If we want more evidence-based practice, we need more practice-based evidence.*

CHAPTER 11:  APPLICATIONS IN THE HEALTH CARE SETTINGS

Table of Contents

Headlines, Timelines, & Milestones

Archived Headlines

Supplementary References

Other References

Supplementary Websites


Headlines, Timelines, & Milestones

Picking a Bone With Vitamin A.  (Washington Post, Feb. 3, 2003) - According to a newly published study in the New England Journal of Medicine, high levels of vitamin A are linked to bone fractures.

New U.S. Guidelines Stress First Colon Screening.  (Reuters Health) - New U.S. guidelines on colon screening stress the importance of the first screening after the 50th birthday, over 3 year follow-up screening after the removal of polyps.

HMO Kaiser Plans to Put Its Medical Records Online.  (Wall Street Journal, February 4, 2003) - Kaiser Permanente has announced plans to spend $1.8 billion to automate its patient files.
    

 Few Patients Switch Doctors After Shabby Treatment.  (Wall Street Journal - Harris Interactive Poll, February 5, 2003) - A poll conducted by the Wall Street Journal sampled the public's views on bad experiences with doctors and whether these experiences lead to a change in doctors.    
 


Archived Headlines


 

SUPPLEMENTARY REFERENCES (some are annotated (with abstracts), or provide links to journals)

Amery, W.K. (1999). Coming full circle in pharmacovigilance: Communicating safety information to patients through patient packageinserts. PHARMACOEPIDEMIOLOGY AND DRUG SAFETY 8 (2): 121-129.
    ABSTRACT: Optimal drug therapy requires that the patient should be informed adequately, unequivocally and in timely fashion. Patient package inserts (PPIs) have an important facilitating role to play in this respect. Patients' confidence in the benefit of a drug treatment and their fear of its side effects are strong determinants of their adherence to that treatment. Yet, the European PPI format does not allow a discussion of the treatment's benefits, which results in an unbalanced focus on side effects. This serious shortcoming may significantly interfere with a patient's compliance. In addition, prescribers are often unaware of the content of the PPI of the products they are prescribing. To rectify this situation, the development is proposed of annotated PPIs providing the scientific background to the PPI message. In conclusion, European PPIs need to be improved. The patient should be informed of the expected benefit of a drug treatment, its likelihood and the expected time course of the effect, and not only of side effects and interactions, which constitutes the present focus. Moreover, prescribers need to be informed about the content of the PPIs for the medicines they prescribe.

Barner, J. C., Mason, H. L., & Murray, M. D. (1999). Assessment of asthma patients' willingness to pay for and give time to an asthma self-management program. CLINICAL THERAPEUTICS 21 (5): 878-894.
    ABSTRACT: Despite the success of health education programs for patients with asthma, several researchers have found that patients are reluctant to enroll in and complete a program designed to help them manage their condition. The purpose of this study was to identify factors that influence asthma patients' willingness to pay (WTP) for and willingness to give time (WTGT) to an asthma self-management program. The patient sample consisted of 116 adult asthma patients (age range, 18 to 34 years) from 2 affiliated sites: a county teaching hospital with ambulatory clinics and a staff-model health maintenance organization. To determine WTP and WTGT, patients were presented with a scenario in which the components of an 8-week asthma management program were described. Patients were then asked how much they would be willing to pay for and how much time they would be willing to spend on the program. Regression analyses were used to determine what effect the following factors had on WTP and WTGT with respect to an asthma self-management program: sociodemographic factors; predisposing, enabling, and reinforcing factors; level of asthma self-management; and health care utilization. Mean patient WTP was $29.50 for an 8-week asthma education program. Several factors appeared to influence this amount. Patients who were willing to pay more for a program that would help them manage their asthma exhibited suboptimal behaviors during asthma attacks, had greater perceived access to health care resources, received less educational information from health care providers, had previously participated in a self-management program, and had indicated an interest in participating in a self-management program. This model was statistically significant (P <0.0001), with 35% of the variation in WTP scores explained by the independent variables. Patients reported that they were willing to spend a mean of 5.8 hours per week on an 8-week asthma self-management program. Patients who were willing to spend more time on an asthma self-management program had indicated an interest in participating in such a program, had a higher number of comorbidities, or had more emergency department visits. This model was statistically significant (P = 0.0018), with 18% of the variance explained. This study identified several factors that may affect WTP and WTGT in relation to an asthma self-management program. This information may be helpful in identifying candidates for educational programs.

Black, M. M. (1999). Commentary: feeding problems: an ecological perspective. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 217-219, June.
    For this issue of the Journal, go to: http://jpepsy.oupjournals.org/cgi/reprint/24/3/217.pdf.

Braveman, P., Egerter, S., & Marchi, K. (1999). The prevalence of low income among childbearing women in California: Implications for the private and public sectors. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 868-874.
    The Journal’s Home Page is at: THE AMERICAN JOURNAL OF PUBLIC HEALTH.
    ABSTRACT: Objectives. This study examined the income distribution of childbearing women in California and sought to identify income groups at increased risk of untimely prenatal care. Methods. A 1994/95 cross-sectional statewide survey of 10132 postpartum women was used. Results. Sixty-five percent of all childbearing women had low income (0%-200% of the federal poverty level), and 46% were poor (0%-100% of the federal poverty level). Thirty-five percent of women with private prenatal coverage had low income. Most low-income women with Medi-Cal (California's Medicaid) or private coverage received their prenatal care at private-sector sites. Compared with women with incomes over 400% of the poverty level, both poor and near-poor women were at significantly elevated risk of untimely care after adjustment for insurance, education, age, parity, marital status, and ethnicity (adjusted odds ratios = 5.32 and 3.09, respectively). Conclusions. This study's results indicate that low-income women are the mainstream maternity population, not a "special needs" subgroup; even among privately insured childbearing women, a substantial proportion have low income. Efforts to increase timely prenatal care initiation cannot focus solely on women with Medicaid, the uninsured, women in absolute poverty, or those who receive care at public-sector sites.

Brown, R., Butow, P.N., Boyer, M.J., & Tattersall, M.H.N. (1999). Promoting patient participation in the cancer consultation: evaluation of a prompt sheet and coaching in question asking. BRITISH JOURNAL OF CANCER 80 (1-2): 242-248.
    ABSTRACT: Active participation in the medical consultation has been demonstrated to benefit aspects of patients' subsequent psychological well-being. We investigated two interventions promoting patient question-asking behaviour. The first was a question prompt sheet provided before the consultation, which was endorsed and worked through by the clinician. The second was a face to face coaching session exploring the benefits of, and barriers to, question-asking, followed by coaching in question-asking behaviour employing rehearsal techniques. Sixty patients with heterogeneous cancers, seeing two medical oncologists for the first timer were randomly assigned to one of three groups: two intervention groups and one control group. Sociodemographic variables and anxiety were assessed prior to the intervention which preceded the consultation, The consultations were audiotaped and subsequently analysed for question-asking behaviour. Anxiety was assessed again immediately following the consultation. Questionnaires to assess patient satisfaction, anxiety and psychological adjustment were sent by mail 2 weeks following the consultation. Presentation and discussion of the prompt sheet significantly increased the total number of questions asked and the number of questions asked regarding tests and treatment. Coaching did not add significantly to the effects of the prompt sheet. Psychological outcomes were not different among the groups, We conclude that a question prompt sheet addressed by the doctor is a simple, inexpensive and effective means of promoting patient question asking in the cancer consultation.

Buetow, S.A. (1999). Unsolicited GP advice against smoking: To give or not to give? JOURNAL OF HEALTH COMMUNICATION 4 (1): 67-74.
    ABSTRACT: This article discusses whether general practitioners (GPs) should give unsolicited antismoking advice to patients who smoke. Patient preferences and GP advice-giving are discussed,vith particular reference to professional roles. It is suggested that gluing unsolicited advice against smoking at nearly every encounter is a competitive rather than collaborative behavior. General practitioners should ascertain patients' readiness for change before offering to help produce individualized agreements of joint benefit on change. Three strategies for negotiation-bridging, trading, and logrolling-are discussed.

