Ethical issues in community-based cancer control: considerations in designing interventions.

Intervention studies are essential in the drive to reduce the burden of cancer in the United States. The means to accomplish primary and secondary cancer prevention is possible through health education focused on smoking, dietary changes, and the judicious application of screening technologies. The goal is to demonstrate these can work in the "real world" of the community workplace. The challenge of designing and conducting effective studies must include practical solutions to ethical as well as methodological issues.

Improving residents' knowledge of cancer prevention: are physicians prepared for prevention?

BACKGROUND: Primary care physicians recognize the goal of integrating cancer-prevention strategies into clinical practice. However, there is little formal training in cancer prevention and early detection. This study describes the effectiveness of a cancer-prevention curriculum called "Recommendations for Cancer Prevention (ReCaP) for Residents" for primary care residency programs. METHODS: The ReCaP for Residents curriculum was organized into eight instructional modules by organ site-specific areas for which there are established primary and secondary cancer-prevention recommendations. The modules include content outlines, learning objectives, slides, and case studies. In-house faculty and 21 residents of two family practice programs participated in an intervention comprising seven one-hour modular presentations during their regular summer teaching program. An established cancer-prevention knowledge test with 100 test items was used to test the residents' knowledge before and after the intervention; the data were analyzed by factor analysis with principal-component extraction and varimax rotation. RESULTS: The residents knew significantly more about cancer prevention after the ReCaP for Residents program. The mean overall prevention knowledge increased significantly (p < .05), and the scores of six of eight specific organ-site areas also increased. CONCLUSION: This study provided evidence that ReCaP for Residents was an effective curriculum for increasing residents' knowledge of cancer prevention. The authors recommend that more extensive programs of this type be implemented.

Confirmation. Practice behavior for treatment of new morbidity disorders reflects residency experience.

The purpose of the present study was to evaluate congruence between practice and residency training in the treatment of children with five "new morbidity" disorders. Data were obtained through mailed questionnaires. Counseling and behavior modification, without medications, were used for all five disorders by respondents most recently completing pediatric residency. Medications were used more frequently by pediatricians who had completed their residency training longer ago, particularly for nocturnal enuresis and chronic abdominal pain. The most recent graduates tended to treat a larger number of children with temper tantrums and separation anxiety. This is believed to result from more recent graduates being more comfortable and confident in recognizing and treating these conditions. In contrast, no association was noted between year in which residency was completed and number of children treated for nocturnal enuresis and chronic abdominal pain. This results from parents volunteering these symptomatic conditions since they perceive them to be medical problems.

Use of a modified Delphi technique to guide coordination of cancer education in Texas medical schools.

Delphi technique is a method of structuring group communication and is useful in achieving consensus on goals, plans, or positions. The Delphi technique was used to determine a course of action to enhance cancer education at each of eight medical schools in Texas. Participants in this study were deans of medicine and a faculty member considered to be the lead cancer expert in the curriculum. A three-generation Delphi study was conducted with the deans using a telephone interview, a personal interview, and a conference of participants, including cancer experts. The Delphi technique was found to be an effective approach for increasing awareness of the statewide cancer plan, for involving all medical schools in achieving the goals of the plan, and for identifying means for enhancing cancer education at each medical school. A consensus was reached to develop a statewide standardized assessment of graduating medical students' knowledge about principles of cancer prevention and screening. The results could serve as a means of determining cancer education needs at each medical school.

Expectations of preschool children to protect themselves from cigarette smoke: results of a smoking prevention program for preschool children.

Because preschoolers and first graders show signs of readiness to try smoking and because they are already learning about smoking through their environment, smoking prevention at the preschool level is appropriate. The large numbers of children seen in primary care practices and day care facilities are indicative of the numbers that could be exposed to smoking prevention instruction through these settings. This study assessed the future expectations of children to protect themselves from sidestream smoke after participating in a preschool smoking prevention program offered in four primary care settings. Through this program, children and their parents read stories and complete activities concerning the human body and the health risks of smoking. Using a randomized posttest-only case control design, the authors found that children who were exposed to the curriculum were more than twice as likely as others to report the intention to act to protect themselves from adult sidestream smoke.

Behavioral prescription writing in smoking cessation counseling: a new use for a familiar tool.

