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PubMed1995

Perceived concerns of pregnant women with breast cancer treated with chemotherapy.

PURPOSE/OBJECTIVES: To identify concerns of women who had received chemotherapy for breast cancer while pregnant. DESIGN: Exploratory, descriptive, retrospective pilot study. SETTING: Large cancer center in the Southwestern United States. SAMPLE: Six women (mean age of 35.5 years) who had been treated for breast cancer while pregnant within the previous five years. METHODS: Mailed survey using a demographic form and the Bandyk Concerns Questionnaire--a 30-item Likert-type scale. MAIN RESEARCH VARIABLES: Concerns about the effects of breast cancer treatment on the pregnancy and the fetus. FINDINGS: The primary concern was "living to see my child grow up." Of least concern was "other people's opinion of me." CONCLUSIONS: Although an informational pamphlet was written based on these results, more extensive examination of the special group of patients is needed to draw any conclusions. IMPLICATIONS FOR NURSING PRACTICE: Nurses are in a good position to offer accurate information to women who must make the choices involved with receiving chemotherapy during pregnancy and to support the women during and after the treatment and the child's birth.

Adult↗
PubMedDate not supplied

Community-based breast cancer intervention program for older African American women in beauty salons.

African American women are at high risk for morbidity and mortality from breast cancer. African American women ages 50 and older have been a difficult group to reach through conventional breast cancer intervention programs. Cultural and health beliefs that differ from mainstream society are reported to be factors contributing to the low rates of breast screening among this group. In addition to these attitudinal factors, older African American women are disproportionately represented among uninsured and under-insured Americans. As a result, cost becomes a barrier to mammography screening for many of these women. This project proposes to increase breast cancer screening awareness and provide a referral or free breast screening, or both, for African American women ages 50 and older. This information will be offered in the culturally familiar setting of local beauty salons. The culturally sensitive educational pamphlets developed by the National Cancer Institute (NCI) and video developed by the NCI-funded project, Cancer Prevention Research Unit, will be used to promote mammography, clinical breast examinations, and breast self-examination. Providers staffing a mobile mammography van provided by Dr. Anitha Mitchell of the Association of Black Women Physicians through a grant from the Breast and Cervical Cancer Control Program, funded by the Centers for Disease Control and Prevention, will perform mammograms for women on site during scheduled intervals. A followup telephone survey will be conducted.

Black or African American↗
PubMed1995

Impact of environmental patient education on preventive medicine practices.

BACKGROUND: Studies show that provider-oriented reminders alone are less effective at increasing physician compliance with prevention guidelines than are combinations of patient- and provider-oriented physician reminders. The effectiveness of environmental patient education (ie, office-based videos, pamphlets, and posters) without individual staff or educator involvement has not been well established. The objective of this study was to evaluate the effectiveness of environmental patient education in increasing the amount of preventive services patients receive. METHODS: A nonrandomized controlled trial using historical controls was conducted in a model family practice clinic at the University of New Mexico School of Medicine in Albuquerque. The study group (n = 389) included adult women who had been seen at the clinic at a time when educational materials were present in the waiting area. The control group (n = 381) were similarly selected patients seen during the same period of the previous year, when no such materials were available. During the intervention, patients in the waiting area were exposed to educational materials that encouraged them to ask their physicians about cholesterol testing, Papanicolaou (Pap) smears, tetanus boosters, and mammograms. For both the control and study groups, physician orders for preventive services were monitored over a 4-month follow-up period by reviewing medical records. RESULTS: There were no statistically significant changes in the number of cholesterol tests, Pap smears, tetanus boosters, or mammograms ordered after the environmental patient education intervention, despite adequate statistical power. CONCLUSIONS: Environmental patient education materials were not effective in increasing the amount of preventive services performed by physicians in this study. Although such interventions are inexpensive, easily comprehended, and well intended, they may be ineffective in increasing the performance of patient preventive services.

Adult↗
PubMedDate not supplied

Health care settings as resources for parenting information.

In research designed to investigate and develop health care settings as resources for parenting information, 82 physicians' waiting rooms were surveyed. Less than a third of the waiting rooms surveyed provided any parenting information, but a majority of physicians agreed to display parenting pamphlets for a trial period. All found them useful to their patients, wanted more, and are continuing to display them on an ongoing basis. Providing parenting information like this is a simple intervention in aid of families that nurses could initiate in a variety of health care settings.