Burnand, B. (1999). Editorial. Clinical practice guidelines. A public health perspective. EUROPEAN JOURNAL OF PUBLIC HEALTH 9 (2): 83-85.
    ABSTRACT: http://www3.oup.co.uk/eurpub/hdb/Volume_09/Issue_02 .

Chaney, J. M., Mullins, L. L., Uretsky, D. L., Pace, T. M., Werden, D, & Hartman, V. L. (1999). An experimental examination of learned helplessness in older adolescents and young adults with long-standing asthma. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 259-270, June.
    For this issue of the Journal, go to: http://jpepsy.oupjournals.org/cgi/reprint/24/3/259.pdf.

Cheng, T.L., DeWitt, T.G., Savageau, J.A., & O'Connor, K.G. (1999). Determinants of counseling in primary care pediatric practice - Physician attitudes about time, money, and health issues. ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 153 (6): 629-635.
    ABSTRACT: Objectives: To assess pediatrician goals and practice in preventive counseling, and to use social learning theory to examine physician attitudes about preventive health issues, time, and reimbursement to explain physician counseling behavior. Design: Random sample survey of American Academy of Pediatrics fellows. Participants: A total of 1620 pediatricians were surveyed with a return rate of 72%. The 556 pediatricians who had finished training and who currently performed child health supervision were included. Methods: Pediatricians were asked about their goals in 6 areas of health supervision: biomedical issues, development, behavior, family functioning, safety education, and supportive interpersonal interaction. They were also asked about the prevalence of counseling, importance of specific topics, their self-efficacy, outcome expectation in these areas, and their concerns about time and reimbursement for preventive counseling. Results: Assurance of physical health and normal development were the most important goals of child health supervision among the pediatricians surveyed. Goals involving behavioral, family, and safety issues were less important and less likely to be addressed in practice. Most did not regularly discuss family stress, substance abuse, gun safety, and television. In these areas, physicians had less confidence they could provide guidance and lower expectation that they could prevent problems. Only 17% felt that they receive adequate reimbursement for preventive counseling. Most have adequate time (53%) and receive adequate respect (57%) for their preventive efforts. Physicians who were more concerned about time for preventive counseling reported less overall counseling (r=-0.28, P<.001). Concern about reimbursement was not associated with reported counseling. Multiple regression analysis found that the primary predictors of physician counseling were an issue's importance, a physician's perceived self-efficacy, and perceived effectiveness of counseling, while concerns about time and reimbursement were secondary. Conclusions: Physician goals in child health supervision were primarily biomedical, with psychosocial and safety issues of lesser importance. Concern about time for preventive counseling was associated with less reported counseling. Physician attitudes regarding the importance of a health issue and their confidence and effectiveness in counseling were more predictive of physician practice than their attitudes about time and reimbursement for preventive care.

Desnick, L.., Taplin, S., Taylor, V., Coole, D., & Urban, N. (1999). Clinical breast examination in primary care: Perceptions and predictors among three specialties. JOURNAL OF WOMENS HEALTH 8 (3): 389-397.
    ABSTRACT: To assess predictors of reported performance of screening clinical breast examination (CBE) by internists, family physicians, and obstetrician/gynecologists, we surveyed members of these specialties in four counties of Washington State. We contacted all physicians in the counties and identified 334 providers who saw women ages 50-75 and provided primary care as their principal activity. Seventy-five percent (252 of 334) responded. Physicians were mailed a survey and contacted for telephone completion if they did not respond in writing. The survey inquired about their current performance of CBE and factors that might predispose, enable, or reinforce its use. Differences across specialties were assessed using the chi-square statistic. Factors associated with reported performance of screening CBE in greater than or equal to 90% of women were evaluated using logistic regression. Fifty-one percent of physicians reported that they perform regular CBE on greater than or equal to 90% of their patients, although the proportion varied across specialty type. Beliefs about the benefit of CBE were positive and similar across specialties. Twelve percent of male physicians, but no female physicians, reported that women's embarrassment affected their use of screening CBE. In a multivariate model, male gender, family practice specialty, and the perception of patient embarrassment were all associated with lower reported rates of performing regular CBE (p <0.05). Work to increase the performance of CBE should consider the role of male physician embarrassment and family physician training. Ways to facilitate delivery of preventive care and factors influencing the women themselves may also be important to increased use of CBE.

Diehr, P., Yanez, D., Ash, A., Hornbrook, M., & Lin, D.Y. (1999). Methods for Analyzing Health Care Utilization and Costs. ANNUAL REVIEW OF PUBLIC HEALTH 20: 125-158.
    ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/reprint/20/1/125.pdf.

Durham, M. L.  (1998).  Mental health and managed care.   ANNUAL REVIEW OF PUBLIC HEALTH 19: 493-505. For abstract, go to: http://publhealth.annualreviews.org/cgi/content/abstract/19/1/493

Farmer, K. C. (1999). Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. CLINICAL THERAPEUTICS 21 (6): 1074-1090, June.
    ABSTRACT: Researchers and clinicians have used numerous methods in their attempts to adequately assess patient compliance (adherence) with medication regimens and to identify noncompliant patients. Large variations have been reported in the extent of noncompliance in individual patients and large populations. In addition, nonadherence has often been poorly defined. Direct measures of adherence include drug assays of blood or urine, use of drug markers with the target medication, and direct observation of the patient receiving the medication. Indirect measures of adherence imply that the medication has been used by the patient; these measures include various forms of self-reporting by the patient, medication measurement (pill count), use of electronic monitoring devices, and review of prescription records and claims. Compliance measures should be assessed on the basis of their validity (sensitivity and specificity or statistical correlation) and the reference standard used. Many early studies used pill counts as a reference standard, but electronic monitoring devices such as the Medication Event Monitoring System have replaced pill counts as the reference standard. The choice of a method for measuring adherence to a medication regimen should be based on the usefulness and reliability of the method in light of the researcher's or clinician's goals. Specific methods may be more applicable to certain situations, depending on the type of adherence being assessed, the precision required, and the intended application of the results.

Farris, K. B., & Schopflocher, D. P. (1999). Between intention and behavior: an application of community pharmacists' assessment of pharmaceutical care. SOCIAL SCIENCE & MEDICINE 49 (1): 55-66, July.

Fisher, L. D. (1999). Advances in Clinical Trails in the Twentieth Century. ANNUAL REVIEW OF PUBLIC HEALTH 20: 109-124.
    ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/content/abstract/20/1/109.

Fishman, P. A., & Wagner, E. H. (1998).  Managed care data and public health: The experience of group health cooperative of Puget Sound. ANNUAL REVIEW OF PUBLIC HEALTH 19: 477-491. For abstract, go to: http://publhealth.annualreviews.org/cgi/content/abstract/19/1/477

Franche, R. L., & Mikail, S. F. (1999). The impact of perinatal loss on adjustment to subsequent pregnancy. SOCIAL SCIENCE & MEDICINE 48 (11): 1613-1623.
    ABSTRACT: This study compares the emotional adjustment of pregnant couples with and without a history of perinatal loss. We assessed thirty-one pregnant women with a history of perinatal loss and 31 pregnant women with an unremarkable reproductive history between their 10th and 24th week of gestation. Partners were recruited. Twenty-eight men were in the loss group and 23 men in the comparison group. Couples with a history of loss reported significantly more depressive symptomatology and pregnancy-specific anxiety than couples in the comparison group. Women reported more depressive symptomatology than men. Results: Regression analyses revealed that for the group with a previous loss. depressive symptomatology was significantly associated with self-criticism, interpersonal dependency and number of previous losses. For the comparison group, depressive symptomatology was significantly associated dyadic adjustment. Pregnancy-specific anxiety of women with a previous loss was associated with their belief that their behavior affects fetal health; for women in the comparison group, pregnancy-specific anxiety was associated with the belief that health professionals' behavior affects fetal health. Implications for practice of health care professionals: The importance of early intervention to reduce distress is highlighted by the finding that alterations in mood are apparent in the early stages of pregnancy for both women and men who have experienced a previous perinatal loss. Carefully reducing personal responsibility for fetal health in women with a previous loss may reduce their pregnancy-specific anxiety, but women with an unremarkable obstetrical history may benefit from an approach diminishing their perception of the power that medical staff has on fetal health.

