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Validation of an asthma knowledge questionnaire.

Asthma is responsible for much morbidity and mortality, which might be decreased by increasing parental and patient knowledge about asthma. This report describes the development and validation of an asthma knowledge questionnaire for use in the assessment of asthma knowledge. Two groups of respondents were examined. One group was designated 'high knowledge' and the other 'low knowledge'. The questionnaire had a maximum possible score of 31. The mean score of 69 'high' knowledge parents was 25.3 (median 25, range 18-31). By contrast, the mean score of 69 'low' knowledge parents was 13.0 (median 13, range 0-21). The difference between the two groups was statistically significant (P less than 0.0001). The questionnaire results were reproducible (tau = 0.94, P less than 0.01). Demographic characteristics such as education and socio-economic status were not important confounding variables. Face and content validity of the questionnaire were based on reference to published experience. Concurrent validity was demonstrated by the ability of the questionnaire to distinguish low from high knowledge parents. The questionnaire should prove to be a valuable research tool for the assessment of asthma knowledge either as part of an educational intervention or in a clinical situation.

Asthma↗

Knowledge and beliefs about common eye diseases.

PURPOSE: To ascertain the level of knowledge of common causes of blindness in an adult Australian population and to relate this to use of eye care services. METHODS: A population-based study of common eye diseases in an urban population aged 49 years or older was conducted. The questions were concerned with the awareness and knowledge of and the ability to describe three common eye diseases, namely cataract, glaucoma and age-related macular degeneration (AMD). RESULTS: Awareness of cataract (98%) and glaucoma (93%) were high in this population, but awareness of AMD was low (20%). Among people who were aware of the target eye disease, only 29% showed some knowledge of glaucoma, 26% showed some knowledge of AMD and 20% showed some knowledge of cataract; this was also low in people who had previous eye treatment, such as cataract surgery. Knowledge was related to education level, occupational prestige and knowledge of other eye diseases. After excluding people with a previous eye disease diagnosis, those people who were aware and had some knowledge of eye disease accessed eyecare services more frequently. CONCLUSIONS: Knowledge of common eye diseases is generally lacking. Age-related macular degeneration is the leading cause of blindness in Australia, yet only 20% of the present study population had heard of it. As there are often no early symptoms for glaucoma, community awareness of this disease and the need for screening of people at risk may allow timely diagnosis and more effective therapy before advanced visual field loss has occurred. An informed public is more likely to present earlier with visual symptoms before irreversible visual loss has occurred and is more likely to comply better with recommended therapy.

Adult↗

Knowledge and attitude of Jordanian school health teachers with regards to emergency management of dental trauma.

The purpose of this study was to assess, by means of a self administered structured questionnaire, the level of knowledge of school health teachers in northern Jordan with regards to the immediate emergency management of dental trauma. The questionnaire surveyed teacher's background, Knowledge of management of tooth fracture, avulsion, and loss of consciousness, it also investigated teacher's attitudes, and self assessed knowledge, as well as knowledge of availability of emergency services in Jordan. The sample consisted of all school health teachers in northern Jordan (220) who attended an oral health education course held by the Jordanian dental association. Only 190 were included in the survey. Sixty-three percent were females, 44% were in their twenties, and 43% in their forties. Their school health teaching experience ranged from 1 to 7 years. Only 20% were officially trained in school health. Less than half of the teachers received first aid training only once in their teaching career, not necessarily as part of school health training. Only 10 teachers were trained in dental first aid, and more than half had a previous experience with handling dental trauma in children. Overall the teachers' knowledge with regards to the emergency management of the trauma cases presented in the report was deficient. Chi-square test showed that, the difference in their responses to the knowledge part of the questionnaire was not statistically significant with regards to age, gender, years of teaching experience, first aid training, or number of seen trauma cases. Generally, the attitude was positive, most teachers wanting further education on the topic, however those who were trained in first aid, thought they were able to give proper action when needed in cases of trauma (P = 0.026). Most teachers were unsatisfied with their level of knowledge, and only 30% knew of the availability of after hour emergency services for dental trauma. The present report indicated the gross lack of knowledge among school health teachers with regards to dental trauma emergency management. Educational programs to improve the knowledge and awareness of this group of adults, who are usually the first line of advice in case of dental trauma in schools, are mandatory. These programs should be properly designed to insure that proper information is retained with a positive effect on attitude, and self assessed competence.

