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PubMedDate not supplied

Getting the most out of the clinical encounter: the four habits model.

Medical interviewing is the foundation of medical care and is the clinician's most important activity. A growing body of evidence suggests that clinicians use distinctive, describable behaviors to conduct medical interviews. This article describes four patterns of behavior that we term Habits and reviews the research evidence that links each Habit with both biomedical and functional outcomes of care. The Four Habits are: Invest in the Beginning, Elicit the Patient's Perspective, Demonstrate Empathy, and Invest in the End. Each Habit refers to a family of skills. In addition, the Habits bear a sequential relationship to one another and are thus interdependent. The Four Habits approach offers an efficient and practical framework for organizing the flow of medical visits. It is unique because it concentrates on families of interviewing skills and on their inter-relationships.

Empathy↗

PubMed2001

[Reduction of the use of habit-forming drugs in Vest-Agder].

BACKGROUND: For several years, the county of Vest-Agder has been over the Norwegian average for sales of habit-forming prescription medication. MATERIAL AND METHODS: A quasi-experimental project was implemented in an attempt to reduce prescription of habit-forming medication by general practitioners. 59% of eligible physicians participated in the ten-month project; 192 physicians were invited to participate, 114 accepted; 13 of these were excluded, primarily due to low weekly patient contact hours. All participating physicians received profiles of their own prescribing habits as well as the habits of other participating doctors in the region (anonymous). Physicians with a documented (via pharmacy registry) prescription rate of over 4,000 defined daily doses (DDD) per month were defined as heavy prescribers and offered a colleague-based counseling session regarding their prescribing habits. RESULTS: A comparison of heavy prescribers (n = 9) with other participating physicians (n = 92) revealed that after ten months, prescription of habit forming medication was reduced 8.5% in heavy subscribers, while the other participating physicians increased their prescription rates by 2.1%. The reduction in DDD observed among heavy subscribers was accounted for by reductions in both the number of prescriptions and the number of DDD per prescription. INTERPRETATION: Identification and feedback, rather than the colleague-based interview, seemed to be responsible for the reductions observed among heavy prescribers.

Drug Prescriptions↗

PubMedDate not supplied

Urinary catecholamines as a measure of emotional stress in children with a digit-sucking habit: a preliminary study.

This cross-sectional study investigated the relationship between digit-sucking habit and emotional stress measured by the urinary catecholamines in 314 children, boys and girls, ages six to eight years. The digit-sucking habit was recorded by an interview. A twenty-four hour urine sample was collected for each subject and a representative sample was analyzed by the HPLC technique to assay the catecholamine content. Socioeconomic factors were recorded by a questionnaire distributed to the parents. The logistic multiple-regression analysis was used to test the impact of catecholamines and other related factors on the presence of a digit-sucking habit. The results showed that emotional stress measured by the urinary catecholamines did not have a significant effect on the presence of a digit-sucking habit. Of the socioeconomic factors, father's education had a significant negative effect on the presence of the habit. The evidence provided by this investigation cannot support the view of psychoanalytic theory that continuation of the habit beyond the early childhood is due to emotional stress.

Catecholamines↗

PubMed2002

Dentofacial anomalies related to the digit sucking habit.

Digit (thumb or finger) sucking is the most common oral habit, frequently seen among young children. With an increase in the prevalence of the oral habit in Nigeria in recent years there should be an expected increase in the dentofacial effects of the habit. In this study 81 children, 29 males and 52 females aged 3-16 years were examined. Each child was still actively engaged in the digit sucking habit. Subjects were divided into 3 age groups--3-6 years, 7-10 years and 11 years and above. The dentofacial effects of the habit on each subject were assessed. Increased overjet was observed in 63-705 of the children in the different age groups while the occurrence of anterior open bite ranged from 33.3% to 80% declining in frequency with increase in age. Unilateral posterior crossbite was observed in 8.65 of children while no case of bilateral crossbite was observed. Lip incompetence occurred in 51.8% of children examined, occurring most frequently in the oldest age group. Class 2 skeletal pattern was observed in 22.2% of the sample population. Results show that malocclusion is a frequent result of digit sucking especially when prolonged. There is a need to increase social awareness of the detrimental effects of this habit and if necessary offer alternative non-nutritive sucking methods.