Freund, D., Lave, J., Clancy, C., Hawker, G., Hasselblad, V., Keller, R., Schneiter, E., & Wright, J. (1999). Patient Outcomes Research Teams: Contribution to Outcomes and Effectiveness Research. ANNUAL REVIEW OF PUBLIC HEALTH 20: 337-360.
    ABSTRACT/Full-Text:
 ABSTRACT

Goldberg, B. W. (1998). Managed care and public health departments: Who is responsible for the health of the population? ANNUAL REVIEW OF PUBLIC HEALTH 19: 527-537. For abstract, go to: http://biomedical.annualreviews.org/current/16.shtml

Green, L. W. (1999). What can we generalize from research on patient education and clinical health promotion to physician counseling on diet? EUROPEAN JOURNAL OF CLINICAL NUTRITION 53 (Suppl. 2): S9-S18.
    AUTHOR’S ABSTRACT: Objective: This paper explores the status of knowledge development from clinical trials and other studies of patient education and clinical health promotion. Design: It asks what this cumulative literature has to offer dietary counseling of patients by family doctors. A series of meta-analyses of drug education and preventive health education research in clinical settings provide a starting framework for guidelines on dietary counseling. Conclusions: Smoking cessation studies, in particular, have mounted in quantity and quality to the greatest extent and offer the clearest statement on what can be achieved, under what conditions, and with what support beyond the physician's counseling session or sessions. The Precede-Proceed Model offers a further guide to assuring the comprehensiveness of approaches to dietary change - enabling and reinforcing the change, not just predisposing it through admonitions and altering of knowledge, attitudes and beliefs. The specific evidence supporting the application of a patient counseling algorithm based on the Precede-Proceed model is reviewed here.

Griffin, J.F., Hogan, J.W., Buechner, J.S., Leddy, T. M. (1999). The effect of a Medicaid managed care program on the adequacy of prenatal care utilization in Rhode Island. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (4): 497-501.  
    ABSTRACT: Objectives. The purpose of this study was to determine whether adequacy of prenatal care utilization improved after the implementation of a Medicaid managed care program in Rhode Island. Methods. Rhode Island birth certificate data (1993-1995; n = 37021) were used to analyze pre- and post-program implementation changes in adequacy of prenatal care utilization. Logistic regression models were used to characterize the variation in prenatal care adequacy as a function of both time and the various covariates. Results. Adequacy of prenatal care utilization for Medicaid patients improved significantly after implementation of the program, from 57.1% to 62.1% (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.1, 1.3), After the program was implemented, Medicaid patients who went to private physicians' offices for prenatal care were 1.4 times as likely as before to receive adequate prenatal care (OR = 1.4, 95% CI = 1.2, 1.7). Conclusions. Unlike many other Medicaid expansions for pregnant women, the RIte Care program in Rhode island has resulted in significant improvement in adequacy of prenatal care utilization for its enrollees. This improvement has been due to specific program interventions that addressed and changed organizational and delivery system barriers to care.

Hale, J. F (1998). Application of the PRECEDE-PROCEED Model for comprehensive community assessment, education programming, and evaluation in a combat hospital community during the Gulf War. HOME HEALTH CARE MANAGEMENT & PRACTICE 11(1): 52-65.
    ABSTRACT: "This article describes the Persian Gulf combat hospital community of the 410th [Evacuation Hospital of the US Army Reserve] as it evolved, dissolved, and was evaluated in terms of the PRECEDE-PROCEED model as a community that attained and maintained a high quality of life for both community members and patients during its 'life' in the barren desert of Saudi Arabia..."(p.52). The quality of life of the 400 uprooted personnel is described in detail in the social diagnosis, including stressors, fears, physiologic and physical strains such as sleep deprivation, sand storms, extremes temperatures, and lack of privacy and control over personal life. The epidemiologic diagnosis includes 9 "wounded in action" factors, 6 diseases and nonbattle injuries, and battle fatigue. These analyses produced 12 desired social and quality-of-life outcomes and 11 health goals. Phase 3 produced a list of 12 behavioral and environmental concerns, with safety identified as the number one risk factor. Each of the subsequent phases is described in graphic and fascinating detail. The author concludes that the Precede-Proceed "model provides an excellent framework in which to organize and document data in assessing a target population for any reason. It can then be applied for planning, implementing and evaluating interventions, not only for health promotion planning but also for any other types of interventions that could impact on the quality of life and the health outcomes of a population, community, or home setting. This article echoes previous ones in support of this framework for not only nursing interventions, but also for interdisciplinary community-based interventions and interactions as well. The author has found it to be invaluable in both an academic setting for teaching graduate students a process for and application of an advanced level of community assessment, planning, and evaluation both nationally and internationally when one needs to look at the targeted population or setting from the 'ground up'. The readers are challenged to apply this framework to home health care settings and further add to the diversity and applicability of the model" (p. 64).

Haslam, C. (1999). Maternal factors, obstetric history and smoking stage of change. Journal of Public Health Medicine 21(2): 185-191.
    For abstract: http://www.oup.co.uk/pubmed/hdb/Volume_21/Issue_02/210185.sgm.abs.html

Helliwell, P.S.m, O'Hara, M., Holdsworth, J., Hesselden, A., King, T., Evans, P. (1999). A 12-month randomized controlled trial of patient education on radiographic changes and quality of life in early rheumatoid arthritis. RHEUMATOLOGY 38 (4): 303-308.
    ABSTRACT: Objective. In rheumatoid arthritis, education programmes successfully impart knowledge but, notwithstanding issues of empowerment, this knowledge has to be translated into behavioural change to have a chance of improving disease outcome. Arguably, behavioural change must also occur early if outcomes are to be improved. For these reasons: we planned a study of patient education in early disease, with radiological damage and quality of life as the main outcome variables. Methods. We performed a randomized controlled trial in people with rheumatoid arthritis of <5 yr duration. The main intervention was a 4 week education programme, each weekly session lasting 2 h. Assessments were made at entry, at 4 weeks and at 12 months. The main outcome variables were the modified Larsen radiological score for the hands and the SF-36 quality of life questionnaire. Secondary outcome variables were the Health Assessment Questionnaire (HAQ), Ritchie Articular Index (RAI), Patient Knowledge Questionnaire (PKQ), Compliance Questionnaire (CQ), plasma viscosity (PV), pharmaceutical changes and consulting behaviour. Results. The patient numbers were 34 (10 male, 24 female) for the control group and 43 (16 male, 27 female) for the education group. The groups were matched for age (56.5 yr for control, 55 yr for education), disease duration (3.5 yr vs 3.0 yr) and duration of second-line drug therapy (14 months vs 12 months). We found no significant difference between the groups for Larsen scores at 12 months, although scores for the education group were lower (39.5 vs 43.0, P = 0.13). The 'social functioning' and 'general health perception' subscales of the SF-36 showed a significant improvement in the education group, but no significant differences between groups were seen. No significant differences were found for the HAQ, RAI, PV and CQ, but the education group had more disease-specific knowledge than the control group at 12 months (PKQ scores: 17 vs 21, P = 0.0002). No differences were found for out-patient visits and in-patient admissions, but the education group had slightly more changes in second-line drugs during the study (0.43 changes/person in the control group, 0.51 changes/person in the education group). Conclusions. We found no significant difference between the groups in our primary outcome measures, but a trend in favour of the education group was found in radiological progression. Further studies of this kind, using larger patient numbers, are required since the difference may result from improved self-care, better compliance with joint protection strategies and, possibly, improved drug compliance.

