PubMed · 247399
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G H Murphy, M McArdle. 1978-04-27. Behaviour modification with the retarded.. https://pubmed.ncbi.nlm.nih.gov/247399/
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Behaviour modification is often delivered to teaching subgroups. For example, experimental and control smoking cessation programmes may be given to 15 classes (subgroups) with 10 (otherwise independent) individuals. We present general statistical tests and power estimates to compare continuous outcomes from two interventions in settings where the magnitude of teaching subgroup heterogeneity, number of subgroups and subgroup size can differ between intervention arms. An application is made to data from a trial to reduce disease-transmitting sexual behaviour. The statistical impact of teaching subgroup heterogeneity effect increases as the (a) number of participants in a subgroup increases, and (b) ratio of 'averaged experimental and control subgroup effect variance' to study subject variance increases. If plausible levels of subgroup teaching effect heterogeneity are ignored, the true sizes of tests with nominal 0.05 two-sided type I errors range from 0.055 to 0.47, while when planning studies, estimated sample sizes are only 11.1-95.2 per cent of the true requirements.
BACKGROUND: Uncontrolled hypertension is the most common and important risk factor for cardiovascular and renal disease. We studied factors associated with hypertension control in the Third National Health and Nutrition Examination Survey. METHODS: A total of 3077 non-Hispanic whites, 1742 non-Hispanic blacks, and 1067 Mexican Americans 18 years or older with hypertension were included in the current analysis. Blood pressure was measured by trained observers by means of a standard mercury sphygmomanometer, and controlled hypertension was defined as a mean systolic/diastolic blood pressure less than 140/90 mm Hg. RESULTS: Percentages of persons with controlled hypertension differed significantly by ethnicity and sex: 19.2% and 28.7% for white men and women, 17.5% and 28.6% for black men and women, and 12.7% and 18.0% for Mexican American men and women, respectively. After adjustment for important covariables, percentages of persons with controlled hypertension were significantly higher among persons who were currently (odds ratio [OR] 2.39; 95% confidence interval [CI], 1.52-3.74) or formerly (OR, 1.81; 95% CI, 1.12-2.93) married, had private health insurance (OR, 1.59; 95% CI, 1.02-2.49), visited the same facility for their health care (OR, 2.77; 95% CI, 1.88-4.09) or saw the same provider for their health care (OR, 2.29; 95% CI, 1.74-3.02), had their blood pressure checked during the preceding 6 months (OR, 8.00; 95% CI, 3.75-17.1) or 6 to 11 months (OR, 5.31; 2.51-11.2), and reported using lifestyle modification to control their hypertension (OR, 6.02; 95% CI, 4.20-8.63). CONCLUSION: These data strongly suggest that access to a regular source of health care and modification of lifestyle are important factors in the control of hypertension in the community.
Family physicians should take advantage of each contact with smokers to encourage and support smoking cessation. Once a patient is identified as a smoker, tools are available to assess readiness for change. Using motivational interviewing techniques, the physician can help the patient move from the precontemplation stage through the contemplation stage to the preparation stage, where plans are made for the initiation of nicotine replacement and/or bupropion therapy when indicated. Continued motivational techniques and support are needed in the action stage, when the patient stops smoking. Group or individual behavioral counseling can facilitate smoking cessation and improve quit rates. Combined use of behavioral and drug therapies can dramatically improve the patient's chance of quitting smoking. A plan should be in place for recycling the patient through the appropriate stages if relapse should occur.