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Biomedical subjects

D G Simons-Morton

Publications and source records attributed to D G Simons-Morton.

At least 37 records · Page 2Linked to original sources
PubMed1998

Rapid early action for coronary treatment: rationale, design, and baseline characteristics. REACT Research Group.

OBJECTIVE: Early reperfusion for acute myocardial infarction (AMI) can reduce morbidity and mortality, yet there is often delay in accessing medical care after symptom onset. This report describes the design and baseline characteristics of the Rapid Early Action for Coronary Treatment (REACT) community trial, which is testing community intervention to reduce delay. METHODS: Twenty U.S. communities were pair-matched and randomly assigned within pairs to intervention or comparison. Four months of baseline data collection was followed by an 18-month intervention of community organization and public, patient, and health professional education. Primary cases were community residents seen in the ED with chest pain, admitted with suspected acute cardiac ischemia, and discharged with a diagnosis related to coronary heart disease. The primary outcome was delay time from symptom onset to ED arrival. Secondary outcomes included delay time in patients with MI/unstable angina, hospital case-fatality rate and length of stay, receipt of reperfusion, and ED/emergency medical services utilization. Impact on public and patient knowledge, attitudes, and intentions was measured by telephone interviews. Characteristics of communities and cases and comparability of paired communities at baseline were assessed. RESULTS: Baseline cases are 46% female, 14% minorities, and 73% aged > or =55 years, and paired communities have similar demographics characteristics. Median delay time (available for 72% of cases) is 2.3 hours and does not vary between treatment conditions (p > 0.86). CONCLUSIONS: REACT communities approximate the demographic distribution of the United States and there is baseline comparability between the intervention and comparison groups. The REACT trial will provide valuable information for community educational programs to reduce patient delay for AMI symptoms.

Adult↗
PubMed1997

Diet and blood pressure in children and adolescents.

Identifying dietary factors associated with blood pressure (BP) in children and adolescents would help guide recommendations for prevention of elevated BP, which is a major public health problem. This paper reviews 46 reports of studies examining relationships between dietary nutrients and BP in children and adolescents, many of which studied more than one nutrient. Sodium is the most extensively studied nutrient, with 25 observational and 12 intervention studies identified. Although many studies suffer from methodological problems, the results suggest that higher sodium intake is related to higher BP in children and adolescents. The results of 13 observational and 2 intervention studies of potassium and BP do not provide a clear picture of a relationship. The results of 8 observational and 1 intervention study of calcium and BP are inconclusive. Five observational studies of magnesium and BP provide evidence of an inverse relationship, but no intervention studies were identified. Nine studies of macronutrients and food groups or dietary patterns are inconclusive. Additional research is needed to provide more information about the relationships between dietary nutrients and BP in children and adolescents. Recommendations are provided for methodological features of additional research on diet and BP in children and adolescents.

Adolescent↗
PubMed1997

A meta-analysis of trials evaluating patient education and counseling for three groups of preventive health behaviors.

OBJECTIVES: To examine the overall effectiveness of patient education and counseling on preventive health behaviors and to examine the effects of various approaches for modifying specific types of behaviors. DATA SOURCES: Computerized databases (Medline, Healthline, Dissertation Abstracts, and Psychological Abstracts), bibliographies 1971-1994. Search terms (patient education, patient compliance, and self care) with modifiers (evaluation and specific preventive behaviors). STUDY SELECTION: Randomized and non-randomized controlled trials measuring behavior in clinical settings with patients without diagnosed disease. Abstracts and retrieved studies screened by multiple reviewers; 13% of retrieved studies met screening criteria. DATA EXTRACTION: Replicated coding by multiple observers. DATA SYNTHESIS: Behaviors were grouped based on whether the behavior is addictive and whether the desired change required subtraction of existing behaviors or adding new behaviors. The weighted average effect size from a random effects model for smoking/alcohol studies was 0.61 (CI = 0.45, 0.77), for nutrition/weight, 0.51 (CI = 0.20, 0.82) and for other behaviors, 0.56 (CI = 0.34, 0.77) indicating that the behavioral outcomes for these subgroups were significantly different from zero. Multiple regression models for the three groups indicated that using behavioral techniques, particularly self-monitoring, and using several communication channels, e.g., media plus personal communication, produces larger effects for the smoking/alcohol and nutrition/weight groups. CONCLUSIONS: Patient education and counseling contribute to behavior change for primary prevention of disease. Some techniques are more effective than others in changing specific behaviors.