Age Distribution↗

PubMed2003

[A study on the influence of daily life habits on people's health symptoms].

PURPOSE: The purpose of this study was to understand the relation between daily life habits and subjective symptoms and to gather basic data about improvement of the quality of life and its influence on a person's health. METHOD: The subjects were middle-aged (including all residents, males and female, all between the ages of 20 and 59. n = 2,520) in an agricultural village near a large urban center on the main island of Japan. A total of 1,834 villagers who responded to the survey in 1995 could be followed until 1998. The contents of the questionnaire covered age, sex, past history, daily life habits, mental condition, and activities of daily living. Using the method chi 2 verification and multiplex logistic analysis the village residents daily life habits their relation with subjective symptoms after 3 years were investigated. RESULTS: According to the analysis focusing on factors which had effects on subjective symptoms, the odds ratio were as follow: people who often skip breakfast-shortness of breath: 3.37 people who often eat between meals-toothache: 2.06 smokers-headache: 0.39, nausea: 18.89, urination problem: 0.03 people with insufficient sleep-eye fatigue: 1.76, diarrhea: 4.07 people with a BMI value less then 18.5-dizziness: 1.82 The results showed a significant relationship between people's daily life habits and their health condition. (all P < 0.05). CONCLUSION: From the results of this study, we can clearly see the tendency to minimize the subjective symptoms by desirable daily habits and that there is a possibility to prevent some of the through even slight improvement of habits. The study also indicates that it is necessary to stimulation a more diverse life style to maintain good health.

Activities of Daily Living↗

PubMed1992

Long-term maintenance of a low-fat diet: durability of fat-related dietary habits in the Women's Health Trial.

The Women's Health Trial (WHT) was a feasibility study for a randomized trial of a low-fat diet for the prevention of breast cancer. One year after the WHT was terminated, a random sample of 894 participants who had been active in the WHT for an average of 16 months (range = 5 to 37) completed questionnaires about their dietary habits (a 21-item instrument that measures five dimensions of low-fat dietary habits) and food intake (a food frequency questionnaire). Women who participated in the intervention program maintained most of the low-fat dietary habits adopted during the study: mean total fat intake increased from 37.8 g to 41.0 g and scales describing substitution of specially manufactured low-fat foods and modification of meats to be lower in fat increased only slightly (by 0.11 and 0.14, respectively, on a scale of 1 = always to 4 = never). Scales describing avoiding meat and avoiding fats as a flavoring increased by 0.23 and 0.22, respectively, which suggests some recidivism. Women in the control group lowered their dietary fat intake from 65.0 to 57.5 g, but all differences in fat intake and fat-related dietary habits scales between women in the control and intervention groups remained highly statistically significant. In multiple regression models, all five low-fat dietary habits scales were independently associated with percentage of energy from fat, but the strongest association was for avoiding fats as flavorings. These results suggest that substitutions of specially manufactured low-fat foods are easily adopted and maintained dietary changes, but that maintenance of new habits related to avoiding fats as flavorings and avoiding meat will require long-term reinforcement strategies.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2005

Effective prevention of carotid artery atherosclerosis by following this motto for healthy habits: "Give up one, reduce two, and increase three".

OBJECTIVES: Lifestyle has a major influence on the development and progression of atherosclerosis. Our motto for healthy habits is "give up one, reduce two, and increase three". The one thing that is to be given up is smoking. The two things that are to be reduced are intake of food and alcohol. The three things that are to be increased are exercise, rest and enjoyable activities. We assessed correlation between these six health habits and plaque score indicating degree of atherosclerosis in the carotid artery. METHODS: Subjects were divided into unfavorable (practicing zero to three habits) and optimal (practicing four to six habits) healthy habits groups. RESULTS: Plaque score was significantly higher in the unfavorable group (7.6 +/- 5.8) than in the optimal group (4.9 +/- 4.2) (P<0.001). CONCLUSIONS: The healthy habits that significantly contributed to prevention of atherosclerosis were quitting smoking and increasing rest and enjoyable activities.

