Prostate carcinoma knowledge, attitudes, and screening behavior among African-American men in Central Harlem, New York City.

BACKGROUND: Although the benefits of prostate carcinoma screening in reducing mortality rates have not been proven or shown to be cost-effective, screening, particularly using prostate specific antigen (PSA) tests, is widespread. A better understanding of screening behavior, knowledge of prostate carcinoma risk, and attitudes toward screening among men at high risk, such as African-American men, would be valuable. METHODS: A prevalence survey was conducted using 2 samples of African-American men, aged 50-74 years: a clinic sample drawn from all clinics in Central Harlem (n = 404) and a random-digit dial sample from the same geographic region (n = 319). The prevalence of self-reported PSA screening was estimated using a cognitive survey methodology based on the internal consistency of answers to four different questions. Prevalence estimates were adjusted to take into account the high proportion of nontelephone residences. RESULTS: The clinic sample, representing a poorer, more ill population (as determined by MOS Physical Function Scores, was less likely to report PSA screening than the community sample (11.1% in clinic sample vs. 25.5% in community). The prevalence of PSA testing in Central Harlem overall in this age group by using two different techniques was estimated to be 24%. In multiple logistic models, self-reported PSA screening was associated with age, education, favorable attitudes toward screening, and knowing someone who had prostate carcinoma. However, the association between these factors and the likelihood of self-reported PSA screening differed between clinic and community samples. CONCLUSIONS: The prevalence of self-reported PSA screening in Central Harlem was lower than that reported for other populations. These findings may be useful in the design of health education campaigns and for counseling innercity, low-income African-American patients appropriately about the disease.

Acceptance and use of Put Prevention into practice materials at an inner-city hospital.

Many studies indicate that physicians' prevention practices frequently differ from published guidelines. Put Prevention into Practice (PPIP) consists of a variety of paper-based materials for providers, patients, and the office setting designed to enhance the delivery of clinical preventive services. Prototype PPIP materials were distributed to physicians and patients at the Harlem Hospital medical clinic in conjunction with a series of prevention lectures for physicians. Acceptance and use of these materials were assessed through self-administered questionnaires for physicians and structured interviews for patients. A regression analysis was conducted to assess correlates of physician use of PPIP materials. Physicians reported a high degree of use of and satisfaction with PPIP materials. Multiple regression analysis indicated that the physicians' perceived self-efficacy in their ability to provide preventive counseling to patients at baseline was significantly associated with increased use of PPIP materials. When controlling for baseline physician self-efficacy, physicians whose self-efficacy increased during the study period were more likely to have used the materials. A majority of patients (53%) reported that the main patient-based component of the program-a pocket-sized booklet providing health education information and record-keeping of preventive tests and procedures-was very useful. Results from this study indicate a high degree of acceptance of prototype PPIP materials by physicians and patients at an inner-city hospital. Educational programs for physicians that enhance physician self-efficacy may be more effective in helping practitioners to adopt office-based prevention resources. Medical Subject Headings (MeSH): prevention, primary care, preventive health services, clinical practice patterns.

Putting prevention into practice. Impact of a multifaceted physician education program on preventive services in the inner city.

BACKGROUND: Physicians' prevention practices often differ from guidelines published by national authorities. Effective preventive services are most needed in inner city settings that suffer disproportionately from preventable diseases. This study examined the impact of a multifaceted physician prevention education program on the provision of preventive services in an inner city municipal hospital. METHODS: The study used a controlled intervention comparative design at two inner city municipal hospitals--Harlem Hospital Center, New York, NY (intervention site) and Kings County Hospital, Brooklyn, NY (comparison site)--serving predominantly African-American patient populations. The intervention site received prototype materials for physicians, patients, and the office setting from the US Public Health Service's Put Prevention Into Practice campaign and a series of prevention lectures from November 1991 through April 1992. Change in physician prevention practices and knowledge was assessed by self-administered questionnaires and change in patients' reports of preventive services received was assessed by structured interviews. RESULTS: Physicians at Harlem Hospital Center reported a greater postintervention increase in prevention practices and demonstrated a greater increase in prevention knowledge in comparison with physicians at Kings County Hospital. Patients at Harlem Hospital Center reported receiving increased preventive services from physicians after the intervention, while patients at Kings County Hospital did not report any significant change in preventive services received. CONCLUSIONS: A multifaceted physician education program using prototype materials from the Put Prevention Into Practice campaign with prevention lectures significantly increased the prevention knowledge and practices reported by physicians and the preventive services reported received by patients at an inner city municipal hospital.

Reversible ocular toxicity related to tamoxifen therapy.

A 42-year-old woman with metastatic breast cancer developed bilateral optic disc swelling, retinal hemorrhages, and visual impairment three weeks after starting treatment with low doses of tamoxifen. Neurologic evaluation failed to provide an explanation for the ocular findings which resolved completely after cessation of tamoxifen therapy. This case suggests that tamoxifen has the potential for causing serious ophthalmologic toxicity which may be reversible if recognized early.

A comparison of computer-assisted instruction and tutorials in hematology and oncology.

In the study reported here, third-year medical students in an internal medicine clerkship were randomly assigned to computer-assisted instruction (CAI) and to tutorials to compare the effectiveness of these methods in teaching hematology and oncology topics. A multiple-choice test was used to assess the students' knowledge after instruction, and the students completed a 14-item questionnaire concerning their opinions of CAI. No statistically significant difference was found between the test scores of the students using CAI and those in the tutorials for oncology; but in hematology the students in the tutorials had higher scores than those using CAI. The study design does not permit a definite explanation of the disparity in outcome for the two topics, but it is possible that the effectiveness of the presentations in the two sections was different. There was no statistically significant correlation between the time spent in the teaching setting and the score attained. The students did not consider CAI more effective than the tutorials but rather seemed to view it as a supplement to traditional teaching by lectures, textbooks, and studying from notes.