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ABSTRACT: In the US, Hispanic women have a higher incidence of, and mortality from, cervical cancer than non-Hispanic white women. The reason for this disparity may be attributable to both low rates of screening and poor adherence to recommended diagnostic follow-up after an abnormal Pap test. The 'Cervical Cancer Screening and Adherence to Follow-up Among Hispanic Women' study is a collaboration between a research institution and community partners made up of members from community based organizations, the Yakima Valley Farm Workers Clinic and the Breast, Cervical, and Colon Health Program of the Yakima District . The study will assess the efficacy of two culturally-appropriate, tailored educational programs designed to increase cervical cancer screening among Hispanic women, based in the Yakima Valley, Washington, US.
A parallel randomized-controlled trial of 600 Hispanic women aged 21-64, who are non-compliant with Papanicolau (Pap) test screening guidelines. Participants will be randomized using block randomization to (1) a control arm (usual care); (2) a low-intensity information program, consisting of a Spanish-language video that educates women on the importance of cervical cancer screening; or (3) a high-intensity program consisting of the video plus a 'promotora' or lay-community health educator-led, home based intervention to encourage cervical cancer screening. Participants who attend cervical cancer screening, and receive a diagnosis of an abnormal Pap test will be assigned to a patient navigator who will provide support and information to promote adherence to follow-up tests, and any necessary surgery or treatment. Primary endpoint: Participants will be tracked via medical record review at community-based clinics, to identify women who have had a Pap test within 7 months of baseline assessment. Medical record reviewers will be blinded to randomization arm. Secondary endpoint: An evaluation of the patient navigator program as a method to improve adherence and reduce time to follow-up among participants who receive an abnormal Pap test result. An additional secondary endpoint is the cost-effectiveness of the two different intensity intervention programs.
This culturally sensitive intervention aims to increase compliance and adherence to cervical screening in a Hispanic population. If effective, such interventions may reduce incidence of cervical cancer.
NCT01525433.
BMC Cancer 05/2012; 12:170. · 3.01 Impact Factor
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ABSTRACT: Low-glycemic load (GL) diets improve insulin resistance and glucose homeostasis in individuals with diabetes. Less is known about whether low-GL diets, independent of weight loss, improve the health profile for persons without diabetes or other preexisting conditions. We conducted a randomized, cross-over feeding study testing low- compared to High-GL diets on biomarkers of inflammation and adiposity in healthy adults. Eighty participants (n = 40 with BMI 18.5-24.9 kg/m²; n = 40 with BMI 28.0-40.0 kg/m²) completed two 28-d feeding periods in random order where one period was a high-GL diet (mean GL/d = 250) and the other a low-GL diet (mean GL/d = 125). Diets were isocaloric with identical macronutrient content (as percent energy). All food was provided and participants maintained weight and usual physical activity. Height, weight, and DXA were measured at study entry and weight assessed again thrice per week. Blood was drawn from fasting participants at the beginning and end of each feeding period and serum concentrations of high-sensitivity CRP, serum amyloid A, IL-6, leptin, and adiponectin were measured. Linear mixed models tested the intervention effect on the biomarkers; models were adjusted for baseline biomarker concentrations, diet sequence, feeding period, age, sex, and body fat mass. Among participants with high-body fat mass (>32.0% for males and >25.0% for females), the low-GL diet reduced CRP (P = 0.02) and marginally increased adiponectin (P = 0.06). In conclusion, carbohydrate quality, independent of energy, is important. Dietary patterns emphasizing low-GL foods may improve the inflammatory and adipokine profiles of overweight and obese individuals.
Journal of Nutrition 12/2011; 142(2):369-74. · 3.92 Impact Factor
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ABSTRACT: Available data indicate that Asian Americans as a group have lower levels of physical activity than non-Latino whites. However, few studies have focused on physical activity among Asian American sub-groups. Our objectives were to describe levels of physical activity, as well as individual and environmental correlates of physical activity among Cambodian Americans. We conducted a telephone survey of Cambodians living in three geographic areas (Central California, Northern California, and the Pacific Northwest) during 2010. Physical activity levels were assessed using the International Physical Activity Questionnaire (IPAQ) short version. Survey items addressed demographic characteristics, knowledge about the health benefits of physical activity, social norms and supports with respect to physical activity, the availability of neighbourhood recreational facilities, and neighbourhood characteristics. Our study group included 222 individuals. Only 12% of the study group reported low levels of physical activity, 40% reported moderate levels, and 48% reported high levels. Physical activity was strongly associated with the availability of neighborhood recreational facilities such as parks, but not with neighborhood characteristics such as heavy traffic. Our results suggest that a majority of Cambodian Americans are adherent to current physical activity guidelines. Neighborhood recreational facilities that provide opportunities for leisure-time physical activity are associated with higher levels of physical activity in Cambodian communities. Future research should assess the reliability and validity of the IPAQ in a Cambodian American study group.
