Free Screenings Research Articles

Communicating with Patients and Providers

You have accessThe ASHA LeaderFeature1 Aug 2009Communicating with Patients and Providers Ann W. KummerPhD, CCC-SLP Ann W. Kummer Google Scholar More articles by this author , PhD, CCC-SLP https://doi.org/10.1044/leader.FTR2.14102009.10 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In All businesses (including health care organizations and private practices) need to market their services to attract customers, clients, or patients. Marketing is so important that it is usually part of any successful organization’s strategic plan. The effectiveness of marketing designed to develop name recognition and a public perception of quality, value, and trust can determine the organization’s ultimate market share and financial viability. In the Division of Speech Pathology at Cincinnati Children’s Hospital, we market our services in many ways. As a result, we are the largest pediatric speech-language pathology program in the country and have a long list of patients waiting for services. From our experience, we suggest several strategies. Marketing to Potential Referral Sources We found the following strategies to be effective in reaching out to referral sources: Lectures. Offer to speak to physician groups about disorders that they see and we treat. Many physicians do not know about the services we can provide. Certainly, putting a face and personality to your program also helps. Handouts and brochures. Provide easy-to-read handouts/brochures at lectures and mail them to potential referral sources. These handouts should include important clinical information but also information on how to refer to your program. Surveys. Send a survey to current and potential referring physicians to demonstrate that you care about serving their needs. From our surveys, for example, we learned that physicians do not want long, detailed reports. We changed our report format and let physicians know we responded to their feedback. Personal visits. Set up 15-minute meetings with physician practices. Give them brochures and discuss the types of patients that are appropriate to refer. Letters. Send an annual letter to professionals who are current or potential referral sources. Include a brochure that describes your services and gives guidelines for referrals and a phone number for physicians to call if they have a question, are concerned about a patient, or need patient handouts. Web site. Include material on your Web site that describes your services and provides information for physicians and families. We find that people are more likely to seek services if they find helpful information on our Web site. Media coverage. Look for every opportunity to obtain publicity about your program. Although television and newspaper coverage may be hard to get, it is relatively easy to place an article in a physician’s monthly newsletter or on the hospital’s Intranet. Marketing to Potential Patients The following two strategies worked well in raising awareness of our services to potential patients: Free screenings. Free or low-cost screenings advertised through the media often provide an ongoing source of new patients. Events. Partner with another business or organization to host a mutually beneficial event. Through a partnership with local bookstores, for example, we offer a free program about using books to stimulate language development; in return, the bookstore attracts more people to the store. We offer a valuable service, and we receive free publicity and books. Marketing your program doesn’t require a billboard on the expressway or a sign on a bus. Instead, marketing typically involves direct communication with potential patients or referral sources. Marketing can be done while serving others and, therefore, has more credibility and value than advertising. Regardless of the size of your program or budget, marketing should always be part of your strategic plan. Author Notes Ann W. Kummer, PhD, CCC-SLP, is senior director of the Division of Speech Pathology at Cincinnati Children’s Hospital Medical Center and professor of clinical pediatrics and otolaryngology-head and neck surgery at the University of Cincinnati. Contact her at [email protected]. Additional Resources FiguresSourcesRelatedDetails Volume 14Issue 10August 2009 Get Permissions Add to your Mendeley library History Published in print: Aug 1, 2009 Metrics Downloaded 79 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2009 American Speech-Language-Hearing AssociationLoading ...

Knowledge about glaucoma and barriers to follow-up care in a community glaucoma screening program

