Biomedical subjects

M G Goldstein

Publications and source records attributed to M G Goldstein.

60 records · Page 4Linked to original sources

PubMedDate not supplied

Integrating pros and cons for mammography and Pap testing: extending the construct of decisional balance to two behaviors.

BACKGROUND: The ability to study health-related behaviors in combination rather than singly will lead to a more comprehensive approach to health promotion. This investigation focused on mammography and Pap testing. One index was created to reflect the recency of receiving both examinations. A second index integrated opinions about the two procedures into a single measure, guided by the pros, cons, and decisional balance constructs of the Transtheoretical Model of behavior change. METHOD: Data were drawn from the baseline and 1-year follow-up surveys of an HMO sample of women ages 40-74 (N = 1,605). Data collection occurred by telephone. A series of analyses examined whether recency of screening was associated with opinions about screening. RESULTS: The first analysis showed that recency of Pap testing and whether or not a Pap test was obtained between the two surveys were associated with opinions about Pap testing. The next analysis examined the association between the indicator for regularity of both Pap testing and mammography, with the measure of opinions toward the two procedures. The variable measuring receipt of Pap test and mammography was associated with the combined measure of opinions. CONCLUSIONS: The ability to employ combined indicators for recency of testing and test-related opinions is promising for being able to take a more comprehensive approach to women's health. The paper discusses methodological considerations that arise when attempting to integrate two or more behaviors.

Adult↗

PubMedDate not supplied

Activity counseling by primary care physicians.

Modifying patients' sedentary lifestyle, a risk factor for many chronic diseases, is a challenge to health professionals. Although physicians can play a vital role in promoting physical activity among sedentary patients, the prevalence of physician-based exercise counseling is low. This paper presents a review of studies that have targeted physicians as agents of behavior change. Changing sedentary behavior is more likely to be effective when the intervention is grounded in theory. This paper outlines an integration of two theoretical models that have potential for enhancing behavior change, and it describes specific techniques for physicians interested in promoting a more active lifestyle among their patients.

Exercise↗

PubMedDate not supplied

A population-based survey of physician smoking cessation counseling practices.

BACKGROUND: To be most effective, physicians' smoking cessation interventions must go beyond advice, to include counseling and follow-up. A full profile of physician performance on the recommended activities to promote smoking cessation has not been provided previously. METHODS: We surveyed a representative sample of 246 community-based primary care physicians who had agreed to participate in a 3-year study to evaluate a strategy for disseminating smoking cessation interventions, based on the National Cancer Institute 4-A model and on the Transtheoretical Model of Change. RESULTS: A majority reported they Ask (67%) and Advise (74%) their patients about smoking, while few go beyond to Assist (35%) or Arrange follow-up (8%) with patients who smoke. The criteria for "thorough" counseling was met by only 27% of physicians. More than half were not intending to increase counseling activity in the next 6 months. After controlling for other variables, physicians in private offices were more likely than physicians in HMO or other settings to be active with smoking cessation counseling. General Internal Medicine physicians were most active, and Ob/Gyn physicians were least active, with smoking cessation counseling among primary care specialty groups. CONCLUSIONS: Innovative approaches are needed to motivate, support, and reward physicians to counsel their patients who smoke, especially when considering the movement toward managed health care. PRECIS: A survey of primary care physicians focusing on national guidelines for smoking cessation counseling showed a majority Ask (67%) and Advise (74%) patients about smoking, but few Assist (35%) or Arrange follow-up (8%).

Adult↗

PubMedDate not supplied

Increasing mammography among women aged 40-74 by use of a stage-matched, tailored intervention.

BACKGROUND: Tailoring is a promising technique for encouraging greater performance of health-related behaviors. Tailored interventions are designed to be more individualized to personal characteristics, in contrast to "standard" interventions where all participants receive the same materials. METHODS: A total of N = 1864 women aged 40-74 were recruited from a staff model HMO and randomly assigned to one of three intervention groups: (a) No Educational Materials, (b) Standard Materials, and (c) Stage-Matched Materials. A provider-directed component was common across all three conditions. The Standard and Stage-Matched groups each received two mailed educational packets after baseline and follow-up telephone interviews. The Stage-Matched intervention was based on the Transtheoretical Model of behavior change. RESULTS: Analyses of n = 1397 women (after all attrition) showed that receipt of mammography after the baseline interview was higher for the Stage-Matched group (63.6%) than for the No Materials group (54.9%; OR = 1.43, 95% CI = 1.10, 1.86). The Standard intervention group was intermediate (58. 5%). The Standard group did not differ from the No Materials group, but did differ from the Stage-Matched group in multivariate analysis. CONCLUSIONS: Stage-matched, tailored materials may be a means to encourage screening mammography. Such interventions can be implemented by telephone and mail.

Adult↗

PubMedDate not supplied

Psychological factors affecting physical condition. Endocrine disease literature review.

Research exploring the relationship between psychological factors and the onset, exacerbation, and perpetuation of endocrine diseases has focused primarily on three diseases: diabetes mellitus (DM), Graves' disease, and Cushing's disease. There is insufficient evidence to support the position that psychological factors directly affect the onset of DM. Recent laboratory studies suggest that stress is associated with changes in glucose regulation in a subset of diabetic patients and that temperament and coping strategies influence glycemic control in diabetic children and adolescents. Relaxation training may improve blood glucose control in non-insulin-dependent DM patients. There is no good evidence that psychological characteristics affect the development and course of thyroid disorder or Cushing's disease. Recommendations are made for future research.

Depressive Disorder↗

PubMedDate not supplied

Counseling strategies for obese patients.

Counseling strategies usually assume that an individual is ready to change; however this assumption is probably not true for many obese individuals seeking medical care. Since individuals progress through a series of stages of change, some may not yet be ready to change. The transtheoretical model of behavior change proposes that individuals move through stages of change: precontemplation, contemplation, preparation, action, and maintenance. This model has been successfully applied to a range of addictive behaviors. The application of the transtheoretical model of behavior change to obesity treatment holds promise because interventions that match treatment strategies to an individual's stage of change may be more effective than current treatments. This article reviews the potential benefits of using the transtheoretical model for weight management in the primary care setting. Medical Subject Headings (MeSH): obesity, counseling, behavior.

Adaptation, Psychological↗