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Tests the hypothesis that pictographs can improve recall of spoken medical instructions. Junior college subjects (N=21) listened to two lists of actions, one of which was accompanied by pictographs during both listening and recall while the other was not. Mean correct recall was 85% with pictographs and 14% without, indicating that pictographs can enhance memory of spoken medical instructions. (Author/GCP)

This report applies problem-solving principles to the design and implementation of nutrition education and counseling programs. A framework is proposed that builds on an extensive body of research in mental health and health education that has demonstrated the efficacy of a problem-solving approach to helping people cope with stressful life events. Our framework uses problem-solving principles in helping participants in nutrition education or counseling programs to overcome obstacles they experience in changing their nutrition behaviors. Both research and clinical experience suggest that incorporating problem-solving techniques in nutrition education and counseling will increase long term change in nutrition behaviors.

The efficacy of problem-solving therapy (PST) to reduce psychological distress was assessed among a sample of 132 adult cancer patients. A second condition provided PST for both the patient and a significant other. At posttreatment, all participants receiving PST fared significantly better than waiting list control patients. Further, improvements in problem solving were found to correlate significantly with improvements in psychological distress and overall quality of life. No differences in symptom reduction were identified between the 2 treatment protocols. At a 6-month follow-up, however, patients who received PST along with their significant other reported lower levels of psychological distress as compared with members of the PST-alone condition on approximately half of the outcome measures. These effects were further maintained 1-year posttreatment.

The usual method of assessing an outpatient's need for physical assistance can be distorted by gender or long-term family roles. Six hundred twenty-nine cancer patients living at home were asked about whether they received assistance with common tasks; whether they needed the assistance or were following long-term family roles; and whether they received less assistance than needed for independently performed tasks. While male patients reported a high level of assistance and women a relatively low level, after adjustments were made the assessments of need did not differ greatly.

The Pennsylvania Cancer Registry was used to contact breast cancer patients and, through them, their adult sisters and daughters. The sisters and daughters were counseled concerning their higher than average risks for breast cancer and their need for mammography and breast self-examination. Results showed a 9 percent increase in mammography and a 10 percent increase in breast self-examination rates for the counseled over control group. Costs were $49 per counseled sister or daughter indicating a need to increase cost effectiveness before implementalion is practical. (Am J Public Health 1990; 81:386--388), To learn more about the effects of counseling first-degree relatives of breast cancer patients concerning their increased risk of having the disease, a cancer registry in Pennsylvania was used to identify breast cancer patients, and through them to reach female relatives. Sisters and daughters of patients who were diagnosed between June 1982 and June 1984 were contacted and counseled about their elevated risk and the importance of mammography and breast self-examination. The subjects (patients' sisters and daughters) were divided randomly into three groups to be counseled at different times during the study. Counseling sessions consisted of educational programs about breast cancer risks and the importance of mammography and breast self-examination. At the end of 21 months, subjects' knowledge and behavior concerning breast cancer were evaluated in telephone interviews. Those who had received counseling by this time (611 women) belonged to the experimental group; those who had not yet received it, to the control group (395). Results showed that the counseling program affected subjects' knowledge, attitudes and behavior, with the least impact on behavior. The experimental group had a 9 percent higher rate of undergoing mammography and a 10 percent higher rate of breast self-examination than the control group. It is noted that a significant proportion of physicians (29 percent) and patients (30 percent) refused to participate by providing names of patients or relatives, respectively. The cost of conducting the program was $49 per person counseled, which was not found to be cost-effective; improvements need to be made in this area. The use of a cancer registry for such purposes, however, seems feasible. (Consumer Summary produced by Reliance Medical Information, Inc.)

Five years after the Three Mile Island nuclear accident, the mental health of women who had been pregnant and living within 10 miles of Three Mile Island at the time of the accident was similar to that of women from the same area who became pregnant after the accident. Ratings of the development of the two groups of children when they were 5 years old were also similar. However, women who were pregnant during the crisis and had been extremely disturbed' about their pregnancies rated their children's health as poorer than did the women who were pregnant later. (Am J Public Health 1991; 81:384-386), Pregnant women, or those with young children, who lived near the Three Mile Island (TMI) nuclear facility experienced considerable psychological distress after the accident in 1980. A subsequent study indicated little biological consequences of the accident for the children, however. To evaluate the long-term psychological and physical effects of the TMI crisis, a random sample of people living within 10 miles of the facility were interviewed. Mothers and children (1,833 pairs) for whom birth occurred within 12 months after the accident made up the study group, while pairs (1,808) who gave birth 13 to 24 months after the accident formed the control group. Of interest were the number of physician visits, the children's developmental profiles, scores on tests suggesting emotional problems, maternal anxiety and depression, and mothers' impressions of their own and their children's health. Results showed a trend toward poorer status for the study group for all factors evaluated, but the only variable for which the study and control groups differed significantly was the study group mothers' more negative ratings of their children's health. Seven percent fewer mothers in this group than in the control group rated their children's health as ''excellent''. Mothers who rated their children's health as poorest were those who reported feeling the most disturbed shortly after the children's births. In general, the results show only small differences between the study and control groups, with perhaps the strongest effect found among those who were most disturbed. Follow-up studies will evaluate whether the children of these mothers were, in fact, in poorer health, or whether their mothers paid more attention to their health than the less disturbed parents. (Consumer Summary produced by Reliance Medical Information, Inc.)