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C S Skinner

Publications and source records attributed to C S Skinner.

32 records · Page 2Linked to original sources
PubMed1995

Incorporating mobile mammography units into primary care: focus group interviews among inner-city health center patients.

Mammography screening is underutilized, especially among women of lower socioeconomic status (SES). Mobile mammography units reduce cost and patient burden of mammography, and therefore might enhance screening rates among underserved populations. Few studies have explored factors associated with the acceptability of mobile mammography; none have targeted low-SES women. To explore these issues, we conducted focus group interviews in five university-affiliated urban primary-care clinics. The forty-three participants were 74% African-American, ranged in age from 40 to 70 years and most (67%) had household incomes below $15,000. A trained moderator led the groups of eight to 12 women through standardized, open-end interview questions exploring perceptions of mobile mammography. Findings suggest mammography vans are acceptable under only certain circumstances, including advance notice and assurance of privacy and quality. Convenience was important; 53% related being more likely to have mammograms if scheduled in conjunction with primary-care visits. Participants felt strongly that vans were inappropriate for public forums such as shopping centers. Association with primary-care health centers seemed to legitimize mammography vans and to allay concerns. If mammography screening is to become more widespread among low-income populations, these exploratory findings must be addressed in research and intervention development.

Adult↗
PubMed1994

Physicians' recommendations for mammography: do tailored messages make a difference?

OBJECTIVES: Message tailoring, based on individual needs and circumstances, is commonly used to enhance face-to-face patient counseling. Only recently has individual tailoring become feasible for printed messages. This study sought to determine whether printed tailored recommendations addressing women's specific screening and risk status and perceptions about breast cancer and mammography are more effective than standardized printed recommendations. METHODS: Computer-assisted telephone interviews were conducted with 435 women, aged 40 to 65 years, who had visited family practice groups within the previous 2 years. Subjects were randomly allocated to receive individually tailored or standardized mammography recommendation letters mailed from physicians to patients' homes. Follow-up interviews were conducted 8 months later. RESULTS: Tailored letter recipients were more likely to remember and to have read more of their letters than standardized version recipients. After controlling for baseline status, tailored letter receipt was associated with more favorable follow-up mammography status for women with incomes below $26,000 and for Black women. CONCLUSIONS: Tailored messages are a more effective medium for physicians' mammography recommendations; tailoring may be especially important for women of low socioeconomic status.

Adult↗
PubMed1994

The effects of computer-tailored smoking cessation messages in family practice settings.

BACKGROUND: Many conventional health education materials, such as pamphlets and booklets, are designed to reach as wide an audience as possible; they are therefore often lengthy and contain information irrelevant to many consumers. Computer technologies allow sophisticated tailoring of messages targeted to individual patients and free of irrelevant information. METHODS: In two studies in North Carolina (study 1, N = 51; study 2, N = 197), adult cigarette smokers were identified from a cohort of family practice patients. Cigarette consumption, interest in quitting smoking, perceived benefits and barriers to quitting, and other characteristics relevant to smoking cessation were collected. Based on this information, smoking cessation letters were tailored by computer to individuals. Smokers were randomly assigned to experimental (tailored health letters) or comparison groups (generic health letter in study 1, no health letter in study 2). Smoking status was assessed again at 4 months (study 1) or 6 months (study 2). RESULTS: Both studies found statistically significant positive effects of tailored health letters among moderate to light smokers. In study 1, 30.7% reported quitting after 6 months vs 7.1% in the control group (P < .05); in study 2, 19.1% vs 7.3% (P < .05). CONCLUSIONS: Results from both studies indicate positive effects of computer-tailored smoking messages among moderate to light smokers. These findings are consistent with the focus of our computer-tailored program on psychological and behavioral factors related to smoking cessation. Smoking cessation outcomes may be enhanced by combining tailored messages with nicotine replacement therapies to treat physical dependency. Methods of tailoring health messages and incorporating the results into family practice are described.

Adult↗
PubMed1993

The potential of computers in patient education.

Typical computer programs for patient education are didactic and fail to tailor information to an individual's specific needs. New technology greatly enhances the potential of computers in patient education. Computer-assisted instruction programs can now elicit information from users before leading them through problem-solving exercises. New authoring systems enable health professionals to develop their own programs. The capacity to elicit and report back information about factors that influence patients' health behaviors give the newest computer programs one of the strengths of face-to-face patient counseling: the ability to tailor an educational message for an individual patient. These programs are not intended to replace but rather to enhance personal interaction between providers and patients. This article describes the advantages of using computers for individualizing patient education and assessing trends across groups of patients. Innovative programs and features to look for in programs and equipment selection are also described.

Computer-Assisted Instruction↗
PubMed1992

The natural history of mammographic calcifications subjected to interval follow-up.

