Cancer patients' information needs across the cancer care continuum: evidence from the cancer information service

This study examines the information needs of cancer patients who contacted the National Cancer Institute's (NCI's) Cancer Information Service (CIS) via a toll-free telephone number. Records from 19,030 calls received from cancer patients between September 2002 and August 2003 were analyzed to determine differences in subjects of interaction (main topics of inquiry and discussion) for subgroups of patients based on demographic characteristics and stage along the cancer care continuum (pretreatment, in-treatment, post-treatment, recurrence). Females were more likely than males to inquire about cancer screening/diagnosis, support services, psychosocial issues, and general cancer site information, but they were less likely to seek specific cancer treatment information. Older patients were more likely than younger patients to seek specific treatment information, but they were less interested in support services, psychosocial issues, and prevention/risk factors. Compared with White callers, Hispanics and most minorities were more likely to seek support service information, and African Americans were more likely to have questions related to psychosocial issues. Compared with patients in treatment, patients in recurrence were more likely to seek specific treatment information; patients not in treatment were more likely to seek medical referral information; and patients in post-treatment were more likely to seek screening/diagnosis and prevention/risk factor information. Findings will help the CIS and other cancer-focused organizations address the distinct information needs of different subsets of cancer patients.     

Gender differences across racial and ethnic groups in the quality of care for diabetes.

High-quality care for diabetes is based on proper prevention, coordination of care among a multidisciplinary team of health care professionals, enhanced patient-provider relationships, and patient self-management skills. This paper discusses gender differences across racial and ethnic groups in the quality of care for type 2 diabetes according to 10 measures defined by the National Healthcare Quality Report and the National Healthcare Disparities Report. These measures include 5 process measures and one composite measure derived from the Medical Expenditure Panel Survey and 4 outcome measures derived from the Healthcare Cost and Utilization Project. National rates for 2 process measures--measurement of HbA1c (women 89.70% versus men 90.10%) and lipid profile (women 92.9% versus men 95.3%)--are high, but only 28.9% of women and 33.9% of men with diabetes received all 5 recommended process measures (HbA1c, lipid profile, eye exam, foot exam, and influenza immunization). Screening rates for retinal and foot exams and influenza immunization should be improved for all, but the need is particularly urgent for Hispanics and non-Hispanic blacks. Women and men have similar rates of hospital admissions for uncontrolled diabetes, but rates for lower extremity amputations were higher for men, particularly non-Hispanic blacks and Hispanics. Avoidable hospitalizations for diabetes decreased as income increased across racial/ethnic groups, but other factors (e.g., quality of primary care, age, relationship with providers, patients' self-management skills) may influence such rates. Moreover, any improvements in the diabetes outcomes measures may lag many years behind any measurable improvements in quality of care. Well-designed interventions that reallocate resources for diabetes self-care should be developed to ensure that gender differences are addressed across racial/ethnic groups. Because much of this care involves the management of risk factors, self-management education should be tailored to the lifestyles and beliefs specific to gender and racial/ethnic groups.     

Stomach cancer in New Zealand: time trends, ethnic group differences and a cancer registry-based case-control study

Stomach cancer trends in New Zealand were examined. Age-standardized mortality and incidence rates have declined over the past four decades, as in other countries. Rates have been consistently higher for men, and for Maori. A cancer registry-based case-control study of 1016 male stomach cancer cases and 19,042 male controls with other cancers was also conducted, to evaluate the relationships between stomach cancer and specific occupations. Adjustment was made for age, ethnicity, socioeconomic level, and smoking status. When 22 occupational groups were examined, adjusted odds ratios (ORs) and 95% confidence intervals (95% Cls) were elevated above unity for only one group: forestry workers (OR 1.83, 95% Cl 1.01-3.32). When two large, heterogeneous groups were broken down into 15 subgroups, adjusted ORs and 95% Cls elevated above unity were found for three sub-groups: grain millers and related workers; brewers, wine and beverage makers; and field crop workers. These findings may be because of the multiple comparisons and subgroup analyses undertaken. Men who had ever smoked cigarettes were found to have an increased stomach cancer risk compared to those who had never smoked (adjusted OR 1.36, 95% Cl 1.15-1.60).     

