METHODS: Family medicine residency directors completed a survey that asked how many hours of oral health teaching are included in their programs in addition to what topics are covered and the perceived barriers to this education. The response rate was 35%.

RESULTS: A total of 72% of respondents agreed that oral health is an important topic, but only 32% are satisfied with their residents' competency in oral health. Barriers to this education included competing priorities (85%), inadequate time (69%), and lack of faculty expertise (52%).

CONCLUSIONS: The findings suggest that programs are including more hours than in previous years, yet continued efforts are needed to cover core oral health topics and increase the competency of family medicine residents. Awareness of STFM's Smiles for Life and use of its modules were associated with increased hours of training.

METHODS: Eleven questions were embedded in the nationwide CERA survey to US family medicine residency directors regarding the processes, components, and barriers to early PGY-1 assessment. Responses are described, and bivariate analyses of the relationship between assessment variables and percentage of international medical graduates (IMGs), type of program, and barriers to implementation were performed using chi square testing.

RESULTS: Almost four of five (78.4%) responding programs conduct formal early assessments to establish baseline clinical skills (89.6%), provide PGY-1 residents with a guide to focus their learning goals (71.6%), and less often, in response to resident performance problems (34.3%). Barriers to implementing PGY-1 early assessment programs include cost of faculty time (56.3%), cost of tools (42.1%), and time for the assessment during the PGY-1 resident's schedule (41.0%). Cost of faculty time and time for assessment from the PGY-1 resident's schedule were statistically significant major/insurmountable barriers for community-based, non-university-affiliated programs.

CONCLUSIONS: Early PGY-1 assessments with locally developed tools for direct observation are commonly used in family medicine residency programs. Assessment program development should be targeted toward using existing, validated tools during the PGY-1 resident's patient care schedule.

METHODS: In the large, prospective NIH-AARP Diet and Health Study, we analyzed baseline (1995-1996) data from adult men, aged 50-71 years. Incident prostate cancer cases (n = 22,523; 1,089 among African Americans) were identified through December 2006. Lifestyle and health risk information was ascertained by questionnaires administered at baseline. Area-level socioeconomic indicators were ascertained by linkage to the US Census and the Area Resource File. Multilevel Cox models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs).

RESULTS: A differential effect among African Americans and Caucasians was observed for neighborhood deprivation (p-interaction = 0.04), percent uninsured (p-interaction = 0.02), and urologist density (p-interaction = 0.01). Compared to men living in counties with the highest density of urologists, those with fewer had a substantially increased risk of developing advanced prostate cancer (HR = 2.68, 95 % CI = 1.31, 5.47) among African American.

CONCLUSIONS: Certain socioeconomic indicators were associated with an increased risk of prostate cancer among African American men compared to Caucasians. Minimizing differences in healthcare availability may be a potentially important pathway to minimizing disparities in prostate cancer risk.

METHODS: A total of 64,554 participants (aged 55-74) completed baseline questionnaires and underwent FSG at baseline. Of these, 39,385 participants returned for repeat screening. We used logistic regression models to assess factors that are associated with inadequate FSG (defined as a study in which the depth of insertion of FSG was <50 cm or visual inspection was limited to <90% of the mucosal surface but without detection of a polyp or mass).

RESULTS: Of 7084 (11%) participants with inadequate FSG at baseline, 6496 (91.7%) had <50 cm depth of insertion (75.3% due to patient discomfort) and 500 (7.1%) participants had adequate depth of insertion but suboptimal bowel preparation. Compared to 55-59 year age group, advancing age in 5-year increments (odds ratios (OR) from 1.08 to 1.51) and female sex (OR = 2.40; 95% confidence interval (CI): 2.27-2.54) were associated with inadequate FSG. Obesity (BMI > 30 kg/m(2)) was associated with reduced odds (OR = 0.67; 95% CI: 0.62-0.72). Inadequate FSG screening at baseline was associated with inadequate FSG at repeat screening (OR = 6.24; 95% CI: 5.78-6.75).

CONCLUSIONS: Sedation should be considered for patients with inadequate FSG or an alternative colorectal cancer screening method should be recommended.

METHODS: We evaluated the prevalence of adenomas detected by sex, age, race/ethnicity, and colon location among 20,792 Kaiser Permanente Northern California members >/=50 years of age who received a screening colonoscopy exam (102 gastroenterologists, years 2006-2008).

RESULTS: Prevalence of detected adenomas increased more rapidly with age in the proximal colon (adjusted odds ratio [OR], 2.39; 95% confidence interval [CI], 2.05-2.80; 70-74 vs 50-54 years) than in the distal colon (OR, 1.89; 95% CI, 1.63-2.19). Prevalence was higher among men vs women at all ages (OR, 1.77; 95% CI, 1.66-1.89), increasing in men from 25% to 39% at ≥70 years and in women from 15% at 50-54 years to 26% (P < .001). Proximal adenoma prevalence was higher among blacks than whites (OR, 1.26; 95% CI, 1.04-1.54), although total prevalence was similar, including for persons <60 years old (OR, 1.17; 95% CI, 0.91-1.50).

