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Biomedical subjects

K Glanz

Publications and source records attributed to K Glanz.

At least 55 records · Page 3Linked to original sources
PubMed1995

A survey of occupational health professionals' preventive pulmonary practices and worksite environments: development and initial findings.

This article describes the development of a worksite survey to evaluate a continuing medical education (CME) program to improve preventive pulmonary practices and worksite environments of occupational physicians and nurses, and baseline findings from the survey. The two-part instrument assessed individual counseling practices for preventing lung disease and worksite environments. Eighty-one occupational physicians and nurses completed the survey before the CME program. Reliability coefficients (Cronbach's alpha) were calculated for five test subsections: smoking counseling (.72), workplace hazards (.70), environmental programs (.78), workplace environment (.94), and smoking policies (.91). Baseline findings indicated that 80% of respondents reported that their employees/patients were exposed to various workplace hazards. This instrument can be used to evaluate occupational health professionals' performance and worksite environments and may be useful for evaluating change over time or following a training program for occupational health professionals.

Education, Continuing↗
PubMed1995

Environmental and policy approaches to cardiovascular disease prevention through nutrition: opportunities for state and local action.

This article reviews environmental and policy intervention approaches to cardiovascular disease prevention through nutrition and recommends opportunities for state and local health departments to initiate and participate in environmental and nutrition policy initiatives. By addressing these complementary aims, the authors hope to stimulate further efforts to achieve progress in nutrition promotion among state and local health-related organizations. Key categories of opportunity to develop new or expanded nutrition policies and environmental strategies include economic incentives, food assistance and feeding programs, regulations for institutional food service operations, and nutrition services in health care. Environmental strategies to reduce barriers to following dietary guidelines, such as point-of-choice programs and school nutrition programs, should be tailored for local communities and widely disseminated. In addition, current federal policy efforts, notably nutrition labeling rules, will provide a valuable focal point for state and local advocacy, education, and monitoring.

Cardiovascular Diseases↗
PubMed1994

Stages of change in adopting healthy diets: fat, fiber, and correlates of nutrient intake.

The stages of change construct, which addresses the readiness to change, has only recently been applied to dietary behavior, such as fat consumption. This article describes the application of the stages of change construct to dietary fat and fiber consumption and examines the association of dietary stages to eating practices and related demographic and psychosocial factors in a large, geographically diverse population of workers. We present results from the baseline survey of 17,121 employees in the Working Well Trial. We assessed stage from an algorithm based on seven items and measured dietary intake with an 88-item food frequency questionnaire. Findings indicated that a greater proportion of the population has actively tried to reduce fat intake than to consume more fiber. Stage of change was associated with fat, fiber, and fruit and vegetable intake in a stepwise manner, as predicted. In multivariate analyses that controlled for demographic characteristics, stage of change predicted between 8 and 13% of the variance in dietary intake, and more than demographic variables. These findings have implications for the design of nutrition interventions and for the evaluation of intermediate outcomes.

Adult↗
PubMed1993

Development and validation of measures of psychosocial factors influencing fat- and fiber-related dietary behavior.

BACKGROUND: Understanding factors influencing food choices is likely to enhance the effectiveness of strategies to promote healthy eating patterns. This article describes the process used to develop measures of psychosocial factors related to eating patterns in the Working Well project. METHODS: Working Well is a multicenter controlled trial of worksite health promotion interventions, including a nutrition intervention aimed at promoting low-fat, high-fiber eating. The process for developing measures included several steps. First, we defined three domains of psychosocial factors influencing dietary behavior: predisposing, enabling, and change-related factors. We then reviewed large-scale survey findings, compiled a catalogue of items, and developed and refined a 65-item questionnaire for pretesting in a working population. RESULTS: Based on frequency distributions and interitem correlations, the item pool was reduced to 24 items. The 24 remaining items were included in a pilot survey of 652 employees (response rate = 80%). On the basis of pilot data analyses, we eliminated one item and made minor modifications to other items. Factors most strongly associated with dietary intake were self-rated diet, past success at change, and motivation to eat low-fat foods. CONCLUSIONS: Analyses of the cross-sectional pilot data suggest directions for analyses of the final survey. The measures and the development process yielded an instrument and process that can be useful to other researchers.

Adult↗
PubMed1993

Informed consent for blood transfusion: a regional hospital survey.