Objective: To assess perceived barriers to glaucoma follow-up care, including the lack of glaucoma knowledge and the lack of health care access, among participants in a community glaucoma screening program. Design: Community survey. Participants: Two hundred forty-three consecutive participants in a series of free glaucoma screenings between November 2002 and August 2003. Methods: The survey consisted of 20 questions designed to elicit knowledge of glaucoma and perception of potential barriers to follow-up care. Our aim was to find correlations between patient demographics and knowledge of glaucoma as well as perceived potential barriers to follow-up care. The data were analyzed using SPSS, v. 10.1. Results: The average age of the respondents was 70 years, and females predominated (66%). About half of the respondents knew of an eye doctor in their neighborhood, and 60% had had an eye examination in the past year. Two hundred twenty-two (91%) indicated they could get to an eye doctor if the screening examination indicated they needed a follow-up examination. Two hundred twenty (90.5%) had medical insurance. One hundred seventy-eight (73%) of the participants had heard of glaucoma; 71 (29%) identified an accurate definition of glaucoma. The level of education and the language spoken at home were correlated with both glaucoma awareness ( p < 0.001; p < 0.001) and knowledge of an accurate definition of glaucoma ( p < 0.001; p < 0.025). Conclusions: In this population, a lack of adequate education about glaucoma may be more significantly associated with poor follow-up rates than a lack of access to care in those identified as glaucoma suspects.

Risk factors for presumptive melanoma in skin cancer screening: American Academy of Dermatology National Melanoma/Skin Cancer Screening Program experience 2001-2005

Since its inception in 1985, the American Academy of Dermatology (AAD) National Melanoma/Skin Cancer Screening Program has strived to enhance early detection of cutaneous malignant melanoma (MM) by providing nationwide skin cancer education campaigns in combination with free skin cancer screenings. To analyze the AAD screening data from 2001 to 2005 in order to identify factors associated with MM detection, and thereby derive a model of increased likelihood for MM detection through visual skin examinations at screenings. Patients completed a standardized AAD pre-screening form with historical and phenotypic information. Clinicians then recorded suspected clinical findings noted at visual skin examination. Statistical analyses were conducted using SPSS 14 (SPSS Inc., Chicago, Ill). Five factors, which can be remembered with the acronym HARMM, independently increased the likelihood of suspected MM being found in the 362,804 persons screened: History of previous melanoma (odds ratio [OR] = 3.3; 95% confidence interval [CI], 2.9-3.8); Age over 50 (OR = 1.2; 95% CI, 1.1-1.3); Regular dermatologist absent (OR = 1.4; 95% CI, 1.3-1.5); Mole changing (OR = 2.0; 95% CI, 1.9-2.2); and Male gender (OR = 1.4; 95% CI, 1.3-1.5). Individuals at highest risk (4 or 5 factors) comprised only 5.8% of the total population, yet accounted for 13.6% of presumptive MM findings, and were 4.4 times (95% CI, 3.8-5.1) more likely to be diagnosed with suspected MM than individuals at lowest risk (0 or 1 factor). Receipt of a total skin examination at screening independently increased the likelihood for identifying suspected MM (OR = 1.4; 95% CI, 1.3-1.6). However, significantly fewer screenees in the highest risk group versus those in the lowest risk group underwent total skin examinations (53.7% vs 62.5%). Risk factors studied limited to variables collected in screenee enrollment form. A higher-risk subgroup of the skin cancer screening population can be identified through assessment of MM risk factors using the HARMM criteria. Refocusing efforts to provide a total skin examination to those individuals with multiple risk factors has the potential to both reduce costs and increase yields for suspected MM in future mass screening initiatives.

Skin Problems Related to the Occupation of Commercial Fishing in North Carolina

Commercial fishing is one of the most dangerous professions with many of the occupational health problems related to the skin. This study elucidates the types of occupational skin disorders that occur in commercial fishermen in North Carolina. STUDY DESIGN/SETTINGS: Booths were set up offering free skin cancer screenings at various seafood festivals, a "blessing of the fleet" event and commercial fishing shows, which were located throughout eastern North Carolina from 2002-2004. When commercial fishermen were screened, they were asked about significant skin problems that they had experienced and were related to their occupation. They were specifically asked about their history of (1) cancerous and precancerous skin lesions, (2) eczemas, (3) superficial fungal infections, (4) bacterial infections of the skin, (5) traumatic injuries related to the skin, (6) bites and stings, (7) shocks from fish, and (8) skin problems related to environmental extremes. Eighty-one North Carolina watermen were screened: seven of the fishermen (9%) had at least one basal cell carcinoma, five (6%) had at least one squamous cell carcinoma, and no melanomas were detected. Many occupationally related skin disorders were noted on the historical survey, and some of the more dangerous of these included traumatic injuries related to fishing equipment, cutaneous cancers, fish bites, infections, stingray injuries, and man-of-war stings. The sample population was comprised of volunteers, which limits generalizability, and some diagnoses were established retrospectively. There are a wide variety of skin disorders among commercial fishermen in North Carolina and healthcare professionals should be aware of these when working with watermen.

