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Biomedical subjects

V J Stevens

Publications and source records attributed to V J Stevens.

At least 37 records · Page 2Linked to original sources
PubMed1993

Weight loss intervention in phase 1 of the Trials of Hypertension Prevention. The TOHP Collaborative Research Group.

BACKGROUND: Phase 1 of the Trials of Hypertension Prevention was a collaborative, randomized controlled clinical trial designed to determine the feasibility and efficacy of selected nonpharmacologic interventions in reducing or preventing an increase in diastolic blood pressure. METHODS: Participants aged 30 to 54 years who had a high-normal diastolic blood pressure (80 to 89 mm Hg), and were between 115% and 165% of their desirable body weight, were randomly assigned to either an 18-month weight loss intervention (n = 308) or a usual-care control condition (N = 256). Intervention consisted of 14 weekly group meetings followed by monthly maintenance sessions. Intervention participants received training in behavioral self-management technique and were asked to make life-style changes aimed at achieving a moderate reduction in energy intake and an increase in physical activity. RESULTS: The average weight losses in the intervention group at 6, 12, and 18 months of follow-up were 6.5, 5.6, and 4.7 kg for men and 3.7, 2.7, and 1.6 kg for women. The mean (+/- SE) change in diastolic blood pressure for intervention participants compared with controls at termination was -2.8 +/- 0.6 mm Hg for men and -1.1 +/- 0.9 mm Hg for women. For systolic blood pressure, the corresponding change was -3.1 +/- 0.7 mm Hg for men and -2.0 +/- 1.3 mm Hg for women. Blood pressure reductions were greater for those who lost larger amounts of weight. Sex-related differences in blood pressure response were largely due to the smaller amount of weight lost by women, and sex differences in weight loss could be accounted for by differences in baseline body weight. CONCLUSIONS: During an 18-month follow-up period, this weight reduction program was shown to be an effective nonpharmacologic intervention for reducing blood pressure in overweight adults with high-normal blood pressure.

Adult↗
PubMed1993

Nurse-assisted counseling for smokers in primary care.

OBJECTIVE: Physician-delivered advice to stop smoking is effective, but time demands often reduce the number of smokers who receive assistance. We evaluated three nurse-assisted interventions designed to minimize physician burden and increase counseling in primary care settings. DESIGN: Randomized controlled trial with a 12-month follow-up. SETTING: Internal medicine and family practice offices in a health maintenance organization. PARTICIPANTS: Smokers (n = 3161) who were patients of participating physicians or other medical care providers (n = 60). INTERVENTION: Medical care providers delivered a 30-second stop-smoking prompt to 2707 smokers and referred them to an on-site nurse smoking counselor. The nurse randomly provided a two-page pamphlet (advice control) or one of three nurse-assisted interventions: 1) self-quit training; 2) referral to a group cessation program; or 3) a combination of self-quit training and referral. Each nurse-delivered intervention included a 10-minute video, written materials, and a follow-up phone call. RESULTS: Physicians delivered brief advice to 86% of identified smokers during the 1-year program. The proportion of participants reporting abstinence after both 3 and 12 months of follow-up nearly doubled (P = 0.01) for the nurse-assisted self-quit (7.1%), group-referral (7.6%), and combination (6.9%) interventions, compared to brief physician advice alone (3.9%) (P < 0.05). Saliva cotinine tests confirmed these effects (P < 0.004), although quit rates were lower (3.4%, 4.7%, 4.3%, and 2.3%, respectively) because roughly one half of quitters chose not to provide a saliva sample and were counted as smokers. CONCLUSION: Involving nurses in counseling smokers reduces physician burden, makes counseling more likely, and significantly increases cessation rates compared with brief physician advice alone.

Adult↗
PubMed1993

A smoking-cessation intervention for hospital patients.

Many patients attempt to stop smoking during hospitalization, but most relapse after discharge. This study developed and evaluated a brief smoking-cessation and relapse-prevention program for hospitalized smokers. All hospitalized smokers (n = 1,119) were identified by questionnaire at hospital admission and then received either usual care or usual care plus a hospital-based smoking-cessation intervention regardless of interest in stopping smoking. Intervention components included a 20-minute bedside counseling session, a 12-minute videotape, a variety of self-help materials, and a follow-up telephone call. Special attention was given to techniques for preventing relapse after hospital discharge. Defining ex-smokers as those who reported no tobacco use at both 3- and 12-month follow-up assessments, and counting those lost to follow-up as smokers, the intervention increased the proportion of patients who quit smoking by one half (9.2% vs 13.5%, P < 0.05). These results demonstrate the efficacy of a brief in-hospital intervention and suggest that relapse-prevention efforts are needed to convert temporary cessation during hospitalization into long-term abstinence.