Hiddink, G. J., Hautvast, J. G. A. J., van Woerkum, C. M. J., van’t Hot, M. A., & Fieren, C. J. (1999). Cross-sectional and longitudinal analyses of nutrition guidance by primary care physicians. EUROPEAN JOURNAL OF CLINICAL NUTRITION 53 (Suppl. 2): S35-S43.
    ABSTRACT: Objective: To investigate in primary care physicians (PCPs) the determinants of a nutrition guidance practice ('noticing patients' overweight and guidance of treatment'), as well as their mechanism of action, in a cross-sectional and a longitudinal approach. Design: Mixed longitudinal design. Five years follow up study of a previous cross-sectional study in October 1992. Subjects: A representative sample of 675 Dutch PCPs, in practice for 5 up to 20y. Interventions: A shortened version of the Wageningen PCPs Nutritional Practices Questionnaire was mailed to the subjects in August 1997. Main outcome measure: To obtain with the LISREL-program a model of the mechanism of action of determinants of the dependent variable 'noticing patients' overweight and guidance of treatment' with an adequate fit of the empirical data, both in the cross-sectional and in the longitudinal approach. Results: The same set of predisposing factors and intermediary factors explains the dependent variable both in two different representative cross-sectional study populations of PCPs, and in a cohort cross-sectional study at two points in time. Two dynamic LISREL-models were developed (the 'determinant-longitudinal approach' and the 'early behavior longitudinal approach') which explain the dependent variable. The latter model has, as added value, a gain in explained variance. In 5 y time, the dependent variable decreased significantly (P < 0.001). Conclusions: This study reconfirms that PCPs' nutritional guidance practices are determined partly directly by predisposing factors, and indirectly via driving forces and barriers. However this study also reveals that an important nutrition guidance practice of PCPs, 'noticing patients' overweight and guidance of treatment', shows a significant decrease over the last 5 y. At the same time, two of the four predisposing factors and two of the three driving factors also decreased significantly. As research findings indicate that the role of diet in health and disease becomes of greater influence PCPs need to be activated to apply their responsibility in this field within a multi-faceted approach.

Holzemer, W.L., Corless, I.B., Nokes, K.M., Turner, J.G., Brown, M.A., Powell-Cope, G.M., Inouye, J., Henry, S.B., Nicholas, P.K., Portillo, C.J. (1999). Predictors of self-reported adherence in persons living with HIV disease. AIDS PATIENT CARE AND STDs 13 (3): 185-197.  
    ABSTRACT: This study examined the relationships between the five dimensions of the Wilson and Cleary model of health-related quality of life and three self-reported adherence measures in persons living with HIV using a descriptive survey design. Data collection occurred in seven cities across the United States, including university-based AIDS clinics, private practices, public and for-profit hospitals, residential and day- care facilities, community-based organizations, and home care. The three dependent adherence measures studied were "medication nonadherence," "follows provider advice," and "missed appointments." The sample included 420 persons living with HIV disease with a mean age of 39 years of which 20% were women and 51% were white; subjects had a mean CD4 count of 321 mm(3). HIV-positive clients with higher symptom scores, particularly depression, were more likely to be nonadherent to medication, not to follow provider advice, and to miss appointments. Participants who reported having a meaningful life, feeling comfortable and well cared for, using their time wisely, and taking time for important things were both more adherent to their medications and more likely to follow provider's advice. No evidence was found demonstrating any relationship between adherence and age, gender, ethnicity, or history of injection drug use. These findings support the need to treat symptoms, particularly depression, and to understand clients' perceptions of their environment as strategies to enhance adherence. A limitation of this study was that adherence was measured only by self-report; however, the study did expand the concept of adherence in HIV care beyond medication adherence to include following instructions and keeping appointments.

Horne, R., Weinman, J., & Hankins, M. (1999). The beliefs about medicines questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication.     
    ABSTRACT: This paper presents a novel method for assessing cognitive representations of medication: the Beliefs about Medicines Questionnaire (BMQ). The BMQ comprises two sections: the BMQ-Specific which assesses representations of medication prescribed for personal use and the BMQ-General which assesses beliefs about medicines in general. The pool of test items was derived from themes identified in published studies and from interviews with chronically ill patients. Principal Component Analysis (PCA) of the test items resulted in a logically coherent, 18 item, 4-factor structure which was stable across various illness groups. The BMQ-Specific comprises two 5-item factors assessing beliefs about the necessity of prescribed medication (Specific-Necessity) and concerns about prescribed medication based on beliefs about the danger of dependence and long-term toxicity and the disruptive effects of medication (Specific-Concerns). The BMQ-General comprises two 4-item factors assessing beliefs that medicines are harmful, addictive, poisons which should not be taken continuously (General-Harm) and that medicines are overused by doctors (General-Overuse). The two sections of the BMQ can be used in combination or separately. The paper describes the development of the BMQ scales and presents data supporting their reliability and their criterion-related and discriminant validity.

Hulscher, M.E.J.L., Wensing, M., Grol, R.P.T.M., van der Weijden, T., & van Weel, C. (1999). Interventions to improve the delivery of preventive services in primary care. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (5): 737-746.
    ABSTRACT: Objectives. This review was conducted to determine the effectiveness of different interventions to improve the delivery of preventive services in primary care. Methods. MEDLINE searches and manual searches of 21 scientific journals and the Cochrane Effective Professional and Organization of Care of trials were used to identify relevant studies. Randomized controlled trials and controlled before-and-after studies were included if they focused on interventions designed to improve preventive activities by primary care clinicians. Two researchers independently assessed the quality of the studies and extracted data for use in constructing descriptive overviews. Results. The 58 studies included comprised 86 comparisons between intervention and control groups. Postintervention differences between intervention and control groups varied widely within and across categories of interventions. Most interventions were found to be effective in some studies, but not effective in other studies. Conclusions. Effective interventions to increase preventive activities in primary care are available. Detailed studies are needed to identify factors that influence the effectiveness of different interventions.

Jelalian, E., & Saelens, B. E. (1999). Empirically supported treatments in pediatric psychology: pediatric obesity. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 223-248, June.
    For this issue of the Journal, go to: http://jpepsy.oupjournals.org/cgi/content/abstract/24/3/223.

Jirojwong, S., Dunt, D., & Goldsworthy, D.  (1999). Social support and antenatal clinic attendance among Thai pregnant women in Hatyai, a city in southern Thailand. JOURNAL OF ADVANCED NURSING 29 (2): 395-406.  
    ABSTRACT: Many studies in western countries have shown that persons who have a high level of social support are likely to have better health behaviors, including use of preventive health services, than those who have low support. The present study aims to investigate the impact of level of social support among Thai pregnant women on their attendance at antenatal care (ANC) clinics. The study was conducted in Hatyai, a city in Southern Thailand, between 1990 and 1991. Relationships between various measures of the women's social support and their use of antenatal clinics were assessed. Open ended and closed ended questions were used to gather information relating to these women's level of social support, including the number of supporters and their age, the percentage of females among the supporters, the sources of support (spouse, kin, friend and health professionals), the frequency of contact, the types of support and the sufficiency of support. Social support indices were constructed: sources of support indices, a social network index, a subjective support index, and a social support index. One hundred and seventy-seven postpartum women were interviewed at their homes. Spouses, relatives and friends were important sources of the four principle types of support, namely emotional, instrumental, information and appraisal supports. Less than 10% of the women studied identified health personnel as providing support. The majority of supporters were women who had daily, face-to-face communication with the women studied. Approximately 76% of the women studied had sufficient support. The majority of supporters, except health personnel, provided all four types of support. Only 47% of the women studied made four or more antenatal clinic visits as recommended by the Thai government. No significant relationship between the indices of social support and the use of ANC clinics was identified, The Thai extended family by its nature generates large numbers of supporters. Little variation in support levels among all the women therefore occurred. Support to the women could have positive and/or negative effects on the women's use of ANC clinics. It was concluded that in Thai communities, social support is not an important determinant of the use of ANC clinics and the indices of social support were not the most appropriate techniques to use in the communities.

