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Biomedical subjects

R A Carleton

Publications and source records attributed to R A Carleton.

At least 55 records · Page 3Linked to original sources
PubMed1991

Community-based approach to weight loss: the Pawtucket "weigh-in".

The Pawtucket Heart Health Program (PHHP), in its attempt to treat obesity in the community, has delivered many traditional group and self-help weight loss programs. However, in order to reach a sufficient number of people to produce a public health impact in Pawtucket, PHHP devised a monthly city-wide "weigh-in." This program, designed to be delivered by volunteers, allowed individuals to set a weight loss goal and pledge a monetary incentive toward this goal. Self-help materials and the opportunity to join weight loss groups were provided. In the pilot study, 129 (61%) of 213 enrollees completed the 10-week program with a mean weight loss of 8.2 lb (p less than .001). A large decrease in total serum cholesterol was also observed. Nonpersonnel costs, including the total costs of the cholesterol measurement, were $1.30 per pound lost. Moreover, success is also evident by continued availability of the program and the increasing number of new participants "referred" to the weigh-in by members.

Adult↗
PubMed1991

The threshold for myocardial ischemia varies in patients with coronary artery disease depending on the exercise protocol.

It is generally accepted that angina pectoris and, presumably, myocardial ischemia occur at a fixed heart rate-systolic blood pressure product in a given patient. This concept of a fixed threshold has recently been challenged. To evaluate the effects of varying exercise intensity on the ischemic threshold, 33 patients with coronary artery disease and provokable myocardial ischemia, documented by thallium-201 myocardial perfusion imaging, underwent two exercise tests 2 to 7 days apart. A symptom-limited incremental treadmill exercise test was followed by a 20 min submaximal treadmill test at an intensity approximating 70% of the peak heart rate attained during the incremental test. During the incremental exercise test, angina pectoris developed in 16 patients and 17 patients were asymptomatic. At least 0.1 mV of ST segment depression developed in all subjects during the incremental exercise test at a mean exercise duration of 5.3 +/- 2.6 min, a rate-pressure product of 19,130 +/- 5,735 and oxygen uptake of 19.6 +/- 7.0 ml/kg per min. During the submaximal exercise test, 28 (85%) of the 33 patients had significant ST segment depression. Of these patients, 24 (86%) were asymptomatic, including 10 patients who had previously reported anginal symptoms during the incremental test. The average time to onset of 0.1 mV ST segment depression during the submaximal test was 8.1 +/- 4.5 min. These changes occurred at a rate-pressure product of 15,250 +/- 3,705 and an oxygen uptake of 14.3 +/- 5.9 ml/kg per min, and were significantly (p less than 0.001) lower than values observed during the graded exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1991

Enhancing adherence to referral advice given at blood cholesterol screenings: impact on participant follow-up and physician behavior.

Adherence to referral recommendations given to participants at blood cholesterol screening programs is a critical aspect of these efforts to help detect and control high blood cholesterol in the US adult population. In this study, 386 participants who had received two consecutive blood cholesterol measurements above 240 mg/dl (6.21 mmol/l) were interviewed by telephone 3 months after their second measurement (May 1987 - May 1988). Approximately 40% of respondents had seen a physician by the time of the interview; another 30% reported having scheduled an appointment. There was no significant difference in adherence behavior between participants who received a letter reiterating the referral and those who did not. However, participants who received the letter reported greater physician attention to the evaluation and treatment of their high blood cholesterol, primarily because these participants stated that they visited their physician for their high blood cholesterol. Significantly higher rates of further blood tests, cholesterol education material distribution, cholesterol-lowering medication prescription and patient-physician discussions about cholesterol were the result. These findings suggest that consumers can be effective in stimulating and reinforcing physician practice behaviors related to cholesterol control. However, strategies must be crafted so that consumers are aware of, and appreciate, the necessity of seeking physician care when they become aware of a high blood cholesterol level.

Adult↗
PubMed1991

Use of population-based data to assess risk factor profiles of blue and white collar workers.

In light of increasing interest in the workplace as a site for primary prevention of chronic disease, more information concerning the current health status of workers is needed. This report compares "blue collar" (n = 2118) and "white collar" (n = 1900) respondents from a population-based random sample survey conducted in two southeastern New England communities. The specific responses were to a household interview and physiological measures emphasizing the risk factors for cardiovascular disease. These risk factors were elevated blood cholesterol, elevated blood pressure, smoking, being overweight and physical inactivity. Designation as blue or white collar was based upon the Standard Occupational Classification Manual. Gender specific comparisons of physiological status and self-reported knowledge attitudes and behaviors related to cardiovascular disease revealed that blue collar workers are at higher risk only for certain controllable risk factors, namely smoking and body mass index (women only). Contrary to other reports in the literature we have not found any significant difference in blood pressure or total cholesterol between the two groups. Even when people in high risk categories (systolic blood pressure greater than or equal to 140 mm/Hg, diastolic blood pressure greater than or equal to 90 mm/Hg cholesterol greater than or equal to 240 mg/dL) were studied the distributions were equally similar in both blue and white collar workers among each gender group. These findings indicate that educational interventions should target all segments of the population regardless of the nature of their occupation. More emphasis should be placed on offering programs to increase knowledge and improve health-related attitudes of blue collar workers.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude to Health↗
PubMed1991

The Pawtucket Heart Health Program. Influencing adolescent eating patterns.