A Most Irregular Threat: Old Gas Regulators Can Present Mercury Exposure

Residential gas regulators reduce the pressure of gas from main feeder lines to usable levels for household pipes. Gas regulators built before 1961 were commonly located within dwellings and incorporated a component that contained, on average, 136 grams (about 2 teaspoons) of elemental mercury. Newer units do not contain mercury, but as a group of Chicago-area researchers report, careless replacement of the older units can result in potentially hazardous mercury contamination [EHP 114:848–852; Hryhorczuk et al.]. The authors describe how this newly identified source of residential mercury exposure came to light in 2000, when a suburban Chicago family discovered a pool of the silvery element on the floor of their basement workroom six weeks after a gas company contractor removed and replaced their gas regulator and meter. An investigation showed that the air in the house contained elevated levels of mercury vapor, and the father and the 9-year-old son, who spent more time in the basement area than the mother, had blood and urine mercury levels above recommended background limits. Short-term exposure to high levels of metallic mercury vapors can cause lung damage, nausea, vomiting, diarrhea, elevated blood pressure or heart rate, skin rash, and eye irritation. Fortunately, ventilation and remediation of the home brought mercury concentrations in the home’s air down to safe levels, and several weeks after exposure ceased, the father’s and son’s blood and urine mercury levels returned to normal background ranges. Neither ever manifested overt clinical signs of mercury poisoning. This case and a cluster of similar cases quickly caught the attention of area authorities. Ultimately, two area gas companies were required to conduct inspections in 361,000 homes where their employees or subcontractors had replaced old gas regulators. Free urine mercury screenings were offered to concerned residents. Of the 301,000 homes inspected by one of the companies, 1,308 (0.43%) were found to be contaminated, and 1,033 were remediated. Of 60,000 homes screened by the other company, 55 (0.09%) were found to be contaminated and were remediated. The risk was considerably higher in homes where the equipment had been replaced by one particular subcontractor—of 120 homes screened, 20 (16.7%) were found to have been contaminated by mercury. Of the 625 residents who elected to undergo urine mercury screenings, 9 (1.4%) had positive bioassays, defined as a 24-hour urine mercury concentration equal to or higher than 10 micrograms per liter. Although none of the subjects showed overt symptoms of mercury poisoning, as the authors point out, the screenings were not designed to detect subclinical effects of mercury exposure. Interestingly, positive urine mercury in residents was more strongly associated with elevated air mercury concentrations on the first floor of the homes than with elevated basement air levels, even though the air concentrations were considerably higher in basements, where the spills typically occurred. The authors attribute this result to the simple fact that people generally spend less time in their basements than in the living quarters aboveground. The Chicago episode not only revealed a previously unidentified environmental exposure hazard but also provided valuable lessons on how to respond quickly and efficiently. As the authors note, gas companies and their subcontractors, clinicians, public health and environmental officials, and residents all need to be aware of the potential for contamination in older homes or other buildings where mercury-containing gas regulators have been replaced in the past, or where they may still exist.

Free Screenings for Asthma in May

Free Screenings for Asthma in May

Depression, Stress, and Blood Pressure in Urban African‐American Women

African-American women have disturbingly high rates of hypertension, exceeding those of African-American men and other ethnic groups. Reasons for these disparities are not understood. Depression, more common in women than men, has been linked to endothelial dysfunction, inflammation, metabolic and hematologic abnormalities, and increased sympathetic nervous system activity--all factors associated with cardiovascular disease. A descriptive correlational design was used to test the following hypotheses: 1) African-American women with higher levels of depression will have higher blood pressure (BP) levels, more cardiovascular risk factors, greater stress, and lower social support; and 2) depression will mediate the relationship between stress and BP. A convenience sample of 245 hypertensive African-American women (mean age, 61+/-12.7 years) was recruited through free BP screenings offered in the community. All data were collected during a structured interview and brief physical examination. Pearson r correlation coefficients, analysis of variance, and multiple regression analyses were used to analyze the hypotheses. Women with higher levels of depression had higher diastolic BP and were more likely to smoke, eat fewer fruits and vegetables, and have more stress and less social support. Depression mediated the relationship between stress and diastolic BP. The findings emphasize the importance of assessing both behavioral and psychosocial factors in urban African-American women with hypertension.