Journal of Community Health 12/2011; 37(5):1040-8. · 1.28 Impact Factor
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ABSTRACT: Breast cancer is the cancer with the highest incidence among women in Chile and in many Latin American countries. Breast cancer screening has very low compliance among Chilean women.
We compared the effects on mammography screening rates of standard care, of a low-intensity intervention based on mail contact, and of a high-intensity intervention based on mail plus telephone or personal contact. A random sample of 500 women with the age of 50 to 70 years registered at a community clinic in Santiago who had not had a mammogram in the past 2 years were randomly assigned to one of the three intervention groups. Six months after randomization, participants were re-evaluated for their compliance with mammography screening. The outcome was measured by self-report and by electronic clinical records. An intention to treat model was used to analyze the results.
Between 92% and 93% of participants completed the study. Based on electronic records, mammography screening rates increased significantly from 6% in the control group to 51.8% in the low-intensity group and 70.1% in the high-intensity group. About 14% of participants in each group received opportunistic advice, 100% of participants in the low- and high-intensity groups received the mail contact, and 50% in the high-intensity group received a telephone or personal contact.
A primary care intervention based on mail or brief personal contact could significantly improve mammogram screening rates.
A relatively simple intervention could have a strong impact in breast cancer prevention in underserved communities.
Cancer Epidemiology Biomarkers & Prevention 09/2010; 19(9):2254-61. · 4.12 Impact Factor
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ABSTRACT: Breast cancer is the leading cause of cancer among women in Chile and in many Latin American countries. Breast cancer screening is an effective strategy to reduce mortality, but it has a very low compliance among Chilean women.
To understand barriers and facilitators for breast cancer screening in a group of Chilean women aged 50-70.
Following the Predisposing, Enabling and Reinforcing (PRECEDE) framework, seven focus groups (N = 48 women) were conducted with women that have had diverse experiences with breast cancer and screening practices. Information was collected using field notes and audio and video recording. Following the grounded theory model, a sequential process of open, axial and selective coding was used for the information analysis. Atlas ti 5.5 software was used for coding and segmenting the data obtained from the interviews.
The presence of symptoms and/or the finding of lumps through breast self-examination (BSE) were the main predisposing factors for getting a mammogram. Secrecy, embarrassment and fatalism about breast cancer were significant cultural factors that influenced the decision to seek mammogram screening. Confidence in medical staff and dignity in the treatment at the clinic were important enabling factors. The main reinforcing factors for getting the test were a sense of fulfilment by doing something good for themselves and getting timely information about the results.
Primary health care providers should use culturally appropriate strategies to better inform women about the importance of mammography screening and the limitations of BSE for preventing advanced breast cancer.
Family Practice 11/2009; 27(1):85-92. · 1.50 Impact Factor
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ABSTRACT: To evaluate the effectiveness of a community intervention in promoting adoption of behaviors to reduce the take-home pathway of pesticide exposure in farmworker households.
Using two cross-sectional samples of farmworker households in 11 intervention and 12 comparison communities in Washington State, we examined whether differences over time in reported pesticide safety practices varied by community intervention status.
Pesticide safety practices increased in both intervention and comparison communities over time. Changes were significantly greater in intervention communities for removing work shoes before entering the home (P = 0.003) and marginally significantly greater for changing out of work clothes within 1 hour of arriving home (P = 0.05).
