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Biomedical subjects

E Meland

Publications and source records attributed to E Meland.

At least 37 records · Page 2Linked to original sources
PubMed1999

The importance of self-efficacy in cardiovascular risk factor change.

SUBJECTS AND DESIGN: The study was based on the total patient sample (n = 110) of a randomized controlled trial comparing two intervention methods advising cardiovascular high-risk men of lifestyle changes in general practice. Behaviour and risk factor changes during the one-year intervention study were analysed using multiple regression and logistic regression analyses with the above-mentioned independent variables. SETTING: Twenty-two general practice centres in the county of Hordaland, western Norway. RESULTS: Self-efficacy of increased physical exercise was the only variable significantly related to exercise change. Age and self-efficacy were statistical significant predictors of smoking cessation success. None of the independent variables was statistically significantly related to blood pressure or cholesterol change. Educational level related negatively, although statistically insignificantly, with total risk change. CONCLUSION: The study confirms the importance of self-efficacy in both human behaviour and motivation for behaviour change. OBJECTIVES: The objectives of the study were to explore the impact of possible predictors for cardiovascular risk behaviour change, predictors such as education, age, self-efficacy, doctors' interpersonal skills, and number of appointments.

Adult↗
PubMed1999

Lessons from the Oslo Study Diet and Anti-smoking Trial: a qualitative study of long-term behaviour change.

The aim of this study was to identify factors associated with sustainable behaviour change among persons at increased risk for future cardiovascular disease. A qualitative approach based on focus group interviews was used. Twenty-five men aged 62-71 years who participated in the Oslo Study Diet and Anti-smoking Trial were interviewed in four focus groups. The study identified five categories of factors linked to the process of lifestyle changes: the doctor-patient relationship, significant others, motivators, barriers, and empowerment. A strong personal attachment to the principal investigator of the Oslo Study was revealed. The relationship was described as friendly and supportive. The family based approach and the impact of spouses, in particular, was emphasized by the participants. Somatic symptoms and fear often acted as motivators to behavioural change. Individual feedback was also identified as an important motivator. Psychological resistance to external pressure, concerns regarding behaviour change, and benefits from current (unhealthy) behaviour were identified as barriers. Participants reported a process of empowerment and personal control as an important element of sustainable change. The importance of the unique relationship with a certain provider has implications for future healthcare planning. This factor may also limit the external validity of studies of human behaviour.

Aged↗
PubMed1997

Salt restriction: effects on lipids and insulin production in hypertensive patients.

The object of the study was to evaluate blood pressure, insulin and glucose metabolism, and serum lipids in hypertensive patients, during 8 weeks on a moderately salt-restricted diet. A double-blind, cross-over study was conducted with hypertensive patients following a moderately salt-restricted diet. Patients were randomised to sodium capsules in one period and placebo capsules during the other period. After a 1-month run-in period, 13 males and three females with mild to moderate essential hypertension (mean age 50 years) complied with a salt-reduced diet. They were randomized to a salt-supplemented group (5 capsules of 10 mmol sodium per capsule) or a salt reduced diet group (5 capsules of placebo) with cross-over after 8 weeks. Serum insulin, insulin C-peptide, and glucose were measured, fasting and 30 min after a 75-g glucose load. Serum lipids and lipoproteins constituting an atherogenic index were measured, along with blood pressure and 24-h urine excretion of sodium and chloride. Non-significant reductions of systolic and diastolic blood pressure (4 mmHg, p = 0.06, and 2 mmHg, p = 0.13, respectively) were observed during the reduced-salt period. The changes observed for fasting insulin, insulin C-peptide, glucose, serum lipids and the atherogenic index were also non-significant. It is concluded that moderate salt restriction seems not to adversely influence insulin resistance or serum lipids in hypertensive patients.

Adult↗
PubMed1997

Focus groups as a path to clinical knowledge about the acutely and severely ill child.

