Copyright (c) 2009 All rights reserved. http://works.bepress.com/costanzam Recent documents in Mary E. Costanza en-us Sun, 31 May 2009 04:35:46 PDT 3600 http://works.bepress.com/costanzam/84 http://works.bepress.com/costanzam/84 Thu, 27 Mar 2008 16:47:09 PDT Mary E. Costanza Aged Antineoplastic Agents Biopsy, Needle Bleomycin Carcinoma, Basal Cell Cyclophosphamide Drug Therapy, Combination Fluorouracil Humans Lung Neoplasms Lymphatic Metastasis Male Methotrexate Neoplasm Metastasis *Thigh http://works.bepress.com/costanzam/83 http://works.bepress.com/costanzam/83 Thu, 27 Mar 2008 16:47:05 PDT The objectives of this research were to document adherence to mammography screening guidelines among women over 50 years of age and to investigate factors related to adherence. Selected sociodemographic variables--personal breast health history, provider-related variables, and medical care utilization--were studied. Data were collected through a random digit dial telephone survey of 693 women from two geographic areas. While 48% had had a mammogram in the last year, only 20% reported at least two recent mammograms at yearly intervals. Adherence was significantly associated with having a higher income, being white, being 51 to 64 years old and having had breast symptoms and/or a family history of breast cancer. Additionally, women who had a regular physician, higher frequency of clinical breast examination, and a recent physician visit were more adherent. Women enrolled in Health Maintenance Organizations (HMOs) and/or covered by commercial plans were more adherent than women with no insurance or with entitlement coverage only. These relationships were generally maintained in multivariate analysis. While this study is consistent with others that demonstrate increasing adoption of mammographic screening, it also illustrates that the goal of regular screening according to guidelines has yet to be achieved. Jane G. Zapka Age Factors Aged Cross-Sectional Studies Female Humans Insurance, Health Logistic Models Mammography Mass Screening Massachusetts Middle Aged Patient Acceptance of Health Care Socioeconomic Factors http://works.bepress.com/costanzam/82 http://works.bepress.com/costanzam/82 Thu, 27 Mar 2008 16:47:00 PDT Tailored telephone counseling (TTC) is effective in increasing utilization of screening mammography, but has received limited testing on a large scale in a contemporary HMO setting in which most eligible women get regular screening. We conducted a randomized controlled trial comparing TTC to an active control (mailed reminders) among women aged 50-80 enrolled in two HMOs in New England (n=12,905). Over a 1-year period counselors attempted to contact women in the intervention arm who had not had a mammogram within the last 15 months. The absolute increase in mammography use due to the intervention was 4.9% (OR 1.3, 95% CI 1.0-1.6) in one HMO and 3.1% (OR 1.2, 95% CI 1.0-1.3) in the other. We estimated that one additional woman was screened for each 10.9 women eligible for counseling. An intervention process analysis documented a high level of acceptance of TTC and identified subgroups that could be targeted for counseling to improve the efficiency of TTC. Roger Luckmann Aged Aged, 80 and over Breast Neoplasms Counseling Female Health Maintenance Organizations Health Promotion Humans Mammography Middle Aged New England *Patient Acceptance of Health Care *Reminder Systems Telephone http://works.bepress.com/costanzam/81 http://works.bepress.com/costanzam/81 Thu, 27 Mar 2008 16:46:57 PDT Mary E. Costanza Female Humans *Leadership *Physician's Role *Physicians, Women *Role http://works.bepress.com/costanzam/80 http://works.bepress.com/costanzam/80 Thu, 27 Mar 2008 16:46:53 PDT BACKGROUND. Efforts to detect breast cancer in its early stages are necessary to reduce breast cancer-associated mortality. This study evaluated the impact of a multicomponent intervention implemented between 1987 and 1990 to increase a community's utilization of breast cancer screening by women over 50 years of age. METHODS. The study used a pretest/post-test two-community design, with one community assigned as the intervention community and the other as the comparison. The intervention consisted of a comprehensive physician involvement component and a community education effort. To assess the overall impact of the interventions, we measured women's participation in screening via random digit dial telephone surveys at three time points, each approximately 18 months apart. RESULTS. Over the course of the study, there were dramatic improvements in breast cancer screening participation in both communities. However, the intervention city showed more improvement in selected variables than did the comparison community in the early phases of the project between baseline and midpoint. These included increased advice by physicians to have mammograms, increased awareness that screening is necessary in the absence of symptoms, increased awareness that many women over 50 have mammograms, decreased perception of barriers to clinical breast exam, and an increase in the proportion of women having a clinical breast exam. In addition, significantly fewer women in the intervention city than in the comparison city reported never having had a mammogram