The intervention was associated with modest effects in certain behaviors among farmworkers. Further research is needed to identify successful strategies for reducing the take-home pathway of pesticide exposure.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 08/2009; 51(8):922-33. · 1.88 Impact Factor
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ABSTRACT: OBJECTIVE:: We examined the effectiveness of a community randomized intervention among farmworkers who did and did not work in pome fruit (apples and pears). METHODS:: Urine samples were collected from two cross-sectional groups of farmworkers and analyzed for the presence of dimethylthiophosphate. RESULTS:: There was no significant time by crop interaction for changes in urinary metabolite concentrations among adult farmworkers (P = 0.79 pome fruit workers; P = 0.83 non-pome fruit workers) or their children (P = 0.25 children of pome fruit workers; P = 0.91 children of non-pome fruit workers). We found greater urinary metabolite concentrations of dimethylthiophosphate among pome fruit workers (compared with non-pome fruit workers) and among workers at final data collection (compared with baseline). CONCLUSION:: Further research is needed to identify effective interventions to reduce pesticide exposure in farmworkers and their children.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 04/2009; · 1.88 Impact Factor
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ABSTRACT: The evaluation for Celebremos La Salud, a community randomized trial of Hispanic cancer prevention found no differences in mammography screening rates between intervention and control communities. The goal of the present study was to determine reasons for the intervention's lack of effectiveness. In the first aim, we assessed reach of the intervention. In the second, we assessed which intervention activities were associated with mammography use. In the third, we examined whether factors related to health care access, education level, or age modified the effect of the intervention. Data were used from a post-intervention survey of 20 rural communities in Washington State. Hispanic (N = 202) and non-Hispanic White (N = 389) women, over age 40 formed the sample. Reporting having awareness of or having participated in intervention activities was positively associated with Hispanic ethnicity and intervention group and negatively associated with lack of health insurance and having a lower education level. Only one intervention activity was associated with screening use. Having participated in presentations at organizations was positively associated with having had a mammogram in the previous 2 years for Hispanic women. No individual level modifiers influenced the intervention's effectiveness. Heavily targeting the intervention to Hispanic women and not reaching as many White women may have contributed to the lack of intervention effect. Increasing mammography screening rates among women living in a rural area may require improved access to health care and reaching women with lower education levels and lack of health insurance.
Journal of Community Health 10/2008; 34(1):47-55. · 1.28 Impact Factor
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ABSTRACT: Chinese immigrants to North America have substantially higher rates of chronic hepatitis B infection than the general population. One area for strategic development in the field of health education is the design and evaluation of English-as-a-Second language (ESL) curricula. The theoretical perspective of the Health Behavior Framework, results from a community-based survey of Chinese Canadian immigrants with limited English proficiency, and findings from focus groups of ESL instructors as well as Chinese ESL students were used to develop a hepatitis B ESL educational module. This research was conducted in Vancouver, BC. Survey data showed that less than three-fifths of the respondents had been tested for hepatitis B, and documented some important hepatitis B knowledge deficits. Further, only about one-quarter had ever received a physician recommendation for hepatitis B serologic testing. The ESL curriculum aims to both promote hepatitis B testing and improve knowledge, and includes seven different ESL exercises: Warm-up, vocabulary cards, information-gap, video, jigsaw, guided discussion, and problem/advice cards. Our quantitative and qualitative methods for curriculum development could be replicated for other health education topics and in other limited English speaking populations.
Journal of Community Health 09/2008; 33(4):217-24. · 1.28 Impact Factor
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ABSTRACT: Regular physical activity reduces the risk of many chronic conditions. Multiple studies have shown that Asians in North America engage in less physical activity than the general population. One area for strategic development in the area of health education is the design and evaluation of English as a second language (ESL) curricula. The PRECEDE model and findings from focus groups were used to develop a physical activity ESL curriculum for Chinese immigrants. In general, focus group participants recognized that physical activity contributes to physical and mental wellbeing. However, the benefits of physical activity were most commonly described in terms of improved blood circulation, immune responses, digestion, and reflexes. The importance of peer pressure and the encouragement of friends in adhering to regular physical activity regimens were mentioned frequently. Reported barriers to regular physical activity included lack of time, weather conditions, and financial costs. The ESL curriculum aims to both promote physical activity and improve knowledge, and includes seven different ESL exercises. Our curriculum development methods could be replicated for other health education topics and in other limited English-speaking populations.
Journal of Immigrant and Minority Health 09/2008; 10(4):379-87. · 1.16 Impact Factor
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ABSTRACT: This study was undertaken to assess workplace hazards and protective practices among Hispanic men and women working post-harvest in asparagus, apple and pear packaging warehouses.