Use of Hormone Replacement Therapy (HRT) and Survival Following Breast Cancer Diagnosis

Data from BreastScreen Victoria, which provides free biennial breast screenings for women over 40 years of age, was used to evaluate the association of hormone replacement therapy (HRT) use with the diagnosis and survival of breast cancer in postmenopausal women. Between January 1993 and December 2000, 4402 eligible women over age 55 were diagnosed with invasive breast cancer and ductal carcinoma in situ. The rate of use of HRT at the time of breast cancer diagnosis ranged from 20% to 24% in the years from 1993 to 1999 and increased to 29% in 2000. Compared with women with breast cancer who were not taking hormones, those who were taking HRT were younger (mean 62.3 years vs 66.7 years; P > .01) and were more regular attendees at screening appointments with an average interval between screenings of 25.3 months compared with 36.1 months (P = .02) for nonHRT users. Women taking hormones were more likely to be diagnosed with lobular tumors that were well differentiated and more likely to have an interval cancer (P < .01). Lumpectomy was more common in HRT users. Of 312 deaths in the study population during the study period, 157 were attributed to invasive breast cancer. The average length of survival among these women was 46.0 months. The average follow up for all women in the study was 6.1 years. The 5-year disease-specific survival rate for women taking HRT at the time of diagnosis of breast cancer was 98.2% compared with 97.1% for those not taking HRT (P = .07). For death from any cause, the 5-year survival rate was 97.4% for HRT users and 94.5% for nonusers (P < .01). Analyses of variables contributing to death from breast cancer were made using a proportional hazards model. High-risk factors included grade III tumor, positive lymph nodes, and tumor size greater than 20 mm. Considering these variables, analysis of risk of death associated with surgery type found that women who underwent lumpectomy had a longer survival compared with women who had mastectomy or no surgery (P < .01). Analyses according to HRT use considering all variables generated a hazard ratio for death from breast cancer of 0.67 (95% confidence interval [CI], 0.37–1.22) for HRT users compared with nonusers when breast cancer was detected in the first round of screening. When detection was made in subsequent screenings, the hazard ratio for death from breast cancer was 0.61 (95% CI, 0.31–1.18). Hazard ratios for death from all causes for users versus nonusers were 0.88 (95% CI, 0.58–1.32) in the first screening and 0.49 (95% CI, 0.28–0.86) in subsequent screenings.

Free Asthma Screenings in May

Free Asthma Screenings in May

Effect of nitrogen, seed rate and plant growth regulator (chlormequat chloride) on the grain quality of oats (Avena sativa)

The physical parameters of oats of prime importance in determining milling quality are kernel content, the content of free kernels, hullability and screenings. In addition to screenings, hectolitre weight is used in the commercial trading of grain as an indicator of quality due to the absence of suitable methods, for commercial use, for determining the parameters that are closely related to milling quality. The effects of nitrogen (0–200 kg/ha), seed rate (200 and 300 seeds/m2) and plant growth regulator, chlormequat chloride, on grain quality were investigated at two locations, in one spring and three autumn sown experiments, in 1997/98 and 1998/99. Yields increased at higher rates of nitrogen and at the higher seed rate but were not significantly affected by chlormequat chloride. The effects of nitrogen rate and seed rate on kernel content were inconsistent but overall there was a small reduction at the higher nitrogen and higher seed rates and where chlormequat chloride was applied. In general, free kernels were reduced at the higher rates of nitrogen, at the higher seed rate and where chlormequat chloride was applied. Hullability improved at higher rates of nitrogen but was poorer at the higher seed rate and with chlormequat chloride. Screenings increased and hectolitre weight declined at the higher rates of nitrogen, the higher seed rate and with chlormequat chloride. The decline in hectolitre weight due to treatments within each experiment in general was associated with reductions in kernel content, content of free kernels and an increase in screenings. However, variation in hectolitre weight did not reflect variation in kernel content, free kernels and screenings between experiments. Overall, the changes in quality due to nitrogen rate, seed rate and chlormequat chloride were small compared with differences between varieties.