Kegler, M.C., Malcoe, L.H., Kegler, S.R., Lynch, R.A., Tolliver, R. (1999). Caregiver beliefs and behaviors in the prevention of childhood lead poisoning. FAMILY & COMMUNITY HEALTH 22 (1): 50-65.    
    ABSTRACT: Caregivers living in areas with environmental lead problems are often advised to engage in behaviors to protect their children from lead. This study investigates caregiver knowledge, beliefs, and barriers associated with lead poisoning prevention behaviors. Interviews were conducted with 332 caregivers of children ages 1 through 6 living in a mining area with large quantities of lead-contaminated soil. Findings indicated low to moderate levels of preventive behaviors. Of the health beliefs examined, self-efficacy and barriers most consistently predicted the preventive behaviors. Applications of the findings are discussed for both family and community-based lead poisoning prevention programs.

Kerwin, M. L. E. (1999). Empirically supported treatments in pediatric psychology: severe feeding problems. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 193-214, June.
    For this issue of the Journal, go to: http://jpepsy.oupjournals.org/cgi/content/abstract/24/3/193.

Kok, G. (1999). Targeted prevention for people with HIV/AIDS: feasible and desirable? PATIENT EDUCATION AND COUNSELING 36 (3): 239-246.   
    ABSTRACT: People with HIV/AIDS are rarely chosen as a target group for prevention activities. In this paper we look at empirical and theoretical evidence for the feasibility and desirability of directing preventive interventions at HIV-positives. Research data on the behavior and motivation of HIV-positives suggests that the differences between HIV-positives and HIV-negatives and those who are unaware of their HIV-status are not large. However, specific determinants of behavior, such as responsibility for others or the risk of superinfection, have seldom been measured. Effective interventions targeting at HIV-positives and focussing on prevention are lacking. Fear of increased stigmatization has been used as an argument against focussing prevention activities at HIV-positives. Theoretically that argument is probably not correct: positive coping with HIV may invite positive reactions. The conclusion is that HIV- positives should be chosen as a special target group for additional planned preventive interventions. Because people need to be aware of their HIV status, testing and treatment sites are adequate settings. Effective interventions should be developed on the basis of theory and evidence about the specific determinants of risk behavior of HIV- positives: protecting oneself for superinfection and protecting one's partner.

Korenbrot, C.C., Miller, G., & Greene, J. (1999). The impact of medicaid managed care on community clinics in Sacramento County, California. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 913-917.
    The Journal’s Home Page is at: THE AMERICAN JOURNAL OF PUBLIC HEALTH.
    ABSTRACT: Objectives. The purpose of this study was to determine the impact of countywide Medicaid managed care on service use at community clinics. Methods. Clinic use before and after introduction of Medicaid plans in one county was compared with that in a group of comparable counties without such plans. Results. There were significant declines of 40% to 45% in the volumes of Medicaid clients, encounters, and revenues at clinics with the introduction of Medicaid plans. Declines of 23% in uninsured clients and encounters did not differ significantly. Conclusions. The introduction of Medicaid managed care with multiple commercial plans can have significant negative effects on nonprofit community clinics.

Krieger, J., Collier, C., Song, L., & Martin, D. (1999). Linking community-based blood pressure measurement to clinical care: A randomized controlled trial of outreach and tracking by community health workers. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 856-86.
    The Journal’s Home Page is at: THE AMERICAN JOURNAL OF PUBLIC HEALTH.
    ABSTRACT: Objectives. This study assessed the effectiveness of enhanced tracking and follow-up services provided by community health workers in promoting medical follow-up of persons whose elevated blood pressures were detected during blood pressure measurement at urban community sites. Methods. In a randomized controlled trial, 421 participants received either enhanced or usual referrals to care. Participants were 18 years or older; were either Black or White, and had blood pressure greater than or equal to 140/90 mm fig and income equal to or less than 200% of poverty. The primary outcome measure was completion of a medical follow-up visit within 90 days of referral. Results. The enhanced intervention increased follow-up by 39.4% (95% confidence interval [CI] = 14%, 71%; P = .001) relative to usual can. Follow-up visits were completed by 65.1% of participants in the intervention group, compared with 46.7% of those in the usual-care group. The number needed to treat was 5 clients (95% CI = 3, 13) per additional follow-up visit realized. Conclusions. Enhanced tracking and outreach increased the proportion of persons with elevated blood pressure-detected during community measurement who followed up with medical care.

Lipton, H. L., Kreling, D. H.; Collins, T., & Hertz, K. C. (1999). Pharmacy Benefit Management Companies: Dimensions of Performance. ANNUAL REVIEW OF PUBLIC HEALTH 20: 361-402.
    ABSTRACT/Full-Text:
ABSTRACT.

Loffler, W., & Hafner, H. (1999). Ecological pattern of first admitted schizophrenics in two German cities over 25 years. SOCIAL SCIENCE & MEDICINE 49 (1): 93-108, July.

Luft, H.S. (1998).  Medical and managed care. ANNUAL REVIEW OF PUBLIC HEALTH 19: 459-475.
    ABSTRACT: http://biomedical.annualreviews.org/current/16.shtml

Maiburg, H. J. S., Hiddink, G. J., van’t Hof, M. A., Rethans, J. J., & van Ree, J. W. (1999). The NECTAR-Study: development of nutrition modules for general practice vocational training; determinants of nutrition guidance practices of GP-trainees. EUROPEAN JOURNAL OF CLINICAL NUTRITION 53 (Suppl. 2): S83-S88.
    ABSTRACT: Objective: To identify determinants of nutrition guidance practices of general practitioner-trainees (GP-trainees), to investigate whether these determinants differ from those found by experienced general practitioners; to reveal educational directions towards the development of computer-based instruction on nutrition. Design: Cross-sectional study by means of validated questionnaires. Subjects: All CTP-trainees in training at the eight university departments for vocational training in the Netherlands in September, 1998 (n = 985). Main outcome measures: Reliability of determinants of nutrition guidance practices was calculated by means of Crohnbach's alpha. The mechanism of action of determinants was identified by means of linear structural relationship analysis (LISREL) using a model developed for GPs. Results: Crohnbach's alphas for factors ranged from 0.58-0.90. The empirical GP-trainee-data fitted with the corresponding GP-model on the mechanism of action. Conclusions: The same predisposing factors, driving forces and barriers as found with GPs were identified with GP-trainees. Comparing the GP-and GP-trainee-models, only minor differences were found in the path coefficients between factors. Lack of nutrition training and education proved to be of great influence on the extent of nutrition information given. The GP-trainee-model will be of use in developing computer-based instruction on nutrition. It is expected that GPs may also benefit from this instruction.

Mainous, A. G. III, Hueston, W. J., Love, M. M., & Griffith, C. H. III. (1999). Access to care for the uninsured: Is access to a physician enough? AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 910-912.
    The Journal’s Home Page is at: THE AMERICAN JOURNAL OF PUBLIC HEALTH.
    ABSTRACT: Objectives. This study examined a private-sector, statewide program (Kentucky Physicians Care) of care for uninsured indigent persons regarding provision of preventive services. Methods. A survey was conducted of a stratified random sample of 2509 Kentucky adults (811 with private insurance, 849 Medicaid recipients, 849 Kentucky Physicians Care recipients). Results. The Kentucky Physicians Care group had significantly lower rates of receipt of preventive services. Of the individuals in this group, 52% cited cost as the primary reason fur not receiving mammography, and 38% had not filled prescribed medicines in the previous year. Conclusions. Providing free access to physicians fills important needs but is not sufficient for many uninsured patients to receive necessary preventive services.