Three focus groups were conducted in July 2003 with 25 workers (20 women, 5 men) recruited from communities in the Yakima Valley, Washington. Focus group content informed the design of an in-person structured interview administered to 50 additional warehouse workers from August to November 2006.
Focus group participants reported difficult working conditions, exposure to chemicals, adverse health effects and use of work and home protective practices to minimize exposures for themselves and their families. Structured interview participants reported few workplace exposures to chemicals although many reported engaging in workplace and home protective practices.
Findings from this research can direct initial efforts to determine if and how interventions for warehouse workers may be designed to protect against hazardous workplace exposures.
Journal of Immigrant and Minority Health 07/2008; 11(2):122-30. · 1.16 Impact Factor
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ABSTRACT: Chilean women have the highest smoking rates in Latin America. Prevalence in this population is about 40%. There are no national programs for smoking cessation at the primary care level. This study explores the feasibility and effectiveness of a brief counseling intervention targeted to women smokers of childbearing age who seek primary care in Santiago, Chile. A quasi-experimental design was used to compare the effect of an intervention based on the '5A' model developed by the National Cancer Institute in the United States and the standard care provided in two control clinics. Women smokers seeking care at the three primary care clinics were contacted during a 2 months period and offer to participate in the study. Sampling was stratified according to the age groups to ensure comparability between cohorts. Quotas were calculated for each age group. Participants were asked about their willingness to quit, self-efficacy, smoking behavior, addiction level as well as support received for smoking cessation. After 18 months of intervention all women were re-evaluated. A total of 773 women were recruited for the study; 76% of them completed the trial. Women smokers are characterized by a large percentage of light smokers with a low self-efficacy for quitting and with very low information on where and how to get assistance to quit. At study end, 15.2% of women reported quitting smoking at least for 1 month in the intervention clinic versus 7.8% in one of the control clinics (p < 0.05) and 14.6% in the second control clinic (p = NS). Over 70% of women in the intervention clinic were asked, assessed and received advice for quitting in comparison with <15% in the control clinics (p < 0.01). To conclude, a primary care intervention based on the '5A' model for smoking cessation is feasible and can have a significant effect in reducing smoking prevalence in this population.
Health Promotion International 04/2008; 23(3):240-50. · 1.94 Impact Factor
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ABSTRACT: Environmental measures of food availability are surrogates of consumption. Such measures may be useful among populations for whom standard dietary assessment is difficult. The objective of this cross-sectional study was to test whether a measure of the household dietary environment would perform as well as or better than a standard fruit and vegetable assessment among ethnically diverse rural women. Participants were 154 non-Hispanic white, 157 Hispanic, and 102 Native American adult women residing in rural Washington state. Participants completed an interviewer-administered household inventory of fruits and vegetables and a standard measure of fruit and vegetable intake used in the 5 A Day for Better Health Program. Pearson correlation coefficients assessed the validity of the measures against biomarkers of fruit and vegetable consumption (serum carotenoids). Pearson correlations were poor to modest between the household inventory and serum carotenoids (r=0.06 to 0.22) and between the 5 A Day responses and serum carotenoids (r=-0.08 to 0.17). There were no differences by ethnic group; both short tools performed poorly compared with the biomarkers across Hispanic, non-Hispanic white, and Native-American participants. In conclusion, both the household inventory and the popular 5 A Day measure were poor indicators of fruit and vegetable intake in this sample of ethnically diverse rural women.
Journal of the American Dietetic Association 05/2007; 107(4):672-7. · 3.59 Impact Factor
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ABSTRACT: College is an important transition period during which young adults explore tobacco use. Few large-scale studies have been conducted among college students regarding tobacco use. We initiated a study examining tobacco use in 30 colleges and universities in the Pacific Northwest. We conducted a baseline survey among students. Sample size varied by the school size; for the 14 largest schools, we drew a random sample of all students, oversampling freshmen (n approximately 750) so that we could recruit and follow a cohort to assess smoking onset during the college years. Of the remaining students, we sampled equivalent numbers of sophomores, juniors, and seniors (n = 200 each). For the 16 schools with fewer than 1,350 students, we surveyed all students. We found overall smoking rates of 17.2%. Males (18.6%) were more likely to smoke than females (16.6%; p = .03), and public college students were more likely to smoke (20.5%) than those who attended private independent schools (18.9%; p = .61), whose rates were higher than those of private religious schools (11.6%; p = .001). Overall, college students are light smokers who do not smoke every day of the month. Further, they tend not to be highly dependent on tobacco, do not consider themselves regular smokers, and plan to quit before they graduate (56.8%). School type should be considered when estimating smoking rates among 4-year college students. Data indicate that college smokers wish and plan to quit before graduation, suggesting that efforts to assist smokers in quitting during the college years may be fruitful.
