ContextDespite wide promulgation, clinical practice guidelines have had limited
effect on changing physician behavior. Little is known about the process and
factors involved in changing physician practices in response to guidelines.ObjectiveTo review barriers to physician adherence to clinical practice guidelines.Data SourcesWe searched the MEDLINE, Educational Resources Information Center (ERIC),
and HealthSTAR databases (January 1966 to January 1998); bibliographies; textbooks
on health behavior or public health; and references supplied by experts to
find English-language article titles that describe barriers to guideline adherence.Study SelectionOf 5658 articles initially identified, we selected 76 published studies
describing at least 1 barrier to adherence to clinical practice guidelines,
practice parameters, clinical policies, or national consensus statements.
One investigator screened titles to identify candidate articles, then 2 investigators
independently reviewed the texts to exclude articles that did not match the
criteria. Differences were resolved by consensus with a third investigator.Data ExtractionTwo investigators organized barriers to adherence into a framework according
to their effect on physician knowledge, attitudes, or behavior. This organization
was validated by 3 additional investigators.Data SynthesisThe 76 articles included 120 different surveys investigating 293 potential
barriers to physician guideline adherence, including awareness (n = 46), familiarity
(n = 31), agreement (n = 33), self-efficacy (n = 19), outcome expectancy (n
= 8), ability to overcome the inertia of previous practice (n = 14), and absence
of external barriers to perform recommendations (n = 34). The majority of
surveys (70 [58%] of 120) examined only 1 type of barrier.ConclusionsStudies on improving physician guideline adherence may not be generalizable,
since barriers in one setting may not be present in another. Our review offers
a differential diagnosis for why physicians do not follow practice guidelines,
as well as a rational approach toward improving guideline adherence and a
framework for future research.

https://www.ghdonline.org/uploads/Cabana_1999_JAMA_-_Why_dont_physicians_follow_clinical_practice_guidelines_-_a_framework_for_improvement.pdf

Why Don't Physicians Follow Clinical Practice Guidelines?: A Framework for Improvement

SALLIS, J. F., J. J. PROCHASKA, and W. C. TAYLOR. A review of correlates of physical activity of children and adolescents. Med. Sci. Sports Exerc., Vol. 32, No. 5, pp. 963‐975, 2000. Background: Understanding the factors that influence physical activity can aid the design of more effective interventions. Previous reviews of correlates of youth physical activity have produced conflicting results. Methods: A comprehensive review of correlates of physical activity was conducted, and semiquantitative results were summarized separately for children (ages 3‐12) and adolescents (ages 13‐18). The 108 studies evaluated 40 variables for children and 48 variables for adolescents. Results: About 60% of all reported associations with physical activity were statistically significant. Variables that were consistently associated with children’s physical activity were sex (male), parental overweight status, physical activity preferences, intention to be active, perceived barriers (inverse), previous physical activity, healthy diet, program/facility access, and time spent outdoors. Variables that were consistently associated with adolescents’ physical activity were sex (male), ethnicity (white), age (inverse), perceived activity competence, intentions, depression (inverse), previous physical activity, community sports, sensation seeking, sedentary after school and on weekends (inverse), parent support, support from others, sibling physical activity, direct help from parents, and opportunities to exercise. Conclusion: These consistently related variables should be confirmed in prospective

A review of correlates of physical activity of children and adolescents.