British Columbia↗
PubMedDate not supplied

A modification of anti-streptolysin-O-test.

In this short communication, we have suggested a simple and economic method of performing ASOT. It is a simpler method than that previously recommended by the Wellcome Reagents Limited, in their pamphlet. It requires only 0.05 ml. of the patient's serum and also smaller quantities of all reagents. This reduces the cost of each investigation considerably.

Antistreptolysin↗
PubMed1995

Diet modification in lowering plasma cholesterol levels. A randomised trial of three types of intervention.

OBJECTIVE: To compare the efficacy of three types of diet and lifestyle interventions for lowering plasma lipid levels. DESIGN: Randomised parallel-group trial. SUBJECTS AND SETTING: Adults with plasma cholesterol levels of 5.5-8.0 mmol/L attending two Sydney community health screening clinics were asked to participate: 179 agreed and 131 completed the study. INTERVENTIONS: A pamphlet with brief advice; group dietary counselling; or individual counselling. Counselling included three sessions with a dietitian/nutritionist over six months. MAIN OUTCOME MEASURES: Plasma total cholesterol levels measured by Reflotron analyser; fasting serum lipid levels measured by standard laboratory methods; and calculated low-density lipoprotein cholesterol levels. RESULTS: Significantly lower plasma total cholesterol levels (Reflotron) were observed at two months and at six months with each of the three interventions. Additionally, both types of dietitian-based counselling resulted in small but significant decreases in plasma low-density lipoprotein cholesterol levels at six months in a subset of subjects. CONCLUSION: Although there were no statistically significant differences in efficacy between the three types of intervention, dietitians have a role to play in setting up such counselling programs.

Adult↗
PubMed1995

Caries diagnosis and risk assessment. A review of preventive strategies and management.

The scientific basis for caries risk assessment, prevention and treatment on an individual patient basis requires further development, specification and continuing validation. Still, current technologies and techniques, taken together, can provide enhanced capabilities over those that have been employed traditionally. Undoubtedly, the clinical tools for carrying out these responsibilities will be refined and expanded in the future in response to the changing clinical profile of caries in the population. For example, bacteriologic testing methods have become easier and more reliable, and will become more widely used. Other effective methods to detect the early, pre-cavitation stage of caries also should become more available in the future. Practitioners will be continually challenged and responsible for evaluating the effectiveness and value of emerging technologies in their practices and in light of their patients' needs. But how can this be accomplished best? Effectiveness claims will be made for new drugs and devices that come onto the market. There are several sources of information to assist the practitioner in making such decisions. The American Dental Association acceptance programs (voluntary) and the U.S. Food and Drug Administration compliance programs (law) provide standards and guidance as to product safety and effectiveness. Without such determinations, the practitioner must judge independently product claims and clinical studies. Marketing materials by themselves (advertisements, videos, pamphlets) may not be sufficient evidence of effectiveness particularly when scientific references supporting claims either are not provided or are inadequate. Peer-reviewed scientific literature in publications of the major scientific and professional associations can be viewed as generally reliable. Changing the way dental caries is managed in clinical practice will require integrating new scientific information and technology into workable clinical procedures. Dental education and third-party reimbursement issues must be addressed also but are beyond the scope of this document. Given that disease patterns are always changing in the population, dentists need to modify practice decisions using risk assessment. Ultimately, the goal for dentistry is that adult patients also will enjoy the same low level of caries experience that many children enjoy today.

Adolescent↗
PubMed1994

Increasing bicycle helmet use in the community. Measuring response to a wide-scale, 2-year effort.

OBJECTIVE: To determine whether a wide-scale, long-term community promotional effort would increase the use of bicycle helmets among children. DESIGN: Over 2 years, a non-profit group coordinated a range of activities to promote helmet use. On one date before the intervention began and three dates during the intervention, observers surveyed students riding bicycles. SETTING: Cyclists were observed at 5 elementary schools, three secondary schools, and two community college entrances. PARTICIPANTS: A total of 851 cyclists were observed, 536 of them at elementary schools in a convenience sample. INTERVENTIONS: Print, radio, and television advertising; posters; pamphlets; bicycle rodeos; and a play were used in a public awareness campaign. Health promotion activities included education, social marketing, community development, and legislative action. MAIN OUTCOME MEASURES: Number of cyclists and whether they wore helmets. RESULTS: Combining the two observation dates for each year, helmet use increased from 5.4% in 1990 to 15.4% in 1991. The greatest increase was observed among elementary school students, the group most at risk of serious head injury or death. Overall, girls were twice as likely to wear helmets as boys. CONCLUSIONS: Wide-scale, long-term community promotion appears to be effective in increasing the use of bicycle helmets.

