A randomized community trial to increase mammography utilization among low-income women living in public housing

BACKGROUND: A randomized trial was conducted to evaluate the impact of a community-based intervention on mammography use among low-income women living in public housing. METHODS: All 41 public housing high-rise buildings were randomized to treatment and delayed treatment (control) conditions. After a cross-sectional baseline survey, an intervention called Friend to Friend was conducted in the treatment buildings by American Cancer Society and building resident volunteers. The intervention consisted of a health professional talk, small group discussions, and an opportunity to request assistance in obtaining a mammogram or mammogram reminder. A second cross-sectional survey was conducted to measure differences in screening rates between the study groups. RESULTS: Participation in the intervention averaged 27%. The study groups were equivalent at baseline. At follow-up, the proportion of women age 50-79 years who reported mammography screening in the previous 15 months was significantly higher in the treatment group (64%) than in the control group (52%). Breast cancer knowledge, attitudes, and beliefs did not differ between groups. CONCLUSIONS: These findings suggest that a multidimensional intervention which reaches women within their social environment and uses community volunteers can increase mammography utilization among women in public housing.     

Breast cancer screening adherence: does church attendance matter?

Little is known about the health behaviors of church attendees. This article reviewed telephone interview data of 1,517 women who were church members from 45 churches located in Los Angeles County to determine their breast cancer screening status and to identify the key predictors of screening. Almost all of this sample (96%) reported attending church at least once a month. Key predictors of screening included physician-patient communication, ethnic background, and having medical insurance. Although church-related predictors were not significantly related to screening adherence, the authors compared community-based screening rates from another sample to their sample rates and found that, when controlling for income and education, church members fared better on mammography screening than women who were community residents. This finding suggests that frequent church attendance contributes to better mammography screening status and that the relationship between religious involvement and health behaviors needs further explanation.     

Restructuring health services delivery research: a community-based model

As management of acute illness shifts to the community from tertiary care centres, there is a need for community-based research into the delivery of health services. One author is the coordinator of a health services delivery research unit located in a community health centre as well as the director of research in the Department of Family Medicine at McMaster University. The other author is a member of the administration of the sponsoring institution. The research unit, created in 1994, has close links with the sponsoring hospital, a research centre and the faculty of health sciences at a nearby university. Its staff has grown from 2 to 12 members, mainly as a result of grant support. Its aim is to improve the delivery of community-based health services, and to this end it conducts research in collaboration with programs at the health centre, stakeholder groups, communities and institutions. Research projects have been undertaken in clinical guidelines, women's health, mature adults' health, medication use and new technologies for screening. As an example, concern about chlamydial infections in women in the community led to research into burden of illness, diagnosis, screening methods, test technologies, validation of guidelines and provider behaviors. In the future, funding will be a major concern. The authors contend that more funding from such agencies as the Medical Research Council of Canada should flow to community-based research.     

Effects of a long-term hypertension control program on stroke incidence and prevalence in a rural community in northeastern Japan

BACKGROUND AND PURPOSE: Although randomized clinical trials have demonstrated the benefit of antihypertensive treatment in preventing stroke, the effectiveness of community-based programs is largely unknown. We investigated long-term community-based prevention activities. METHODS: In rural northeastern Japan, people aged > or = 30 years numbered 3219 in the full intervention community and 1468 in the minimal intervention community in 1965. Systematic blood pressure screening and health education began in 1963. Stroke was registered through 1987. RESULTS: More than 80% of people aged 40 to 69 years were screened in both communities in the 1960s. One community charged for screening services after 1968, whereas the other community intensified intervention; subsequently, screening rates and the follow-up of hypertensive individuals declined in the minimal intervention community, especially in men. In men, stroke incidence declined more (P < 0.001) in the full intervention (42% in the period 1970 to 1975, 53% in the period 1976 to 1981, and 75% in the period 1982 to 1987) than in the minimal intervention community (5% increase, 20% decrease, and 29% decrease, respectively); in women, the stroke incidence declined about 45% to 65% in both communities. Changes in stroke prevalence paralleled those in stroke incidence. Trends in systolic blood pressure levels tend to explain the differential stroke rates in men. CONCLUSIONS: Delivery of hypertension control services through intensive, free, community-wide screening and health education was effective in prevention of stroke for men in a community.     

A model psychosocial screening program for children and youth with newly diagnosed Type 1 diabetes: Implications for psychologists across contexts of care.