Primary care cancer control interventions including Latinos: A review

Background Even though 86% of adult Latinos have a usual source of care, there is a paucity of literature on primary care–based interventions to promote cancer prevention and control in this population. This systematic review examines published primary care–based cancer control interventions that included Latinos. Methods MEDLINE, the Cochrane Registry, and EMBASE were searched from January 1985 to January 2003. Any primary care–based intervention using a controlled trial, quasi-experimental, or pre–post design that targeted breast, cervical, or colorectal cancer was included if at least 5% of the sample was Latino. Results A total of 14 intervention studies met inclusion criteria. Seven of the 14 studies described patient or provider reminder interventions. Other interventions incorporated into the primary care setting one of the following: community health educators, culturally sensitive videos, audit with feedback, materials from the “Put Prevention Into Practice” campaign, and vouchers for free screenings. The heterogeneity of designs and outcome variables and the low number of Latinos presented obstacles to combining data to estimate the overall effectiveness of primary care interventions for this population. Qualitatively, patient and physician reminders and management systems strategies including audit with feedback for providers appear to result in improved screening utilization. Conclusions There is a paucity of data on the effectiveness of primary care cancer control interventions directed at Latinos. Primary care–based interventions that have been effective in non-Latinos could incorporate culturally appropriate elements and lessons from community-based research and could be applied to Latinos so that their effectiveness can be assessed in this group.

Student leadership in public health advocacy: lessons learned from the hepatitis B initiative.

Increasing hepatitis B vaccination rates for Asian Americans and Pacific Islanders is a priority. Laws requiring vaccination prior to school enrollment have helped, yet many youths remain unvaccinated. The Hepatitis B Initiative (HBI), launched in 1997 and operated by public health and medical school students, provides free screenings and vaccinations to Boston's Asian American/Pacific Islander community, with a focus on youths. By October 2002, 997 HBI patients from Boston's Chinatown had received free hepatitis B screenings. Of these, 384 patients (39%) were deemed susceptible to the hepatitis B virus and provided with free vaccination.

Storms From the Sun: The Emerging Science of Space Weather

Storms From the Sun: The Emerging Science of Space Weather expounds on a term that is now familiar to the general public. In the United States, educational programming about space weather routinely appears on the Public Broadcasting System, the Discovery Channel, the Learning Channel, and other networks. Space weather articles appear in the popular press around the world, while AGU members often read about the topic in Eos and Physics Today. Indeed, during recent AGU meetings in San Francisco and Boston, attendees enjoyed free screenings of the IMAX movie “Solar Max,” which received standing ovations from appreciative audiences. However, there have been few documents describing space weather in its full historical, economic, technological, and political context. This book attempts to fill that niche.

Current concepts in the management of patients with melanoma.