Age Factors↗
PubMed1994

Worksite AIDS education: a case study of the New York City police.

The New York City Police Department (NYCPD) offers AIDS education on a continuing basis to all uniformed police personnel. The program consists of a videotape, published materials, lecture with medical experts, and individual counseling available on request. This study focuses on police officers' sources of information about AIDS, comparing the workplace program to other sources, as well as their knowledge about HIV transmission and their attitudes towards co-workers with AIDS. Two precincts were surveyed, one in an area of higher prevalence of AIDS cases and the other in an area of lower prevalence. All employees valued the workplace program as more informative than personal and professional sources, but somewhat less informative than the media and the Surgeon General's pamphlet. While officers in both precincts were knowledgeable about the spread of HIV, those more knowledgeable had more positive attitudes towards infected co-workers. Precinct differences suggest that future programs might take into account site-specific characteristics.

Adult↗
PubMed1994

The effects of computer-tailored smoking cessation messages in family practice settings.

BACKGROUND: Many conventional health education materials, such as pamphlets and booklets, are designed to reach as wide an audience as possible; they are therefore often lengthy and contain information irrelevant to many consumers. Computer technologies allow sophisticated tailoring of messages targeted to individual patients and free of irrelevant information. METHODS: In two studies in North Carolina (study 1, N = 51; study 2, N = 197), adult cigarette smokers were identified from a cohort of family practice patients. Cigarette consumption, interest in quitting smoking, perceived benefits and barriers to quitting, and other characteristics relevant to smoking cessation were collected. Based on this information, smoking cessation letters were tailored by computer to individuals. Smokers were randomly assigned to experimental (tailored health letters) or comparison groups (generic health letter in study 1, no health letter in study 2). Smoking status was assessed again at 4 months (study 1) or 6 months (study 2). RESULTS: Both studies found statistically significant positive effects of tailored health letters among moderate to light smokers. In study 1, 30.7% reported quitting after 6 months vs 7.1% in the control group (P < .05); in study 2, 19.1% vs 7.3% (P < .05). CONCLUSIONS: Results from both studies indicate positive effects of computer-tailored smoking messages among moderate to light smokers. These findings are consistent with the focus of our computer-tailored program on psychological and behavioral factors related to smoking cessation. Smoking cessation outcomes may be enhanced by combining tailored messages with nicotine replacement therapies to treat physical dependency. Methods of tailoring health messages and incorporating the results into family practice are described.

Adult↗
PubMed1994

Effectiveness of two methods of advising mothers on infant feeding and dietetic management of diarrhoea at an outpatient clinic in Peru.

The effectiveness of two educational intervention programmes in promoting infant feeding practices was assessed among mothers of small children attending a hospital's Oral Rehydration Unit in Peru. One group of mothers received 5 min of counselling and a recipe pamphlet. The other group received the same counselling plus a 20-min cooking demonstration. Both interventions had a statistically significant (p < 0.05) impact on maternal knowledge and practices; differences between the impact of the two practices were negligible. After merging both groups into a single sample, it was observed that changes over time were significantly large (p < 0.05). Knowledge rates were 27.6% before the intervention, 73.7% 2 days later and 75% 30 days later. The corresponding figures for practices were 2.6%, 58.3% and 37.5% respectively. We conclude that when place, time and message are adequately chosen, a simple method may be an effective way of good communication. We suggest that a larger implementation trial would be useful before starting larger infant feeding programmes.

Counseling↗
PubMedDate not supplied

Transition issues for survivors of childhood cancer and their healthcare providers.

