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Biomedical subjects

H P Greenwald

Publications and source records attributed to H P Greenwald.

At least 19 recordsLinked to original sources
PubMed2001

Changing the health care system: a professional education program for Hispanic leaders in California.

This article reports characteristics and evaluation findings on a program aimed at promoting change in California's health care system by training minority managers and policy specialists. Between 1990 and 1992, 30 Hispanic college graduates enrolled in the University of Southern California's Hispanic Leadership Program. Funded in part by the W. K. Kellogg Foundation, this program led to award of the Master of Health Administration degree and involved students in a series of community workshops. Evaluation took place via alumni surveys and focus groups. Although four individuals failed to complete the program, nearly all others entered careers potentially leading to positions of influence in health care delivery. Graduates indicated that they possessed most of the skills they considered necessary to help improve services to Hispanic people. All had taken concrete action toward this objective. Experience with the program has provided lessons valuable for conducting efforts of this kind, the principal one being that success requires substantial human and material resources. Long-term follow-up will be necessary to assess the program's ultimate impact on California's health care system.

California↗
PubMed2000

Minority recruitment and retention in dietetics: issues and interventions.

To better understand the reasons why minorities and males are underrepresented among registered dietitians (RDs) and dietetic technicians, registered, (DTRs) and to develop focuses for intervention, the investigators performed a telephone survey of newly credentialed RDs and DTRs and directors of RD and DTR education programs. Using lists of students recruited by the American Dietetic Association for participation in the survey, the investigators interviewed 83 RDs and DTRs and 20 education program directors. RDs and DTRs attributed minority underrepresentation primarily to the field's lack of visibility and underrepresentation of men to the traditional association with women. Education program directors attributed minority underrepresentation to educational disadvantages, particularly in scientific subjects. Findings from this study support program-level interventions such as increasing program flexibility, initiating outreach to K-12 schools and lower-division college students, providing tutoring in a nondemeaning atmosphere, and visibly expressing commitment to minority representation. More fundamental changes in the profession itself appear necessary for large-scale increases in minority representation. These include increasing internship opportunities; raising the profession's level of remuneration, prestige, and independence; increasing scholarship support; and advertising nationally through channels capable of reaching minorities.

Black or African American↗
PubMed1998

Social factors, treatment, and survival in early-stage non-small cell lung cancer.

OBJECTIVES: This study assessed the importance of socioeconomic status, race, and likelihood of receiving surgery in explaining mortality among patients with stage-I non-small cell lung cancer. METHODS: Analyses focused on Black and White individuals 75 years of age and younger (n = 5189) diagnosed between 1980 and 1982 with stage-I non-small cell lung cancer in Detroit, San Francisco, and Seattle. The main outcome measure was months of survival after diagnosis. RESULTS: Patients in the highest income decile were 45% more likely to receive surgical treatment and 102% more likely to attain 5-year survival than those in the lowest decile. Whites were 20% more likely to undergo surgery than Blacks and 31% more likely to survive 5 years. Multivariate procedures controlling for age and sex confirmed these observations. CONCLUSIONS: Socioeconomic status and race appear to independently influence likelihood of survival. Failure to receive surgery explains much excess mortality.

Black or African American↗
PubMed1997

The physician executive: role in the adaptation of American medicine.

In the arena of managed care and large delivery systems, professional associations find it increasingly difficult to influence the environments in which their members practice. Physician executives appear likely to play key roles in the response of medicine to change. This article discusses how an analysis of the work of physicians involved in management fails to yield a clear analytic distinction between physicians engaged in management and the behavior of others who have managerial responsibility.

Health Care Reform↗
PubMed1996

Race, socioeconomic status and survival in three female cancers.

OBJECTIVES: Although many studies have reported that socioeconomic status (SES) and race affect cancer survival, researchers have not established whether SES and race affect survival independently. The research reported here addresses this question with special attention to cancers affecting large numbers of women in the US. METHODS: The authors analyzed data on survival among patients in the Centralized Cancer Patient Data System (CCPDS) with cancers of the breast (n = 6896), cervix (n = 2209) and uterine corpus (n = 1492). RESULTS: According to Cox proportional hazards models, race predicted survival in all three cancers, while socioeconomic status predicted survival for cancers of the breast and uterine corpus. Interaction effects between race and SES were generally not statistically significant. This study includes larger numbers of observations within specific forms of cancer and covers a broader patient population than most previous investigations. These features promote detectability of SES effects, comparability among disease sites, and generalizability to cancer patients throughout the US. CONCLUSIONS: Findings imply that SES and race affect cancer mortality risk independently of each other, and that the impact of SES and race may vary by malignancy. Survival disadvantages due to race-which may be more pronounced among women than men-should remain a continuing concern.