Aged↗

PubMed1991

Tobacco habits among teenagers in the city of Göteborg, Sweden, and possible association with dental caries.

Frome nine dental clinics within the Public Dental Service in the City of Göteborg, 2145 patients aged 14 to 19 answered a questionnaire concerning their tobacco habits. Tobacco was used in some form by 27 per cent of the patients and use increased with age. Smoking was more common among girls than among boys: 24 and 12 per cent, respectively. The statistical analyses showed that smoking as a habit and an increased number of cigarettes smoked per day are positively correlated with increases in the number of decayed, missing and filled teeth and the number of initially decayed proximal surfaces. Further, all caries epidemiological data were significantly higher among patients with tobacco habits compared to non-users. It can be concluded that there is a correlation between the tobacco habit and increased caries prevalence. However, dietary and oral habits have to be further elucidated before any definite conclusions can be made regarding the effect of the tobacco habit per se on the development of caries.

Adolescent↗

PubMedDate not supplied

Comparison of health habits of military personnel with civilian populations.

The relationship between health habits and health status has gained attention in the literature in recent decades. In this report, the health habits of a particular occupational group--the military--are compared with those of the civilian population, and the extent to which the health habits of the military personnel are associated with their health status is examined. Responses to two surveys conducted in 1985 were analyzed by age group, sex, race, and educational level. The comparisons involved six of the seven health habits included in the Alameda study. Military personnel, because they are younger and their lives are more regimented, excel in meeting weight standards for the services and engaging in desirable levels of physical activity. Smoking habits of military personnel were less favorable than those of the civilians. An examination of the health status of the military for the year preceding the survey suggested that some health habits have immediate manifestations, but the impact of others may not be evident until later in life.

Adolescent↗

PubMed1989

[Dummy- and finger-sucking habits among 5-year old children. An investigation of frequency and effect on the dentition and occlusion].

Dummy- and finger-sucking habits were investigated among 60 5 year olds, born in 1982. The children were living in Raufoss, a small rural community in eastern part of Norway. Information about the sucking habits was obtained from their parents by means of questionnaires. The position of the teeth and the occlusion were registered by an orthodontist. Total prevalence of sucking habits was 63%. Thirty-seven percent, had used a dummy and 30% had been or were still finger-suckers. Two children had both used a dummy and sucked their fingers. This is a significant lower total prevalence of sucking habits than recorded in recent Swedish and Danish studies (1-8), but comparable with a Swedish study from 1971 (9). Most dummy-suckers had broken their habits at 3-4 years of age, while the finger-suckers were still active at 5 years of age. Finger-sucking had the largest impact on the position of the front teeth. The finger-suckers had significantly larger overjet and smaller overbite, more proclined upper incisors and retroclined lower incisors than dummy-suckers and those without any sucking habit. The only measurable effect of previous dummy-sucking of 5 years of age was a more open position of the lips and a smaller overbite. Otherwise, no significant effect on the occlusion was observed in any of the dummy- or fingersuckers.

Child↗

PubMed1988

[Desirable and undesirable food customs, practices and habits].

The purpose of this paper is to analyze the role of habits and practices in shaping human dietary behavior. After defining terms and concepts, the origin of habits is briefly reviewed and ideas on the strategies to modify them are discussed. Habits stand among the most important determinants of food consumption, but their extreme complexity is poorly understood; a great number of physiological, psychological, economic, technological and sociocultural factors participate. Even though some habits are deleterious to health, many others are beneficial or irrelevant; while the first should be corrected, beneficial habits should be reinforced. By their own nature, habits are modifiable, and at the same time quite stable. Modification is possible, but prudence and patience are required.

Cultural Characteristics↗

PubMed1995

[Smoking habits among hospital employees in 1992].

