Characterisation of spatial variability in water quality in the Great Barrier Reef catchments using multivariate statistical analysis

Water quality monitoring is important to assess changes in inland and coastal water quality. The focus of this study was to improve understanding of the spatial component of spatial-temporal water quality dynamics, particularly the spatial variability in water quality and the association between this spatial variability and catchment characteristics. A dataset of nine water quality constituents collected from 32 monitoring sites over a 11-year period (2006-2016), across the Great Barrier Reef catchments (Queensland, Australia), were evaluated by multivariate techniques. Two clusters were identified, which were strongly associated with catchment characteristics. A two-step Principal Component Analysis/Factor Analysis revealed four groupings of constituents with similar spatial pattern and allowed the key catchment characteristics affecting water quality to be determined. These findings provide a more nuanced view of spatial variations in water quality compared with previous understanding and an improved basis for water quality management to protect nearshore marine ecosystem.

Cost minimisation using clinic-based treatment for common hand conditions--a prospective economic analysis

INTRODUCTION

The purpose of this study was to compare the cost of treatment of Dupuytren's disease, ganglia and trigger digits in the out-patient department with the operating theatre.

PATIENTS AND METHODS

All patients seen in a new patient hand clinic with a diagnosis of Dupuytren's disease, trigger digit or ganglion of the wrist or hand requiring treatment were prospectively identified over a 6-month period. The numbers undergoing a procedure in the out-patient clinic or theatre were recorded. Costings of theatre time and out-patient time, as well as national tariff income, were obtained from the hospital management.

RESULTS

Over the 6-month period, 80, 26, and 52 patients were treated with regard to Dupuytren's disease, ganglia and trigger digits, respectively. Of these, 37, 23, and 44 were treated by an out-patient procedure, and 43, 3 and 8 underwent a formal operation. The total cost of the out-patient procedures was calculated at pound 1560 over 6 months. To perform these as formal operations would have cost pound 64,896. The cost savings were, therefore, pound 63,336, or pound 126,672 per annum.

CONCLUSIONS

Out-patient interventions for Dupuytren's disease, ganglia and trigger digits result in significant cost savings over formal surgical treatment.

Foramen ovale recordings: a presurgical investigation in epilepsy

The aim of our study was to determine when foramen ovale recordings add useful information to scalp EEG recordings and magnetic resonance imaging (MRI) with hippocampal measurements. We evaluated the outcome of 79 patients with non-lesional partial epilepsy with presumed temporal seizure onset. Ictal foramen ovale recordings were performed in 16 patients with normal MRI ('MRI-negative group') and 41 patients with lateralizing MRI but non-lateralizing scalp EEG ('discordant group'). 22 patients with concordant MRI and scalp EEG were not investigated with foramen ovale recordings ('concordant group'). The seizure-free rate was higher in concordant than discordant patients despite additional investigation with foramen ovale electrodes (71 and 55% seizure free, respectively). No useful localizing information was added with foramen ovale recordings in MRI-negative patients.

Prevention of generalized reactions to contrast media: a consensus report and guidelines

The aim of this study was to document, using consensus methodology, current practice for prevention of generalized reactions to contrast media, to identify areas where there is disagreement or confusion and to draw up guidelines for reducing the risk of generalized contrast media reactions based on the survey and a review of the literature. A document with 165 questions was mailed to 202 members of the European Society of Urogenital Radiology. The questions covered risk factors and prophylactic measures for generalized contrast media reactions. Sixty-eight members (34%) responded. The majority indicated that a history of moderate and severe reaction(s) to contrast media and asthma are important risk factors. The survey also indicated that patients with risk factors should receive non-ionic contrast media. In patients at high risk of reaction, if the examination is deemed absolutely necessary, a resuscitation team should be available at the time of the procedure. The majority (91%) used corticosteroid prophylaxis given at least 11 h before contrast medium to patients at increased risk of reaction. The frequency of the dosage varied from one to three times. Fifty-five percent also use antihistamine Hl, mainly administered orally and once. Antihistamine H2 and ephedrine are rarely used. All essential drugs are available on the emergency resuscitation trolley. Patients with risk factors are observed up to 30 min by 48% and up to 60 min by 43% of the responders. Prophylactic measures are not taken before extravascular use of contrast media. Prophylactic drugs are given to patients with a history of moderate or severe generalized reaction to contrast media. In patients with asthma, opinion is divided with only half of the responders giving prophylactic drugs. Aspirin, beta-blockers, interleukin-2 and non-steroid anti-inflammatory drugs are not considered risk factors and therefore are not stopped before injection of contrast media. The survey showed some variability in rating of risk factors for generalized contrast medium reactions, and marked variability in the prophylactic measures used. There remain major areas of uncertainty, and there is insufficient data in the literature to guide practice. Some simple guidelines for prophylaxis of generalized contrast medium reactions are proposed.