CONCLUSIONS: Prevalence of detected adenomas increases substantially with age and is much higher in men; proximal adenomas are more common among blacks than whites, although the total prevalence and the prevalence for agesvalid, without adjustment, for comparing providers serving different populations. The variation in prevalence and location may also have implications for the effectiveness of screening methods in different demographic groups.

METHODS: We analyzed prospective National Institutes of Health-AARP Diet and Health Study data on 506 488 participants who were recruited in 1995-1996 from six US states and two metropolitan areas and followed through 2006. Detailed baseline data on risk factors for colorectal cancer, including health behaviors, were obtained using questionnaires. SES was measured by self-reported education and census-tract data. The outcome was primary incident invasive colorectal adenocarcinoma. Poisson regression was used to estimate the association between SES and risk of incident colorectal cancer, with adjustment for age, sex, race and ethnicity, family history, and state of residence. The model estimates were used to derive percentage mediation by behavioral risk factors; bias-corrected 95% confidence intervals were obtained through bootstrap techniques.

RESULTS: Seven-thousand six-hundred seventy-six participants developed colorectal cancer during follow-up. SES differences in prevalence of physical inactivity, unhealthy diet, smoking, and unhealthy weight each explained between 11.3% (BMI) and 21.6% (diet) of the association between education and risk of colorectal cancer and between 8.6% (smoking) and 15.3% (diet) of the association between neighborhood SES and risk of colorectal cancer. Health behaviors and BMI combined explained approximately 43.9% (95% CI = 35.1% to 57.9%) of the association of education and 36.2% (95% CI = 28.0% to 51.2%) of the association of neighborhood SES with risk of colorectal cancer. The percentage explained by all factors and BMI combined was largest for right colon cancers and smallest for rectal cancers.

CONCLUSION: A substantial proportion of the socioeconomic disparity in risk of new-onset colorectal cancer, and particularly of right colon cancers, may be attributable to the higher prevalence of adverse health behaviors in low-SES populations.

OBJECTIVE: To describe partnership approach taken by 2 CBOs; determine staffs' views of this unique partnership, highlight aspects of the partnership that contributed to its success, identify challenges and mechanisms for overcoming them, and note lessons learned. Assess health center patients' use of YWCA facility.

METHODS: Usage data were obtained from YWCA records. Staff were interviewed using primarily open-ended questions. Inductive approach was used to analyze qualitative data.

RESULTS: The approach to partnership was largely organic, without formal working documents; nevertheless, the partnership reflected the organizations' missions. Over 4 years, 1134 health center patients made more than 23 000 visits to the YWCA. Responses of health center staff and provider interviewees about partnership processes sorted into the following categories: partnership description and results, partnership benefits, challenges, lessons learned, and advice to other CBOs. YWCA staff interviewee responses reflected the categories: staffing, clientele, and public face. Comments also included challenges, lessons learned, and advice to other YWCAs.

CONCLUSIONS: This partnership achieved notable successes largely because (a) it formed to serve a specific purpose that met both agencies' goals, (b) leaders made sustained commitments, and (c) it managed conflict. The partnership has taken on new projects over time; new ideas for improving access and service to underserved patients continue to emerge. Interorganizational trust and allegiance have been key to addressing challenges; nevertheless, the organic nature of the partnership's origins and the challenges of success have meant that the partnership has restructured its agreement and, to avoid being overwhelmed, limited new patient use.

METHODS: We surveyed Massachusetts family physicians about their screening practices of adult patients for a history of childhood abuse and found that 33.6% had some experience of personal trauma, with 42.4% of women and 24.3% of men reporting some kind of lifetime personal abuse, including witnessing violence between their parents. These rates are comparable to or higher than those reported in prior studies of physicians' histories of abuse.

RESULTS: Physicians with a past history of trauma were more likely to feel confident in screening and less likely to perceive time as a barrier to screening.

CONCLUSIONS: Given the high prevalence of prior childhood and victimization of both men and women physicians with the associated effects on their clinical work, we recommend that educational and training settings adopt specific competencies to provide safe and confidential environments where trainees can safely explore these issues and the potential impact on their clinical practice and well-being.

METHODS: We studied 279 476 alerted prescriptions written by 2321 Massachusetts ambulatory care clinicians using a single commercial e-prescribing system from January 1 through June 30, 2006. An expert panel reviewed a sample of common drug interaction alerts, estimating the likelihood and severity of adverse drug events (ADEs) associated with each alert, the likely injury to the patient, and the health care utilization required to address each ADE. We estimated the cost savings due to e-prescribing by using third-party-payer and publicly available information.

