Douglas Easterling

Contribution of concrete cognition to emotion: neutral symptoms as elicitors of worry about cancer.

The relationship between worry about cancer and judged cancer risk was examined among 54 expatients who had been cured of breast cancer and 81 women with no history of cancer. Worry required both a perception of substantial risk and the presence of concrete perceptual cues. Worry promoters include visits to a physician and concrete, noncancerlike symptoms (e.g., fever, pain). Supporting analyses indicate that the symptom effects are not due to self-report biases or attributions of symptoms to cancer but are the result of a reminder process whereby vulnerability beliefs are aroused by somatic cues. Judged cancer risk was unrelated to affective cues, suggesting that across-time variation in worry about cancer reflects the onset and offset of symptom episodes rather than a shift in risk appraisals. Expatients were more worried overall than nonpatient controls. The results have implications for controlling disease worry and initiating preventive behaviors.

Changes in the Location of Death after Passage of Medicare's Prospective Payment System

We reviewed age-specific national mortality data for the years 1981 through 1985 to evaluate changes in the location of death among the nations elderly after implementation of Medicares prospective payment system (PPS). Although it was unchanged in 1981 and 1982, the percentage of deaths occurring in the nations nursing homes increased from 18.9 percent in 1982 to 21.5 percent in 1985. The increases in nursing home deaths were greatest between 1983 and 1984, when 33 states showed larger-than-expected increases when compared with a base period before implementation of PPS. These changes were accompanied by a decline in the percentage of deaths that occurred in hospitals. These changes in the location of death were most pronounced in the Midwest, South, and West; they were very small in the Northeast and in states not affected by the PPS. Furthermore, the states with high population enrollments in health maintenance organizations and with large declines in the mean hospital length of stay in 1984 showed the greatest shifts in the location of death. We conclude that Medicares PPS resulted in the increased transfer of terminally ill patients from hospitals to nursing homes. Further study is required to determine whether such transfer is medically appropriate.

The dilemma of siting a high-level nuclear waste repository

I: The Siting Dilemma. 1. Introduction. 2. The Dilemma of Siting a High-level Waste Repository. 3. A Framework for Examining Siting Efforts. II: Public Opposition to a Repository. 4. The Dynamics of Public Opposition. 5. Objection #1: Noxious Impacts. 6. Objection #2: Doubts about the Appropriateness of a Repository. 7. Objection #3: Inequity in Outcome and Process. III: Empirical Analyses of Repository Attitudes. 8. Models of Public Acceptance. 9. The Doughnut Effect. IV: Current Strategies for Overcoming Opposition to a Repository. Introduction. 10. Scientifically Based Choice of Technology. 11. Reducing Public Perceptions of Risks. 12. Compensation and Benefit Sharing. 13. Fairness in Site Selection. V: Recommendations for Successful Siting. 14. A Siting Process to Gain Public Acceptance. 15. Applying the Voluntary Approach to Permanent Disposal. Appendix I. Appendix II. Appendix III. Appendix IV. Bibliography.

Anxiety and drug taste as predictors of anticipatory nausea in cancer chemotherapy.

Interview data from 192 patients receiving cytotoxic chemotherapy for the first time were analyzed to identify factors predictive of the development of anticipatory nausea. Posttreatment nausea and vomiting (particularly vomiting), tastes of drugs during injections, and anxiety before injections were all associated with an increased probability of anticipatory nausea. An index consisting of those three variables, plus age, was found to have good predictive power, even when the predictor variables were assessed only at the first chemotherapy administration and the index was used to predict the development of anticipatory nausea at any time during the first six chemotherapy cycles.

Conservation of energy, uncertainty reduction, and swift utilization of medical care among the elderly: study II.

This study examined age differences in the timing of the decision to seek medical care. The data were obtained from a longitudinal study of 366 community dwelling adults aged 45 to 93 years. Subjects were paired for age, gender, and health status, and both members of a pair were interviewed when either one initiated a medical visit for a new problem. This allowed the authors to examine delay in care-seeking for individuals with new symptoms who did not seek care as well as those who did. Survival analysis was used to test hypotheses respecting age differences for total delay (the time from first noticing symptoms until calling for care) and its two constituent phases: appraisal delay (symptom onset until deciding one was ill) and illness delay (decision one was ill until calling for care). Older persons were expected to be more avoidant of uncertainty and conserving of physical and psychic resources and thus quicker to seek care. The results and findings on reasons for delay support the uncertainly avoidance hypothesis but did not replicate signs of higher levels of avoidance behavior by middle-aged subjects than by older subjects.