The purpose of this investigation was to determine the natural history and risk of malignancy associated with isolated indeterminate microcalcifications subjected to interval follow-up. During a 2-year study, 91 patients were identified with indeterminate microcalcifications alone. Specific roentgenographic features of the calcifications were evaluated on initial and follow-up mammograms. During a mean follow-up of 36 months, 19 (21%) of the women exhibited mammographic changes. Ten patients (11%) with suspicious changes underwent a needle-directed biopsy 6 to 30 months after the initial mammographic screening. Five women (5.5%) were diagnosed as having breast carcinoma; three had invasive ductal carcinoma and two had purely intraductal lesions. Four patients had axillary lymph node dissections and no metastatic disease was found. We found no significant differences in the roentgenographic features associated with malignant vs benign lesions apart from an increased overall estimation of the probability of malignancy rating in the five patients with breast carcinoma. We recommend that patients be followed up with mammography at regular intervals for at least 18 months following recognition of indeterminate microcalcifications.

Aged↗
PubMed1990

Analysis of biological reference materials, prepared by microwave dissolution, using inductively coupled plasma mass spectrometry.

A procedure has been developed for the analysis of biological materials by inductively coupled plasma mass spectrometry (ICP-MS). Fast, efficient and complete sample digestion is achieved by a combined microwave-nitric acid/open beaker-nitric acid-hydrogen peroxide procedure. The ICP-MS analysis is performed with an on-line five-element internal standard to correct for matrix and instrumental drift effects. Results are presented for 24 elements in three biological reference materials (National Institute of Standards and Technology Standard Reference Materials 5277a Liver and 1566 Oyster and International Atomic Energy Agency Certified Reference Material H4 Animal Muscle). For all elements significantly above the detection limit and reagent blank concentrations, good agreement exists between ICP-MS and certified values.

Animals↗
PubMed1982

Application of a dermal self-exposure model to worker reentry.

The dermal toxicity of five commonly used organophosphate insecticides was investigated with a mouse intermittent self-exposure model. Blood cholinesterases were monitored on d -3 and -1 before exposure and for 4--6 d during exposure to foliar residues. Responses were much greater in unmuzzled than in muzzled animals due to oral contamination. After two 10-h exposures, muzzled mice showed log-linear cholinesterase responses across a wide range of foliar pesticide concentrations. Foliar pesticide levels that caused 50% depression in plasma or red blood cell cholinesterase were determined with log-probit dose-response analysis. The greatest cholinesterase responses for both emulsifiable concentrate and encapsulated formulations were found with diazinon, followed by parathion and methyl parathion. Azinphos-methyl and mevinphos produced no significant responses in muzzled mice at maximal foliar concentrations. Symptomatology, food consumption, and body weight provided less sensitive indicators of response than cholinesterases. No consistent relation existed between the mouse intermittent self-exposure toxicities and mouse dermal LD50 values. Use of data from acutely exposed animals to predict the hazard of intermittent foliar exposure appears inadvisable.

Acetylcholinesterase↗
PubMed1982

Percutaneous penetration of [14C]parathion in the mouse: effect of anatomic region.

Percutaneous penetration of [14C]parathion in mouse skin of nose, hind foot, scrotum, and tail was measured by recovery of excreted radioactivity relative to an intravenous dose. Oral ingestion was prevented by use of face muzzles and polyethylene rings at application sites. Penetration per unit area was in the following order (iv = 1.0): nose (0.8), scrotum (0.4), foot (0.3), and tail (0.3). Because of their greater surface area, tail and foot regions would contribute most to absorption in uniform ventral exposure. Daily recovery curves indicate apparent first-order kinetics of elimination.

Animals↗
PubMed1982

Acute dermal toxicities of various organophosphate insecticides in mice.

Dermal LD50 values for five organophosphate insecticides were determined in mice by application of solutions to hind feet. Values were simultaneously generated for the ED50 (milligrams per kilogram) for both cholinesterase and acetylcholinesterase. Lethality was greatest with mevinphos, followed by parathion, methyl parathion, diazinon, and azinphosmethyl. LD50 values were higher than reported values for mice treated on shaved back skin. Cholinesterase ED50 values roughly agreed with LD50 values for mevinphos, parathion, methyl parathion, and azinphos-methyl, but diazinon appeared much more inhibitory of blood than neuronal cholinesterase. Red blood cell and plasma cholinesterase activities were equally sensitive for all but mevinphos and diazinon.

Animals↗
PubMedDate not supplied

Colorectal cancer screening beliefs. Focus groups with first-degree relatives.

