Biomedical subjects

B Oldenburg

Publications and source records attributed to B Oldenburg.

At least 55 records · Page 3Linked to original sources

PubMed1995

Preventive care in general practice in Australia: a public health perspective.

There is considerable potential in Australia for implementing effective preventive care strategies in the general practice setting, especially in the context of Australia's new health goals and targets towards the year 2000. There is a clear need for the clinical paradigm, which focuses on developing efficacious, intensive, practitioner-delivered lifestyle change interventions, to be integrated within a broader public health approach. However, while there has been considerable growth in the breath and variety of health promotion research and activity being carried out in general practice in Australia, the evidence supportive of the efficacy and effectiveness of physician-based interventions (except in the case of smoking cessation) has been less than compelling, and a number of problems still remain. These include: health promotion still remains a minor component of the great majority of consultations; there are many potential interventions which are possible, but little evidence that they will be used appropriately; there is little evidence that patients who are most in need are receiving appropriate services; there is generally a poor linkage between research and practice; and there are real doubts about the ability of the system to sustain preventive care in general practice.

Australia↗

PubMed1995

PEAPS-Q: a questionnaire to measure the psychosocial effects of having an abnormal pap smear. Psychosocial Effects of Abnormal Pap Smears Questionnaire.

We have developed the Psychosocial Effects of Abnormal Pap Smears Questionnaire (PEAPS-Q) which measures distress experienced by women undergoing follow-up investigation after an abnormal Pap smear result. A thorough literature review and qualitative research resulted in the development of a questionnaire which was tested on 350 women attending a Family Planning New South Wales (FPNSW) clinic. This sample included women at different stages of management after detection of a cervical abnormality: 93 first colposcopy clients and 257 follow-up colposcopy clients. Factor analysis identified four dimensions of distress: experience of medical procedures, beliefs/feelings about cervical abnormality and changes in perception of oneself, worry about infectivity and effect on sexual relationships. Repeatability of the PEAPS-Q was indicated by intra-class correlations of 0.88 overall and at least 0.60 for each scale. Internal consistency was shown by Cronbach's alpha of 0.84 overall and at least 0.72 for each scale. Validity was demonstrated by the correlation of scale scores with the 12-item General Health Questionnaire (GHQ) score of 0.32 (95% CI 0.22-0.41). The PEAPS-Q is a valid, reliable and multidimensional instrument for quantifying distress experienced by women with abnormal Pap smears.

Adult↗

PubMed1995

Randomised trial of an asthma self-management programme for adults.

BACKGROUND: A hospital based, community service asthma education programme for adults to improve asthma knowledge, promote compliance with medication, and reduce morbidity was evaluated. METHODS: The programme was evaluated using a randomised experimental and control group design with repeated measurements over 12 months. A volunteer community sample of 192 respondents was recruited of whom 116 satisfied the inclusion criteria. At the 12 month follow up some data were obtained for all subjects. Intervention subjects attended four 2.5 hour education sessions at weekly intervals. An asthma knowledge questionnaire was administered and compliance was assessed from diary records. Morbidity was assessed retrospectively by questionnaire, prospectively by diary, and objectively by spirometry and serial peak expiratory flow rate monitoring. The adequacy of medical treatment was also assessed. Data were collected at baseline, immediately after the intervention, and at three, six, nine, and 12 months after intervention. RESULTS: Improvements occurred in knowledge and compliance in the intervention group but the impact on morbidity was modest; this was due, at least in part, to the inadequacy of medical treatment. CONCLUSIONS: Treatment of asthma should be reviewed and optimised in conjunction with self-management programmes in order to improve health outcomes.

Adolescent↗

PubMed1995

An economic evaluation of four work site based cardiovascular risk factor interventions.

We used outcome data from a randomized work site intervention trial to examine the cost-effectiveness of four cardiovascular disease (CVD) risk reduction programs: health risk assessment (HRA), risk factor education (RFE), behavioral counseling (BC), and behavioral counseling plus incentives (BCI). Composite CVD risk scores were derived from measures of serum total cholesterol, blood pressure, number of cigarettes smoked, body mass index, and aerobic capacity. The economic evaluation of the programs focused on the subset of costs most sensitive to the differences between the interventions, and a sensitivity analysis examined some of the relevant cost variations. At the 6-month follow-up (i.e., the "action" or initiation stage of lifestyle change), the RFE, BC, and BCI interventions produced a significant reduction in cardiovascular risk. Incremental analyses demonstrated RFE to be more cost-effective, but not as clinically effective as BC; BC was more cost-effective than RFE when assessment costs were included, and BCI was judged to be the least cost-effective. At the 12-month follow-up (i.e., the "maintenance" stage of lifestyle of change), BC was the only program found to produce a significant reduction in CVD risk. Individualized behavioral counseling was found to be a cost-effective strategy for the initiation and maintenance of CVD risk factor reduction.

