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Biomedical subjects

W Rakowski

Publications and source records attributed to W Rakowski.

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

Health practice correlates in three adult age groups: results from two community surveys.

Independently done surveys of a target population can make an important contribution to knowledge about the determinants of personal health behavior by highlighting variables that consistently emerge as significant predictors. This investigation examined the correlates of four health practice and knowledge indices related to cardiovascular disease (CVD) in two baseline community surveys of the Pawtucket Heart Health Program (N = 2,413; N = 2,808). An additional dimension was the use of three adult age groups (18-29, 30-49, 50-64) in conducting the analyses. Results of both surveys showed that sex was the strongest correlate of the four indices--knowledge of CVD, encouraging health practice changes in others, dietary intake, and exercise. The four indices related to CVD were also associated with years of education, primary language, and whether or not a recent cholesterol measurement had been obtained, although these relationships were not as consistent as the results for sex. Overall, about half of each survey's significant associations were also found in the other survey (survey 1, 30 of 62; survey 2, 30 of 56). Consistency of significant results between surveys was best for the group ages 30-49. In either survey, it was rare for an association between a predictor and behavioral index to appear in each of the three age groups. This study supports the importance of the subjects' sex in research on personal health practices, suggests the potential for independence even among health-related indices pertinent to a single type of illness, and emphasizes the usefulness of utilizing independent samples to identify important correlates of health behavior.

Adolescent↗
PubMedDate not supplied

Persistence of personal health practices over a 1-year period.

A large amount of research has been devoted to identifying the psychosocial and demographic correlates of personal preventive health practices. An additional factor to consider, however, is the stability of personal health practices over time. At least over short periods, the prediction of current behavior may be substantially improved by having information about an individual's previous performance of the practice being studied. To address this question, data from Wave 1 (1979) and Wave 2 (1980) of the National Survey of Personal Health Practices were examined. Using nine health practices as indices, performance reported at Wave 1 was used to predict performance of that same practice as reported at Wave 2, 1 year later. A two-step analysis strategy was followed to estimate how much more variance could be explained when the behavioral reports were added to a list of psychosocial and demographic predictors. Results showed that over the 1-year interval, the Wave 1 behavioral reports were by far the strongest predictors of their corresponding measures obtained at Wave 2. The explained variance was increased substantially for most of the nine health practices, suggesting a strong tendency for persistence of the practices. Psychosocial and demographic variables tended to account for much smaller amounts of variance and often dropped out of the prediction equation when the Wave 1 behavior report was entered in the second step of analysis. Health practices other than the corresponding Wave 1 index did not improve prediction of the Wave 2 index greatly. The tendency for previous behavior to persist may overshadow the influence of other factors and account for the modest amounts of explained variance that are usually found for psychosocial and demographic indices in cross-sectional surveys. Although stability does not imply rigidity or impossibility of change, the strength of prediction found in these data attest to the "force of habit" that community interventions can encounter.

Adult↗
PubMedDate not supplied

Predictors of health practices within age-sex groups: National Survey of Personal Health Practices and Consequences, 1979.

Health promotion-disease prevention programs share with health behavior research the common objective of identifying population subgroups toward whom services can be targeted. For this report, six age-sex groups were examined to determine similarities and differences in the predictors of eight health practice indices. Data were from the 1979 National Survey of Personal Health Practices and Consequences. Results showed very little similarity of predictors across the three age cohorts (20-34, 35-49, 50-64), between men and women, and among the six age-sex groups. No predictor achieved significance consistently for several health practices in any of the six groups, although years of education made the best showing. The lack of overlap among predictors helps to explain why health promotion messages and recruitment strategies may not appeal to as diverse an audience as initially intended. Possible explanations for the absence of similar predictors include differences in the nature of the various practices themselves, absence of data on intentions behind a person's behavior, and the "over-determined" character of an individual person's behavior.

Adult↗
PubMedDate not supplied

Sodium transport across isolated epithelial structures in vitro--Ledakrin in the liposomes as a moderator of the bioelectric activity of frog skin.

