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1.  Assessment of leadership training needs of internal medicine residents at the Massachusetts General Hospital 
Internal medicine (IM) physicians, including residents, assume both formal and informal leadership roles that significantly impact clinical and organizational outcomes. However, most internists lack formal leadership training. In 2013 and 2014, we surveyed all rising second-year IM residents at a large northeastern academic medical center about their need for, and preferences regarding, leadership training. Fifty-five of 113 residents (49%) completed the survey. Forty-four residents (80% of respondents) reported a need for additional formal leadership training. A self-reported need for leadership training was not associated with respondents' gender or previous leadership training and experience. Commonly cited leadership skill needs included “leading a team” (98% of residents), “confronting problem employees” (93%), “coaching and developing others” (93%), and “resolving interpersonal conflict” (84%). Respondents preferred to learn about leadership using multiple teaching modalities. Fifty residents (91%) preferred to have a physician teach them about leadership, while 19 (35%) wanted instruction from a hospital manager. IM residents may not receive adequate leadership development education during pregraduate and postgraduate training. IM residents may be more likely to benefit from leadership training interventions that are physician-led, multimodal, and occur during the second year of residency. These findings can help inform the design of effective leadership development programs for physician trainees.
PMCID: PMC4462209  PMID: 26130876
2.  Universal Approach to FRAP Analysis of Arbitrary Bleaching Patterns 
Scientific Reports  2015;5:11655.
The original approach to calculating diffusion coefficients of a fluorescent probe from Fluorescence Recovery After Photobleaching (FRAP) measurements assumes bleaching with a circular laser beam of a Gaussian intensity profile. This method was used without imaging the bleached cell. An empirical equation for calculating diffusion coefficients from a rectangular bleaching geometry, created in a confocal image, was later published, however a single method allowing the calculation of diffusion coefficients for arbitrary geometry does not exist. Our simulation approach allows computation of diffusion coefficients regardless of bleaching geometry used in the FRAP experiment. It accepts a multiple-frame TIFF file, representing the experiment as input, and simulates the (pure) diffusion of the fluorescent probes (2D random walk) starting with the first post-bleach frame of the actual data. It then fits the simulated data to the real data and extracts the diffusion coefficient. We validate our approach using a well characterized diffusing molecule (DiIC18) against well-established analytical procedures. We show that the algorithm is able to calculate the absolute value of diffusion coefficients for arbitrary bleaching geometries, including exaggeratedly large ones. It is provided freely as an ImageJ plugin, and should facilitate quantitative FRAP measurements for users equipped with standard fluorescence microscopy setups.
PMCID: PMC4479983  PMID: 26108191
3.  An Academic-Public Health Department Partnership for Education, Research, Practice, and Governance 
Public health departments and medical schools are often disconnected, yet each has much to offer the other. There are 4 areas in which the 2 entities can partner; in Atlanta, Georgia, the Morehouse School of Medicine (particularly its Prevention Research Center or PRC) and the Fulton County Department of Health and Wellness have demonstrated partnership in each area. With respect to teaching, the 2 have collaborated on clerkships for medical students and rotations for preventive medicine residents. In research, Morehouse faculty and health department staff have worked together on projects. In service, the 2 entities have been able to put into practice interventions developed through their joint research efforts. In governance, the health department has a representative on the PRC board, while the PRC principal investigator serves on the Fulton County Board of Health. Benefits have accrued to both entities and to the communities that they serve.
PMCID: PMC4315501  PMID: 24667192
academic-health department partnership; community-based participatory research; prevention research center; public health department
4.  Implementing a pilot leadership course for internal medicine residents: design considerations, participant impressions, and lessons learned 
BMC Medical Education  2014;14:257.
Effective clinical leadership is associated with better patient care. We implemented and evaluated a pilot clinical leadership course for second year internal medicine residents at a large United States Academic Medical Center that is part of a multi-hospital health system.