Nicotine & Tobacco Research 04/2007; 9(3):429-38. · 2.58 Impact Factor
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ABSTRACT: Compared to non-Hispanic whites, Hispanics in the United States are at higher risk for certain types of cancer.
In a randomized controlled trial of 20 communities, we examined whether a comprehensive intervention influenced cancer screening behaviors and lifestyle practices in rural communities in Eastern Washington State. Cross-sectional surveys at baseline and post-intervention included interviews with a random sample of approximately 100 households per community. The interview included questions on ever use and recent use of Pap test, mammogram, and fecal occult blood test (FOBT) and sigmoidoscopy/colonoscopy, fruit and vegetable consumption and smoking practices.
We found few significant changes in use of screening services for cervical (Pap test), breast (mammogram) or colorectal cancer (fecal occult blood test (FOBT) or sigmoidoscopy/colonoscopy) between intervention and control communities. We found no significant differences in fruit and vegetable consumption nor in smoking prevalence between the two groups. We found more awareness of and participation in intervention activities in the treatment communities than the control communities.
Our null findings might be attributable to the low dose of the intervention, a cohort effect, or contamination of the effect in non-intervention communities. Further research to identify effective strategies to improve cancer prevention lifestyle behaviors and screening practices are needed.
Cancer Causes and Control 07/2006; 17(5):733-46. · 2.88 Impact Factor
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ABSTRACT: Chile has one of the highest prevalence rate of smoking in the world. Brief counseling interventions for smoking cessation at the primary health care level are effective. Compliance with counseling intervention is strongly associated with beliefs and attitudes of the primary health care team that deliver it. The effectiveness of these interventions improve if they are applied to smoking populations with higher motivation of change and high self-efficacy for quitting.
To study the smoking profile of a group of smoking women in Santiago and to identify beliefs and attitudes of the primary health care team members to implement smoking cessation interventions.
A cross-sectional design that included 306 women smokers attending two primary health care clinics in Santiago. Perceptions, beliefs and attitudes of 34 primary care team members from three clinics in Santiago were explored using a qualitative methodology.
The study identified a subgroup of 18% of women highly motivated to quit (decisional stage of change) and a 58% with a high self-efficacy. Beliefs and attitudes of staff at the clinics were characterized by invisibility, ambivalence and fatalism regarding the effectiveness of smoking cessation interventions.
There is a subgroup of smoking women with a high probability of quitting if they receive an appropriate counseling. Developing a systematic approach for smoking cessation intervention at the primary care setting in Chile should consider the invisibility, ambivalence and fatalism of primary health care team members towards this topic.
Revista medica de Chile 07/2006; 134(6):726-34. · 0.33 Impact Factor
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Barbara A Israel,
Edith A Parker,
Zachary Rowe,
Alicia Salvatore,
Meredith Minkler,
Jesús López,
Arlene Butz,
Adrian Mosley,
Lucretia Coates,
George Lambert,
Paul A Potito,
Barbara Brenner,
Maribel Rivera,
Harry Romero,
Beti Thompson, Gloria Coronado,
Sandy Halstead
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ABSTRACT: Over the past several decades there has been growing evidence of the increase in incidence rates, morbidity, and mortality for a number of health problems experienced by children. The causation and aggravation of these problems are complex and multifactorial. The burden of these health problems and environmental exposures is borne disproportionately by children from low-income communities and communities of color. Researchers and funding institutions have called for increased attention to the complex issues that affect the health of children living in marginalized communities--and communities more broadly--and have suggested greater community involvement in processes that shape research and intervention approaches, for example, through community-based participatory research (CBPR) partnerships among academic, health services, public health, and community-based organizations. Centers for Children's Environmental Health and Disease Prevention Research (Children's Centers) funded by the National Institute of Environmental Health Sciences and U.S. Environmental Protection Agency were required to include a CBPR project. The purpose of this article is to provide a definition and set of CBPR principles, to describe the rationale for and major benefits of using this approach, to draw on the experiences of six of the Children's Centers in using CBPR, and to provide lessons learned and recommendations for how to successfully establish and maintain CBPR partnerships aimed at enhancing our understanding and addressing the multiple determinants of children's health.