Objectives: Lao Juan (LJ, 劳倦) is a syndrome described in Chinese medicine (CM) that manifests with : Lao Juan (LJ, 劳倦) is a syndrome described in Chinese medicine (CM) that manifests with fatigue, fever, spontaneous sweating, indigestion, work-induced pain, weakness of the limbs, and shortness of breath. fatigue, fever, spontaneous sweating, indigestion, work-induced pain, weakness of the limbs, and shortness of breath. The present study was conducted to examine the reliability and validity of a Lao Juan Questionnaire (LJQ). The present study was conducted to examine the reliability and validity of a Lao Juan Questionnaire (LJQ). Methods: A total of 151 outpatients and 73 normal subjects were asked to complete the LJQ. Seventy-three normal subjects A total of 151 outpatients and 73 normal subjects were asked to complete the LJQ. Seventy-three normal subjects were additionally asked to complete the Chalder Fatigue Scale (CFS). Twelve clinicians determined whether the were additionally asked to complete the Chalder Fatigue Scale (CFS). Twelve clinicians determined whether the 151 outpatients exhibited LJ or not. The internal consistency and construct validity for the LJQ were estimated using 151 outpatients exhibited LJ or not. The internal consistency and construct validity for the LJQ were estimated using data from the outpatient subjects. The CFS data were used to examine the concurrent validity of the LJQ. Total LJQ data from the outpatient subjects. The CFS data were used to examine the concurrent validity of the LJQ. Total LJQ scores and the clinicians' diagnoses of the outpatients were used to perform receiver operating characteristics (ROC) scores and the clinicians' diagnoses of the outpatients were used to perform receiver operating characteristics (ROC) curve analyses and to defi ne an optimum cut-off score for the LJQ. curve analyses and to defi ne an optimum cut-off score for the LJQ. Results: The 19-item LJQ had satisfactory internal : The 19-item LJQ had satisfactory internal consistency (α=0.828) and concurrent validity, with signifi cant correlations between the LJQ and the CFS subscales. consistency (α=0.828) and concurrent validity, with signifi cant correlations between the LJQ and the CFS subscales. In the test of construct validity using principal component analysis, a total of six factors were extracted, and the overall In the test of construct validity using principal component analysis, a total of six factors were extracted, and the overall variance explained by all factors was 59.5%. In ROC curve analyses, the sensitivity, specifi city, and area under the variance explained by all factors was 59.5%. In ROC curve analyses, the sensitivity, specifi city, and area under the curve were 76.0%, 59.2%, and 0.709, respectively. The optimum cut-off score was defi ned as six points. curve were 76.0%, 59.2%, and 0.709, respectively. The optimum cut-off score was defi ned as six points. Conclusions: Our results suggest that the LJQ is a reliable and valid instrument for evaluating LJ. Our results suggest that the LJQ is a reliable and valid instrument for evaluating LJ. KEYWORDS Chinese medicine, chronic fatigue syndrome, Chinese medicine-pattern Chinese medicine, chronic fatigue syndrome, Chinese medicine-pattern

Development and Validation of A

This article examines health promotion and disease prevention from the perspective of social cognitive theory. The areas of overlap with some of the most widely applied psychosocial models of health are identified. The models of health promotion and disease prevention have undergone several generational changes. We have shifted from trying to scare people into health, to rewarding them into health, to equipping them with self-regulatory skills to manage their health habits, to shoring up their habit changes with dependable social supports. These transformations have evolved a multifaceted approach that addresses the reciprocal interplay between self-regulatory and environmental determinants of health behavior. Social cognitive theory addresses the socio structural determinants of health as well as the personal determinants. A comprehensive approach to health promotion requires changing the practices of social systems that have widespread detrimental effects on health rather than solely changing t...