The course met weekly for two to three hours during July, 2013. Sessions included large group discussions and small group reflection meetings. Topics included leadership styles, emotional intelligence, and leading clinical teams. Course materials were designed internally and featured “business school style” case studies about everyday clinical medicine which explore how leadership skills impact care delivery. Participants evaluated the course’s impact and quality using a post-course survey. Questions were structured in five point likert scale and free text format. Likert scale responses were converted to a 1-5 scale (1 = strongly disagree; 3 = neither agree nor disagree; 5 = strongly agree), and means were compared to the value 3 using one-way T-tests. Responses to free text questions were analyzed using the constant comparative method.
All sixteen pilot course participants completed the survey. Participants overwhelmingly agreed that the course provided content and skills relevant to their clinical responsibilities and leadership roles. Most participants also acknowledged that taking the course improved their understanding of their strengths and weaknesses as leaders, different leadership styles, and how to manage interpersonal conflict on clinical teams. 88% also reported that the course increased their interest in pursuing additional leadership training.
A clinical leadership course for internal medicine residents designed by colleagues, and utilizing case studies about clinical medicine, resulted in significant self-reported improvements in clinical leadership competencies.
Electronic supplementary material
The online version of this article (doi:10.1186/s12909-014-0257-2) contains supplementary material, which is available to authorized users.
PMCID: PMC4261637  PMID: 25433680
Leadership development; Management; Quality of care; Teamwork; Patient safety
5.  Black White Disparities in Receiving a Physician Recommendation for Colorectal Cancer Screening and Reasons for not Undergoing Screening 
There is consensus that all adults over 50 years of age, regardless of gender, race, or ethnicity, should receive a physician recommendation for colorectal cancer (CRC) screening. Disparities in CRC screening result in poorer health outcomes for Blacks than for Whites. The purpose of this study was to determine whether there are Black-White differences in receiving a physician recommendation for CRC screening and reasons for undergoing screening. With 12,729 U.S. adults ages 50 to 74 included in the analysis, Whites were more likely than Blacks to report receiving a physician recommendation for CRC screening. Based on age-adjusted odds ratio, one out of three Blacks were less likely to report receiving a CRC screening recommendation from their physician (OR=0.68, 95% CI 0.57,0.81). This association persisted after adjusting for socioeconomic and other health-related factors (OR=0.61; 95% CI 0.53,0.71). This study suggests that additional steps need to be taken to reduce cancer health disparities.
PMCID: PMC4017350  PMID: 23974385
Cancer screening; predictors; race/ethnicity; insurance; health disparity
6.  Guidance for Structuring Team-Based Incentives in Health Care 
New payment methods designed to incentivize more efficient care delivery are accelerating the movement of health care providers into organized provider groups. More efficient health care delivery requires explicit structuring of care delivery processes around teams of clinicians working toward common patient care goals. Provider organizations accepting new payment methods will need to design and implement compensation systems that provide incentives for team-based care. While lessons from studies performed both outside and inside health care provide some guidance on designing and implementing team-based incentives, organized delivery systems face several significant barriers to designing and implementing them.
PMCID: PMC3984877  PMID: 23448116
7.  Faith-Based Partnerships in Graduate Medical Education 
American journal of preventive medicine  2011;41(4 0 3):S283-S289.
Faith-based organizations can be strategic partners in addressing the needs of low-income and underserved individuals and communities. The Morehouse School of Medicine (MSM) Public Health/Preventive Medicine Residency Program (PH/PMR) collaborates with faith-based organizations for the purpose of resident education, community engagement, and service. These partners provide guidance for the program’s community initiatives and health promotion activities designed to address health inequities. Residents complete a longitudinal community practicum experience with a faith-based organization over the 2-year training period. Residents conduct a community health needs assessment at the organization and design a health intervention that addresses the identified needs.