Ninety-two hospitals in a three-state mid-Atlantic region were surveyed to determine their policy toward obtaining written informed consent for transfusion and to examine the content of written consent documents and the process by which consent is obtained. Of 81 hospitals responding, 50 (62%) required written informed consent. Hospitals with fewer than 200 beds were more likely to require written informed consent. The attending physicians had responsibility for obtaining consent in 28 (57%) of 49 institutions, most often on the day or evening before surgery. Twenty-seven of 48 forms mentioned complications: hepatitis in 80 percent, human immunodeficiency virus infection in 46 percent, nonhemolytic reactions in 32 percent, and hemolysis in 25 percent. Alternatives to allogeneic transfusion were mentioned infrequently; eight hospital forms listed autologous transfusion options and only two mentioned designated donation. The reading level required to comprehend 34 consent forms submitted was grade 14.6, which has been attained by only 23 percent of the adult United States population. Although the majority of respondent institutions require written informed consent, those forms, per se, do not document that the fundamental tenets of informed choice have been applied to the decision to transfuse blood.

Blood Banks↗
PubMed1992

Evaluation of implementation of a cholesterol management program in physicians' offices.

This article describes an evaluation of the implementation of a cholesterol management program in family physicians' offices as part of the Physician-Based Nutrition Program to Lower Coronary Heart Disease Risk (PBNP). The evaluation, conducted through a partnership evaluation model, used multiple case study methodology and combined the use of quantitative and qualitative methods. Data sources included office staff reports and interviews, records of contacts with study personnel, patient care data, and patient telephone interviews. Data from these sources revealed gradual program implementation and considerable variation in practitioner and clinic involvement in cholesterol management. Clinic staff reported that the support provided by PBNP in the form of training, operations materials, patient education materials and ongoing assistance was very useful. This formative evaluation has implications for refinement of the PBNP and for other prevention programs in primary care settings. It demonstrates the feasibility and acceptability of a systems approach to physicians, cholesterol/nutrition educators and clinic support staff. It also suggests ways in which researchers and clinicians can implement and evaluate health care innovations.

Adult↗
PubMed1992

Comparing the transfusion medicine content of the NBME's examinations in 1984-1985 and 1989-1990.

Recognition of the seriousness of transfusion-transmitted diseases has been demonstrated by U.S. medical schools through the integration of transfusion medicine (TM) content into their curricula. To evaluate the degree to which these changes in curricula have been reflected in the National Board of Medical Examiners' (NBME) examinations, a study conducted in 1991 evaluated the proportions of TM-related items on Parts I and II of the NBME examinations for 1984-1985 versus 1989-1990. Both Part I (basic sciences) and Part II (clinical sciences) demonstrated significant gains in TM items between the comparison periods (p less than .001), with Part II having the higher gain. An analysis of students' knowledge revealed that students in 1989-1990 tended to perform better on TM items than on examination items generally. The increases in TM content and student performance on TM items on the 1989-1990 examinations suggest that the national effort to expand and improve teaching of TM in U.S. medical schools has been effective.

Blood Transfusion↗
PubMed1992

Physicians, preventive care, and applied nutrition: selected literature.

The authors review a core of 25 articles (dating from 1982 through 1991) regarding medical school curricula and physicians' knowledge, attitudes, and practices related to nutritional care, with a focus on prevention of coronary heart disease through cholesterol control. They supplement this review by discussing the relation of the core articles' results to those of additional articles, which focus more generally on physicians' health promotion and patient counseling. While there appear to be modest increases in attention to nutrition at various levels of medical training and some improvement in physicians' attitudes about dietary intervention, the authors conclude that both educational opportunities and physicians' practices warrant increased and more effective attention to nutrition. Finally, in light of recent trends and growing efforts to better prepare physicians to play a leading role in preventive care, the authors identify gaps in physicians' training and in research on physicians, preventive care, and applied nutrition.

Coronary Disease↗
PubMed1992

Factors associated with adherence to breast cancer screening among working women.

