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Biomedical subjects

L W Green

Publications and source records attributed to L W Green.

At least 19 recordsLinked to original sources

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for behavior change to prevent disease, we conducted an extensive literature review of published and unpublished studies from 1971 to 1989.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

The implementation of a restrictive worksite smoking policy in a large decentralized organization.

This study investigates the implementation of a restrictive smoking policy in decentralized worksites. A model which includes four elements--concept, context, process, and outcomes--is used as a framework for identifying characteristics that influence implementation. The organization studied was a state human services agency with approximately 400 worksites spread across 12 geographic regions. Quantitative data collection included three cross-sectional surveys of employees and supervisors administered before and after the date the policy became effective. Qualitative data were collected from three sources, including written comments on surveys, focus groups, and structured interviews with supervisors and top administrators. Tabular analyses and one-way analyses of variance were used to analyze quantitative data. Qualitative data were examined for key themes and have been used to elucidate findings. Those characteristics related to concept, context, and process which appeared to have the strongest influence on expected and unexpected outcomes of the restrictive smoking policy were degree of policy restrictiveness, job characteristics, perceived level of participation in formulation and implementation, and support of supervisors responsible for day to day enforcement. In particular, in this decentralized organization, lack of participation was found to underlie many of the problems experienced in implementation. The practical implications for developing and implementing a worksite restrictive smoking policy are discussed.

Cross-Sectional Studies

The validity of single-item, self-assessment questions as measures of adult physical activity.

Individual energy expenditure (kcal/kg/day) was calculated from a detailed set of questions from the Health Promotion and Disease Prevention Supplement of the 1985 National Health Interview Survey. Responses to three single-item, self-assessment questions were compared to the energy expenditure variable to test criterion validity. Spearman's correlation coefficient revealed moderate correlations between energy expenditure and corresponding levels of self-assessed leisure-time physical activity for each single-item question (r = 0.14 to 0.41). For purposes of measuring prevalence of physical activity, the energy expenditure variable was used to categorize individuals into activity levels. The single-item questions were found to have Spearman's correlations with the categorical measures ranging from 0.11 to 0.37 for leisure-time activities. Generally higher correlations were found for males and younger age groups (18-34 years). The relationships were interpreted as being weak relative to an expected correlation of 0.75 for criterion validation. However, the single-item questions show promise for obtaining proxy estimates of the degree of leisure-time physical activity in a population.

Adult

Maintaining employee participation in workplace health promotion programs.

This article examines the issue of maintaining participation in workplace health promotion programs. The term "maintaining participation" is defined here as both continued program attendance and maintenance of recommended behaviors. The factors associated with participation and approaches to maintaining participation are reviewed. Evidence suggests that combinations of environmental and individual approaches are necessary to address the problem of maintenance. An approach to maintaining participation is suggested that utilizes a preprogram diagnostic interview model to identify and address environmental and individual factors that may cause an employee to drop out of a program or relapse into prior behavioral patterns.

Community Participation

Education for self-treatment by adult asthmatics.

A prospective experimental design evaluated the ability of a series of educational and motivational interventions to enhance self-treatment by adult asthmatics and to reduce use of emergency department services for asthma attacks. After treatment for an asthma attack, subjects were randomly assigned to the following sequential interventions: (1) reinforcement by interpersonal similarity at the time of the emergency visit, (2) recepit of positive written appeals, and (3) follow-up telephone reinforcement. The asthmatic nurse educator was generally more effective in achieving short-term reduction of emergency department visits. Although the usefulness of the positive written appeal increased when employed by the asthmatic nurse, there were no substantive independent effects of the written message on emergency department use.

Activities of Daily Living

Health education for hypertensive patients.

Three educational interventions for the control of essential hypertension in ambulatory patients were based on analyses of the educational needs of patients and providers. The educational program increased reported compliance with medication, improved the proportion of patients losing weight, and improved appointment keeping. Most important, there was a favorable effect on blood pressure (BP) control. The proportion of patients with BP under control in the group assigned to all three interventions increased by 28% (from 38% to 66%), while the proportion in the control group receiving standard medical therapy with no educational interventions remained unchanged at 42%.

Adult

Evaluations of continuing medical education for chronic obstructive pulmonary diseases.

A continuing medical education program which linked primary care physicians to a source of needed appropriate clinical knowledge at a relatively low cost has been demonstrated. Chronic obstructive pulmonary disease was identified as the health problem; the reference patient population was comprised of coal miner health fund beneficiaries living in a 10-county region. Primary care physicians treating beneficiaries in this region were the eligible program participants. Content of the program was based on multiple sources of information about actual practice needs. Several educational techniques were used in combination to convey the knowledge identified as appropriate in the diagnostic stage. A quasi-experimental program evaluation indicated significant changes in physician knowledge, judgment, and self-reported behavior related to diagnosis and treatment of chronic obstructive pulmonary disease.

Adult

Cost-effectiveness evaluation of a home visiting triage program for family planning in Turkey.

Graduate Turkish midwives were trained in triage rules for determining family planning home visit frequency based on risk of couples. In a sample of 542 couples followed for six months, modern contraceptive use increased 22 per cent among high-risk and about 15 per cent among moderate- and low-risk couples. After making assumptions about the fecundity, contraceptive success, and pregnancy complications, the estimated average cost per complication averted was $61 for high-risk, $177 for moderate-risk and $526 for low-risk couples.

Adolescent