Community organization to promote breast cancer screening ordering by primary care physicians.

Community organization has been viewed as a promising approach to changing preventive behaviors. We evaluated the impact of community organization strategies to promote breast cancer screening ordering by primary care physicians in Washington State. Physicians practicing in two intervention and two control communities were surveyed by mail pre-intervention (1989) and post-intervention (1993). Intervention activities targeting the health care sector included the formation of local physician planning groups, a series of informational mailings, medical office staff training sessions, and reminder system support. There were no significant post-intervention differences in the self-reported mammography ordering of physicians practicing in the intervention and control areas. Over the four-year study period, the proportions of physicians who ordered regular mammography increased by 36%. By 1993, over 80% of the respondents routinely used mammographic screening. Concerns about the high price of mammograms and inadequate insurance coverage were significantly reduced over time in both community pairs. Also, use of patient reminder systems increased significantly between 1989 and 1993. Secular trends resulting from diffusion of strategies to promote mammography were responsible for increases in physician ordering of the procedure. Year 2000 goals for breast cancer screening use by physicians may already have been met in some communities.

Medical community involvement in a breast cancer screening promotional project.

The analysis, mobilization, and involvement of medical communities in two counties targeted for intervention by the Washington State Community Breast Cancer Screening Project is described. Principles of community organization were applied to the health care sectors in the counties, and the PRECEDE-PROCEED model was used as a conceptual framework for considering individual physician behavior. Quantitative and qualitative medical community assessment methods included a demographic study, a survey of primary care physicians, personal interviews with physicians, and medical office staff focus groups. In both intervention areas, physician planning groups selected, developed, and helped implement intervention activities targeting the health care sectors. These activities included informational mailings to physicians, training of medical office staff members and clinical mammographers, and support for a reminder system. The experience demonstrated that physicians practicing in medium-sized cities are willing to be active in community disease prevention programs.

[Neurologic complications after bone marrow transplantation]. / Neurologische Komplikationen nach Knochenmarktransplantation.

The retrospective study presented here reports clinical, electrophysiological and CT-data from 21 patients who underwent bone marrow transplantation for leukemia or aplastic anemia between 1980 and 1985. The aim of the investigation, which was performed at the end of 1986, was to elucidate whether antineoplastic drugs and radiation can result in long-term damage of the central nervous system. In 9 patients we observed neurological signs (1 leukencephalopathy, 5 cerebellar symptoms). Seven patients revealed dysrhythmia in the EEG and five had delayed latencies of visual evoked potentials. Eight patients exhibited pathological changes in CT (3 atrophy of supratentorial structures, 3 periventricular lucencies, 2 a combination of both). The results indicate that long-term damage to the CNS may be encountered after successful bone marrow transplantation.

Evaluation of the cardiovascular system in children with simple obesity. Part I. Clinical, electrocardiographic and functional studies.

In 45 children with simple obesity (overweight 70 +/- 16%) clinical, electrocardiographic and functional assessment of the cardiovascular system was carried out. The results were compared with those in a control group of 20 healthy children without overweight. Raised arterial blood pressure was found in 14 children (31%) in the studied group. In the control group the blood pressure was normal. Resting electrocardiogram was abnormal in 5 obese (11%) and 2 thin (10%) children. Exercise tolerance was similar in both groups, while the values of systolic pressure and double product were higher in obese children. The value of the tolerated exercise was not correlated with the degree of overweight.

Evaluation of the cardiovascular system in children with simple obesity. Part II. Echocardiographic assessment.

In a group of 45 children with simple obesity (overweight 70 +/- 16%) echocardiographs evaluation of the morphology and function of the left cardiac ventricle was carried out comparing the obtained results with those in a control group (20 children). The mass of the left ventricle was greater in obese children, and the degree of hypertrophy was not correlated with the degree of overweight. The tested parameters of left ventricle systolic activity were within normal limits and were non-significantly lower than in the control group.

The effect of training on the physical working capacity of MI patients with left ventricular dysfunction.

Exercise performance in 41 men with impaired left ventricular function following an acute myocardial infarction was studied. Twenty (intervention group) subsequently underwent a 4-month supervised exercise training programme in an outpatient capacity, with three sessions per week. On completion, exercise performance was compared to the 21 control patients who received conventional rehabilitation. Initial tests showed no difference between the two groups. At the end of the programme significant improvement was found in all the investigated parameters in the intervention group. Supervised training had a beneficial effect on the physical working capacity of the patients with left ventricular dysfunction and no complications arose.