Search

Early detection is the primary way to control breast cancer, and mammography screening can reduce breast cancer mortality 30 to 40 percent among women aged 50 years and older. Geographic areas with a high proportion of cases with late-stage diagnoses may reflect gaps in screening efforts. We used a spatial scan statistic, adjusting for the multitude of possible region locations and sizes, to test whether any particular region of Massachusetts had statistically significant excesses of late-stage diagnoses during the period 1982 to 1986. The novel geographic analysis technique utilized here can also be used in the control of other types of cancer.

OBJECTIVE: To examine the rate of weight gain over time among Americans by age, gender, and race. PARTICIPANTS: Scientific sample of 5117 Americans, ages 25–74?y in 1971 followed for 20?y. RESULTS: Rates of weight gain estimated by mixed effects models are highest among young adults and rates of weight loss are greatest among older adults. The overall shape of the growth curves are similar for men and women, black and white, in terms of both weight gain and weight loss. Rates are also affected by baseline body mass index (BMI=wt in kg/height in m2). CONCLUSIONS: Americans gain weight until middle age, stabilize, and begin to lose weight near age 60. Weight loss during old age is especially evident for obese Americans. The ability to accurately identify groups with increased risk and target them for obesity prevention will help combat the steady rise of overweight and obesity in America.

We studied the relationship of malpractice claims and the personal, educational, and practice characteristics of a sample of surgeons (n = 427). The surgeons were members of a physician-owned malpractice trust and represented all those who had fewer than 0.13 malpractice claims per year and those with more than 0.54 claims per year. Data are reported separately for orthopedic surgeons (148), obstetrician-gynecologists (115), and a mixed group of other surgeons (164). The last group included otolaryngologists, neurosurgeons, and general, vascular, thoracic, and plastic surgeons. We studied the relationship between the number of malpractice claims (ranging from no history of claims to those terminated from the trust because of high rates of claims) and the surgeon's personal, educational, and practice characteristics. The major differences were between the surgeons who were terminated because of a high number of claims and those with few or no claims. Terminated surgeons were less likely to have completed a fellowship, belong to a clinical faculty, be members of professional societies, be graduates of an American or Canadian medical school, have specialty board certification, or be in a group practice. The data also suggest that orthopedists with high numbers of claims may be less likely to have a religious affiliation or to have a registered nurse working in their office practice. These findings suggest that surgeons with lower claim rates may be more likely to manifest exemplary modes of professional peer relationships and responsible clinical behavior.

The relationship between moral reasoning and malpractice claims was studied in 53 orthopedic surgeons. Levels of moral reasoning were defined by the percentage of principled responses (P-score) on Rest's Defining Issues Test, while annualized rates of malpractice claims were computed on the basis of data from a regional, physician-owned, interindemnity/liability protection trust. Orthopedic surgeons with fewer than 0.20 claims per year demonstrated significantly (P = 0.04) higher levels of moral reasoning (mean P-score of 43.8) than did those with claims rates higher than 0.40 claims per year (mean P-score of 38.0). Only 1 of 13 orthopedists with P-scores over 50 was found in the higher claims group, suggesting that high levels of moral reasoning may provide a protective element against malpractice claims.

A computer based education (CBE) lesson was developed for patients with rheumatoid arthritis (RA) and evaluated using a controlled experiment. There were statistically significant differences in the CBE group compared with controls in knowledge gained (p less than 0.01), improved outlook on life (p less than 0.01), hopefulness of a good prognosis (p less than 0.01), decreased belief in the role of luck or fate in determining their health (p less than 0.05) and reported increase in use of behaviors such as joint protection (p less than 0.02) and rest (p less than 0.05). The lesson was accepted and enjoyed by the patients.

Few physical therapy education programs offer formal rheumatology courses taught by specialists in the field of rheumatic diseases. We modified, evaluated, and formalized a rheumatology course for undergraduate physical therapy students taught by a rheumatologist and a specially trained physical therapist. Although the course is applicable to our undergraduate program, the process we used to modify and evaluate the course content could be useful to others in their development of similar courses elsewhere. Our intent in discussing this process, the course content, and the rationale for our study is to stimulate a national review of rheumatology course content in physical therapy education programs.