Screening Habits Research Articles

Serving Native American Communities

Academic departments have a shared purpose to better serve the local community, to bring diversity to our experience in training sites, and to reflect the diversity of those who reside in our states. Nowhere is that mission better demonstrated than in the departments of family medicine based in states with large Native American populations. These departments have developed innovative programs to reach and collaborate with members of their Native American communities. The University of North Dakota (UND) School of Medicine and Health Sciences Department of Family Medicine has residency programs in Bismarck and Minot involved with their local reservations. Faculty and residents from Minot travel weekly to provide maternity and women’s health services to the Fort Berthold area. Both residency groups provide inpatient services at their main teaching hospitals. Several of the residents have gone on to work in these sites, which is one goal of the program. In addition, medical students have family medicine clinical experiences on the reservations at Indian Health Service (IHS) sites. Similarly, the physician assistant (PA) program is working to attract students from the Native populations, enhance the PA student training in cultural issues, and improve care to Native American elders through a cooperative educational program with local elders. The university regularly admits 7 Native American students yearly through the Indians into Medicine (INMED) Program; 5 students stay in North Dakota, and 2 go to the University of South Dakota (USD) for their clinical education. UND is also the recipient of a telemedicine grant to develop an annual eye screening program for Native Americans with diabetes. The University of New Mexico Department of Family and Community Medicine has a long-standing commitment to serving Indian people. Three of the 5 founding department faculty worked in the IHS, and today, of the 46 faculty in the department, 28% have worked or are working with the IHS and 4 (9%) are American Indian. Strong links have been established between the Department and the Albuquerque IHS, including faculty appointments for the IHS physicians. Department faculty provide health services in rural and urban Indian communities, faculty and residents admit referred Indian patients to the department’s inpatient service, and residents train in IHS facilities. Since l998, 2 of 18 family medicine residents at New Mexico admitted each year are allowed to select the Albuquerque Indian Hospital for their required 3-year continuity clinic. A review of the outcome of this residency “track” shows that, of the 13 residents who have graduated after 3 years of continuity clinic training at the IHS, 7 (54%) were American Indian; 9 (69%) currently work in IHS, tribal, or urban Indian settings; and 4 (31%) work in non-Indian, underserved rural, urban or migrant health centers. Family medicine residency training in Native Indian communities has benefits for the Indian communities in terms of service, benefits for IHS in terms of recruitment of a stable health workforce, and benefits for the residency in terms of unique educational opportunities. Finally, the USD School of Medicine and Health Sciences Department of Family Medicine has a central focus of reducing health disparities, especially for the American Indian population. This work is done through medical student rotations in preventive medicine, obstetrics-gynecology, and community health at IHS clinics and hospitals, medical student research projects addressing tribal and IHS priorities, faculty research and service grants/contracts with tribes, and an epidemiology contract through the Center for Rural Health Improvement with the Aberdeen Area IHS. Medical student projects include helping a tribe develop its own cancer plan, conducting a research survey of IHS provider screening habits and training needs for domestic violence, and a follow-up project the next year that provides ACOG domestic violence screening training CME to IHS providers. Department faculty and residents provide community lectures on educational opportunities in medicine and the health sciences to students in the communities where they work. Like politics, health care is inherently a local issue, and the needs and concerns of local groups are as varied as the groups themselves. Academic departments must adapt to the local environment, build on local strengths, and respond to local needs. The programs described here represent only a small part of the diversity of departmental programs, but they are models of how departments have responded to their local conditions and built programs and systems that reach out to, collaborate with, and help those we seek to serve.

Pediatric Residency Training on Domestic Violence: A National Survey

Between 3.3 and 10 million children witness domestic violence (DV) each year. These children are at risk for both emotional and behavioral problems. In 1998, the American Academy of Pediatrics issued guidelines for pediatricians to screen for DV and for residency programs to include DV education. Prior studies have assessed practicing pediatricians' DV screening habits. This study was designed to assess chief residents' attitudes and training regarding DV screening. A 53-question survey regarding residents' attitudes and training surrounding DV was mailed to the chief residents of all 194 nonmilitary US pediatric residency programs. Descriptive and inferential analyses were performed. Sixty-eight percent of surveys were returned. Sixty-eight percent of respondents were female. Although 93% of chief residents felt that pediatricians should screen for DV, only 21% screen every patient. Only 24% agreed or strongly agreed that they felt experienced in handling DV cases. Although 60% of respondents say that they received 11 or more hours of residency training in how to handle child abuse, the majority (80%) received 4 hours or less of DV training. Seventy-one percent agreed or strongly agreed that pediatricians do not screen secondary to lack of training. Pediatric chief residents believe that DV is a significant pediatric health problem. However, screening practices are variable. Most chief residents feel that their training was not sufficient to make them comfortable screening for DV. Chief residents demonstrated openness to incorporating DV training into their programs, indicating a positive environment for DV curricula.

