Examining the influence of personal goal interference and attainability on psychological distress in non-metastatic breast cancer patients.

The present study investigated the relationship between two goal-related appraisals - perceived cancer-related interference and perceived attainability of important personal goals - and psychological distress among non-metastatic breast cancer patients across the short-term treatment and recovery period. Forty-five women completed self-report questionnaires at approximately 1 and 6 months following surgery. A mixed idiographic-nomothetic goal methodology assessed perceived cancer-related interference and attainability of self-generated important personal goals. Psychological distress symptoms were assessed with the Depression Anxiety Stress Scales short form. Correlation analyses and general linear modelling were used to evaluate the hypothesised relationships over time. Average cancer-related interference and attainability of important personal goals were significantly associated with concurrent depression, anxiety and stress symptoms at 6 months following surgery. Perceived attainability of highly important goals at 6 months post-surgery uniquely predicted change in psychological distress symptoms over time. The findings suggest that low perceived attainability of important personal goals may be an important predictor of elevated distress symptoms across the short-term following surgery. Further insight into the relationship between these negative goal appraisals and psychological functioning among different groups of cancer patients could inform the provision of targeted psychosocial support across the cancer continuum.

Sleep quality, fatigue and physical activity following a cancer diagnosis.

Research on physical activity for cancer survivors suggests a relationship with improved quality of life. The aim of this study was to explore if there was also a relationship of physical activity with sleep difficulties and fatigue, common effects of cancer and its treatments. Recruitment was by posters and flyers in medical waiting rooms and by letter of invitation. Thirty-two breast and 59 prostate cancer survivors completed the questionnaire. Poor sleep quality was reported by 57.8%. A greater proportion of breast cancer (36.7%) than prostate cancer survivors (15.5%) reported poor sleep latency, and sleep disturbance (48.4% vs. 17.2%). The mean minutes of moderate physical activity was lower among participants reporting poor sleep quality [F(1,89) = 11.36, P < 0.001]. A greater proportion of breast cancer (65.7%) than prostate cancer survivors (43.1%) reported high fatigue. Participants who reported no physical activity had significantly greater fatigue (M = 31) than those reporting high physical activity levels (M = 42). While at an early stage of research, results are suggestive of a relationship of physical activity with sleep problems among cancer survivors. Findings have implications for improving quality of life as poor sleep was associated with greater fatigue and regular physical activity shows promise as an aid to alleviating these problems.

Physician assessment of patient motivation: influence on disposition for follow-up care.

This study of 3,318 outpatient visits evaluated the influence of the physician-assessed level of patient motivation on the level of physician involvement in follow-up care. Data collected included patient demographics, health risk factors, physician-assessed level of patient motivation, and the disposition for follow-up care (return office visit or self-care). Physicians more frequently scheduled patients for a return office visit, regardless of assessed level of patient motivation, when they presented with a traditional biomedical problem. Patients with health promotion-disease prevention problems were more frequently relegated to self-care; patients physicians judged to be poorly motivated were four times as likely to be relegated to self-care. We discuss the implications of physician overuse of self-care strategies on the health status of poorly motivated patients. Factors influencing such physician behavior may include prior unrewarding experiences with poorly motivated patients, perceived lack of skill in affecting behavior change, time constraints, lack of reimbursement for preventive care services, and the actual process of physician education and professional socialization.

Health behavior models compared.

This study compares the health belief, Fishbein/Ajzen, and PRECEDE models to predict changes in smoking, exercise, and consumption of sweet and fried foods over an eight-month interval. Data were collected from a panel of 326 adults in two large cities of the western United States. The PRECEDE model accounted for more variance in behavior than both the Fishbein/Ajzen and health belief models, but it required far more questions. Fishbein/Ajzen and PRECEDE provide a limited theoretical basis for selecting specific types of beliefs or predisposing factors without turning to the health belief model, making the health belief model complementary to either Fishbein/Ajzen or PRECEDE.

Comparison of HIV-risk behaviors and demographics of adolescents tested or not tested for HIV infection.

In a survey of 2,548 adolescents, 11.5 percent reported ever having had the human immunodeficiency virus (HIV) antibody test. Those who had been tested were significantly more likely to be male, black, and to reside in metropolitan areas than those who had not been tested. Tested adolescents were more than three times as likely to report having injected drugs and were more than twice as likely to have had sexual intercourse, had sexual intercourse at earlier ages, and with multiple partners. More than half of adolescents who had been HIV-tested had no reported risks for HIV infection. More than one-quarter of adolescents not tested reported at least one HIV risk factor. These data suggest the importance of discussing the HIV testing and counseling process within any HIV education program directed to adolescents.