McDonnell, R., Johnson, Z., Doyle, A. & Sayers, G. (1999). Determinants of folic acid knowledge and use among antenatal women. Journal of Public Health Medicine 21(2): 145-149.
    ABSTRACT: http://www.oup.co.uk/pubmed/hdb/Volume_21/Issue_02/210145.sgm.abs.html

Morrell, S., Taylor, R., Slaytor, E., & Ford, P. (1999). Urban and rural suicide differentials in migrants and the Australian-born, New South Wales, Australia 1985-1994. SOCIAL SCIENCE & MEDICINE 49 (1): 81-91, July.

Nawaz, H., Adams, M.L., & Katz, D.L. (1999). Weight loss counseling by health care providers. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (5): 764-767.
    ABSTRACT: Objectives. This study explores the pattern of weight loss counseling by health care providers in Connecticut and the associated weight loss efforts by patients. Methods. Data from the 1994 Connecticut Behavioral Risk Factor Surveillance system survey were analyzed to determine (1) the frequency of weight management counseling by health care providers of overweight adults with and without additional cardiovascular risk factors and (2) the current weight loss practices of overweight subjects. Results. Only 29% of all overweight respondents, and fewer than half with additional cardiovascular risk factors, reported that they had been counseled to lose weight. Conclusions. the findings suggest need for more counseling of overweight persons, especially those with cardiovascular disease risk factors.

Nichol, M. B., Venturini, F., & Sung, J. C. Y. (1999). A critical evaluation of the methodology of the literature on medication compliance. ANNALS OF PHARMACOTHERAPY 33 (5): 531-540.
    ABSTRACT: OBJECTIVE: To develop a simple evaluation tool to assess methodological rigor of the literature on patient compliance with medications, and to apply the tool to a sample of the literature. METHODS: A computerized search of the MEDLINE database (January 1980-December 1996) was performed. All English-language articles on compliance with medications were identified, using the MeSH terms patient-compliance and drug-therapy. A 10% sample was then randomly selected for review, Methodological rigor was assessed on eight standards: study design, specification of patient sample, power analysis, specification of disease, specification of therapeutic regimen, duration of follow-up, definition of compliance, and compliance measurement. The raw scores of the eight standards were then combined in three summary scores, standardized from 0 to 100: study design, disease-related features, and compliance issues. RESULTS: Seventy-two articles from 719 identified were reviewed. The majority of the research articles were descriptive (63.9%), and patients in these studies were selected mainly from a convenience sample (41.7%). Just nine studies were multicenter studies, and three employed power analysis. The compliance definition was replicable in 41.7% of the studies. In 22 articles neither the compliance measure nor the criteria were stated. One-quarter of the studies (18) used a nonvalidated measure of compliance. Only two studies reached a score of 6 in the compliance measure, and eight studies used two different measures of compliance simultaneously. The median values in the summary scores were: study design 8.3, disease 42.9, compliance issues 50. CONCLUSIONS: The quality of the compliance research was generally poor. These low scores reflect very important shortcomings in the methodology, such oversights make it difficult for the reader to critically assess the validity of the conclusions.

Powell-Griner, E., Bolen, J., & Bland, S. (1999). Health care coverage and use of preventive services among the near elderly in the United States. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 882-886.
    The Journal’s Home Page is at:  THE AMERICAN JOURNAL OF PUBLIC HEALTH.
    ABSTRACT: Objectives. It has been proposed that individuals aged 55 to 64 years be allowed to buy into Medicare. This group is more likely than younger adults to have marginal health status, to be separating from the workforce, to face high premiums, and to risk financial hardship from major medical illness. The present study examined prevalence of health insurance coverage by demographic characteristics and examined bow lack of insurance may affect use of preventive health services. Methods. Data were obtained from the Behavioral Risk Factor Surveillance System, an ongoing telephone survey of adults conducted by the 50 states and the District of Columbia. Results. Many near-elderly adults least likely to have health care coverage were Black or Hispanic, had less than a high school education and incomes less than $15 000 per year, and were unemployed or self-employed. Health insurance coverage was associated with increased use of clinical preventive services even when sex, race/ethnicity, marital status, and educational level were controlled. Conclusions. Many near-elderly individuals without insurance will probably not be able to participate in a Medicare buy-in unless it is subsidized in some way.

Ratner, P., Johnson, J., Bottorf, J. (1999). Smoking cessation in the clinical setting. Chap. 1 in Green, L.W., Frankish, C.J., McGowan, P., Ratner, P., Bottorff, J., Lovato, C.Y., Shoveller, J., Johnson, J., Williamson, D. (Eds.), SMOKING CESSATION: A SYNTHESIS OF THE LITERATURE ON PROGRAM EFFECTIVENESS. Vancouver: University of British Columbia Institute of Health Promotion Research, for the BC Ministry of Health.
    A systematic review of the research literature on smoking cessation effectiveness in clinical settings. http://www.commhealth.ihpr.ubc.ca/mohscr/Ch1clin.PDF.

Raube, K., & Merrell, K. (1999). Maternal minimum-stay legislation: Cost and policy implications. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 922-923.
    ABSTRACT: Recently, most state legislatures and Congress have passed laws mandating insurance coverage for a minimum period of inpatient care following delivery. This study analyzed the likely cost implications of one state's law. To view the complete abstract, go to: http://www.ajph.org/cgi/content/abstract/89/6/922.
    The Journal’s Home Page is: http://www.ajph.org/ .

Riekert, K. A., & Drotar, D. (1999). Who participates in research on adherence to treatment in insulin-dependent diabetes mellitus? Implications and recommendations for research. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 253-258, June.
    For this issue of the Journal, go to: http://jpepsy.oupjournals.org/cgi/content/abstract/24/3/253.

Rimer, B. K., Conaway, M., Lyna, P., Glassman, B., Yarnall, K. S. H., Lipkus, I., & Barber, L. T. (1999). The impact of tailored interventions on a community health center population. PATIENT EDUCATION AND COUNSELING 37 (2): 125-140.

Rosenbach, M. L., & Gavin, N. I.  (1998). Early and periodic screening, diagnosis, and treatment and managed care. ANNUAL REVIEW OF PUBLIC HEALTH 19: 507-525. For abstract, go to: http://publhealth.annualreviews.org/cgi/content/abstract/19/1/507

Rowland, D., Salganicoff, A., & Keenan, P. S. (1999). The Key to the Door: Medicaid's Role in Improving Health Care for Women and Children. ANNUAL REVIEW OF PUBLIC HEALTH 20: 403.
    ABSTRACT/Full-Text:
ABSTRACT.

Ryan, A. A. (1999). Medication compliance and older people: a review of the literature. INTERNATIONAL JOURNAL OF NURSING STUDIES 36 (2): 153-162.
    ABSTRACT: This critical review of the literature pertaining to medication compliance among older people included (a) a critique of the more commonly cited compliance theories, (b) an analysis of the key variables influencing medication compliance among older people and (c) a critical evaluation of the literature that examines these phenomena. Additional studies that explore the benefits of Self-Administration of Medication Schemes are examined for their coverage of the educational component as well as the behavioral component of a well-organized patient education program. The review covers material published in English since 1980 excluding literature on compliance theories that originated in previous decades. Search terms included medication, compliance, older people, self-medication and education. The literature was then critically reviewed using the criteria identified by Roe (1993) [Roe, B., 1993. Undertaking a critical review of the literature. Nurse Researcher 1(1), 35-46.] which emphasizes the need for clarity in key areas such as research design, sample selection, research methods, results, discussion and conclusions. Empirical studies that met these criteria were included in the review and in the main, were found in academic rather than professional journals. The review concludes with a summary of the main points and a discussion of the implications for nursing practice, education and research.