OBJECTIVES: The purpose of this paper is to describe the perceived benefits and barriers to colorectal cancer screening reported by first-degree relatives of colorectal cancer patients. MATERIALS AND METHODS: In this study, the authors used focus groups to identify perceived benefits and barriers to colorectal cancer screening among parents and children of colorectal cancer patients. Four focus groups were conducted with relatives of colorectal cancer patients seen at two university medical centers in the Midwest. The groups ranged in size from five to eight members each and were stratified by gender. RESULTS: Four benefits of colorectal cancer screening were identified by participants: finding colorectal cancer early, decreasing the chances of dying from colorectal cancer, freedom from worry about colorectal cancer, and reassurance that one was cancer-free. Four main barriers were identified that applied to all four types of colorectal cancer screening or to colorectal cancer screening in general. These included inadequate public awareness of colorectal cancer, inconsistent recommendations from healthcare providers, concerns about the efficacy of screening tests, and embarrassment. Barriers unique to each screening test also were identified. CONCLUSIONS: Understanding individual beliefs about the benefits and barriers to colorectal cancer screening will allow clinicians and researchers to develop effective interventions to increase screening. Results from the focus groups have been used to develop an instrument to measure benefits and barriers to colorectal cancer screening, which now needs to be tested with more culturally and socioeconomically diverse groups.

Adult↗
PubMedDate not supplied

Depressive symptoms, menopausal status, and climacteric symptoms in women at midlife.

OBJECTIVE: Previous studies have found increased rates of depression in women aged 45 to 54 years, but the factors that influence these rates are not understood. It was assessed whether higher rates of depressive symptoms were associated with menopausal status, climacteric symptoms, and use of hormone replacement therapy. DESIGN: Cross-sectional survey. SETTING: Community sample. METHODS: Data are from 581 women ages 45 to 54 years who were interviewed by telephone between October 1998 and February 1999. MEASURES: Depression was measured with the abbreviated CES-D, a depressive symptoms screening measure. Women's reported perception of menopausal stage, frequency of periods in the preceding 12 months, and history of oophorectomy were used to classify their menopausal status into four categories: (1) no indication of menopause; (2) close to menopause; (3) had begun menopause; and (4) had completed menopause. RESULTS: There were 168 women (28.9%) who reported a high level (> or = 10) of depressive symptoms when the abbreviated CES-D was used. In a logistic-regression analysis, significant factors associated with increased depressive symptoms included physical inactivity, inadequate income, use of estrogen/progesterone combination, and presence of climacteric symptoms (trouble sleeping, mood swings, or memory problems). Menopausal status was not associated with depressive symptoms. CONCLUSIONS: In this sample of women age 45 to 54 years, climacteric symptoms but not menopausal status were associated with higher rates of depressive symptoms.

Climacteric↗
PubMedDate not supplied

Factors influencing compliance with home exercise programs among patients with upper-extremity impairment.

OBJECTIVE: Patient cooperation and satisfaction with home exercise programs are important for successful outcomes of intervention. This study investigated factors from three models to predict increased compliance and satisfaction with home exercise programs: the Model of Human Occupation (MOHO), including the volition subsystem (interests), habituation subsystem (roles), and performance subsystem (reported physical capacity); the Health Belief Model (HBM), including perceived barriers, benefits, self-efficacy, and severity; and the Health Locus of Control (HLOC). METHOD: Sixty-two outpatients at an orthopedic upper-extremity rehabilitation facility completed a battery of questionnaires and self-report instruments, including a health belief survey to assess HBM factors, the Multidimensional Health Locus of Control Scale, the Modified Activity Profile to assess the performance subsystem of the MOHO, a demographic questionnaire (including roles), a report of home exercise, and a satisfaction scale of their therapist's treatment. Compliance was determined by comparing participants' report of exercises performed to exercises specified on their medical chart. RESULTS: Stepwise regression identified two predictors of compliance: perceived self-efficacy and internal HLOC, R2 = .16. CONCLUSION: Results supported the role of the MOHO's volition subsystem, but roles and physical capacity--representing the habituation and performance subsystems of the MOHO--did not contribute significantly to the prediction of compliance.

Adult↗
PubMedDate not supplied

The effects of standard care counseling or telephone/in-person counseling on beliefs, knowledge, and behavior related to mammography screening.

PURPOSE/OBJECTIVES: To determine the most effective methods of increasing mammography adherence while also considering ease of intervention delivery in evolving healthcare systems. DESIGN: Experimental. SETTING: Women from a health maintenance organization and a large general medicine practice. SAMPLE: Women 50-85 years of age who had not had breast cancer and did not have a mammogram within the last 15 months. METHODS: Once consent and baseline information were obtained, women were randomized to receive in-person, telephone, or no mammography counseling. MAIN RESEARCH VARIABLES: Mammography adherence, perception of susceptibility to breast cancer, and benefits, barriers to, and knowledge of mammography. FINDINGS: Compared to standard care, telephone counseling was more than twice as effective at increasing mammography adherence, whereas in-person counseling resulted in almost three times the mammography adherence postintervention. Both telephone and in-person counseling are successful in changing perceived susceptibility, knowledge, barriers, and benefits. CONCLUSION: Both telephone and in-person counseling interventions were successful in changing beliefs, which, in turn, increased mammography adherence. IMPLICATIONS FOR NURSING PRACTICE: Interventions based on altering beliefs are effective for increasing mammography adherence.

Aged↗