The promotion of physical activity in the United States population: the status of programs in medical, worksite, community, and school settings.

While the medical care encounter is considered an ideal situation in which patients are encouraged to increase their physical activity levels, very little research has been conducted in this setting. In fact, with the exception of the physical activity components of cardiac rehabilitation programs, few formal physical activity programs are available in medical care settings. Although the workplace is currently the focus of the greatest interest by those persons who implement physical activity programs, there is little precision in defining what constitutes a worksite physical activity program. A number of researchers and authors, using program experience rather than empirical findings, have described what they believe to be the important components of successful worksites health promotion and physical education programs. The greatest variety of physical activity programs are found in community settings. They are offered by a number of nonprofit private organizations, nonprofit public agencies, and for-profit organizations. While relatively little research has been done concerning changes in the community environment, it is clear that such changes can effect community participation. Community campaigns to increase physical activity have been studied, and it appears that they clearly affect residents' interest and awareness in physical activity, but they do not have a major effect on behavioral changes in the short term. It appears that a major opportunity to influence favorable physical activity in the United States is being missed in schools. A large majority of students are enrolled in physical education classes, but the classes appear to have little effect on the current physical fitness levels of children and, furthermore, have little impact on developing life-long physical activity skills.

Prostate cancer screening in the midst of controversy: Canadian men's knowledge, beliefs, utilization, and future intentions.

Despite controversy about prostate cancer screening, administrative data show that the use of prostate specific antigen (PSA) testing in Canada has increased. This study sought to determine awareness and knowledge of prostate cancer and screening, use to date, and future intentions to have a digital rectal examination (DRE) and PSA test among Canadian men aged 40 and over. Data were collected through a Canada-wide cross-sectional random digit dial telephone survey of 629 men. Awareness of DRE and PSA, use to date, and future intended use varied with age and education. Although only 9% of respondents had had PSA testing for screening, future intentions to undergo this test were higher than use to date. Knowledge of prostate cancer and screening controversies was low, and men received more information about PSA from the media than from doctors. Men would, therefore, benefit from age- and education-specific information regarding the factors to consider in making an informed choice about prostate cancer screening.

The development and management of a primary care research network, 1978-87.

The Ambulatory Sentinel Practice Network (ASPN) was created to increase the knowledge of primary care. Building on the experiences of other national and regional primary care research networks, ASPN has evolved as a North American network including practices in 25 U.S. states and four Canadian provinces in 1987. This paper summarizes ASPN's growth and development since 1978, the involvement of the ASPN practices, and the mechanisms used in developing and managing studies.

Verification of data reported by practices for a study of spontaneous abortion.

Little is known about the accuracy of data reported in practice based primary care research. The Ambulatory Sentinel Practice Network (ASPN) undertook a 100% audit of 226 patients included in a study of spontaneous abortion (SAB). The audit was conducted to assess the feasibility of conducting audits in primary care research networks dispersed over large geographic areas, verify that patients met inclusion criteria, and assess the frequency of reporting errors using the medical record as a standard. Of the originally reported SABs, 24% could not be verified. The overall error rate was 4.5%, a total of 106 errors out of a possible 2,361. Seventy percent of these errors came from five of the 34 participating practices. Sixty-six percent of the records were error-free. Seventy-seven percent of the errors were associated with problems with methods and clustered into three categories: gravidity, gestational age, and dilation and curettage (D&C). According to this audit, the data reported by the practices for research purposes were very similar to the data found in the medical record.

Issues related to designing and conducting school health education research.

Investigators interested in conducting school health research face many important challenges. First, an appropriate research course for school health must be charted so the most important research issues are addressed in a systematic way. Second, there is a continuing need to develop scientifically sound research methods that can be used in the school setting. Third, there is the immediate need to identify ways of overcoming the usual problems encountered in the conduct of school health research. This paper focuses on the third challenge, via an analysis of the research design and measurement issues that most frequently confront school health researchers. The research design issues addressed include randomization of experimental units to treatments and selection of the appropriate statistical unit of analysis. The measurement issues addressed included use of existing versus newly developed instruments, use of norm-referenced versus criterion-referenced instruments, use of self-report techniques, and appropriate use of affective instruments. Following an analysis of the issues a series of relevant questions are posed.