The Pawtucket Heart Health Program, a research effort testing a process of community activation for cardiovascular risk factor behavior change, risk factor change, and coronary heart disease event rate change, utilizes risk factor behavior change programs for the entire population of a northeastern city. A diversity of nutrition programs designed to teach new skills and to alter the nutrition environment have been delivered. These include group programs, highlighting restaurant menus, labeling grocery shelf items, screening for blood cholesterol levels accompanied by nutritional counseling, and provision of programs in schools. In addition to standard curricula, the Heart Healthy Cook-Off for both junior high school and high school students has been developed. Students select recipes, make substitutions to lower fat, saturated fat, and cholesterol content, analyze original and substitution recipe nutrient content using a microcomputer and nutrient analysis software, and prepare the food. A panel of judges assesses presentation, taste, and health-promoting characteristics. In one junior high school class, cholesterol measure before and after the cook-off decreased by 10.7% among those with elevated cholesterol. The Heart Healthy Cook-Off is an education program that influences the culinary practices of children in an enjoyable, challenging format.

Adolescent↗
PubMed1991

Are people more health conscious? A longitudinal study of one community.

Secular changes in cardiovascular health awareness, knowledge and behavior were observed in four biennial cross-sectional surveys and a cohort survey in a New England community. These changes are not related to more health promotion activities in the social milieu of respondents, but are more likely due to national mass media health campaigns, the effects of which may influence outcomes of community-based cardiovascular disease prevention studies.

Adolescent↗
PubMed1990

Efficacy of an incentive-based community smoking cessation program.

Although the number of smokers has declined in recent years, many people remain resistant to traditional smoking cessation programs. Therefore, new and innovative approaches have been attempted. This study describes the application and effects of a community-wide smoking cessation program over three successive years. Smoking cessation rates ranged from 10.6% (CO verified) to 30.1% (self-report) at 1 month, and 17.3% to 24.5% at 1 year follow-up. Analyses revealed that successful quitters were more likely to have heart about the program at work and to have used materials contained in the self-help kit; and were more likely to be married and have a higher average income than either people who attempted to quit or made no attempt. Twelve-month follow-up data were used to classify participants into four new, distinct groups: maintainers, new quitters, relapsers, and nonquitters. Maintainers were more likely to have heard about the program at work and less likely to have become involved at Octoberfest. These programs do reach representative samples of the community. Their results compare favorably to other minimal contact intervention and physician-mediated efforts.

Adolescent↗
PubMed1990

Heart healthy cook-offs in home economics classes: an evaluation with junior high school students.

The Pawtucket Heart Health program works closely with the 23 parochial and public schools in Pawtucket, R.I., to educate students and teachers about heart health promotion. As part of that partnership, the PHHP developed a program to teach junior high school home economics students about nutrition, food purchasing techniques, and heart healthy cooking methods. In this Heart Healthy Cook-off program, the PHHP distributes recipe guidelines to home economics teachers who instruct students in recipe modification, food preparation, and presentation. Students choose recipes and make heart healthy substitutions to lower fat and sodium content. Recipes are analyzed for nutrient content by the PHHP and returned to the students with suggestions for lowering fat and sodium if necessary. Final recipes are judged for heart healthiness by a nutritionist and for taste by a panel of judges. Prizes are awarded to students with winning recipes. Before and after the Cook-offs, classes host a blood cholesterol SCORE (screening, counseling, and referral event) where students learn about their blood cholesterol level and its relationship to dietary intake. In 1988-1989, 105 junior high school students participated in the Cook-off/SCORE program. Forty percent had elevated blood cholesterol levels of 170 mg/dl or above. A statistically significant decrease in blood cholesterol levels was observed during a 12-week time period. The Cook-off is a fun, effective program for teaching secondary school students about heart healthy eating habits.

Adolescent↗
PubMed1990

Characteristics of volunteers who deliver health education and promotion: a comparison with organization members and program participants.

The use of volunteers in this culture for community health endeavors is an understudied area. Yet, there may be many potential benefits for utilizing volunteers in the delivery of community health education and promotion. Volunteers may have more immediate access to their peers, credibility, and familiarity with the cultural environment and organization elements. An assumption of volunteer use is that persons drawn from a targeted organization (or community subgroup) will be like other members. Such an assumption, however, should be confirmed or disproved. This article compares a sample of volunteers to a sample of members from organizations from which the volunteers were recruited. The paper also compares the volunteers to a sample of program participants. The participants were persons to whom the volunteers delivered CVD prevention programming and, in most cases, were also organization members. Collectively using the variables under investigation, multivariate analyses of variance found that the volunteers were different from the organization members, and different from program participants. To assess differences between the samples on each individual variable, univariate tests were conducted stratifying the samples by age. Statistically significant differences were found regarding organization activity, formal education level, success with past health habit change, health self-assessment, occupation, gender, and marital status.

