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Biomedical subjects

T M Vogt

Publications and source records attributed to T M Vogt.

At least 55 records · Page 3Linked to original sources
PubMed1991

Nurse-assisted smoking counseling in medical settings: minimizing demands on physicians.

BACKGROUND: In an effort to find more practical smoking intervention models for primary-care settings, three physician-and-nurse team approaches to patient counseling were compared with brief physician advice alone. METHODS: Subjects were 3,161 adult smokers surveyed while waiting to see 1 of 40 primary-care physicians. Physicians delivered a brief stop-smoking prompt to 2,707 (86%) of these smokers and referred them to an on-site smoking counselor (e.g., nurse) who randomly provided a two-page pamphlet (advice-only control) or one of three brief nurse-assisted interventions: (a) self-quit training, (b) recruitment to a group program, or (c) a combination intervention. Smokers usually (87%) agreed to see the counselor. RESULTS: After 3 months, subjects in the three nurse-assisted conditions were more likely to report a serious quit attempt (50% vs 39%, P less than 0.001) than were physician-advice-only subjects. Quit rates at 3 months were also higher (P less than 0.001) in the nurse-assisted self-quit (12.9%), recruitment (14.1%), and combination (13.0%) conditions, compared with those for brief physician advice only (7.6%). CONCLUSION: If long-term efficacy is confirmed, these nurse-assisted counseling approaches will serve as practical smoking intervention models for most medical-care delivery settings.

Adult↗
PubMed1986

Recruitment of elderly volunteers for a multicenter clinical trial: the SHEP pilot study.

Few large trials have involved the elderly, and little is known about the feasibility of recruiting such participants for study and the validity of inferences drawn from them. This article reviews the recruitment experience of the Systolic Hypertension in the Elderly Program (SHEP) pilot study. That program involved five clinical centers, and contacted approximately 75,000 persons in order to enroll a cohort of 551 individuals over 60 years old isolated systolic hypertension. The enrolled cohort was somewhat older and more highly educated than those screened. Except for deliberate oversampling of blacks and those over 70 years old, the enrolled population resembled the U.S. population, although individuals in the SHEP group were initially healthier, and more likely to have had some college education than those in the general population. There was substantial variation among sites in number of staff hours spent per participant recruited. The SHEP experience indicates that older persons are willing to volunteer for clinical trials research and that problems of inference are probably not any greater for that age group than for any other.

Aged↗
PubMed1986

Systolic Hypertension in the Elderly Program, Pilot Study (SHEP-PS): morbidity and mortality experience.

SHEP-Pilot Study, a randomized, double-blind, placebo-controlled trial of drug therapy for isolated systolic hypertension, followed 551 participants aged 60 years or more with untreated blood pressures of greater than or equal to 160/less than 90 mmHg for an average of 34 months. Mean age was 72 years, 63% were female and 82% white. Pretreatment blood pressures averaged 172/75 mmHg. As their Step I drug, 443 participants were assigned chlorthalidone and 108 placebo. Of 512 surviving participants, 80% and 84% of the chlorthalidone and placebo groups, respectively, attended their last clinic visit; 71% and 60% were still taking blinded drug; and 60% and 33% had systolic blood pressures less than 160 mmHg. Final blood pressures averaged 140/67 and 154/72 mmHg for the chlorthalidone and placebo groups, respectively. All-cause mortality rates were 25 and 23 deaths per 1000 participant-years of risk, respectively; rates for 'definite' first strokes were 8.3 and 13 deaths. Differences between chlorthalidone and placebo groups were significant for blood pressure but not for event rates.

Aged↗
PubMed1985

Systolic Hypertension in the Elderly Program (SHEP): antihypertensive efficacy of chlorthalidone.

The Systolic Hypertension in the Elderly Program (SHEP) is a randomized, blinded test of the efficacy of antihypertensive drug treatment. In a large feasibility trial, 551 men and women who had isolated systolic hypertension and were at least 60 years old received chlorthalidone (25 to 50 mg/day) or matching placebo as the step I drug. After 1 year, 83% of the chlorthalidone group and 80% of the placebo group were still taking SHEP medications. Of those still taking chlorthalidone, 88% had reached goal blood pressure (BP) without requiring a step II drug, and most had responded to the lower dose (25 mg/day). The BP response was similar in all age, sex and race subgroups, with an overall mean difference between randomized groups of 17 mm Hg for systolic BP (p less than 0.001) and 6 mm Hg for diastolic BP (p less than 0.001). The only common adverse effects were asymptomatic changes in the serum levels of potassium (0.5 mEq/liter lower in the chlorthalidone group, p less than 0.001), uric acid (0.9 mg/dl higher, p less than 0.001) and creatinine (0.08 mg/dl higher, p = 0.02). This study indicates that chlorthalidone is effective for lowering BP in elderly patients with systolic hypertension and sets the stage for a larger trial of the effects of such treatment on the incidence of cardiovascular disease.

