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Moderators and mediators of behaviour change in a lifestyle program for treated hypertensives: a randomized controlled trial (ADAPT)
Burke, V., Beilin, L. J., Cutt, H. E., Mansour, J., Mori, T. A. Tue, 08 Jul 2008 00:00:00 -0000
We aimed to examine moderators and mediators of behaviour change in a cognitive lifestyle program for drug-treated overweight hypertensives in Perth, Australia. We collected data at baseline, 4 months (post-intervention) and 1-year follow-up in a randomized controlled trial of a program that focused on weight loss, diet, and exercise. Mediation analysis used regression models that estimate indirect effects with bootstrapped confidence limits. Outcomes examined were saturated fat intake (% energy) and physical activity (hours per week). In total, 90/118 individuals randomized to usual care and 102/123 to the program-completed follow-up. Sex was a moderator of response post-intervention for diet and physical activity, with a greater response among women with usual care and among men with the program. Change in self-efficacy was a mediator of dietary change post-intervention [effect size (ES) –0.055, 95% confidence interval (CI) –0.125, –0.005] and at follow-up (ES 0.054, 95% CI –0.127, –0.005), and in physical activity post-intervention (ES 0.059, 95% CI 0.003, 0.147). These findings highlight different responses of men and women to the program, and the importance of self-efficacy as a mediator. Mediators for physical activity in the longer term should be investigated in other models, with appropriate cognitive measurements, in future trials.
Storage of household firearms: an examination of the attitudes and beliefs of married women with children
Johnson, R. M., Runyan, C. W., Coyne-Beasley, T., Lewis, M. A., Bowling, J. M. Tue, 08 Jul 2008 00:00:00 -0000
Although safe firearm storage is a promising injury prevention strategy, many parents do not keep their firearms unloaded and locked up. Using the theory of planned behavior as a guiding conceptual framework, this study examines factors associated with safe storage among married women with children and who have firearms in their homes. Data come from a national telephone survey (n = 185). We examined beliefs about defensive firearm use, subjective norms, perceived behavioral control and firearm storage practices. A Wilcoxon–Mann–Whitney test was conducted to assess associations between psychosocial factors and firearm storage practices. Women were highly motivated to keep firearms stored safely. Those reporting safe storage practices had more favorable attitudes, more supportive subjective norms and higher perceptions of behavioral control than those without safe storage. One-fourth believed a firearm would prevent a family member from being hurt in case of a break-in, 58% believed a firearm could scare off a burglar. Some 63% said they leave decisions about firearm storage to their husbands. Women were highly motivated to store firearms safely as evidenced by favorable attitudes, supportive subjective norms and high perceptions of behavioral control. This was especially true for those reporting safer storage practices.
Will patients agree to have their literacy skills assessed in clinical practice?
Ryan, J. G., Leguen, F., Weiss, B. D., Albury, S., Jennings, T., Velez, F., Salibi, N. Tue, 08 Jul 2008 00:00:00 -0000
If health providers are aware of their patients' literacy skills, they can more appropriately tailor their communication with patients. Few providers, however, assess patient's literacy skills for fear of offending patients, but no research has ever determined if patients object to such assessments. Our objectives were to determine the percentage of patients seen for routine health care that would agree to undergo literacy assessment and if satisfaction of patients differs in practices that perform literacy assessments versus practices that do not. We randomized 20 private and public medical practices to an intervention group that implemented literacy assessments with the Newest Vital Sign and a control group that did not. For intervention practices, we noted the percentage of patients agreeing to undergo the assessment. For both intervention and control practices, we assessed patient satisfaction. Of 289 patients asked to undergo literacy assessment in the intervention practices, 284 (98.3%) agreed to do so, including 125 (46.1%) with low or possibly low literacy skills. There was no difference in satisfaction between the intervention group and the control group. We conclude that patients are willing to undergo literacy assessments during routine office visits and performing such assessments does not decrease patient satisfaction.

Public Health News From Medical News Today

Florida Officials Meet To Discuss High Black Infant Mortality Rates
Fri, 18 Jul 2008 12:00:00 -0700
The Black Infant Health Practice Initiative in Miami-Dade County, Fla., on Wednesday held a town hall meeting to examine why the rate of infant mortality among blacks in the county is twice as high as that of whites, the Miami Herald reports.
Senate Passes PEPFAR Reauthorization Bill With $2B In Funds For American Indian Programs
Fri, 18 Jul 2008 10:00:00 -0700
The Senate on Wednesday voted 80-16 to approve legislation (S 2731) that would reauthorize the President's Emergency Plan for AIDS Relief at $50 billion over five years and direct $2 billion of that total to American Indian health care and other programs, the
U.S. Spends More Than Twice As Much On Health Care Per Person Than Most Other Industrialized Nations, Ranks Last In Preventable Mortality, Study Finds
Fri, 18 Jul 2008 10:00:00 -0700
The U.S. spends twice as much on health care per capita than most other industrialized nations but ranks lower than those nations on a number of criteria, according to a report released on Thursday by the Commonwealth Fund, the New York Times reports (Abelson, New York Times, 7/17).

Public Health News Headlines from Johns Hopkins

Older Patients More Satisfied with Care When Accompanied to Medical Visits
paffairs@jhsph.edu (Office of Communications) Mon, 14 Jul 2008 16:30:00 -0400
A study by researchers at the Johns Hopkins Bloomberg School of Public Health found that 38 percent of Medicare beneficiaries are accompanied to routine medical visits. These accompanied beneficiaries tended to be older, sicker and less educated but more satisfied with their health care provider compared to unaccompanied patients. The study is published in the July 14 edition of Archives of Internal Medicine.
Hand Washing Saves Newborn Lives
paffairs@jhsph.edu (Office of Communications) Mon, 07 Jul 2008 17:30:00 -0400
Washing hands with soap and water in preparation for delivery significantly reduced the risk of death for infants within the first month of life, according to a study in Nepal conducted by researchers at the Johns Hopkins Bloomberg School of Public Health. The study found a 19 percent lower risk of death among newborns born at home in rural Nepal when the birth attendant washed their hands before delivery. The study also found a 44 percent reduction in risk of death if mothers washed their hands prior to handling their newborn infant. The findings are published in the July 2008 edition of the journal Archives of Pediatric and Adolescent Medicine.
Newborn Vitamin A Reduces Infant Mortality
paffairs@jhsph.edu (Office of Communications) Mon, 07 Jul 2008 09:15:00 -0400
A single, oral dose of vitamin A, given to infants shortly after birth in the developing world can reduce their risk of death by 15 percent, according to a study conducted by researchers at the Johns Hopkins Bloomberg School of Public Health. The study is published in the July 2008 edition of the journal Pediatrics.

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