Influence of behavioral science research on oral health promotion.

To realize the benefits of advances in preventive and problem-focused dentistry, patients must carry out specific oral health behaviors. The behaviors range from seeking preventive care, to keeping appointments, to carrying out home-based self-care regimens. Unfortunately, rates of these behaviors are less than optimal and maximizing patient involvement in dental care is a major challenge facing dentistry. In fact, poor rates of patient adherence remains a significant problem in all areas of health care. Aspects of the treatment regimen itself as well as provider and patient actions impact these outcomes. Theoretical models grounded in the behavioral sciences provide useful frameworks for understanding the process of health behavior change that can be applied to patient care. Research in health promotion and disease prevention have identified a number of psychological, social, and environmental issues related to oral health behaviors and outcomes, including personal barriers, social support, stress and coping, health beliefs, and dental anxiety. These barriers are discussed, and examples of interventions that have incorporated theoretical models and behavioral outcomes and linking them to oral health are provided. Future directions of the expanding area of behavioral science and oral health promotion in clinical practice are discussed.

New diabetes screening criteria for midlife women evaluated for coronary heart disease risk.

The usefulness of new, lowered diabetes diagnostic criterion to identify undiagnosed diabetics in a high-risk sample of women was evaluated. Participants were 228 midlife women undergoing screening for heart attack risk. Fasting plasma glucose levels of participants who were not diagnosed with diabetes were examined to assess the number of women who would meet diagnostic criteria for diabetes using old (140 mg/dL) and new 126 mg/dL) American Diabetes Association criteria. The new criterion identified more women than did the old criterion, particularly African Americans. Use of the new criterion flagged nearly 50% as many women as originally diagnosed as diabetic at the time of screening. Early identification of diabetes may afford earlier, preventive interventions that may reduce morbidity and mortality. Thus, findings from this study suggest that use of the new, lowered diabetes diagnostic criterion may have significant public health benefits for midlife women.

Prospective evaluation of the effects of stress on exercise adherence in community-residing women.

The effects of stress on exercise behavior in community-residing women exercising on their own were assessed. Participants (N = 82) completed a background questionnaire and kept exercise diaries and Weekly Stress Inventories (P. J. Brantley, G. N. Jones, E. Boudreax, & S. L. Catz, 1997) for 8 consecutive weeks. During weeks with a high frequency of stressful events, participants exercised for less time and reported lower self-efficacy for meeting upcoming exercise goals. During weeks of high perceived stress, participants exercised significantly fewer days, omitted more planned exercise sessions, were less satisfied with their exercise, and had lower self-efficacy for meeting exercise goals. Findings suggest that perceptions of stressful events and cognitive reactions to missed exercise may play a significant role in mediating exercise behavior and support the view of exercise relapse as an ongoing process.

Holistic health stress management program. Nursing student and client health outcomes.

This descriptive study examines the application of stress management techniques by nursing students to their clients (i.e., patients, family members, friends) within a model holistic stress management nursing course. Out of 90 students, 88 completed a Client Teaching Relaxation Questionnaire during the course. Responses indicated a decrease in clients' perceived levels of discomfort following a stress reduction intervention (paired t = 18.7, df = 84, p < .0001). The students further reported that stress management skills were applicable to clients with a wide range of diagnoses in hospitals, homes, and other community settings. Imagery (52%) was documented as the predominant strategy taught to clients. Study results suggest that with teaching time allowed for self-mastery during the course, students can successfully apply these simple to complex stress management skills to many different clients, enhancing the caring aspect for both client and student. The course presented in this study provided students with essential foundational skills necessary to deal with client stress.

Using the telephone interview for evaluation of baccalaureate nursing programs.

Efficient use of the telephone is certainly relevant in the 20th century telecommunication age. A 20- to 30-minute phone call allows for interactive communication between the nurse educators and those who hire their graduates. Important information can be quickly obtained for assessing the outcomes of curriculum related to the perceived quality of nurse graduates practicing in various health care settings. This interview method was found to be efficient, convenient, and facilitated dynamic interchange. Feedback from respondents varied in their familiarity with the graduates and programs.

Evaluating the treatment integrity of a continuing education program.

Effective Patient Teaching (EPT), a health profession continuing education course, improves educators' teaching skills. The authors, through this dissemination study, aimed to learn whether, through a train-the-trainers approach, others could teach Effective Patient Teaching as its developers intended--that is, the assessment of what has been called "treatment integrity." Trainers' overall fidelity within and between three test sites was good, supporting Effective Patient Teaching's generalizability and transportability.

Continuing education on teaching skills for health professionals. Evaluation of training the trainers.