Adult↗

PubMed1995

Serial mass-media campaigns to promote physical activity: reinforcing or redundant?

Changes associated with two serial, nationwide, mass-media-based campaigns to promote physical activity conducted by the National Heart Foundation of Australia in 1990 and 1991 were examined. Surveys conducted before and after each campaign found statistically significant differences in message awareness (46% vs 71% in 1990; 63% vs 74% in 1991). In 1990, there were significant increases in walking, particularly among older people, and in intentions to exercise. No such changes were apparent in 1991. In the case of these two campaigns, conducted 1 year apart, the second may have been redundant.

Adolescent↗

PubMed1995

Tourist health services at tropical island resorts.

An unfamiliar holiday environment may give rise to a range of common and unique medical conditions and injuries. Based on a six-month retrospective analysis of clinic records, the present study reports a detailed profile of health services provided for guests at three tropical island tourist resorts. A total of 1183 clinic visits were analysed; 735 (62 per cent) concerned medical conditions, while 448 (38 per cent) were related to injuries. The most common medical conditions treated were respiratory, digestive, skin problems, eye disorders, and genito-urinary complaints. Injuries included lacerations, bites and stings, sprains and fractures. Health services consisted mainly of medication, specialist nursing care and first aid. Study findings highlight the advantages of using an internationally accepted classification system for primary health research, and the critical role of the nurse in tourist health services.

Australia↗

PubMed1994

Work-site cholesterol screening and dietary intervention: the Staff Healthy Heart Project. Steering Committee.

OBJECTIVES: The Staff Healthy Heart Project was established to run a work-site cholesterol screening project and a randomized controlled trial of dietary interventions. METHODS: Screening was offered to all staff at six Australian hospitals. Participants with blood cholesterol of 5.2 mmol/L (200 mg/dL) or above were randomly allocated to receive screening only (control group), a self-help package, or a nutrition course. Participants were seen 3 and 6 months after intervention to measure blood cholesterol and dietary changes. RESULTS: Eighty percent of available staff (n = 2638) were screened. Of those eligible, 67% (n = 683) entered the trial. Follow-up measures of blood cholesterol and dietary intake were obtained for 63% and 38% of trial participants, respectively. A reduction in reported dietary fat was found for all groups, but there were no significant differences between groups. Reported dietary fiber rose by 0.6 g/MJ/day for those in the nutrition course. There were no changes in total blood or high-density lipoprotein cholesterol. CONCLUSIONS: Cholesterol reduction was not demonstrated, but this result is difficult to interpret given the poor ongoing participation rates. Strategies to improve ongoing participation in work-site projects are needed to achieve adequate assessment of dietary interventions used in cholesterol screening.

Adolescent↗

PubMed1993

Population prevalence and correlates of stages of change in physical activity.

Stages of change for exercise, sociodemographic variables, and beliefs about the health benefits of exercise were obtained for a representative sample of Australian adults (N = 4404). Logistic regression analysis was used to examine the relationship between exercise stage of change and sociodemographic variables and beliefs about the benefits of exercise. Thirteen percent of respondents stated that they did not exercise and did not intend to start; 10% stated that they did not exercise but were thinking of starting; 16% stated that they exercise occasionally and were not thinking of doing more; 23% stated that they exercised occasionally and were thinking of doing more; and 38% stated that they exercised regularly and intended to continue. Intention to do more exercise generally decreased with increasing age, but increased with level of education. An increased frequency of exercise and an intention to do more exercise was associated with the belief that exercise would help to prevent heart disease and with a higher level of education. The results provide a useful profile of the exercise habits (and intention to change those habits) of population subgroups. Public communication campaigns on the benefits of physical activity should focus particularly on those who do not intend to exercise, older adults, and the less well educated.

Adolescent↗

PubMed1993

Work-site cardiovascular risk reduction: a randomized trial of health risk assessment, education, counseling, and incentives.