https://www.uky.edu/~eushe2/Bandura/Bandura1998PH.pdf

Health promotion from the perspective of social cognitive theory

Obese individuals are highly stigmatized and face multiple forms of prejudice and discrimination because of their weight (1,2). The prevalence of weight discrimination in the United States has increased by 66% over the past decade (3), and is comparable to rates of racial discrimination, especially among women (4). Weight bias translates into inequities in employment settings, health-care facilities, and educational institutions, often due to widespread negative stereotypes that overweight and obese persons are lazy, unmotivated, lacking in selfdiscipline, less competent, noncompliant, and sloppy (2,5–7). These stereotypes are prevalent and are rarely challenged in Western society, leaving overweight and obese persons vulnerable to social injustice, unfair treatment, and impaired quality of life as a result of substantial disadvantages and stigma. In 2001, Puhl and Brownell published the first comprehensive review of several decades of research documenting bias and stigma toward overweight and obese persons (2). This review summarized weight stigma in domains of employment, health care, and education, demonstrating the vulnerability of obese persons to many forms of unfair treatment. Despite evidence of weight bias in important areas of living, the authors noted many gaps in research regarding the nature and extent of weight stigma in various settings, the lack of science on emotional and physical health consequences of weight bias, and the paucity of interventions to reduce negative stigma. In recent years, attention to weight bias has increased, with a growing recognition of the pervasiveness of weight bias and stigma, and its potential harmful consequences for obese persons. The aim of this article is to provide an update of scientific evidence on weight bias toward overweight and obese adults through a systematic review of published literature since the 2001 article by Puhl and Brownell. This review expands upon previous findings of weight bias in major domains of living, documents new areas where weight bias has been studied, and highlights ongoing research questions that need to be addressed to advance this field of study. A systematic literature search of studies published between January 2000 and May 2008 was undertaken on computerized psychological, medical, social science, sport, and education databases including PsycINFO, PubMed, SCOPUS, ERIC, and SPORTDiscus. The following keyword combinations were used: weight, obese, obesity, overweight, BMI, fat, fatness, size, heavy, large, appearance, big, heavyweight, bias, biased, discrimination, discriminatory, discriminate, stigma, stigmatized, stigmatization, prejudice, prejudicial, stereotype(s), stereotypical, stereotyping, victimization, victimize(d), blame(d), blaming, shame(d), shaming, teasing, tease(d), unfair, bully, bullying, harassment, assumptions, attributions, education, health, health care, sales, employment, wages, promotion, adoption, jury, customer service, housing, media, television. Reference lists of retrieved articles and books were also reviewed, and manual searches were conducted in the databases and journals for authors who had published in this field. Most studies retrieved for this review were published in the United States. Any articles published internationally are noted with their country of origin. Research on weight stigma in adolescents and children was excluded from this review, as this literature was recently reviewed elsewhere (8). Unpublished manuscripts and dissertations were also excluded. In addition, issues pertaining to measurement of weight stigmatization, and demographic variables affecting vulnerability to weight bias such as gender, age, race, and body weight are not addressed in this review. This article instead primarily reviews the evidence of specific areas where weight bias occurs toward adults and its consequences for those affected. This article is organized similarly to the first review published by Puhl and Brownell (2), with sections on weight bias in settings of employment, health care, and education. New sections have been added including weight bias in interpersonal relationships and the media, as well as psychological and physical health consequences of weight bias, and the status of stigma-reduction research. As with the 2001 article, this review also provides an update on legal initiatives to combat weight discrimination, and outlines specific questions for future research.

https://www.sochob.cl/pdf/obesidad_adulto/The%20Stigma%20of%20Obesity%20%20A%20Review%20and%20Update.pdf

The stigma of obesity: a review and update.

Given the results from early trials, COVID-19 vaccines will be available by 2021. However, little is known about what Americans think of getting immunized with a COVID-19 vaccine. Thus, the purpose of this study was to conduct a comprehensive and systematic national assessment of COVID-19 vaccine hesitancy in a community-based sample of the American adult population. A multi-item valid and reliable questionnaire was deployed online via mTurk and social media sites to recruit U.S. adults from the general population. A total of 1878 individuals participated in the study where the majority were: females (52%), Whites (74%), non-Hispanic (81%), married (56%), employed full time (68%), and with a bachelor's degree or higher (77%). The likelihood of getting a COVID-19 immunization in the study population was: very likely (52%), somewhat likely (27%), not likely (15%), definitely not (7%), with individuals who had lower education, income, or perceived threat of getting infected being more likely to report that they were not likely/definitely not going to get COVID-19 vaccine (i.e., vaccine hesitancy). In unadjusted group comparisons, compared to their counterparts, vaccine hesitancy was higher among African-Americans (34%), Hispanics (29%), those who had children at home (25%), rural dwellers (29%), people in the northeastern U.S. (25%), and those who identified as Republicans (29%). In multiple regression analyses, vaccine hesitancy was predicted significantly by sex, education, employment, income, having children at home, political affiliation, and the perceived threat of getting infected with COVID-19 in the next 1 year. Given the high prevalence of COVID-19 vaccine hesitancy, evidence-based communication, mass media strategies, and policy measures will have to be implemented across the U.S. to convert vaccines into vaccinations and mass immunization with special attention to the groups identified in this study.