Adult↗

Knowledge of Brazilian general dentists and endodontists about the emergency management of dento-alveolar trauma.

The purpose of this study was to determine Brazilian dentists' knowledge of emergency management of dento-alveolar trauma. A two-part questionnaire containing questions on demographic data and knowledge were mailed to 230 general dental practitioners (GDPs) and 70 endodontists. Questionnaires were returned by 42.6% of the GDPs and 62.8% of the endodontists. The survey data were statistically analyzed using Mann-Whitney U-test for practitioners' knowledge and Pearson's correlation coefficient for association between knowledge scores and practitioner age or years since graduation. The mean knowledge score of endodontists was significantly greater than for GDPs (P<0.0001). Dentists with trauma experience in their practices and those who had attended postgraduate courses on dental trauma had a significant higher mean knowledge score. In contrast, there was a poor correlation between the knowledge score and the ages of the respondents (r=0.086) or the years since graduation (r=0.108). In conclusion, this survey showed a poor knowledge of dental trauma management among the surveyed dentists and highlights the need to develop strategies to improve the knowledge base in this area of dentistry for the benefit of the dental trauma patient.

Adult↗

Investigation of the variables that impact upon the knowledge of cardiac risk factors.

OBJECTIVE: Awareness of cardiac disease risk factors is required before they can be modified. The present study aimed to investigate risk factor knowledge and the variables that impact upon this knowledge. METHODS: We undertook an analytical, cross-sectional survey of 226 patients attending an ED. Patients were asked to recall as many cardiac risk factors as possible and to rate the risk of nine given risk factors. Data relating to sources of risk factor information were collected. Uni- and multivariate (multiple linear regression) analyses determined variables that impacted upon the risk factor knowledge score. RESULTS: Mean patient age was 60.2 +/- 15 years, 55.3% (95% confidence interval 48.6-61.9) were male and 19.9% (95% confidence interval 15.0-25.8) had known cardiac disease. The mean risk factor knowledge score of 2.5 +/- 1.5 out of a possible 12 (median 3) was indicative of poor knowledge. Smoking, poor diet and stress/worry/tension were the most common factors reported. Variables impacting significantly on the knowledge score were English as a first language (P < 0.001), age (negative correlation, P < 0.001) and the receipt of information relating to cardiac health (P < 0.001). The patients' general practitioner and the media were the most important sources of information. CONCLUSIONS: Patients' knowledge of cardiac risk factors is generally poor and education strategies are indicated. At the individual level, the general practitioner is likely to remain as an important influence on knowledge. However, complementary media education programs are indicated at the community level. Patient subgroups at 'high risk' through poor knowledge should be specifically targeted.

Coronary Disease↗

Labelling and patient knowledge of dispensed drugs as quality indicators in primary care in Botswana.

OBJECTIVES: To assess the quality of dispensing and patient knowledge of drugs dispensed in primary care in Botswana. SETTING: Thirty randomly assigned primary healthcare facilities in three districts of Botswana. PARTICIPANTS: Patients visiting clinics and health posts. DESIGN: Analysis of data from prospective participative observations of the drug dispensing process and interview of patients about their knowledge of drugs received immediately after dispensing. The quality of drug labelling was assessed by calculating mean labelling scores composed of five dispensing attributes: name of patient, and name, strength, dosage, and volume of the drug (incorrect or no labelling=0, 1 point for each correct labelling attribute; maximum score=5). Mean knowledge scores were obtained immediately after dispensing from patient recall of name and dosage of drug, duration of treatment, and reason for prescription (incorrect recall=0, 1 point for each correct recall attribute; maximum score=4). RESULTS: 2994 consecutive patient consultations were analysed. The mean labelling score was 2.75. Family welfare educators and pharmacy technicians scored highest (3.15 and 2.98, respectively) and untrained staff lowest (2.60). Factors independently associated with the labelling score were analgesics v other drugs, district, health posts v clinics, education of prescriber (nurse best), and years of experience of prescriber (4-11 years best). The mean patient knowledge score was 2.50. The reason for prescription of the drug(s), dosage, duration of treatment, and name of the drug(s) was recalled by 92%, 83%, 44%, and 31% of patients, respectively. The qualification level of the dispenser was the strongest factor independently associated with the knowledge score. Antibiotics had the second lowest score, both for labelling (2.39) and patient knowledge (2.39). CONCLUSION: Only trained dispensing staff provided satisfactory quality of labelling. Patients had a fair knowledge of the drugs dispensed. The knowledge of drugs dispensed by family welfare educators was less than satisfactory. The labelling score is a useful indicator of the quality of dispensing, and the knowledge score of both the quality of prescribing and of dispensing. These indicators should be added to the WHO list of patient care indicators.