Psychosocial factors are strongly associated with long-term medical and mental health outcomes for children with Type 1 diabetes. As a result, current national and international guidelines now call for psychosocial screening at or near the time of diabetes diagnosis. Despite this recommendation, there are no published protocols to provide guidance to psychologists attempting to screen and identify at-risk patients and their families and prevent the emergence of secondary psychological and medical complications. In this article, the authors describe a model psychosocial screening program that was designed to minimize barriers to implementation and that can potentially be adapted for use by psychologists in different settings. Preliminary findings from the pilot phase of program development suggest that the screening is effective at identifying patients at risk for subsequent problems with diabetes management. The screening was able to identify specific, modifiable risk factors that provide targets for efforts at preventive intervention using treatment approaches familiar to most psychologists. The authors conclude with a discussion of the importance of screening and knowledge of diabetes risk factors for psychologists working in different treatment settings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychological Response to Test Results in an Ovarian Cancer Screening Program: A Prospective, Longitudinal Study.

To identify the psychological impact of receipt of an abnormal yet benign screening test result, the authors examined the response to a transvaginal ultrasound screening (TVS) test for ovarian cancer (OC) in asymptomatic women (N=540) undergoing an initial TVS screening test. Interviews were conducted prior to undergoing TVS screening and at 2 weeks and 4 months following this baseline. Women receiving an abnormal yet benign TVS test result (n=33) reported elevated OC-specific, but not general, distress at 2-week follow-up. Distress returned to baseline levels at 4-month follow-up. Consistent with the monitoring process and cognitive-social health information processing models, response to an abnormal TVS result was moderated by a monitoring coping style, low optimism, and a family history of OC. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening and treatment of distress.

The screening and treatment of psychological distress is an increasingly important aspect of providing comprehensive care to medical patients. The importance of this within oncology was illustrated most recently by the publication of the National Comprehensive Cancer Network's Distress Guidelines (Holland, 1997). Given that measures of general distress assess for symptoms across diagnostic categories, it is not unusual to have a combination of symptoms indicating distress without meeting diagnostic criteria (Derogatis, Morrow, & Petting, 1983). We would suggest that general measures of distress and psychiatric diagnoses not assessed by Coyne et al. (e.g., somatoform or adjustment disorders) may reflect better the distress (health anxiety and somatic preoccupation) of women at increased risk for cancer and be more informative than assessing selectively for mood disorders, anxiety disorders, and alcohol abuse. The authors additionally concluded that if there is not psychiatric disorder, then there is no impairment. We believe it premature at best to reify the DSM in a nonpsychiatric population. Distress exists on a continuum. To wait until patients meet psychiatric criteria before they are seen is not in the spirit of comprehensive medical care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing screening mammography in asymptomatic women: Evaluation of a second-generation, theory-based program.

Two theory-based programs to increase mammography screening rates among asymptomatic women were implemented and evaluated in the community. One program (E) was based on the Health Belief Model (HBM); the second program (EP) added exercises adapted from the social psychology of compliance. Program impact on screening among 295 primarily Caucasian, middle-class women was evaluated against untreated controls (C) over a 6-month period. Both programs led to increases in HBM components (Perceived Susceptibility, and Perceived Benefits) and Intentions to obtain a mammogram. Screening rates 2 to 3 times higher were observed in the EP and E over C conditions; EP and E did not differ. A mediational model of compliance illustrated the interplay of HBM components in the compliance process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changing community responses to wife abuse: A research and demonstration project in Iztacalco, Mexico.

This article describes the process of designing a multifaceted, community-based intervention to change community responses to wife abuse in Iztacalco, a low-income community on the outskirts of Mexico City. The goal of the intervention is to encourage women to recognize and disclose abuse and to encourage more constructive, less victim-blaming attitudes among family members, friends, and the community at large. The intervention is based on the belief that the response that a woman first gets upon disclosing her situation will be critical in setting the course of her future actions. The intervention includes small-scale media (e.g., buttons, posters, events) and a 12-session workshop to train women as community change agents. The design is based on insights derived from formative research and from the transtheoretical model of behavior change as elaborated by J. O. Prochaska and C. C. DiClemente (1982) and adapted to the special case of domestic violence by J. Brown (1997). The article also illustrates the utility of adapting popular education techniques to the research setting in order facilitate more honest disclosure of prevailing norms and attitudes about abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public health advocacy on behalf of women in S?o Paulo: learning to participate in the planning process

In 1988, a new Constitution was adopted in Brazil in which guidelines for community participation in the development and implementation of the national health system were delineated. The health and welfare of women and children were given priority. Implementation of these guidelines presents a major challenge in a city such as S?o Paulo with a population of 15 million, of which an estimated 5.8 million are women of childbearing age. In order to determine the extent to which community organizations are actively participating in planning health services for women and children in S?o Paulo, a study was undertaken to examine the experience of community and professional organizations in public health advocacy. This paper describes a sample of these organizations, their constituents, membership, history, funding, advocacy objectives, and strategies used and results obtained. The information gathered indicates that the community organizations are involved in activities that include major efforts to improve access to health care by providing specialized courses in women's health, including the status of women's work, sexuality, discrimination, family planning, and the politics of health; publishing newsletters; producing radio programs; engaging in legal action; and using petitions, demonstrations, and public meetings to garner public support on specific issues.     