The effect of Ledakrin (an acridine derivative with antineoplastic action), free or liposome-bound, on the bioelectric activity of frog skin was studied by the method of Ussing and it was shown that this activity (being a function of sodium transport) depended on the chemical composition of the liposomes as well as on the calcium content of the experimental medium. Two conclusions have been drawn: 1) the first phase of the response triggered by Ledakrin is due to its action on the cell membrane, 2) the second phase depends on an intracellular mechanism due, probably, to Ledakrin effect on the cytoskeleton.

Action Potentials↗
PubMedDate not supplied

Determinants of breast cancer screening among inner-city Hispanic women in comparison with other inner-city women.

A telephone survey of a random sample of Rhode Island women ages 40 and older residing in minority low-income census tracts--census tracts in the lowest quartile of a variety of socioeconomic indicators in which at least 5 percent of the population was classified as Hispanic or non-Hispanic black--was conducted in 1991, focusing on breast cancer screening. Hispanic women were found to have about half the breast cancer screening rate (20 percent, according to current screening guidelines) of other respondents (37 percent). Determinants of screening were explored to suggest reasons for this difference. The Health Belief Model was used to identify and compare determinants of breast cancer screening (sociodemographics, health care utilization, perceived susceptibility to breast cancer, perceived seriousness of breast cancer, cues to screening such as a provider's recommendation, and the perceived benefits and costs of screening) among Hispanics, non-Hispanic whites, and non-Hispanic blacks. Hispanics were younger, less educated, and had lower family incomes than other women residing in minority low-income census tracts, were less likely to receive medical care, to perceive themselves as susceptible to breast cancer, and to perceive breast cancer as curable. Logistic regression analyses revealed the importance of use of health care, cues for screening, and perceptions of mammography to explain the screening behavior of Hispanics and non-Hispanics alike. Access to medical care is a significant problem in the Rhode Island Hispanic community, related to recent immigration, undocumented immigration, and low income characteristics of its members. Efforts to increase long-term screening for breast cancer in this community should focus on access while paying attention to its unique perceptions of breast cancer.

Adult↗
PubMedDate not supplied

Developing a competency-based preventive medicine curriculum for medical schools.

Trends in patient morbidity and mortality, cost-effectiveness, and national recommendations mandate that we practice more preventive medicine. To address this need, we set out to develop a comprehensive curriculum in preventive medicine for medical schools. We constructed a competency-based (i.e., performance-based) curriculum with specific educational objectives defined by outcomes. Subject areas were subdivided by life stages, and learning objectives were created separately for epidemiology, assessment, and intervention. We hope that adoption of such an educational blueprint by medical schools will measurably enhance the attitudes, knowledge, and skills necessary for the incorporation of preventive principles into all aspects of clinical medicine.

Clinical Competence↗
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Integrating behavior and intention regarding mammography by respondents in the 1990 National Health Interview Survey of Health Promotion and Disease Prevention.

Achieving and maintaining high rates of screening mammography are major public health priorities. This report examines data from the 1990 National Health Interview Survey of Health Promotion and Disease Prevention on the utilization of mammography among women ages 40-75. Results show that progress is being made in some areas--57.7 percent of women "ever had" a mammogram; 50.3 percent, in previous 2 years. However, those not having repeated regular screening appear to be a sizable proportion. Only 28.6 percent of women ages 40-75 had been both screened on the recommended age-specific schedule and expressed an intention to continue screening; another 29.2 percent indicated no intention to have a mammogram in the near future. Income, clinical breast examination, and Pap (Papanicolaou's) test, having no regular source of care, region of the country and residential variables, smoking status, not exercising, not knowing how to do breast self-examination, and race were among the variables having the strongest associations with mammography status. Several groups in the population therefore remain at risk of not receiving regular screening. The combination of mammography status to date and future intention to have the examination provides an important perspective on efforts to reach public health screening objectives and appears to provide a strategy for targeting interventions.