Testicular microlithiasis: is it a benign condition with malignant potential?

OBJECTIVE

To review the findings of testicular ultrasonography (US) in patients referred for testicular symptoms including pain, swelling and infertility, and to determine the prevalence of testicular microlithiasis (TM) and ist relevance to the development of testicular cancer.

METHODS

Records of 3,026 patients referred for testicular US between 1994 and 1999 were evaluated. The indications for testicular US diagnosis, management and relevant histological details were obtained from medical records. Patients with TM had an annual sonographic follow-up unless they had testicular cancer, in which case follow-up repeat US with clinical reviews was more frequent.

RESULTS

TM was found in 54 patients (1.77%; median age 34 years, range 12-83 years). The median follow-up was 36 months (range 12-18 months). Sixteen of these patients had testicular malignancy (30%). The remaining 38 patients had hydrocele and epididymal cysts (14), varicocele (7), epididymitis (2) and small testes (8), with 14 patients having no other pathology. One patient with a small testis developed a seminoma while under surveillance. Another patient with metastatic embryonal-cell carcinoma at initial diagnosis was found to have a seminoma 4 years following chemotherapy. The relative risk of testicular tumours in the presence of TM was 13.2 (confidence interval 8.3-21.5).

CONCLUSION

TM can no longer be regarded simply as a benign condition because of its association with testicular malignancy. In our series, 2 patients (5.2%) developed interval testicular cancers during follow-up US. There is no convincing evidence to suggest that TM might be premalignant. In rare instances of radiologically indeterminate cases, biopsy of the testis may be necessary.

Contribution of dihydrocodeine and dihydromorphine to analgesia following dihydrocodeine administration in man: a PK-PD modelling analysis

AIMS

It is not clear whether the analgesic effect following dihydrocodeine (DHC) administration is due to either DHC itself or its metabolite, dihydromorphine (DHM). We examined the relative contribution of DHC and DHM to analgesia following DHC administration in a group of healthy volunteers using a PK-PD link modelling approach.

METHODS

A single oral dose of DHC (90 mg) was administered to 10 healthy volunteers in a randomised, double-blind, placebo-controlled study. A computerized cold pressor test (CPT) was used to measure analgesia. On each study day, the volunteers performed the CPT before study medication and at 1.25, 2.75, 4.25 and 5.75 h postdose. Blood samples were taken at 0.25 h (predose) and then at half hourly intervals for 5.75 h postdose. PK-PD link modelling was used to describe the relationships between DHC, DHM and analgesic effect.

RESULTS

Mean pain AUCs following DHC administration were significantly different to those following placebo administration (P = 0.001). Mean pain AUC changes were 91 score x s(-1) for DHC and -17 score x s(-1) for placebo (95% CI = +/- 36.5 for both treatments). The assumption of a simple linear relationship between DHC concentration and effect provided a significantly better fit than the model containing DHM as the active moiety (AIC = 4.431 vs 4.668, respectively). The more complex models did not improve the likelihood of model fits significantly.

CONCLUSIONS

The findings suggest that the analgesic effect following DHC ingestion is mainly attributed to the parent drug rather than its DHM metabolite. It can thus be inferred that polymorphic differences in DHC metabolism to DHM have little or no effect on the analgesic affect.

The OMENS trial: opportunistic evaluation of musculo-skeletal physician care among orthopaedic outpatients unlikely to require surgery

STUDY OBJECTIVE

For orthopaedic outpatients judged as unlikely to require surgery, how does the cost-effectiveness of treatment from a musculo-skeletal medicine physician compare with that of a conventional orthopaedic surgeon-led service?

DESIGN

Partially randomised, pragmatic trial comparing management from a single musculo-skeletal medicine physician with orthopaedic surgeon-led management, with the timing and nature of treatments at the discretion of individual clinicians. Main outcomes were: change in patient reported health (SF-36 and EuroQol), and marginal health service costs.

SETTING

Outpatient department of an Edinburgh orthopaedic hospital.

SUBJECTS

One thousand three hundred and twenty six people; aged over 18, referred to and later attending the outpatient department with a 'non-surgical' musculo-skeletal condition, who provided baseline information. Eight hundred and twenty nine were randomly allocated to management by either the musculo-skeletal medicine physician (medical group) or a conventional orthopaedic surgeon-led service (surgical group); 497 were assigned to the treatment groups according to their general practitioner's preference.

