to change behavior. Cues such as physical pain or illness in them or family members of cab drivers, trigger a visit to the physician’s office. Cab drivers were open to receiving educational material provided by physicians or health information provided on TV/cellphone about disease prevention. DISCUSSION/SIGNIFICANCE OF IMPACT: Obesity is steadily on the increase in the US population and has become a major public health concern [1–3]. Latinos are at the higher risk of heart diseases such as obesity, hypertension compared to other ethnical groups [3, 13]. There is a higher prevalence of obesity among particular occupational groups with cab drivers having one of the highest obesity prevalence among all professions [5, 7–9, 13]. Obesity risks therefore seem to affect NYC cab drivers who are of Latino background more than others. Surveys conducted in different countries in Asia, Europe, and Africa reported that taxi, truck, and bus show that drivers are at a higher risk of developing obesity, diabetes, and hypertension [5, 8–11]. This study is the first to evaluate the knowledge, perception, and behaviors of NYC Latino taxi cab drivers with respect to obesity. The study uncovers factors and barriers that contribute to their behavior, and identify possible ways that can modify their behavior and decrease their chances of developing obesity. The study results demonstrated that Latino immigrant taxi drivers perceive themselves at a high risk for obesity development. As the result of discussions with focus groups, the eight dominant themes were identified. Participants perceive their risk susceptibility and understand that working as a driver is a sedentary occupation with lack of physical activity significantly contributing to obesity development. Additionally, taxi drivers report that their unhealthy diet is a major factor that contributes to their weight gain. Taxi drivers perceive their poor diet as the result of the food they consume being high in fat content. Due to financial constraints and their cultural diet requirements, they feel limited to unhealthy food options. They acknowledge the risk that poor diet contributes to obesity, high cholesterol, obesity development. Participants also expressed that work stress is another important factor. Busy traffic, lack of organization, financial stress to support their families-push them to work prolonged hours. Participants also admitted that in their leisure time, they use alcohol, smoke cigarettes, and watch TV, instead of going to the gym, because they feel too tired to exercise. Taxi drivers perceive their barriers as a lack of education and knowledge about healthy food choices, places where they can buy healthy affordable snacks, information about physical activities, stress management skills, and organizational skills. Other perceived barriers that prevent them from leading healthy lifestyle include lack of discipline, lack of time for physical activity, economic uncertainty, financial responsibility and the perception that the wellbeing of their families is more important than themselves and their health. HBM is a widely used model that helps to identify perception of risks of unhealthy behavior, barriers to healthy behavior, actions taken by patients to stay healthy, self-efficacy, and commitment to goals. Based on the Glasgow theory, the core of health behavior models is the identification of the barriers and self-efficacy [25]. Our study is unique as it involves using the HBM to explain the basis of taxi cab drivers’ behavior. Results of our research study showed that our participants perceived barriers very well. However, lack of self-efficacy, lack of perceiving benefits of action, lack of cues to action, and lack of understanding the risk of disease severity explain why taxi drivers have greater risk for obesity among occupations, and are not ready to embrace health behavior modification. This qualitative study shows us where the window of opportunity for intervention lies, how we can intervene and modify the health behavior of the at-risk NYC Latino cab driver population. By Glasgow theory, self-efficacy is an important factor in behavior modification models [25]. If the barriers that are perceived by participants as too high, and self-efficacy is low, one can intervene by improving self-efficacy. Bandura has offered ways to increase patients’ self-efficacy by using three strategies: (a) setting small, incremental, and achievable goals; (b) using formalized behavioral contracting to establish goals and specify rewards; and (c) monitoring and reinforcement, including patient self-monitoring by keeping records [20]. We can also improve perception of the benefits of action by providing cues to action namely education during the office visits, by providing reading materials, and the use of modern technology (emails, interactive Web sites, apps, etc.). A study was conducted in South Asia, encouraging taxi drivers to exercise through the use of pedometers [7]. This study provides an example of ways to motivate taxi drivers, improve their self-efficacy, overcome barriers, and provide cues to action. As one of the theories that can explain and help in behavioral modification, the Health Belief model includes the impact of the environment and elements of social learning. Using this model, we were able to differentiate and identify the factors that influence their behavior that need to be addressed by health care workers and public health representatives to improve obesity related risks among inner city taxi cab drivers in NYC.

ABSTRACTObjective:Both trait and contextual self-concealment, as well as shame- and guilt-proneness, have previously been found to be associated with psychological distress. However, findings regarding the associations between these variables among patients with cancer and among the spouses of patients with cancer are limited. The aim of the current study was therefore to investigate the relationship between shame-proneness and psychological distress (anxiety and depression) by examining the mediating role of both trait and contextual self-concealment among patients with cancer and among the spouses of patients with cancer.Method:The current study was part of a large-scale cross-sectional study on self-concealment among patients with cancer and spouses of patients with cancer. It was based on two independent subsamples: patients with cancer and spouses of patients with cancer,who were not dyads. A total of 80 patients with cancer and 80 spouses of (other) patients with cancer completed questionnaires assessing shame- and guilt-proneness, trait and contextual self-concealment, anxiety, and depression.Results:Results indicate that spouses reported both greater shame-proneness and anxiety than did patients (main effect of role). Female participants reported greater shame-proneness, higher levels of contextual self-concealment, and greater depression and anxiety than did male participants (main effect of gender). No group differences (role/gender) were found for guilt-proneness and trait self-concealment. Trait and contextual self-concealment partially mediated the relationship between shame-proneness and distress, pointing out the need to further examine additional mediators.Significance of results:Findings suggest that contextual self-concealment and shame-proneness are important variables to consider when assessing distress in the setting of psycho-oncology. Study results may have significant clinical implications regarding the need to identify patients and spouses who are more prone to shame and self-concealment behavior in order to better tailor interventions for them.