Adult↗
PubMed1993

Seniors' Program for Injury Control and Education.

The Seniors' Program for Injury Control and Education (SPICE) examines the effects of exercise and physical fitness on falls and related injuries among older persons. The design is a two-group, randomized trial with 2 years of follow-up. The study is at Northwest Region of Kaiser Permanente (NWKP), a large hospital-based prepaid group practice HMO in Portland, OR. The participants are 1,323 community-living persons 65 years or older who are enrolled in NWKP and are at moderate risk of falling. A multifaceted intervention strategy uses a group approach to falls and injury prevention which includes moderate intensity endurance-building exercise (walking), strength and balance training, home safety improvements, and mental practice. Sessions of 20-25 participants are led by two nurses. Participants set their own realistic goals for exercising to accommodate to differing functional abilities and baseline conditioning. The control group receives usual care from the HMO. Participants report all falls for 2 years after randomization. Outcome measures include health status, physical functioning, falls, and fall-related medical care use and cost. If SPICE is effective, cost-effectiveness analysis will examine the relative efficiency of SPICE versus other successful FICSIT interventions. Thus far, recruitment and intervention compliance goals have been met from a population of frail elderly HMO members.

Accidental Falls↗
PubMed1992

Smokeless tobacco habits and oral mucosal lesions in dental patients.

As part of a smokeless tobacco (ST) intervention study, we collected data on tobacco use habits and oral health for 245 male ST users aged 15 to 77. The study sample was identified during routine dental office visits and represents a relatively diverse population of patients. Oral health data collection included grading the clinical appearance of oral mucosal lesions using Greer and Poulson's classification system, as well as identifying and recording the primary anatomic location of ST placement. Results show that 78.6 percent of ST users had observable oral lesions, 23.6 percent of which were in the most clinically advanced category (degree III). Of the lesions noted, 85 percent were in the same location the patient identified as his primary area of smokeless tobacco placement. In a comparison sample of 223 non-ST-users with the same age distribution, only 6.3 percent had observable lesions. A multiple logistic regression model for ST users showed that lesion presence and severity were most significantly related to current frequency of ST use.

Adolescent↗
PubMed1992

Effective smokeless tobacco intervention for dental hygiene patients.

This study was designed to test the effectiveness of a smokeless tobacco (ST) intervention delivered in the oral healthcare office setting. A total of 518 male ST users were identified by questionnaire in clinic waiting rooms and then randomly assigned to either a usual-care control group or a special intervention group. Dental hygienists took the primary role in delivering the intervention, which consisted of a soft-tissue examination with special attention to oral lesions, advice to quit ST, distribution of self-help materials, a short video on why and how to stop using smokeless tobacco, and encouragement to set a quit date. Follow-up assessments conducted three months after the office visit showed that a significantly greater proportion of intervention group patients had stopped using ST (32% of the intervention group participants versus 21% of control group patients, kappa 2 = 8.03, p less than .01). The intervention protocol is described in detail so that dental hygienists may adapt it for use in their practice.

Adolescent↗
PubMed1992

Nicotine chewing gum use in the outpatient care setting.

BACKGROUND: The purpose of this study was to assess nicotine gum use when prescribed in a nonresearch, routine outpatient setting. Special attention was given to comparing actual use patterns with established guidelines for use based on clinical research. METHODS: A randomly selected group of 612 patients who had received a prescription for nicotine gum during an 18-month period were surveyed regarding their smoking history and use of the gum. RESULTS: Most of the gum prescriptions (75%) were requested by patients rather than recommended by medical care providers. Less than one half of the users were heavy smokers. The reported amount of gum used was small, with more than one half reporting consumption of one box or less, and about one third reporting use of the gum for only 1 week or less. Larger amounts of gum use, however, were associated with abstinence from tobacco. Only one in 20 users attended a structured behavioral treatment program while using the gum. Over one half of the patients reported using nicotine gum to help them cut down on, rather than quit, smoking. CONCLUSIONS: Only a small percentage of the patients used the nicotine gum according to the established guidelines, and most of the patients used the gum in ways that have been shown to be ineffective for smoking cessation. Providers should educate their patients in the techniques that maximize the use and effectiveness of nicotine gum in smoking cessation.

