An integrated pest management concept for hospitals.
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Biomedical subjects
Publications and source records attributed to E White.
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This report examines the maintenance of a low-fat diet 1 year on average after the completion of intervention sessions among participants in the Women's Health Trial (WHT). The WHT was a randomized controlled trial of the feasibility of adoption of a low-fat diet among women of moderate or increased risk of breast cancer, conduced in Seattle, Houston, and Cincinnati in 1985-1988. The women randomized to the low-fat diet attended an intensive dietary intervention program for 5-37 months. Intervention women were highly successful in reducing their dietary fat intake from 40.0% of energy intake at baseline to 26.3% by the end of the trial, based on a food frequency questionnaire (or an estimated 24% adjusted for the inaccuracies of a food frequency questionnaire versus a 4-day diet record). During 1989, 1 year on average after the WHT ended, 448 intervention women and 457 control women (87% of eligibles) completed a follow-up survey to determine the degree of maintenance of the diet. The intervention women maintained the low-fat diet with an increase of only 1.4 percentage points of energy from fat, despite the fact that they had attended no further intervention sessions and had made no commitment to maintain the diet beyond the end of the WHT. Furthermore, the degree of maintenance of the low-fat diet was not dependent on the length of time in the intervention, which suggests that intervention led to a sustained change in eating habits after as little as 5-9 months (8-13 classes).(ABSTRACT TRUNCATED AT 250 WORDS)
A dietary intervention delivered to one family member with a beneficial impact on other members could provide a cost-effective approach to public health dietary intervention programs. The Women's Health Trial (WHT) was a study in which women were randomized to be trained in adopting a low-fat diet or to continue their normal diet. The intervention women consumed 21% of total calories from fat versus 38% for control women at six months postrandomization. Husbands of women in the Seattle Clinical Center of the WHT were surveyed between 1985 and 1988 to determine whether and to what extent the husbands' diets changed at six months. Ninety-one intervention men and 162 control men, 79% of those eligible, participated. Intervention men reported an average weight loss of 2.4 pounds, compared to an average 0.7-lb loss among controls (P = .03). Based on self-reported change of specific foods, we found that intervention men more often reduced butter, margarine, eggs, and red meat over the six months than did control men (P less than .001). Based on nutrient consumption estimated by a food frequency questionnaire, intervention husbands consumed 34% of total calories from fat versus 36% for controls (P = 0.04). The number of meals shared with wives per week modified the effect of the intervention: among the intervention group, for every three meals shared, an accompanying one percentage point reduction in percentage of calories from fat occurred in the husband's diet. Thus, we suggest that dietary intervention programs attended by one spouse appear to exert a small beneficial effect on the other spouse.
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Public health researchers frequently rely on random-digit dialing (RDD) telephone surveys in monitoring trends in health behavior and evaluating health promotion interventions. RDD response rates have declined during the past decade, and cost-effective methods to increase response rates are needed. The authors evaluated two levels of enhanced calling efforts in an RDD survey of cancer-related health behavior in the State of Washington. The first level of enhanced calling effort was 1 month after 11 original calling attempts to a household, when the authors attempted up to 11 recalls. The second level was 6 months after the first answered call, when the authors recalled those persons who could not be interviewed. Enhanced calling efforts increased the overall survey response rate by 11 percent. Nine percentage points of the increase were attributable to call backs. There were demographic differences among the participants reached at different levels of calling effort, but no consistent associations of level of calling effort with health behavior related to alcohol use, smoking, diet, or health screening. Marginal costs for interviews completed with enhanced calling efforts were about 50 percent higher than costs for interviews reached in the first 11 calls. The authors concluded that enhanced calling efforts may be justified, because they increase confidence in the generalizability of survey results. However, the authors found very little change in survey results by including interviews from persons who were difficult to reach and to interview.
The field of cancer genetics is rapidly changing. Demand for information on genetic testing is increasing and persistent patient pressure is likely to result in increased NHS resource allocation. Cancer genetics clinics must change from small ad hoc research clinics to large throughput, patient-centred specialist services run jointly by doctors and clinical nurse specialists expert in cancer genetics and cancer medicine. We describe the development of a regional breast cancer genetics service in East Anglia based on the three-tier cancer care model outlined in the Calman report.