Schwartz, M.D., Rimer, B.K., Daly, M., Sands, C., & Lerman, C. (1999). A randomized trial of breast cancer risk counseling: The impact on self-reported mammography use. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 924-926.
    The Journal’s Home Page is: THE AMERICAN JOURNAL OF PUBLIC HEALTH.
    ABSTRACT: Objectives. We evaluated the impact of individualized breast cancer risk counseling on mammography use among women at risk for breast cancer. Methods. Participants (n = 508) were randomized to the breast cancer risk counseling intervention or a general health education control intervention, and 85% completed follow-up. Results. in multivariate modeling, a significant group-by-education interaction demonstrated that among less-educated participants, standardized breast cancer risk counseling led to reduced mammography use. There was no intervention effect among the more-educated participants. Conclusions. These results suggest that standard breast cancer risk counseling could have an adverse impact on the health behaviors of less-educated women.

Shannon, W., Buller-Taylor, T., Green, L.W. (1999). BC Doctors Stop Smoking Program: Results of the Spring 1998 retrospective evaluation. Chap. 7 in Green, L.W., Frankish, C.J., McGowan, P., Ratner, P., Bottorff, J., Lovato, C.Y., Shoveller, J., Johnson, J., Williamson, D. (Eds.), SMOKING CESSATION: A SYNTHESIS OF THE LITERATURE ON PROGRAM EFFECTIVENESS. Vancouver: University of British Columbia Institute of Health Promotion Research, for the BC Ministry of Health.
    A systematic review of the research literature on smoking cessation effectiveness of a program designed to instruct and support physicians in their efforts to help their patients stop smoking. http://www.commhealth.ihpr.ubc.ca/mohscr/Ch7BCDoc.PDF

Shiboski, C.H., Palacio, H., Neuhaus, J.M., & Greenblatt, R.M. (1999). Dental care access and use among HIV-infected women. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 834-839.
    ABSTRACT: This study sought to identify predictors of dental care use in HIV-infected women. For the complete abstract, go to: http://www.ajph.org/cgi/content/abstract/89/6/834. The Journal’s Home Page is at: http://www.ajph.org/.

SjÖstrom, M., Karlsson, A. B., Katti, G., Yngve, A., Green, L. W., Bygren, L. O. (1999). A four week residential program for primary health care patients to control obesity and related heart risk factors: Effective application of principles of learning and lifestyle change. EUROPEAN JOURNAL OF CLINICAL NUTRITION 53 (Suppl. 2): S72-S77.
    ABSTRACT: Objective: To test the short and long-term effectiveness of a four week residential program for primary health care patients to control obesity and related risk factors for card-vascular disease (CVD), especially blood pressure (BP). Design: Prospective clinical study, with follow up after 1 and 5 y. Setting: Vindeln Patient Education Centre, Vindeln, and Department of Social Medicine, University of Umea, Sweden. Subjects: Approximately 2500 individuals, with two or more of the traditional risk factors for CVD, participated in the program. This report describes a subsample of 100 consecutive patients, 52+/-9 y, 53 men, with obesity and/or high BP. Intervention: Four week residential program with lectures and group discussions as well as practical sessions in smaller groups (meal preparations, physical exercise, etc). The patients were followed-up medically in their home area. Outcome measures: Weight and blood pressure. Results: Dramatic reductions of weight and, especially, of blood pressure (BP) occurred during the residential weeks, and the reductions were pronounced also after 1 y. After 5 y, the total mean weight among men with initial BMI greater than or equal to 30 kg/m(2) was still 5 kg lower, and diastolic and systolic BP among those with hypertension was 15 and 20 mm Hg lower, respectively, than before the program. Conclusions: The full-time participation in the residential program and the enrollment and commitment of the patients may explain the clinical outcome. A level of predisposition greater than that required of most weight- and BP-control programs was confirmed and a great preventive or therapeutic potential was indicated. The study illustrates an effective application of the Precede-Proceed model of health promotion planning.

Stark, L. J. (1999). Commentary: beyond feeding problems: the challenge of meeting dietary recommendations in the treatment of chronic diseases in pediatrics. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 221-222, June.
    For this issue of the Journal, go to: http://jpepsy.oupjournals.org/cgi/reprint/24/3/221.pdf.

Svikis, D.S., Pickens, R.W., Schweitzer, W., Johnson, E., Haug, N. (1999). Weekly patterns of drug treatment attendance. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (5): 752-755.
   ABSTRACT: Objectives. This study examined weekly patterns of drug treatment attendance in relation to date of welfare payment receipt and reason for treatment absence. Methods. Treatment attendance by Medicaid-eligible pregnant women who were drug dependent was examined by calendar week over a 29-month period. Results. Time series analyses showed that attendance was lower during week 1 than week 4. Drug use was the most frequently reported reason for treatment absence during week 1 (25%) but was not reported as a reason during week 3. Conclusion. Drug-dependent out-patients had increased absences associated with illicit drug use during the first week of the month when welfare payments were received. The generalizability of the findings is unknown.

Sword, W. (1999). A socio-ecological approach to understanding barriers to prenatal care for women of low income. JOURNAL OF ADVANCED NURSING 29 (5): 1170-1177.
    ABSTRACT: This paper critically examines the notion of barriers as conceptualized in the literature and suggests an expanded orientation to more fully appreciate its complexity. This alternative approach not only takes into account factors and processes relevant to the individual that create constraints to utilization, but also acknowledges influences on the design and delivery of health care. These latter considerations determine the availability and characteristics of programmes and services that may or may not encourage or enable participation by persons of law income. A socio-ecological model is proposed that compels health care practitioners and researchers to acknowledge the many influences on utilization behaviour. The literature on barriers to prenatal care is subsequently reviewed and evaluated, with consideration given to the range of behavioural determinants suggested by the model. Finally, a case is made for qualitative methods for inquiry to further enhance knowledge about factors and processes influencing use of the health care system, including prenatal care. It is argued that these approaches lead to enhanced appreciation of behaviour as: a social product and are consistent with the ideology of health promotion.

Ulmi, S., McGowan, P., Gray, D., & Savoy, D. (1999). Moving beyond information: Evaluation of a nutrition education tool based on a theoretical model. EUROPEAN JOURNAL OF CLINICAL NUTRITION 53 (Suppl. 2): S49-S53.
    ABSTRACT: Objective: This study investigated the relative effectiveness of a nutrition education brochure based on a theoretical model versus a more traditional information-based brochure in getting subjects to accurately assess daily calcium intake, make a plan to increase intake if needed, and to implement the plan. Design: A randomized trial involving 216 women between the ages of 19-49y. Subjects were randomly assigned to a group which received educational materials containing an interactive brochure designed using the Motivation Generating model (Calcium Calculator(R)), or to a group which received a calcium information brochure (An Appetite for Good Health). Within a two week period the women were contacted by telephone to assess use of materials, calcium intake assessment information, and plans for dietary change. Setting: Subjects were recruited at five fitness centers in the Vancouver area. The research was conducted by the Institute of Health Promotion Research at the University of British Columbia. Results: Results indicated significantly greater numbers of subjects conducting self- assessment and increased group accuracy for calcium intake assessment in subjects using the interactive brochure. Conclusion: Use of a theoretical model designed to create behavior change such as the Motivation Generating Model can increase specific behaviors which may lead to improvements in dietary consumption.