Effective Patient Teaching (EPT), a health professions continuing education course, improves educators' teaching skills when presented by its developers. This study aimed to determine whether others could teach EPT with similar effectiveness. Four nurse managers who provide staff training and supervision for multiple hospital diabetes care units presented EPT to health care professionals at seven such sites; another seven served as controls. The evaluation included observations of trainers conducting EPT programs in the field, teaching skills ratings of health professionals in both groups, and knowledge test administered to patients. Six months after training, teaching skills scores of health professional EPT participants were better (p < .05) than controls. The EPT program improves participants' teaching skills and maintains these effects in field settings, when presented by faculty not involved in its development.

Improving dietitians' teaching skills.

Many health professionals lack important teaching skills, perhaps adding to patient difficulties in understanding and adopting therapeutic diets. Research suggests that teaching skills improved after dietitians took a continuing education course entitled "Effective Patient Teaching." Our study tested whether dietitians' new skills would persist in the field and whether selected patient outcomes would differ as a result. Thirty staff dietitians from six urban hospitals were videotaped teaching patients, then randomly assigned to take the Effective Patient Teaching course or not (control group). Follow-up videotapes were made after 1 week, 1 month, and 3 months. After each teaching session, patient satisfaction and recall were assessed. Two judges rated 20 teaching skills, which were divided into four subsets for analysis. Repeated measures analyses of variance showed overall gains only for the group that took the Effective Patient Teaching course, which scored higher than the control group at 1 week and 1 month, but not at baseline or 3 months. Gains occurred in presentation skills and essential teaching functions. Throughout the study, interpersonal skills were high and adherence promotion skills were low for dietitians in both groups. Groups did not differ on patient satisfaction or recall. Improvements in dietitians' teaching skills translated to the field immediately after they completed the continuing education program, but not all gains were sustained after 3 months. We recommend that dietitians assess their teaching and adherence promotion skills, obtain training where warranted, and periodically reassess the application of those skills during patient teaching sessions.

Registered dietitians' teaching and adherence promotion skills during routine patient education.

Even following education sessions, dietary adherence among medical patients is generally poor. One contributor to this problem may be the quality of teaching and adherence promotion skills employed by Registered Dietitians, whose behavior during routine patient interactions was evaluated in this observational study. Thirty dietitians were videotaped with one of their patients. Twenty operationally defined skills were rated on a scale from 0 (skill absent) to 3 (excellent). Dietitians' interpersonal skills were good (mean = 2.1, S.D. = 0.35), but all other skills were performed significantly less well (mean scores less than 1.0). Adherence promotion skills were rarely observed. Dietitians need supplemental training to improve teaching and adherence promotion skills.

The effects of aerobic exercise on psychological adjustment: a randomized study of sedentary obese women attempting weight loss.

This study evaluated the psychological effects of aerobic conditioning in 40 moderately obese, sedentary women participating in a 12-week behavioral weight loss program. Participants were randomly assigned to a no-exercise or moderate walking condition. Emotional impact of the treatment was assessed in two ways: (1) Subjects reported subjective mood prior to each eating episode and (2) the SCL-90-R was administered before and after the program. Exercisers lost more weight and body fat than non-exercisers. Both groups of subjects showed numerous improvements in mood as a result of participating in the weight loss program. Exercise had no specific differential effect on emotions as measured by daily mood ratings or the SCL-90-R. Exercise did not appear to add appreciably to the psychological benefits of losing weight in this sedentary obese population. Future studies utilizing longer periods of aerobic exercise training, larger sample size, and exercise specific measures are recommended.

The impact of cigarette smoking on headache activity in headache patients.

The present study was designed to explore the relationship between cigarette smoking and headache activity in a sample of patients presenting for treatment. Subjects completed various self-report measures and monitored headache activity four times per day over a 4-week period. Analyses revealed that smokers experienced greater weekly peak headache intensity, and reported higher levels of depression and general physical symptoms. Among smokers, nicotine content of the preferred brand was associated with mean headache index and weekly headache-free days, as well as depression and anxiety scores. Daily smoking rate and pack-year history were related to level of general physical symptoms only. Thus, both smoking status and the nicotine content of the preferred cigarette appear to adversely impact headache activity. Further, smokers who are more anxious or depressed may increase their headache activity via their preference for higher nicotine-content cigarettes. These results are discussed in the context of possible mechanisms underlying these effects, and implications for the clinical management of headache suffers who smoke.

The relationship between cigarette smoking and chronic low back pain.

This study investigated the extent to which habitual cigarette smoking relates to physical and psychological indices of chronic pain. From a review of patient records, 54% of back pain patients referred for treatment of their pain admitted to smoking cigarettes. Response from a smoking questionnaire showed that 57% of the patients who smoked reported having a need to smoke when they were in pain. Most patients (91%), however, believed that smoking had no effect on their pain intensity. When smoking and nonsmoking back pain patients were compared, the smokers showed significantly higher levels of emotional distress, they tended to remain inactive, and they relied on medication more often than the nonsmoking patients. The results further suggest that pain patients are at risk for increasing smoking behavior when they are experiencing periods of heightened pain intensity.