RESULTS

There are aspects of the study design concerning statistical power, potential selection bias and generalisability, which mean that any results must be treated with caution. Although there was no statistically significant difference in health gain between the randomly allocated groups (with similar findings in the non-randomised medical and surgical groups), the patient groups were heterogeneous and the confidence intervals did not rule out clinically important differences. The medical group received more outpatient treatment, 20% vs. 10% (difference 95% CI 5% to 15%) with a higher rate of physiotherapy referral, 45% vs. 30% (15%, 9% to 22%). The surgical group received more inpatient surgical care 6% vs. 17% (-11%, -15% to -7%). Mean healthcare costs in the medical group were 179 Pounds per patient compared with 287 Pounds in the surgical group (-108 Pounds, -25 Pounds to -191 Pounds).

CONCLUSIONS

Interpretation should take into account the practical difficulties and circumstances of the study. Although no differences in health gain were found between these two management policies for 'non-surgical' orthopaedic outpatients, the trial was less statistically powerful than planned and the confidence intervals included clinically important differences. Differences in treatment emphasis gave estimated costs savings to the Health Service of 108 Pounds per patient treated by the musculo-skeletal medicine service.

Quantitative magnetic resonance imaging in consecutive patients evaluated for surgical treatment of temporal lobe epilepsy

We present the results of quantitative Magnetic Resonance Imaging (MRI) in 55 consecutively referred patients with clinical evidence of temporal lobe epilepsy (TLE). The Cavalieri method was used in combination with point counting to provide unbiased estimates of the volume of the left and right hippocampus, amygdala, temporal lobe, lateral ventricles and cerebral hemisphere, and pixel by pixel maps of the T2 relaxation time were computed for both central and anterior sections of the hippocampus. The 99th centiles of hippocampal volume, hippocampal volume asymmetry and T2 relaxation times in 20 control subjects provided limits which identified the presence of MTS. The results of the quantitative MRI were compared with the results of conventional diagnostic MRI, foramen ovale (FO) recording and the WADA test. Thirty-one patients were found to have unilateral MTS (17 left and 14 right) and 7 bilateral MTS. No evidence of MTS was detected in 16 patients. Of the 31 patients diagnosed with unilateral MTS on the basis of hippocampal volume and T2 measurement, 74% and 77% would respectively have received the same diagnosis on the basis of hippocampal volume and T2 measurements alone. In comparison to FO recording, quantitative MRI has a sensitivity of 55% and a specificity of 86%, while conventional diagnostic MRI has a sensitivity of 42% and a specificity of 80% for detection of MTS. Unilateral abnormalities were detected by FO recording in 30% cent of patients who appeared normal on quantitative MRI. WADA test results were available for 40 patients. The findings were consistent with quantitative MRI showing reduced memory function ipsilateral to unilateral MTS in 18 patients, but reduced memory function contralateral to unilateral MTS in two patients, and reduced memory function without MR abnormality in seven patients. WADA testing revealed unilateral memory impairments where MRI found bilateral pathology in 4 patients and in 4 patients in whom quantitative MRI detected unilateral MTS there was no evidence of reduced memory during WADA testing of the corresponding cerebral hemisphere. In the patients with unilateral right MTS a highly significant negative correlation (p = 0.0003) was observed between age of onset and the volume of the contralateral temporal lobe. Quantitative MR imaging of the hippocampus (i.e. volume and T2 measurement) is preferable to conventional radiological reporting for providing objective evidence of the presence of MTS on which to base the referral of patients for surgery, and since it has associated morbidity FO recording is now only being used in selected patients. Furthermore, stereology provides a convenient method for estimating the volume of other brain structures, which is relevant to obtaining a better understanding of the effects of laterality and age of onset of TLE.

How common are polycystic ovaries and the polycystic ovarian syndrome in women with Cushing's syndrome?

OBJECTIVE

Women with Cushing's syndrome (CS) may present with menstrual irregularity and symptoms/signs of hyperandrogenism, a phenotype similar to that of the polycystic ovarian syndrome (PCOS); however, currently there are no data on the prevalence of either polycystic ovaries (PCO) and/or PCOS in patients with CS. The aim of this study was to investigate their presence among women of reproductive age presenting with CS by analysing clinical, endocrinological and ultrasonographic features.

DESIGN

Prospective study of all women within the reproductive age (range 18-40 years) who presented with CS between August 1994 and January 2000.

SUBJECTS AND METHODS

Thirteen women (median age 32 years, range 18-39 years) with CS were evaluated. The diagnosis of CS was based on the presence of appropriate clinical features and an elevated serum midnight cortisol with failure to suppress 0900 hours serum cortisol to less than 50 nmol/l following a formal low-dose dexamethasone suppression test (LDDST). All women had their clinical features relevant to possible hyperandrogenism, menstrual disorder and infertility recorded, and circulating gonadotrophins, oestradiol, androgens and SHBG levels measured; ovarian ultrasonography was performed during their initial assessment. Relevant MR/CT imaging of the pituitary and/or adrenal glands was performed.

