Barbara A. Elliott

Physician attitudes and beliefs about use of morphine for cancer pain.

The recent literature asserts that mistaken physician beliefs and attitudes are critical barriers to adequate cancer pain relief. To determine the prevalence of 12 proposed myths or misconceptions about morphine use in cancer pain management (CPM), we surveyed all physicians engaged in direct patient care in Duluth, Minnesota (N = 243). A 62% response was obtained. Many physicians misunderstood concepts of morphine tolerance, both to analgesia (51%) and to side effects (39%). Many were unaware of the use of adjuvant analgesics (29%), efficacy of oral morphine (27%), and nonexistent risk of addiction in CPM (20%). Analysis of result by physician age and specialy groups confirmed significant levels of misunderstanding in all subsets. Strategies to change physician attitudes and beliefs regarding morphine in CPM should focus on tolerance concepts, dosing schemes, safety, efficacy, lack of addictive risk, use of drug combinations, and the fact that cancer pain can be relieved.

Physician knowledge and attitudes about cancer pain management: A survey from the Minnesota cancer pain project

The purposes of the study were to determine the knowledge and attitudes about cancer pain management (CPM) among practicing physicians in six Minnesota communities and to determine the physician-related barriers to optimal CPM. Eligible community physicians were surveyed by telephone. The study analyzed responses of 145 physicians (response rate, 87%). The majority of the physicians were primary care specialists (73%). Significant knowledge deficits were identified in nine of 14 CPM principles, but inappropriate attitudes were found in only two of nine CPM concepts. Medical specialty had the strongest influence on knowledge and attitudes, with primary care physicians having significantly better outcomes than surgeons or medical subspecialists. Effective education strategies must address knowledge deficits, attitudes, and motivations of the relevant peer group influencing physicians, as well as those of individual physicians. The Minnesota Cancer Pain Project is testing strategies to enhance CPM by physicians and improve patient outcomes.

Enhancing Coordinated Community Responses to Reduce Recidivism in Cases of Domestic Violence

This study evaluated the effectiveness of a project designed to enhance coordinated community responses by examining recidivism rates. Project enhancements included expanded danger assessment and information sharing among criminal justice practitioners and advocates. When compared to a baseline period, results indicated that offenders had significantly lower rates of recidivism after the project was implemented. There were steady declines in the number of recidivists over 3 years of the project, beginning in the pilot year and decreasing significantly during the intervention years. Logistic regression procedures found two variables that were significantly related to offenders not having recidivated during all years of the study: the offender having been court mandated to attend the Mens Nonviolence Program and the offender having completed the program. There was evidence to support the use by probation officers of a danger assessment tool to predict recidivism

Impact of Income and Income Inequality on Infant Health Outcomes in the United States

OBJECTIVES: The goal was to investigate the relationships of income and income inequality with neonatal and infant health outcomes in the United States. METHODS: The 2000–2004 state data were extracted from the Kids Count Data Center. Health indicators included proportion of preterm births (PTBs), proportion of infants with low birth weight (LBW), proportion of infants with very low birth weight (VLBW), and infant mortality rate (IMR). Income was evaluated on the basis of median family income and proportion of federal poverty levels; income inequality was measured by using the Gini coefficient. Pearson correlations evaluated associations between the proportion of children living in poverty and the health indicators. Linear regression evaluated predictive relationships between median household income, proportion of children living in poverty, and income inequality for the 4 health indicators. RESULTS: Median family income was negatively correlated with all birth outcomes (PTB, r = −0.481; LBW, r = −0.295; VLBW, r = −0.133; IMR, r = −0.432), and the Gini coefficient was positively correlated (PTB, r = 0.339; LBW, r = 0.398; VLBW, r = 0.460; IMR, r = 0.114). The Gini coefficient explained a significant proportion of the variance in rate for each outcome in linear regression models with median family income. Among children living in poverty, the role of income decreased as the degree of poverty decreased, whereas the role of income inequality increased. CONCLUSIONS: Both income and income inequality affect infant health outcomes in the United States. The health of the poorest infants was affected more by absolute wealth than relative wealth.

