The ultimate goal? It depends

The knowledge that cervical cancer should be a preventable disease has provided the impetus to improve the Pap smear. Now, for the first time in 50 years, two new computerized technologies are available--the AutoPap and Papnet systems--that could change the way they are interpreted. Of course, these new innovations come at a price, perhaps doubling or tripling the cost--by one estimate, the new technologies could add $1 billion per year. The health policy issue is whether these innovations address the limitations of cervical cancer screening programs in an efficient way. The analysis is entirely different when cast as an individual patient care issue. Here the patient and physician, who serves as her advocate, want to use the best screening method. The goal is not how to best allocate resources to improve the health of the overall population, but instead how to get the best care for the individual patient.     

The chasm: what can be done, and what should be done

The case study of growth hormone in short-stature children offers an example of the high cost of bioengineered therapies and the attendant ethical concerns. Despite uncertainties as to its efficacy, it is estimated that the annual U.S. expenditure for growth hormone, which costs about $20,000 per year for a 30 kg child, exceeds $375 million dollars. Ultimately, at this point in its evolution, the use of GH therapy illustrates the dilemma commonly created by new medical technology--the chasm between what can be done and what should be done. Unfortunately, the knowledge of what can be done precedes the understanding of what should be done.     

National registry of health care providers in clinical social work

News of the societies

National registry of health care providers in clinical social work     

The presidential effect: the public health response to media coverage about Ronald Reagan's colon cancer episode

Little previous research has been done on the public health impact of mass media coverage of cancer episodes of public figures. This paper uses a variety of data sources to examine the impact of President Reagan's colon cancer episode of July, 1985. Records of phone calls to the Cancer Information Service of the National Cancer Institute are examined as a measure of public interest and concern about colorectal cancer; data on the use of two colorectal early detection tests--proctoscopy and fecal occult blood tests--are looked at as a measure of behavioral change; and data on the incidence of early and advanced colorectal cancer are used to estimate the potential public health impact of this behavioral change. We find that there was a sharp, albeit somewhat transitory, increase in public interest in colorectal cancer in the wake of President Reagan's colon cancer episode, with a corresponding increase in the use of early detection tests. The incidence data on early and advanced disease is indicative of a beneficial public health impact, but this can be confirmed only after additional data on mortality becomes available.     

Biracial identity and social marginality

This comparative analysis of classic and recent literature explores the developmental and social implications of biracial identity in the U.S. Though specific attention was given to Black-White biracial persons, a broader analysis yielded some surprising insights into the nature and implications of the biracial personality and the accompanying differences in interpersonal styles and social relationships.Dr. Brown is in private practice.     

Healthy Active Living: A Residence Community–Based Intervention to Increase Physical Activity and Healthy Eating During the Transition to First-Year University

Abstract

Objective: To examine the effects of a Healthy Active Living (HAL) community intervention on moderate-to-vigorous physical activity (MVPA), fruit and vegetable consumption (FVC), and psychosocial mediators of physical activity among students transitioning into university. Methods: Sixty undergraduate students were assigned to reside in either the HAL community or no-treatment control residence and completed questionnaire measures at the beginning and end of the academic year. Results: Students living in the HAL community reported significantly more MVPA (F[1, 58] = 19.93, p <.001, η_p² =.26) and greater FVC (F[1, 56] = 3.12, p =.08, η_p² =.05) compared with controls. Participants in the HAL condition also scored significantly higher in action planning (F[1, 58] = 4.79, p <.05, η_p² =.08), partially mediating the effect of the intervention on MVPA. Conclusion: A peer-delivered healthy lifestyles intervention targeting first-year university students appears to be effective in preserving or enhancing health behaviors and cognitions during their transition into university life.