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Biomedical subjects

D G Simons-Morton

Publications and source records attributed to D G Simons-Morton.

8 recordsLinked to original sources

Characteristics of controlled studies of patient education and counseling for preventive health behaviors.

To determine characteristics of controlled studies (quasi-experimental and randomized) of clinical patient education/counseling for behavior change to prevent disease, we conducted an extensive literature review of published and unpublished studies from 1971 to 1989. Sixty-four studies with 101 intervention groups met specific criteria for relevance and scientific acceptability. We examine these studies in terms of prevention area, subject source, intervention characteristics, and use of educational principles. Findings reveal many controlled clinical studies in smoking cessation, nutrition, and weight control but sparcity in other areas (injury prevention, exercise, stress, drug and alcohol misuse, STD prevention); an emphasis on communication by a single clinical practitioner; and varied use of educational principles. We recommend adhering to educational principles to enhance likelihood of success.

Adolescent

An ecological approach to the prevention of injuries due to drinking and driving.

Among the many alcohol-related public health concerns, motor vehicle crashes account for nearly one-third of all deaths attributable to alcohol. Adolescents and young adults, particularly males, are important target populations for intervention efforts. Taking an ecological perspective of individuals within their social and physical environments, a diagnostic framework is employed in reviewing the literature on factors associated with drinking and driving injuries and on interventions to prevent injuries due to drinking and driving. Intervention planning is conceptualized according to a multilevel intervention framework, which consists of four phases: (1) health goals selection, (2) intervention planning, (3) intervention, and (4) evaluation. Possible intervention objectives, targets of the intervention actions, intervention approaches, and evaluation criteria are identified and discussed for three societal levels and four practice settings.

Accidents, Traffic

Prescribing physical activity to prevent disease.

Despite an increase in the public's awareness of the ample health benefits of physical activity, less than 20% of US adults regularly participate in moderate to vigorous physical activity. For most adults, increasing physical activity even moderately is likely to benefit health. Physicians can prescribe physical activity and incorporate an emphasis on physical activity into clinical practice.

Adult

Developing comprehensive smoking control programs in schools.

During the school years, students encounter peer influences and role models who encourage smoking initiation. To counteract these influences, schools can provide comprehensive programs that include smoking prevention and cessation education and a supportive nonsmoking environment. In the past several years, programs and information have become available to help schools establish curricula to address smoking and to create nonsmoking environments. In addition, state and local governments have acted to legally restrict smoking in schools or to require smoking content in curricula. Efforts can be categorized into three avenues of intervention: student education, school and school system policy, and governmental regulation. Resources are suggested for each category to assist in developing a comprehensive intervention to foster nonsmoking by children and adolescents in the school setting.

Adolescent

Denial, delay and disappointment: discovering and overcoming the causes of drug errors and missed appointments.

Although the medical management of epilepsy is possible with effective therapeutics, such management is complicated by patient errors of self-medication. Efforts to improve adherence to prescribed regimens of anticonvulsant medication have not been extensively studied, although several promising results have been obtained. Research on adherence to medication regimens has been more extensive in other chronic conditions, such as hypertension, that have similarities to epilepsy in their demand for long-term treatment, often in the absence of symptoms, with drugs that may produce side effects. From the combined research on factors associated with drug errors, we have analyzed characteristics of the patient, of the regimen, of the illness, and of the patient - provider relationship. The most promising areas for improving compliance appear to be the influence of family and friends, the complexity of the treatment regimen, the patient's belief in severity of the illness, and the patient - provider relationship. Strategies to improve compliance can target 3 sets of factors: predisposing factors including patients' motivation and perception, factors that enable patients to comply more easily, and factors that reinforce compliance. Physician-directed interventions tailored to each of these categories of factors, taken together, can make up a comprehensive health education program. A model for the interventions and their evaluations is presented.

Anticonvulsants

Health promotion and disease prevention. Roles for the primary care physician.

The practice of health promotion and disease prevention (HPDP), an increasingly important approach to healthcare, includes influencing health behaviors of the population at risk for disease as well as environmental conditions that affect health. The major role of the clinician in HPDP is at the individual level: screening for risk factors and disease and providing early treatment, advice, counseling, and referral. Primary care physicians can broaden their impact by assuming roles at organizational, community, and government levels (eg, as an active member of an organization or a consultant to an outside organization, a community leader or an agent of change, an influential constituent or a lobbyist). These roles enable primary care physicians to have an impact both on individuals and on environments to reduce disease risk factors.

Health Promotion

Data sources for penetrating trauma.

Three city data sources (CDSs)--police reports, ambulance reports, and medica examiner (ME) logs--were evaluated for their usefulness in epidemiologic studies of trauma. The CDSs were employed to identify all cases of penetrating injury to the chest and/or abdomen severe enough to require care in a medical institution during 1979 and 1980 in Baltimore city. The percent of cases identified by source was: police, 66.8%; ambulance, 47.9%; ME, 16.6%; police plus ambulance, 89.4%; police plus ME, 82.9%; and ambulance plus ME, 50.1%. Hospital admissions to six study hospitals due to chest and/or abdomen penetrating injury were located and matched to the CDS reports: 89.2% of the hospitalized cases were reported in one or more CDS, and 34.7% of the cases identified by one or more CDS could not be located in the hospital records. Using hospital records as the standard, each source was determined to have the following completeness of case reporting: police, 66.2%; ambulance, 72.9%; and ME, 92.2%. The authors conclude that existing CDSs should be used with caution, and that the usefulness of data from multiple sources far outweighs that from any single source.

Abdominal Injuries