Background: Literature revealed that men tends to use healthcare services much lesser and visit much later, resulting in poor health outcomes. This is often regarded as a way of exhibiting masculinity. In Brunei, there is an increasing number of mortality resulting from the complication of diabetes mellitus, a non-communicable disease, which arguably can be prevented.Objectives: To explore their health-help seeking behavior and health maintenance pattern of male diabetic patients in Brunei.Methods: Qualitative research guided by phenomenology research design. COREQ Checklist was used to prepare the report of this study. Individual semi-structured interview on eleven men were conducted from February to November 2018. Interviews were audio-recorded, transcribed and analyzed thematically.Results: Three themes were developed: “Maintaining health to enable the performance of masculine roles”, “Men delay seeking healthcare services”, and “Maintaining control and self reliance in looking after own sick body”. Conclusion: Health is perceived as important - it enables men to perform their ‘masculine responsibilities’. When men are in ill-health and realized how this could jeopardize their masculine roles, they would actively involve in taking care of their own body. This suggested how masculinity is in fact context –dependent. Level of knowledge and experiences with healthcare services and treatments also influenced men decision in health-help. Despite evidence that suggests how men often decline involvement with health promoting activities and delay seeking health from healthcare professionals, it was found that being able to continue supporting their family act as a legitimate reason for them to access healthcare services.

The Medicine students need to increase their research skills. Therefore, there is a main goal to train the fifth year students in epidemiological analysis methods during educational activities in work hours. In the Tula Aguilera Health Area, the fifth year Medicine students conducted a control-case study, where they applied a 14 questions survey to 69 persons sick with infectious diarrhea during June to December 2013. The results were compared to those of 131 healthy persons. The survey collected demographic, environmental and lifestyle variables. For each factor found, odd ratios (OR) were determined and the behavior of the analyzed variables was compared in both groups with the logistic regression technique. The basic reproductive number (Ro) was determined considering its impact and a simulation was compared with the usual historical dispersion of those diseases. Among the results, the students were trained to gather information and to transfer data to Excel Worksheets to analyze causal relationships. The students, after analyzing, were able to establish that the surveyed population had a low risk perception, they were also able to establish and calculate differences between sick and healthy people; for instance, people who don’t cover solid wastes and become sick have nearly three times more risk (OR=2.81; IC 1.34-6.03), moreover the students were able to demonstrate the presence of environmental hazards. They found that the survey was reliable and became familiar with the usage of the basic reproductive number and derived simulations. We conclude that the designed training allowed the students to increase their skills during the educational practices at work regarding the learning by doing research methodology. The trainig strategy is valid, sustainable, updated and of great value in the Medicine students instruction.

The ArgumentPain has important biomedical socioanthropological, semiotic, and other facets. In this contribution pain and the experssion of pain are looked at from the perspective of evolutionary biology, utilizing, among others, cross-cultural data from field work in Melanesia.No other being cares for sick and suffering conspecifics in the way humans do. Notwithstanding aggression and neglect, common in all cultures, human societies can be characterized as empathic, comforting, and promoting the health and well-being of their members. One important stimulus triggering this caring response in others is the expression of pain. The nonverbal channel of communication, particularly certain universal — i.e., culture-independent facial expressions, gestures, and body postures, convey much of the message from the painstricken person to the group.These behaviors signal the person's physical and psychical pain, sadness, grief, and despair in ways very similar to the signs given by infants and small children: the body loses tonus and sinks or drops to the ground, the gestures are those of helplessness. Pain and grief may be so strong that control is lost not only over the body's posture but also over the mind's awareness. In such cases the afflicted person may carry out actions endangering himself or others. In general, these behavior patterns resemble those of infants in situations of distress and danger, and it is not surprising that the response of the members of the group is basically parental: taking care, assisting and consoling.Perceptive and behavioral patterns which developed in the course of avian and mammalian phylogeny to serve the well-being of the young have proven, as was shown by Eibl-Eibesfeldt (1989), to be powerful building blocks for actions in other spheres of human interaction. Love is one such field, the reactions to a conspecific suffering pain is another.