RESULTS

Eleven women had ACTH-dependent CS [nine Cushing's disease (CD), one ectopic ACTH syndrome due to a bronchial carcinoid, one periodic CS of unknown origin); two patients had ACTH-independent CS (adrenal adenomas). All women with CS had at least one symptom/sign of hyperandrogenism (13 hirsutism, seven acne, five male-pattern alopecia). Nine women (70%) had menstrual disturbances (four oligomenorrhoea, four amenorrhoea, one polymenorrhoea) while four women (30%) had a normal menstrual pattern. Serum oestradiol levels for the group as a whole were similar to those observed in the early follicular phase of normally menstruating women; however, seven women had low oestradiol, LH and FSH levels suggestive of hypogonadotrophic hypogonadism. Serum androgen levels (testosterone, androstendione and DHEAS), even in the presence of symptoms/signs of hyperandrogenism, were within the normal reference range but SHBG levels were uniformly decreased even in women with normal menstrual cycles. There was a negative correlation between urinary free cortisol, but not mean serum cortisol, and serum oestradiol, testosterone and SHBG levels (r = - 0.8, r = - 0.86 and r = - 0.66, P<0.02, P<0.01 and P<0.05, respectively), but not LH or FSH levels. Despite the fact that seven of these 13 patients lacked normal gonadotrophin stimulation, ovarian volumes of both ovaries were relatively preserved: right 7.3 ml, range 2.8-12.8 ml, and left 5.3 ml, range 2.3-13 ml. Women who were defined as oestrogen sufficient (E2 > 140 pmol/l) had higher serum androstenedione, and lower urinary free cortisol levels, than women who were oestrogen deficient (E2 < 140 pmol/l). Six of the 13 women (46%) had ovarian morphology suggestive of PCO, four of six oestrogen sufficient women and two of seven oestrogen deficient women. The results did not differ according to the underlying cause of CS.

CONCLUSIONS

PCO and PCOS are common in women with Cushing's syndrome; women with Cushing's syndrome and only moderately elevated cortisol secretion maintain gonadotrophin stimulation to the ovary with normal oestradiol levels, in contrast to women with Cushing's syndrome and higher cortisol secretion who develop hypogonadotrophic hypogonadism. However, even in the latter group, high ovarian volumes were maintained and some had ovarian morphology suggestive of PCO.

Rapid MRI assessment of renal space-occupying lesions

The aim of this study was to determine whether rapidly acquired MRI sequences, taking less than 5 min imaging time, can accurately characterise renal masses. All patients found to have a renal space-occupying lesion on CT or asked to participate in a prospective study using rapidly acquired MRI. The MRI technique was performed on a GE Signa (General Electric, Milwaukee, Wis.) 1.5 T magnet using breath-hold coronal and axial T1 GRASS (fast spoiled gradient-recalled acquisition into steady state, FSPGR30/90) and axial T2 fast spin-echo sequences. The results were analysed by two radiologists unaware of the CT or ultrasound findings. The CT/US was independently viewed by a third radiologist. Lesions were characterised as simple cysts, indeterminate or solid. The MR and CT/US results were correlated and the sensitivity and specificity of MR for the characterisation of simple cysts and solid renal masses calculated. A total of 144 lesions (68 patients; 29 women 39 men, age range 32-78 years, average age 60 years) were studied: 111 simple cysts; 3 hyperdense cysts; 26 renal cell carcinomas; and 4 indeterminate lesions on CT/US. There was agreement between the CT/US and MRI in 82% of cases. All renal cell carcinomas were correctly characterised on MRI. Of simple cysts, 79% were correctly identified using this technique. Breath-hold MRI performed in less than 5 min can accurately characterise the majority of renal masses. It is 100% sensitive in the characterisation of renal carcinoma, and it correctly identified approximately 80% of simple cysts. If used at the time a renal mass is detected on MRI, it would reduce the need for further investigation of the majority of incidentally detected lesions which are simple cysts.

Feature and classifier fusion for 12-lead ECG classification

Two methodologies, feature and classifier fusion, for the problem of computerized 12-lead electrocardiogram classification, are investigated. Firstly, the entire classification problem is subdivided into a number of smaller bi-dimensional ones. By employing bi-group Neural Network classifiers, independent feature vectors for each diagnostic class are examined individually and the output from each classifier are fused together to produce one single result. Secondly, two classifiers, namely the aforementioned and a decision tree, are fused together through a novel approach of a Specificity Matrix. This methodology addresses the problem of unresolved conflict during fusion of classifiers and aims to exploit the merits of each classifier and suppress their weaknesses. 290 validated 12-lead electrocardiogram recordings, comprising six diagnostic classes, were used to train, validate and test both methodologies. The framework of bi-group classifiers enhanced the overall performance by 12.0% in comparison with conventional approaches. In the second instance, the fusion of the two classifiers produced a performance level of 81.3%; superior to either classifier in isolation. This approach offers a viable solution to the unresolved problem of conflict between classifiers during fusion and can be extended readily to accommodate any number of diagnostic classes and classifiers.

