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Biomedical subjects

R C Lefebvre

Publications and source records attributed to R C Lefebvre.

35 records · Page 2Linked to original sources
PubMed1987

Theory and delivery of health programming in the community: the Pawtucket Heart Health Program.

The Pawtucket Heart Health Program is one of the community studies examining whether population-based efforts to lower cardiovascular risk factors will reduce cardiovascular morbidity and mortality. The Pawtucket Heart Health Program intervention is based on a blend of social learning theory, community organization models, community psychology tenets, and diffusion research. This model allows for multifaceted programs that target individuals, groups, organizations, and the entire community to alter their cardiovascular risk through managing blood pressure, lowering blood cholesterol, quitting smoking, increasing fitness, and maintaining desirable weight levels. A dominant feature of the intervention is the emphasis that it places on volunteers for program delivery. The role of volunteers in providing direct services to help citizens lower their blood pressure and lose weight is highlighted to demonstrate the feasibility and effectiveness of these services. In addition, church-based programming which utilizes volunteers to manage and direct programs is also presented as an example of community-based health promotion efforts that promote collective efficacy.

Adolescent↗
PubMed1987

Characteristics of participants in community health promotion programs: four-year results.

Four years of participant tracking data (N = 24,995) for community-based programs targeting cardiovascular disease risk factors are presented. Over two-thirds of contacts were female; age segment representation in these programs was comparable to the city's demography. However, the data show that programs of varying formats which target specific risk factors attract different types of participants. Implications for marketing strategy are discussed.

Adolescent↗
PubMed1986

Community intervention to lower blood cholesterol: the "Know Your Cholesterol" campaign in Pawtucket, Rhode Island.

Sufficient data exist to support approaches to lowering cardiovascular disease risk which target population-wide reductions in elevated blood cholesterol levels. Within the context of a multifactorial cardiovascular disease prevention program, a 2-month cholesterol education campaign was launched to encourage citizens to "Know Your Cholesterol" by attending screening, counseling, and referral events (SCOREs) held throughout the community. These events featured assessment of dietary fat and cholesterol, rapid blood cholesterol analyses with a fingerstick procedure and the Kodak Ektachem DT60, and immediate dietary counseling by trained volunteers. A total of 1439 persons attended 39 SCOREs: nearly 60% were found to have blood cholesterol levels that exceeded recommended goal levels. At a 2-month follow-up of 1040 of these same individuals, 600 had lowered their blood cholesterol level by an average of 29.1 mg/dl. This experience suggests that similarly modeled campaigns may have a significant impact on the distribution of blood cholesterol levels in the entire U.S. population.

Cholesterol↗
PubMed1985

A multi-modal questionnaire for stress.

This paper presents data regarding the Strain Questionnaire (SQ), a 48-item scale designed to measure self-report levels of behavioral, cognitive, and physical stress complaints. A heterogeneous sample of 412 adults completed the SQ, and correlational, reliability, factor analytic and validity data are reported. Results suggest that the items reflect a wide range of content which show high internal consistency on each of the three subscales and the total SQ. Test-retest reliability demonstrated satisfactory temporal stability of the scales. Factor analysis of the SQ produced eleven orthogonal factors. The most salient factor was "cognitive/behavioral strain" which highlights the necessity for including these variables in self-report surveys of stress. Future research needs are also discussed.

Adolescent↗
PubMed1979

Cognition and the disease process: genesis, maintenance, and treatment.

The present paper is directed toward the conceptualization of disease states and their management from the cognitive point of view. The role of cognitive sytlesand self-statements in the pathogenesis of disease and the execution of coping styles is presented. A review of the literature on the cognitive treatment of medical disorders has documented the utility of such approaches with several medical problems, but a need for more rigorous empirical efficacy remains. The necessity of analyzing the coping processes elicited by specific disease states is viewed as essential to the understanding of the patient and the design of intervention strategies. Finally, a cognitive analysis of patient compliance to treatment regimens is presented.