Background:One of the greatest challenges of the COVID-19 pandemic for rheumatologists concerns the patient’s adherence to treatment (1). The impact of poor adherence on the effectiveness of chronic disease treatment is severe in terms of poorer health outcomes and increased health care costs (2). Information regarding covid-19 on adherence behavior in Latin-American is scarce.Objectives:The aim of this study is to describe impact of COVID-19 outbreak on adherence behavior in Latin-American population with rheumatic diseases.Methods:We carried out a descriptive, cross-sectional, self-report study through voluntary telephonic survey, to determine adherence behaviors during the COVID-19 pandemic, from September 9th, 2020 to November 19th, 2020, for consecutive patients of the outpatient rheumatology clinic in the Hospital Universitario (Monterrey, Nuevo Leon, Mexico), which serves a resource limited population that lack access to health insurance, from five neighboring states. A 17-items survey was designed. Baseline demographics that were collected included age, sex, rheumatologic diagnosis, current medications and patient perception of disease control. Patients were asked if they continued follow-up care, last prescribed therapy and reasons. Also, the survey assessed whether patients had any issues with medication supply and where they were obtaining information about covid-19 (could choose as many options as applicable). Transferred to SPSS for analysis for descriptive statistics.Results:A total of 150 patients were called, the survey response rate was 54.6% (n=82), with a mean completion time of 10 minutes. The mean +/- SD age of the participants was 52 +/- 15.9 years, and 95% were female. The most common self-reported diagnoses were rheumatoid arthritis (RA) (13.4%) and systemic lupus erythematosus (SLE) (13.4%) [Table 1]. Patient perception of disease control was primary good 37.8% and regular 35.4%.Patients that continued their follow-up with their rheumatologist (on the clinic face-to-face, electronically or telehealth) or in another clinic were 26.9%, the majority were nonadherent 73%. Persistence to treatment was 82.9%, the main reason to discontinue therapy was lack of prescriptions or medical advice 8.5% and overall 58.5% had trouble finding their medicine.Information regarding covid-19 was mainly obtained by television (health secretary conference) 90.2%, and the least directly from their doctor 4.8%.Table 1.Survey ResultsN (%)Age, mean +/- SD years 52 +/- 15.9Female/ Male78 (95.1) / 4 (4.9)DiagnosesRA50(61)SLE11(13.4)Osteoarthritis10(12.2)Other11(13.4)Disease Control during covid-19Excellent8 (9.8)Good31 (37.8)Regular29 (35.4)Bad14 (17.1)Continued follow-up(face-to-face, telehealth, other)22 (26.9)Continued last prescribed treatment68 (82.9)Reasons to discontinue treatmentLack of prescriptions/ medical advice7 (8.5)Lack of availability6(7.3)Economic disadvantage3 (3.6)Fear of getting sick of COVID-192(2.4)“Trouble” finding medicine48 (58.5)COVID-19 informationTelevision (Health Secretary conference)74 (90.2)Social network27 (32.9)Newspaper/ magazines14 (17)Internet9 (10.9)From a doctor4 (4.8)Conclusion:Patients continue their therapeutic regimen, still many of them have trouble finding their medications, which affects the disease control. Also, despite having a poor disease control (majority between regular and bad) they are not continuing their follow-up care, more objective studies are needed to determine a specific cause.References:[1]Pineda-Sic RA, Galarza-Delgado DA, Serna-Pena G, et al. Ann Rheum Dis Epub ahead of print: [20-06-2020]. doi:10.1136/ annrheumdis-2020-218198[2]Anghel, L. A., Farcaş, A. M., & Oprean, R. N. (2018). Medication adherence and persistence in patients with autoimmune rheumatic diseases: a narrative review. Patient preference and adherence, 12, 1151–1166. https://doi.org/10.2147/PPA.S165101Disclosure of Interests:None declared

It has been well established, in the literature, the association between low health literacy rates and poor health outcomes. With the increase of technology dependence, more people are using the internet to look up health information. Research has shown that shared decision making between providers and patients can improve patients' health outcomes. This research aims to examine whether electronic health (eHealth) literacy impacts patient-provider relationships. This research will also examine how geography specifically state residency impacts eHealth literacy rates. Data collected from a national sampling of online health and medical information users who participated in the Study of Health and Medical Information in Cyberspace (N=710) is used to construct structural equation models from SPSS AMOS v. 20.0. After path analysis, the results shown that white males with higher education were more likely to have higher eHealth literacy rates and that eHealth literacy rates are associated with better self-care, higher patient satisfaction and increased trust in provider. Also, state residency does not have an impact on eHealth literacy rates. eHealth literacy will be significant in patient-provider relationships. Program development should be established on focusing on eHealth literacy across the lifespan. Also, it will be important to review federal policy on technology disbursements in order to achieve national goals on eHealth literacy rates.

Thesis (M.S.)--University of Florida, 2004.
Typescript. Title from title page of source document. Document formatted into pages; contains 25 pages. Includes Vita. Includes bibliographical references.

The problem of the study was to measure the association between physical self-efficacy, using the Physical Self-Efficacy Scale, and frequency, intensity, time and type of exercise among mid-west college students who participated in regular physical activity.The role of physical self-efficacy on preventative health behaviors has been well established in the literature and is of interest to health educators. This study was designed to measure the strength of association between physical self-efficacy and the specific components of exercise.The sample consisted of Ball State students (n= 412) who completed an Exercise Behavior and Physical Self-Efficacy questionnaire. Multiple regression and analysis of variance (ANOVA) were used to measure associations.Levels of physical self-efficacy were most closely correlated with intensity of exercise participation (r2 = 0.15). Duration of exercise sessions was only slightly related (r2 = 0.01) and frequency was not found to be significant. Students who participated in the types of exercises which required the greatest amount of intensity also had the highest self-efficacy scores.
Department of Physiology and Health Science

