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PubMedDate not supplied

Effect of health education in promoting prescription refill compliance among patients with hypertension.

A multifactorial health-education program designed to enhance compliance with a once-daily regimen of atenolol was evaluated among 453 patients enrolled in health maintenance organizations (HMOs). The initiation of the 180-day study period was used to classify patients as either new or existing cases of hypertension. In turn, patients in these two categories were randomly assigned to a control or an experimental group. Patients assigned to the experimental groups received an enrollment kit upon exercising their initial prescription (new patients) or their first refill request (existing patients). The kit contained: a 30-day supply of atenolol; an educational newsletter about hypertension; information on nutrition and life-style changes; and an explanation of the intent and content of the program. Before the next scheduled prescription-refill date, each patient was contacted by telephone to inquire about his or her experience with the therapy and to stress the importance of adherence to the regimen. Each month thereafter, the newsletter and an enclosed prescription-refill reminder were mailed to each patient. The medication possession ratio, defined as the number of days' supply of atenolol obtained by a patient during the 180-day study period, was significantly (P less than or equal to 0.001) enhanced for the new and existing experimental groups relative to the control groups. Multiple regression analyses revealed that enrollment in the health-education program increased the number of days' supply of atenolol obtained by existing patients by 27 (P less than or equal to 0.001), and by new patients by 40 (P less than or equal to 0.001).

Atenolol↗
PubMed1990

The medical management of reflux esophagitis. Role of antacids and acid inhibition.

Of the more than 60 million adult Americans who have heartburn at least once a month, 60% choose over-the-counter medication rather than consulting their physician. Those individuals who do seek medical advice for reflux symptoms will probably receive a prescription for an H2-receptor antagonist, although in many instances simple life-style changes and occasional use of antacids may provide effective therapy. Patients who have severe esophagitis or reflux symptoms unresponsive to H2-receptor antagonists may be treated with a more potent antisecretory agent (proton pump inhibitor). The author discusses the role of antacids and acid inhibition in the treatment of gastroesophageal reflux disease. The results of the clinical trials with the H2-receptor antagonists, cimetidine, ranitidine, famotidine, and nizatidine, and the proton pump inhibitor omeprazole, are compared and contrasted.

Antacids↗
PubMed1991

Safety belts and public health. The role of medical practitioners.

Medical practitioners have helped the public become aware of the importance of health-promoting life-style changes such as getting more exercise and abstaining from smoking. They can likewise help their patients protect themselves from the threat of automobile crash injury. Safety belt use remains too low, and increased use offers unusual potential for averting death and disability. Various characteristics associated with a failure to use safety belts can be used to help identify patients at high risk of traffic injury. These include male sex, persons who are ethnic minorities, young people, poor people, those with low educational levels, and persons with negative attitudes to seat belt use. Various methods and resources are available to help practitioners provide appropriate safety belt advice to patients, although the specific resources available vary from place to place. At a minimum, patients need to be told that a proper use of occupant protection can at least double the chances of avoiding death or severe injury in an automobile crash.

Adult↗
PubMed1990

[Changes in life style confronted by patients with chronic health conditions].

The purpose of this study was to identify the life style changes in patient with chronic illness. The sample consisted of 45 patients with chronic diseases. The findings showed that the patients had to face changes in their life Style such as: First, new tasks including compliance with terapeutic regimens seeking information about their diseases and managing their disconforts. Second, --losses referring to their social relationship, finances, locomotion and work capacity, and leisure activities losses. Third, treats --including treat to their personal self, their life and hope.

Brazil↗
PubMed1990

Counseling women at high risk for breast cancer.

Cancer risk analysis is a relatively new clinical service that has developed as more precise information has become available regarding specific risk factors. Both epidemiological and genetic factors contribute substantially to the identification of women at higher risk for developing breast cancer. The definition of what constitutes risk, an understanding of which factors influence risk, and the ability to present risk information clearly are critical features. In addition to providing information about risk and assessing each woman's perception of risk, the emotional issues must be addressed. The focus of intervention should center upon the benefits of early detection, assessment of breast self-examination skills, individualized breast cancer screening recommendations, such as mammography and physical exams, and recommendations for life style changes for possible prevention.

Breast Neoplasms↗
PubMed1989

Collaboration in action.