Novel techniques for field assessment of copper toxicity on fouling assemblages

Laboratory toxicity tests generally expose organisms to a constant concentration of a toxicant in a uniform environment. The two techniques outlined in this paper assess the impact of a model toxicant, copper, on marine fouling assemblages in the field. These techniques allow natural assemblages to develop under a regime of toxicant dosing. The experiments were conducted using both techniques over time frames ranging from 2 weeks to 6 months. Short term experiments using the techniques assess the effects of toxicant exposure on recruitment. The longer term experiments enabled detection of certain indirect impacts of pollution. These include effects due to competition for space and variations in the susceptibility of organisms with age. Over the course of the experiments, a range of responses to copper was observed for different taxa. Both techniques have the potential to be used for testing the impact of other toxicants. Approaches such as those described are necessary in order to understand how communities react to toxicants in real world situations.

Contrast-media-induced nephrotoxicity: a consensus report. Contrast Media Safety Committee, European Society of Urogenital Radiology (ESUR)

The purpose of this study was, using consensus methodology, to document current understanding of contrast media nephrotoxicity (CMN) and to identify areas where there is disagreement or confusion. To draw up guidelines for avoiding CMN based on the current understanding of the condition established by the survey. One hundred sixty-four statements were mailed to 148 members of the European Society of Urogenital Radiology (ESUR) and to 48 experts in the field of CMN. They were asked about the definition, clinical features, predisposing factors and pathophysiology of CMN and about prophylactic measures. The importance of the statements was rated on a scale from 1 to 10 (1 least important, 10 most important). Fifty-three members (38%) and 23 experts (48%) responded. Both groups considered that an increase in serum creatinine that peaks within 3-4 days and a decrease in creatinine clearance are the most important (rating > 7) features of CMN. Enzymuria was not considered important (rating < 6). Pre-existing renal insufficiency, diabetic nephropathy, dehydration, congestive heart failure, concurrent administration of nephrotoxic drugs and the dose and type of contrast media were considered to be risk factors. Reduction in renal perfusion and damage to tubular cells were considered the main factors in the pathophysiology of CMN (rating > 6). Hydration and the use of low osmolar contrast media were thought to minimize the incidence of CMN (rating > 6). The majority of the responders (84.6% of members and 95.5% of experts) believe that the incidence of CMN in patients with normal renal function is less than 5%. Of the members, 62.5%, and 35.3% of experts, believe that the incidence of CMN is 20-30% in the presence of risk factors. There was disagreement about the definition of CMN, the threshold dose of contrast media above which renal complications may develop, the safe period between repeat injections, the relevance of contrast media renal retention shown on CT and whether contrast media have long-term effects on renal function. The survey showed good understanding of CMN among those who answered the questionnaires, although areas of disagreement remain which require further research. Simple guidelines are proposed.

Intentions to use alcohol among fifth and sixth graders: the roles of social and stress/coping motives

This study of children in grades five and six assessed the relationship between social and stress/coping motives and students' intentions to drink in junior high school. Whereas the two motives were not seen as separate by fifth graders, they were differentiated by sixth graders, for whom they were associated--social motives more strongly than stress/coping motives--with intentions to use alcohol. Implications for the design and timing of prevention programs are considered.

Asymptomatic carotid arterial disease in young patients following neck radiation therapy for Hodgkin lymphoma

PURPOSE

To determine the prevalence and severity of asymptomatic carotid arterial disease in young patients following neck radiation therapy for Hodgkin lymphoma and to compare the prevalence of carotid arterial disease following radiation therapy alone with that following radiation therapy and chemotherapy.

MATERIALS AND METHODS

Forty-two survivors of childhood or early adult Hodgkin lymphoma aged 18-37 years who had undergone radiation therapy more than 5 years earlier underwent carotid arterial ultrasonography. Common carotid intima-media thickness was measured; carotid vessels were assessed for intima-media abnormalities. Results were compared with those from 33 control subjects.