Glaucoma screening by primary care physicians in southern Alberta: patterns, methods and deficiencies

Background: This study was undertaken to determine the proportion of primary care physicians who routinely assess their patients for risk factors associated with glaucoma as well as the elements that underlie whether these physicians screen for glaucoma.Methods: A brief, confidential questionnaire was distributed to primary care physicians on 3 occasions. The survey asked about the physicians' background, their glaucoma screening habits, reasons for not doing routine screening and measures that would help the physician begin to do screening. Responses were categorized and percentages calculated.Results: Of the 161 questionnaires distributed, 49 (30.4%) were returned. Of the respondents, 53% claimed that they routinely screened for glaucoma; more urban than rural physicians did so (57% vs. 44%). Some of the screening methods documented were inappropriate. The reasons most often given for not screening were lack of equipment and skills, cited by 48% and 30%, respectively, of the physicians who claimed not to be currently screening. Most (85%) of the respondents who claimed to routinely screen for glaucoma said they would refer the patient to an ophthalmologist or optometrist if they suspected the condition. Among the measures that would help physicians currently not screening to begin doing so, training and access to equipment and facilities were most often suggested by those not currently screening as well as those routinely doing so.Interpretation: If family physicians are an appropriate group to screen for glaucoma, and if mass screening for this condition is worth while, education and access to equipment are critical.

Prostate-specific antigen screening coverage and prostate cancer incidence rates in the Belgian province of Limburg in 1996-1998.

According to the 1996-1998 cancer incidence report of the cancer registry of the Belgian province of Limburg (LIKAR), prostate cancer is the most common cancer in men with a crude invasive cancer incidence rate of 123.7 per 100000 person-years (125.4 and 81.8 after standardization for the European and the world standard population). In a study on geographical differences between the occurrence of cancers in municipalities, prostate cancer standardized incidence rates (SIRs) were significantly higher in a number of municipalities, with mean relative risks of 1.2 and 1.3 after full Bayesian smoothing. We hypothesized that prostate cancer incidence rates are largely influenced by the prostate-specific antigen (PSA) screening policy of local physicians and that differences between municipalities are more informative about local screening habits then about real differences in cancer occurrence. The aim of this study was to test this hypothesis by relating local prostate cancer SIRs to the PSA screening coverage of the population of men in each municipality. The SIRs of prostate cancer in 1996-1998 for each municipality were provided by LIKAR. They related to all histologically or cytologically proven new invasive prostate cancers during these years. For each municipality, PSA coverage data were provided by the largest sick fund of the region. Coverage was defined as the proportion of men above the age of 40 that was tested at least once within the registration period. The SIR of each municipality (dependent variable) was related to the age-standardized corresponding coverage (independent variable) by linear regression and was adjusted for the number of inhabitants per municipality: log (standardized incidence rate) = 164 + 602 * (standardized PSA coverage), = 0.12. The model explained 6% of the variance in incidence. In conclusion, in this study no statistically significant relationship was identified between PSA coverage and prostate cancer incidence rate per municipality. This could result from no such relationship existing or from low statistical power.

Improved Screening for Breast Cancer Associated with a Telephone-Based Risk Assessment

Background. Our objective was to develop and field-test a telephone-based breast cancer risk assessment and to assess its efficacy in improving screening behavior. The study was performed at a financial institution and a manufacturing corporation with main offices in Boston, Massachusetts, and branch offices in various regions of the United States.Methods. A longitudinal study consisting of an initial health risk assessment administered by telephone, with a subsequent follow-up study initiated 8 months later, was performed. Study design was influenced by some of the suggestions made by the benefits departments of the corporate sponsors. A voice-response, telephone system collected risk information from callers and gave real-time risk assessment. These callers could receive a risk assessment over the phone and remain completely anonymous or furnish name and address to receive a more detailed written report. Main outcome measures included the response rate and demographics of the respondents, risk profiles of the callers, and breast cancer screening statuses.Results. There were 343 participants of whom 189 relinquished anonymity to receive more detailed information by mail and were available for a follow-up study. Sixty-three women (18%) reported a family history of breast cancer, with 34 women (10%) responding that one first-degree blood relative had been diagnosed before the age of 50. A strong positive correlation between the level of familial risk and the decision to remain anonymous existed (P< 0.0001). There was an increase in compliance with breast self-examination from 34% (40/119) at time of use of the system to 62% (74/119) at follow-up,P< 0.0001. Clinical breast exams showed similar improvements, from 82 (98/119) to 92% (110sol;119),P< 0.0137. Paired and unpaired data of women 40 years of age and older indicate an improvement in mammography compliance from time of system use to follow-up, 76 (22/29) to 93% (27/29),P< 0.0572, and 79 (33/42) to 93% (27/29),P< 0.0129, respectively.Conclusions. A population of women with a risk profile higher than that of the U.S. population called the survey. System use is associated with an improvement in breast cancer screening habits. Self-reported, increased genetic risk for breast cancer was strongly correlated with a decision to remain anonymous.