OBJECTIVE: To identify elements of clinical information beyond the area of knowledge presented in medical textbooks, but used by the general practitioner when confronted with the acutely and severely ill child. DESIGN: Focus group approach. SETTING: A course for teachers in General Practice at the Division for General Practice, University of Bergen, Norway. SUBJECTS: 25 experienced general practitioners serving as clinical teachers at the Division for General Practice. MAIN OUTCOME MEASURES: Clinical descriptions arising from incident-based anecdotes and experiences. RESULTS: Issues were reported concerning the doctor's emotional reactions, cues from the parents of the child, atypical contact between doctor and child, cognitive discrepancies, and difficulties in acting on cues. CONCLUSION: This material identifies elements of tacit clinical knowledge which may provide a basis for further analysis and shared action.

Acute Disease↗
PubMed1997

Effectiveness of two preventive interventions for coronary heart disease in primary care.

OBJECTIVES: 1. To compare a patient-centred, self-directive intervention with conventional care; 2. To evaluate longitudinal within-group changes of coronary heart disease risk. METHODS: Risk factor changes were evaluated in 110 men with high coronary heart disease risk attending a one year intervention study in general practice. The 22 participating general practice centres were randomly allocated to follow either a patient-centred, self-directive intervention or a conventional approach. RESULTS: No significant between-group differences were found in any single risk factor or in the combined risk of coronary heart disease. The improvement of total risk from screening time to conclusion of the study corresponded with changes of relative risks of CHD to 0.64 (95% CI: 0.54-0.77) and 0.65 (0.54-0.77) in the patient-centred, self-directive and the conventional care group respectively (p < 0.0001 in both groups). CONCLUSION: Everyday general practice clinical work seems as efficacious as a specific intervention method based on currently advocated behaviour change principles.

Adult↗
PubMed1996

Life style intervention in general practice: effects on psychological well-being and patient satisfaction.

The objectives of this study were to: (1) study if an opportunistic screening of coronary heart disease (CHD) risk factors among male attenders in general practice (GP) influenced the overall subjective satisfaction with life of persons labelled 'high risk' compared to other screened persons; (2) compare psychological well-being and patient satisfaction in a patient centred and self-directive (PCSD) intervention with conventional care (CC); and (3) evaluate patient satisfaction and psychological well-being among subjects with high CHD risk during a one year intervention study. Effects of 'labelling' were evaluated in 115 subjects with high CHD risk in comparison with a low risk reference population. The 22 participating GP centres were randomly allocated to follow either a PCSD intervention or a CC approach. An overall satisfaction with life question was employed and psychological well-being were measured using the General Health Questionnaire (20 item version). Satisfaction measures on health care aspects were also included. No difference of change between the high risk and the reference population was found concerning satisfaction with life after screening. No significant difference of change was found within or between the PCSD and the CC group concerning emotional well-being or overall satisfaction with life during one year intervention. Satisfaction with the care received was significantly better in the CC group as compared with the PCSD group (p = 0.02). Satisfaction with own efforts for improving health was, however, more pronounced in the PCSD group (p = 0.01). A substantial number (n = 61) of the participants reported distaste of being reminded of the risk of heart disease and no more than 60 of the participants were satisfied with their own efforts for improving health. Although no significant change of satisfaction with life and emotional well-being due to screening or intervention could be detected, clinicians should be aware that encouraging patients to change life style may lead to patients' annoyance of being reminded of the risk of disease and dissatisfaction with their own efforts. Increasing patient responsibility and self-determination may improve their satisfaction with their own efforts, but reduce satisfaction with medical care.

Adaptation, Psychological↗
PubMed1994

Assessment of coronary heart disease risk, I. A postal inquiry among primary care physicians.

The purpose of the present study was to examine general practitioners' abilities to make a correct estimation of the risk of coronary heart disease (CHD). A 10% random sample of Norwegian primary care physicians (n = 288) received a questionnaire that presented 10 case histories containing information about five CHD risk factors. The respondents' risk estimation was compared with a composite score computed from epidemiologic data. The observed general tendency was towards underestimating the CHD risk. However, 'high-risk' histories were recognized as CHD risk persons. Assessment of CHD risk due to multiple marginal abnormalities was only exceptionally correct. Hypercholesterolaemia and hypertension in men were acknowledged as contributing to clinically significant CHD risk only by a minority of GPs. Heavy smoking and a positive family history were associated with a more accurate estimation of CHD risk. Forty per cent of the physicians did not recognize the sex dependency of cholesterol as a CHD risk factor. None of the physician characteristics could predict variation in correct risk assessment.