Evaluation of the home-based maternal record: a WHO collaborative study

Thirteen centres in eight countries (Egypt, India, Pakistan, Philippines, Senegal, Sri Lanka, Democratic Yemen and Zambia) participated in the WHO collaborative study to evaluate the home-based maternal record (HBMR). The evaluation showed that use of the HBMR had a favourable impact on utilization of health care services and continuity of the health care of women during their reproductive period. When adapted to local risk conditions, their cut-off points and the available resources, the HBMR succeeded in promoting self-care by mothers and their families and in enhancing the timely identification of at-risk cases that needed referral and special care. The introduction of the HBMR increased the diagnosis and referral of at-risk pregnant women and newborn infants, improved family planning and health education, led to an increase in tetanus toxoid immunization, and provided a means of collecting health information in the community. The HBMR was liked by mothers, community health workers and other health care personnel because, by using it, the mothers became more involved in looking after their own health and that of their babies. Apart from local adaptation of the HBMR, the training and involvement of health personnel (including those at the second and tertiary levels) from the start of the HBMR scheme influenced its success in promoting maternal and child health care. It also improved the collection of community-based data and the linking of referral networks.     

Planning a community-based mental health system: Perspective of service recipients.

From the perspective of individuals with experience in the ex-mental patient movement, the authors (former patients) each provide a consumer perspective on the planning of mental health systems (MHSs). Problems in the current system are addressed, and the role of self-help and of patient and ex-patient organizations in developing a community-based MHS is highlighted. Opportunities for meaningful change provided by the Mental Health Planning Act, Pub. L. 99-660, are noted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Glycation accelerates the oxidation of low density lipoprotein by copper ions

The American Cancer Society recommends periodic mammography, clinical breast examination and breast self-examination beginning at age 40 years for asymptomatic women at average risk of breast cancer. Although there is substantial evidence from meta-analyses and non-randomized studies to support these recommendations, individual randomized clinical trials of breast cancer screening have not demonstrated mortality reduction in women aged 40-49 years. The opportunity to study this issue further in the United States has been diminished by the high prevalence of screening already being conducted in that population of younger women. The International Union Against Cancer, the American Cancer Society and the National Cancer Institute of the United States have convened a series of workshops and planning meetings to consider the available data and outline plans for future research. Plans are being developed to conduct a randomized trial of mammography in women younger than 50 years in multiple European sites. Successful completion of this trial may provide critical data on efficacy of breast cancer screening in younger women.     

Community-based participatory research: Partnering with communities for effective and sustainable behavioral health interventions.

The present issue contains one of the first studies published in Health Psychology—by Resnicow and colleagues—that uses elements of community-based participatory research (CBPR) (Resnicow et al., 2009). The authors engaged community partners (three health maintenance organizations or HMOs) to develop and implement a fruit and vegetable promotion intervention (Tolsma et al., 2009). African American HMO patients (the intervention targets) participated in formative work (i.e., focus groups) on survey items and intervention content and in survey pilot testing. A diverse group of researcher and nonresearcher expert stakeholders (e.g., African American health plan staff; consultants with expertise in Black identity theory, on which the intervention was based) was engaged in major project decisions regarding the measures and intervention design. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The North Carolina Breast Cancer Screening Program: foundations and design of a model for reaching older, minority, rural women

Breast cancer screening programs do not reach all women at the same rate. Screening mammography use varies according to sociodemographic characteristics; mammography utilization is highest among women in their fifties but then decreases with age. In North Carolina, breast cancer is a particular burden for Black and lower-income women. Black women are more likely to be diagnosed with late stage disease, and their rate of breast cancer mortality is higher than it is for White women even though the incidence in White women is greater. Older, Black, and low-income women are less likely to obtain screening by mammography and clinical breast examination. The Black-White gap is even more pronounced among rural women, in part because they are more likely to be poor. The North Carolina Breast Cancer Screening Program (NC-BCSP) was established to increase the rate of regular mammography screening by an absolute 20% in 3 years among older Black women ages 50 and older in five rural counties in the eastern part of the state. In this paper, we describe the genesis of this comprehensive community intervention model, highlighting the behavioral science constructs, health education principles, and theories of behavioral and organizational change that form its conceptual foundation. NC-BCSP's theoretical foundations include the social ecological perspective, the PRECEDE model of health promotion, the Health Belief Model of individual change, and the "stages of change" transtheoretical model. We also review the experiences and lessons learned from two previous outreach initiatives in North Carolina that provided valuable "lessons" in the development of the NC-BCSP intervention model. In the second half of the paper, we describe the actual NC-BCSP interventions, activities, and evaluation tools, citing specific examples of how the underlying theories are implemented. NC-BCSP's goal goes beyond individual behavior change to raise low mammography screening rates among Black women in rural North Carolina. Its ultimate objective is to create linkages across agencies, and between agencies and communities, that will endure after the research project ends.     

