Secondary Prevention Behaviors Research Articles

Does Outpatient Telephone Coaching Add to Hospital Quality Improvement Following Hospitalization for Acute Coronary Syndrome?

Telephone counseling in chronic disease self-management is increasing, but has not been tested in studies that control for quality of medical care. To test the effectiveness of a six-session outpatient telephone-based counseling intervention to improve secondary prevention (behaviors, medication) in patients with acute coronary syndrome (ACS) following discharge from hospital, and impact on physical functioning and quality of life at 8 months post-discharge. Patient-level randomized trial of hospital quality improvement (QI-only) versus quality improvement plus brief telephone coaching in three months post-hospitalization (QI-plus). medical record, state vital records, patient surveys (baseline, three and eight months post-hospitalization). pooled-time series generalized estimating equations to analyze repeated measures; intention-to-treat analysis. Seven hundred and nineteen patients admitted to one of five hospitals in two contiguous mid-Michigan communities enrolled; 525 completed baseline surveys. We measured secondary prevention behaviors, physical functioning, and quality of life. QI-plus patients showed higher self-reported physical activity (OR = 1.53; p = .01) during the first three months, with decline after active intervention was withdrawn. Smoking cessation and medication use were not different at 3 or 8 months; functional status and quality of life were not different at 8 months. Telephone coaching post-hospitalization for ACS was modestly effective in accomplishing short-term, but not long-term life-style behavior change. Previous positive results shown in primary care did not transfer to free-standing telephone counseling as an adjunct to care following hospitalization.

Abstract 3017: Physiological Factors Associated with Fatigue in Older Adults after Myocardial Infarction

Fatigue after myocardial infarction (MI) is a barrier to secondary prevention behaviors such as engaging in recommended levels of physical activity. However, little is known about physiologic factors that may contribute to fatigue. The purpose of this study was to describe the prevalence of fatigue in older adults after MI and to examine the associations of physiological factors of cardiac function (b-natriuretic peptide [BNP], mean arterial pressure, heart rate), inflammation (IL-6), BMI, and hemoglobin (Hgb) with self-reported fatigue. Methods: A convenience sample of women ( n =49) and men ( n =49) ages ≤65 completed questionnaires and underwent physiologic measures 6 – 8 months after discharge post MI. Subjects completed a demographic health form and fatigue measures (Revised Piper Fatigue Scale and the Multidimensional Assessment of Fatigue Scale functional items), and had height, weight, pulse, and blood pressure measured. Fatigue was measured as a total score (range 0 –310) and as 5 subscales (behavior/severity, affective, sensory, cognitive/mood, and function). Blood samples were also taken, and Hgb, IL-6, and BNP were measured in the same laboratory using standardized procedures. Results: Patients were an average of 75.69 ± 6.45 years of age. Fatigue was reported by 75 (77%) with a mean score of 102.46 (SD=57.7; range 8 –235). More women (84%) reported fatigue than men (69%), though this difference was not statistically significant. Patients reported higher fatigue scores on the behavior/severity and sensory subscales compared to the other fatigue subscales. Bivariate correlations of physiological factors and the total fatigue score revealed one significant physiological correlate, IL-6 ( r =.29). Controlling for age and gender, a multiple linear regression model explained 8.7% of the variance in fatigue ( F = 2.769 ; p <.05) with IL-6 as the only significant independent variable ( p =.010). An unexpected finding was that BNP did not correlate with fatigue. Discussion: Fatigue is prevalent in the majority of older adults after MI. Results indicate that inflammation may play a stronger role in fatigue than other physiological factors. Further research is needed to examine how inflammation and other physiologic factors may influence fatigue post MI.

Persistent Depression Affects Adherence to Secondary Prevention Behaviors After Acute Coronary Syndromes

Persistent Depression Affects Adherence to Secondary Prevention Behaviors After Acute Coronary Syndromes

Increasing Dentists’ Capacity for Secondary Prevention of Eating Disorders: Identification of Training, Network, and Professional Contingencies