Adult↗
PubMedDate not supplied

Mammography, clinical breast exam, and pap testing: correlates of combined screening.

This study examines the correlates of screening for both breast and cervical cancer combined in a single indicator. Data used were from the 1990 National Health Interview Survey of Health Promotion and Disease Prevention. We used two indices to characterize the receipt of breast and cervical cancer screening among women 50-75 years of age. The first measure compared women who had three screening exams--clinical breast examination (CBE), mammography, and Pap test--in the past two years with those who had not received all three exams. The second measure compared women who had a Pap test and at least one breast screening exam (i.e., mammogram or CBE) in the previous two years with women who were underscreened. Age, level of education, smoking status, and access to health care were associated with both outcome measures. Black women were more likely to use screening services in the office setting (i.e., CBE and Pap), without a corresponding use of mammography. Nevertheless, more black than white women received a routine Pap test in combination with a CBE, a very positive trend with respect to the successful diffusion of at least two screening procedures among older black women. The data suggest that barriers to mammography screening remain even among women who are screened by CBE and Pap. Perhaps the biggest challenge is to educate primary care physicians and their patients to view different components of preventive health--CBE, Pap smear testing, breast self-examination, and mammographic screening--as equally necessary and interrelated. Medical Subject Headings (MeSH): screening, mammography, cervical cancer, Pap, breast exam.

Black or African American↗
PubMedDate not supplied

Breast cancer screening practices among black, Hispanic, and white women: reassessing differences.

INTRODUCTION: We examine racial and ethnic variations in use of screening mammography. We first review recent literature on Blacks', Hispanics', and non-Hispanic Whites' mammography use. Here we extend that body of literature through use of a comprehensive national database and discussion of the implications of race- and nonrace-stratified mammography modeling. METHODS: Data were extrapolated from the 1990 National Health Interview Survey. Using the Transtheoretical Model as a conceptual guide, we derived a women's stage of mammography adoption by integrating screening history with intention to have a future mammogram. The outcome variables included (1) not being screened at regular intervals and (2) not intending to have a mammogram in the future. Analyses were stratified by three groups: Blacks, Hispanics, and non-Hispanic Whites. RESULTS: The results from the multiple logistic regressions demonstrate that race continues to be a factor influencing mammography use. Across all three groups, women who reported less regular cancer screening by clinical breast exam (CBE), Pap smear testing, or breast self-examination were less frequent users of mammography. However, the magnitude of the associations varied for the groups being compared. The findings also demonstrate that there were unique factors associated with not being screened routinely and not intending to have a mammogram in the future for all three racial/ethnic groups. CONCLUSIONS: Researchers must give explicit attention, both empirically and methodologically, to how race and ethnicity interact with sociodemographic factors, health practices, and access to health care to refine our understanding of barriers to breast cancer screening. Common barriers to routine screening may be perceived differently by Black, Hispanic, and White women and may contribute to underuse of mammography in distinct ways.

Adult↗
PubMedDate not supplied

Cancer screening practices among women in a community health center population.

BACKGROUND: Cancer takes a disproportionate toll on disadvantaged Americans. Poverty and low education are risk factors for underuse of cancer screening. METHODS: In this report, we discuss predictors of adherence to cancer screening (mammography, clinical breast exam [CBE], and Pap tests) among 926 women who receive care at a community health center that serves a predominantly low-income and minority population. We examine predictors for each of the tests and for a composite measure of overall cancer screening test compliance. In studying multiple screening behaviors we not only investigate factors associated with each individual behavior, but we also identify consistently effective factors across several behaviors. RESULTS: The analysis indicates consistent effects of age, education, and insurance status on cancer screening. In addition, decisional balance, a measure of a person's beliefs about the pros and cons of complying with the screening test, is associated strongly with adherence. We have extended earlier findings about the positive relationship between decisional balance and mammography to include decisional balance and Pap tests, as well. This finding suggests that behavioral interventions that target decisional balance can effectively promote adherence to cancer screening tests.

Adolescent↗