Over the last decade, the number of childhood cancer survivors has increased and late effects of therapy on organ function, growth, and development have become evident. Specific healthcare and psychosocial needs of survivors are now being addressed by multidisciplinary pediatric oncology teams. These survivors may eventually transfer their healthcare to an adult practitioner who may lack current information regarding survivorship issues and who may not use a multidisciplinary approach. Transition models developed for adolescents with chronic illness address some issues, but are not entirely applicable to the experience of those cured of cancer. The importance of lifetime annual follow-up must be communicated to young adult survivors and their new practitioners. A pamphlet was developed, as part of a comprehensive program, to facilitate transition by providing an overview of the concept of survivorship, general follow-up recommendations, and resources available to assist clients and their healthcare providers.

Adaptation, Psychological↗
PubMed1993

Older callers to the Cancer Information Service.

Cancer incidence and mortality are disproportionately high in older adults, yet most public service campaigns have not been directed explicitly at this population. We analyzed Cancer Information Service (CIS) call data from the years 1983-1990 to characterize callers age 60 years and over. Of 1,091,809 calls from which the age of the caller was ascertained, 206,104 (19%) were from this age group. Most older callers learned of the CIS from the telephone book, television, and brochures or pamphlets. In addition, we examined calls specifically from 1990 to ascertain recent trends in CIS utilization. Comparisons also were made between callers 60 and older and those 40-59. Additional targeting could increase calls from older adults.

Adult↗
PubMed1994

General recommendations on immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP).

This revision of the General Recommendations on Immunization updates the 1989 statement. Changes in the immunization schedule for infants and children include recommendations that the third dose of oral polio vaccine be administered routinely at 6 months of age rather than at age 15 months and that measles-mumps-rubella vaccine be administered routinely to all children at 12-15 months of age. Other updated or new sections include a) a listing of vaccines and other immunobiologics available in the United States by type and recommended routes, advice on the proper storage and handling of immunobiologics, a section on the recommended routes for administration of vaccines, and discussion of the use of jet injectors; b) revisions in the guidelines for spacing administration of immune globulin preparations and live virus vaccines, a discussion of vaccine interactions and recommendations for the simultaneous administration of multiple vaccines, a section on the interchangeability of vaccines from different manufacturers, and a discussion of hypersensitivity to vaccine components; c) a discussion of vaccination during pregnancy, a section on breast-feeding and vaccination, recommendations for the vaccination of premature infants, and updated schedules for immunizing infants and children (including recommendations for the use of Haemophilus influenzae type b conjugate vaccines); d) sections on the immunization of hemophiliacs and immunocompromised persons; e) discussion of the Standards for Pediatric Immunization Practices (including a new table of contraindications and precautions to vaccination), information on the National Vaccine Injury Compensation Program, the Vaccine Adverse Events Reporting System, and Vaccine Information Pamphlets; and f) guidelines for vaccinating persons without documentation of immunization, a section on vaccinations received outside the United States, and a section on reporting of vaccine-preventable diseases. These recommendations are based on information available before publishing and are not comprehensive for each vaccine. The most recent Advisory Committee on Immunization Practices (ACIP) recommendations for each specific vaccine should be consulted for more details.

Adolescent↗
PubMed1993

Sudden unexpected death in the emergency department: caring for the survivors.

OBJECTIVE: To determine whether emergency department staff met the needs of the next of kin and close friends ("survivors") of patients dying in an emergency department and to assess the effectiveness of a program to improve care of survivors. DESIGN: Mail survey before and after program implementation. SETTING: Emergency department of a tertiary care, adult teaching hospital. PARTICIPANTS: Two groups of survivors, identified through a review of emergency department records of deaths during two 6-month periods. In the first group, surveyed in 1987, before program implementation, 26 (53%) of 49 responded; in the second group, surveyed in 1990, after program implementation, 40 (70%) of 57 responded. INTERVENTIONS: A structured, multidisciplinary protocol for notifying next of kin of death and supporting the survivors was implemented. An educational program was provided to all emergency department staff. An information pamphlet was created and provided to survivors. MAIN OUTCOME MEASURES: Questionnaire responses regarding the adequacy and timeliness of information provided, the support and actions by emergency department staff and the survivors' desire to be present during resuscitation efforts. RESULTS: Comparison of responses before and after program implementation showed that adequate information was provided before notification of death in 32% and 83% of cases respectively (p < 0.001), lengthy delays in receiving medical information occurred in 60% and 15% of cases (p < 0.01), adequate medical information concerning the events of death was provided in 53% and 88% (p < 0.05), the presence of emergency department staff was sufficient in 40% and 79% (p < 0.01), survivors spent less than 2 hours in the emergency department in 50% and 81% (p < 0.05), and survivors expressed a desire to be present during resuscitation efforts in 95% and 11% of cases (p < 0.001). CONCLUSION: The grievous experience of learning that a loved one has suddenly and unexpectedly died in the emergency department can be alleviated somewhat by a structured, multidisciplinary approach combined with staff sensitization and education.