RESULTS

Patients had a significantly greater number of abnormal scans than did control subjects (11 [26%] vs one [3%]; P < .01). Ten patients (24%) had intima-media abnormalities that did not cause significant stenosis; one patient had diffuse bilateral intima-media thickening (mean, 1.99 mm) with greater than 70% stenosis of both common carotid arteries. Intima-media thickness was significantly greater in patients (0.51 mm) than in control subjects (0.43 mm; P < .005). The number of abnormalities in patients with radiation therapy plus chemotherapy (six [19%] of 31 patients) did not differ significantly from the number in patients with only radiation therapy (five [45%] of 11 patients; P = .12); there was no significant difference between median intima-media thicknesses (0.50 mm vs 0.51 mm, P > .2).

CONCLUSION

Asymptomatic carotid arterial disease occurs frequently in young patients following neck radiation therapy for Hodgkin lymphoma. No difference in prevalence was shown between only radiation therapy and radiation therapy plus chemotherapy.

Breast cancer screening among ethnically diverse low-income women in a general hospital psychiatry clinic

Most low-income minority women do not obtain screening mammography on a regular basis. Compliance with recommended breast cancer screening guidelines may be even lower in women with psychiatric illnesses. We investigated compliance with breast cancer screening guidelines among 121 ethnically diverse low-income women recruited from a general hospital psychiatry clinic. Mammography and clinical breast examination (CBE) had been obtained in the previous year by 59% and 70% of the patients 40 years of age and older, respectively. Among patients 20 years of age and older, 42% reported monthly breast self-examination (BSE). Physician recommendation of mammography was the strongest predictor of having obtained both a mammogram and a CBE within the previous year. There was an inverse relationship between breast cancer knowledge and screening mammography. Patients who were Hispanic, more educated, more confident in performing BSE, and whose physicians recommended monthly BSE were more likely to perform BSE monthly. These results highlight the importance of physician recommendation of compliance with screening guidelines for early detection of breast cancer. Because psychiatric patients typically are treated by psychiatrists on a regular and frequent basis, psychiatrists are in a unique position not only to encourage cancer screening but also to monitor patient compliance with their recommendations.

Long-term effects of nasoalveolar molding on three-dimensional nasal shape in unilateral clefts

OBJECTIVE

This objective of this study was to determine the effect of presurgical nasoalveolar molding on long-term nasal shape in complete unilateral clefts.

DESIGN

The study was retrospective, and the subjects were chosen at random. Nasal casts of the subjects were scanned in three dimensions. Each nose was best fit to its mirror image, and a numerical asymmetry score was determined.

SETTING

All patients were treated at the Institute of Reconstructive Plastic Surgery, NYU Medical Center, New York, New York.

PATIENTS

The study subjects (n = 10) were selected from a group that had undergone presurgical nasal molding in conjunction with alveolar molding. The control subjects (n = 10) were selected from a group that had undergone presurgical alveolar molding alone.

INTERVENTIONS

All subjects underwent presurgical orthopedic treatment until the age of approximately 4 months at which time the primary surgery was performed.

MAIN OUTCOME MEASURE

The nasal shape following nasal molding should be more symmetrical than if molding had not been done.

RESULTS

The mean asymmetry index for the nasoalveolar molding group was 0.74, and the control group was 1.21. This difference was statistically significant (p < .05).

CONCLUSIONS

Presurgical nasoalveolar molding significantly increases the symmetry of the nose. The increase in symmetry is maintained long term into early childhood. The limitations of this study include (1) asymmetry alone is not an adequate shape result in most situations, (2) the children evaluated in this study were not fully grown, and (3) the control group was not age matched.

Psychological and behavioral factors associated with colorectal cancer screening among Ashkenazim

BACKGROUND

Psychological and behavioral factors related to annual colorectal cancer (CRC) screening were examined in a sample of Ashkenazi Jewish individuals. Identification of factors related to regular CRC screening in this population is important because of the possibility of a heightened incidence of CRC.

METHODS

Eligible participants were 171 Ashkenazi Jewish adults 40 years or older attending an educational program about breast cancer genetics. Compliance with recommended guidelines for digital rectal examination and fecal occult blood test in the past year were dependent measures. Demographic variables, family history of CRC, perceived risk, physician recommendation, and worry about cancer were independent measures.

RESULTS

Digital rectal examinations and fecal occult blood tests had been obtained in the past year by 46 and 31% of the participants, respectively. A logistic regression showed that physician recommendation was related significantly to obtaining digital rectal examinations. Physician recommendation and education were related significantly to obtaining fecal occult blood tests. Although participants with family histories of CRC perceived themselves as being at increased risk of developing CRC, and were more worried about developing colon cancer, they were no more likely to adhere to CRC screening guidelines than those without such histories.

CONCLUSIONS

Overall, compliance with recommended CRC screening was low even among high-risk individuals. Physicians play a key role in motivating people to comply with CRC screening. Physicians need to en courage all asymptomatic patients 50 years and older to be screened for CRC.

