Preventing falls among community-dwelling older persons: results from a randomized trial.

A randomized trial of falls prevention program that addressed home safety, exercise, and behavioral risks was conducted with 3,182 independently living HMO members age 65 and older. The intervention decreased the odds of falling by 0.85, but only reduced the average number of falls among those who fell by 7%.

Modifying dietary and tobacco use patterns in the worksite: the Take Heart Project.

This article describes the conceptual basis, design, and intervention approach for a worksite-based heart disease risk reduction project. Baseline characteristics of the 26 moderate size worksites participating in the Take Heart Project are also described. The trial is designed to produce changes at both the organization and employee level on tobacco use, dietary fat intake, and serum cholesterol.

Biochemical validation of smoking status: pros, cons, and data from four low-intensity intervention trials.

Biochemical validation of smoking status has long been considered essential, but recent reports have questioned its utility in certain kinds of field trials. We describe efforts to biochemically validate self-reports of smoking cessation from participants in four large-scale randomized trials in outpatient clinics, hospitals, worksites, and dental clinics. These studies included over 5,000 adults smokers who participated in the population-based low-intensity intervention evaluations.

A biomechanical evaluation of an intramedullary fixation device for intertrochanteric fractures.

The strength and stability of an intramedullary device when used to fix intertrochanteric fractures were determined and compared with the dynamic hip screw (DHS). A standard four-part osteotomy was created in eight paired fresh frozen human cadaver femurs. The intramedullary fixation device and a DHS were implanted in each pair member, and mechanical testing was performed.

Results of a year-long incentives-based worksite smoking-cessation program.

This study evaluated the impact of a year-long incentives-based worksite smoking-cessation program. Nineteen moderate-sized worksites, employing a total of approximately 1100 smokers, were randomized to Incentive or No Incentive conditions. All identified smokers in the worksite were considered as subjects, whether or not they participated in the intervention.

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.

A stop-smoking telephone help line that nobody called.

The purpose of this study was to evaluate the reach of a smoker's hotline that provided a variety of services to over 2100 health maintenance organization members. Formative evaluation procedures identified topics of concern, and repeated promotions advertised the service via multiple channels. Excluding a special giveaway promotion, an average of less than three calls per month were made during the 33 months of operation.

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.

Improvements in hostility and depression in relation to dietary change and cholesterol lowering. The Family Heart Study.

Objective: To describe changes in negative emotions among participants of a cholesterol-lowering study.

Design: Cohort study. Quantitative evaluation of changes in negative emotions in relation to diet and plasma cholesterol levels before and after a 5-year dietary intervention program aimed at reducing plasma cholesterol levels.

Implementation of "Open Airways" as an educational intervention for children with asthma in an HMO.

This article describes the adaptation and implementation of an existing pediatric asthma-management educational program, Open Airways, for members of a large group practice health maintenance organization. Seventy-four children ages 4 to 14 years and their families were randomized into one of seven class cohorts as part of a larger study of pediatric asthma management. The Open Airways program was modified to increase the emphasis on behavioral change and medication information and to reflect the different sociodemographic makeup of the population, compared with that for which the program was developed.

Social networks as predictors of ischemic heart disease, cancer, stroke and hypertension: incidence, survival and mortality.

Three social network measures were obtained from a randomly sampled cohort of 2603 HMO members in 1970-71. Mortality and first incidence of ischemic heart disease, cancer, stroke, and hypertension were assessed over the next 15 years. Outcome data were adjusted for age, sex, smoking, SES, and baseline health status.

Patient referral to a smoking cessation program: who follows through?

Background: While health care providers are often urged to refer smokers to a smoking cessation program, little information is available about patient adherence to such advice.

Methods: A group of primary care patients who smoked (N = 1380) received brief advice to quit from their provider, and were then asked to stay and talk to a counselor for more information. Counselors randomly delivered one of two interventions.

Baseline characteristics of participants in phase I of the Trials of Hypertension Prevention.