Counseling↗
PubMed1997

Nutrient intake and blood pressure in the Dietary Intervention Study in Children.

Delineating the role that diet plays in blood pressure levels in children is important for guiding dietary recommendations for the prevention of hypertension. The purpose of this study was to investigate relationships between dietary nutrients and blood pressure in children. Data were analyzed from 662 participants in the Dietary Intervention Study in Children who had elevated low-density lipoprotein cholesterol and were aged 8 to 11 years at baseline. Three 24-hour dietary recalls, systolic pressure, diastolic pressure, height, and weight were obtained at baseline, 1 year, and 3 years. Nutrients analyzed were the micronutrients calcium, magnesium, and potassium; the macronutrients protein, carbohydrates, total fat, saturated fat, polyunsaturated fat, and monounsaturated fat; dietary cholesterol; and total dietary fiber. Baseline and 3-year longitudinal relationships were examined through multivariate models on diastolic and systolic pressures separately, controlling for height, weight, sex, and total caloric intake. The following associations were found in longitudinal analyses: analyzing each nutrient separately, for systolic pressure, inverse associations with calcium (P < .05); magnesium, potassium, and protein (all P < .01); and fiber (P < .05), and direct associations with total fat and monounsaturated fat (both P < .05); for diastolic pressure, inverse associations with calcium (P < .01); magnesium and potassium (both P < .05), protein (P < .01); and carbohydrates and fiber (both P < .05), and direct associations with polyunsaturated fat (P < .01) and monounsaturated fat (P < .05). Analyzing all nutrients simultaneously, for systolic pressure, direct association with total fat (P < .01); for diastolic pressure, inverse associations with calcium (P < .01) and fiber (P < .05), and direct association with total and monounsaturated fats (both P < .05). Results from this sample of children with elevated low-density lipoprotein cholesterol indicate that dietary calcium, fiber, and fat may be important determinants of blood pressure level in children.

Age Factors↗
PubMed1997

Safety of a fat-reduced diet: the Dietary Intervention Study in Children (DISC).

OBJECTIVE: To assess the relationship between energy intake from fat and anthropometric, biochemical, and dietary measures of nutritional adequacy and safety. DESIGN: Three-year longitudinal study of children participating in a randomized controlled trial; intervention and usual care group data pooled to assess effects of self-reported fat intake; longitudinal regression analyses of measurements at baseline, year 1, and year 3. PARTICIPANTS: Six hundred sixty-three children (362 boys and 301 girls), 8 to 10 years of age at baseline, with elevated low-density lipoprotein cholesterol, who are participants of the Dietary Intervention Study in Children. MEASURES: Energy intake from fat assessed from three 24-hour recalls at each time point was the independent variable. Outcomes were anthropometric measures (height, weight, body mass index, and sum of skinfolds), nutritional biochemical determinations (serum ferritin, zinc, retinol, albumin, beta-carotene, and vitamin E, red blood cell folate, and hemoglobin), and dietary micronutrients (vitamins A, C, E, thiamin, riboflavin, niacin, vitamins B-6, B-12, folate, calcium, iron, zinc, magnesium, and phosphorus). RESULTS: Lower fat intake was not related to anthropometric measures or serum zinc, retinol, albumin, beta-carotene, or vitamin E. Lower fat intake was related to: 1) higher levels of red blood cell folate and hemoglobin, with a trend toward higher serum ferritin; 2) higher intakes of folate, vitamin C, and vitamin A, with a trend toward higher iron intake; 3) lower intakes of calcium, zinc, magnesium, phosphorus, vitamin B-12, thiamin, niacin, and riboflavin; 4) increased risk of consuming less than two-thirds of the Recommended Dietary Allowances for calcium in girls at baseline, and zinc and vitamin E in boys and girls at all visits. CONCLUSIONS: Lower fat intakes during puberty are nutritionally adequate for growth and for maintenance of normal levels of nutritional biochemical measures, and are associated with beneficial effects on blood folate and hemoglobin. Although lower fat diets were related to lower self-reported intakes of several nutrients, no adverse effects were observed on blood biochemical measures of nutritional status. Current public health recommendations for moderately lower fat intakes in children during puberty may be followed safely.