Tacrolimus effect on rosacea

Twenty-four patients with erythrotelangiectatic or papulopustular rosacea were treated with 0.1% tacrolimus topical ointment in a 12-week open-label trial. Erythema was significantly improved in both rosacea subtypes (P<.05). There was no decrease in the number of papulopustular lesions. Side effects were consistent with those on the tacrolimus topical ointment labeling.

Birth order and health: Major issues

Birth Order has been described as a variable with a complex relationship to child and adult outcomes. A review of the medical literature over the past 5 years identified 20 studies that investigated the relationship between Birth Order and a health outcome. Only one of the studies established a relationship between Birth Order and a health outcome: third and fourth-born children have a higher incidence of accidents that result in hospitalization. The other demonstrated relationships are each explained by intervening variables or methodological limitations. Although Birth Order is not a strongly independent explanatory factor in understanding health outcomes, it is an important marker variable. Statistically significant relationships between Birth Order and health outcomes yield insights into the ways a family influences an individuals health.

Dying of old age: An examination of death certificates of Minnesota centenarians

OBJECTIVES: To compare how causes of death are recorded on the death certificates of centenarians with those who die in their 70s, 80s, and 90s. We also examined direct and indirect acknowledgment of age as a cause of death.

The Minnesota cancer pain project: Design, methods, and education strategies

The Minnesota Cancer Pain Project (MCPP) is a community-based research project to test various innovative education strategies for improving cancer pain management (CPM) in Minnesota. The main hypothesis is that community-based, multidisciplinary and integrated education programs can improve CPM and change knowledge, attitudes, and behaviors regarding CPM in cancer patients, their families, and community physicians and nurses. The specific aim of the MCPP is to demonstrate effective methods to improve CPM in communities. The MCPP design is a randomized trial with before- and after-intervention assessments of cancer pain and CPM knowledge, attitudes, and behaviors among cancer patients and their families, physicians, and nurses. The unit of randomization and study is the community, with six Minnesota communities participating in the MCPP. This paper describes the hypotheses, design, methods, and education strategies of the MCPP. Baseline data from the participating communities and the cancer patient sample are reported.

Physician acquisition of cancer pain management knowledge

Insufficient physician education in cancer pain management (CPM) is one of the major factors contributing to inadequate pain relief of cancer patients throughout the world. A survey of all physicians in direct patient care in Duluth, MN, (N = 243) was conducted to determine where they learned about CPM and how they would like to further their knowledge. Responses from 150 physicians (62%) have been analyzed, especially focusing on physician age and specialty. Statistically significant differences (p less than 0.001) document that residency training programs have been including CPM in their curricula since 1978 and that medical schools have not. Additional significant sources of CPM have been consultations with expert physicians, conferences and the literature. When asked how they would like to learn more about CPM, 84% of all physicians indicated that local conferences would be most effective. Physicians in various specialties indicated their differing preferences, too. This study suggests that improvements in CPM can occur through these mechanisms.

Risk Factors Associated With Camp Accidents

OBJECTIVE Project goals included creating a database for medical incidents at a Minnesota canoe and backpacking camp and identifying those most at risk within this population using one summers experience. METHODS YMCA Camp Widjiwagan employed a total of 123 staff and served 725 campers in summer 2000. This resulted in 9418 camper trail days (CTD), 2497 staff trail days (STD), and 20150 participant days (PD), the evaluation units for this study. Data were collected using routine documentation: treatment logs (TL) for any event that required care, and incident reports (IR) for more serious injuries and near misses. Information was entered into an Access database and analyzed using descriptive statistics and analysis of variance. RESULTS Canoe and backpack trips were compared using staff and camper days (CD). There were 582 TL and 59 IR, including 12 cases that resulted in evacuation to medical care (1/1000 PD). Canoe groups were no more at risk than backpack groups (P = .607), and campers reported more incidents than staff regardless of sex or location of injury (0.4/1000 CD compared with 0.1/1000 CD; P < .001). The camper groups most at risk were those beginning a series of advanced canoe trips (10 IR/1000 CTD; P < .001) and those on the longest, most advanced backpack trips (9 IR/1000 CTD; P < .001). CONCLUSION Careful tracking of health incidents and near misses over time can reveal which campers and camper groups are at greatest risk for injuries and illnesses occurring during participation.