Adolescent↗
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↗
PubMed1991

Weight-loss experience of black and white participants in NHLBI-sponsored clinical trials.

We examined race-specific weight-loss results from two randomized, multicenter trials; the Hypertension Prevention Trial (HPT) and the Trials of Hypertension Prevention (TOHP). Mean weight change from baseline averaged 2.2 kg less in black women than in white women during 18 mo of follow-up in TOHP and 2.7 kg less during 36 mo of follow-up in HPT. Mean weight loss averaged 2.0 kg less in black than in white men in TOHP and 1.4 kg less in HPT. Because of greater weight gain in black control subjects, a comparison of net weight loss (change in intervention minus change in control participants, within-race) showed a less marked difference than did black-white differences in weight loss within the actively treated group. Thus, relative to weight that would have been gained without the intervention, the experience of blacks and whites was more similar. Racial differences in weight loss may result from a combination of behavioral, sociocultural, biological, and programmatic factors.

Black or African American↗
PubMed1991

Food records: a predictor and modifier of weight change in a long-term weight loss program.

Overriding concerns about the accuracy of self-reported food records have overshadowed discussion of their practical value as a self-management, intervention tool. This study examined the relationship between keeping food records and subsequent weight loss in a large-scale, conservative weight loss program. Keeping food records was a better predictor of weight loss than were baseline body mass index, exercise, and age. Monthly as well as cumulative weight loss was directly related to the number of days in which food records were kept. The strong, linear relationship between food record patterns and weight loss suggests that in spite of legitimate concern about the accuracy and representativeness of self-reported food records, they have considerable power as a predictor of success in achieving weight loss.

Adult↗
PubMed1990

Stressful life events, Type A behavior, and the prediction of cardiovascular and total mortality over six years. MRFIT Group.

The relationship between stressful life events and subsequent mortality and morbidity were determined prospectively over 6 years for 12,866 men participating in the Multiple Risk Factor Intervention Trial (MRFIT). Aslo evaluated was the impact of life events on cardiovascular outcomes for persons exhibiting and not exhibiting coronary prone (Type A) behavior. Subjects completed life events checklists at baseline and each of five annual visits. Participants were also administered the Jenkins Activity Survey measure of Type A behavior at baseline and a subsample of 3110 participants was categorized as to behavior type based on the structured interview assessment method. Cox proportional hazard analyses indicated that number of life events experienced during each of 6 years of follow-up was unrelated to risk in the subsequent year of CHD death or fatal plus nonfatal MI and was inversely related to total mortality. The impact of life events on cardiovascular risk did not differ by behavior type category.

Adult↗
PubMed1990

The inside scoop on the stuff called snuff: an interview study of 94 adult male smokeless tobacco users.

This interview study collected information from 94 adult males about a variety of factors related to their smokeless tobacco (ST) habit. Eighty-nine percent of this sample used moist snuff and most analyses focused on this group. Three measures of self-reported snuff use were intercorrelated and compared to a saliva cotinine assay. Correlations demonstrated potential usefulness of measures such as number of dips per day when biochemical measures are not practical. A majority (68%) of the Ss reported attempts to quit smokeless tobacco use, but relapsed from 1 to 3 months later. Ninety-six percent of snuff users reported awareness of cancer and other oral health risks and 56% reported an intention to quit in the next 12 months. A majority (67%) of subjects report receptivity to receiving advice to quit from medical and dental providers although only one-third had received such advice. The results are discussed in terms of designing an effective cessation intervention in dental clinics for ST users.

Adolescent↗
PubMed1990

Dental office practices for tobacco users: independent practice and HMO clinics.

Surveys of independent dental practitioners and health maintenance organization (HMO) dentists and their adult male patients in Oregon found that cessation information and advice was being given to tobacco-using patients, especially smokeless tobacco users, and that the tobacco users surveyed expressed interest in obtaining help to quit. Oral health providers expressed an interest in further training in how to help their tobacco-using patients to quit.