The aim of the study was to investigate the smoking habits of employees of a Danish hospital on the basis of a questionnaire given in October 1992 and compare the results with two similar previous studies of smoking habits among the Danish population (1991) and physicians and nurses (1989). It was performed as a cross-sectional questionnaire study in collaboration with Bispebjerg Hospital and Tobaksskaderådet. Three thousand one hundred and fifty-four (84%) employees responded. The results showed that 37% of male and 33% of female employees were daily smokers. The prevalence of smokers and the distribution of smoking habits according to social class of the employees were equal to the general population except for male physicians and female nurses where the prevalence of smokers was lower than the corresponding social classes. Female doctors smoked as much as class I from the population study. Twenty-two percent of male and 17% of female employees smoked 15 cigarettes a day or more (heavy smokers). Eighty-seven percent of the smokers smoked at work, and one-third smoked more than five cigarettes on each workday. It is concluded that the smoking habits of Danish hospital employees correspond to the smoking habits of the general population. Rules on smoking restriction in Danish hospitals are needed. The smoking habits of female doctors calls for attention.

Adult↗

PubMed1995

[Characteristics of smoking, drinking, dietary habits, and physical exercise in health behavioral models].

Various kinds of preventive health behaviors are promoted by health education. The extent of behavioral modification achieved, however, obviously differs from individual to individual according to habits, one of the reasons being the characteristics of various health habits are perceived differently. This cross-sectional study examined the association of indices representing health behavior models with smoking, drinking, dietary habits, and physical exercise. The indices and their meaning were as follows; health locus of control (HLC) and saliency of health are thought to cause the most active behavioral change, health norm relatively passive change, and vulnerability to illness the most passive change. The indices and lifestyle (health related practices) were surveyed by a self-administered questionnaire in a rural town in March 1994. The study sample consisted of 1,010 males and 1,055 females aged 20 years or older who responded to all questions related to the indices. Results are as follows: 1) Smoking and alcohol drinking were associated with vulnerability to illness, suggesting that people who quit smoking or alcohol drinking do so because of perception of their association with illness. Alcohol drinking seemed to have a higher magnitude of being associated with becoming ill or with fear of illness than smoking. 2) Consuming green-yellow vegetables and fresh fish, and physical fitness were associated with internal HLC, saliency of health, and health norm. These habits appeared to be easy to modify by active personal behavior choice. 3) Consuming milk, yogurt, boiled beans, tofu, oranges, and other fruits were associated with saliency of health. These habits seemed to relate to personal sense of being "healthy". 4) It seemed that younger people more likely changed their behavior by active self-management, while, older people changed due to their sense of value or norm. While it is important for health education to promote "self-management of health" by active behavioral change, certain habits are more resistant to change despite educational efforts possibly because of their characteristics in health behavioral models. For cases such as these, techniques promoting passive behavioral change should be considered.

Adult↗

PubMed1997

Oral health habits and the number of teeth present in Japanese aged 50-80 years.

OBJECTIVE: To suggest appropriate oral health habits for daily practice in order to prevent tooth loss. DESIGN: Cross sectional study correlating mean number of teeth and oral health habits. SETTING: All 97 dental clinics in an urban area (population 256,000) in Osaka Prefecture, Japan. SUBJECTS: 1,248 persons aged 50-80 who received dental treatment at any of the dental clinics between 10 January and 7 February, 1992. OUTCOME MEASURES: The number of teeth present was recorded by the dentists in their clinics. The subjects were asked to complete questionnaires on oral health habits, prior dental attendance patterns and the perceived general health status. RESULTS: Mean number of teeth present had a significant relationship with perceived health status. Implementation of particular oral health habits, such as using a toothbrush with nylon tufts and hard tufts, changing the toothbrush within three months, receiving tooth brushing instruction, scaling, and prompt dental treatment were related positively to the number of teeth present. Furthermore, the frequency of dental visits in the past showed an inverse relationship with the mean number of teeth present. This result does not necessarily mean, however, that regular dental visits are undesirable. From multiple regression, the mean number of teeth was calculated to be from 27.9 to 16.9 at 50 years of age and from 12.2 to 3.0 at 80 years of age in relation to oral health habits. CONCLUSIONS: To keep more teeth in the later years, it is evident that prevention of dental disease in earlier life is essential, and that individuals should receive prophylactic treatment, and maintain proper tooth brushing habits throughout life.