Adolescent↗

The correlation between nutrition knowledge and eating behavior in an American school: the role of ethnicity.

The purpose of this study was to examine the relationship between nutrition knowledge and eating behavior of a sample of middle school children. The participants were 532 students in the sixth, seventh, and eighth grades from Shawnee Middle School in Lima, Ohio. The students were asked to a complete a questionnaire (CANKAP--Comprehensive Assessment of Nutrition Knowledge, Attitudes, and Practices), which measured nutrition knowledge and eating behavior, and is reproduced here. The data were coded and computer-analyzed using the SAS statistical program for analysis by frequency distribution, one-way analysis of variance, Pearson Correlation Coefficients. Data analysis provided the following results: Mean nutrition knowledge scores of sixth grade students (68.4) were higher than mean nutrition knowledge scores of seventh and eighth grade students (58.5 per cent). The relationship between nutrition knowledge and eating behavior was insignificant for sixth grade students, but significant for seventh and eighth grade students. Also, "Caucasians" had higher mean knowledge scores than "Other" ethnic groups combined. The students demonstrated knowledge about the cultural and psychological aspects of nutrition. However, they were not able to identify the food sources of nutrients or nutrient functions, and they did not use a daily food guide to choose foods, although they were aware of the importance of milk and vegetable consumption. Knowledge about nutrition and healthy eating behavior appears to be weak within this group, and it would be beneficial to promote a nutrition curriculum for students in middle schools.

Adolescent↗

Knowledge, attitude and practice regarding organic solvents among printing workers in Hong Kong.

To find out the prevalence of good knowledge, appropriate attitude and safe practice among printing workers exposed to organic solvents in Hong Kong, and to see if safe practice was influenced by the knowledge of and the attitude towards the harmful effects of organic solvents as well as other factors. The survey was conducted in a sample of 501 male printing workers from 28 factories in Hong Kong. The knowledge of and attitude towards the harmful effects of organic solvents, as well as the good practices adopted by the workers when handling solvents were explored using a questionnaire. Multiple logistic regression analysis was conducted to identify the major factors that influenced the knowledge, attitude and practice of workers. The prevalence of good knowledge, appropriate attitude and safe practice was low, being 20.4%, 38.4% and 22.0% respectively. Good knowledge was positively associated with awareness of the relevant legislation and past drinking behavior and negatively associated with current smoking. Appropriate attitude depended on having good knowledge and younger age. Safe practice did not depend on knowledge and attitude, but was positively associated with being informed of safety precautions and being supplied with chemical information by supervisors. The majority of workers believed that their employers, the Government and other statutory bodies should be responsible for providing information on chemicals, but very few of them actually obtained information from these sources. More workers preferred publications and talks rather than television as the means of obtaining further knowledge on chemicals. Front line supervisors have a pivotal role to play in improving safe practices of workers by informing them of the necessary precautions and supplying the relevant chemical information.

Adolescent↗

Knowledge on the Haemophilia Care Among Healthcare Providers in Tanzania: A Multicenter Cross-Sectional Study.

