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Biomedical subjects

K E Grady

Publications and source records attributed to K E Grady.

16 recordsLinked to original sources
PubMed1993

The relationship of obesity to the frequency of pelvic examinations: do physician and patient attitudes make a difference?

Obese women are at higher risk for the development of both endometrial and ovarian carcinoma. Biochemical mechanisms represent documented causal factors but the role of psycho-social attitudes has received limited attention. This study examined the difference in the frequency of pelvic screening examinations between obese and non-obese women and the effect of physician and patient attitudes toward obesity on examination frequency. A total of 291 women subjects and 1316 physician subjects participated in this study. Data reported in this paper suggest that attitudes and behaviors are negatively influenced by weight. As subjects' weight went up, negative opinions about their appearance and reluctance to obtain pelvic examinations also increased while the likelihood of having annual pelvic examinations decreased. A substantial minority (17%) and an overwhelming majority (83%) of physicians indicated they were reluctant to perform pelvic examinations on obese and reluctant patients respectively. If physicians are more reluctant to perform pelvic examinations on obese and reluctant women and obese women are more reluctant to be examined, there may be a critical delay in detecting adenocarcinomas of the female genital tract.

Adult↗
PubMed1992

The importance of physician encouragement in breast cancer screening of older women.

METHODS: The relationship between physician encouragement and breast cancer screening is examined with a population-based survey of 630 women between the ages of 45 and 75. Although the women interviewed were selected on the basis of their noncompliance with mammography guidelines, nearly half had previously had at least one mammogram. RESULTS: Women reported having received more physician encouragement of breast self-examination than of mammography. Older women reported less encouragement of both screening modalities than younger women. Multivariate analyses revealed physician encouragement to be more strongly associated with screening mammography than with health status, health care utilization, attitudes, and sociodemographic characteristics: those who reported having received physician encouragement were nearly four times more likely to have ever had screening mammography. CONCLUSIONS: These and related findings are used to highlight the critical importance of physician behavior in the secondary prevention of breast cancer in older women and to identify types of patients whose needs for screening are most likely to be overlooked by physicians.

Aged↗
PubMed1992

The efficacy of breast self-examination.

Literature related to the efficacy and to the definition and measurement of breast self-examination (BSE) is reviewed with particular attention to its relevance for women over 65. Overall, data on the efficacy of BSE suggest that it has a small but measurable impact on earlier detection of breast cancer as measured by clinical stage and tumor size and sometimes by pathological stage. The largest differences are between some BSE and no BSE. An analysis of BSE suggests that instructions could be simplified for older women in order to increase the reliability and acceptability of the examination. A research agenda is proposed which includes (a) testing BSE instructions tailored for older women, (b) studying the intervening steps between BSE and cancer diagnosis, (c) testing methods to increase acceptance by older women, and (d) investigating the relationship between BSE and earlier detection of breast cancer in older women.

Adult↗
PubMed1990

Quality of social support and associated social and psychological functioning in women with rheumatoid arthritis.

Using a cross-sectional interview study of 194 women with rheumatoid arthritis, investigated the relationship between health status, social integration, qualitative aspects of social support, and social and psychological functioning in the presence of a chronic, disabling disease. Even after controlling for the influences of current physical limitations and social integration, qualitative dimensions of social support as measured by the Quality of Social Support Scale, a scale developed for this study, explained a significant proportion of the variance in home and family functioning and in depression.

Adaptation, Psychological↗
PubMed1989

Work disability among women with rheumatoid arthritis. The relative importance of disease, social, work, and family factors.

Yelin and others have shown social work factors to be more important than disease factors in predicting work disability among arthritis patients; however, the effects of family factors on work role functioning have not been considered in previous explanatory models. In this study, we use Yelin's model to explain work disability among 122 women with rheumatoid arthritis and to incorporate family factors into the model. Using logistic regression, we found, as with previous studies, that work autonomy, social factors, and disease factors are important predictors of work disability. In the logistic regression model, self-assessed health status seemed to be more important than work factors in predicting work status. Further, family factors significantly contributed to the explanatory model, in that having more home responsibilities was associated with lower risk of work disability.