OBJECTIVES: This study reports an efficacy trial of four work-site health promotion programs. It was predicted that strategies making use of behavioral counseling would produce a greater reduction in cardiovascular disease risk factors than screening and educational strategies. METHODS: Twenty-eight work sites were randomly allocated to a health risk assessment, risk factor education, behavioral counseling, or behavioral counseling plus incentives intervention. Participants were assessed before the intervention and at 3, 6, and 12 months. RESULTS: Compared with the average of the health risk assessment and risk factor education conditions, there were significantly higher validated continuous smoking cessation rates and smaller increases in body mass index and estimated percentage of body fat in the two behavioral counseling conditions. The behavioral counseling condition was associated with a greater reduction in mean blood pressure than was the behavioral counseling plus incentives condition. On average among all groups, there was a short-term increase in aerobic capacity followed by a return to baseline levels. CONCLUSIONS: Work-site interventions that use behavioral approaches can produce lasting changes in some cardiovascular risk factors and, if implemented routinely, can have a significant public health impact.

Adult↗

PubMed1992

Prevalences and perceptions of licit and illicit drugs among New South Wales secondary school students, 1989.

This paper presents findings on drug prevalences for licit and illicit drugs among New South Wales secondary school students (n = 3753) in late 1989. It also considers the accuracy of students' perceptions of the drug causing the most and fewest drug-related deaths. Data were analysed by age and gender, using logistic regression for the prevalence data. Findings indicate that licit drugs (tobacco, alcohol and analgesics) were the most frequently and widely used. Rates for illicit drugs were low, although there was some degree of experimental use of cannabis which increased amongst older males. Perceptions were found to be inaccurate in emphasising the dangers of the illicit drug heroin over those of the licit drugs tobacco and alcohol. Reasons for these findings are discussed, and more in-depth research recommended into the relationship between drug prevalences and perceptions for different age groups, and its relevance for planning drug prevention initiatives.

Adolescent↗

PubMed1992

Changes in reported drug prevalence among New South Wales secondary school students, 1983 to 1989.

Three drug use surveys employing a standardised questionnaire format and sampling procedure were conducted on samples of New South Wales school students in 1983, 1986 and 1989. Alcohol and tobacco were the most frequently used substances across the surveys, with rates of use of illicit substances being considerably lower. Declines in the prevalence of alcohol, tobacco and stimulant use were found between 1983 and 1986 and between 1986 and 1989 for both males and females. Rates of use of inhalants, sedatives, hallucinogens and narcotics declined between 1983 and 1986, but remained unchanged between the 1986 and 1989 samples. Cannabis use declined significantly among females between 1983 and 1989, but not among males. Possible reasons for the general decline in drug use over the six-year period are discussed.

Adolescent↗

PubMed1992

Lifestyle change and cardiovascular disease. Principles and practice.

Changes in patients' lifestyles can be approached in a practical fashion by working through the relevant 'stages of change'. Helping patients to change their lifestyles does not have to be a very time-consuming process for the clinician, but it does require planning, and attention to those factors that are important at each stage of the process. Although this paper has a focus on lifestyle change for the reduction of CVD risk factors, the same principles can apply to lifestyle change and disease prevention for other disorders.

Cardiovascular Diseases↗

PubMed1992

Lifestyle change and cardiovascular disease. Evidence and issues.

Lifestyle change is an area in which the medical practitioner has a great deal to offer: to high-risk patients and to individuals generally. The evidence supporting the cardiovascular health benefits of lifestyle change comes from a variety of scientific sources. While the recent large-scale intervention studies have not always had unequivocal outcomes, on balance, the epidemiological evidence points to the central importance of lifestyle change in reducing CVD risk. Recently the United States Preventive Services Task Force22 has published guidelines on lifestyle change and other interventions for CVD risk and for a range of other preventable health problems. The United States Task Force's recommendations have been favourably reviewed by the National Health and Medical Research Council in Australia, and are considered to be relevant to medical practice in this country.

Cardiovascular Diseases↗

PubMed1992

Cardiovascular risk reduction through lifestyle change in clinical settings.

A large amount of observational and experimental research has demonstrated that lifestyle factors are important determinants of cardiovascular disease. In particular, epidemiological evidence from large, controlled multiple risk factor intervention trials and research examining the effects of secular changes in lifestyle on changing morbidity and mortality rates indicate that changes in lifestyle can reduce the risk of coronary heart disease (CHD). This paper provides an overview of the lifestyle change process and provides guidelines for increasing the efficacy of lifestyle change interventions in clinical settings.