BACKGROUND: Haemophilia is a rare inherited bleeding disorder associated with recurrent bleeding, disability, and mortality when diagnosis and management are delayed. In low- and middle-income countries, limited diagnostic capacity, access to treatment and gaps in Healthcare Providers' (HCPs') knowledge are major contributors to morbidity and mortality. In Tanzania, the recent improvement in haemophilia services highlights the need for systematic evaluation of HCPs' knowledge and clinical practices. OBJECTIVE: The study assessed the knowledge of haemophilia care among healthcare providers in Tanzania. METHODS: A multicenter hospital-based cross-sectional study was conducted among HCPs in tertiary and regional hospitals in Tanzania. A structured self-administered questionnaire assessed knowledge on haemophilia, including the pathophysiology, clinical features, diagnosis, treatment, and complications. Data were analyzed using IBM SPSS statistics version 27. RESULTS: Among 799 HCPs assessed (50.9%) aged 20-29 and (59.2%) males. Nurses were the majority (31.8%), and 75.2% had &#x2264;5 years' experience. Overall haemophilia knowledge was high (median 83.3%, IQR: 75.9-88.9), strongest performance in general knowledge and weakest in treatment (68.2%, IQR: 54.5-77.3). Most respondents identified haemophilia as inherited (95.6%), non-infectious (93.7%), and recognized prolonged bleeding after injury or circumcision as key-symptoms (>90%). Knowledge varied by cadre, department, and experience (p<0.05); physicians and specialists scored higher than nurses, while health attendants scored lower. CONCLUSION: Healthcare providers demonstrated fairly adequate general knowledge of haemophilia. However, gaps remain in understanding genetic inheritance, acquired haemophilia, and modern treatment strategies, with knowledge variation by cadre, department, and experience, highlighting the need for targeted education across all HCPs groups.

Tanzania↗

University students and AIDS: knowledge, attitudes and behavioral adjustment.

This study addresses the relations between AIDS-related knowledge, attitudes, and behavior change among university students. A questionnaire covering such issues and personal background variables was administered to 750 students at the University of Zagreb. Over-all, 62.7% of the knowledge items were answered correctly, while functional, self-protective aspects of knowledge proved to be much better than general knowledge. On the average, attitudinal responses were moderately liberal. Both self-reported change in risk-reduction behavior and personal concern due to the appearance of AIDS were very small. Correlations of risk-reducing behavior with permissive (.15) and restrictive (.14) attitude orientations and with general and functional knowledge (.08) were modest. The level of personal concern correlated neither with permissive attitudes nor with functional knowledge, while it correlated negatively with restrictive attitudes (-.20) and with general knowledge (-.08). Substantial association was only established between functional knowledge and permissive (.51) and restrictive attitude orientations (-.23). It is concluded that, in addition to knowledge and attitudes, a number of factors which restrain desired behavioral adjustment should be considered in anti-AIDS campaigns, such as perceived level of exposure to HIV in a particular environment, young age-specific illusion of invulnerability, peer norms, and others.

Acquired Immunodeficiency Syndrome↗

A knowledge-resonance (KRES) model of category learning.

This article introduces a connectionist model of category learning that takes into account the prior knowledge that people bring to new learning situations. In contrast to connectionist learning models that assume a feedforward network and learn by the delta rule or backpropagation, this model, the knowledge-resonance model, or KRES, employs a recurrent network with bidirectional symmetric connection whose weights are updated according to a contrastive Hebbian learning rule. We demonstrate that when prior knowledge is represented in the network, KRES accounts for a considerable range of empirical results regarding the effects of prior knowledge on category learning, including (1) the accelerated learning that occurs in the presence of knowledge, (2) the better learning in the presence of knowledge of category features that are not related to prior knowledge, (3) the reinterpretation of features with ambiguous interpretations in light of error-corrective feedback, and (4) the unlearning of prior knowledge when that knowledge is inappropriate in the context of a particular category.

Animals↗

[Pitfalls in 'orthodox knowledge'].

Within contemporary society both 'pseudoscience' and 'pseudomedicine' can be found. Such knowledge is seen as incorrect, wrong or irrational. I call them 'unorthodox (uncertain) knowledge'. Conversely, 'orthodox knowledge'--for example, science, medicine, etc.--is seen as correct, right or rational. Some people believe 'unorthodox (uncertain) knowledge'. Experts castigate such people from the standpoint that they lack the basic understanding of 'orthodox knowledge'. That is, experts see the ordinary lay person as subjective, ignorant or irrational (whereas they see themselves as objective, analytical, prudent or rational). But are people ignorant or irrational? The aim of this paper is to examine this question in terms of analyzing the interplay among the characteristics of 'orthodox knowledge', 'unorthodox (uncertain) knowledge' and the nature of people's concerns. Thus, this paper explains that people develop certain situated understandings of 'orthodox knowledge' and/or 'unorthodox (uncertain) knowledge' through their intensive experiences. Also, this paper suggests that people need to rethink or reflect on the good institutions which mediate between people and experts.