Effects of significant weight gain on chronic pain patients.

This study examined the effect of significant weight gain on physical, demographic, behavioral, and psychosocial factors in a representative sample of chronic pain patients. One hundred fifty-five chronic pain patients who reported gaining more than 15 pounds since the onset of their pain were compared with 341 pain patients who stated that their weight had remained the same since the onset of their pain. All patients were given a medical examination and each patient completed a comprehensive pain questionnaire and an SCL-90. Results showed that a significant relationship exists between weight gain and decreased physical activity, increased emotional distress, and accident liability. This study suggests that the inclusion of weight management training in multidisciplinary pain centers may play an important part in the rehabilitation of chronic pain patients.

Evaluation of an alternating-calorie diet with and without exercise in the treatment of obesity.

This study examined the effects of calorie alternation and exercise on weight loss. Moderately obese women (130-160% of ideal body weight) were randomly assigned to an alternating- or constant-calorie diet with or without aerobic exercise. Both diets provided an average of 1200 kcal/d over a 12-wk period; daily intake of subjects in the alternating-diet condition varied in a prescribed pattern from 600 to 1800 kcal/d. Exercising subjects walked 5 d/wk. All subjects participated in an intensive outpatient behavior-modification program. At the end of the study, exercised subjects had greater reductions in body weight and body fat percentage than did nonexercised subjects. The type of caloric restriction did not affect weight or fat loss. Changes in resting metabolic rate did not differ among groups. Alternating calories was neither beneficial nor detrimental as a weight-loss strategy whereas exercise was clearly beneficial in weight-loss therapy.

Cognitive and behavioral features of adolescent coping in high-risk drinking situations.

The present study examined the coping responses used by adolescents in high-risk situations. Sixty-six adolescents described situations in which it was difficult to resist drinking alcohol. Cognitive and behavioral responses in the perceived high-risk alcohol situations were examined. Abusing and nonabusing adolescents reported similar high-risk situations, but differed significantly in the cognitive and behavioral strategies used to cope with drinking pressures. Cognitive strategies associated with abstaining from alcohol use included defining oneself as a nondrinker and viewing other drinkers negatively. Behavioral responses associated with not drinking included engaging in an alternative activity and avoiding or limiting direct exposure to the high-risk situations. Theoretical and clinical implications for effective coping in alcohol situations are discussed.

Coping with drinking pressures: adolescent versus parent perspectives.

Fifteen techniques to limit or stop alcohol consumption were rated by 94 adolescents, aged 12 to 19, and their parents. Factor analysis of effectiveness ratings demonstrated consistency in appraisal of adult options for coping strategies, but significant differences in adolescent and parent views of how teenagers should cope with drinking pressures.

Arrangement of glucose residues in the lipid-linked oligosaccharide precursor of asparaginyl oligosaccharides.

The lipid-linked oligosaccharide synthesized in vitro, in the presence of 1.0 microM UDP-[3H]Glc, GDP-[14C]Man, and UDP-GlcNAc has been isolated and the structure of the oligosaccharide has been analyzed. The oligosaccharide contains 2 N-acetylglucosamine, 9 mannose, and 3 glucose residues. The N-acetylglucosamine residues are located at the reducing terminus. The 3 glucose residues are arranged in a linear order at one of the nonreducing termini in the sequence Glc 1,2--Glc 1,3--Glc--(Man)9 (GlcNAc)2. The structural analysis was made possible largely by the availability of glucosidase preparations of fungal anad microsomal origin which remove glucose residues from the oligosaccharide without releasing mannose residues.

Comparative rates of transfer of lipid-linked oligosaccharides to endogenous glycoprotein acceptors in vitro.

We have shown previously that particulate preparations of Nil 8 fibroblasts catalyze the synthesis of two oligosaccharide-lipids: one composed of N-acetylglucosamine and mannose residues and the other containing, in addition to mannose and N-acetylglucosamine, one or two glucose residues. These two oligosaccharide-lipids were purified and added to fresh microsomal preparations. In comparative studies, we find that the glucose-containing lipid-linked oligosaccharide is transferred much more rapidly to endogenous protein acceptors than the glucose-free compound. With materials of comparable specific activities, as much as 41% of the glucose-containing oligosaccharide was transferred to protein as compared to 5% for the glucose-free compound. These results suggest that the attachment of glucose to mannosyl lipid-linked oligosaccharide serves an important role in the transfer of these compounds from lipid carrier to protein acceptor.