RESULTS: Based on the expert panel's estimates, electronic drug alerts likely prevented 402 (interquartile range [IQR], 133-846) ADEs in 2006, including 49 (14-130) potentially serious, 125 (34-307) significant, and 228 (85-409) minor ADEs. Accepted alerts may have prevented a death in 3 (IQR, 2-13) cases, permanent disability in 14 (3-18), and temporary disability in 31 (10-97). Alerts potentially resulted in 39 (IQR, 14-100) fewer hospitalizations, 34 (6-74) fewer emergency department visits, and 267 (105-541) fewer office visits, for a cost savings of 402,619 USD (IQR, 141,012-1,012,386 USD). Based on the panel's estimates, 331 alerts were required to prevent 1 ADE, and a few alerts (10%) likely accounted for 60% of ADEs and 78% of cost savings.

CONCLUSIONS: Electronic prescribing alerts in ambulatory care may prevent a substantial number of injuries and reduce health care costs in Massachusetts. Because a few alerts account for most of the benefit, e-prescribing systems should suppress low-value alerts.

METHODS: Individual-level data on three measures of care adequacy were obtained for Massachusetts Medicaid Managed Care women who met the National Committee on Quality Assurance's Healthcare Effectiveness Data and Information Set denominator criteria for the prenatal and postpartum care measures in 2007 (n = 1,882). We modeled individual compliance with each measure separately as a binomial logistic function with individual and neighborhood characteristics, provider type, and health plan as explanatory variables.

FINDINGS: In our sample, 85% of women initiated care in the first trimester, but only 62% met the goal of receiving more than 80% of the recommended number of prenatal visits. Just 60% had a timely postpartum care visit. Having a diagnosis of substance abuse or dependence reduced the odds of meeting all measures. Women with disabilities were less likely to attain two of the three measures of adequate care, as were women with other children in the household. Women who enrolled in Medicaid in the first trimester were more likely to receive the recommended number of prenatal visits than those who were enrolled before pregnancy.

CONCLUSION: Given the importance of prenatal and postpartum care for maternal and child health and the recent national declining trend in timely care, initiatives to improve rates of timely and adequate care are crucial and must include components tailored toward particularly vulnerable subpopulations. All rights reserved.

Analyses, using an ordinary least squares regression model, find that families with a positive alcohol or drug screen in the year prior stay 85 days longer than those without a positive screen; families leaving shelter with a housing subsidy stay 66 days longer than those leaving without a subsidy.Demographic factors, education, employment, health, and mental health are not found to predict shelter stay duration.

Consistent with prior research, housing resources relate to families' time in shelter; with the exception of a positive substance abuse screen, individual-level problems are not related to their time in shelter. Efforts to expand these resources at the local, state, and national levels are a high priority.

METHODS: A broad-based public and private organization partnership with local and national funding created a steering committee to organize school administrators, community leaders, and a medical school to collaborate on five goals: advocate for changes in oral health policy, increase oral health care access, provide school-based dental services for underserved children, establish a Dental General Practice Residency, and educate medical professionals about oral health.

RESULTS: A state legislative Oral Health Caucus helped secure sought-after policy improvements; more regional dentists now accept Medicaid; community health center capacity to provide dental services was expanded; school-based programs were designed and delivered needed dental services; a dental residency was created; and methods of educating medical professionals were established.

CONCLUSIONS: Significant sustainable gains in oral health care access were created through our multifaceted approach, ongoing evaluation and communication, coordination of CMOHI partner resources, and collaboration with other involved parties.

METHODS: Men (N = 140) experiencing a first onset of low back pain (LBP) were examined for lifetime psychiatric disorders approximately 8 weeks post pain-onset using the Diagnostic Interview Schedule (DIS-III-R), then re-evaluated at 6 months after pain onset to determine who did or did not progress to pain chronicity.

OUTCOME MEASURE: Transition to chronic pain and disability was based on 6-month self-report measures of pain intensity and perceived disability.

RESULTS: Men with a pre-pain lifetime diagnosis of major depressive disorder had 5 times greater risk of transitioning to chronic LBP (odds ratio [OR] = 4.99; 95% confidence interval [CI] 1.49-16.76). Increased risk was also associated with a pre-pain lifetime diagnosis of generalized anxiety (OR = 2.45; 95% CI 1.06-5.68), post-traumatic stress (OR = 3.23; 95% CI 1.11-9.44), and with current nicotine dependence (OR = 2.49; 95% CI 1.15-5.40). There were no statistically significant effects for abuse or dependence of alcohol or other psychoactive substances.

DISCUSSION: Lifetime history of major depression or a major anxiety disorder may represent potential psychosocial "yellow flags" for the transition to chronicity in men with first-onset LBP. Screening for lifetime depressive or anxiety disorders may identify individuals at higher risk, who may benefit from referral for more intensive rehabilitation.