at midpoint. CONCLUSIONS. The findings demonstrate limited impact of a community intervention during a period of increasing adoption of mammography screening, in part, due to this rapidly rising secular trend. Additionally, increased activities in the comparison community were documented. Therefore, as incidence of screening increases, targeted activities aimed at population subgroups are warranted, and evaluation designs need to include multiple comparison groups or broader geographic random samples. Jane G. Zapka Aged Breast Neoplasms Community Health Services Female Health Promotion Humans Intervention Studies Mammography Mass Screening Massachusetts Middle Aged Models, Statistical Physical Examination Questionnaires http://works.bepress.com/costanzam/79 http://works.bepress.com/costanzam/79 Thu, 27 Mar 2008 16:46:49 PDT The American Cancer Society (ACS) convened a workshop in March 1997 to consider new scientific findings related to breast cancer screening and to determine whether these findings warrant a change in the existing ACS guidelines. The meeting was timed so that participants could benefit from new data related to screening women aged 40 to 49 years. A recommendation based on the new data and subsequently approved by the ACS Board of Directors is reported. A. M. Leitch Adult Breast Neoplasms Female Humans Mammography Middle Aged Randomized Controlled Trials Time Factors United States http://works.bepress.com/costanzam/78 http://works.bepress.com/costanzam/78 Thu, 27 Mar 2008 16:46:45 PDT OBJECTIVE. To improve breast cancer screening skills, practicing non-academic primary care physicians were offered an opportunity to participate in a one-hour private skills-assessment session with a patient instructor. Research questions included: would physicians in non-academic practice be interested in a skills course; would the course improve their skills in breast examination and/or in counseling for mammography; and if they did improve, would the effect endure? DESIGN. Pilot study with cohort follow-up. INTERVENTIONS. Physicians were offered an opportunity to have their counseling and physical examination skills evaluated in a one-on-one interaction with standardized patients. The protocol included patient instructors who were trained to use a uniform breast health history that emphasized their increased risk of breast cancer, scant knowledge of breast-cancer screening, and fear of medical tests and cancer. The standardized patients were trained using a 77-point checklist. They demonstrated a high degree of consistency and reproducibility. A critical part of the learning experience was immediate feedback to the physicians regarding their performances. Physicians who took the course were given an opportunity to repeat it approximately 18 months later. MEASUREMENTS AND MAIN RESULTS. Of the 82 primary care physicians in the community, 49 (60%) were eligible to have their skills evaluated. Of these, 38 (77.6%) participated in the intervention. Baseline skills had mean scores (correct responses) better than 50% in most aspects of the physical examination but less than 35% in several critical counseling areas: reviewing mechanics of getting mammography, actually recommending mammography, and directing the patient regarding scheduling. Of the 38 physicians, 15 repeated the course. There was a significant improvement in their overall performance: 49% vs 67% (p = 0.002). CONCLUSIONS. Primary care physicians in a non-academic practice are interested in reviewing and improving their counseling skills. They are capable of improving their skills after receiving background information, instruction, and brief feedback. They maintain these improvements over time. Mary E. Costanza Breast Neoplasms Clinical Competence *Counseling *Family Practice Feasibility Studies Female Humans Male Patient Simulation *Physical Examination http://works.bepress.com/costanzam/77 http://works.bepress.com/costanzam/77 Thu, 27 Mar 2008 16:46:41 PDT Jane G. Zapka Breast Neoplasms Community Health Centers Female Health Knowledge, Attitudes, Practice Hispanic Americans Humans Inservice Training Mammography Mass Screening Massachusetts *Patient Acceptance of Health Care Patient Education Pilot Projects Program Evaluation http://works.bepress.com/costanzam/76 http://works.bepress.com/costanzam/76 Thu, 27 Mar 2008 16:46:37 PDT Cardiotoxicity manifested as myocardial ischemia is not generally recognized as a side effect of 5-fluorouracil. However, there have been at least 35 cases reported since 1975. In only one of these cases was a somewhat detailed evaluation done to rule out underlying coronary disease. The case reported here of 5-FU cardiotoxicity included an extensive cardiac evaluation to rule out underlying coronary disease and to assess spasm. The literature on 5-FU cardiotoxicity is also reviewed, and its possible mechanisms are analyzed. N. J. Freeman Electrocardiography Fluorouracil Heart Humans Male Middle Aged http://works.bepress.com/costanzam/75 http://works.bepress.com/costanzam/75 Thu, 27 Mar 2008 16:46:33 PDT Mary E. Costanza Adolescent Adult Aged Bone Marrow Brain Neoplasms Clinical Trials Drug Therapy, Combination Female Glioblastoma Humans Hydroxyurea Lomustine Male Middle Aged Nitrosourea Compounds Vincristine