Phase I of the Trials of Hypertension Prevention was designed to test the effectiveness and safety of three life-style (weight loss, sodium restriction, and stress management) and four nutrition supplement (calcium, magnesium, potassium, and fish oil) interventions in reducing diastolic blood pressure (DBP) in persons with a high-normal blood pressure. A total of 2182 persons with a DBP between 80 and 89 mm Hg met the eligibility criteria for participation in phase I and were randomized to one of the active intervention or control treatment groups. Most were white (82%), male (70%), married (76%), nonsmoking (88%), college graduate (53%), full-time employees (91%).

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.

Smoking cessation and change in diastolic blood pressure, body weight, and plasma lipids. MRFIT Research Group.

Cigarette smoking cessation was examined for its impact on diastolic blood pressure, weight, and plasma lipids in 3,470 special intervention males in the Multiple Risk Factor Intervention Trial. Change in smoking status (quitters vs nonquitters) was not independently associated with change in diastolic blood pressure or the subsequent use of antihypertensive medication for smokers who were normotensive at entry. More quitters (35%) became hypertensive than nonquitters (27%, P less than 0.

Patterns of nicotine gum use in a health maintenance organization.

Nicotine chewing gum is designed as an aid to smokers who intend to stop smoking. However, the efficacy of the gum in general medical practice has been questioned. This study describes the extent of nicotine chewing gum use among health maintenance organization members, the characteristics of prescribers and users, and the patterns of gum use over a two-year period.

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.

The effects of knee motion and external loading on the length of the anterior cruciate ligament (ACL): a kinematic study.

A six-degrees-of-freedom mechanical linkage device was designed and used to study the unconstrained motion of ten intact human cadaver knees. The knees were subjected to externally applied varus and valgus (V-V) moments up to 14 N-m as well as anterior and posterior (A-P) loads up to 100 N. Tests were done at four knee flexion angles; 0, 30, 45, and 90 deg.

Tensile properties of the human femur-anterior cruciate ligament-tibia complex. The effects of specimen age and orientation.

The structural properties of 27 pairs of human cadaver knees were evaluated. Specimens were equally divided into three groups of nine pairs each based on age: younger (22 to 35 years), middle (40 to 50 years), and older (60 to 97 years). Anterior-posterior displacement tests with the intact knee at 30 degrees and 90 degrees of flexion revealed a significant effect of knee flexion angle, but not of specimen age.

Providing an integrated program of low intensity tobacco cessation services in a health maintenance organization.

This paper reports on the development, promotion and use of a coordinated program of low intensity intervention services designed to appeal to smokers (and smokeless tobacco users) at various stages of change. An initial package of four components: a telephone advice line, self-help materials, single session group meetings and bi-monthly newsletter was offered to subjects in a variety of different settings (outpatient clinics, dental offices, worksites, hospitals) within a health maintenance (HMO) program project. Based upon consumer response and formative evaluations, these components were modified during the course of the year-long intervention.

Implementing a year-long, worksite-based incentive program for smoking cessation.

Background: There have been few reports of the process of implementing ongoing worksite health promotion programs. This article describes the implementation of a year-long smoking cessation program in nine worksites employing a total of approximately 700 smokers.

Methods: Issues discussed include: forming a partnership with organizations, design of the multicomponent incentive intervention, program promotion, maintaining participation, and the need to modify program components over time.

Employee and organizational factors associated with participation in an incentive-based worksite smoking cessation program.

This study investigated employee and worksite characteristics prospectively predictive of participation among 474 smokers in nine different worksites taking part in a year-long incentive-based smoking cessation program. Several different ways of defining participation (e.g.

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.

A new device to measure the structural properties of the femur-anterior cruciate ligament-tibia complex.

Previous studies of biomechanical properties of femur-anterior cruciate ligament-tibia complex (FATC) utilized a wide variety of testing methodologies, particularly with respect to ligament orientation relative to loading direction. A new device was designed and built to test the anterior-posterior displacement of the intact porcine knee at 30 and 90 deg of flexion, as well as the tensile properties of the FATC at any loading direction and flexion angle. Tensile tests were performed with the knees at 30 and 90 deg of flexion with the loading direction along either the axis of the tibia (tibial axis) or the axis of the anterior cruciate ligament (ligament axis).

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.