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Biomedical subjects

D Heller

Publications and source records attributed to D Heller.

101 records · Page 6Linked to original sources
PubMedDate not supplied

Cancer information service-initiated outcalls to promote screening mammography among low-income and minority women: design and feasibility testing.

BACKGROUND: The telephone information service of the Cancer Information Service (CIS) historically is most effective in eliciting calls from higher income, white women. This article describes the design and feasibility of a project that tested the use of telephone outcalls to extend the reach of the telephone information service to underserved women. METHODS: Neighborhoods throughout Colorado were identified using a geodemographic database (INFORUM) that allowed selection of census block groups according to demographic characteristics. Households were assigned randomly to: (1) a control group; (2) an outcall-only group, which received "cold" telephone outcalls promoting screening mammography; and (3) an advance card plus outcall group, which received a card introducing the program prior to the outcall. RESULTS: The use of INFORUM to target low-income, less educated, and black women was largely successful. While quality of intervention delivery was high, the protocol was labor intensive, requiring an average of 40 min to identify and counsel each eligible woman. The advance card did not increase acceptance of the outcalls. CONCLUSIONS: This approach successfully extended the CIS's audience; however, its labor intensity may limit its applicability. Strategies for increasing the efficiency of outcall efforts are suggested.

Aged↗
PubMedDate not supplied

Quit Today! A targeted communications campaign to increase use of the cancer information service by African American smokers.

BACKGROUND: African Americans have traditionally made little use of the Cancer Information Service (CIS), an information and education program of the National Cancer Institute, for smoking cessation assistance. This study evaluated whether a targeted communications campaign utilizing strategically placed radio and television advertisements in combination with community outreach could lead more adult African American smokers to call the CIS for smoking cessation information and materials. METHODS: Fourteen communities, served by four CIS regional offices, were carefully matched on demographic variables and then randomly assigned to either an experimental or a control group. Six radio advertisements targeting African American smokers to call the CIS for help in quitting smoking were developed and pretested for three different black-oriented formats. One television spot also was produced and pretested. The audio portion of the television ad was utilized as a seventh radio spot for the general programming formats. These advertisements were placed on selected radio and television stations reaching predominantly African American adult audiences. Also, copies of a videotape designed to motivate African American smokers to quit and to call the CIS for help in quitting were widely disseminated through community-based organizations in each experimental market. The aim was to increase the number and proportion of quitting-related calls to the CIS from African Americans within experimental communities. RESULTS: The call volume from African American smokers was significantly higher in the experimental communities than in the control communities (P < 0.008). The call rate from African American men was higher than typically observed. Overall, African Americans in the experimental communities reported radio more often than television as the way they heard about the CIS. CONCLUSION: The results suggest that paid targeted advertising, using radio as a primary channel, is an effective method of reaching an underserved population at risk. Future research directions are discussed.

Adult↗
PubMedDate not supplied

A self-help intervention for African American smokers: tailoring cancer information service counseling for a special population.

BACKGROUND: African Americans remain a critically underserved group for smoking cessation interventions. This study tested the effectiveness of a tailored, culturally sensitive intervention for African American smokers who called the NCI Cancer Information Service (CIS) for help to quit smoking. METHODS: This paper presents results of a 2-year study of tailored counseling strategies among African American smokers (n = 1,422) who called four regional CIS offices in response to a radio-based media campaign in 14 communities. Callers were randomly assigned to receive either the standard CIS quit smoking counseling and guide (Clearing the Air) or counseling and a guide (Pathways to Freedom) tailored to the quitting needs and barriers of African American smokers. Callers were predominantly female (63.6%). ages 20-49 (88%), with a high school education or more (84%). Median smoking history was 17 years; median smoking rate was 20 cigarettes/day. Standard (n = 689) and Tailored (n = 733) group subjects did not differ on most baseline measures. RESULTS: On most measures, Standard and Tailored counseling/guides received similar ratings, but the Tailored guide was rated as having more appealing photos (P = 0.001) and as being more appropriate for family members (P = 0.003). Six-month follow-up with 893 subjects (response rates were 63% Standard, 62% Tailored, ns) showed significantly more quit attempts (P = 0.002) and greater use of prequitting strategies (P < 0.05) among Tailored than among Standard subjects, but no differences in self-reported 1-week abstinence (14.4% Standard, 16.2% Tailored) (ns). An opportunistic 12-month follow-up of subjects recruited in the last year of the study (n = 445) (response rates were 57% Standard, 60% Tailored, ns) showed a significantly higher quit rate (15.4% Standard, 25.0% Tailored) for Tailored subjects (P = 0.034). CONCLUSIONS: Results show promise for tailored approaches to boost quit attempts and success rates among African American smokers.