Adaptation, Psychological↗
PubMedDate not supplied

Using the stages of change model to increase the adoption of physical activity among community participants.

PURPOSE: This study examined the use of the stages of change model to design an exercise intervention for community volunteers. DESIGN: The "Imagine Action" campaign was a community-wide event incorporating the involvement of local worksites and community agencies. Community members registering for the campaign were enrolled in a six-week intervention program designed to encourage participation in physical activity. SUBJECTS: Six hundred and ten adults aged 18 to 82 years old enrolled in the program. Seventy-seven percent of the participants were female and the average age was 41.8 years (SD = 13.8). SETTING: The campaign was conducted in a city with a population of approximately 72,000 and was promoted throughout community worksites, area schools, organizations, and local media channels. MEASURES: One question designed to assess current stage of exercise adoption was included on the campaign registration form as were questions about subject name, address, telephone number, birthdate, and gender. INTERVENTION: The intervention included written materials designed to encourage participants to initiate or increase physical activity, a resource manual describing activity options in the community, and weekly "fun walks" and "activity nights." RESULTS: A Stuart-Maxwell test for correlated proportions revealed that subjects were significantly more active after the six-week intervention. Sixty-two percent of participants in Contemplation became more active while 61% in Preparation became more active. CONCLUSIONS: Most participants increased their stage of exercise adoption during the six-week intervention. This study provides preliminary support for use of the stages of change model in designing exercise interventions.

Adolescent↗
PubMedDate not supplied

Health practice correlates in three adult age groups: results from two community surveys.

Independently done surveys of a target population can make an important contribution to knowledge about the determinants of personal health behavior by highlighting variables that consistently emerge as significant predictors. This investigation examined the correlates of four health practice and knowledge indices related to cardiovascular disease (CVD) in two baseline community surveys of the Pawtucket Heart Health Program (N = 2,413; N = 2,808). An additional dimension was the use of three adult age groups (18-29, 30-49, 50-64) in conducting the analyses. Results of both surveys showed that sex was the strongest correlate of the four indices--knowledge of CVD, encouraging health practice changes in others, dietary intake, and exercise. The four indices related to CVD were also associated with years of education, primary language, and whether or not a recent cholesterol measurement had been obtained, although these relationships were not as consistent as the results for sex. Overall, about half of each survey's significant associations were also found in the other survey (survey 1, 30 of 62; survey 2, 30 of 56). Consistency of significant results between surveys was best for the group ages 30-49. In either survey, it was rare for an association between a predictor and behavioral index to appear in each of the three age groups. This study supports the importance of the subjects' sex in research on personal health practices, suggests the potential for independence even among health-related indices pertinent to a single type of illness, and emphasizes the usefulness of utilizing independent samples to identify important correlates of health behavior.

Adolescent↗
PubMedDate not supplied

Performance characteristics of a blood cholesterol measuring instrument used in screening programs.

Four experiments were conducted to assess the precision and accuracy of the Boehringer Mannheim Diagnostics Reflotron, an instrument that is being adopted by many public health groups to conduct blood cholesterol screening programs. Our study is one of the first to evaluate and document the instrument's performance characteristics. Successive generations of reagent tabs supplied by the manufacturer were tested against a reference laboratory method standardized by the Centers for Disease Control. Three of the experiments also compared two or more Reflotrons to assess intermachine reliability. The Reflotron analyzer provided precise blood cholesterol measurements both in repeated tests and among instruments. The accuracy of the method varied across reagent lots, with an average negative bias of 21.05 milligrams per deciliter (mg per dl), decreasing steadily to a negative bias of 4.07 mg per dl. Reliability between and within analyzers was high. The data provide support for the use of the instrument in blood cholesterol screening efforts, yet signal the need for attention to quality control procedures, both by the manufacturer and operators, to ensure the validity and accuracy of the results.