Introduction: Due to the high prevalence of smoking in China, exposure to second hand smoke (SHS) is a serious public health issue. However, school-aged children’s behavioral responses to SHS exposure and the associated factors are unclear. Aims: This study aims to (a) identify the sources and settings of SHS exposure among school-aged sick children and their mothers in Guangzhou, China; (b) describe the behavioral responses of those children and mothers when exposed to SHS; and (c) examine the personal and environmental factors associated with children’s responses to SHS exposure. Methods: Qualitative and quantitative methods were combined in this study. Forty-five in-depth individual interviews were conducted to investigate sick school-aged children and their mothers’ understanding of and responses to SHS. A pilot survey was used to assess the validity and reliability of the questionnaire and the feasibility of the study. A cross-sectional survey was conducted with the children and their mothers at three hospitals in Guangzhou in 2012. All sick children who were aged 6 to 12 years, able to communicate in Mandarin Chinese, and not acutely or severely ill, along with their nonsmoking mothers, were invited to join this study. Results: A total of 339 pairs of sick children and their mothers were included in the data analysis. Of these pairs, 169 (49.9%) lived with smokers. All sick children and their mothers experienced high-level SHS and third hand smoke (THS) exposure inside or outside the home. Those living with nonsmokers were also at risk of household SHS and THS exposure from guests. Most of the sick school-aged children were unaware of the dangers of SHS and THS, while the mothers had a better understanding of SHS and THS. The majority of children would adopt self-protective behaviors when exposed to SHS. The regression model for children’s behavioral responses to SHS exposure by family smokers found two significant factors: amount of social support and family smoke-free policy. Five factors were associated with children’s behavioral responses to SHS exposure by guest smokers, including boys, living with smokers, amount of social support, family members informed of the dangers of smoking, and fathers protecting children from SHS. The amount of social support, and fathers protecting children from SHS were also associated with children’s behavioral responses to SHS exposure by stranger smokers. Conclusions: To our knowledge, this is the first study to describe self-protective behavioral responses to SHS exposure among sick school-aged children in mainland China and the personal and environmental factors associated with these responses. Boys, living with smokers, and a partial smoke-free policy at home were negatively related to children’s responses to SHS exposure; however, more information about smoking, fathers’ protection from SHS, and information about the harms of smoking by family members were associated with greater self-protection among sick school-aged children. Therefore, multiple-direction interventions should be considered for children’s health promotion about smoking and SHS.
published_or_final_version
Nursing Studies
Master
Master of Philosophy

Objective: This study explored the relationship of risk perception with change in health behaviors and social cognitive theory (SCT) constructs. Additionally, this study evaluated the feasibility, utility, and practice of self blood pressure monitoring (SBPM). Design: Adults with prehypertension, ages 45-62 (N = 23) completed the Risk Perception Survey for Developing Hypertension (RPS-DH) and Health Belief Survey (HBS) during the screening portion of Dash-2-Wellness (D2W), a lifestyle modification intervention. Participants were randomized into one of two treatment groups, Dash-2-Wellness Plus (D2W Plus) or Dash-2-Wellness Only (D2W Only). Both groups were given dietary counseling regarding the DASH diet and encouraged to monitor their physical activity using a pedometer. The D2W Plus group also engaged in SBPM. Results: Moderate correlations were found between composite risk perception and change in step count (r = -.47, p = .03), and change in systolic blood pressure (r = .42, p = .04). Baseline risk perception was not related to SCT variables, with few exceptions. High levels of compliance (M = 90.36%, SD = 12.62) were reported for SBPM. Conclusions: Findings indicate that risk perception may play a limited role in motivating change in continuous health behaviors, particularly in asymptomatic conditions. Additionally, the nature of the risk reduction offered by the behavior may also influence its association with risk perception as a motivator for change. Findings suggest that SBPM is a feasible and useful behavior. Reports regarding positive affect and ease of machine use in regards to this behavior may increase the likelihood of regular compliance.
Master of Science

Archived data was utilized for the present study which examined knowledge about non-suicidal self-injury, or NSSI, in individuals who engage in various degrees of the behavior and those who do not self-injure. Knowledge about NSSI was measured in three groups of respondents: those with no history of self-injurious behavior (no NSSI group), those with more limited experience with NSSI who reported 1-30 incidences of NSSI (limited NSSI group), and those with an extensive history (extensive NSSI group) who reported over 30 incidences of NSSI. To measure knowledge, participants were asked level of agreement with myths and facts about NSSI using Jeffery and Warm’s (2002) knowledge measure. It was hypothesized that the knowledge base would be higher in individuals with more extensive histories of NSSI. Further, individuals with limited histories of NSSI were predicted to have more knowledge than those who have never self-injured. Additionally, this study also hypothesized that the individual item response will vary; depending on extent of NSSI behavior. Group mean scores on the measure were analyzed for differences using a one-way analysis of covariance (ANCOVA) while controlling for the differing group demographic variables of age, sexual orientation, and education level. Results indicated that individuals who have more extensive histories of NSSI evidenced higher mean scores on the measure when controlling for age, sexual orientation and educational level. Individuals with limited histories of NSSI evidenced lower mean scores, and those with no history of NSSI evidenced the lowest scores. In regard to individual item response, items were correlated with seven levels of NSSI (no NSSI, one incident of NSSI, 2-4 incidences, 5-10 incidences, 11-20 incidences, 21-30 incidences and more than 30 incidences). It was found that accuracy was significantly correlated with degree of self-injurious behaviors, with the exception of one item. This item and three additional items also produced weak correlations with other items on the measure. Each item is discussed with regard to group item performance and possible deletions in order to strengthen the measure. Overall, the results of this investigation supported the reliability and validity of the Jeffery and Warm (2002) knowledge measure for use with individuals who self-injure. Results are discussed in relation to the need for accurate knowledge about NSSI, the importance of refining and strengthen the measure for this use, and additional research directions.

