Biomedical subjects

Ginny Gildengorin

Publications and source records attributed to Ginny Gildengorin.

16 recordsLinked to original sources

PubMed2006

Papanicolaou testing among Vietnamese Americans: results of a multifaceted intervention.

BACKGROUND: Vietnamese-American women have the highest incidence of cervical cancer of any ethnic group, and they underutilize Papanicolaou (Pap) tests. DESIGN: Development and implementation of a multifaceted intervention using community-based participatory research (CBPR) methodology and evaluated with a quasi-experimental controlled design with cross-sectional pre-intervention (2000) and post-intervention (2004) telephone surveys. Data were analyzed in 2005. SETTING: Santa Clara County, California (intervention community) and Harris County, Texas (comparison community). PARTICIPANTS: Vietnamese-American women aged 18 and older (n =1566 at pre-intervention and 2009 at post-intervention). INTERVENTION: A community-academic coalition developed and implemented six components: Vietnamese-language media campaign, lay health worker outreach, Vietnamese Pap clinic, patient registry/reminder system, restoration of a government-funded low-cost screening program, and continuing medical education for Vietnamese physicians. OUTCOME MEASURE: Pap test receipt. RESULTS: Overall response rate was 56%. Pap test receipt increased in the intervention (77.5% to 84.2%, p <0.001), but not in the comparison community (73.9% to 70.6%, p >0.05). In multivariate analyses, the intervention was associated with increased Pap test receipt (odds ratio [OR]=2.02, 95% confidence interval [CI]=1.37-2.99). Other factors associated with increased Pap testing included longer U.S. residence, having health insurance, having a regular site of care, having a respectful physician, having a non-Vietnamese or a female Vietnamese physician, and recalling exposure to Vietnamese-language media about Pap testing. Factors associated with reduced likelihood of Pap test receipt were age 65 years and older, never married, less than high school education, and income below poverty level. CONCLUSIONS: A multifaceted CBPR intervention was associated with increased Pap test receipt among Vietnamese-American women in one community.

Adolescent↗

PubMed2005

Disparities in colorectal cancer screening rates among Asian Americans and non-Latino whites.

Among Asian Americans, colorectal cancer (CRC) is the second most commonly diagnosed cancer, and it is the third highest cause of cancer-related mortality. The 2001 California Health Interview Survey (CHIS 2001) was used to examine 1) CRC screening rates between different Asian-American ethnic groups compared with non-Latino whites and 2) factors related to CRC screening. The CHIS 2001 was a population-based telephone survey that was conducted in California. Responses about CRC screening were analyzed from 1771 Asian Americans age 50 years and older (Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese). The authors examined two CRC screening outcomes: individuals who ever had CRC screening and individuals who were up to date for CRC screening. For CRC screening, fecal occult blood test (FOBT), sigmoidoscopy/colonoscopy, and any other form of screening were examined. CRC screening of any kind was low in all populations, and Koreans had the lowest rate (49%). Multivariate analysis revealed that, compared with non-Latino whites, Koreans were less likely to undergo FOBT (odds ratio [OR], 0.40; 95% confidence interval [95% CI], 0.25-0.62), and Filipinos were the least likely to undergo sigmoidoscopy/colonoscopy (OR, 0.62; 95% CI, 0.44-0.88) or to be up to date with screening (OR, 0.68; 95% CI, 0.48-0.97). Asian Americans were less likely to undergo screening if they were older, male, less educated, recent immigrants, living with >or= 3 individuals, poor, or uninsured. Asian-American populations, especially Koreans and Filipinos, are under-screened for CRC. Outreach efforts could be more focused on helping Asian Americans to understand the importance of CRC screening, providing accurate information in different Asian languages. Other strategies for increasing CRC screening may include using a more family-centered approach and using qualified translators.

Aged↗

PubMed2005

Are risk factors for breast cancer associated with follow-up procedures in diverse women with abnormal mammography?