An intelligent framework for the classification of the 12-lead ECG

An intelligent framework has been proposed to classify an unknown 12-Lead electrocardiogram into one of a possible number of mutually exclusive and combined diagnostic classes. The framework segregates the classification problem into a number of bi-dimensional classification problems, requiring individual bi-group classifiers for each individual diagnostic class. The bi-group classifiers were generated employing Neural Networks (NN), combined with a combination framework containing an Evidential Reasoning framework to accommodate for any conflicting situations between the bi-group classifiers. A number of different feature selection techniques were investigated with the aim of generating the most appropriate input vector for the bi-group classifiers. It was found that by reducing the original input feature vector, the generalisation ability of the classifiers, when exposed to unseen data, was enhanced and subsequently this reduced the computational requirements of the network itself. The entire framework was compared with a conventional approach to NN classification and a rule based classification approach. The framework attained a significantly higher level of classification in comparison with the other methods; 80.0% compared with 66.7% for the rule based technique and 68.00% for the conventional neural approach.

Thyroid nodular disease after radiotherapy to the neck for childhood Hodgkin's disease

Patients who receive radiotherapy to the neck are at risk of developing thyroid dysfunction. This prospective study of patients whose treatment for Hodgkin's disease in childhood included radiotherapy to the neck aimed to investigate the incidence and natural history of thyroid dysfunction and the morphological changes of the gland demonstrated on ultrasound. Forty-seven patients were investigated by clinical examination, thyroid function tests and thyroid ultrasound. Only six patients had a clinically detectable abnormality, but 64% had abnormal thyroid function tests. All patients had an abnormal thyroid ultrasound scan and 42% had at least one focal abnormality. A significant association was found between the presence of a focal lesion on ultrasound and young age at radiotherapy, longer follow-up and the length of time that the thyroid-stimulating hormone (TSH) level had been elevated. During follow-up, 65% of patients not on thyroxine developed new focal abnormalities. The longest time interval between radiotherapy and an increase in TSH level was 94 months, and from radiotherapy to the appearance of a focal abnormality on thyroid ultrasound was over 18 years. Three patients were found to have a thyroid carcinoma. These findings indicate the importance of long-term follow-up for patients treated by neck irradiation for Hodgkin's disease in childhood.

Sex knowledge and sexual attitudes among medical and nursing students

OBJECTIVES

The aim of this study was to assess the relationship between background and sociodemographic variables, attitudes toward controversial aspects of human sexuality and sex knowledge among medical and nursing students.

METHOD

The study design was a questionnaire-based survey of medical and nursing students in Western Australia. Participants were first- through fifth-year medical students at the University of Western Australia and first- through third-year undergraduate nursing students at Edith Cowan University. Outcome measures were students' attitudes toward controversial aspects of human sexuality expressed on a five-point Likert scale and a modified version of the Kinsey Institute/Roper Organization National Sex Knowledge Test.

RESULTS

A significant relationship was found between certain background and sociodemographic variables, sexual attitudes and sex knowledge. The background variable most strongly related to both attitudes and knowledge was frequency of attendance at religious services of any religious denomination during the past month, with those attending three or more times more likely to express negative attitudes and have lower sex knowledge scores. Lower sex knowledge was related to negative attitudes toward gay/lesbian/bisexual behaviour, masturbation, premarital sex and contraception. Other important background and sociodemographic variables related to negative attitudes were: never having experienced sexual intercourse; right-wing political orientation; lower family income; gender and ethnicity.

CONCLUSIONS

Negative attitudes toward controversial aspects of human sexuality and lower sex knowledge scores among medical and nursing students can be predicted on the basis of background and sociodemographic variables. Education aimed at increasing sex knowledge and modifying negative attitudes may increase students' ability to function more effectively as sexual history takers and sex counsellors.

Psychological impact of receiving negative BRCA1 mutation test results in Ashkenazim

PURPOSE

Most DNA test results for breast/ovarian cancer susceptibility are negative. Because negative test results might be interpreted incorrectly and may have serious psychological and behavioral implications, determining the psychological impact of such results is important.

METHODS

A community-based sample of 289 Ashkenazim was tested for 185delAG. The 199 mutation-negatives provided data at baseline and follow-up. Increased risk participants included those who received negative test results but remained at increased risk because positive family and/or personal histories of breast or ovarian cancer made the results uninformative. Average risk meant those who tested negative and had negative family and personal histories of breast or ovarian cancer. Using a logistic regression analysis, both groups' psychological distress levels were compared at baseline and at 1 and 6 months after notification of DNA test results.