Arthritis, Rheumatoid↗
PubMed1988

The effect of reward on compliance with breast self-examination.

Based on a behavioral analysis of compliance with breast self-examination (BSE), this study replicates a previously successful stimulus control intervention and tests the effectiveness of two types of reward for increasing compliance: external reward and self-reward. Patient volunteers (N = 153) were randomly assigned to experimental conditions and followed for 1 year, equally divided into experimental and postexperimental periods. Compliance was measured by the monthly return of BSE records, with self-reports used as a secondary measure. The results indicate that external reward was most effective; self-reward was used by only half the participants but was effective when used. In the postexperimental period, all rates of record return declined, especially in the external reward group. A cycle-by-cycle analysis indicates that the decline was gradual except for a sharp drop when the external reward was withdrawn. The results are discussed in terms of the acceptability of both interventions and contingencies.

Adult↗
PubMed1987

The impact of rheumatoid arthritis on the homemaker.

Few current studies of the effects of chronic conditions on social functioning examine the effects of disease on the role of homemaker. A major problem confronting researchers in this area is the difficulty in operationalizing dysfunction in social roles other than work roles. In this study we have developed a measure of homemaker functioning based on conceptualizing the homemaker role on two dimensions: the instrumental functions associated with meeting the physical needs of the household and the nurturant dimension concerned with meeting the expressive needs of the household. We used our measure of homemaker functioning to study the effects of rheumatoid arthritis on 142 women, whether employed outside the home or not, between the ages of 21 and 65, all living with husband and/or children at the time of disease onset. The disease significantly limited both instrumental and nurturing functions associated with managing a household. The more strenuous instrumental functions were more likely to be limited, although women in our study experienced serious limitations in nurturant role functions, as well. Limitations in functioning along the nurturant dimension were surprisingly high and previously undocumented. Comparisons between women employed outside the home and those not employed found few differences between the groups in social functioning on either dimension of the homemaker role. Employed women were somewhat less physically disabled than the unemployed, but both groups of homemakers continued to assume major responsibility for homemaking. Assessing functioning in social roles other than work, and functioning in nurturant as well as instrumental areas, is especially important in evaluating the effects on women of a chronic disease such as rheumatoid arthritis.

Adult↗
PubMed1986

Weight loss: a comparison of group and individual interventions.

A series of 12 behavior modification group programs (with 125 participants) was compared with 28 individual programs to determine differences in short- and long-term weight loss success. Data were collected directly and via questionnaire during the program and 10 to 36 months after the program. Different factors predicted weight loss during and after program participation, but in neither case was type of program (group vs. individual) significant. When data for the two collection periods were pooled, several factors were identified as significantly related to overall weight loss: (a) Individuals who were more overweight lost more weight. (b) The more prior programs tried the less weight loss occurred. (c) Men participating in group sessions and women seen in individual sessions lost the most weight. (d) The more sessions attended, the greater the weight loss. (e) Attending subsequent programs resulted in greater weight loss. (f) The use of behavioral technique--slow rate of eating--resulted in greater weight loss. (g) Increasing age was associated with less weight loss. The seven variables accounted for almost two-thirds (64%) of the variance.

Adolescent↗
PubMed1984

Cue enhancement and the long-term practice of breast self-examination.