Aged↗

Knowledge of hypoglycemia by primary health care centers registered diabetic patients.

OBJECTIVE: To assess the knowledge of diabetic patients about symptoms of Hypoglycemia, and the variables that may be associated with that knowledge. METHODS: A cross-sectional study of 1039 diabetic subjects, registered in the urban and rural primary health care centers of Makkah. The tool of data collection was a structured questionnaire. The parameters of the study were lack of knowledge about hypoglycemia measured as knowledge of individual symptoms; and the proportions of patients with poor knowledge score. RESULTS: The frequency of lack of knowledge of symptoms of hypoglycemia was around 50% of subjects. Two-third of subjects had a poor knowledge score. Main variables significantly associated with poor knowledge score were male gender (P < 0.001), low education (P < 0.0001), non-compliance with treatment (P < 0.02), and lack of knowledge about hypoglycemia (P < 0.00001). CONCLUSION: There is a need for health education of diabetic subjects about symptoms of hypoglycaemia, in order to deal with it in an effective way.

Adolescent↗

Knowledge and practice of breast cancer screening amongst public health nurses in Singapore.

AIM OF STUDY: The study aimed to examine the knowledge and practice of breast cancer screening amongst Public Health nurses who are patient educators. METHOD: A self-administered questionnaire was sent to all 447 nurses in the Public Health Service to assess their knowledge and practice of breast cancer screening. Response rate was 96.4%. Knowledge scores ranged from 0-17 with one point given to a correct knowledge question, zero for wrong answer. RESULTS: Median knowledge score was nine and 58.3% of nurses scored > or = 9. Statistically significant factors influencing knowledge scores were related to the nursing profession, namely nursing qualifications, current nursing post and current workplace. 76.2% of Nursing Officers/Higher Nursing Officers and 74.5% of midwives had knowledge scores > or = 9 compared with 57.3% of staff nurses and 40.8% of assistant nurses (p < 0.01). 60.1% of nurses who were taught breast-self examination scored > or = 9 (p < 0.05). As for practice, 93.7% of nurses did breast-self-examination, 54.1% had clinical breast examination in the past one year and 50.2% had mammogram done. On multivariate analysis, significant factors affecting practice of clinical breast examination were marital status (Prevalence Rate Ratio 1.94, 95% Confidence Interval 1.20-3.15), doctor's gender (PRR 1.35, CI 1.04-1.75) and those affecting mammogram were age group (PRR 1.78, CI 1.27-2.48), marital status (PRR 1.63, CI 1.03-2.59), history of breast disease (PRR 1.51, CI 1.06-2.16). CONCLUSIONS: The majority of nurses had certain misconceptions in the knowledge of breast cancer and breast cancer screening. A higher proportion of nurses in the Family Health Service had higher knowledge scores than other nurses in the Public Health Service. Most of the nurses did breast-self-examination. Having ever married and the availability of a female doctor influenced the nurses attending clinical breast examination. Nurses who were > or = 50 years old, ever married and those with a positive history of breast disease were more likely to have mammography done.

Adult↗

Knowledge and practice of eye-care among leprosy patients.

In one hundred and thirty leprosy patients attending the Schieffelin Leprosy Research and Training Center, Karigiri, Tamil Nadu, India, the knowledge, attitude and practice of eye-care were ascertained using a questionnaire developed by Mathews & Mangalam. 74.6% the patients surveyed were aware of the disease, 60% knew about the early signs of leprosy, 74.6% considered leprosy curable and 36.9% knew the duration of treatment with MDT. Less than half of the patients (40.8%) knew that blindness occurred in leprosy and was preventable. More males had this knowledge (46.5%) than females (22.6%) (P = 0.001). Knowledge on how to take care of the eyes (26.9%), that eyes become anaesthetic due to leprosy (27.7%), and that precautions should be taken if sensation is lost (27. 7%) was very poor. Knowledge on prevention of damage in eyes (57.7%) and the fact that rubbing eyes could cause damage (55.4%) was found in more than half the patients. More males (64.6%) had knowledge on the prevention of damage in eyes than females (35.5%) (P = 0.008). Only 25.4% of the patients tried some measures to prevent eye injury, 21.5% used home remedies and all had the help of family members in their eye-care. More males (26.3%) used home remedies than females (6.5%). The older age group had better knowledge on taking care of the eyes than those aged 40 and below (P = 0.026). Although more patients with existing complications knew to take care of their eyes than those who did not have complications, the knowledge and practice of eye-care in both these groups were poor. Knowledge of leprosy in illiterate patients was not different from those who had some formal schooling, but the practice of eye-care differed significantly (P = 0.02). Health education must be undertaken to increase the knowledge of eye-care among leprosy patients, especially among illiterate persons, women and younger patients.

