A community-based trial of vocational problem-solving to increase employment among methadone patients.

UNLABELLED: Unemployment remains a common problem among methadone patients. This study examined the effectiveness of the Vocational Problem-Solving Skills (VPSS) intervention to help unemployed methadone patients obtain employment. METHODS: 109 patients were randomly assigned to receive 10 sessions of either VPSS (n=62) or Interpersonal Problem-Solving (IPS) (n=47). Fourteen counselors from two methadone programs were trained to deliver both the VPSS and IPS counseling sessions. RESULTS: Overall, 93% (101/109) of the patients completed a 6-month follow-up assessment which revealed that 58.6% (34/58) of patients in the VPSS condition were employed, whereas 37.2% (16/43) in the comparison condition worked (chi-square=4.53, 1 df, p<0.05). However, a multinomial regression equation found that the VPSS intervention did not significantly contribute to the prediction of employment. Other factors such as longer length of previous work experience, 40 years of age or older, treatment site, and baseline patient motivation to work emerged as significant predictors. CONCLUSION: Although VPSS alone was not a strong independent predictor of improved employment functioning, improvements in employment functioning were detected at one of the two sites as a function of VPSS.

Using a faculty evaluation triad to achieve evidence-based teaching.

Aneffective and comprehensive faculty evaluation system provides both formative and summative data for ongoing faculty development. It also provides data for annual faculty evaluation and tenure and promotion decision making. To achieve an effective system, a triad of faculty evaluation data sources--student ratings, teaching portfolio, and peer evaluation--were developed. Concurrently, a system of faculty mentorship was implemented, as well as an administrative structure to effectively use data to assist in merit pay and promotion decisions. Using a comprehensive, evidenced-based system to document, analyze, and improve teaching effectiveness is essential to assuring excellence in teaching and learning.

Breast cancer: genetics, risks, and strategies.

Breast cancer is the most common cause of cancer among women, with 175,000 new cases diagnosed in 1999. The recent discovery of inherited mutations on the BRCA1 and BRCA2 genes and related research has increased our understanding of key risk factors. After identifying those who are at risk, health care providers must counsel women regarding appropriate prevention and early detection strategies. This article reviews the influence of genetics on breast cancer, identifies risk factors, discusses risk factor analysis, and suggests strategies for prevention and early detection of breast cancer.

Knowledge of menopause and hormone replacement therapy use in low-income urban women.

Hormone replacement therapy (HRT) can have significant long-term health benefits in postmenopausal women, yet rates of HRT use are low, especially in low-income urban women. Previous research has revealed that knowledge of menopause is a key predictor of HRT use in this population. A descriptive cross-sectional survey of 215 perimenopausal and postmenopausal low-income urban women was carried out to characterize knowledge of menopause and HRT and factors associated with knowledge level. Sociodemographic characteristics, patterns of HRT use, and knowledge about menopause and HRT were collected through a structured interview. Results revealed a general lack of knowledge about menopause and HRT, particularly relative to heart disease and the role of HRT in prevention. Major independent predictors of increased knowledge (R2 = 0.31) were having talked with a healthcare provider about HRT, having at least a high school education, and being less than 60 years of age. These findings emphasize the key role of providers in educating this vulnerable population about menopause and HRT and the potential subsequent impact on HRT use.

Prevention, early detection, and treatment of breast cancer: a collaborative approach.

Breast disorders are not only common and concerning, but in many cases, represent a real risk of death. Dealing knowledgeably with breast-related concerns is a priority for all HCPs and requires a thorough understanding of primary and secondary prevention strategies; first, to reduce the incidence of breast cancer, and second, to reduce the morbidity and mortality associated with the disease. Coordinated and supportive care for women diagnosed with breast cancer is essential to promote optimal health and well-being. The knowledgeable primary HCP, working collaboratively with a breast specialist, can help women achieve these goals.