The faith-based community practicum also serves as a vehicle for achieving skills in all eight domains of the Public Health Competencies developed by the Council on Linkages and all six Accreditation Council for Graduate Medical Education (ACGME) Core Competencies. The MSM PH/PMR Program has engaged in faith-based partnerships for 7 years. This article discusses the structure of these partnerships, how partners are identified, funding sources for supporting resident projects, and examples of resident health needs assessment and intervention activities. The MSM PH/PMR Program may serve as a model to other residency and fellowship programs that may have an interest in developing partnerships with faith-based organizations.
PMCID: PMC3976957  PMID: 21961677
8.  Using Service-Learning to Teach Community Health: The Morehouse School of Medicine Community Health Course 
Medical education is evolving to include more community-based training opportunities. Most frequently, third-and fourth-year medical students have access to these opportunities. However, introducing community-based learning to medical students earlier in their training may provide a more formative experience that guides their perspectives as they enter clinical clerkships. Few known courses of this type exist for first-year medical students.
Since 1998, the Morehouse School of Medicine (MSM) has required first-year students to take a yearlong Community Health Course (CHC) that entails conducting a community health needs assessment and developing, implementing, and evaluating a community health promotion intervention. In teams, students conduct health needs assessments in the fall, and in the spring they develop interventions in response to the problems they identified through the needs assessments. At the end of each semester, students present their findings, outcomes, and policy recommendations at a session attended by other students, course faculty, and community stakeholders.
The authors describe the course and offer data from the course’s past 11 years. Data include the types of collaborating community sites, the community health issues addressed, and the interventions implemented and evaluated. The MSM CHC has provided students with an opportunity to obtain hands-on experience in collaborating with diverse communities to address community health. Students gain insight into how health promotion interventions and community partnerships can improve health disparities. The MSM CHC is a model that other medical schools across the country can use to train students.
PMCID: PMC3976958  PMID: 20881688
9.  Driving to Better Health: Cancer and Cardiovascular Risk Assessment among Taxi Cab Operators in Chicago 
While a number of investigations of the health of taxi cab drivers have been conducted in Europe, Asia, and Africa, virtually none have been conducted in the United States. We undertook a survey of taxi cab operators in the Chicago area to understand better their health status and health promotion practices. The survey was completed by a convenience sample of 751 Chicago taxi drivers. Taxi drivers had low rates of insurance coverage, fruit and vegetable consumption, and physical activity compared with the general Chicago population. Participation in cancer screening tests was also lower for this group. A high proportion of taxi drivers are immigrants. They tend to be highly educated and report a readiness to engage in more health-promoting behaviors. Further research is needed to develop a targeted intervention for this population.
PMCID: PMC3976959  PMID: 22643623
Taxi drivers; risk assessment; cancer; cardiovascular
10.  Innovative Ways of Integrating Public Health Into the Medical School Curriculum 
American journal of preventive medicine  2011;41(4 0 3):S309-S311.
This is one of six short papers that describe additional innovations to help integrate public health into medical education; these were featured in the “Patients and Populations: Public Health in Medical Education” conference. They represent relatively new endeavors or curricular components that had not been explored in prior publications. Although evaluation data are lacking, it was felt that sharing a description of the methods use by Morehouse School of Medicine to integrate public health in the curriculum would be of value to medical educators.
PMCID: PMC3976960  PMID: 21961683
11.  Is Community-Based Participatory Research Possible? 
The researcher seeking guidance in conducting research that is truly community-participatory may fınd too much guidance rather than too little and must recognize that his or her project will be evaluated not only on the quality of the science, but on the extent to which it adheres to the principles of CBPR.