[Truncated abstract] Regular engagement in physical activity is proven to decrease the risk of numerous chronic diseases and to improve mental well-being. However, many children and adults around the world fail to engage in sufficient levels of activity required to produce health benefits, with reports showing physical activity levels still on the decline. Perhaps because of this increase in sedentary lifestyles, obesity has become one of the biggest public health threats in the 21st century. Furthermore, both obesity and physical inactivity are closely related to psychological health, and may play an important role in shaping self-perceptions and feeling of general well-being. '...' In the first study, physical status, physical activity levels, and social physique anxiety measures were obtained from an adolescent sample of 259 participants. Partial correlation analyses revealed that physical activity involvement was not directly linked with physical status; however, both factors were significantly associated with social physique anxiety, which suggested evidence of an indirect link between the two constructs. That is, analyses showed that poor physical status was associated with higher levels of physique anxiety, which in turn linked to low engagement in physical activity. In addition, age and gender effects emerged, revealing unique differences in the ways in which these three variables may be related. To cross-validate and further examine these relationships STUDY 2 extended the range of self-perception measures to include a multidimensional assessment of physical self-concept and a global self-esteem measure along with physique anxiety. These variables were assessed in a German adult sample (N = 229), again alongside measures of physical status and physical activity involvement. Consistent with STUDY 1, no direct link was found between physical status and levels of physical activity involvement. However, evidence of an indirect link did emerge as both variables were related to multiple dimensions of physical self-concept, thereby reinforcing and extending the findings from STUDY 1. Furthermore, age effects emerged for physical self-concept, which had not been confirmed in previous research on physical self-concept. STUDY 3 employed a longitudinal design and investigated changes in physical self-concept, global self-esteem and social physique anxiety before, during, and after participation in a 12-week weight management programme. Participants (N = 63) were assigned to one of three conditions: (1) cognitive-behavioural treatment only, (2) cognitive-behavioural treatment and exercise, and (3) non-treatment control. Statistical analyses revealed a small, but significant reduction in weight for members of both treatment groups. Relative to controls, both treatment groups also improved on a variety of physical self-concept dimensions. At the same time, however, significant group main effects suggested that a weight-loss program incorporating exercise involvement may provide physical self-concept benefits that go beyond those obtained with standard CBT regimes. Collectively, these studies add to the growing body of literature on the connections between physical activity, self-perceptions and physical status. They also highlight the importance of involvement in habitual physical activity throughout the lifespan. Findings are discussed with regards to their contribution to the extant literature, and applied implications, limitations, and future directions are considered.

Accompanying materials housed with archival copy.
The purpose of this research was to describe and critically interpret girls' experiences with respect to body image, physical activity and health. The qualitative inquiry included focus group and individual interviews, document analysis and field observations. These methods were used to explore the perceptions of sixty-three girls (grades eight and eleven) and staff from an inner-city high school. Through interpretive data analysis (and constant comparison), the inter-related themes of body image, physical activity and health branched into the sub-themes of societal influences and personal attitudes including: friends, boys, family, school and media. Girls' body images ranged from minor preoccupations to major dissatisfaction with their bodies, while a few girls were happy being themselves. Weak or negative family influences gave way to influences by media, boys and friends. A few girls were very active, whereas others' low levels of participation were attributed to: disinterest in physical activity, intimidation by boys, or perceived lack of opportunity. The girls' perceptions of health incorporated fitness, weight, and eating habits. Girls often used negative qualifiers when describing their weight or body shape. Generally, girls perceived overweight individuals as not taking care of themselves. This research supports the development of gender sensitive physical education programs promoting healthier lifestyles for females.

Each day, when you take your morning shower, you face a 1 in 1,000 chance of serious injury or even death from a fall. You might at first think that each time you get into the shower your chance of a fall and serious injury is 1 in 1,000 and therefore there is very little to worry about. That is probably because you remember that someone once taught you the famous coin-flip rule of elementary statistics: because each toss is an independent event, you have a 50% chance of heads each time you flip. But in this case you would be wrong. The actual chance of falling in the shower is additive. This is known in statistics as the “law of large numbers.” If you do something enough times, even a rare event will occur. Hence, if you take 1,000 showers you are almost assured of a serious injury—about once every 3 years for a person who takes a shower every day. Of course, serious falls are less common than that because of a variety of intervening factors. Nevertheless, according to the CDC, mishaps near the bathtub, shower, toilet, and sink caused an estimated 234,094 nonfatal injuries in the United States in 2008 among people at least 15 years old. In 2009, there were 10.8 million traffic accidents and 35,900 deaths due to road fatalities in the United States. The CDC estimates a 1-in-100 lifetime chance of dying in a traffic accident and a 1-in-5 lifetime chance of dying from heart disease. But none of these realities affect our behaviors very much. We don’t take very many (if any) precautions when we shower. We text, eat, talk on the phone, and zone out while driving, paying little attention to the very real risk we pose to ourselves (and others) each time we get in the car. And we keep eating at McDonald’s and smoking cigarettes, completely disregarding the fact that these behaviors could eventually affect our health in extreme and fatal ways. On the other hand, there is zero proven risk of death as a result of the diphtheria- tetanus- pertussis (DTP) vaccine.