Adult↗
PubMed1989

Preventing smoking relapse, using an individually tailored skills-training technique.

The effectiveness of a relapse prevention program was studied in a population of 744 smokers. Subjects first attended an intensive 4-day series of 2-hr meetings in which they were trained to use more than 40 behavioral and cognitive smoking cessation techniques. At the 1-week follow-up session, those abstinent from smoking (79%, carbon monoxide verified) were randomly assigned to one of three follow-up conditions: (a) a three-session skills-training program in which subjects developed and actively rehearsed individually tailored coping strategies for likely relapse situations, (b) a three-session discussion control condition in which subjects discussed maintenance but did not develop or rehearse coping strategies, or (c) a no-treatment control condition. Survival analysis indicated higher abstinence rates for the skills-training group than for the control groups throughout the following year. After 12 months, the biochemically confirmed continuous abstinence rate was higher in the skills-training group (41.3%) than in the discussion and no-treatment groups (34.1% and 33.3%, respectively).

Adaptation, Psychological↗
PubMed1989

Freedom from fat: a contemporary multi-component weight loss program for the general population of obese adults.

This report summarizes results for the first 2,037 participants in the Freedom from Fat (FFF) weight loss program. FFF combined nutrition education, a low-fat dietary pattern, exercise, behavioral self-management, and social support in a program designed to serve the general population of overweight and obese adults. Participants ranged in age from 18 to 84 and from ideal weight to massively obese. After enrolling, program participants attended professionally led weekly meetings as long as they wished. Participants were encouraged to keep daily food diaries, to reduce the proportion of calories from fat to 30% or less, to exercise at moderate intensity for 30 minutes a day 5 days a week, to keep graphic records of weight change and exercise, and to display their graphs at each weekly group meeting. Attrition rates were comparatively low for a large-scale program, with half of the participants still active in the fifth month and 22% still active after 1 year. Mean weight loss for obese participants (BMI 30 or greater) at 6 months was 7.3 kg (16.2 lb) for men and 5.3 kg (11.6 lb) for women. The best predictors of weight loss at 6 months were number of days per week in which food diaries were kept, baseline body mass index, number of minutes of exercise per week, and age.

Adult↗
PubMed1988

Validity and usefulness of medical chart weights in the long-term evaluation of weight loss programs.

The high rate of delayed recidivism seen in behavioral weight loss studies makes follow-up over a number of years essential. Unfortunately, these data are both expensive and difficult to collect. This report examines the validity of body weights routinely recorded in medical charts and their usefulness in the long-term evaluation of weight control programs. Comparison of 123 pairs of chart weights and research clinic weights recorded within 30 days of each other showed a mean difference of .06 lb (.03 kg) and a standard deviation of 2.38 lb (1.08 kg). This measurement error is considerably less than that seen in self-reported weights of obese adults. The accuracy, economy and relative ease of collection make the use of medical chart weights well suited for long-term evaluations of weight loss studies and other research purposes.

Adult↗
PubMed1981

Acetaldehyde adducts with hemoglobin.

Clinical studies on the minor hemoglobins (hemoglobin A1a-c) have suggested that a novel adduct may form in people abusing alcohol. Such patients were found to have an elevated concentration of minor hemoglobins, but normal or subnormal amounts of glycosylated hemoglobin (hemoglobin A1c) as determined by radioimmunoassay, Acetaldehyde, a reactive metabolite of ethanol, was postulated to form adducts with hemoglobin A that change its chromatographic properties. At physiological concentrations, acetaldehyde was found to form adducts with hemoglobin that were stable to extensive dialysis for several days. The amount of hemoglobin adducts formed were a function of the concentration and number of exposures to acetaldehyde. The reaction of acetaldehyde with hemoglobin A produced chromatographic variants, some of which migrated in the hemoglobin A1a-c region. Analysis of stable acetaldehyde-hemoglobin adducts demonstrated that valine, lysine, and tyrosine residues of globin were sites of reaction. The acetaldehyde-modified amino acid residues appear to exist in interconvertible conformations, only one of which is reducible by sodium borohydride. The amount of these adducts was found to be significantly elevated in hemoglobin from alcoholics as compared with normal volunteers.

Acetaldehyde↗