Primary care physician compliance with colorectal cancer screening guidelines.

OBJECTIVE: To assess self-reported compliance to colorectal cancer (CRC) screening guidelines among primary care physicians (PCPs) and to assess physician and practice characteristics associated with reported compliance. METHODS: Survey data from 984 PCPs in Arizona were used. Self-reported CRC screening practices, recommendations, and compliance with guidelines were assessed. Physician and practice characteristics associated with guideline compliance were also evaluated. RESULTS: While 77.5% of physicians reported using national screening guidelines, only 51.7% reported recommendations consistent with the guidelines. Younger physicians were significantly more likely to report compliance with screening guidelines (OR = 1.50, 95% CI = 1.07-2.10) as were female clinicians (OR = 1.46, 95% CI = 1.11-1.92). Physicians practicing in solo (OR = 0.33, 95% CI = 0.19-0.58), group (OR = 0.36, 95% CI = 0.21-0.62), or community health centers (OR = 0.37, 95% CI = 0.17-0.81) were significantly less likely to report following guidelines as compared to those in academic practice. Guideline compliance was higher for fecal occult blood test (FOBT) (65.0%) than colonoscopy (56.7%); overuse of screening for these modalities was reported among 34.4% of physicians. CONCLUSIONS: PCPs are not adequately following CRC screening guidelines. Further studies are needed to clarify the reasons for this lack of compliance, especially as guidelines become more complex.

Quick assessment of literacy in primary care: the newest vital sign.

PURPOSE: Current health literacy screening instruments for health care settings are either too long for routine use or available only in English. Our objective was to develop a quick and accurate screening test for limited literacy available in English and Spanish. METHODS: We administered candidate items for the new instrument and also the Test of Functional Health Literacy in Adults (TOFHLA) to English-speaking and Spanish-speaking primary care patients. We measured internal consistency with Cronbach's alpha and assessed criterion validity by measuring correlations with TOFHLA scores. Using TOFLHA scores <75 to define limited literacy, we plotted receiver-operating characteristics (ROC) curves and calculated likelihood ratios for cutoff scores on the new instrument. RESULTS: The final instrument, the Newest Vital Sign (NVS), is a nutrition label that is accompanied by 6 questions and requires 3 minutes for administration. It is reliable (Cronbach alpha >0.76 in English and 0.69 in Spanish) and correlates with the TOFHLA. Area under the ROC curve is 0.88 for English and 0.72 for Spanish versions. Patients with more than 4 correct responses are unlikely to have low literacy, whereas fewer than 4 correct answers indicate the possibility of limited literacy. CONCLUSION: NVS is suitable for use as a quick screening test for limited literacy in primary health care settings.

Predicting anaerobic capabilities in 11-13-year-old boys.

Anaerobic exercise is involved in many recreational and competitive sport activities. This study first established regression equations to predict maximal anaerobic power and then cross-validated these prediction equations. Using stepwise multiple regression analysis prediction equations for relative (watts per kilogram of body mass) and absolute (watts) mean and peak anaerobic power using the 30-second Wingate Test as the power measure were determined for 40 boys (age, 11-13 years). Percentage of body fat, free-fat weight, midthigh circumference, and 30-m dash were the independent predictive variables with the generated regression equations subsequently cross-validated using 20 different boys (age, 11-13 years). Significant correlations (Pearson r) were found for the cross-validation subjects between the measured power outputs and predicted power outputs for relative mean power (r = 0.48, p < 0.05), absolute mean power (r = 0.77, p < 0.01), and absolute peak power (r = 0.76, p < 0.01). Using paired t-tests, no significant mean differences (p > 0.05) were found for the same subjects between actual and predicted power outputs for relative mean power, absolute mean power, and absolute peak power. Prediction of maximal anaerobic power from selected anthropometric measurements and 30-m dash appears tenable in 11-13-year-old boys and can be accomplished in a simple cost- and time-effective manner.