Adipose Tissue↗
PubMed1996

Funding avenues for research in emergency medicine at the National Institutes of Health and the National Heart, Lung, and Blood Institute.

There are opportunities for research in EM at the NIH, which may be appropriate for a variety of Institutes, depending on the topic area. Most NIH-funded research is through investigator-initiated grant applications, and the PHS 398 application packet is a source of more information. RFAs and RFPs, which have set-aside funding, are released for specific topic areas when an Institute identifies an area requiring multiple studies or multicenter research. PAs, which do not have set-aside funding, announce areas of interest for an Institute. The NIH Guide to Grants and Contracts announces RFAs, RFPs, and PAs. It is important to become expert in a field of research to be successful in achieving research funding, whether investigator- or institute-initiated.

Emergency Medicine↗
PubMed1993

Hypertension treatment trials and stroke occurrence revisited. A quantitative overview.

To provide further understanding of the decline in stroke mortality in the United States, data from 16 randomized controlled trials of hypertension treatment and stroke published to date are pooled. The overall weighted average blood pressure reduction was 13/6 mm Hg. The pooled odds ratio was 0.61 (95% confidence interval: 0.55, 0.68), indicating approximately a 39% (32 to 45%) reduction in stroke occurrence. Percent reduction was somewhat higher in studies of mild-moderate hypertension (47%) and somewhat lower in studies of the elderly (35%). There was no differential effect by gender (reductions of 37% for women, 34% for men) or by race (32% for blacks, 37% for whites). The magnitudes of reductions for fatal (41%) and nonfatal (37%) strokes, and for diuretics and beta-blockers (odds ratio diuretic versus beta-blocker, 0.86; 95% CI: 0.69, 1.08) were similar. Implications for the decline in stroke mortality in the United States are discussed.

Adult↗
PubMed1992

Characteristics of controlled studies of patient education and counseling for preventive health behaviors.

To determine characteristics of controlled studies (quasi-experimental and randomized) of clinical patient education/counseling for behavior change to prevent disease, we conducted an extensive literature review of published and unpublished studies from 1971 to 1989. Sixty-four studies with 101 intervention groups met specific criteria for relevance and scientific acceptability. We examine these studies in terms of prevention area, subject source, intervention characteristics, and use of educational principles. Findings reveal many controlled clinical studies in smoking cessation, nutrition, and weight control but sparcity in other areas (injury prevention, exercise, stress, drug and alcohol misuse, STD prevention); an emphasis on communication by a single clinical practitioner; and varied use of educational principles. We recommend adhering to educational principles to enhance likelihood of success.

Adolescent↗
PubMed1991

Definition and yield of inclusion criteria for a meta-analysis of patient education studies in clinical preventive services.

Because selection of studies for a literature review influences conclusions, inclusion criteria are of utmost importance. For a meta-analysis of studies testing effects of patient education on preventive behaviors, we present the framework and concepts used for setting inclusion criteria for primary studies. We also present the yield in terms of number and distribution of studies that resulted from the inclusion criteria. Because we were interested in a diverse range of behaviors and a broad definition of patient education, we present a method for grouping behaviors by type of behavior change and describe parameters for subgrouping interventions by orientation and communication channel. Of 5,451 citations located and abstracts screened, 561 citations reporting potentially relevant studies were reviewed. Based on our inclusion criteria, 171 citations contained relevant studies, of which 64 studies (found in 62 citations) also met our acceptability criteria. We examine the effects of alternate inclusion criteria on the yield of primary studies and their distributions across the subgroupings.

Data Collection↗
PubMed1989

An ecological approach to the prevention of injuries due to drinking and driving.

Among the many alcohol-related public health concerns, motor vehicle crashes account for nearly one-third of all deaths attributable to alcohol. Adolescents and young adults, particularly males, are important target populations for intervention efforts. Taking an ecological perspective of individuals within their social and physical environments, a diagnostic framework is employed in reviewing the literature on factors associated with drinking and driving injuries and on interventions to prevent injuries due to drinking and driving. Intervention planning is conceptualized according to a multilevel intervention framework, which consists of four phases: (1) health goals selection, (2) intervention planning, (3) intervention, and (4) evaluation. Possible intervention objectives, targets of the intervention actions, intervention approaches, and evaluation criteria are identified and discussed for three societal levels and four practice settings.