Age Factors↗

PubMed1998

Oral habits in children--a prevalence study.

This epidemiological study was conducted upon 4,590 school children to find the prevalence of oral habits in Mangalore in relation to their age and sex and to find the correlation, if any, between the habits and the malocclusion status. We noted that 29.7% of the population had habits of which 3. 1% had digit sucking, 4.6% mouth breathing, 3.02% tongue thrusting, 6.2% bruxism, 6% lip/cheek biting, 12.7% nail biting, 9.8% pencil biting and 0. 09% masochistic habits respectively. Digit sucking, pencil biting and tongue thrust were highly prevalent among Group 1 (3-6 years) children. Mouth breathing and bruxism were significant in Group 2 (7-12 years) cases whereas lip/cheek biting and nail biting were more common in Group 3 (13-16 years) cases. Digit sucking, tongue thrust, mouth breathing and bruxism were more prevalent among the boys whereas lip/cheek biting, nail biting and pencil biting were more prevalent among the girls. 28.95% of the children in Group 2 and 3 with habits had malocclusion. There was a significant correlation between class I type 2, class II div 1 and tongue thrust and mouth breathing whereas children with digit sucking showed a high correlation with class I type 2 malocclusion.

Adolescent↗

PubMed2002

[Significance of bad habits in orthodontics].

The author is concerned with the etiological role of bad habits in the development. Disturbances caused by pacifier habits, finger sucking, various forms of swallowing habits and their therapeutical possibilities are discussed. The role of mouth breathing, nail biting, bruxism and self-mutilation in development of anomalies and their therapy are also mentioned. The attention is called to the fact that dentists have responsibility and task to diagnose as early as can be the oral bad habits and that the adequate therapy in time in co-operation with other specialists helping the child get out of bad habits, preventing the development of severe anomaly.

Bruxism↗

PubMed1985

A comparison of contingent vs non-contingent competing response practice in the treatment of nervous habits.

Previous research found that two components of the habit reversal procedure, the practice of a competing response (CR) and awareness training, suppressed muscle tics to the same degree as Azrin's entire habit reversal program. This study compared the effectiveness of two variations of the competing response procedure (contingent vs non-contingent practice) on the nervous habits of nine subjects. The results showed the non-contingent competing response to be largely ineffective in decreasing the target behaviors. The contingent competing response procedure greatly reduced the nervous habits of most subjects, and the complete habit reversal procedure further decreased the behavior for two subjects. This research indicates that the competing response procedure is most effective when used in a contingent fashion.

Adult↗

PubMed2006

Oral habits and their association with signs and symptoms of temporomandibular disorders in adolescents: a gender comparison.

OBJECTIVES: The prevalence of oral parafunctions and signs and symptoms of temporomandibular disorders (TMD) in female and male adolescents were compared and their relationship to one another evaluated. STUDY DESIGN: The study consisted of 314 adolescents (136 males and 178 females). Each participant filled out a questionnaire regarding their oral habits and symptoms of TMD. A clinical examination was carried out regarding signs of TMD. RESULTS: Generally, the prevalence of most oral habits was higher among adolescent females than males. Most examined signs and symptoms of TMD showed a statistically significant higher prevalence among females. Gender and nearly all oral habits were a risk factor for TMD. CONCLUSIONS: Adolescent females had a higher prevalence of TMD signs and symptoms and carried out oral habits more intensively. Parafunctional activity may be another contributing factor in the discrepancies found in the prevalence of signs and symptoms between the sexes. Parafunctional habits and gender may be risk factors of TMD.

Adolescent↗