METHOD: Workers with LBP (n = 38) participated in five focus groups, and audio recordings of sessions were analysed to assemble lists of common challenges and coping strategies. A separate analysis provided a general categorisation of major themes.

RESULTS: Workplace pain challenges fell within four domains: activity interference, negative self-perceptions, interpersonal challenges and inflexibility of work. Self-management strategies consisted of modifying work activities and routines, reducing pain symptoms, using cognitive strategies and communicating pain effectively. Theme extraction identified six predominant themes: knowing your work setting, talking about pain, being prepared for a bad day, thoughts and emotions, keeping moving and finding leeway.

CONCLUSIONS: To retain workers with LBP, this qualitative investigation suggests future intervention efforts should focus on worker communication and cognitions related to pain, pacing of work and employer efforts to provide leeway for altered job routines.

METHODS: The study focuses on the 442 LBP claimants in the Readiness for Return-to-Work Cohort Study. Claimants (n = 259) who had already returned to work, approximately 1 month post-injury were categorized as the low risk group. A latent class analysis was performed on 183 workers absent from work, categorized as the high risk group. Groups were classified based on: pain, disability, fear avoidance beliefs, physical demands, people-oriented culture and disability management practice at the workplace, and depressive symptoms.

RESULTS: Three classes were identified; (1) workers with 'workplace issues', (2) workers with a 'no workplace issues, but back pain', and (3) workers having 'multiple issues' (the most negative values on every scale, notably depressive symptoms). Classes 2 and 3 had a similar rate of return to work, both worse than the rate of class 1. Return-to-work status and recurrences at 6 months were similar in all 3 groups.

CONCLUSION: This study largely confirms that several subgroups could be identified based on previously defined risk factors as suggested by an earlier theoretical model by Shaw et al. (J Occup Rehab 16(4):591-605, 2006). Different groups of workers might be identified and might benefit from different interventions.

METHODS Lost-time claimants completed a telephone survey 1 month (n = 632) and 6 months (n = 446) after a work-related musculoskeletal injury. Exploratory (Varimax and Promax rotation) and confirmatory factor analyses of self-efficacy items were conducted with two separate subsamples at both time points. Construct validity was examined by comparing scale measurements and theoretically derived constructs, and the phase specificity of RTWSE was studied by examining changes in strength of relationships between the RTWSE Subscales and the other constructs at both time measures.

RESULTS Factor analyses supported three underlying factors: (1) Obtaining help from supervisor, (2) Coping with pain (3) Obtaining help from co-workers. Internal consistency (alpha) for the three subscales ranged from 0.66 to 0.93. The total variance explained was 68% at 1-month follow-up and 76% at 6-month follow-up. Confirmatory factor analyses had satisfactory fit indices to confirm the initial model. With regard to construct validity: relationships of RTWSE with depressive symptoms, fear-avoidance, pain, and general health, were generally in the hypothesized direction. However, the hypothesis that less advanced stages of change on the Readiness for RTW scale would be associated with lower RTWSE could not be completely confirmed: on all RTWSE subscales, RTWSE decreased significantly for a subset of participants who started working again. Moreover, only Pain RTWSE was significantly associated with RTW status and duration of work disability. With regard to the phase specificity, the strength of association between RTWSE and other constructs was stronger at 6 months post-injury compared to 1 month post-injury.

CONCLUSIONS A final 10-item version of the RTWSE has adequate internal consistency and validity to assess the confidence of injured workers to obtain help from supervisor and co-workers and to cope with pain. With regard to phase specificity, stronger associations between RTWSE and other constructs at 6-month follow-up suggest that the association between these psychological constructs consolidates over time after the disruptive event of the injury.

METHODS: working adults (n = 97; 64% men; median age, 38 years) with acute LBP completed baseline surveys, agreed to audio recording of provider visits, and were followed for 3 months. Using the Roter Interaction Analysis System, 10 composite indices of communication were compared with 1- and 3-month patient outcomes.

RESULTS: patients (n = 30) with significant pain and dysfunction persisting at 3 months provided more biomedical information (t[75], 2.61; P < .05) and engaged in more negative rapport building (t[75], 2.33; P < .05) but showed no increase in psychosocial/lifestyle communication during the initial visit (P > .05). Providers asked these patients more biomedical questions (r = 0.35 with dysfunction), more psychosocial/lifestyle questions (r = 0.30), made more efforts to engage the patient (t[75], 4.49; P < .05), and did more positive rapport building (t[75], 2.13; P < .05).

CONCLUSIONS: providers adapt their communication patterns to collect more information and establish greater rapport with high-risk patients, but patients focus more on biomedical than coping concerns. To better elicit psychosocial concerns from patients, providers may need to administer brief self-report measures or adopt more structured interviewing techniques.