Biomedical subjects

Melissa A Clark

Publications and source records attributed to Melissa A Clark.

10 recordsLinked to original sources

PubMed2004

Prevalence and correlates of repeat mammography among women aged 55-79 in the Year 2000 National Health Interview Survey.

BACKGROUND: Utilization of mammography has increased steadily since the early 1990s. It is now important to expand the attention given to obtaining repeat examination. This study examines the prevalence and cross-sectional correlates of repeat mammography, among women aged 55-79, using a 12-month (N = 3,502) and a 24-month interval (N = 3,491). METHODS: Data were from the Year 2000 Cancer Control Module of the National Health Interview Survey (NHIS-CCM). The NHIS-CCM asked about the most recent mammogram and the total number of mammograms over the prior 6 years. An algorithm estimated repeat mammography for the two intervals. RESULTS: Prevalence estimates were 49% for the 12-month interval, and 64.1% for the 24-month interval. Correlates of lower likelihood of repeat mammography for both indicators were: no regular source of care, having public or no health insurance, less than a college education, household income less than $45K, not being married, current or never smoking, age 65-79, and lower absolute risk of breast cancer (Gail Model score). CONCLUSIONS: A substantial percentage of women do not receive repeat mammography. The correlates of repeat mammography were similar to those often found for ever-had and recent mammography. There is probably some imprecision in the prevalence estimates due to the nature of NHIS-CCM questions. Issues pertinent to the definition of repeat examination are addressed.

Aged↗

PubMed2003

Filling the gaps in physician communication. The role of the Internet among primary care patients.

BACKGROUND: Millions of people use the Internet as a source for health information yet little is understood about how the use of the Internet for health information is related to the doctor-patient relationship. OBJECTIVE: We conducted the present study to understand the association between one's interest in using the Internet for general and quality-oriented health information and attitudes about one's communications with health care provider(s). DESIGN: Cross-sectional survey. SETTING: Four community-based primary care practices in Rhode Island. MEASUREMENTS: A single self-administered survey included items to measure: interest in using the Internet to look for general and quality-oriented information and a patient's perceptions of the degree to which their doctors over the previous year have: (1) given them information and (2) engaged them in the decision-making process. RESULTS: A total of 300 patients completed the survey. Among patients without Internet access, interest in using the Internet for health related activities was less among patients who felt that their doctor gave less information: Odds ratio 0.83 (95% CI, 0.70-0.98) and greater among patients who felt that their doctor engaged them more in decision making: Odds ratio 1.3 (95% CI, 1.1-1.6). Among patients with Internet access, we found no relationship between interest in using the Internet for health related activities and measures of patient-physician communication or patient-physician decision making. CONCLUSIONS: Interest in using the Internet for health information is greater for those who (1) felt their doctors provided less information and (2) felt their doctors engaged them more in the decision-making process, but this is true only for those without access to the Internet.

Adolescent↗

PubMed2003

Reminder letter, tailored stepped-care, and self-choice comparison for repeat mammography.

BACKGROUND: The main benefits of mammography come from regular on-schedule screening. However, few studies have examined interventions to achieve repeat screening. SETTING AND PARTICIPANTS: Participants were women aged 50 to 74, recruited through one setting in Rhode Island and another in North Carolina. Participants had a mammogram already scheduled at recruitment, and had to keep that appointment in order to be eligible for the repeat mammography intervention. A total of 1614 women were in the intervention sample. DESIGN: A four-group randomized design was used: Group 1, a simple reminder letter; Group 2, a 2-month, tailored, stepped intervention delivered 2 months after the completed mammogram; Group 3, a 10-month, tailored, stepped intervention delivered 2 months before the repeat mammogram was due; and Group 4, self-choice of one of the above three strategies. INTERVENTION: The intervention took place between June 1996 and May 1997. The reminder letter and two levels of the stepped intervention were delivered by mail. The third level of the stepped strategy was a counselor telephone call. Groups 2 and 3 were identical, except for timing. OUTCOME MEASURE: Obtaining the next due mammogram within 15 months, based on clinic records. RESULTS: There were no statistically significant differences among the four groups, both in the total sample and at the two sites separately. CONCLUSIONS: On average, a simple reminder may be as effective as more complex strategies for women with a prior on-schedule exam. However, attention is still needed to identify women at risk of lapsing from screening. Some women may require more-intensive interventions.

Aged↗

PubMed2003

Evaluating transdisciplinary science.