A neighborhood health center and a school of nursing in the southwest collaborated in a pilot project to offer two workshops for low-income, Hispanic diabetics. The collaboration process used participatory management and change theories, accepted and incorporated features of Hispanic culture, and fostered interpersonal relationships. The project enabled the center to augment its client education services while providing a teaching experience for nursing students. Through the workshops, clients gained knowledge and skills that enabled them to institute life-style changes in meal planning, medication management, exercise routines, and community involvement.

Community Health Centers↗
PubMedDate not supplied

Hypercholesterolemia. Prevention and control.

In the last few years, public concern about cholesterol has become a national preoccupation. Concerned consumers increasingly direct their questions about cholesterol to the nurses with whom they come in contact. Nurses in any setting who are knowledgeable about cholesterol are in an ideal position to teach current, accurate, potentially life-saving information about it. Nurses everywhere have a responsibility to assist consumers to achieve the goals of the National Cholesterol Education Program (NCEP) panel of experts within the next few years. This article describes the prevention and control of hypercholesterolemia through dietary and life-style changes. Drug therapy for control of hypercholesterolemia is discussed. Specific nursing interventions that are designed to assist people to achieve the NCEP goals are outlined.

Anticholesteremic Agents↗
PubMed1986

Recurrence of stenoses after coronary angioplasty.

Recurrence remains a major problem after PTCA. The recurrence rate is higher in patients with diabetes, patients 70 years of age or older, and patients with severe coronary artery disease. Intimal tearing during the procedure may lower the recurrence rate. Recurrence in patients with multivessel angioplasty is higher than for those with single-vessel angioplasty, and it appears to be cumulative. The nurse can play an important role in risk-factor modification, teaching, and promoting smooth transitions in life-style changes after patients undergo angioplasty. Through education by the nurse, patients can learn to recognize angina and learn how to seek treatment for recurrence of ischemic symptoms. Lastly, the nurse can play an important role in patient follow-up. This can be done by reinforcing and encouraging patient compliance. Through further research the management and control of recurrence can be better understood.

Adult↗
PubMed1988

Reflux esophagitis. Diagnosis, pathophysiology, and management.

Reflux esophagitis is a common disorder in which esophageal inflammation is caused by the reflux of gastric contents. The diagnostic approach includes documentation that reflux is present, that the patient's symptoms are caused by the reflux, and that esophageal mucosal damage has occurred. Therapy is guided by the current multifactorial pathophysiology model, which includes efficacy of the antireflux mechanism, volume of gastric fluid, potency of refluxed material, esophageal clearance, and tissue resistance factors. Although recurrences are common, treatment with life style changes supplemented with combinations of liquid antacids, H2 blockers, sucralfate, bethanechol, and metoclopramide is usually effective.

Diagnosis, Differential↗
PubMed1988

Economic impact of type II diabetes mellitus.

Diabetes is a dangerous, expensive disease with a major economic impact. The cost to the nation in 1984 was estimated to be $14 billion. We now believe the total costs approach $20 billion. Of this, $10.5 billion is guesstimated to be direct cost due to the diagnosis and treatment of the disease, while indirect costs (due to complications, work days lost, decreased productivity, and premature death) are about $9.5 billion. A typical patient with NIDDM and hypertension spends about $1000 per year for doctor visits, lab tests, oral diabetes tablets, blood pressure medications, lancets and blood test strips (4 per week), and miscellaneous expenses. NIDDM is clearly the major diabetes cost to the nation because it represents 85 to 90 per cent of all diabetes and because half the patients are undiagnosed and untreated. We believe the morbidity, mortality, and economic burden of NIDDM can be favorably affected by a concerted national effort as defined by the National Diabetes Advisory Board in its 1987 National Long Range Plan to Combat Diabetes. Finally, one must not forget the "other costs" of NIDDM, which are statistically unmeasurable: emotional costs, loss of freedom, inconvenient life style changes, and the permanent dependence on "others" (family, professionals, and so on) for help.

Costs and Cost Analysis↗
PubMed1986

Public education in cancer prevention.