OBJECTIVE: We evaluated the association of risk factors for breast cancer with reported follow-up procedures after abnormal mammography among diverse women. METHODS: Women ages 40--80 years were recruited from four clinical sites after receiving a screening mammography result that was classified as abnormal but probably benign, suspicious or highly suspicious, or indeterminate using standard criteria. A telephone-administered survey asked about breast cancer risk factors (family history, estrogen use, physical inactivity, age of menarche, age at birth of first child, parity, alcohol use), and self-reported use of diagnostic tests (follow-up mammogram, breast ultrasound, or biopsy). RESULTS: Nine hundred and seventy women completed the interview, mean age was 56, 42% were White, 19% Latina, 25% African American, and 15% Asian. White women were more likely to have a positive family history (20%), use estrogen (32%), be nulliparous (17%) and drink alcohol (62%). Latinas were more likely to be physically inactive (93%), African Americans to have early onset of menarche (53%) and Asians first child after age 30 (21%). White women were more likely to have suspicious mammograms (40%) and to undergo biopsy (45%). In multivariate models, Latinas were more likely to report breast ultrasound, physical inactive women reported fewer follow-up mammograms, and care outside the academic health center was associated with fewer biopsies. Indeterminate and suspicious mammography interpretations were significantly associated with more biopsy procedures (OR=8.4; 95% CI=3.8-18.5 and OR=59; 95% CI=35-100, respectively). CONCLUSIONS: Demographic profile and breast cancer risk factors have little effect on self-reported use of diagnostic procedures following an abnormal mammography examination. Level of mammography abnormality determines diagnostic evaluation but variance by site of care was observed.

Adult↗

PubMed2005

Current cervical neoplasia screening practices of obstetrician/gynecologists in the US.

OBJECTIVE: The purpose of this study was to determine cervical cancer screening practices of obstetrician/gynecologists in the US after recent revised guidelines. STUDY DESIGN: Questionnaires were mailed to 355 randomly selected US obstetrician/gynecologists. Questions were structured as clinical vignettes. RESULTS: Questionnaires were returned by 60% (213/355) of recipients; 185 were eligible. Seventy-four percent would begin screening virginal girls at age 18. Sixty percent would continue annual screening in a 35-year-old woman with 3 or more normal tests. Frequent screening is common in women after total hysterectomy for symptomatic fibroids and no history of dysplasia, and in 70-year-old women with a 30-year history of previous normal tests. Most (82%) use liquid-based cytology; 78% of female respondents would prefer it for themselves. Most (64%) would not adopt triennial Pap/HPV DNA screening, although 58% of women would choose it for themselves. CONCLUSION: Most US obstetrician/gynecologists screen low-risk women often and indefinitely, despite national guidelines designed to minimize screening harms resulting from overtesting.

Adult↗

PubMed2005

Cervical cancer screening continues to limit provision of contraception.

PURPOSE: Balancing needs for contraception and cervical cancer screening is challenging for clinicians. We assessed US obstetrician/gynecologists' practices regarding requirement of Pap testing before prescribing oral contraceptive or emergency contraceptive pills. METHODS: Questionnaires structured as clinical vignettes describing women desiring contraception with different risks of cervical dysplasia were mailed to a national sample of 355 obstetrician/gynecologists. RESULTS: A minority (3%) of the 185 obstetrician/gynecologists who responded would refill 12 months of oral contraceptives without requiring Pap testing. However, most would provide a limited supply of oral contraceptives until Pap testing could be performed. A substantial proportion (11-16%) would refuse to prescribe emergency contraception to women who they felt required Pap testing. Younger physicians, those practicing in academic settings and those who follow American Cancer Society guidelines were more willing to prescribe contraceptives without Pap testing. CONCLUSIONS: Cervical cancer screening continues to limit prescription of routine and emergency contraception by many US obstetrician/gynecologists.

Contraception↗

PubMed2005

Promoting use of colorectal cancer screening tests. Can we change physician behavior?