Adult↗
PubMed1994

Assessment of coronary heart disease risk, II. A clinical multicentre study of general practitioners' risk assessment.

The objectives of the present study were: (i) to compare clinical assessment of coronary heart disease (CHD) risk with risk estimation faced with simulated, written case histories; (ii) to observe the risk assessment performed by general practitioners (GPs) in their clinical setting. Thirty-one GPs participating in a multicentre study were asked to invite 20 consecutive male patients aged 30-59 years to an opportunistic screening of CHD risk factors. They assessed the risk status of these patients and of 10 written case histories containing information about corresponding CHD risk factors. A composite 'infarction score' computed from epidemiologic data was used as a gold standard. Diagnostic performance in the clinical setting was compared with that in the simulated setting by Pearson's correlation. A weak, but statistically significant positive correlation was demonstrated when comparing correct estimation in the two settings. No correlation was found for over- and underestimation. Sensitivity was increased faced with clinical patients at the sacrifice of specificity compared to the simulated setting. The impact of a positive family history on clinical assessment parallels the epidemiological estimate. Due to lack of sensitivity, the other factors had a lower impact on risk estimation than an epidemiological estimate would presuppose. We advocate the application of a formal risk estimation to improve risk assessment accuracy. The synergistic effect of multiple risk factors should be emphasized in medical training to improve the clinical risk estimation.

Adult↗
PubMed1994

Salt restriction in hypertension--the effect of dietary advice and self monitoring of chloride concentration in urine.

The aims of this present study were firstly to examine whether diet compliance and blood pressure effect could be enhanced by self monitoring with a titrator strip (Quantab 1176) measuring the urine chloride concentration. This was achieved by an open, randomized parallel group design. The study also sought to evaluate the blood pressure effect of a moderately salt restricted diet by using a pre-test-post-test design with a run-in period and controlling for relevant confounding factors (weight, training and alcohol consumption). Furthermore, the study aims were to validate the measurement of chloride concentration in the morning urine by the Quantab titrator strip. We compared Quantab 1176 measurement of chloride concentration in the morning urine with 24 h sodium excretion, determined by the clinical chemical laboratory, was performed. Twenty men and 14 women (mean age 53 years) with essential hypertension (mean: 165/96 mmHg) were observed during a run-in period of 4 weeks before randomization to either dietary advice combined with self monitoring of morning urine chloride concentration for 12 weeks, or dietary advice alone. The reduction in diastolic blood pressure of 6 mmHg was not different in the two groups (between groups p = 0.44). Within group changes of systolic blood pressure were 10 mmHg and 6 mmHg (p = 0.006 and p = 0.04) in the diet plus Quantab group, and the diet only group respectively (between groups p = 0.30). No significant difference in 24 h sodium excretion could be detected between the groups. The morning urine chloride concentration correlated moderately to the 24 h urine sodium excretion (r = 0.66, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Salt restriction and increased insulin production in hypertensive patients.

The present study was performed to evaluate glucose metabolism, serum lipids and sympathetic activity during 12 weeks of a moderate salt restricted diet in hypertensive patients. The study was designed as a pre-test-post-test study. All patients from a controlled trial evaluating self-monitoring of urine chloride concentration as a remedy for enhancing diet compliance and blood pressure effect were included. Twenty male patients and 14 female patients with essential hypertension (mean age 53 years) were randomized to a self monitoring diet group and a diet only group. They were exposed to a moderately salt restricted diet during 12 weeks. Fasting serum insulin C-peptide, glucose, HbA1c, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were measured along with 24 h urine excretion of adrenaline, noradrenaline and vanillylmandelic acid (VMA). As a result, insulin C-peptide increased by 40% (p = 0.0001) whereas glucose rose by 6% (p = 0.02). Total cholesterol, LDL-cholesterol and HDL-cholesterol concentration were reduced by 6% (p = 0.001), 12% (p = 0.008) and 11% (p = 0.004) respectively. HbA1c, serum triglycerides, total/HDL-cholesterol ratio, urine catecholamines and VMA were unchanged during the trial. It is concluded that salt restriction may increase insulin resistance in hypertensive patients.

Adult↗