The past two decades have seen a growing interest and investment in transdisciplinary research teams and centers. The Transdisciplinary Tobacco Use Research Centers (TTURCs) exemplify large-scale scientific collaborations undertaken for the explicit purpose of promoting novel conceptual and methodological integrations bridging two or more fields. Until recently, few efforts have been made to evaluate the collaborative processes, and the scientific and public policy outcomes, of such centers. This manuscript offers a conceptual framework for understanding and evaluating transdisciplinary science and describes two ongoing evaluation studies covering the initial phase of the TTURC initiative. The methods and measures used by these studies are described, and early evaluative findings from the first 4 years of the initiative are presented. These data reveal progress toward intellectual integration within and between several of the TTURCs, and cumulative changes in the collaborative behaviors and values of participants over the course of the initiative. The data also suggest that different centers may follow alternative pathways toward transdisciplinary integration and highlight certain environmental, organizational, and institutional factors that influence each center's readiness for collaboration. Methodological challenges posed by the complexities of evaluating large-scale scientific collaborations (including those that specifically aspire toward transdisciplinary integrations spanning multiple fields) are discussed. Finally, new directions for future evaluative studies of transdisciplinary scientific collaboration, both within and beyond the field of tobacco science, are described.

Humans↗

PubMed2003

Classification and regression tree analysis in public health: methodological review and comparison with logistic regression.

BACKGROUND: Audience segmentation strategies are of increasing interest to public health professionals who wish to identify easily defined, mutually exclusive population subgroups whose members share similar characteristics that help determine participation in a health-related behavior as a basis for targeted interventions. Classification and regression tree (C&RT) analysis is a nonparametric decision tree methodology that has the ability to efficiently segment populations into meaningful subgroups. However, it is not commonly used in public health. PURPOSE: This study provides a methodological overview of C&RT analysis for persons unfamiliar with the procedure. METHODS AND RESULTS: An example of a C&RT analysis is provided and interpretation of results is discussed. Results are validated with those obtained from a logistic regression model that was created to replicate the C&RT findings. Results obtained from the example C&RT analysis are also compared to those obtained from a common approach to logistic regression, the stepwise selection procedure. Issues to consider when deciding whether to use C&RT are discussed, and situations in which C&RT may and may not be beneficial are described. CONCLUSIONS: C&RT is a promising research tool for the identification of at-risk populations in public health research and outreach.

Decision Trees↗

PubMed2003

Repeat mammography: prevalence estimates and considerations for assessment.

Despite recent controversies in mammography efficacy, encouraging women to obtain regular screenings is still an important public health priority. Published articles about repeat or regular screening were reviewed to determine trends in rates of mammography adherence. A search of MEDLINE and PsycINFO from January 1990 to December 2001 identified 45 empirical articles of U.S. samples that reported, or provided sufficient data to calculate, the percentage of women 50 years of age and older who obtained 2 or more consecutive, on-schedule mammograms. Keywords used in the searches included pairing mammography with regular, repeat, adherence, compliance, annual, rescreen, and maintenance. The weighted average repeat mammography percentage across all eventually included studies (N = 37) was 46.1% (confidence interval: 39.4%, 52.8%). There was no substantial difference in the average repeat screening percentages comparing studies that collected data from 1995 to 2001 versus 1991 to 1994. Within each of 3 time periods of data collection (pre-1991, 1991-1994, 1995-2001), there was substantial variation in repeat rates. This variation appears to be due to several characteristics of study design and sampling, including the definition/methods of collecting data about the adherence measure, prior mammography status, and use of an upper age limit at recruitment. Consensus is needed regarding the definition of repeat mammography. National surveys must include items to assess repeat mammography in order to have estimates that accurately represent population-level rates. Although this study involved mammography, similar challenges in assessing prevalence rates can occur with other screening behaviors.

Aged↗

PubMed2003

The cancer screening project for women: experiences of women who partner with women and women who partner with men.

The Cancer Screening Project for Women is a study about the experiences of legally unmarried women with breast, cervical, and colorectal cancer screening. During the initial phase of the study, we conducted focus groups to explore factors that influence unmarried women's decisions about cancer screenings. Women were invited to attend one of four group discussions: (1) never married women who either partner with women (WPW) or with both women and men (WPWM), (2) previously married women who now partner either with women (WPW) or with both women and men (WPWM), (3) never married women who partner with men (WPM), and (4) previously married women who partner with men (WPM). Twenty-eight women attended the focus groups, 14 WPW and 14 WPM. Several barriers to screening were consistent across the groups and included lack of acknowledgement and validation in medical settings, administrative barriers, pain, and concerns about body image. WPW specifically discussed fears about discrimination if and when they acknowledge their sexual orientation. WPW also described how women who express their gender androgynously are more likely to avoid health care facilities. Further studies are needed to determine if the themes we identified are consistent among larger samples of unmarried women.

