Biomedical subjects

R A Hiatt

Publications and source records attributed to R A Hiatt.

94 records · Page 6Linked to original sources

PubMedDate not supplied

Behavioral research contributions and needs in cancer prevention and control: adherence to cancer screening advice.

BACKGROUND: Research has been critical in understanding human behavior related to the early detection of cancer. METHODS: Based on the literature and the author's experience, this paper reviews behavioral research accomplishments in the past decade and needs for the future. RESULTS: Accomplishments have included an improved understanding of the barriers to screening, methods to improve the provision of tests by practitioners, and progress in the development and application of community interventions. Outstanding needs are summarized in 12 areas that include a continued focus on underserved populations and an examination of the use of screening tests in the presence of incomplete evidence of efficacy, translational research that explores the behavioral consequences of genetic susceptibility testing, continued development and use of computer-based technologies in the delivery of preventive services, and studies of the potential negative consequences of screening. Critical changes in the delivery of health care in the era of managed care call for increased behavioral research in health services and health care policy. CONCLUSION: Although this review of research needs is not exhaustive, it is clear that the challenges and opportunities for behavioral research are substantial, and this effort will be a critical part of the overall national research agenda for cancer control.

Community-Institutional Relations↗

PubMedDate not supplied

Assessment of schistosomiasis in the Dominican Republic.

Active transmission of intestinal schistosomiasis is currently limited to the southeastern part of the Dominican Republic. A population-based stool survey in 1980 detected 4 asymptomatic individuals among 114 selected at random in 2 towns and a rural community in El Seibo Province. The distribution of the transmitting snail, Biomphalaria glabrata, considerably exceeds that of Schistosoma mansoni, extending to the National District and capital city of Santo Domingo and well into certain central valley provinces. There is evidence that transmission sites have shifted during the past three decades because of urban development, molluscicidal activities and, perhaps, introduction of competing mollusks. In spite of intermittent control activities, the combination of domestic and recreational use of streams with consequent fecal contamination, and the extended distribution of B. glabrata indicates that the potential for new transmission foci is as great today as it was 10 years ago. This potential transmission of S. mansoni is a continuing threat to public health in the Dominican Republic.

Adolescent↗

PubMedDate not supplied

Dipstick urinalysis screening, asymptomatic microhematuria, and subsequent urological cancers in a population-based sample.

Screening urine for microhematuria as an indicator of serious disease is controversial because of the low positive predictive value of such screening and the costs and risks of the associated evaluation. To further evaluate test properties, we retrospectively examined the outcomes of 20,571 men aged > or = 35 years and women aged > or = 55 years who voluntarily had a Personal Health Appraisal in 1980 as members of a large prepaid health plan. Hematuria was detected by dipstick in 876 cases (4.3%); 278 were excluded because of evidence of previous urological disease which could cause hematuria. Review of the medical records of 598 patients with asymptomatic microhematuria as shown by a positive dipstick result indicated that 99% had a follow-up evaluation within 3 months of positive test results for hematuria and had various levels of urological evaluation thereafter. However, urological cancers (2 prostate, 1 bladder) developed in only 3 patients within the next 3 years. On the basis of San Francisco-Oakland Surveillance, Epidemiology, and End Results program data, rates of urological cancer were evaluated among patients whose test results were negative for hematuria, and these cancer rates were found to be almost the same as the rate among patients with asymptomatic microhematuria. Sensitivity of a single dipstick urinalysis result using microhematuria to indicate urological cancer within 3 years was 2.9%; specificity was 96.7%; and positive predictive value was 0.5%. Multivariate analysis which adjusted for age, gender, and race showed that the relative risk of 2.1 (95% confidence interval, 0.7-6.6) for urological cancer was not significantly elevated among patients with asymptomatic microhematuria compared with patients who had negative test results. These findings based on a single test are consistent with the current lack of recommendations for screening for microhematuria among asymptomatic adults.

Adult↗

PubMedDate not supplied

The effect of patient and provider reminders on mammography and Papanicolaou smear screening in a large health maintenance organization.

BACKGROUND: We evaluated the effectiveness of 2 reminder interventions to increase the use of screening mammograms and Papanicolaou (Pap) smears among female members of a large health maintenance organization. METHODS: Seven thousand seventy-seven female health maintenance organization members (aged 50-74 years with no prior mammogram in the previous 30 months or aged 20-64 years with no prior Pap smear in the previous 36 months) were randomized to receive one of the following: a letter inviting them to make an appointment for a mammogram or a Pap smear; in addition to the letter, a reminder manually placed in the patient's medical chart alerting providers of that member's need for screening; or their usual care. RESULTS: Compared with women who did not receive the reminder letter, women who did receive the letter were more likely to obtain mammograms (16.0% vs 25.5%, respectively; P < .001) or Pap smears (9.1% vs 19.5%, respectively; P < .001) in the 6 months following their entry into the study. Compared with women who received only the reminder letter, women who received a reminder letter and had a reminder placed in their medical chart were more likely to obtain mammograms (26.5% vs 30.9%, respectively; P = .02) and marginally more likely to receive Pap smears (19.5% vs 22.8%, respectively; P = .04). CONCLUSIONS: We recommend the use of patient reminder letters as a first step in a mammography or Pap smear screening outreach program. Further research is needed to evaluate a cost-effective provider reminder system and additional outreach strategies directed to women who do not use health care services.

Adult↗