Life-style is now recognized as a main determinant of cancer risk. Public education is an important component of cancer control programmes and has been shown to be effective in leading to life-style changes. Four basic types of education programmes are reviewed: for increasing the public's awareness of cancer, for changing specific risk behaviour (such as stopping smoking), for learning self-examination skills (such as breast self-examination), and for promoting early cancer detection in the community.To change human behaviour it is best to approach the risk habit through the same forces that develop and sustain the habit. Simply giving information of an association between specific habits and cancer, even if repeated several times, will lead to increased public awareness and encourage some to make a minimal effort to change their behaviour, but in general the new habit does not persist and continuing and intensifying this approach are ineffective. An alternative strategy utilizes socially active forces to support the prevention practice and remove possible barriers to action. For example, an antismoking programme should create a favourable social image of the non-smoker. Although a culturally and socially relevant mass media campaign can influence knowledge and beliefs and induce people to participate in a screening activity, this needs to be supplemented over a period of time by personal contact methods, such as group discussions, telephone conversations and home visits, in order to promote a regular screening habit. Contrary to popular opinion, mass communication methods can be expensive on a per person cost-effectiveness basis because of low participation rates and weakness in sustaining healthy behaviour.

Health Education↗
PubMedDate not supplied

A small-group approach to teaching family medicine.

The authors describe a method for teaching preclinical medical students some important family medicine concepts utilizing a seminar format which allows for improved student-teacher interaction and individualization of material. These seminars, on family health behavior, compliance, behavioral interventions for life-style change, and managing stress, were designed to encourage freshman medical students to understand and apply concepts concerning health behavior and attitudes, both personally and professionally. The format of these sessions included the use of self-assessment instruments, discussion, role play, and case studies. Results of student evaluations indicate they perceived the seminars positively. Specific areas of positive value included the content and small-group related processes. The seminars also provided data useful for developing programs for students.

Education, Medical, Undergraduate↗
PubMed1985

Obesity a family matter: creating new behavior.

The family as culture transmitter plays a role in the development of health maintenance practices. A review of the epidemiological variables associated with obesity suggests that familial factors--genetic and environmental--have a significant effect on the onset, causes, and prognosis of treatment. Chances of success in losing weight may depend upon the extent of family functioning or upon finding a support system within and/or outside the family. The weight control program described is family oriented. Life-style changes learned in the group meetings reach home and affect family members. Four-pronged in its approach (nutrition, behavior change, exercise, and a positive support system), the program uses "skill builders," which are special situational modules that deal with specific family situations. A skill builder offers a step-by-step guided approach to identifying and changing problem behavior in the area of diet and exercise, e.g., eating in social situations, new food shopping patterns, and the role of significant others in the weight loss process.

Adolescent↗
PubMed1985

On the advantage of screening kindergarten children for atherogenesis-related risk indicators.

On the basis of our practical experience we can recommend screening of young children outside the clinic. Our methodology has proven to be appropriate for this purpose. Among young children, three groups are easily accessible: Newborns - since delivery occurs mostly in a clinic; infants up to one year - since these children are provided with basic medical care, and kindergarten children. According to our experience, kindergartens are favorable places for screening children because many children are together in one place. Children of this age can be easily motivated to cooperate during the examination, and since they stay in the kindergartens for a considerable period of the day, they only can be guided by nurses who can provide positive motivation for educational programs. As an additional advantage, the cooperation between nurses and parents, as well as positive influence on the parents, by the nurses might be taken into account. In this context, nurses must be regarded as key persons for strategies when considering life-style changes. Identifying children at risk at this early age could shorten the pathogenetic period and increase the chance for regression of the atherosclerotic disease process. Furthermore, children of this age are willing to learn and to change their habits. There is also a possibility that children may implant in their families experiences and information obtained in the kindergartens. Such parents might be more open to advice from kindergarten personnel, and thus also profit for themselves. An additional and valuable advantage of screening kindergarten children is the possibility of detecting first-degree relatives at risk before clinical manifestation of the disease, thereby having a good chance for successful intervention.

Arteriosclerosis↗
PubMed1979

The development and evaluation of a behavioral weight-reduction program.