Cardiovascular Diseases↗

PubMed1990

The NSW Ambulance Service healthy lifestyle program--a case study in the evaluation of a health promotion program.

A variety of approaches have been used to reduce Cardiovascular Disease (CVD) risk in the community, including programs based in the workplace. To date, it has been difficult to draw accurate conclusions on the effectiveness of worksite CVD risk reduction programs. Typically, such programs suffer from poor participation and high attrition rates and most lack physical and biochemical validation of self-reported lifestyle changes. The present paper describes an evaluation of four health promotion worksite interventions (screening, education, incentive and lifestyle change) conducted in the NSW Ambulance Service. The study achieved very high participation and low attrition rates. Self-reported changes in lifestyle were validated with physical and biochemical measures. The results suggest greater change in some risk factors for those individuals receiving the incentive and lifestyle change programs compared to screening alone or education.

Ambulances↗

PubMed1989

Coronary risk factor outcomes following coronary artery bypass surgery.

The coronary risk factor status of patients prior to and following coronary artery bypass surgery (CABG) has been poorly investigated. Two consecutive series of CABG patients were surveyed following CABG. One hundred and thirty patients were assessed immediately following CABG and 530 patients were assessed 12-30 months following CABG. For the long-term post-CABG group, over 80% of those who had ever smoked had ceased. Sixty-four per cent of these males and 50% of females were classified as being overweight. Twenty-five per cent of males and 34% of females reportedly had high serum cholesterol (i.e. greater than or equal to 6.5 mmol/L). Comparing these CABG data with age-adjusted National Heart Foundation Risk Factor Prevalence Survey data, there was a higher prevalence of ex-smokers, overweight, hypertension, and elevated cholesterol. It was concluded that on most coronary risk factors, except for smoking, these CABG patients had a worse profile than the general Australian community. This problem warrants further research and the development of appropriate treatment programs.

Adult↗

PubMed1988

Controlled trial of enalapril in patients with chronic fluid overload undergoing dialysis.

About one third of patients receiving dialysis for end stage renal failure have chronic fluid overload despite advice to restrict their oral fluid intake. To investigate the potential of an angiotensin converting enzyme inhibitor in reducing the urge to drink and consequent gain in weight, a double blind, placebo controlled crossover trial of enalapril was conducted in 25 patients receiving dialysis who had fluid overload. The trial comprised a baseline period of four weeks; two periods of treatment, each of four weeks, during which patients received either placebo or enalapril 5 mg twice each week; and a follow up period of four weeks. Five patients withdrew from the trial, one because of an adverse drug reaction to enalapril. A range of biochemical and behavioural variables was measured during the baseline period, at the completion of periods 1 and 2, and during follow up. These variables included gain in weight between dialysis sessions; blood pressure; plasma concentrations of sodium, angiotensin II, and vasopressin; plasma renin and angiotensin converting enzyme activities; osmolality; and estimations of thirst, intake of fluid, and control of drinking. Enalapril caused a significant reduction in gain in weight between dialysis sessions, thirst, and oral intake of fluid in parallel with significantly increased renin activity, significantly decreased angiotensin converting enzyme activity, and decreased concentrations of angiotensin II. Gain in weight and angiotensin converting enzyme activity returned to baseline values once patients stopped taking enalapril. These results suggest that enalapril may act on the renin-angiotensin system and reduce intake of fluid by inhibiting angiotensin converting enzyme.

Blood Pressure↗

PubMed1988

Prevention of exercise-induced muscle membrane damage by oestradiol.

Exercise can damage the muscle membrane, followed by leakage of certain muscle proteins into the bloodstream. This postexercise response differs for males and females; as an explanation for this difference it has been suggested that oestrogens have a protective effect on the female muscle membrane. We recently developed an animal exercise model in which postexercise damage can be studied in laboratory animals in vivo. A postexercise dimorphism, similar to that in humans, exists in rats and indirect evidence for the involvement of oestradiol (E2) was found. We report here 1) that ovariectomized females show postexercise damage like males, 2) that this response can be prevented by E2-replacement before exercise, and 3) that males, after E2-treatment, no longer show postexercise muscle damage. We therefore conclude that oestradiol indeed plays an important role in protecting skeletal muscle, both in females and in males.

Animals↗