Adult↗
PubMed1996

Managed care and public health: building a partnership.

Critics today charge that managed care organizations, intent on reducing costs to ensure survival and profitability, have forsaken public health. In fact, managed care and public health face common challenges and share common interests. Public health problems ultimately affect managed care enrollees and increase the cost of their care. Managed care organizations, then, must help reduce community-wide health risks. Public health agencies, traditionally responsible for population health, today face serious challenges due to budget reductions and public indifference. The article to follow proposes a model for mutually beneficial collaboration between managed care and public health. Programs linking managed care with public health in the Puget Sound area illustrate this model's feasibility and value.

Adolescent↗
PubMed1996

A modified health risk appraisal as a component of a senior health promotion program.

Because of their comprehensive service capabilities and traditional focus on prevention, HMOs have an outstanding potential for contributing to health promotion and disease prevention among special populations. But HMOs must acknowledge the special needs of key groups and modify traditional offerings accordingly. This article describes the use of the health risk appraisal (HRA) in a program, A Healthy Future, aimed at promoting health and preventing disease among elders. Unlike ¿standard¿ HRAs, this program developed questions of special pertinence to elders and used face-to-face, human contact for communicating results. Most important, the program linked the HRA to primary care and to interventions particularly useful and acceptable to elders.

Aged↗
PubMed1996

Health care providers and violence: opportunities for action.

Staff at Group Health Cooperative of Puget Sound have undertaken numerous strategies and community alliances in an effort to decrease violence in their community. Beginning with pilot programs and interventions for their own providers and enrollees, programs now focus on strengthening the community, controlling firearms, and supporting youth.

Community Health Planning↗
PubMed1996

Explaining reduced cancer survival among the disadvantaged.

The fact that socially disadvantaged cancer patients face a greater risk of mortality than the advantaged is well recognized but poorly understood. Existing research and a newly completed 10-year survival study suggest that complex interrelations among biological factors, medical interventions, and specific dimensions of social differentiation determine survival differences. Patterns of interrelations among determinants of survival appear compatible with an "economic" model in some forms of cancer and a "cognitive-behavioral" model in others. Findings presented here suggest that improved access to health care will reduce mortality risk among the disadvantaged in at least some malignancies, but will not alone make their survival chances equal to those of the advantaged.

Adult↗
PubMed1995

Stop violence now.

Explore the source record for details and available documents.

Community Health Planning↗
PubMed1994

Detecting survival effects of socioeconomic status: problems in the use of aggregate measures.

Direct measures of SES are seldom included in medical records or large databases on disease incidence or survival, forcing researchers to infer the SES characteristics of individuals from aggregate data (e.g. census tract-level income, education, etc.). This paper assesses the degree of error that results from such inference and the impact this error may have on reported relationships between SES and survival. The authors obtained both individual and census tract-level data on 536 persons diagnosed with cancer between 1980 and 1982 and monitored their survival through 1992. Pearson correlations between individual-level and census tract-level SES variables ranged between 0.2 and 0.4. Statistically significant relationships between SES and survival were observed in the models based on individual-level but not census tract-level SES data. The authors computed the degree to which inference of individual-level from census tract-level SES reduces estimates of risk ratios across SES. It appears likely that much larger numbers of observations than have been used in published studies will be needed to better understand the relationship of SES to survival and other disease outcomes.

Age Factors↗
PubMed1994

Managing diversity: the best for everyone.

Howard Greenwald argues that social diversity can be transformed from a "problem" to a solution if leaders can fashion ways of incorporating the commonalities across different groups in the population. Core values of "hard work, just rewards, and personal liberty" can form the foundation of shared understandings among persons of different nativity, culture, and gender. At the same time, Greenwald notes the importance of designing different strategies for different people.

Employment↗
PubMed1992

HMO membership, treatment, and mortality risk among prostatic cancer patients.