Over the years, a variety of health professionals have developed terms or phrases to denote seemingly unique clinical combinations of symptoms and signs. A disorder or syndrome does not necessarily exist simply because it has been described in the medical literature. Some have stood the test of time, others overlap with syndromes described by different specialists, and additional terms may be favored by a single practitioner advocating a “cause.” This chapter reviews conditions that have overlapping features with fibromyalgia but are not yet regarded as full-blown, legitimate disorders by organized medicine. When Dr. Fine first met Wanda, she was a basket case. Wanda had canceled three prior appointments because smells from a new carpet had made her sick, Med fly agricultural spraying 30 miles away prevented her from getting out of bed, and she developed a severe headache when her neighbors’ house was being painted. She almost passed out in the elevator going to Dr. Fine’s office because somebody was smoking. Wanda had been to three allergists, who obtained normal skin tests and blood tests. Desperate, she traveled to Mexico, where “immune rejuvenating” injections were administered, and to Texas, where a clinical ecologist sequestered her in a pollution-free, environmentally safe quonset hut for a month. There she received daily colonies, antiyeast medication, and vitamin shots, to no avail. Dr. Fine elicited a history of aching, sleep disorder, a “leaky gut,” muscle pains, fatigue, and a spastic colon. His physical examination and mental status examination revealed evidence of anxiety, obsessive-compulsive tendencies, and fibromyalgia tender points. Wanda was treated with fluoxetine (Prozac) for pain and obsessive behavior, buspirone (Buspar), for anxiety during the day, and trazodone (Desyrel), a tricyclic, to help her sleep at night. She was referred to a psychologist who worked to improve Wanda’s socialization skills and encouraged her to go out rather than be a prisoner in her own home. Wanda is slowly improving but will need many months of therapy. Self-reported environmental sensitivities are observed in 15 percent of Americans.

Clinical risk management has been shaped by the growing consciousness of the number of errors, incidents, and near-misses that occur in healthcare and their impact on the safety of patients. Instead, patient safety emphasizes performance, team and system orientation, the regulatory framework, and patient centeredness. However, the patient safety movement, dealing either with the person or system approach, is only one aspect of patient safety. Risk perception, as a patient safety dimension, comes into play through personalized self-care. As a result, tailored health communication, that is, any combination of information and behavior change strategies, intended to reach one specific person based on information unique to that person, and derived from an individual assessment, is essential.

В статье рассматриваются особенности челленджей социальной сети TikTok и влияние их на психологическое благополучие подростка. Тематика роликов и трендов, представленных в приложении, не только сильно сказываются на восприятии и понимании молодыми людьми реальности, но и воздействуют на конструкцию самоидентификации подростков, их психологическое развитие, межличностное отношение и социальное поведение. The article discusses the features of the TikTok social network challenges and their impact on the psychological well-being of a teenager. The topics of videos and trends presented in the app not only have a strong impact on the perception and understanding of reality by young people, but also affect the structure of self-identification of teenagers, their psychological development, interpersonal attitude and social behavior.

Extensive experiments were performed aimed at obtaining physical insight into the behavior of in-line pin fin heat sinks with pins of square cross-section. Detailed pressure measurements were made inside an array of square pins in order to isolate the inlet, developing, fully developed, and exit static pressure distributions as a function of row number. With this as background data, overall pressure drop was measured for a self-consistent set of aluminum heat sinks in side inlet side exit flow, with top clearance only. Pin heights of 12.5 mm, 17.5 mm, and 22.5 mm, pin pitch of 3.4 mm to 6.33 mm, and pin thickness of 1.5 mm, 2 mm and 2.5mm were evaluated. Base dimensions were kept fixed at 25 × 25 mm. In total, 20 aluminum heat sinks were evaluated. A “two-branch by-pass model” was developed, by allowing inviscid acceleration of the flow in the bypass section, and using pressure loss coefficients obtained under no bypass conditions in the heat sink section. The experimental data compared well to the proposed hydraulic models. Measurements in the array of pins showed that full development of the flow occurs after nine rows, thus indicating that none of the heat sinks tested could be characterized as fully-developed.