Evolution of the national disease prevention and health promotion strategy: establishing a role for the schools.

The history and evolution, during the past decade, of the national disease prevention and health promotion strategy is recounted, culminating with a description of the national prevention objectives. Objectives that directly could be attained by: (1) school health education; (2) school health services; (3) efforts to ensure healthy school environments; and (4) school physical education programs are delineated, as are objectives that could be influenced in important ways by school health programs. The nation's schools could contribute significantly and measurably toward improving the health of all Americans, if school health professionals, individually as well as within their various organizations, could seize and create opportunities to work with other health and educational professionals, and the public, to impel and enable schools to attain relevant national prevention objectives.

Design of the School Health Education Evaluation.

The Center for Health Promotion and Education, Centers for Disease Control, and the Office of Disease Prevention and Health Promotion, US Dept. of Health and Human Services, contracted with Abt Associates, Inc., to evaluate the School Health Curriculum Project as compared with three other approaches to school health education. Background on the reasons for initiating this project, a summary of the original design, and highlights of the main features of the actual implementation of the School Health Education Evaluation (SHEE) are detailed.

A cost-benefit analysis of a smoking cessation program.

Smoking cessation programs are usually evaluated in terms of the percentage of participants who have stopped smoking at least 6 months after the program's completion. This paper shows how a relatively low rate of behavior change may actually result in a high ratio of benefits to costs. Cost-benefit analysis is done for a specific program but the procedures and cost estimates are generalizable to other smoking cessation programs. Benefits to the firm included reduced costs of insurance and the savings due to employee absenteeism and disability. Costs included the program costs as well as the opportunity costs of the participants. Data from the literature and from the specific program are combined to form conclusions about the effectiveness of the program.

Patients with new headache in primary care: a report from ASPN.

From a consecutive series of 3,847 headache patients, 1,331 patients who made first visits for new headache to 120 primary care physicians were studied for usual care over a 14-month period. Either tension or vascular headache was the initial diagnosis in 23.8 percent and 12.8 percent of patients, respectively. Nearly one half (47.8 percent) were classified as having headaches other than tension or vascular. A total of 15.3 percent of headaches were undiagnosed or were regarded as a mixture of traditional diagnostic designations. At first visit, most patients (76.6 percent) were managed without diagnostic tests. Drugs were prescribed for 73.6 percent, and advice was given for 58.6 percent. Only 2.0 percent of patients had computerized tomographic scanning ordered at first visit, although at least 46 percent met National Institutes of Health criteria, a finding with potential economic consequences of at least $2 billion. These findings suggest the need for reevaluation of diagnostic categories for headache, reevaluation of strategies for headache management, and further investigations of headache in primary care patients.

Factors influencing mammogram ordering at the time of the office visit.

BACKGROUND: Breast cancer is the second most common cause of cancer death in women, with mammographic screening the only modality shown to decrease the death rate. However, only 17% to 41% of women have ever been screened, and multiple barriers to screening have been identified. This study examined physician and patient factors at a single encounter to explore components influencing mammography ordering. METHODS: Ten family physicians in a primary care research network completed daily data cards on encounters with women presenting for annual examinations, chronic problems, or breast-related complaints. Information collected included patient age, personal or family history of breast cancer, physician's perception of expected compliance, previous mammogram results, breast examination, physician's perception of need for a mammogram, whether the mammogram was ordered, and the patient's method of payment for the test. RESULTS: Eight hundred thirty-nine patients were entered into the study, and 277 mammograms were ordered. Mammograms were ordered for a greater percentage of patients with insurance (36%) than for those without insurance (26%) (P < .001). A multivariate analysis indicated that several factors helped to correctly classify 90% of mammogram ordering: the patient was making a first visit, a breast-related visit, or a visit for an annual examination; the patient had had a previous mammogram; had a breast examination at the current visit or within the past year; and the physician believed the patient would comply and believed that a mammogram was indicated. CONCLUSIONS: Factors unique to a physician-patient visit influence the physician with regard to ordering a mammogram, including the type of visit, whether the physician believes a mammogram is indicated, and the cost.

Carpal tunnel syndrome in primary care: a report from ASPN. Ambulatory Sentinel Practice Network.