BACKGROUND: Colorectal cancer (CRC) screening is underutilized despite evidence that screening reduces mortality. OBJECTIVE: To assess the effect of an intervention targeting physicians and their patients on rates of CRC screening. DESIGN: A randomized clinical trial of community physicians and their patients. PARTICIPANTS: Ninety-four community primary care physicians randomly assigned to an intervention consisting of academic detailing and direct mailings to patients or a control group. Patients aged 50 to 79 years in the intervention group physicians received a letter from their physician, a brochure on CRC screening, and a packet of fecal occult blood test (FOBT) cards. MEASUREMENTS: After 1 year we measured receipt of the following: (1) FOBT in the past 2 years, (2) flexible sigmoidoscopy (SIG) or colonoscopy (COL) in the previous 5 years, and (3) any CRC screening. We report the percent change from baseline in both groups. RESULTS: 9,652 patients were enrolled for 2 years, and 3,732 patients were enrolled for 5 years. There was no increase in any CRC screening that occurred in the intervention group for patients enrolled for 2 years (12.7 increase vs 12.5%, P=.51). Similar results were seen for any CRC screening among patients enrolled for 5 years (9.7% increase vs 8.6%, P=.45). The only outcome on which the intervention had an effect was on patient rates of screening SIG (7.4% increase vs 4.4%, P<.01). CONCLUSION: With the exception of an increase in rates of SIG in the intervention group, the intervention had no effect on rates of CRC screening. Future interventions should assess innovative approaches to increase rates of CRC screening.

Aged↗

PubMed2004

Change in cognitive function by glucose tolerance status in older adults: a 4-year prospective study of the Rancho Bernardo study cohort.

BACKGROUND: A few studies have examined change in cognitive performance by diabetes status with disparate results. We examined the 4-year change in cognitive performance among older adults according to glucose tolerance status. METHODS: Three cognitive tests (Mini-Mental State Examination, Verbal Fluency [VF] test, and Trail-Making Test B) were measured 4 years apart in 999 white men and women aged 42 to 89 years, who were enrolled in the Rancho Bernardo Study. Participants were classified with normal (NGT), impaired (IGT) or diabetic glucose tolerance. Sex-specific linear regression models adjusted for age, education, depression score, apolipoprotein E epsilon4 allele, and current estrogen use. We checked for mediation by further adjusting for total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels; blood pressure; glycohemoglobin level; and microalbuminuria, retinopathy, stroke, or coronary heart disease. RESULTS: At baseline, mean cognitive function scores did not differ between glucose tolerance groups. Women with diabetes mellitus had a 4-fold increased risk of a major cognitive decline on the VF test after 4 years compared with nondiabetic women. After multivariate adjustment, VF test scores at follow-up for women were 15.2 +/- 0.6 for those with diabetes, 16.7 +/- 0.4 for those with IGT, and 17.2 +/- 0.2 for those with NGT (P =.007). Glycohemoglobin attenuated this effect, but lipid levels, blood pressure, and microvascular or macrovascular disease did not. Performance on Mini-Mental State Examination and Trail-Making Test B did not differ by baseline glucose status. CONCLUSIONS: Elderly white women with diabetes had a more rapid decline in performance on the VF test compared with women with IGT or NGT. Better glucose control might ameliorate this decline.

Adult↗

PubMed2004

Low contrast vision function predicts subsequent acuity loss in an aged population: the SKI study.

Can vision tests predict subsequent loss of acuity? The association between performance on several low contrast spatial vision measures, glare recovery, color discrimination, flicker sensitivity, stereopsis and ocular disease status at baseline and acuity loss 4.4 years later was examined in a large aged random sample with good initial acuity. In univariate analyses, several vision measures, retinal disease status and age were each significant predictors of subsequent acuity loss. In a multiple regression analysis, only low contrast spatial vision was a significant predictor, but the other vision measures, retinal disease status and age were not. For each doubling of low contrast spatial vision threshold at baseline, individuals were more than two times as likely to suffer subsequent significant visual acuity loss. Tests of low contrast spatial vision are strong predictors of significant subsequent visual acuity loss. These findings have implications for clinical trials, clinical management, and acceptance of these measures into clinical practice.

Aged↗

PubMed2004

Barriers to colorectal cancer screening in Latino and Vietnamese Americans. Compared with non-Latino white Americans.