Tobacco use, a self-inflicted epidemic, causes more than 390,000 deaths in the United States each year. Smoking is a habit perpetuated by both physiologic and psychosocial mechanisms. Physician use of behavioral prescriptions is a practical, familiar, and efficient method for achieving smoking cessation. Physicians should ask patients if they want to quit smoking, take a smoking history, motivate patients to quit by personalizing risks, set a quit date, and then follow the behavioral prescription. Behavioral prescription involves writing prescriptions based on a plan that leads the patient through five successive weeks of behavioral modification, culminating in complete cessation of cigarette use. Physician time involved is minimal, since the approach requires only two meetings in person--one at an initial patient visit, and a second at a follow-up appointment.

A developmental basis for social support.

Developmental theory is proposed as a basis for understanding how social support is learned. The effect of life events on learning about social support is described. Six themes common to the developmental process which help to shape individual perceptions about social support are outlined.

Role and functions of the academic coordinator of clinical education in physical therapy education: a survey.

The Academic Coordinator of Clinical Education occupies a unique position in physical therapy education, often serving as the link between the didactic and the clinical domains of the program. A wealth of anecdotal information suggests the need for a more systematic study of the role and functions of the ACCE. A survey based on a self-administered questionnaire was sent to the ACCEs at 101 physical therapy education programs in the United States. A usable response rate of 79% was sufficient for the analysis. This study identifies some of the functions of the ACCEs, profiles their demographic characteristics, and describes the educational programs in which they work. The time ACCEs devote to participation in teaching, administrative, scholarly, and service activities is reported. In general, the ACCEs reported that the didactic and clinical curricula of their programs were well integrated.

The influence of technology on the future of allied health professionals.

Technology has been a major factor in the creation of allied health disciplines and continues to shape the future of the field. Predictions are made about the effects of technology in allied health. Suggestions are offered to allied health practitioners and educators for taking an active role in directing the future of the field.

Measuring social support: a synthesis of current approaches.

Definitions and concepts of social support are reviewed in an attempt to develop a theoretical structure for future research. Fourteen techniques for measuring social support are assessed to ascertain the degree to which they reflect common theoretical elements. A paradigm that should help to focus research efforts on the construction of a systematic knowledge base about social support is proposed.

The tracer method of curriculum analysis: identifying changes in oncology subject matter in medicine.

Changes occurring in oncology subject matter in an undergraduate medical curriculum over a 5-year period were documented using the tracer method of curriculum analysis. The tracer method is an empirical approach somewhat analogous to tracing one thread through a tapestry, as a way of following a subject matter interwoven throughout a curriculum. Advantages of the method can be to bring particular material to the attention of teaching staff and students, to facilitate more efficient instruction, and to introduce peer review of educational material.

Lessons from Roseto 20 years later: a community study of heart disease.

The findings of a community study of coronary artery disease were reviewed retrospectively to highlight applications to current research and clinical practice. Roseto, Pennsylvania, an ethnically homogenous county, was studied in the 1960s by an interdisciplinary team of researchers. Twenty years later the findings are being confirmed in the studies of other investigators. The major finding was the importance of social support and close family ties in buffering the deleterious effects of stress and life change, factors which have been implicated in the occurrence of myocardial infarction and sudden death.

Minority recruitment to the health professions: a matched comparison six-year follow-up.

An experiential program was designed to attract minority students to health careers and to affect the supply and distribution of health manpower in a medically underserved area. A six-year follow-up study of participants and a matched comparison group of nonparticipants indicate the value of the program. Participants were found to by employed in health careers and to achieve long-term career preferences more often than nonparticipants, even though they experienced slightly more obstacles to career attainment. Although more of the participants appeared to remain in the underserved area to practice their health profession, respondents from both groups who had achieved a health career and who had been educated in the underserved area were more likely to remain in the area to practice. This study is evidence of the value of long-term follow-up evaluation.

Should health systems agencies be involved in environmental health planning?

Public Law 93-641 provides health systems agencies (HSAs) with a broad planning preview which has enabled a number of agencies to address environmental health issues in their health systems plans. Opponents of HSA involvement in environmental health planning charge that these activities overextend agency resources, duplicate efforts of other government agencies and involve HSAs in "issues of public policy." Closer examination of these charges finds them lacking in validity. The planning activities of health systems agencies are cooperative in nature, drawing upon the planning efforts of other institutions and agencies. It is illogical to exclude environmental concerns from general health planning in light of the impact of the environment upon health. Charges that issues of public policy are inappropriate topics for health planning are seen as attempts to avoid scrutiny of inconsistant legislative policies. Cooperative planning between health systems agencies and environmental health agencies is considered both desirable and essential for the development of effective health planning.