This study investigates the stimulus control of breast self-examination (BSE) using two methods of cue enhancement: self-managed use of calendars with sticker reminders and monthly reminder postcards. One hundred eighty-nine women patient volunteers with or without menstrual cycles ("cyclic" or "non-cyclic") were randomly assigned to experimental conditions after an initial interview and teaching session. Their monthly BSE records, returned by mail during the 6-month experimental period, constituted the major dependent measure of the study. Results indicate an overall positive effect of postcard reminders and a positive effect for self-management for the cyclic women only. In addition, noncyclic women practiced BSE at a higher rate than cyclic women. A subsequent analysis clarified these results substantially by showing that timing of the postcard and use of self-management account for these group differences. Thus, the interventions seem to be extraordinarily effective in obtaining high rates of BSE over 6 months provided only that they can be appropriately instituted. During the postexperimental period, the rate of BSE practice declined, especially in the postcard conditions. Results are discussed in terms of the applicability of behavioral analysis to intractable problems of patient compliance.

Breast↗
PubMed1983

Who volunteers for a breast self-examination program? Evaluating the bases for self-selection.

Interest in a free breast self-examination (BSE) teaching program offered to a patient population (n = 1590) was assessed, and a follow-up survey of refusers undertaken to determine difference between participants and refusers. Fifty-one percent of the known, eligible women patients expressed interest in the program and 24% ultimately had the teaching. Participants differed from refusers most notably in terms of less previous experience with BSE, more family history of cancer, a longer relationship with their physicians, and different health beliefs. They state more confidence in the effectiveness of breast cancer detection and treatment, less fear and embarrassment, and more personal and physician responsibility for health outcomes, as measured by the Health Locus of Control Scales. Self-selection thus seems rationally based on the kind of program and the needs of the women. Such self-selection can be cost-effective in delivering health education to the people most in need of it and most likely to benefit from it.

Adolescent↗
PubMed1983

Weight loss: long-term results in an ambulatory setting.

Maintenance of weight loss is an issue of interest to the dietetic practitioner. A series of 12 weight-loss classes was conducted using the behavioral approach. Mean weight loss of 11.1 lb. in this study compared favorably with weight losses in other studies reported in the literature. Continuous evaluation and updating of the program did not result in greater weight loss nor was it cost-effective. The participants who lost weight during the program tended to maintain weight loss over time. One-third of those participants attended additional weight-loss programs.

Adult↗
PubMed1980

Openness between gay persons and health professionals.

A study of homosexual men and women was undertaken to ascertain what factors contribute toward being open with health professionals about one's sexual orientation and how this openness affects quality of care. Six hundred twenty-two men and women responded to a questionnaire distributed in the Gay Community News. Almost half (49%) had explicitly shared with their primary health professional that they were homosexual, another 11% assumed their health provider knew, and only 7% would not share this information with their health provider under any circumstances. Those who had shared this information were more satisfied with their primary health professional and, if male, were more likely to have been checked for venereal disease. Health professionals' attitudes towards homosexuality were an important concern of respondents; 27% felt that a previous health professional had been prejudiced towards homosexual persons.

Attitude of Health Personnel↗
PubMedDate not supplied

Clinical decision-making and mammography referral.

BACKGROUND: Physician characteristics, practice/structural factors, and patient characteristics have all been found to influence mammography referral. The relationship of a patient's advanced age and comorbidity to the physician's decision has not received much attention. METHODS: Community-based, primary care physicians (n = 132) in two medium-sized U.S. cities completed questionnaires. RESULTS: Physicians report that they refer nearly all (89%) of the women ages 50-64 in their practice, slightly fewer of those 65-74 (83%), but many fewer (57%) of those 80 and over. Foreign medical graduates and physicians who are not board certified reported lower referral rates, and those who were residency trained reported substantially lower rates for the oldest patient group. Common reasons for not referring included assuming a gynecologist or another physician will make the referral, patient cost, comorbidity, and type of encounter, i.e., whether the patient is being seen for an acute condition. However, the lowest rate of referral was associated with believing that the patient was too old to benefit from early detection. CONCLUSIONS: Results are discussed in terms of the debate about whether guidelines should be based on patient age or functional status and the need to openly discuss and evaluate the decision rules being used.

Adult↗