OBJECTIVE: To identify current colorectal cancer (CRC) screening practices and barriers to screening in the Latino, Vietnamese, and non-Latino white populations. METHODS: We conducted a telephone survey of Latino, non-Latino white, and Vietnamese individuals living in San Jose, California. We asked about demographics, CRC screening practices, intentions to be screened, and barriers and facilitators to screening. RESULTS: Seven hundred and seventy-five individuals (40% white, 29.2% Latino, and 30.8% Vietnamese) completed the survey (Response Rate 50%). Overall, 23% of respondents reported receipt of fecal occult blood test (FOBT) in the past year, 28% reported sigmoidoscopy (SIG) in the past 5 years, and 27% reported colonoscopy (COL) in the past 10 years. Screening rates were generally lower in Latinos and Vietnamese. Vietnamese were less likely than whites to have had SIG in the past 5 years (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.09 to 0.72), but ethnicity was not an independent predictor of FOBT or COL. Only 22% of Vietnamese would find endoscopic tests uncomfortable compared with 79% of whites (P <.05). While 21% of Latinos would find performing an FOBT embarrassing, only 8% of whites and 3% of Vietnamese felt this way (P <.05). Vietnamese were more likely than whites to plan to have SIG in the next 5 years (OR, 2.24; 95% CI, 1.15 to 4.38), but ethnicity was not associated with planning to have FOBT or COL. CONCLUSIONS: Rates of CRC screening are lower in ethnic minority populations than in whites. Differences in attitudes and perceived barriers suggest that culturally tailored interventions to increase CRC screening will be useful in these populations

Aged↗

PubMed2004

The language divide. The importance of training in the use of interpreters for outpatient practice.

PURPOSE: Provision of interpreter services for non-English-speaking patients is a federal requirement. We surveyed clinicians to describe their experience using interpreters. SUBJECTS AND METHODS: In this cross-sectional study we surveyed clinicians in three academic outpatient settings in San Francisco (N = 194) regarding their most recent patient encounter which involved an interpreter. Questions about the visit included type of interpreter, satisfaction with content of clinical encounter, potential problems, and frequency of need. Previous training in interpreter use, languages spoken, and demographics were also asked. Questionnaires were self-administered in approximately 10 minutes. RESULTS: Of 194 questionnaires mailed, 158 were completed (81% response rate) and 67% were from resident physicians. Most respondents (78%) were very satisfied or satisfied with the medical care they provided, 85% felt satisfied with their ability to diagnose a disease and treat a disease, but only 45% were satisfied with their ability to empower the patient with knowledge about their disease, treatment, or medication. Even though 71% felt they were able to make a personal connection with their patient, only 33% felt they had learned about another culture as a result of the encounter. Clinicians reported difficulties eliciting exact symptoms (70%), explaining treatments (44%), and eliciting treatment preferences (51%). Clinicians perceived that lack of knowledge of a patient's culture hindered their ability to provide quality medical care and only 18% felt they were unable to establish trust or rapport. Previous training in interpreter use was associated with increased use of professional interpreters (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.4 to 7.5) and increased satisfaction with medical care provided (OR, 2.6; 95% CI, 1.1 to 6.6). CONCLUSIONS: Clinicians reported communication difficulties affecting their ability to understand symptoms and treat disease, as well as their ability to empower patients regarding their healthcare. Training in the use of interpreters may improve communication and clinical care, and thus health outcomes.

Adult↗

PubMed2004

Adult immunization in university-based primary care and specialty practices.

The purpose of this study was to assess vaccination status of adults in primary and specialty care practices in a retrospective review of medical records from 1997 to 2000 at one university medical center. Eligible patients were aged 50 and older and had two or more visits to primary and specialty care practices (N=14,556). Outcomes were receipt of pneumococcal vaccine once, tetanus booster within 10 years, and influenza vaccine in 2 of the 3 years. Vaccination rates for patients aged 65 and older were 59% for pneumococcal, 51% for tetanus, and 32% for influenza. Asians, Latinos, and African Americans were more likely than whites to have received influenza, pneumococcal, or tetanus vaccinations. Patients seen in primary care (41%) or in both primary care and specialty practices (42%) were more likely to receive adequate vaccination than those in specialty practices (17%) (P<.001). For pneumococcal vaccinations, relative to patients receiving specialty care only, patients receiving primary care only had an adjusted odds ratios (OR) of 6.6 (95% confidence interval (CI)=5.6-7.7) and patients in both primary care and specialty care had an OR of 7.2 (95% CI=6.2-8.3). For influenza, the corresponding ORs were 3.9 and 4.8, respectively, and for tetanus, 4.6 and 5.2. Patients who received care only from specialty practices were less likely than those with some primary care to receive adequate adult vaccinations. With the exception of Russian immigrants, the study did not find that racial and ethnic minorities had lower rates of vaccination than whites.

