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Biomedical subjects

N M Clark

Publications and source records attributed to N M Clark.

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

Creating capacity: establishing a health education research agenda for special populations.

On Day 2 of the joint CDC/SOPHE conference on Creating Capacity: Establishing a Research Agenda for Health Education, the participants were asked to identify research needs or special issues in working with children and adolescents, the elderly, women, men, and underserved groups. This article presents the priority research areas across subgroups identified by the participants. The cross-group priorities are followed by research recommendations for each subgroup.

Adolescent↗
PubMed1995

Examining a paradox: does religiosity contribute to positive birth outcomes in Mexican American populations?

A particularly interesting and consistent finding regarding the health of the Latino population is that Mexican American women, despite their relatively lower socioeconomic status, deliver significantly fewer low birth weight babies and lose fewer babies to all causes during infancy than do women of other ethnic groups. A central thesis of this discussion is that the religiosity and spirituality of many of these Latinas, a key factor in their culture, may protect them and their infants through the pre- and antenatal phases of life. We also suggest that lack of research, related to cultural similarities and differences in Hispanic/Latino subgroups, can lead to faulty or simplistic understanding regarding their health behavior and health status.

Acculturation↗
PubMed1994

Management of asthma by patients and families.

This paper focuses on assessment of asthma-management outcomes resulting from interventions for patients. Noted is the need to design both programs and evaluations that reflect a theoretical understanding of behavior change. For purposes of illustration, the theoretical construct of self-regulation is used. It is posited that individuals are predisposed to take action to handle asthma problems by virtue of internal (knowledge, attitudes, beliefs) and external (models of behavior, technical advice and service, money, etc.) factors. Through processes of self-regulation--that is, the ability to observe, make judgments, and react to one's own behavior--individuals learn which management strategies (prevention, symptom management, negotiation, and communication) work for them. If these management strategies are effective, one would expect certain outcomes: the patient's personal goal will be reached; physiologic and psychological health status will be maintained or improved; and health care use will be appropriate. A range of good studies of patient behavior related to asthma management and of interventions to enhance behavior are available, and provide some evidence that these outcomes can be attained. A solid foundation for the development of more sophisticated and refined self-management assessment measures is available. Objective measures have been used to verify behavior in two or three research projects. Although objective measures are costly and can be cumbersome to administer, more effort to develop and use such measures is needed. Testing of the reliability and validity of existing patient-management measures has been perfunctory, and greater attention, especially to the validity of measures, is needed. Six recommendations for better measurement are made.

Adult↗
PubMed1994

Patient and family management of asthma: theory-based techniques for the clinician.

Several model asthma education programs are available to improve patient self-management, and elements of these models are discussed as they relate to the teaching role of health-care providers. Self-regulation is being explored in current asthma education research, and preliminary findings of a study are presented that show self-regulation behaviors to be associated with more frequent use of asthma management strategies by patients. Using more management strategies was associated with being observant of symptoms (p = .0001) and feeling confident to manage them (p = .01). Taking more preventive actions was associated with being observant (p = .001) and feeling confident to keep the child out of the triggering situation (p = .02) and prevent symptoms (p = .001). Important issues arising from recent psychosocial research are outlined for consideration by the clinician. These include ways that counseling by the health professional can encourage self-regulation and better at-home management of asthma.

Adult↗
PubMed1994

Reducing tobacco smoke in the environment of the child with asthma: a cotinine-assisted, minimal-contact intervention.

Children with asthma who are exposed to environmental tobacco smoke are at increased risk for adverse health consequences. An experimental design was used to evaluate a minimal-contact intervention aimed at modifying parents' smoking behavior in their homes. All subjects received counseling on the health effects of passive smoking and advice to quit smoking inside the home. Treatment subjects were also mailed the results of a urine cotinine test on their child and a self-help manual. More treatment (35%) than control (17%) subjects reported smoking outside their homes at posttest (and their children's cotinine levels were lower), but this difference was not statistically significant.

Adolescent↗
PubMed1993

Sustaining collaborative problem solving: strategies from a study in six Asian countries.

This paper presents findings from seven case studies of collaborative problem solving. The cases represent models of large-scale collaborative effort to improve the social, economic or health status of residents in poor communities. In these examples a variety of organizations worked together: government, business, voluntary agencies, community groups and people's organizations. A range of strategies was evident as these entities tried to sustain their collaboration. Strategies identified included those deployed collectively, those used by an individual organization to maintain its ability to participate and those used to persuade or pressure needed collaborators to become involved or stay the course. Specific strategies employed and descriptions of their use are presented and comprise a compelling profile of how collaborative problem solving functions.

Asia↗
PubMed1993

Activation of the human T-cell leukemia virus type I enhancer is mediated by binding sites for Elf-1 and the pets factor.