PMCID: PMC3976961  PMID: 21335275
13.  A Comparison of Breast and Cervical Cancer Legislation and Screening in Georgia, North Carolina, and South Carolina 
We identified legislation (1989–2005) relating to breast and cervical cancer in Georgia, North Carolina, and South Carolina and examined its impact on screening rates for these cancers and on Black-White disparities in screening rates. Legislation was identi-fied using the National Cancer Institute’s (NCI) State Cancer Legislative Database (SCLD) Program. Screening rates were identified using the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System. Georgia and North Carolina enacted more laws on breast and cervical cancer than did South Carolina. The laws specifically intended to increase breast and cervical cancer screening were mandates requiring that insurance policies cover such screening; Georgia and North Carolina enacted such laws, but South Carolina did not. However, we were unable to demonstrate an effect of these laws on either screening rates or disparities. This may reinforce the importance of evidence-based health promotion programs to increase screening.
PMCID: PMC3751800  PMID: 22643558
African Americans; breast neoplasm; mammography; cervical cancer; legislation
14.  Efficacy to effectiveness transition of an Educational Program to Increase Colorectal Cancer Screening (EPICS): study protocol of a cluster randomized controlled trial 
African Americans have the highest incidence and mortality and are less likely than whites to have been screened for colorectal cancer (CRC). Many interventions have been shown to increase CRC screening in research settings, but few have been evaluated specifically for use in African-American communities in real world settings. This study aims to identify the most efficacious approach to disseminate an evidence-based intervention in promoting colorectal screening in African Americans and to identify the factors associated with its efficacy.
In this study, investigators will recruit 20 community coalitions and 7,200 African-Americans age 50 to 74 to test passive and active approaches to disseminating the Educational Program to Increase Colorectal Cancer Screening (EPICS); to measure the extent to which EPICS is accepted and the fidelity of implementation in various settings and to estimate the potential translatability and public health impact of EPICS. This four-arm cluster randomized trial compares the following implementation strategies: passive arms, (web access to facilitator training materials and toolkits without technical assistance (TA) and (web access, but with technical assistance (TA); active arms, (in-person access to facilitator training materials and toolkits without TA and (in-person access with TA). Primary outcome measures are the reach (the proportion of representative community coalitions and individuals participating) and efficacy (post-intervention changes in CRC screening rates). Secondary outcomes include adoption (percentage of community coalitions implementing the EPICS sessions) and implementation (quality and consistency of the intervention delivery). The extent to which community coalitions continue to implement EPICS post-implementation (maintenance) will also be measured. Cost-effectiveness analysis will be conducted.
Implementing EPICS in partnership with community coalitions, we hypothesized, will result in more rapid adoption than traditional top-down approaches, and resulting changes in community CRC screening practices are more likely to be sustainable over time. With its national reach, this study has the potential to enhance our understanding of barriers and enablers to the uptake of educational programs aimed at eliminating cancer disparities.
Trial registration NCT01805622
PMCID: PMC3750535  PMID: 23924263
Dissemination; Implementation; Colorectal cancer screening; Health disparities; Community-based participatory research
15.  The Southeastern u.S. collaborative center of Excellence in the Elimination of disparities (SUCCEED): reducing Breast and cervical cancer disparities for african american Women 
This supplement highlights the efforts of Morehouse School of Medicine’s Prevention Research Center and its partners to reduce the disparities experienced by African American women for breast and cervical cancer in Georgia, North Carolina and South Carolina. The project (entitled the Southeastern U.S. Collaborative CEED, or SUCCEED) is supported by a Centers for Disease Control and Prevention (CDC) grant to establish a Center of Excellence in the Elimination of Disparities (CEED). This introductory paper provides an overview describing the project’s goals and core components and closes by introducing the adjoining papers that describe in more detail these components. The program components for SUCCEED include providing training and technical assistance for implementing evidence-based interventions for breast and cervical cancer; supporting capacity-building and sustainability efforts for community-based organizations; promoting the establishment of new empowered community coalitions and providing advocacy training to cancer advocates in order to affect health systems and policies.