Attention to safety and health are of ever-increasing priority to industrial organizations. Good Safety is demanded by stockholders, employees, and the community while increasing injury costs provide additional motivation for safety and health excellence. Safety has always been a strong corporate value of DuPont and a vital part of its culture. As a result, DuPont has become a benchmark in safety and health performance. Since 1990, DuPont has re-engineered itself to meet global competition and address future vision. In the new re-engineered organizational structures, DuPont has also had to re-engineer its safety management systems. A special Discovery Team was chartered by DuPont senior management to determine the “best practices’ for safety and health being used in DuPont best-performing sites. A summary of the findings is presented, and five of the practices are discussed. Excellence in safety and health management is more important today than ever. Public awareness, federal and state regulations, and enlightened management have resulted in a widespread conviction that all employees have the right to work in an environment that will not adversely affect their safety and health. In DuPont, we believe that excellence in safety and health is necessary to achieve global competitiveness, maintain employee loyalty, and be an accepted member of the communities in which we make, handle, use, and transport products. Safety can also be the “catalyst” to achieving excellence in other important business parameters. The organizational and communication skills developed by management, individuals, and teams in safety can be directly applied to other company initiatives. As we look into the 21st Century, we must also recognize that new organizational structures (flatter with empowered teams) will require new safety management techniques and systems in order to maintain continuous improvement in safety performance. Injury costs, which have risen dramatically in the past twenty years, provide another incentive for safety and health excellence. Shown in the Figure 1, injury costs have increased even after correcting for inflation. Many companies have found these costs to be an “invisible drain” on earnings and profitability. In some organizations, significant initiatives have been launched to better manage the workers’ compensation systems. We have found that the ultimate solution is to prevent injuries and incidents before they occur. A globally-respected company, DuPont is regarded as a well-managed, extremely ethical firm that is the benchmark in industrial safety performance. Like many other companies, DuPont has re-engineered itself and downsized its operations since 1985. Through these changes, we have maintained dedication to our principles and developed new techniques to manage in these organizational environments. As a diversified company, our operations involve chemical process facilities, production line operations, field activities, and sales and distribution of materials. Our customer base is almost entirely industrial and yet we still maintain a high level of consumer awareness and positive perception. The DuPont concern for safety dates back to the early 1800s and the first days of the company. In 1802 E.I. DuPont, a Frenchman, began manufacturing quality grade explosives to fill America’s growing need to build roads, clear fields, increase mining output, and protect its recently won independence. Because explosives production is such a hazardous industry, DuPont recognized and accepted the need for an effective safety effort. The building walls of the first powder mill near Wilmington, Delaware, were built three stones thick on three sides. The back remained open to the Brandywine River to direct any explosive forces away from other buildings and employees. To set the safety example, DuPont also built his home and the homes of his managers next to the powder yard. An effective safety program was a necessity. It represented the first defense against instant corporate liquidation. Safety needs more than a well-designed plant, however. In 1811, work rules were posted in the mill to guide employee work habits. Though not nearly as sophisticated as the safety standards of today, they did introduce an important basic concept — that safety must be a line management responsibility. Later, DuPont introduced an employee health program and hired a company doctor. An early step taken in 1912 was the keeping of safety statistics, approximately 60 years before the federal requirement to do so. We had a visible measure of our safety performance and were determined that we were going to improve it. When the nation entered World War I, the DuPont Company supplied 40 percent of the explosives used by the Allied Forces, more than 1.5 billion pounds. To accomplish this task, over 30,000 new employees were hired and trained to build and operate many plants. Among these facilities was the largest smokeless powder plant the world had ever seen. The new plant was producing granulated powder in a record 116 days after ground breaking. The trends on the safety performance chart reflect the problems that a large new work force can pose until the employees fully accept the company’s safety philosophy. The first arrow reflects the World War I scale-up, and the second arrow represents rapid diversification into new businesses during the 1920s. These instances of significant deterioration in safety performance reinforced DuPont’s commitment to reduce the unsafe acts that were causing 96 percent of our injuries. Only 4 percent of injuries result from unsafe conditions or equipment — the remainder result from the unsafe acts of people. This is an important concept if we are to focus our attention on reducing injuries and incidents within the work environment. World War II brought on a similar set of demands. The story was similar to World War I but the numbers were even more astonishing: one billion dollars in capital expenditures, 54 new plants, 75,000 additional employees, and 4.5 billion pounds of explosives produced — 20 percent of the volume used by the Allied Forces. Yet, the performance during the war years showed no significant deviation from the pre-war years. In 1941, the DuPont Company was 10 times safer than all industry and 9 times safer than the Chemical Industry. Management and the line organization were finally working as they should to control the real causes of injuries. Today, DuPont is about 50 times safer than US industrial safety performance averages. Comparing performance to other industries, it is interesting to note that seemingly “hazard-free” industries seem to have extraordinarily high injury rates. This is because, as DuPont has found out, performance is a function of injury prevention and safety management systems, not hazard exposure. Our success in safety results from a sound safety management philosophy. Each of the 125 DuPont facilities is responsible for its own safety program, progress, and performance. However, management at each of these facilities approaches safety from the same fundamental and sound philosophy. This philosophy can be expressed in eleven straightforward principles. The first principle is that all injuries can be prevented. That statement may seem a bit optimistic. In fact, we believe that this is a realistic goal and not just a theoretical objective. Our safety performance proves that the objective is achievable. We have plants with over 2,000 employees that have operated for over 10 years without a lost time injury. As injuries and incidents are investigated, we can always identify actions that could have prevented that incident. If we manage safety in a proactive — rather than reactive — manner, we will eliminate injuries by reducing the acts and conditions that cause them. The second principle is that management, which includes all levels through first-line supervisors, is responsible and accountable for preventing injuries. Only when senior management exerts sustained and consistent leadership in establishing safety goals, demanding accountability for safety performance and providing the necessary