Venturini, F., Nichol, M.B., Sung, J.C.Y., Bailey, K.L., Cody, M., & McCombs, J.S. (1999). Compliance with sulfonylureas in a health maintenance organization: A pharmacy record-based study. ANNALS OF PHARMACOTHERAPY 33 (3): 281-288.   
    ABSTRACT: OBJECTIVE: To determine which factors affect compliance with sulfonylureas in a population served by a health maintenance organization in Southern California. METHODS: Retrospective analysis of pharmacy records and healthcare utilization data for two years (April 1993-March 1995), and a sun;survey mailed to patients, Patients treated with sulfonylureas were selected for analysis on the basis of their prescription profile, Compliance was measured from the pharmacy records as the proportion of days the patient was in possession of the prescribed medications, patient compliance with sulfonylureas was modeled as a function of four clusters of determinants: patient-related attributes, drug regimen characteristics and complexity, health status and disease-related variables, and characteristics of the interaction with healthcare providers. RESULTS: 786 patients were identified for analysis (49.1% women, mean age 59 y). The mean compliance rate was 83% +/- 22% SD. Compliance was significantly positively related with age and self-reported level of medication-taking compliance at baseline. Factors shown to have an inverse relationship with compliance were treatment complexity, perception of general health, and being a newly treated patient (adjusted R-2 for the final model = 0.148). CONCLUSIONS: Our results suggest that factors found to be associated with noncompliant behavior (e.g,, being a newly treated patient, self-reported compliance, regimen complexity) can be assessed by physicians and pharmacists as a routine practice.

Williams, P.L., Innis, S.M., Vogel, A.M.P., & Stephen, L.J. (1999). Factors influencing infant feeding practices of mothers in Vancouver. CANADIAN JOURNAL OF PUBLIC HEALTH-REVUE CANADIENNE DE SANTE PUBLIQUE 90 (2): 114-119.
    ABSTRACT: This study describes factors influencing infant feeding choices of 434 mothers with 9-month-old infants in Vancouver. Consistent with Social Cognitive Theory, both internal personal and socio-environmental factors influence infant feeding choices. Mothers attributed the choice to breastfeed primarily to personal choice, whereas the choice to formula feed was attributed to socio-environmental factors. Among mothers who breastfed <3 months, the choice to ean was primarily attributed to concern for baby's nutrition; compared to returning to work, concern about milk supply and concern for baby's nutrition among those who breastfed greater than or equal to 3 to <6 months; and returning to work and personal choice among those who breastfed greater than or equal to 6 months. Among Caucasian mothers, the choice to wean was primarily attributed to returning to work, compared to concern for baby's nutrition among non-Caucasian mothers. Initiatives to facilitate further advances in breastfeeding promotion could address three areas; 1) prenatal intentions, 2) early postpartum concerns, and 3) later issues surrounding returning to work and infant nutrition.

    Other References

McCraig, L. F. (1999). National Hospital Ambulatory Medical Care Survey: 1997 Outpatient Department Summary. Advance data from vital and health statistics; no. 307. Hyattsville, MD: National Center for Health Statistics.
    Describes ambulatory care visits to hospital outpatient departments in the United States. Presents statistics on selected hospital, clinic, patient, and visit characteristics.

Prenatal Discussion of HIV Testing and Maternal HIV Testing --- 14 States, 1996--1997. Morbidity and Mortality Weekly Reports 48(19), May 21, 1999.
    In July 1995, the Public Health Service recommended that health-care providers counsel all pregnant women about human immunodeficiency virus (HIV) prevention and encourage testing for HIV infection (1) and, if indicated, initiate zidovudine therapy (2). To evaluate compliance with these recommendations, CDC analyzed population-based data on HIV counseling and testing during 1996-1997 from 14 states participating in the Pregnancy Risk Assessment Monitoring System (PRAMS). This report presents an analysis of survey data collected from 1996 through 1997; results indicate that HIV counseling and testing of pregnant women were common but varied by state, type of prenatal health-care provider, Medicaid status, and maternal demographic characteristics. References cited:
1. CDC. US Public Health Service recommendations for human immunodeficiency virus counseling and voluntary testing for pregnant women. MMWR 1995;44(no. RR-7):1-14.
2. Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med 1994;331:1173-80.

SUPPLEMENTARY WEBSITES

www.clinicaltrials.com Clinical Trials Posting, an Internet service providing information about national and local clinical trials and support services. E.g., Asthma Research START (Inhaled Steroid Treatment as Regular Therapy in Early Asthma) clinical trial was posted at this site.

Wired health http://www.hc-sc.gc.ca/hppb/wired/ "Remembering the Victims of AIDS" is the first installment in HealthPromotion Online's new monthly magazine, Wired Health. Every month, new articles will feature different programs and events about health promotion. If you have any questions or comments, or you would like to contribute a story idea, contact the editor.

Web sites on smoking cessation:

Action on Smoking & Health
www.ash.org

The American Cancer Society

American Heart Association
www.americanheart.org/CATALOG/Health_catpage14.html

American Lung Association  
www.lungusa.org/tobacco/index.html

Americans for Nonsmokers Rights  
www.nosmoke.org

Arizona Tobacco Education & Prevention Program
http://www.tepp.org/

BADvertising Institute
http://www.badvertising.org/

Breed's Tobacco Activism Guide (annotated links)
http://www.tobacco.org/Resources/lbguide.html

Campaign for Tobacco Free Kids
http://www.tobaccofreekids.org/

Centers for Disease Control & Prevention
http://www.cdc.gov/nccdphp/osh

Cable News Network (CNN) - Tobacco
http://cnn.com/HEALTH/indepth.health/smoking

Environmental Protection Agency (EPA)
http://www.epa.gov/smokefree/index.html

Florida Tobacco Education Resources
http://www9.myflorida.com/tobacco/index.html

Food and Drug Administration
http://www.fda.gov/opacom/campaigns/tobacco.html

Friends of Tobacco  
http://www.fujipub.com/fot

International Union Against Cancer - Globalink  
http://www.globalink.org

House Committee on Commerce
http://www.house.gov/commerce/TobaccoDocs/documents.html

INFACT    
http://www.infact.org

Investor Responsibility Research Center 
http://www.irrc.org/

JoinTogether/Quitnet/Advocacy Institute 
http://www.jointogether.org/home/

Maryland Dept of Health   
http://www.dhmh.state.md.us/

Mass. Tobacco Control Program  
http://www.quitnet.org

Minnesota Attorney General - Tobacco Trial
http://news.mpr.org/features/199805/08_stawickie_history/index.shtml

Minnesota Blue Cross - Tobacco Trial 
http://www.cdc.gov/tobacco/industrydocs/mnbluecross.htm

Reuters News Service  
http://www.reuters.com/news.jhtml

Save Lives, Not Tobacco
http://www.savelives.org

Smokescreen Action Network  
http://www.smokescreen.org

State Tobacco Information Center (STIC)
http://stic.neu.edu

Tobacco BBS (extensive links)
http://www.tobacco.org

Tobacco Control Resource Center
http://www.tobacco.neu.edu

Tobacco Control Supersite (links by topic) 
http://www.health.usyd.edu.au/tobacco

Tobacco Resolution (tobacco industry documents) 
http://www.tobaccoresolution.com

Univ Calif SF - Tob Archives  
http://www.library.ucsf.edu/tobacco

USA Today - Tobacco
http://www.usatoday.com/news/smoke/smoke00.htm

Washington Doctors Ought to Care (DOC)
http://kickbutt.org

World Health Organization  
http://www5.who.int/tobacco/

Interactive web site
www.thelastdraw.com

Interactive kiosk-based smoking cessation program in English and Spanish. Tailors itself to the user on many characteristics (incl. gender, race/ethnicity, and age). You can see a glimpse at http://www.orcashealth.com/html/gh3.html

Kick the Smoking Habit - http://www.nhlbi.nih.gov/index.htm - This publication is part of a set of booklets that present key steps that Latinos can take to reduce their chances of having a heart attack or stroke. Written in a friendly English/Spanish side-by-side style, the booklets present facts and dispel myths. The set includes the following titles: Take Steps--Prevent High Blood Pressure; Cut Down on Salt and Sodium; Learn Your Cholesterol Number; Protect Your Heart--Lower Your Blood Cholesterol; Watch Your Weight; Cut Down on Fat--Not on Taste; Stay Active and Feel Better; Kick the Smoking Habit.

The US DHHS Agency for Health Care Policy and Research has Clinical Practice Guidelines for smoking cessation. http://www.ahcpr.gov/consumer/index.html#smoking