PubMed · 5567180
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D J Dunn. Work and behavior change.. https://pubmed.ncbi.nlm.nih.gov/5567180/
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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.
Psychoneuroimmunology is a field that investigates the interactions between the brain and the immune system. One important goal of this field of research is to translate basic research in order to understand how behavior affects health and resistance to disease in humans. This review evaluates the impact of depression on morbidity and mortality risk and asks whether neuroimmune mechanisms contribute to this association. Examples are drawn from three diseases: cardiovascular disease, infectious disease, and rheumatoid arthritis. Finally, the potential for biobehavioral interventions to impact psychological adaptation and the course of immune related disease is discussed.