Accidents, Traffic↗
PubMed1988

Prescribing physical activity to prevent disease.

Despite an increase in the public's awareness of the ample health benefits of physical activity, less than 20% of US adults regularly participate in moderate to vigorous physical activity. For most adults, increasing physical activity even moderately is likely to benefit health. Physicians can prescribe physical activity and incorporate an emphasis on physical activity into clinical practice.

Adult↗
PubMed1988

Developing comprehensive smoking control programs in schools.

During the school years, students encounter peer influences and role models who encourage smoking initiation. To counteract these influences, schools can provide comprehensive programs that include smoking prevention and cessation education and a supportive nonsmoking environment. In the past several years, programs and information have become available to help schools establish curricula to address smoking and to create nonsmoking environments. In addition, state and local governments have acted to legally restrict smoking in schools or to require smoking content in curricula. Efforts can be categorized into three avenues of intervention: student education, school and school system policy, and governmental regulation. Resources are suggested for each category to assist in developing a comprehensive intervention to foster nonsmoking by children and adolescents in the school setting.

Adolescent↗
PubMed1988

Denial, delay and disappointment: discovering and overcoming the causes of drug errors and missed appointments.

Although the medical management of epilepsy is possible with effective therapeutics, such management is complicated by patient errors of self-medication. Efforts to improve adherence to prescribed regimens of anticonvulsant medication have not been extensively studied, although several promising results have been obtained. Research on adherence to medication regimens has been more extensive in other chronic conditions, such as hypertension, that have similarities to epilepsy in their demand for long-term treatment, often in the absence of symptoms, with drugs that may produce side effects. From the combined research on factors associated with drug errors, we have analyzed characteristics of the patient, of the regimen, of the illness, and of the patient - provider relationship. The most promising areas for improving compliance appear to be the influence of family and friends, the complexity of the treatment regimen, the patient's belief in severity of the illness, and the patient - provider relationship. Strategies to improve compliance can target 3 sets of factors: predisposing factors including patients' motivation and perception, factors that enable patients to comply more easily, and factors that reinforce compliance. Physician-directed interventions tailored to each of these categories of factors, taken together, can make up a comprehensive health education program. A model for the interventions and their evaluations is presented.

Anticonvulsants↗
PubMed1987

Health promotion and disease prevention. Roles for the primary care physician.

The practice of health promotion and disease prevention (HPDP), an increasingly important approach to healthcare, includes influencing health behaviors of the population at risk for disease as well as environmental conditions that affect health. The major role of the clinician in HPDP is at the individual level: screening for risk factors and disease and providing early treatment, advice, counseling, and referral. Primary care physicians can broaden their impact by assuming roles at organizational, community, and government levels (eg, as an active member of an organization or a consultant to an outside organization, a community leader or an agent of change, an influential constituent or a lobbyist). These roles enable primary care physicians to have an impact both on individuals and on environments to reduce disease risk factors.

Health Promotion↗
PubMed1986

Data sources for penetrating trauma.

Three city data sources (CDSs)--police reports, ambulance reports, and medica examiner (ME) logs--were evaluated for their usefulness in epidemiologic studies of trauma. The CDSs were employed to identify all cases of penetrating injury to the chest and/or abdomen severe enough to require care in a medical institution during 1979 and 1980 in Baltimore city. The percent of cases identified by source was: police, 66.8%; ambulance, 47.9%; ME, 16.6%; police plus ambulance, 89.4%; police plus ME, 82.9%; and ambulance plus ME, 50.1%. Hospital admissions to six study hospitals due to chest and/or abdomen penetrating injury were located and matched to the CDS reports: 89.2% of the hospitalized cases were reported in one or more CDS, and 34.7% of the cases identified by one or more CDS could not be located in the hospital records. Using hospital records as the standard, each source was determined to have the following completeness of case reporting: police, 66.2%; ambulance, 72.9%; and ME, 92.2%. The authors conclude that existing CDSs should be used with caution, and that the usefulness of data from multiple sources far outweighs that from any single source.

Abdominal Injuries↗