PMCID: PMC3707612  PMID: 22643554
African American women; breast and cervical cancer; cancer control; cancer; disparities
16.  Association of Public Reporting for Percutaneous Coronary Intervention with Utilization and Outcomes among Medicare beneficiaries with Acute Myocardial Infarction 
Public reporting of patient outcomes is an important tool to improve quality of care, but some observers worry that such efforts will lead clinicians to avoid high-risk patients.
To determine whether public reporting for percutaneous coronary intervention (PCI) is associated with lower rates of PCI for patients with acute myocardial infarction (MI) or with higher mortality rates in this population.
Design, Setting, and Patients
Retrospective observational study conducted using data from fee-for-service Medicare patients (49,660 from reporting states and 48,142 from nonreporting states) admitted with acute Ml to US acute care hospitals between 2002 and 2010. Logistic regression was used to compare PCI and mortality rates between reporting states (New York, Massachusetts, and Pennsylvania) and regional nonreporting states (Maine, Vermont, New Hampshire, Connecticut, Rhode Island, Maryland, and Delaware). Changes in PCI rates over time in Massachusetts compared with nonreporting states were also examined.
Main Outcome Measures
Risk-adjusted PCI and mortality rates.
In 2010, patients with acute MI were less likely to receive PCI in public reporting states than in nonreporting states (unadjusted rates, 37.7% vs. 42.7%, respectively; risk-adjusted odds ratio [OR], 0.82, 95% CI, 0.71–0.93, P=.003). Differences were greatest among the 6708 patients with ST-segment elevation Ml (61.8% vs 68.0%; OR, 0.73 [95% CI, 0.59–0.89]; P=.002) and the 2194 patients with cardiogenic shock or cardiac arrest (41.5% vs 46.7%, OR 0.79 [0.64, 0.98], P=.030). In Massachusetts, odds of PCI for acute Ml were comparable with odds in nonreporting states prior to public reporting (40.6% versus 41.8%, OR 1.00 [0.71, 1.41]). However, after implementation of public reporting, odds of undergoing PCI in Massachusetts decreased compared with nonreporting states (41.1% versus 45.6%, OR 0.81 [0.47, 1.38], p=.030 for difference in differences). Differences were most pronounced for the 6081 patients with cardiogenic shock or cardiac arrest (pre-reporting, 44.2% versus 36.6%, OR 1.40 [0.85, 2.37] post-reporting, 43.9% versus 44.8%, OR 0.92 [0.38, 2.22], p=.028 for difference in differences). There were no differences in overall mortality among acute MI patients in reporting versus non-reporting states.
Among Medicare beneficiaries with acute Ml, the use of PCI was lower for patients treated in 3 states with public reporting of PCI outcomes compared with patients treated in 7 regional control states without public reporting. However, there was no difference in overall acute Ml mortality between states with and without public reporting.
PMCID: PMC3698951  PMID: 23047360
17.  Training Physicians to Do Office-based Smoking Cessation Increases Adherence to PHS Guidelines 
Journal of community health  2011;36(2):238-243.
Cigarette Smoking is the leading cause of preventable mortality and morbidity in the United States. Healthcare providers can contribute significantly to the war against tobacco use; patients advised to quit smoking by their physicians are 1.6 times more likely to quit than patients not receiving physician advice. However, most smokers do not receive this advice when visiting their physicians. The Morehouse School of Medicine Tobacco Control Research Program was undertaken to develop best practices for implementing the “2000 Public Health Services Clinical Practice Guidelines on Treating Tobacco Use and Dependence” and the “Pathways to Freedom” tobacco cessation program among African American physicians in private practice and healthcare providers at community health centers. Ten focus groups were conducted; 82 healthcare professionals participated. Six major themes were identified as barriers to the provision of smoking cessation services. An intervention was developed based on these results and tested among Georgia community-based physicians. A total of 308 charts were abstracted both pre- and post-intervention. Charts were scored using a system awarding one point for each of the five “A’s” recommended by the PHS guidelines (Ask, Advise, Assess, Assist, Arrange) employed during the patient visit. The mean pre-intervention five “A’s” score was 1.29 compared to 1.90 post-intervention (P < 0.001). All charts had evidence of the first “A” (“asked”) both pre- and post-intervention, and the other four “A’s” all had statistically significant increases pre-to post-intervention.