Adult↗

PubMed2002

The effect of a stage-matched and tailored intervention on repeat mammography(1).

BACKGROUND: Our objective was to determine whether a tailored, stage-matched educational intervention, guided by the transtheoretical model (TTM), would increase rates of repeat-screening mammography. DESIGN SETTING/PARTICIPANTS: A total of 1324 women (N=1026 after attrition) aged 50 to 74 years were recruited from a staff-model health maintenance organization. Some of the women were not due for mammograms at the time of recruitment. INTERVENTION: Women were randomly assigned to one of three intervention conditions: Group 1, no educational materials (usual care); Group 2, standard materials; and Group 3, stage-matched/tailored materials. Women in Groups 2 and 3 received a mailed education packet after both a baseline and a follow-up telephone interview. All women in Group 2 received the same materials regardless of differences in baseline mammography-related attitudes and behaviors. Each woman in Group 3 received materials based on her stage of adoption for mammography and TTM constructs. MAIN OUTCOME: Using clinical records, repeat screening was defined as receipt of a second mammogram within 14 months after obtaining an initial postbaseline mammogram. RESULTS: Women in Group 3 were more likely to obtain repeat-screening mammograms than women in Group 1 (44.2% vs 35.8%; adjusted rate ratio = 1.29, 95% confidence interval [CI]=1.11-1.46; adjusted rate difference = 0.06, 95% CI=-0.01-0.13). The screening percentage in Group 2 was intermediate (39.3%), and did not differ from either Group 3 or Group 1. CONCLUSIONS: The effect of the stage-matched/tailored intervention was sustained for repeat screening, although no educational materials were delivered to coincide with the timing for a second mammogram. However, the stage-matched/tailored intervention was not sufficient to have a substantial impact on screening beyond the effect of standard educational materials. Future interventions may need to administer "booster" sessions to increase repeat screenings.

Aged↗

PubMed2002

Unmet needs of primary care patients in using the Internet for health-related activities.

BACKGROUND: Millions of people use the Internet as a source for health information yet little is understood about the use of the Internet for other health-related activities. OBJECTIVE: We conducted the present study to understand, among primary care patients, the interest in and experience with using the Internet for a variety of health-related activities. METHODS: Cross-sectional survey in the setting of 4 community-based primary care practices in Rhode Island. A single self-administered questionnaire included the following: 14 items measuring interest in using the Internet for a variety of health-related purposes, demographics, self-reported health status, and self-reported health care quality. RESULTS: The survey was completed by 300 patients, 109 without access to the Internet and 191 with access to the Internet. Experiences with and attitudes about each of the health-related activities on the Internet varied widely across each activity. Regardless of access, patients were most interested in using the Internet for finding information about diseases and medications. However, patients with Internet access were more interested, compared to those without access, in each of the health-related activities on the Internet. Among patients with access to the Internet, the largest gap between interest and experience (the opportunity gap) was in using the Internet to investigate the quality of their care (eg, "find out if your health care provider was giving you all of the tests and treatments that you are due to have?") and administrative functions (eg, "schedule an appointment with your doctor?"). CONCLUSIONS: Much opportunity remains for developing health-related Internet Web sites to address the unmet needs of primary care patients.

Adolescent↗

PubMedDate not supplied

Variations in influenza vaccination among the elderly.

OBJECTIVES: To identify unique, mutually exclusive population segments whose members share characteristics associated with likelihood of influenza vaccination. METHODS: Data from 30,668 elderly participants in the 1999 Behavioral Risk Factor Surveillance Systems was analyzed using classification and regression tree analysis. RESULTS: Eleven subgroups were identified: Non-Hispanic Blacks and Hispanics with no recent checkup had the lowest prevalence estimate (28.1%), whereas married white persons aged 75 plus with a recent checkup had the highest (80.6%). CONCLUSIONS: Influenza vaccination varies greatly according to preventive medical care use and race/ethnicity, factors that are amenable to targeted outreach efforts.

Aged↗