Aged↗

PubMed2004

The effectiveness of an advance notice letter on the recruitment of African Americans and Whites for a mailed patient satisfaction survey.

OBJECTIVE: Evaluate an advance notice letter for enhancing patient satisfaction survey response rates in African Americans and Whites. METHODS: Randomized trial of an advance notice letter (versus no letter) mailed two weeks prior to a mail satisfaction survey in a random sample of 600 African American and White patients ages 50 and older, stratified by ethnicity, sex, and age. RESULTS: The advance letter was independently associated with a completed survey in Whites (odds ratio = 2.73; 95% confidence interval [CI] 1.66, 4.50), but not in African Americans (odds ratio = 1.24; 95% CI 0.76, 2.02). Being male was independently associated with returning a survey in Whites (odds ratio = 1.86; 95% CI 1.13, 3.06). Younger age (odds ratio = 0.98; 95% CI 0.96, 0.99) was independently associated with a completed survey in African Americans. DISCUSSION: An advance letter prior to a satisfaction survey is associated with increased response rates in Whites, but not in African Americans.

Black or African American↗

PubMed2003

Risk of cervical cancer associated with extending the interval between cervical-cancer screenings.

BACKGROUND: Although contemporary guidelines suggest that the intervals between Papanicolaou tests can be extended to three years among low-risk women with previous negative tests, the excess risk of cervical cancer associated with less frequent than annual screening is uncertain. METHODS: We determined the prevalence of biopsy-proven cervical neoplasia among 938,576 women younger than 65 years of age, stratified according to the number of previous consecutive negative Papanicolaou tests. Using a Markov model that estimates the rate at which dysplasia will progress to cancer, we estimated the risk of cancer within three years after one or more negative Papanicolaou tests, as well as the number of additional Papanicolaou tests and colposcopic examinations that would be required to avert one case of cancer given a particular interval between screenings. RESULTS: Among 31,728 women 30 to 64 years of age who had had three or more consecutive negative tests, the prevalence of biopsy-proven cervical intraepithelial neoplasia of grade 2 was 0.028 percent and the prevalence of grade 3 neoplasia was 0.019 percent; none of the women had invasive cervical cancer. According to our model, the estimated risk of cancer with annual Papanicolaou tests for three years was 2 in 100,000 among women 30 to 44 years of age, 1 in 100,000 among women 45 to 59 years of age, and 1 in 100,000 among women 60 to 64 years of age; these risks would be 5 in 100,000, 2 in 100,000, and 1 in 100,000, respectively, if screening were performed once three years after the last negative test. To avert one additional case of cancer by screening 100,000 women annually for three years rather than once three years after the last negative test, an average of 69,665 additional Papanicolaou tests and 3861 colposcopic examinations would be needed in women 30 to 44 years of age and an average of 209,324 additional Papanicolaou tests and 11,502 colposcopic examinations in women 45 to 59 years of age. CONCLUSIONS: As compared with annual screening for three years, screening performed once three years after the last negative test in women 30 to 64 years of age who have had three or more consecutive negative Papanicolaou tests is associated with an average excess risk of cervical cancer of approximately 3 in 100,000.

Adolescent↗

PubMed2003

Vision and driving self-restriction in older adults.