Racial/ethnic differences in endometrial cancer risk: the multiethnic cohort study

Few studies have examined differences in endometrial cancer risk among ethnic groups in the United States. The authors assessed the extent to which known risk factors for endometrial cancer explain the racial/ethnic differences in risk among 46,933 postmenopausal African-American, Native-Hawaiian, Japanese-American, Latina, and White women recruited to the prospective Multiethnic Cohort Study in 1993-1996. During a 7.3-year follow up period, 321 incident endometrial cancer cases were identified among these women. Data on known/suspected risk factors were obtained from baseline questionnaires, and comparisons of endometrial cancer incidence across racial/ethnic groups were estimated using log-linear proportional hazard models. Later age at menopause, unopposed estrogen therapy use, and obesity were associated with increased risk, while increasing parity and increasing duration of oral contraceptive use were associated with decreased risk. The relative risks for endometrial cancer (vs. Whites) were 0.76 (95% confidence interval (CI): 0.53, 1.08) for African Americans, 0.92 (95% CI: 0.58, 1.46) for Native Hawaiians, 0.61 (95% CI: 0.46, 0.83) for Japanese Americans, and 0.63 (95% CI: 0.46, 0.87) for Latinas. After adjustment for the risk factors, the relative risks were 0.68 (95% CI: 0.47, 0.98) for African Americans, 0.91 (95% CI: 0.56, 1.46) for Native Hawaiians, 0.74 (95% CI: 0.54, 1.01) for Japanese Americans, and 0.65 (95% CI: 0.47, 0.92) for Latinas. Results from this study show that the interethnic differences in endometrial cancer risk do not appear to be explained by differences in the distribution of known risk factors among women of different races/ethnicities.     

Preventive health examinations: a comparison along the rural-urban continuum.

In this analysis, Medical Expenditure Panel Survey data from 2000 were used to examine differences in reports of preventive health service utilization in 4 types of counties: large metropolitan counties, small metropolitan counties, counties adjacent to metropolitan places, and counties not adjacent to metropolitan areas or with fewer than 10,000 residents. Women from counties with 10,000 or fewer residents and not adjacent to a metropolitan county, classified as rural residents, were less likely to report a number of preventive health examinations during the previous 2 years. Rural women were less likely to obtain blood cholesterol tests, dental exams, and mammograms during the previous 2 years when compared to women from large metropolitan counties. Rural women were more likely to obtain blood pressure checks during the previous year when compared to the metropolitan women. Findings for exams that occurred during the preceding 1- and 2-year periods are reported for blood pressure checks, blood cholesterol checks, physical exams, colon cancer screening, dental exams, breast exams, mammograms, and Pap smears.     

Disability terminology in the media: a comparison of newspaper reports in Canada and Israel.

The terminology used to refer to persons with disability may both reflect and influence attitudes towards them. Negative references may perpetuate negative attitudes and stereotypes. This is of particular importance in the mass media which reaches a broad spectrum of the population. This study looked at disability terminology used in major newspapers in Canada and Israel. It focused on the nature of that terminology and whether its use was related to other factors, such as the disability model reflected in the article, the content of the article (e.g. attributes of the disabled person) and its context (e.g. type of newspaper, feature versus news items). Overall, the use of inappropriate terminology of varying types was quite prevalent in both countries. In addition, in Canada there were a considerable number of articles which had no direct reference to the disability. In general, the terminology used was considerably more positive in articles dealing with individual persons with disabilities (as opposed to groups), with disabled children and with problems of mobility and rights. The results of the study indicate that the choice of terminology cannot be explained by journalistic expedience and conciseness alone.     

Infection control outside the hospital: developing a continuum of care

Pressures to limit or eliminate more expensive inpatient care have led t he way to rapidly expanded use of ambulatory care are extended care services. A consensus panel of infection control specialists have devised new recommendations on what can be addressed when infections occur outside the hospital.     

Gender issues in newspaper coverage of people with disabilities: a Canada-Israel comparison

This research compared how over a three-month period Canadian and Israeli newspapers wrote about females and males with disabilities. The results showed that in both countries there was significantly greater coverage of males than females. In addition, different (and stereotypical) types of details were used to describe the two groups, and females were associated with different kinds of problems than males, including a higher incidence of violence and victimization. There were also some significant differences between the male and female journalists in this study, and evidence of sexism within the newspaper industry. This paper concludes with some ideas for altering the images of disabled women in the media.     

Effectiveness of a healthy work organization intervention: ethnic group differences

This study examined ethnic group differences in the effectiveness of a healthy work organization intervention on organizational climate and worker health and well-being. Our sample consisted of employees from 21 stores of a large national retail chain. The intervention involved establishing and facilitating employee problem-solving teams in 11 of the stores. Teams were charged with developing and implementing action plans tailored to the needs of their specific site. Pre- and postcomparisons of the treatment and control groups showed that the intervention produced positive effects on both the climate and health and well-being outcomes; however, these effects varied significantly by ethnic group. Particularly in terms of organizational climate, black and Hispanic employees were the primary beneficiaries of the participatory intervention process. These results are interpreted in terms of social identification and self-categorization theories and are contrasted with traditional participatory and diversity training approaches.     