Adolescent↗

Parental asthma knowledge.

UNLABELLED: Asthma knowledge an important components of asthma education. OBJECTIVE: To determine the levels of asthma knowledge in parents of asthmatic children and factors that may influence it. METHODS: This is a prospective study done between March 1998 and July 1998. Sixty-seven parents were interviewed using the 31 item asthma knowledge questionnaire that had been validated and translated. The children' asthma severity was classified. The questionnaire includes bio-data of children and parents, types of medication and dosages duration of asthma, exposure to cigarette smoke, acute asthma admissions, and parent's economic status. RESULTS: The mean score for asthma knowledge was 15.5. The total score was 31. Asthma knowledge was significantly higher in parents whose children were using steroids [p = 0.03, CI (-3.58, -0.02)]. It correlated significantly with steroid dosage (r = 0.29, p = 0.02), and was significantly higher in parents of higher economic status. Parent's asthma knowledge had no association with children's asthma status, age of the child or parents, exposure to cigarette smoke, frequency of admission or asthma duration. CONCLUSION: The low asthma knowledge level indicates the need to increase the effort in educating parents. The main indicator for higher knowledge was steroid usage and dosage. Higher asthma knowledge in the high-income group was probably related to levels of education.

Adolescent↗

[Pregnant women's knowledge about HIV and AIDS].

This investigation is based upon information from 820 pregnant women who replied to a questionnaire about AIDS during the period 17.4.1989-14.7.1989. The questions included sources of information, knowledge about routes of infection and risk groups and the extent of spread of infection and disease in the population. 95% agreed to participate. Knowledge had been obtained primarily via the electronic media, while the health services had limited significance. The employment of sources of information depended on age and occupation. Apart from knowledge about the risk involved in breast feeding, the women were, in general, well informed about routes of infection. Knowledge about risk groups and the current extent of spread of infection was, on the the other hand, deficient. Defective knowledge was concentrated in groups which may be characterized by age (less than 24 years) and occupation (trained and untrained workers and the group of "other occupations"). Information obtained from health staff was connected with better knowledge about the extent of spread of infection. The majority of women desired routine information about AIDS in connection with antenatal control. Prophylactic measures should be based, among other things, on knowledge about development in the knowledge in the population and its employment of sources of information, so that specific information may be directed to certain groups of the population by using the most frequently employed and most effective routes of information. The knowledge of population groups, the attitudes and behaviour should be followed continuously.

Acquired Immunodeficiency Syndrome↗

Barriers to colorectal cancer screening: inadequate knowledge by physicians.

BACKGROUND: The rate of colorectal cancer (CRC) screening remains relatively low. One potential barrier to higher rates is the lack of physician knowledge regarding CRC screening. The purpose of this study was to assess physicians' knowledge of (a) American Cancer Society (ACS) CRC screening guidelines for average-risk and high-risk patients, and (b) general colorectal cancer facts which support these guidelines. METHODS: We administered a questionnaire to internal medicine residents, internal medicine attendings and medical students who provide care to patients in a low-income, predominantly minority community, to compare their levels of knowledge regarding CRC screening. Mean knowledge scores were calculated based on the number of correct responses. RESULTS: Knowledge of ACS guidelines for average-risk patients was low, although it did increase directly with level of training: medical students obtained a mean score of 32%, residents 49%, and attendings 56% (p<0.001). Knowledge scores for high-risk patients were even lower, with fewer than half of the respondents offering correct answers. Mean knowledge scores of general CRC screening facts increased with level of training: medical students scored 31%, residents 38% and attendings 42% (p<0.001). CLINICAL IMPLICATIONS: Knowledge of CRC screening guidelines for both average- and high-risk patients was suboptimal among the medical students, residents and attendings studied. Lack of knowledge about CRC is one barrier to screening that may contribute to underutilization of screening for minority populations. Further educational efforts should be targeted to these health care professionals.

Adult↗