/pdf/covid-19-vaccination-hesitancy-in-the-united-states-a-rapid-268e0s1cvo.pdf

COVID-19 Vaccination Hesitancy in the United States: A Rapid National Assessment.

In elementary schools, the prevalence of bullying ranges from 113% in Finland to 498% in Ireland The only United States study of elementary students found that 19% were bullied Bullying behavior declines as students progress through the grades School bullying is associated with numerous physical, mental, and social detriments A relationship also exists between student bullying behavior and school issues such as academic achievement, school bonding, and absenteeism Prevention of school bullying should become a priority issue for schools The most effective methods of bullying reduction involve a whole school approach This method includes assessing the problem, planning school conference days, providing better supervision at recess, forming a bullying prevention coordinating group, encouraging parent-teacher meetings, establishing classroom rules against bullying, holding classroom meetings about bullying, requiring talks with the bullies and victims, and scheduling talks with the parents of involved students Finally, this review suggests further studies needed to help ameliorate the bullying problem in US schools

The Nature and Extent of Bullying at School.

The purpose of this study was to assess the prevalence of sexting among sixth through twelfth grade students and its correlations with other risk behaviors. The survey was conducted in 35 different schools in a midwestern state. Overall, 17% of students engaged in sexting, which varied significantly by age (3% of 12-year-olds to 32% of 18-year-olds). Adjusted odds ratios found statistically significant correlations between sexting and sexual behaviors, substance use behaviors, emotional health behaviors, and time spent texting. Sexting should be addressed by parents, teachers, and mental health professionals who interact with adolescents.

Prevalence and Correlates of Sexting Behavior in Adolescents

COVID-19 vaccines were approved in late 2020 and early 2021 for public use in countries across the world. Several studies have now highlighted COVID-19 vaccination hesitancy in the general public. However, little is known about the nature and extent of COVID-19 vaccination hesitancy in healthcare workers worldwide. Thus, the purpose of this study was to conduct a comprehensive worldwide assessment of published evidence on COVID-19 vaccine hesitancy among healthcare workers. A scoping review method was adopted to include a final pool of 35 studies in this review with study sample size ranges from n = 123 to 16,158 (average = 2185 participants per study). The prevalence of COVID-19 vaccination hesitancy worldwide in healthcare workers ranged from 4.3 to 72% (average = 22.51% across all studies with 76,471 participants). The majority of the studies found concerns about vaccine safety, efficacy, and potential side effects as top reasons for COVID-19 vaccination hesitancy in healthcare workers. The majority of the studies also found that individuals who were males, of older age, and doctoral degree holders (i.e., physicians) were more likely to accept COVID-19 vaccines. Factors such as the higher perceived risk of getting infected with COVID-19, direct care for patients, and history of influenza vaccination were also found to increase COVID-19 vaccination uptake probability. Given the high prevalence of COVID-19 vaccine hesitancy in healthcare workers, communication and education strategies along with mandates for clinical workers should be considered to increase COVID-19 vaccination uptake in these individuals. Healthcare workers have a key role in reducing the burden of the pandemic, role modeling for preventive behaviors, and also, helping vaccinate others.

/pdf/the-nature-and-extent-of-covid-19-vaccination-hesitancy-in-1m16svq8jo.pdf

James H. Price

Papers

COVID-19 Vaccination Hesitancy in the United States: A Rapid National Assessment.

The Nature and Extent of Bullying at School.

Prevalence and Correlates of Sexting Behavior in Adolescents

The Nature and Extent of COVID-19 Vaccination Hesitancy in Healthcare Workers.

Family Practice Physicians’ Beliefs, Attitudes, and Practices Regarding Obesity