The development of a comprehensive weight-reduction program and its implementation in the clinic are described. The program consisted of explicit instructions on food monitoring, stimulus control, chaining, exercise, and self-reinforcement. The results of pilot research indicated that the program produced reliable weight loss and that its implementation in a group format was more positive. A formal experiment evaluated the effectiveness of program components in a 2 x 2 factorial design after ten weeks of treatment and at three-month and one-year follow-ups. There was significant weight loss with no main or interaction effects. At follow-up, those exposed to exercise and/or contingency management better maintained their weight loss or continued to lose. Data on the implementation of the program in a clinical setting are presented and these results compare favorably with reports from other clinics using behavior modification. It is suggested that our more positive results may be related to an emphasis on activity and life-style change in addition to changing eating behavior.

Adolescent↗
PubMed1984

Ethnicity and cancer prevention in a tri-ethnic urban community.

A pilot study of knowledge and behavior regarding primary cancer prevention was conducted in a tri-ethnic urban community. Knowledge of smoking and dietary risk factors was substantial, but awareness of cancer safeguards involving reduced sun exposure and mouth and proctological examinations was low. One of five respondents had taken measures to prevent cancer, and these persons tended to rate their own risk higher than respondents who made no life-style changes. Self-motivated behavior change focused on avoidance of cancer-promoting food. Blacks differed from whites and Mexican-Americans in awareness of cancer cause and prevention, particularly regarding dietary factors and behavior modification. The findings have implications for the design of cancer control measures in multiethnic communities.

Adult↗
PubMed1977

Patient education by videotape after myocardial infarction: an empirical evaluation.

Patients recovering from myocardial infarction (MI) or other heart diseases at St. Francis Hospital, Hartford, Ct, were educated by videotape or by staff lectures on alternating weeks. Both programs included the following: risk factors for MI, medications, diet, MI symptoms and life style changes. Patients were interviewed before and after the educational program. The MI patients under the age of 60 scored equally well on an informational test irrespective of the type of education program experienced. Older MI patients were significantly more likely to complete the educational program when it was given by videotape; those discontinuing attendance at lectures were less psychologically motivated to participate but were not necessarily more ill. Overall, higher education was the single most significant predictor of superior scores following patient education. Implications for the coronary care ward of the success of videotape in educating MI patients are discussed.

Adult↗
PubMed1987

Life-style correlates of risk factor change in young adults: an eight-year study of coronary heart disease risk factors in the Framingham offspring.

This paper describes the life-style and behavioral correlates of change in coronary heart disease risk factors measured eight years apart in the young adult offspring of the Framingham Heart Study cohort. Changes in total cholesterol, lipoprotein cholesterols (high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, very low density lipoprotein (VLDL) cholesterol), and blood pressure were observed longitudinally in 397 men and 497 women who were aged 20-29 years at entry into the study. Stepwise multiple linear regression procedures were used to identify characteristics and their changes that were significantly associated with risk factor changes in each sex. The attribute most strongly and consistently related to lipoprotein and blood pressure changes in both sexes was change in body mass index (p less than or equal to 0.01 or p less than or equal to 0.001). In addition to weight gain, increases in alcohol consumption in men (p less than or equal to 0.001) and beginning oral contraceptive use in women (p less than or equal to 0.01) were associated with increases in blood pressure over the study period. Weight loss, stopping or decreasing cigarette consumption (p less than or equal to 0.01), increasing alcohol intake (p less than or equal to 0.01), and, in women, discontinuing oral contraceptive use (p less than or equal to 0.01) also were independently related to improvements in lipoprotein profiles during follow-up. After adjustment for all life-style correlates of risk factor change, simple self-assessments of physical activity or activity change were negatively associated with changes in VLDL cholesterol (p less than or equal to 0.01) and the total cholesterol/HDL cholesterol ratio (p less than or equal to 0.05) in men and positively associated with changes in HDL cholesterol (p less than or equal to 0.05) in women. Sociodemographic and behavioral characteristics that made a further independent contribution to increases in the total cholesterol/HDL cholesterol ratio in men were blue-collar occupation and trait Type A behavior pattern (p less than or equal to 0.05). Unexplained, but provocative, results of this study included the associations of interim vasectomy with increases in total cholesterol in men (p less than or equal to 0.05) and of number of livebirths with decreases in total cholesterol and HDL cholesterol in women (p less than or equal to 0.01). These findings are among the first to offer prospective evidence which suggests that habits and behaviors during young adulthood have a substantial effect on lipid and lipoprotein profiles in men and women.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