Bereavement↗
PubMedDate not supplied

[Psychosocial support in pregnancy as a strategy to promote the newborn's health].

In this project we developed a social support and health education intervention meant to answer whether or not a program of this kind, within the present medical system, can improve perinatal outcomes. A multicenter randomized controlled trial was conducted in four Latin American countries. In Mexico, the project was carried out in a third level obstetric hospital. Patients were screened between the 15th and 22nd week of gestation. Inclusion criteria were factors associated with high risk of low birthweight. A total of 620 women were recruited, randomized and followed up during pregnancy and up to the 40th day post partum. Women in the intervention group were visited four to six times during pregnancy, could use a telephone hot line and a consultation service. A poster and a pamphlet meant to reinforce health education were handed out in the first visit. A "guided tour" for women at the end of pregnancy was organized periodically. Outcomes were measured in both groups at the 36th week of gestation, post partum and 40 days after delivery. Neonatal outcomes were obtained by blind interviewers from the clinical records. Neither in the multicenter nor in the Mexican sample were we able to modify the incidence of low birthweight and prematurity. However, in Mexico we obtained positive effects on birthweight and gestational age in the whole sample and in some specific strata. These results strongly suggest the convenience of replicating the study in Mexico.

Adolescent↗
PubMed1993

Can effective parent education occur during emergency room visits?

BACKGROUND: Parents might not feel the need to make as many visits to an emergency room (ER) for a sick child if they had more information about common illnesses and their management. This study measured the effect on future ER use of parent education on common childhood illnesses. METHODS: Children who were over 6 months old and had visited the ER at least twice in the preceding year were enrolled in an experimental group (n = 118) or in a control group (n = 128) over consecutive two-month periods. The intervention consisted of a pamphlet and a videotaped presentation that discussed the features and management of common childhood illnesses. RESULTS: Over the following year, an average of 0.43 (SD = 0.9) ER visits were made by experimental subjects compared to 0.52 (SD = 1.31) by control subjects (P = .30). Twenty percent (SD = .4) and 22% (SD = .4) of subsequent illnesses of experimental and control children respectively resulted in an ER visit. CONCLUSION: Our study demonstrated no effect of an educational intervention designed to decrease ER visits. Limitations of our study, however, suggest that further attempts to educate parents in this setting may still be warranted.

Child↗
PubMed1993

Measurement of pharmacokinetics of yttrium-86 radiopharmaceuticals with PET and radiation dose calculation of analogous yttrium-90 radiotherapeutics.

This study was performed to demonstrate the quantitative in vivo assessment of human pharmacokinetics of 90Y-radiotherapeutics using the positron-emitting substitute 86Y and PET. This technique is illustrated in a patient with disseminated bone metastases from breast cancer who was injected with 100 MBq of 86Y-citrate as an analog of the commercially available radiotherapeutic 90Y-citrate. Whole-body distribution was measured with a PET camera 4, 10, 21, 28 and 45 hr postinjection. Uptake data were determined from reconstructed transverse PET images by regions of interest placed in normal bone tissue, liver and metastases. Images of coronal and sagittal whole-body sections were obtained by reformatting the transverse PET images. The ratio of activity concentration in metastases to that in normal bone ranged from 1.5:1 to 3.5:1. Of the injected tracer, 13.4% was found in the skeleton and 0.43% in the metastasis with the highest 86Y concentration. Radiation doses per 1 MBq of injected 90Y-citrate were calculated from 86Y-citrate data and data from MIRD pamphlets 5 and 11. The doses were 1.01 MGy/MBq for red marrow, 593 microGy/MBq for the liver and approximately 3.5 MGy/MBq for the most conspicuous metastases. This study demonstrates that the use of PET via 86Y allows an individual in vivo quantification of activity uptake and radiation dose of both normal tissue and tumor in pain treatment with 90Y-labeled radiotherapeutics.

Adult↗