Proto-professionalism: how professionalisation occurs across the continuum of medical education

INTRODUCTION: Professionalism and its assessment across the medical education continuum have become prominent topics in recent years. We consider the nature of professionalism and how it emerges and relates to the work carried out by doctors and doctors-in-training. THESIS AND DISCUSSION: We suggest 6 domains in which evidence of professionalism can be expected: ethical practice; reflection/self-awareness; responsibility for actions; respect for patients; teamwork, and social responsibility. Furthermore, we propose that a defining characteristic is encapsulated by the Greek term phronesis, or practical wisdom. Phronesis is acquired only after a prolonged period of experience (and reflection on experience) occurring in concert with the professional's evolving knowledge and skills base. The prior period we have termed as one of 'proto-professionalism'. Influences on proto-professionalism are considered in terms of moral and psychosocial development and reflective judgement. CONCLUSION: Curricula that develop meta-skills will foster the acquisition and maintenance of professionalism. Adverse environmental conditions in the hidden curriculum may have powerful attritional effects.     

Childbearing in cohabiting unions: racial and ethnic differences

CONTEXT: Cohabitation provides a two-parent family union in which to have and raise children outside of marriage. Little is known, however, about the conditions under which cohabiting couples conceive and decide to have children. METHODS: The National Survey of Family Growth provides detailed data on the cohabitation and fertility histories of American women. Life-table techniques, event-history analyses and logistic regression were employed to understand the racial and ethnic differences in the timing of childbearing within cohabiting unions and whether childbearing within cohabiting unions is more acceptable to members of minorities than to whites. RESULTS: In multivariate models, Hispanic women were found to be 77% more likely than white women to conceive a child in cohabitation and black women were 69% more likely than white women to do so. Among women who became pregnant while cohabiting, Hispanic women were almost twice as likely and black women were three times as likely as white women to remain cohabiting with their partner when their child was born. In addition, children born to Hispanic women in cohabiting unions were found to be 70% more likely to be intended than were those born to cohabiting white women. CONCLUSIONS: In terms of fertility, cohabitation does not maintain the same place in the American family system for all racial and ethnic groups. These racial and ethnic differences in fertility-related behavior are not explained by socioeconomic differences. Based on levels of childbearing during cohabitation, relationship status at time of birth and intention status of children, it appears that cohabitation is a more acceptable arena for family building among Hispanic women than among whites or blacks.     

Development of a food frequency instrument: ethnic differences in food sources

Dietary intake was assessed among 431 black, white, and Mexican American men and women in southeast Texas using 24-hour dietary recall interviews. These data were collected to provide information on ethnic-specific food sources of selected nutrients; this information was used to construct a food frequency questionnaire for a study of nutrient intake and cancer. Nutrient content of total fat, total vitamin A, and vitamin C was determined for all foods consumed and was aggregated across unique food codes. These aggregated food codes were then ranked according to the contribution of each food to the total population intake of each nutrient. Ethnic differences existed in food sources of nutrients that would not be identified if data from only the analysis of the combined data set were used. Generally, however, the food sources identified from analyses of the combined data set included those foods that were important nutrient sources for each of the ethnic groups as well.     

Abdominal obesity and ethnic differences in diabetes awareness,treatment, and glycemic control

OBJECTIVE: To compare racial/ethnic differences in diabetes awareness, treatment, and glycemic control between non-Hispanic white, non-Hispanic black, and Hispanic Americans. We also determined the impact of abdominal obesity on racial/ethnic differences in diabetes awareness, treatment, and glycemic control between these population groups. RESEARCH METHODS AND PROCEDURES: Third National Health and Nutrition Examination Survey (NHANES III) data were utilized for this study. Diabetes awareness was defined as acknowledging diabetic status. Diabetes treatment was defined as current use of anti-diabetic medications, good glycemic control as HbA(1c) < 8%, and abdominal obesity as waist circumference larger than expected. The impacts of abdominal obesity on racial/ethnic differences in diabetes awareness, treatment, and glycemic control were assessed using logistic regression analyses. Adjustments were made for age, education, smoking, alcohol intake, and health insurance. RESULTS: Rates of diabetes awareness in whites, blacks, and Hispanics suffering from abdominal obesity were approximately 74%, 30%, and 21% in men and 77%, 32%, and 19% in women, respectively. Rates of diabetes treatment were 70%, 23%, and 14% in men and 57%, 45%, and 23% in women, respectively. In men, rates of glycemic control were 64%, 40%, and 30%, and in women, they were 62%, 51%, and 27%, respectively. Abdominal obesity was associated with decreased diabetes awareness and glycemic control in women. DISCUSSION: Subjects with abdominal obesity were found to have poorer glycemic controls compared to those without abdominal obesity. Because diabetes prevalences were partially explained by racial/ethnic differences in diabetes awareness, treatment, and glycemic control, there is a need to craft diabetes awareness, treatment, and control programs along racial/ethnic origins.