Association between PEG3 DNA methylation and high-grade cervical intraepithelial neoplasia.

Background: Epigenetic mechanisms are hypothesized to contribute substantially to the progression of cervical intraepithelial neoplasia (CIN) to cervical cancer, although empirical data are limited.

Methods: Women (n = 419) were enrolled at colposcopic evaluation at Duke Medical Center in Durham, North Carolina. Human papillomavirus (HPV) was genotyped by HPV linear array and CIN grade was ascertained by biopsy pathologic review.

Long-Term Impact of an Electronic Health Record-Enabled, Team-Based, and Scalable Population Health Strategy Based on the Chronic Care Model.

The Chronic Care Model (CCM) is a promising framework for improving population health, but little is known regarding the long-term impact of scalable, informatics-enabled interventions based on this model. To address this challenge, this study evaluated the long-term impact of implementing a scalable, electronic health record (EHR)- enabled, and CCM-based population health program to replace a labor-intensive legacy program in 18 primary care practices. Interventions included point-of-care decision support, quality reporting, team-based care, patient engagement, and provider education.

HPV genotypes and cervical intraepithelial neoplasia in a multiethnic cohort in the southeastern USA.

Purpose: For poorly understood reasons, invasive cervical cancer (ICC) incidence and mortality rates are higher in women of African descent. Oncogenic human papillomavirus (HPV) genotypes distribution may vary between European American (EA) and African-American (AA) women and may contribute to differences in ICC incidence. The current study aimed at disentangling differences in HPV distribution among AA and EA women.

Barriers to adopting a healthy lifestyle: insight from postpartum women.

Background: Postpartum weight retention can contribute to obesity. There may be unique barriers to weight loss in this period.

Findings: Cases are presented for three postpartum women who declined to participate in a postpartum weight loss intervention.

Family physicians as team leaders: "time" to share the care.

A major contributor to shortfalls in delivery of recommended health care services is lack of physician time. On the basis of recommendations from national clinical care guidelines for preventive services and chronic disease management, and including the time needed for acute concerns, sufficiently addressing the needs of a standard patient panel of 2,500 would require 21.7 hours per day.

Estimated time spent on preventive services by primary care physicians.

Background: Delivery of preventive health services in primary care is lacking. One of the main barriers is lack of time. We estimated the amount of time primary care physicians spend on important preventive health services.

Use of email in a family practice setting: opportunities and challenges in patient- and physician-initiated communication.

Background: Electronic mail (email) has the potential to improve communication between physicians and patients.

Methods: We conducted two research studies in a family practice setting: 1) a brief, anonymous patient survey of a convenience sample to determine the number of clinic patients receptive to communicating with their physician via email, and 2) a randomized, controlled pilot study to assess the feasibility of providing health education via email to family practice patients.

Results: Sixty-eight percent of patients used email, and the majority of those (80%) were interested in using email to communicate with the clinic.

Just for Us: an academic medical center-community partnership to maintain the health of a frail low-income senior population.

Purpose: To promote health and maintain independence, Just for Us provides financially sustainable, in-home, integrated care to medically fragile, low-income seniors and disabled adults living in subsidized housing.

Design And Methods: The program provides primary care, care management, and mental health services delivered in patient's homes by a multidisciplinary, multiagency team.

Results: After 2 years of operation, Just for Us is serving nearly 300 individuals in 10 buildings.

Alternative models for academic family practices.

Background: The Future of Family Medicine Report calls for a fundamental redesign of the American family physician workplace. At the same time, academic family practices are under economic pressure. Most family medicine departments do not have self-supporting practices, but seek support from specialty colleagues or hospital practice plans.

Is there time for management of patients with chronic diseases in primary care?

Purpose: Despite the availability of national practice guidelines, many patients fail to receive recommended chronic disease care. Physician time constraints in primary care are likely one cause.

Methods: We applied guideline recommendations for 10 common chronic diseases to a panel of 2,500 primary care patients with an age-sex distribution and chronic disease prevalences similar to those of the general population, and estimated the minimum physician time required to deliver high-quality care for these conditions.

Pain predicts non-adherence to pap smear screening among middle-aged African American women.

Background: Middle-aged African American women have the highest incidence and mortality of invasive cervical cancer in the United States and the lowest adherence to pap smear screening.

Methods: In 2001, we identified factors associated with non-adherence to screening recommendations using three focus group interviews and subsequently developed a questionnaire administered to 144 African American women aged 45 to 65 years.

Results: The perception that the Pap test was painful was associated with non-adherence to screening recommendations (OR = 4.

Reproducibility of self-reported pap test utilization in middle-aged African-American women.

Both clinicians who perform Pap tests and prescribe re-screens and public health officials, who periodically evaluate the success of Pap test screening programs, often depend on women to self-report their most recent Pap test. However, reliability of self-reported Pap test utilization is putatively low, and even lower in African-American women compared to Whites. Between 2001 and 2002, Pap test screening histories were obtained from 144 African-American women, aged 45 to 64 years at two in-person interviews conducted three to six weeks apart.

Risk classification of adult primary care patients by self-reported quality of life.

Background: : Although patient-reported health-related quality of life (HRQOL) is known to predict health services utilization, most risk assessment systems use provider-reported diagnoses as predictors rather than HRQOL.

Objective: : We sought to classify adult primary care patients prospectively by utilization risk based on age, gender, and HRQOL at a single clinic visit.

Research Design: : Patients completed the Duke Health Profile.

Factors associated with condom use among at-risk women students and nonstudents seen in managed care.

Objectives: Sexually transmitted diseases (STD) research has focused on high-risk populations such as STD clinic patients and college students. This report examines predictors of unprotected sex among nonstudent women seen in primary care.

Study Design: Data are taken from the baseline survey of an intervention trial testing tailored print materials to encourage condom use.

Primary care: is there enough time for prevention?

Objectives: We sought to determine the amount of time required for a primary care physician to provide recommended preventive services to an average patient panel.

Methods: We used published and estimated times per service to determine the physician time required to provide all services recommended by the US Preventive Services Task Force (USPSTF), at the recommended frequency, to a patient panel of 2500 with an age and sex distribution similar to that of the US population.

Results: To fully satisfy the USPSTF recommendations, 1773 hours of a physician's annual time, or 7.

Influence of stereotyping in smoking cessation counseling by primary care residents.

This study examined racial differences in primary care residents' rates of addressing smoking cessation. We expected residents to have higher rates of addressing cessation with White female patients as compared with African-American or Hispanic female patients, due, in part, to residents having higher outcome expectancies, self-efficacy, lower barriers, and less reliance on stereotypes. Residents (N = 90) were an average of 31 years old; two-thirds were White internal medicine residents.

Factors associated with patient-recalled smoking cessation advice in a low-income clinic.

It is recommended that providers advise cessation to their patients who smoke. However, patients' reports of cessation advice indicate disparities based on patients' race, gender, age, and smoking level. Providers' reports do not corroborate these disparities.