Smoking behaviour and attitudes of Hungarian Roma and non-Roma population towards tobacco control policies

ObjectivesTo assess the smoking status and support for tobacco control policies among the Roma minority compared with the non-Roma population in Hungary.MethodsA cross-sectional survey was delivered among Roma minority and local non-Roma population; 83 Roma and 126 non-Roma people were interviewed. Chi-square tests and logistic regression were applied to compare Roma and non-Roma populations.ResultsThe prevalence of smoking was significantly higher and the support for tobacco control measures was significantly lower in the Roma population. This effect of ethnicity on attitudes toward tobacco control was explained somewhat, but not completely, by the Roma group’s higher rate of smoking and lower level of education.ConclusionsTobacco control policies are a proven strategy for denormalizing smoking and discouraging initiation. This strategy has important potential for Roma communities because of their high rates of tobacco use. However, this study shows that the Roma are resistant the efforts to limit smoking. Changing these attitudes will require targeted public health interventions that take into account not only the lower educational levels of the Roma, but also their cultural beliefs regarding tobacco.

Gaining Acceptance for Noxious Facilities with Economic Incentives

In recent years considerable controversy has surrounded efforts to site prisons, AIDS treatment centers, and every form of waste disposal facility. While these facilities benefit the majority of the public, they also impose some burden on residents living near the site. Familiar terms such as NIMBY (Not in My Backyard) and LULU (Locally Unwanted Land Use) permeate the media, indicating the strong resistance shown by communities targeted to host these facilities (Popper, 1983). This public opposition is often effective in thwarting projects. For example, since 1980 not a single major new hazardous waste disposal facility has been sited anywhere in the United States, and the outlook does not appear any brighter in the immediate future (Weidenbaum, 1989). The key questions addressed in this chapter are 1) why there is such resistance to siting facilities and 2) whether there are ways that policy makers can reduce the level of resistance to such facilities. The following three examples provide concrete illustrations of the challenges we face in finding locations for siting facilities.

An Evaluation of Increased Mortality Rates in Wisconsin Nursing Homes

We reviewed mortality data from 80 nonprofit and government‐owned skilled nursing facilities (SNFs) to evaluate previously reported increases in deaths occurring in Wisconsin nursing homes since 1983. Comparing nursing home mortality data for 1982 and 1985, we found a 16.6% increase in overall nursing home mortality rates. The increased mortality rates occurred in the sample SNFs regardless of ownership, Medicare certification, bed size, metropolitan area and hospital affiliation. There were two explanations for the increased mortality rates. First, the number of residents dying within 30 days after nursing home admission increased 59%. The majority of these short‐lived residents had been discharged from hospitals indicating a transfer of terminally ill patients into nursing homes just prior to death. Second, there was a 27% increase in the mortality rate of residents living in the nursing home for 1 to 5 years suggesting that the population had become sicker between 1982 and 1985. These data reflect both the impact of Medicares Prospective Payment System (PPS) on the study nursing homes and an increase in the severity of illness of Wisconsins nursing home population between 1982 and 1985. The findings document an increased role for nursing homes in caring for more acutely ill patients since the passage of the PPS, and have implications for nuring home reimbursement policies and quality of care.

Achieving Communitywide Impact by Changing the Local Culture: Opportunities and Considerations for Foundations

REFLECTIVE PRACTICE The Boys and Men of Color Framework: A Model for Community and Systems Change Marc Philpart, M.P.A., M.P.H., Boys and Men of Color initiatives, and Judith Bell, M.P.A, PolicyLink EC TIV Residents and leaders in communities across the nation are spearheading efforts to dismantle the barriers facing young men of color and help them reach their full potential; this article distills key lessons from this work.

IP227 Focus Group Study of Questions, Concerns, and Treatment Factors Important to People With Symptomatic Peripheral Artery Disease: A Roadmap for Patient-Centered Care and Communication

have developed using Apple’s ResearchKit framework. Our goal is to enroll 3000 patients with claudication (Rutherford 1-3) and healthy controls. The app enables data collection from patients all across the United States. This trial is Institutional Review Board approved, and all activities (registration, consent, and data gathering) are performed on the phone. Two main types of data are collected: medical/surgical history and physical activity data. Medical/surgical history is obtained through simple surveys that gather information on cardiovascular risk factors, symptoms, medications, and previous surgical procedures. Physical activity data consists of active and passive components. For the active component, patients get notifications to perform biweekly 6-minute walk tests, which have previously been validated for use on smartphones. For the passive component, the app will record (1) daily total steps walked, (2) total distance walked per day, (3) total flights climbed per day, and (4) maximum steps without stopping per day. This is an algorithm we developed. The Fig presents a summary of the study design. Validation of mobile phone activity monitoring for PAD patients will be done through cluster analysis of all variables measured as well as analysis of variance analysis of PAD vs non-PAD patients. Subanalysis of patients who undergo endovascular or open procedures will be performed to report on actual changes in activity levels postprocedure as well as durability of procedures on activity. Results: Version 1.0 of VascTrac was soft launched in November of 2016 and is currently enrolling patients. We have 76 beta testers and growing. The Table gives preliminary results. Conclusions: Preliminary data show that max steps without stopping is smaller for PAD group compared to non-PAD, which is expected because claudication limits continuous walking. More data will be collected in the next few months to show statistical significance and validation. If validated, VascTrac could represent a personalized medicine approach to PAD surveillance and help identify patients at risk for treatment failure.