Melanoma is a significant health problem. Despite public education and free cancer screenings, the incidence and mortality of melanoma continues to rise; however, many currently diagnosed melanomas are thin lesions, suggesting that education and awareness is having an impact. In addition, there are still subsets of patients who need increased surveillance in order to increase their survival. Although large congenital nevi may be precursors of melanoma, small and medium congenital nevi have an insignificant risk for melanoma development. Large congenital nevi, which are axial in location, appear to be more likely to develop melanoma and are associated with melanocytosis and melanoma of the CNS, both of which portend a poor prognosis. Recently, the recommended margins of excision have become more conservative so that many of the surgical defects can be closed primarily. Lymphoscintigraphy and sentinel node biopsy have replaced elective node dissections, thus decreasing the morbidity associated with the surgical management of melanoma. Although controversy still exists as to whether or not sentinel lymph node biopsy alters a patient's prognosis, it has been shown to be a powerful prognostic indicator. Although most melanomas are managed by routine surgical excision, other modalities are sometimes employed. For example, cryosurgery or radiation therapy may be indicated in the frail, elderly individual with a large facial lentigo maligna. Mohs surgery is the treatment of choice for head and neck melanomas and those located in areas where maximum preservation of tissue is required and for desmoplastic and acral lentiginous melanomas. Much more work remains in the area of adjuvant therapy, chemotherapy, and immunotherapy. Dacarbazine remains the drug of choice in disseminated melanoma, but remissions are usually short lived. Interleukin and biochemotherapy has yielded good results but the percentage benefiting is small. Although high dose interferon increases disease-free and overall survival in some patients, it remains a controversial drug which is not easily tolerated. In the new staging system for melanoma, ulceration is second only to Breslow's thickness. In transit (satellite) lesions have also been included in this new system. The new system also recognizes that patients with only microscopic metastatic nodal disease fare better than patients with clinically enlarged metastatic nodes and that it is the number of nodes involved with metastases, not their size, that determines the patient's prognosis. Except for lesions <1mm thick, the Clark's level of invasion has been de-emphasized.

Health Care in the Community, Interdisciplinary Professional Education for Students in Dietetics, Nursing and Osteopathic Medicine

Deans from three colleges selected tenured faculty to design and implement an interdisciplinary course to meet the need for active learning experiences for students across disciplines and an under-served city population with limited access to health care. A two credit course was designed with objectives in 3 areas: l) Community Service–plan and conduct 2-3 health screenings responding to family health needs; identify and prioritize client needs based on a team assessment; facilitate clients’ entry into the local health care system; 2) Professional Relationships–develop attitudes of mutual respect and practice collaborative case management; and 3) Professional Education–apply clinical skills in home and clinic settings to the in assessment of clients such as–vital signs, anthropometrics, dietary habits, and blood glucose, cholesterol and hemoglobin. Desirable class size was 21 with equal numbers recruited from seniors in Dietetics and Nursing, and 1st or 2 nd year O.M. students. Small group activities throughout the semester were designed to facilitate cross discipline interactions such as visits to community sites, short presentations on health topics, organization and implementation of 3 health screenings, follow-up home visits and small group counseling. Community members benefit by gaining access to free health screenings, health information, referrals and counseling monitored by seasoned health professionals. Students gain clinical, interpersonal and case management experience. Faculty members broaden their perspectives and knowledge by sharing clinical information and by jointly evaluating students. The colleges and university benefit via visibility within the community. The costs of such a course relate to the faculty time involved in designing and maintaining the interdisciplinary approach in an off-campus setting. The colleges view the high labor cost off the course as far surpassed by the benefits of the university's presence in the community and the benefits to faculty and students.

Factors influencing participation among melanoma screening attenders.

We surveyed the demographic profile and motives prompting to participate among people attending voluntary melanoma screening clinics in Southern Limburg, the Netherlands, in June 1993. Precampaign public announcements addressed only melanoma and its precursor lesions. All attendees completed a detailed questionnaire addressing demographic particulars and specific fixed choice questions on their motivation to attend. There were 4,146 persons attending the screening clinics. Most attendees opted for examination of a specific lesion (71%). More females than males participated. Fear of having skin cancer was an important reason to participate (27%). Of all attenders, 16% had to be convinced by relatives or friends to attend the screens, and 33% would not have visited a physician on their own initiative when there had not been a free screening. Females were more concerned about skin cancer than males. The local and regional newspapers formed the most important precampaign publicity channel. Free melanoma screenings attract large numbers of people. Males are underrepresented. They are less aware of the risk profile of melanoma. Future screenings should target the male population.