BACKGROUND: Carpal tunnel syndrome (CTS) is a common condition in primary care, yet little is known about its presentation and management. This study was designed to provide a better understanding of the frequency of CTS in a primary care population, and its presentation, diagnosis, and management. METHODS: Clinicians in 74 Ambulatory Sentinel Practice Network (ASPN) practices from 30 states and three Canadian provinces collected data on all patients presenting with symptoms of CTS during a 30-month period. RESULTS: The adjusted frequencies of all visits and of first visits for symptoms of CTS were 1.01 and 0.68 per 1000 patient visits, respectively. Women visited more frequently than men with new onset symptoms of CTS (0.81 vs 0.55 per 1000 visits), and homemakers accounted for 15.9% of all new cases. Clinicians judged 43.1% of all CTS incident visits to be job-related. The diagnostic evaluation of patients seldom included nerve conduction studies (12.9%) or electromyography (11.8%). The most frequent treatments were splints (56.3%) and nonsteroidal anti-inflammatory agents (50.8%). Four-month follow-up data were obtained for 68.5% of the patients, and symptom relief was reported by 55.2% of patients. Ninety percent of patients were able to continue working at the same job, and 96% were able to continue their usual activities. CONCLUSIONS: Carpal tunnel syndrome symptoms are common in primary care, and most cases occur among women, many of whom are homemakers. Most patients with CTS symptoms are treated conservatively by their primary care clinicians with minimal testing or referral, and most patients report improvement or resolution of symptoms at 4 months.

Does family practice at residency teaching sites reflect community practice?

BACKGROUND: Family medicine has aspired to train residents and conduct research in settings that closely resemble community practice. The purpose of this study was to compare the patient characteristics of the ambulatory teaching centers of a consortium of seven community-based university-affiliated family practice residency programs in northeast Ohio with the National Ambulatory Medical Care Survey (NAMCS) results for family physicians (FPs) and general practitioners (GPs). METHODS: Ninety-eight faculty and resident physicians at the residency training site of the Northeastern Ohio Universities College of Medicine collected data on all ambulatory patient visits (N = 1498) for one randomly chosen week between July 1, 1991, and June 30, 1992. We compared these data with patient visits reported in the 1990 NAMCS for FPs and GPs. RESULTS: The residency training sites saw slightly more children, women, blacks, and Medicare and Medicaid patients. The most common reason for an office visit in both populations was an undifferentiated symptom. Fifteen of the top 20 "reason for visit" codes were identical, as were 14 of the top 20 diagnoses. More preventive and therapeutic services were offered or performed at our residency training sites but fewer diagnostic services were performed. There were fewer consultations requested at our residency training sites but similar hospitalization rates for patients. The mean duration of visit differed by only 1 minute. CONCLUSIONS: The residency training sites of the Northeastern Ohio Universities College of Medicine provide patient care opportunities similar to those found in a national survey of family and general practitioners.

Identification of distinct body mass index trajectories in Australian children.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Recent studies have identified distinct trajectories of obesity development in children, but more research is required to further explore these trajectories. Several socio-demographic variables such as parental education and obesity are associated with these trajectories. WHAT THIS STUDY ADDS: This study further demonstrates that there are distinct trajectories of body mass index in children. The use of raw body mass index values is more sensitive to changes in body composition compared with body mass index categories (e.g. lean vs. overweight). Hence the present results provide a more detailed insight into development patterns of obesity. The socio-demographic predictors of the trajectories offer potential avenues for future obesity interventions. BACKGROUND: A limited number of studies have demonstrated that there may be distinct developmental trajectories of obesity during childhood. OBJECTIVE: To identify distinct trajectories of body mass index (BMI) in a large sample of Australian children. METHODS: Participants included 4601 children aged 4-5 years at baseline, who were followed up at ages 6-7 years, 8-9 years and 10-11 years. Height and weight were measured at each of these time points, and used to calculate BMI. Growth Mixture Modelling was used to identify the presence of distinct BMI trajectories. RESULTS: Four distinct trajectories were identified (i) High Risk Overweight; (ii) Early Onset Overweight; (iii) Later Onset Overweight and (iv) Healthy Weight. Further analyses indicated that factors such as parental overweight, parent education, parent smoking and child birth weight were significant predictors of these trajectories. CONCLUSION: These findings indicate that different patterns of BMI development exist in children, which may require tailored interventions.