OBJECTIVES: Treatment and mortality risk were compared between prostate cancer patients receiving care in fee-for-service settings and those receiving care in a health maintenance organization (HMO). METHODS: Two samples were obtained from a population-based tumor registry. Patients in the first sample (n = 201) were interviewed shortly after diagnosis to obtain data on income, education, overall health status, and expenditures for health status, and expenditures for health care. These data were combined with information from the tumor registry on cancer stage, age, treatment, place of residence, and source of care. Only tumor registry data were obtained for most patients in the second sample (n = 962). For both samples, survival time was monitored for up to 80 months. RESULTS: Multivariate analysis of data from the interviewed sample indicated that HMO patients were less likely to receive surgery but more likely to receive radiation therapy than were those in fee-for-service settings. Mortality risk was lower for the HMO patients than for those in fee-for-service plans. Findings based on the second sample were nearly identical. CONCLUSIONS: This study suggests that HMOs may offer important advantages to lower-income patients at risk for specific life-threatening diseases.

Aged↗
PubMed1989

Work disability among cancer patients.

To identify factors affecting the ability of persons with recent cancer diagnoses to remain in the labor force and retain premorbid levels of work performance, the investigators analyzed data on 247 individuals with lung, pancreatic, prostatic, or cervical cancer. Subjects were selected from a population-based tumor registry. According to Pearson correlations, ordinary least squares multiple regression, and logistic analysis, physical factors related to disease were the strongest predictors of work disability, defined as either leaving the labor force or functioning less fully at work than before becoming ill. The strongest predictors of work disability were physical dysfunction measured by the Sickness Impact Profile (SIP) and disease stage. Social background factors such as age, sex, income, and education were not statistically significant predictors. Two job characteristics, (1) physical demands of work and (2) discretion over hours worked and how much work would be done, predicted work disability, the latter appearing to help prevent this condition. Strictly disease-related factors appear more important here in predicting work disability than in studies of other diseases. Still, it appears that increasing flexibility of working hours and the pace of work could help some individuals with cancer histories remain in the labor force. Unwillingness of employers to facilitate such accommodation where technically feasible may constitute a form of discrimination against the cancer patient.

Activities of Daily Living↗
PubMed1987

The prevalence of pain in four cancers.

Although pain is widely recognized as a major problem in cancer patients, most studies have concentrated on pain among those with advanced or terminal cancer in specialized treatment settings. The study reported here gives a more complete picture of the problem of pain among cancer patients by providing data generalizable to those in early as well as late stages of the disease, and receiving care in the community as well as specialized treatment centers. Having included measures of several distinct features of pain, this study also provides a more complete understanding of the cancer patient's day-to-day pain problem than earlier investigations. The findings presented here indicate that serious pain may occur in all cancer stages, and often represents an ongoing medical problem. The data suggest that many patients may benefit from earlier and more aggressive use of available antipain treatment methods.

Analgesics↗
PubMed1987

The specificity of quality-of-life measures among the seriously ill.

The need to address the impacts of serious disease and the effectiveness of interventions has led to the development of numerous measures of the quality of life. The research reported here explores the possibility that widely used measures do not truly distinguish among separate dimensions of the quality of life in a seriously ill population, but reflect a generalized tendency among such individuals to respond negatively to interviewers' questions about their well-being. This research examines three widely used measures--the Sickness Impact Profile (SIP), the Profile of Mood States (POMS), and the McGill Pain Questionnaire (MPQ)--as applied to 536 individuals with recent cancer diagnoses. In a multitrait-multimethod matrix, correlation coefficients among measures believed to reflect the same phenomena are consistently higher than correlation coefficients among measures supposed to reflect different phenomena. In a factor analysis performed on all 536 subjects, the unrotated factor matrix indicates that no single factor explains a preponderance of the variance in individual measures. Orthogonal rotation indicates that subscales from the SIP, POMS, and MPQ generally load on factors defined by the scales of which they are part. These findings were replicated on subsamples of subjects with particularly severe disease. The study suggests that the SIP, POMS, and MPQ measure the specific dimensions their names imply, even among individuals with illnesses posing immediate threats to survival.

Affect↗
PubMed1987

HMO membership, copayment, and initiation of care for cancer: a study of working adults.

This study compares diagnosis and commencement of treatment for cancer among persons with fully financed fee-for-service coverage, persons with copaid fee-for-service coverage, and persons in an HMO (health maintenance organization). A total of 242 subjects actively employed at the time of their diagnosis were interviewed, typically within six months of beginning cancer treatment. After sex, age, income, education, residence (urban vs rural), and disease site and stage had been controlled, those who made copayments were found to have waited an average of 1.25 months longer (95 per cent confidence limit (cl) +/- .88) between initial suspicion of illness and obtaining a definitive diagnosis than those with full insurance coverage. Time from diagnosis until the beginning of treatment averaged .83 months longer (95 per cent cl +/- .41) for HMO members than those in fee-for-service. These relations were strongest in income categories equal to or exceeding $20,000 per year.

Employment↗