resources, can a safety program be effective in an industrial environment. The third principle states that, while recognizing management responsibility, it takes the combined energy of the entire organization to reach sustained, continuous improvement in safety and health performance. Creating an environment in which employees feel ownership for the safety effort and make significant contributions is an essential task for management, and one that needs deliberate and ongoing attention. The fourth principle is a corollary to the first principle that all injuries are preventable. It holds that all operating exposures that may result in injuries or illnesses can be controlled. No matter what the exposure, an effective safeguard can be provided. It is preferable, of course, to eliminate sources of danger, but when this is not reasonable or practical, supervision must specify measures such as special training, safety devices, and protective clothing. Our fifth safety principle states that safety is a condition of employment. Conscientious assumption of safety responsibility is required from all employees from their first day on the job. Each employee must be convinced that he or she has a responsibility for working safely. The sixth safety principle: Employees must be trained to work safely. We have found that an awareness for safety does not come naturally and that people have to be trained to work safely. With effective training programs to teach, motivate, and sustain safety knowledge, all injuries and illnesses can be eliminated. Our seventh principle holds that management must audit performance on the workplace to assess safety program success. Comprehensive inspections of both facilities and programs not only confirm their effectiveness in achieving the desired performance, but also detect specific problems and help to identify weaknesses in the safety effort. The Company’s eighth principle states that all deficiencies must be corrected promptly. Without prompt action, risk of injuries will increase and, even more important, the credibility of management’s safety efforts will suffer. Our ninth principle is a statement that off-the-job safety is an important part of the overall safety effort. We do not expect nor want employees to “turn safety on” as they come to work and “turn it off” when they go home. The company safety culture truly becomes of the individual employee’s way of thinking. The tenth principle recognizes that it’s good business to prevent injuries. Injuries cost money. However, hidden or indirect costs usually exceed the direct cost. Our last principle is the most important. Safety must be integrated as core business and personal value. There are two reasons for this. First, we’ve learned from almost 200 years of experience that 96 percent of safety incidents are directly caused by the action of people, not by faulty equipment or inadequate safety standards. But conversely, it is our people who provide the solutions to our safety problems. They are the one essential ingredient in the recipe for a safe workplace. Intelligent, trained, and motivated employees are any company’s greatest resource. Our success in safety depends upon the men and women in our plants following procedures, participating actively in training, and identifying and alerting each other and management to potential hazards. By demonstrating a real concern for each employee, management helps establish a mutual respect, and the foundation is laid for a solid safety program. This, of course, is also the foundation for good employee relations. An important lesson learned in DuPont is that the majority of injuries are caused by unsafe acts and at-risk behaviors rather than unsafe equipment or conditions. In fact, in several DuPont studies it was estimated that 96 percent of injuries are caused by unsafe acts. This was particularly revealing when considering safety audits — if audits were only focused on conditions, at best we could only prevent four percent of our injuries. By establishing management systems for safety auditing that focus on people, including audit training, techniques, and plans, all incidents are preventable. Of course, employee contribution and involvement in auditing leads to sustainability through stakeholdership in the system. Management safety audits help to make manage the “behavioral balance.” Every job and task performed at a site can do be done at-risk or safely. The essence of a good safety system ensures that safe behavior is the accepted norm amongst employees, and that it is the expected and respected way of doing things. Shifting employees norms contributes mightily to changing culture. The management safety audit provides a way to quantify these norms. DuPont safety performance has continued to improve since we began keeping records in 1911 until about 1990. In the 1990–1994 time frame, performance deteriorated as shown in the chart that follows: This increase in injuries caused great concern to senior DuPont management as well as employees. It occurred while the corporation was undergoing changes in organization. In order to sustain our technological, competitive, and business leadership positions, DuPont began re-engineering itself beginning in about 1990. New streamlined organizational structures and collaborative work processes eliminated many positions and levels of management and supervision. The total employment of the company was reduced about 25 percent during these four years. In our traditional hierarchical organization structures, every level of supervision and management knew exactly what they were expected to do with safety, and all had important roles. As many of these levels were eliminated, new systems needed to be identified for these new organizations. In early 1995, Edgar S. Woolard, DuPont Chairman, chartered a Corporate Discovery Team to look for processes that will put DuPont on a consistent path toward a goal of zero injuries and occupational illnesses. The cross-functional team used a mode of “discovery through learning” from as many DuPont employees and sites around the world. The Discovery Team fostered the rapid sharing and leveraging of “best practices” and innovative approaches being pursued at DuPont’s plants, field sites, laboratories, and office locations. In short, the team examined the company’s current state, described the future state, identified barriers between the two, and recommended key ways to overcome these barriers. After reporting back to executive management in April, 1995, the Discovery Team was realigned to help organizations implement their recommendations. The Discovery Team reconfirmed key values in DuPont — in short, that all injuries, incidents, and occupational illnesses are preventable and that safety is a source of competitive advantage. As such, the steps taken to improve safety performance also improve overall competitiveness. Senior management made this belief clear: “We will strengthen our business by making safety excellence an integral part of all business activities.” One of the key findings of the Discovery Team was the identification of the best practices used within the company, which are listed below: ▪ Felt Leadership – Management Commitment ▪ Business Integration ▪ Responsibility and Accountability ▪ Individual/Team Involvement and Influence ▪ Contractor Safety ▪ Metrics and Measurements ▪ Communications ▪ Rewards and Recognition ▪ Caring Interdependent Culture; Team-Based Work Process and Systems ▪ Performance Standards and Operating Discipline ▪ Training/Capability ▪ Technology ▪ Safety and Health Resources ▪ Management and Team Audits ▪ Deviation Investigation ▪ Risk Management and Emergency Response ▪ Process Safety ▪ Off-the-Job Safety and Health Education Attention to each of these best practices is essential to achieve sustained improvements in safety and health. The Discovery Implementation in conjunction with DuPont Safety and Environmental Management Services has developed a Safety Self-Assessment around these systems. In this presentation, we will discuss a few of these practices and learn what they mean. Paper published with permission.