Screening to Help Asthmatics Breathe Easier

THE AMERICAN College of Allergy, Asthma & Immunology (ACAAI), Arlington Heights, Ill, has launched the first Nationwide Asthma Screening Program to help people with symptoms of asthma find the medical help and counseling needed to control the disease. The free asthma screenings will take place in shopping malls, civic centers, health fairs, and other public places in approximately 100 communities throughout the United States. The program that began in May seeks to encourage children and adults with breathing problems to speak with the allergists, respiratory therapists, and other health care providers who are volunteering their time and expertise at the screening sites. They will be invited to take a spirometer test and answer a 20-question Asthma Life Quality Test to help determine if a person has asthma and if the asthma is under adequate control. Based on the screening results, the participants will be counseled on whether they should seek

Pediatric preventive cardiology

In recent years there has been a strong emphasis from both medical and nonmedical communities to improve overall cardiovascular health. Continued attention has been focused on finding improved treatment regimens, and, encouragingly, increased attention is being directed toward prevention strategies for coronary heart disease. Emphasis on heart-healthy diets, fitness, and the now commonplace free blood pressure and cholesterol screenings have become part of our daily life. Multiple studies have demonstrated that atherosclerosis begins in childhood, and increasingly, the need for prevention to begin during childhood is being highlighted. Preventive cardiology in children, however, has long relied on adult data for definitions of risk factors, study protocols, and norms. Gradually, the pediatric data is becoming available. Elevated cholesterol levels, hypertension, obesity, and other risk factors defined in adults are all areas of intense interest in the pediatric population. This brief review of preventive cardiology in children provides a look at the risk factors for adult coronary heart disease as they relate to children, the current recommendations (and associated controversies), and a summary of some of the most recent clinical trials.

Disruptive Histories: Toward a Radical Politics of Remembrance in Alain Resnais's Night and Fog

produced a long series of problems that reverberated in the European press for the next two years. The film was Alain Resnais's Night and Fog (1955), a thirty-two minute documentary on the Holocaust. Banned from the festival because of German protests, the film made public a whole process of historical repression. The initial complaint pressed by the German foreign office claimed that the film would incite anti-German hatred. A combination of these protests, cold war anxiety, and the French government's own reservations about archival material in the film (showing French policemen helping with the deportation of prisoners) all helped to get the film removed from the festival. In a weak attempt to assert a moral economy of retribution, the festival organizers also threw out a German film as a token of appeasement. While the German foreign office did anticipate the reaction of other European nations to their protests, truly unexpected was the reaction within Germany. Night and Fog became a site of contention for a wide range of issues. Within months it was being shown at film festivals and film clubs in the major German cities. Willy Brandt, then the president of the Berlin House of Commons, came out with a statement explicitly supporting the film.1 Likewise Paul Bausch, the chairman of the Federal Bureau for the Press, Film, and Radio, released a statement proposing that the government should support free screenings of the film to all civil servants.2 A

Cancer prevention strategies among California farmworkers: preliminary findings.

This study was conducted to identify barriers to cancer prevention and evaluate the effectiveness of a cancer prevention project to increase screening for cervical and breast cancer among Spanish-speaking farmworkers in California's Central Valley. Bilingual health educators met with farmworker communities near Merced and Modesto, CA, to determine barriers that prevented women from seeking screening for breast and cervical cancer. Using information from focus groups and health fairs, a targeted outreach protocol was developed that will eventually enroll 2,500 farmworkers in a cancer education and screening program. Participants received a presentation in Spanish on breast and cervical cancer that included a pretest and post-test to assess increases in knowledge. Clients were encouraged to attend Golden Valley Health Centers Inc. (GVHC) to receive free breast and cervical cancer screenings. Vouchers, redeemable for modest personal hygiene gifts by clients, were tracked to assess prevention behavior when appointments were kept at GVHC. Sixty farmworkers attended focus groups and 363 attended health fairs to provide input to The cancer prevention program. As of December 1, 1995, 1,732 female farmworkers were enrolled in an outreach program designed to increase knowledge and promote cancer screening. Data from pretests and post-tests indicated a statistically significant increase in knowledge about cancer and its prevention among participants. Furthermore, 317 participants redeemed vouchers for cancer screenings at GVHC. Active community collaboration and culturally appropriate intervention strategies, employed in conjunction with clinical services, can be successful in increasing cancer prevention awareness and screenings among female farmworkers.