Adult↗
PubMedDate not supplied

Very low birthweight Infant's placenta and its relation to pregnancy and fetal characteristics.

Our objective was to relate pathology of the very low birthweight (VLBW) infant's placenta to pregnancy and fetal characteristics. We correlated the pathologic features of 1146 placentas from infants with birth weights of 500-1500 g who were born between 1/1/91 and 12/31/93 to the number of gestations per pregnancy, initiator of preterm delivery, gestational age, birth weight Z score, and duration of rupture of membrane (ROM). Placental correlates of acute inflammation and villous edema were associated with preterm labor (PTL), prelabor premature rupture of membranes (PROM), lower gestational age, and higher birth weight Z score. In PTL pregnancies delivered within 1 h of membrane rupture, 61% of placentas already had membrane inflammation. Placental correlates of pregnancy-induced hypertension (PIH) were seen more commonly with PIH pregnancies, older gestational age, and lower birth weight Z score. We found a more prominent histopathologic signature for singleton than for multiple gestation placentas. The placental pathologic findings associated with the clinical diagnoses of infection, PIH, and low-birth weight Z scores in our VLBW/preterm population are similar to those in the literature regarding term pregnancies. The presence of multiple histologic findings consistent with inflammation in placentas of PTL pregnancies with duration of ROM lasting <1 h suggests that some cases of PTL are precipitated by a more long-standing infection than that previously suspected. Morphologic placental features appear to be correlates of the phenomena leading to premature delivery. Examination of the VLBW infant's placenta provides insight into the etiology and management of VLBW/preterm deliveries.

Adult↗
PubMedDate not supplied

Very low birthweight placenta: clustering of morphologic characteristics.

Our objective was to use factor analysis as a data reduction tool to organize a large number of placental pathologic features into useful aggregates. We examined 1146 placentas of live-born infants with a birth weight of 500-1500 g. We then conducted analyses of pairs of characteristics and multiple characteristics to identify "associated groups" and "factors," respectively. We found an associated group and factor that had placental features associated with acute inflammation and another associated group and factor that had features associated with vasculopathy. Acute umbilical vasculitis had the strongest correlation with other features of the acute inflammation associated group and factor. Gross evidence of acute inflammation (opacification and green appearance of membrane) was eliminated in the reduction from associated group to factor. Infarcts and syncytial knots were strongly dissociated with features of acute inflammation. The multiple pathologic features of the very low birthweight placenta can be aggregated into two associated groups or two factors. Lack of membrane opacification cannot be used as a criterion for declining microscopic examination. The absence of infarcts and syncytial knots should prompt a search for features of acute inflammation. If a placenta has two or more findings from the acute inflammation factor or the vasculopathy factor, it is unlikely to demonstrate features from the other factor.

Acute Disease↗
PubMedDate not supplied

A protocol for status epilepticus in a long-term care facility using rectal diazepam (Diastat).

INTRODUCTION: A growing population of residents in long-term care facilities (LTCF) is likely to present with status epilepticus (SE), which requires rapid treatment to avoid permanent neuronal damage, associated morbidity, and mortality. The treatment of choice for SE is an intravenous benzodiazepine; however, this is not feasible in most LTCFs because of the training level of the personnel and the risk of respiratory depression. Transport to acute care facilities is often delayed and, in addition, many LTCF residents have "do not hospitalize" orders. As an alternative to an intravenous benzodiazepine, rectal delivery of diazepam has been shown to be effective in stopping prolonged seizures and is more easily accomplished in the LTCF setting. METHODS: The Badger Prairie Health Care Center (BPHCC), a 132-bed LTCF in Verona, WI, developed a protocol for SE that uses a rectal diazepam gel preparation (Diastat) when intravenous access is unavailable. The protocol provides for initiation of long-term anticonvulsant therapy as a follow-up to the acute treatment of SE. RESULTS: BPHCC staff successfully employed the protocol eight times from August 1999 to November 2000; this article describes the protocol and three representative cases.

Journal Article↗