The incidence of eating disorders has increased substantially over the last forty years. Primary care physicians and dentists share a parallel challenge for secondary prevention of anorexia nervosa and bulimia nervosa. The dentist, in particular, has a uniquely important and valuable role with respect to assessment of oral and physical manifestations, patient communication, referral, case management, and restorative care. Despite this crucial role, few dentists are engaged in eating disorder-specific secondary prevention. The purpose of this study was to explore beliefs, attitudes, and experiences of general dentists regarding eating disorder-specific secondary prevention behaviors using focus group methodology. Three ninety-minute focus groups were conducted with twenty-one general dentists (seventeen male, four female) recruited from the 2004 Academy of General Dentistry Leadership Conference. Data from the focus groups were analyzed to identify two over-arching themes and associated subthemes with regard to supports and barriers to eating disorder-specific secondary prevention practices. Analysis of data revealed that training, network, and dental professional contingencies emerged as places of influence for increasing capacity among dentists with regard to secondary prevention of eating disorders. This exploratory assessment identifies leverage points where strategic interventions including curriculum development, policies, and practices can be developed to support and sustain secondary preventive clinical behaviors among dentists.

Critical thinking, perceived health status, and participation in health behaviors.

Critical thinking has been proposed as crucial for processing conflicting information when people make decisions about participation in health behaviors. The critical thinking of individuals about participation in health behaviors may depend on their perceived health status. To examine the relations between critical thinking and participation in three categories of health behaviors, and to determine whether these relations are moderated by perceived health status. A cross-sectional, correlational design was used to study a sample of 112 community-dwelling adults who resided in a large, urban Midwest community. The participants were women and men 18 to 90 years of age (mean, 55 +/- 20.47 years) who completed self-report, written questionnaires including the Test of Everyday Reasoning and the Health Practices Instrument. According to hierarchical multiple regression analyses, the relation between critical thinking and health promotion behaviors and the relation between critical thinking and secondary prevention behaviors were moderated by perceived health status, whereas the relation between critical thinking and health protection behaviors was not. The relation between critical thinking and participation in health behaviors depends on perceived health status and category of health behaviors. Researchers can explore the role of other variables (e.g., functional status and perceived susceptibility to disease) to explain why perceived health status moderates the relations between critical thinking and participation in various types of health behaviors differently.

Approaches to the prevention and control of skin cancer.

Skin cancer is the most common and the most preventable form of cancer. Nonmelanoma skin cancers are associated with cumulative exposure to ultraviolet radiation, while melanoma is associated with intense episodes of ultraviolet exposure resulting in sunburns. Numerous risk factors are associated with the development of skin cancer. These include exposure to ultraviolet radiation; phenotypic factors such as skin type, eye and hair color, tendency to burn and tan, and having freckles and moles; a personal or family history of skin cancer; and occupational sun exposure. Primary prevention behaviors include applying SPF 15+ sunscreen 30 minutes before exposure, reapplying SPF 15+ sunscreen every 1 1/2 to 2 hours or after swimming or sweating, dressing in protective clothing, using shade, limiting exposure during peak sun hours, and avoiding artificial sources of ultraviolet radiation such as tanning beds. Secondary prevention behaviors include screening and early detection in combination with education on the primary prevention behaviors. Interventions designed to increase sun protective behaviors have resulted in increased knowledge and attitudes, but limited behavior change. And while skin cancer screenings have shown promising results, few studies have a follow-up component. Future studies should focus on developing effective strategies for making sun protective behaviors routine and determining the effectiveness of skin cancer screening. To inform approaches to the prevention and control of skin cancer, this paper will summarize key primary and secondary preventive behaviors, highlight primary and secondary prevention programs, and identify key unanswered questions in the area of skin cancer prevention and control.

Preventive health behavior among black and white women in urban and rural areas

The relationship of race to preventive health behavior among women is examined using data from the 1985 National Health Interview Survey. We find that black women are less likely to engage in primary prevention behaviors such as exercising, non-smoking and maintaining a favorable weight. However, black women are more likely to engage in secondary prevention behaviors such as receiving a Pap test or breast exam. These findings are surprising as they indicate a change in secondary prevention behavior among black women. The racial differences in exercising, maintaining a favorable weight and receiving a Pap test or a breast exam cannot fully be explained by the differing levels of socio-economic status, measured by education and income. However, the higher percentage of smoking among black women is due to their lower levels of education. Urban/rural residence modifies the effect of race on smoking and receiving a Pap test. Black women in urban areas are most likely to be smokers. Almost no difference exists between white women in urban and rural areas concerning their likelihood of receiving a Pap test, we find that black women in urban areas are much more likely to be screened for cervical cancer than black women in rural areas.