Adult↗
PubMed1990

Information-seeking about health in a community sample of adults: correlates and associations with other health-related practices.

Action by individuals to acquire information about their health has been an element incorporated throughout theory, research, and programs related to health promotion. This report describes an attempt to determine if an information-seeking dimension could be empirically identified in a general community-resident sample, and if so, to examine some of its characteristics. A total of 281 adults aged 18-75 were contacted by telephone using random digit dialing and were interviewed about a variety of personal health practices. Factor analysis identified a five-item cluster representing a tendency to seek out information about health. Women were more likely than men to report seeking information. In addition, more frequent information-seeking was associated with favorable responses to several other health-related practices. Formal health service use was the only type of health practice not associated with information-seeking, perhaps because regularity of contact is influenced strongly by health professionals (e.g., reminder cards and having staff call to schedule annual exams). Overall, results of the investigation support the importance of information-seeking as a component of a personal health practice repertoire. Additional attention might be directed toward elaborating its role as a "process" variable in health education programs and social marketing efforts, particularly in areas such as response to recruitment messages, dropout vs. maintenance, and differential gains on outcome measures of program effectiveness.

Adolescent↗
PubMed1990

Pawtucket Heart Health Program point-of-purchase nutrition education program in supermarkets.

Point-of-purchase nutrition education in supermarkets is one intervention strategy of the Pawtucket Heart Health Program, a community cardiovascular disease prevention program in Pawtucket, Rhode Island. Using consumer intercept interviews, awareness of shelf labels and their effect on purchase behavior have been continuously evaluated. Between 1984 and 1988, the percent of shoppers who could identify correct labels increased from 11 percent to 24 percent (95% confidence intervals of difference: 7.17). The percent who reported they were encouraged to purchase the identified foods increased from 36 percent to 54 percent (95% CI of difference: 5.41).

Adult↗
PubMed1990

Marketing cardiovascular disease risk reduction programs at the workplace. The Pawtucket Heart Health Program experience.

The workplace offers a unique setting in which to offer CVD risk reduction programs. Marketing these programs involves at least two distinct processes. First, a corporation must agree to accept and support workplace health programming. Second, workplace programs must be effectively marketed to eligible employees, dependents, and retirees. After identifying critical barriers to the effective marketing of workplace programs, a stepwise approach used by the Pawtucket Heart Health Program to successfully overcome these obstacles is used. Using real world examples and practical tips, a discussion of implications for marketing future programs to the corporate and employee audience is shared.

Cardiovascular Diseases↗
PubMed1989

A new approach to surveillance for acute myocardial infarction: reproducibility and cost efficiency.

A new approach to surveillance of myocardial infarction, the major cardiovascular endpoint is described using an algorithm which depends primarily on enzyme data, using evidence of chest pain and positive electrocardiogram findings as supplemental information only. This approach is evaluated with respect to reproducibility by minimally trained abstractors, cost, and robustness with respect to different hospital systems as well as changes in diagnostic techniques and/or labelling over time. Two pilot studies demonstrate that, in comparison to more traditional approaches, the new surveillance system provides at least a 50% reduction in cost, is highly reproducible over different hospital systems, and potentially, is resilient to changes in diagnostic procedures or coding. The more general applicability of such an innovative surveillance approach to other disease endpoints, in which one reliable procedure contains most of the diagnostic information, is discussed with particular reference to cancer.

Algorithms↗
PubMed1989

A comparison of perceived and objective CVD risk in a general population.

This report examines correspondence between perceived and objective (American Heart Association's RISKO) risk of heart attack and stroke in a randomly selected sample from two surveys (n = 4,171) conducted in each of two New England cities, in 1981-82 and 1983-84, respectively. Results confirmed prior reports that people tend to underestimate their CVD (cardiovascular disease) risk and showed that estimates of those at lowest risk were most accurate.

Adolescent↗
PubMed1988

Labeling of participants in high blood pressure screening programs. Implications for blood cholesterol screenings.

Screening programs have expanded to identify the many persons who are unaware of their high blood cholesterol level and thus are at an increased risk for coronary heart disease. These programs bring both potential benefits and potential risks to the participant. One potential risk is that of iatrogenic effects of learning one's risk status, often referred to as the "labeling phenomenon." Research that has addressed the labeling phenomenon in blood pressure screening programs has important implications for blood cholesterol screenings. Detrimental effects on screening participants are possible, but they can be attenuated by careful attention to characteristics of the debriefing and counseling that should be included in screening protocols.

Absenteeism↗