OBJECTIVES: To assess driving self-restriction (vision related and nonvision related) in relation to vision test performance of older adults. DESIGN: Cross-sectional study. SETTING: Population-based cohort of community-dwelling older adults. PARTICIPANTS: Six hundred twenty-nine current drivers aged 55 and older had driving behavior, health, and physical function assessed and vision function tested in 1993-95. MEASUREMENTS: Self-report of driving restriction as vision or non-vision related and performance on a comprehensive battery of vision tests (visual acuity; contrast sensitivity; effects of illumination level, contrast, and glare on acuity; visual fields with and without attentional load; color vision; temporal sensitivity; and the effect of dim light on walking ability). RESULTS: Demographic, health, and functional characteristics differed significantly between restrictors and nonrestrictors but not between vision- and nonvision-related restrictors. Controlling for potential confounding, only vision-related driving self-restriction was significantly associated with reduced performance on nonstandard measures of acuity. Poor depth perception was significantly associated with restriction for both vision- and nonvision-related reasons. Poor performance on attentional visual field tests, analyzed individually and in combination with standard field tests, was not associated with driving self-restriction. CONCLUSION: Older adults with early changes in spatial vision function and depth perception appear to recognize their limitations and restrict their driving even if they do not acknowledge the visual impairment as the cause for restriction. Poor visual attention, a risk factor for crashes, may not be recognized. Additional studies of driving self-restriction in relation to risk factors for crashes in older adults may help refine this strategy of reducing driving-related injury and death.

Aged↗

PubMed2002

Is vision function related to physical functional ability in older adults?

OBJECTIVES: To assess the relationship between a broad range of vision functions and measures of physical performance in older adults. DESIGN: Cross-sectional study. SETTING: Population-based cohort of community-dwelling older adults, subset of an on-going longitudinal study. PARTICIPANTS: Seven hundred eighty-two adults aged 55 and older (65% of living eligible subjects) had subjective health measures and objective physical performance evaluated in 1989/91 and again in 1993/95 and a battery of vision functions tested in 1993/95. MEASUREMENTS: Comprehensive battery of vision tests (visual acuity, contrast sensitivity, effects of illumination level, contrast and glare on acuity, visual fields with and without attentional load, color vision, temporal sensitivity, and the impact of dimming light on walking ability) and physical function measures (self-reported mobility limitations and observed measures of walking, rising from a chair and tandem balance). RESULTS: The failure rate for all vision functions and physical performance measures increased exponentially with age. Standard high-contrast visual acuity and standard visual fields showed the lowest failure rates. Nonstandard vision tests showed much higher failure rates. Poor performance on many individual vision functions was significantly associated with particular individual measures of physical performance. Using constructed combination vision variables, significant associations were found between spatial vision, field integrity, binocularity and/or adaptation, and each of the functional outcomes. CONCLUSIONS: Vision functions other than standard visual acuity may affect day-to-day functioning of older adults. Additional studies of these other aspects of vision and how they can be treated or rehabilitated are needed to determine whether these aspects play a role in strategies for reducing disability in older adults.

Activities of Daily Living↗

PubMed2002

Long-term effects of nutrient intervention on markers of bone remodeling and calciotropic hormones in late-postmenopausal women.

BACKGROUND: Adequate intakes of calcium and vitamin D reduce bone loss and fracture risk in the elderly. Other nutrients also affect bone health, and adequate intakes may influence bone turnover and balance. OBJECTIVE: We compared the long-term effects on bone turnover markers and calciotropic hormones of a multinutrient supplement, a calcium and vitamin D supplement, and dietary instruction aimed at increasing calcium intake through foods. DESIGN: Ninety-nine healthy postmenopausal women participated in a 3-y, randomized trial, receiving either 1) supplemental calcium (1450 mg/d) and vitamin D [10 microg (400 IU)/d], 2) calcium, vitamin D, and other nutrients (multinutrient supplement), or 3) dietary instruction (dietary control group). Data are from 83 subjects who completed the trial. RESULTS: Increases over baseline in calcium intakes and serum 25-hydroxyvitamin D concentrations were sustained over 3 y in all treatment groups. Circulating parathyroid hormone concentrations were reduced at year 1 in all treatment groups but trended toward baseline thereafter. Bone turnover markers followed a similar pattern, and none of the changes in biochemical concentrations differed significantly between groups. CONCLUSIONS: All 3 interventions offer long-term feasibility for increasing calcium intake and serum 25-hydroxyvitamin D concentrations. The dietary addition of micronutrients implicated in skeletal physiology confers no obvious bone-sparing effect in healthy postmenopausal women beyond that of calcium and vitamin D alone. The attenuation over time in suppression of parathyroid hormone and bone turnover might help explain why nutrient intervention tends to have less of a bone-sparing effect than do skeletally active medications such as estrogen or bisphosphonates.

Aged↗