Occurrence of Echinococcus multilocularis Leuckart, 1863, in foxes (Vulpes vulpes) in the Czech Republic]

Home- and community-based care are deeply rooted in the United States and worldwide. Public and private organizations have provided formal in-home and community health services for more than a century. Today they are an integral part of the care continuum, ranging from highly technical and professional services to simple forms of non-professional and voluntary support in homes. Because the roles and functions of community workers have expanded and diversified, organizations must successfully recruit, train and support workers with widely differing skills. In health care's new economic era, health has re-emerged as a community rather than individual concern. Non-traditional models of service delivery will be the cornerstone of community-based health care. Providers and policy-makers must find new ways to refocus from treating illness to achieving and maintaining health.     

Developing a screening instrument and at-risk profile for nonsuicidal self-injurious behavior in college women and men.

Archival data (N = 1,048 women, 1,136 men) from a mental health survey of college students were used to investigate incidence of nonsuicidal self-injury (NSSI), including cutting. Significant levels (defined as 4–5 lifetime incidents) were found in 9.3% of women and 5.3% of men. The Counseling Center Assessment for Psychological Symptoms (a global symptom inventory) and an assessment of trauma had been field tested with this sample. We randomly partitioned half of these data into a holdout sample and used the remainder to develop an NSSI screening inventory that included (a) 5 women’s screening items, including 1 item to assess trauma experienced; (b) 11 men’s screening items; and (c) 12 items common to men and women, including depression, dissociation, anger, unwanted thoughts, nightmares or flashbacks, and having witnessed trauma. Logistic regression and receiver-operating characteristic curve analysis suggested the inventory significantly discriminated NSSI men and women in the holdout sample, p     

The effects of message framing and ethnic targeting on mammography use among low-income women.

The authors examined the effects that differently framed and targeted health messages have on persuading low-income women to obtain screening mammograms. The authors recruited 752 women over 40 years of age from community health clinics and public housing developments and assigned the women randomly to view videos that were either gain or loss framed and either targeted specifically to their ethnic groups or multicultural. Loss-framed, multicultural messages were most persuasive. The advantage of loss-framed, multicultural messages was especially apparent for Anglo women and Latinas but not for African American women. These effects were stronger after 6 months than after 12 months. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subdural hygromas after bone marrow transplantation: results of a prospective study

Postnatal depression occurs in 10-15% of women. The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-report scale designed specifically as a screening instrument for the postnatal period. It was initially validated for use in the UK, but has subsequently been validated for other communities. It has not been validated for an African community. OBJECTIVE: To determine whether the EPDS is a valid screening scale for depression in a Johannesburg community cohort. PARTICIPANTS AND SETTING: 103 women attending the postnatal clinic at Coronation Hospital, Johannesburg, South Africa. METHOD: The EPDS was validated against the Diagnostic and Statistical Manual (DSM-IV) criteria for depression. It was administered verbally to participants and translated into one of six South African languages where necessary. RESULTS: A threshold of 11/12 on the EPDS identified 100% of women with major depression and 70.6% of women with minor depression. For major and minor depression combined, sensitivity was 80%, specificity 76.6%, positive predictive value 52.6% and negative predictive value 92.2%. CONCLUSION: The EPDS, administered verbally, is a valid screening instrument in this urban South African community.     

Effectiveness of Early Screening for Externalizing Problems: Issues of Screening Accuracy and Utility.

Accurate, early screening is a prerequisite for indicated interventions intended to prevent development of externalizing disorders and delinquent behaviors. Using the Fast Track longitudinal sample of 396 children drawn from high-risk environments, the authors varied assumptions about base rates and examined effects of multiple-time-point and multiple-rater screening procedures. The authors also considered the practical import of various levels of screening accuracy in terms of true and false positive rates and their potential costs and benefits. Additional research is needed to determine true costs and benefits of early screening. However, the results indicate that 1st grade single- and multiple-rater screening models effectively predicted externalizing behavior and delinquent outcomes in 4th and 5th grades and that early screening is justified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)