Cholesterol↗
PubMedDate not supplied

Impact of public education and continuing medical education on physician attitudes and behavior concerning cholesterol.

Current physician attitudes and behavior concerning elevated blood cholesterol, recent changes, and reasons for change were measured in a survey of physicians in two cities. Those in a community with both continuing medical and public education programs reported changing their practice significantly over the past two years, more so than those in a comparison community. The physicians did not identify specific elements of a continuing medical education program as important in these differences. Physicians in Pawtucket, Rhode Island, identified requests from the public as important and statistically significant factors in their changed behavior, suggesting that the public education program has become an important influence on physician behavior.

Attitude of Health Personnel↗
PubMedDate not supplied

Rapid measurement of blood cholesterol: evaluation of a new instrument.

Rapid and reliable techniques for the measurement of blood cholesterol are a necessary first step in implementing effective mass screening efforts to reduce the risks of cardiovascular disease. This paper reports preliminary data gathered on the Kodak Ektachem DT60, one of the first of a new generation of dry chemistry analyzers to appear on the market. The results of the first study demonstrated high reproducibility of the methodology (r = .98, p less than .0001) but showed an average 25 mg/dL underestimate of total blood cholesterol as compared with a standardized lipid laboratory. Changes in the manufacturer's calibration protocol in the second study with two other DT60s reduced this bias on serum samples to -18 mg/dL. A third study using fresh blood samples found a difference of 3-11 mg/dL between the two DT60s and the laboratory. A significant difference between the two analyzers was also found. Alternatives are available to enable those who use this instrument to correct for the observed bias. Despite some problems, several other advantages of the technology lend support for its expanded use in public health interventions.

Adult↗
PubMedDate not supplied

Changing physicians' attitudes, knowledge, and self-efficacy regarding cholesterol screening and management.

The National Cholesterol Education Program (NCEP) has identified a need to convey practical approaches for the management of high blood cholesterol (BC) to physicians. Our study was a joint effort between the Pawtucket Heart Health Program and the Brown University Department of Family Medicine to improve family medicine residents' attitudes, knowledge, self-efficacy, and practices regarding cholesterol screening and management. Thirty-six resident physicians received a BC screening and management training program. This program included training in BC screening using the fingerstick method and a desktop analyzer, diet assessment and counseling, and a management protocol for evaluation and treatment of high BC based on NCEP guidelines. The training program also included evaluation of residents' BC screening activity, incentives, chart audits, and biweekly articles in the departmental newsletter. We administered a survey to residents before and one year after the training program began to assess self-reported knowledge, attitudes, self-efficacy, and practices for BC management. Survey results indicated that the residents significantly improved their reported knowledge and attitudes about BC management. In addition, they significantly increased their reported self-efficacy and practices in dietary counseling and patient education. Residents also indicated that the training program was worthwhile, necessary, and practical and that many would use the materials and protocols in their future practices.

Cholesterol↗
PubMedDate not supplied

Strategic questions for consumer-based health communications.

Using the consumer-oriented approach of social and commercial marketers, this article presents a process for crafting messages designed to improve people's health behaviors. The process, termed consumer-based health communications (CHC), transforms scientific recommendations into message strategies that are relevant to the consumer. The core of CHC is consumer research conducted to understand the consumer's reality, and thereby allowing six strategic questions to be answered. The immediate result of the CHC process is a strategy statement--a few pages that lay out who the target consumer is, what action should be taken, what to promise and how to make the promise credible, how and when to reach him or her, and what image to convey. The strategy statement then guides the execution of all communication efforts, be they public relations, mass media, direct marketing, media advocacy, or interpersonal influence. It identifies the most important "levers" for contact with the consumer. Everyone from creative specialists through management and program personnel can use the strategy statement as a touchstone to guide and judge the effectiveness of their efforts. The article provides a step by step illustration of the CHC process using the 5 A Day campaign as an example.

Communication↗