Environmental Health Perspectives 11/2005; 113(10):1463-71. · 7.04 Impact Factor
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ABSTRACT: Colorectal carcinoma ranks as the second most common cancer and the second leading cause of cancer death in the United States. Hispanics are less likely than their non-Hispanic white counterparts to have ever received a fecal occult blood test (FOBT) or sigmoidoscopy/colonoscopy. Little is known about the barriers to screening in the Hispanic population.
The authors used baseline data from a community randomized trial of cancer prevention to compare screening prevalence and the associations between reported barriers and screening participation between Hispanics (n = 137) and non-Hispanic whites (n = 491) age > or = 50 years.
Hispanics were less likely than non-Hispanic whites to have ever received an FOBT (P = 0.003) or sigmoidoscopy/colonoscopy (P = 0.001). No significant difference across ethnic groups was observed in the prevalence of recent screening using FOBT (29.8% for Hispanics vs. 34.5% for non-Hispanic whites; P = 0.41), but recent use of sigmoidoscopy/colonoscopy was lower for Hispanics (24.1% for Hispanics vs. 33.7% for non-Hispanic whites; P 0.06). Lacking health care coverage or having few years of education were directly associated with failure to ever receive an FOBT or sigmoidoscopy/colonoscopy.
Interventions to improve adherence to colorectal carcinoma screening recommendations among Hispanics should target initial screening examinations, particularly among those lacking health care coverage or having low levels of education.
Cancer 07/2005; 103(12):2491-8. · 4.77 Impact Factor
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ABSTRACT: Regular physical activity is associated with a reduced risk of all-cause mortality, and mortality due to cardiovascular disease and cancer. Among adolescents, physical activity is associated with benefits in the prevention and control of emotional distress, and improvement of self-esteem. Countries in transitional epidemiological scenarios, such as Chile, need to develop effective strategies to improve physical activity as a way to face the epidemic of chronic diseases. The objective of this study was to evaluate the effects of a school-based physical activity program on physical fitness and mental health status of adolescents living in a low socioeconomic status area in Santiago, Chile. A quasi-experimental design was used to evaluate the effects of the program over one academic year. The study included 198 students aged 15 years old. Two ninth grade classes were randomly selected as the intervention group, with two classes of the same grade as controls. A social planning approach was used to develop the intervention. The program was designed and implemented based on student preferences, teachers' expertise and local resources. Changes in physiological and mental health status were assessed. After the intervention, maximum oxygen capacity achieved a significant increase of 8.5% in the intervention versus 1.8% in the control group (p < 0.0001). Speed and jump performance scores improved significantly more in the intervention versus the control group (p > 0.01). Anxiety score decreased 13.7% in the intervention group versus 2.8% in the control group (p < 0.01), and self-esteem score increased 2.3% in the intervention group and decreased 0.1% in the control group after the end of the program (p < 0.0001). No significant change was observed in the depressive score. Student participation and compliance with the program was > 80%. To conclude, a school-based program to improve physical activity in adolescents of low socioeconomic status, obtained a high level of participation and achieved significant benefits in terms of physical fitness and mental health status.
Health Promotion International 06/2005; 20(2):113-22. · 1.94 Impact Factor
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ABSTRACT: Community intervention trials continue to attract researchers as potential ways to achieve widespread, long-term change in health behaviors. The first generations of community studies were somewhat unsophisticated in design and analysis, and their promise may have been overstated. As design and analysis issues were better defined, as secular trends caught up with the behaviors that researchers were trying to change, or as other unknown variables affected community studies, small effects of interventions were observed in community trials. Discussions were held in professional meetings and reported in the literature: Should community trials be discontinued? In general, the answer was a qualified no. In this paper, we briefly review some of the many advances made in community intervention trials, and address in more detail the challenges ahead.
Annual Review of Public Health 02/2003; 24:315-40. · 5.45 Impact Factor