The results demonstrate that, with training of physicians, compliance with the PHS tobacco guidelines can be greatly improved.
PMCID: PMC3668440  PMID: 20697785
Five “A’s”; Smoker; Smoking cessation; Training physicians; Tobacco
18.  Community Health Workers Support Community-based Participatory Research Ethics: 
Ethical principles of community-based participatory research (CBPR)— specifically, community engagement, mutual learning, action-reflection, and commitment to sustainability—stem from the work of Kurt Lewin and Paulo Freire. These are particularly relevant in cancer disparities research because vulnerable populations are often construed to be powerless, supposedly benefiting from programs over which they have no control. The long history of exploiting minority individuals and communities for research purposes (the U.S. Public Health Service Tuskegee Syphilis Study being the most notorious) has left a legacy of mistrust of research and researchers. The purpose of this article is to examine experiences and lessons learned from community health workers (CHWs) in the 10-year translation of an educational intervention in the research-to-practice-to-community continuum. We conclude that the central role played by CHWs enabled the community to gain some degree of control over the intervention and its delivery, thus operationalizing the ethical principles of CBPR.
PMCID: PMC3586526  PMID: 23124502
Colorectal cancer; African Americans; cancer disparities; community-based participatory research; ethics; translational research; community health workers
19.  Operationalization of community-based participatory research principles across the National Cancer Institute’s Community Network Programs 
American Journal of Public Health  2011;102(6):1195-1203.
To examine how the National Cancer Institute-funded Community Network Program (CNP) operationalized principles of community-based participatory research (CBPR).
Based on our review of the literature and extant CBPR measurement tools, scientists from nine of 25 CNPs developed a 27-item questionnaire to self-assess CNP operationalization of nine CBPR principles.
Of 25 CNPs, 22 (88%) completed the questionnaire. Most scored well on CBPR principles to recognize community as a unit of identity, build on community strengths, facilitate co-learning, embrace iterative processes in developing community capacity, and achieve a balance between data generation and intervention. CNPs varied in extent to which they employed CBPR principles of addressing determinants of health, sharing power among partners, engaging community in research dissemination, and striving for sustainability.
Although tool development in this field is in its infancy, findings suggest that fidelity to CBPR processes can be assessed in a variety of settings.
PMCID: PMC3292685  PMID: 22095340
Cancer disparities; community health; empowerment; health status disparities; indigenous populations; minority health; partnerships; training
20.  Triangulating on Success: Innovation, Public Health, Medical Care, and Cause-Specific US Mortality Rates Over a Half Century (1950–2000) 
American journal of public health  2010;100(Suppl 1):S95-104.
To identify successes in improving America’s health, we identified disease categories that appeared on vital statistics lists of leading causes of death in the US adult population in either 1950 or 2000, and that experienced at least a 50% reduction in age-adjusted death rates from their peak level to their lowest point between 1950 and 2000. Of the 9 cause-of-death categories that achieved this 50% reduction, literature review suggests that 7 clearly required diffusion of new innovations through both public health and medical care channels. Our nation’s health success stories are consistent with a triangulation model of innovation plus public health plus medical care, even when the 3 sectors have worked more in parallel than in partnership.
PMCID: PMC2837442  PMID: 20147695
21.  A Trial of Three Interventions to Promote Colorectal Cancer Screening in African Americans 
Cancer  2010;116(4):922-929.
Colorectal cancer (CRC) is the second-leading cause of cancer death in the U.S. CRC incidence and mortality rates are higher in blacks than in whites and screening rates are lower in blacks than in whites. We tested three interventions intended to increase the rate of colorectal cancer screening among African Americans.