This study identified sociodemographic, knowledge, attitude, and social influence correlates of obtaining mammograms among employed women age 40 and over. Telephone interviews were conducted with 798 women who worked at 39 different work sites. Eighty-four percent of respondents had ever had a mammogram, and 72% had had one at the recommended interval for their age group. The only personal characteristic that was associated with past mammography use was having a co-worker, friend, or relative with a history of breast cancer. Logistic regression analyses indicated that a doctor's advice to have a mammogram, knowledge of screening guidelines, knowing someone with breast cancer, and the beliefs that mammography is effective and that mammography is necessary in the absence of symptoms were associated independently with past use of mammography. Three factors contributed independently to explaining adherence to mammography guidelines: younger age, knowledge of guidelines for one's own age group, and the belief that breast cancer is curable. The findings suggest that emphasizing the recommended guidelines, the need for and benefits of mammography in educational programs, and offering low-cost or free mammography at the workplace, can further increase appropriate utilization among working women.

Age Factors↗
PubMed1991

Contributions of public health to patient compliance.

This paper discusses the contributions of public health to compliance in five areas: clinical trials, smoking cessation, dietary compliance, breast cancer screening and hypertension control. Public health programs have been based on a number of theoretical foundations, most notably, social learning theory and the health belief model. Social marketing, community organization, and, more recently, consumer information processing models also are important. The strongest public health programs embody an ecological approach, with interventions directed not only at individuals, but also at groups, communities and changing institutional norms. Among the most important contributions of public health interventions are: multiple levels of intervention and evaluation, tailoring to target audiences, use of social support and community organization for behavior change. Together, community health and clinical compliance-enhancing strategies can exert a synergistic impact on health behavior change.

Breast Neoplasms↗
PubMed1990

The cholesterol controversy and health education: a response to the critics.

The rapid pace of cholesterol reduction initiatives has given rise to considerable controversy regarding the scientific basis for mass efforts to lower blood cholesterol and the proposed guidelines for treatment. This article summarizes the key criticisms in the cholesterol controversy and identifies responses that have been given, as well as emerging perspectives. The issues are summarized in four categories: the science base, translation of the science into clinical medicine, misuse of the cholesterol issue to serve profit motives, and public health policy regarding allocation of resources for prevention. It is important for health and patient educators to be aware of the criticisms, to appreciate their origins and to understand the available responses in order to be effective agents for chronic disease risk reduction.

Health Care Rationing↗
PubMed1990

Readability and content analysis of print cholesterol education materials.

This article reports the results of an analysis of the readability levels and content of 38 print cholesterol education materials available from government, health agency, professional association, university and industry sources. Each item was characterized according to the primary intended audience (general public, public and screening participants, or those identified with elevated cholesterol and patients in treatment), size, length and appearance. Readability analysis was done using the SMOG and Fog Grading formulas and content analysis examined the presence of messages in each of nine key areas. The readability assessment revealed that the average reading grade level was close to Grade 11, which is too difficult for many adults. Content analysis suggested a need to better address other heart disease risk factors, portion size and the use of brand name food recommendations. Further practice and research needs are identified.

Evaluation Studies as Topic↗
PubMed1988

Patient and public education for cholesterol reduction: a review of strategies and issues.

Elevated blood cholesterol is a major risk factor for coronary heart disease and a significant public health problem, affecting as many as 50% of all adults in the U.S. Public, professional and patient education are central to current widespread efforts to increase awareness and effective management of high cholesterol. Screening/case-finding, follow-up and nutrition education are the most widely applicable strategies for cholesterol reduction. The following topics are reviewed: current guidelines for treatment of elevated cholesterol levels; trends in awareness, attitudes and practices of the public and health professionals; reports of interventions for cholesterol reduction; and health policy issues and research needs related to cholesterol education. This review suggests that several major challenges lie ahead for widespread and effective educational management of high cholesterol levels. These include development of practical screening and education systems, establishment of feasible financing arrangements, effective communication of complex information to patients, and techniques for long-term maintenance of reductions in cholesterol levels.

Attitude of Health Personnel↗
PubMed1988

An analysis of the transfusion medicine content of the test of the National Board of Medical Examiners.

A two-year (1984-1985) review of 3,764 questions appearing on Part I and Part II of the National Board of Medical Examiners (NBME) indicated 140 (4%) were transfusion medicine (TM)-related. Fewer questions on TM appeared on Part II than Part I (45 vs. 95, P less than 0.001). Unexpectedly, the lowest proportion of questions (excluding psychiatry) in the Part II examination was in the surgery section. Part I NBME appears to adequately reflect and assess the TM content of the medical school curricula, but the number and distribution of questions in Part II of the NBME does not reflect recent changes in the clinical transfusion medicine curricula of many United States medical schools.

Blood Transfusion↗