Aged↗
PubMed1985

Medical costs of cigarette smoking in a health maintenance organization.

This study involved direct observation of the differences in utilization of medical care by smokers, nonsmokers, and former smokers. A household interview survey conducted in 1970-1971 obtained detailed information about the smoking patterns of 2,582 adult members of the Northwest Kaiser Permanente health maintenance organization in metropolitan Portland, Oregon. These data were linked to computerized medical records which documented all inpatient and outpatient care for 1967-1974. Current smokers used 20% more hospital days/1,000 person-years (adjusted for age, sex, alcohol intake, duration of observation) than did never smokers. Former smokers, but not smokers, used more outpatient services than did nonsmokers. Among smokers, there was no detectable relationship between use of medical care services and number of cigarettes smoked per day.

Adult↗
PubMed1985

Marijuana smoking: effect on expired air carbon monoxide levels.

A group of regular marijuana smokers was given expired air carbon monoxide (CO) tests before and after smoking low-dose, high-dose, and placebo marijuana cigarettes. Expired air CO doubled following smoking. There were no significant differences in CO levels in the different dose categories. Studies of the effects of marijuana on the body should attempt to separate effects of the drug from the effects that are secondary to the method of intake.

Adult↗
PubMed1984

Effects of parental smoking on medical care utilization by children.

A household interview survey of 2,582 adult members of the Kaiser-Permanente Medical Care Program of Oregon conducted in 1970-71 contained detailed questions about cigarette smoking patterns. Detailed, computerized medical records were maintained for all inpatient and outpatient care rendered between 1967 and 1974 to the 1,761 children of the interviewed sample. Adjusted for age, family size, socioeconomic status, and duration of Health Plan membership, children in non-smoking households used significantly more outpatient services than did children in smoking households, a relationship largely accounted for by their use of more preventive medical services than by children in smoking households. There were no significant differences in inpatient medical care use and outpatient care use for respiratory illness by children of smoking and non-smoking households.

Adolescent↗
PubMed1980

Recent changes in the incidence of duodenal and gastric ulcer.

The incidence of duodenal and gastric ulcer was examined in a Health Maintenance Organization with over 200,000 members. Hospitalization data were available from 1966 through 1975, and outpatient data from 1967 through 1973. Outpatient episodes of duodenal ulcer declined from 21.0 +/- 3.6 episodes per 1000 male person years (PY) in 1967 to 6.6 +/- 1.5 per 1000 male PY in 1973, and from 9.4 +/- 2.4 episodes per 1000 female PY in 1967 to 4.1 +/- 0.8 per 1000 female PY in 1973. Similar declines were observed in the hospitalization data. There were slight declines in gastric ulcer rates, but these were not significant except for a decrease in male gastric ulcer hospitalizations. The decrease in duodenal ulcer incidence has no readily apparent explanation.

Adolescent↗
PubMed1979

Smoking cessation program: baseline carbon monoxide and serum thiocyanate levels as predictors of outcome.

One hundred and sixty-two smokers who participated in an aggressive smoking cessation program underwent analysis of expired air carbon monoxide (CO) and serum thiocyanate (SCN) at entry and one year later. Persons who failed to quit smoking had higher baseline CO and SCN and smoked more cigarettes per day than did those who succeeded in quitting. The use of CO, SCN, number of cigarettes smoked, age, and blood pressure at baseline permitted accurate classification of over 70 per cent of the subjects into groups which would succeed and fail in their effort to quit smoking. Persons who failed to quit reduced the reported number of cigaretts smoked per day by one-third, but there was no corresponding reduction in CO and SCN, suggesting that self-reporting of a reduction in the number of cigarettes smoked may not lead to a corresponding decline in exposure.

Adult↗
PubMed1977

Expired air carbon monoxide and serum thiocyanate as objective measures of cigarette exposure.

Expired air carbon monoxide (CO) and serum thiocyanate (SCN) were used to asses exposure to cigarettes in 139 middle-aged men. Subjects who reported smoking cigarettes generally had CO levels exceeding 8ppm and SCN levels exceeding 100umol/L; non-smokers had lower levels. For both tests the mean concentration among men smoking more than one pack daily was three times that of non-smokers. The is a high correlation between the two tests (r=.571 for smokers), an association that was largely independent of the smaller correlations between either test and reported smoking frequency (r=.476 for CO; r=.479 for SCN). The ability to distinguish between individuals who reported "typical" smoking habits and non-smokers was best when the CO and SCN analyses were used together to take advantage of their separate sources of variance; it was 99 per cent when the two tests were mutually concordant (91 per cent of cases). The CO and SCN measurements allowed 16 individuals who reported light smoking habits to be categorized into high and low presumptive tobacco exposure groups. The two tests are inexpensive and suitable for use in epidemiologic and health care delivery programs.

Adult↗