Infection with human T-cell leukemia virus type I (HTLV-I) is associated with adult T-cell lymphoma/leukemia. This disease occurs in only a small minority of people infected with HTLV-I and manifests itself many years after infection. Therefore, it appears that a fine balance exists between HTLV-I and the host T-cell factors with which it interacts. HTLV-I encodes a transactivating protein, Tax, which activates viral transcription via cellular mechanisms which are incompletely understood. As viral gene expression is negligible during latency, it is doubtful that Tax controls the initial transition to the replicative state. Tax-independent cellular factors which control HTLV-I transcription, and presumably latency, have received little study. Recently, the product of the chicken proto-oncogene ets-1 has been shown to bind to the HTLV-I enhancer and modestly activate transcription in certain cell types (S. C. Gitlin, R. Bosselut, A. Gégonne, J. Ghysdael, and J. N. Brady, J. Virol. 65:5513-5523, 1991). However, the functional significance of the ets-binding site in the intact enhancer has not previously been shown. We now demonstrate that site-specific mutation of the purine-rich ets-binding site significantly diminishes inducible enhancer function, but not Tax response, in the human Jurkat T-cell line. Similarly, mutation of the peri-ets (pets) site, not previously noted in the HTLV-I enhancer, markedly inhibits inducible enhancer function but not Tax response. Further, we show that the predominant protein binding the purine-rich HTLV-I enhancer element in human T cells is not ets-1 but Elf-1, a member of the ets family which is very similar to the Drosophila morphogen E74. Regulation of HTLV-I through Elf-1/pets enhancer motifs resembles that seen with human immunodeficiency virus type 2 (D. M. Markovitz, M. Smith, J. Hilfinger, M. C. Hannibal, B. Petryniak, and G. J. Nabel, J. Virol. 66:5479-5484, 1992; J. M. Leiden, C.-W. Wang, B. Petryniak, M. Smith, D. M. Markovitz, G. J. Nabel, and C. B. Thompson, J. Virol. 66:5890-5897, 1992), another human pathogenic retrovirus with a relatively long incubation period.

Animals↗
PubMed1993

Patient, professional, and public education on behavioral aspects of asthma: a review of strategies for change and needed research.

Combating increases in asthma morbidity and mortality necessitates an understanding of social and behavioral aspects of the disease. Education for patients, professionals, and the public based on the most current scientific information is required. This paper reviews the existing research on patient education and management of asthma. It discusses physician and family interaction related to asthma management; identifies gaps in the current understanding of relevant patient, professional, and public behavior; outlines needed strategies to improve asthma education; and poses recommendations for further research.

Adolescent↗
PubMed1992

Impact of self-management education on the functional health status of older adults with heart disease.

This paper presents findings from the evaluation of a self-management education program based on self-regulation principles. Older men and women (N = 324) were randomly assigned to program and control groups. Outcomes were measured using the Sickness Impact Profile. Twelve months following baseline data collection, psychosocial functioning of program participants was significantly better than that of controls. Different program effects were noted when results were analyzed by participant gender.

Activities of Daily Living↗
PubMed1992

The relationship between cognitive maturity and information about health problems among school age children.

This study of urban, multi-ethnic children was undertaken to explore the relationships between age, cognitive developmental capability (termed 'cognitive maturity') and accuracy of information about health problems. A total of 299 children in the first, second and third grades from six public and one private school in New York City were individually interviewed using an open-ended set of questions. Findings indicated that having accurate health information is not the same as comprehending the abstract internal nature of the 'facts'. Results supported Piaget's levels of cognitive development applied to the area of health. Findings also showed that age is a better predictor of children's accuracy about health information than their cognitive maturity. The findings underscore the need for those providing health education to place emphasis on the cognitive abilities of children and not to mistake recitation of factual information for understanding of conceptual elements of a health problem.

Analysis of Variance↗
PubMed1992

Self-regulation of health behavior: the "take PRIDE" program.

Social cognitive theory, in particular, the construct of self-regulation was the basis for developing an educational program for older adults with heart disease. This paper discusses the theoretical principles utilized and describes the program activities based on them. Data from an evaluation conducted with 246 older heart patients who took part in the education are used to illustrate how social cognitive theory constructs operated empirically.

Cognition↗
PubMed1991

Differences in the impact and management of heart disease between older women and men.

Findings are presented from an exploratory study of differences in the impact and management of heart disease between men and women aged 60 and over (N = 323). The sample consisted of ambulatory, non-institutionalized, cardiac patients who had agreed to participate in a self-management intervention study. Differences between men and women were found regarding symptom experience, physical functioning, exercise compliance, use of prescribed drugs, and physician/clinic visits. Differences in emotional well-being and psychosocial functioning were not found; however, women reported more stress and limitation in the area of household management. Implications for future research and practice are discussed.

Activities of Daily Living↗
PubMed1990

Communication within low income families and the management of asthma.

This study examines the effects of communication between low income urban parents and children about a chronic disease on the extent to which parent and child effectively manage the illness. Four asthma communication factors were identified by principal component analysis. We found that mothers whose preferred language was Spanish, and families who were not receiving public assistance, communicated more frequently about asthma in general. Spanish speaking mothers and their children communicated more about potential home treatments for asthma, and the more adults in the household the less there was communication about the need for emergency services for asthma. Mothers who preferred to speak Spanish had higher levels of management of the most recent asthma attack. Those whose children communicated with them about asthma in general were higher level managers. Children who influenced their parents' decisions about school attendance, and those whose mothers were more highly educated, had higher levels of asthma attack management. More educated mothers, ones whose children were younger at the time of the onset of asthma, and one who received public assistance, were more involved "in general" in their child's asthma care.

Adult↗