The interventions were chosen to address evidence gaps in the Guide to Community Preventive Services: one-on-one education, group education, and reducing out-of-pocket costs. Three hundred sixty-nine African American men and women aged ≥50 years were enrolled in this randomized controlled community intervention trial. The main outcome measures were post-intervention increase in colorectal cancer knowledge and obtaining a screening test within six months.
There was substantial attrition: 257 participants completed the intervention and were available for follow-up 3–6 months later. Among completers, there were significant increases in knowledge in both educational cohorts but in neither of the other two. By the 6 month follow-up, 17.7% (11/62) of control group members reported having undergone screening, as compared to 33.9% (22/65) of the group education cohort (p = 0.039). Screening rate increases in the other 2 cohorts were not statistically significant.
Group education can increase colorectal cancer screening rates among African Americans. The screening rate of less than 35% in a group of people who participated in an educational program through multiple sessions over a period of several weeks indicates that there are still barriers to overcome.
PMCID: PMC2819540  PMID: 20052732
Colorectal cancer; health status disparities; minority health; health education; screening; community-based participatory research
22.  A Community Coalition Board Creates a Set of Values for Community-based Research 
Preventing Chronic Disease  2005;3(1):A16.
Researchers generally agree that communities should participate in the community-based research process, but neither a universally accepted approach to community participation nor a set of guiding principles exists.
The Morehouse School of Medicine Prevention Research Center was established in 1999 with the support of a grant from the Centers for Disease Control and Prevention. Its partners include a low-income, predominantly African American community, six public agencies, and two other academic institutions. A Community Coalition Board was established to represent the partners. The majority of the board is community members; it serves in a governance rather than an advisory capacity, with the community acting as the senior partner in interactions with the medical school, the agencies, and other academic institutions.
The Community Coalition Board developed a set of research priorities and a set of 10 community values, or principles, to guide research. A board committee reviews each protocol to ensure they uphold the values.
The Community Coalition Board has been using the values since 1999, and in this article we describe its experience. After an initial period that included some disagreements between researchers and community members on the board, relationships have been good, and protocols have been approved with only minor changes.
Although the established community values reflect universally acknowledged principles of research ethics, they also address local concerns. An equal partnership between community members and researchers is most beneficial if the partners can agree on a set of values to govern research.
PMCID: PMC1500962  PMID: 16356369
23.  Impact of a two-city community cancer prevention intervention on African Americans. 
We report the first multisite, multicomponent community intervention trial to focus on cancer prevention in African Americans. The project explored the potential of historically black medical schools to deliver health information to their local communities and used a community-based participatory research approach. The intervention consisted of culturally sensitive messages at appropriate educational levels delivered over an 18-month period and tested in predominantly black census tracts in Nashville, TN and Atlanta, GA. Chattanooga, TN and Decatur, GA served as comparison cities. Results were evaluated by pre- and postintervention random-digit dial telephone surveys. The intervention cities showed an increase in reported contact with or knowledge of the project. There was little or no effect on knowledge or attitudes in the intervention cities. Compared to Chattanooga, Nashville showed an increase in percentage of women receiving Pap smears. Compared to Decatur, Atlanta showed an increase in percentage of age-appropriate populations receiving digital rectal exams, colorectal cancer screenings and mammograms. The results of this community intervention trial demonstrated modest success and are encouraging for future efforts of longer duration.
PMCID: PMC2594915  PMID: 16334495
24.  Orbital Cellulitis and Sinusitis Caused by Group B β Streptococcus in a 3-Year-Old Child 
This paper reports a case in which an odontogenic infection extended into a maxillary sinus in an otherwise well 3-year-old child. The resulting sinusitis and orbital cellulitis were caused by an organism which does not usually cause disease in this age group, group B β-hemolytic streptococcus.
PMCID: PMC2561832  PMID: 3884823

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