RESULTS

A logistic regression analysis showed significant but small differences in cancer-specific distress after 6 months between increased and average risk participants (P < 0.006). Increased risk participants reported more distress than average risk. General distress declined among all participants after 1 month. Although baseline and follow-up differences in cancer-specific distress obtained by the increased and average risk participants were statistically significant, none of the absolute levels observed reflected especially high degrees of stress.

CONCLUSIONS

Receipt of negative DNA test results does not have a deleterious psychological impact, whether results are informative or uninformative.

Computerised electrocardiology employing bi-group neural networks

A configuration of bi-group neural networks (BGNN) is proposed combined with an evidential reasoning framework to interpret 12-lead electrocardiograms for three mutually exclusive classes. A number of pre-processing feature selection techniques were investigated prior to application of the input feature vector to each individual BGNN. The network outputs were discounted within a belief interval of 1 based on their performance on test data prior to combination. It was found that the application of the feature selection techniques enhanced the individual performance of the BGNN, and subsequently enhanced the overall performance. The proposed framework was compared with conventional classification techniques of multi-output neural networks and linear multiple regression. The framework attained a higher level of classification in comparison with the other methods; 70.4% compared with 66.7% for both multi-output neural and statistical techniques.

Age-related differences in mammography use and in breast cancer knowledge, attitudes, and behaviors

BACKGROUND

This study examined age differences in breast cancer knowledge, attitudes, and early-detection behaviors in a multi-ethnic sample of economically disadvantaged women participating in a breast-cancer education outreach program.

METHODS

Age differences in breast cancer knowledge, perceptions of risk of breast cancer, barriers to mammography, recommendations of mammography by health professionals, health promotion behaviors, and mammography use and intention were investigated. The subjects were 139 women aged 30 or older who were categorized in one of three age groups: 30 to 39, 40 to 49, and 50 years old or older.

RESULTS

One fourth of the women between the ages of 30 and 39 reported both that they had had mammography in the past and that they intended to have it in the next year. Fifty percent of those in their forties reported mammography use at some time in the past, and 56% intended to obtain it in the coming year. Fifty percent of those 50 or older reported that they had had mammography in the past year. Women aged 40 or older were more likely than those in their thirties to report that their healthcare providers had encouraged them to get mammograms. No significant age differences were observed in breast cancer knowledge or perceptions of personal risk of breast cancer.

CONCLUSION

The fact that the three age groups were similar in their perceptions of personal risk of breast cancer suggests that older women may not be accurately assessing their risk and thus may be obtaining screening mammography at less-than-optimal levels.

Replication and extension of a risk profile for Amerasian youth

The relationship between number of risk factors and symptoms of anxiety and depression was examined in a cohort of Vietnamese Amerasians, replicating a study done with a previous cohort. One hundred forty seven subjects awaiting U.S. placement completed the Hopkins Symptom Checklist, the Vietnamese Depression Scale, and a questionnaire which included items found to be risk factors for psychological distress among Amerasians. Number of risk factors was linearly related to symptoms of both depression and anxiety. Results are consistent with previous findings of the relationship between risk factors and symptoms of psychological distress. The profile may be helpful in anticipating which refugees may be at risk for future psychological distress, and thus be useful in preventively allocating scarce treatment resources.

Comparative levels of psychological distress in a pre-migratory refugee population

OBJECTIVE

This study compares levels of psychological distress in a pre-migratory sample of Vietnamese Amerasians with those in a like-aged, non-migratory sample of Vietnamese living in Ho Chi Minh City, Vietnam.

METHOD

Subjects were assessed using two measures developed and validated for Vietnamese clinical populations in the United States: the Hopkins Symptom Checklist-25 and the Vietnamese Depression Scale.

RESULTS

Amerasians had significantly higher symptom levels on the depression scale of the Hopkins Symptom Checklist-25, but not on the other measures utilised.

CONCLUSIONS

Amerasians' higher levels of depressive symptoms are probably a result of their traumatic lives in Vietnam, but may also reflect acute situational factors or selection bias.

A prospective study of psychological distress related to refugee camp experience

OBJECTIVE

Previous reports have suggested a direct relationship between refugee camp experience and levels of psychological distress among refugees. Specifically, it has been postulated that refugee camps with harsh conditions and low levels of social support foster high levels of psychological distress. The present study was designed to assess the relationship between camp conditions and social support within a refugee camp and refugees' levels of psychological distress. Unlike previous reports, which were based on retrospective data, the present study evaluated psychological distress among a group of Vietnamese refugees both prior to departure from Vietnam and during their refugee camp experience.

METHOD

A group of 101 Vietnamese Amerasians was assessed at a transit centre in Vietnam and subsequently at a refugee camp in the Philippines. Assessment instruments were the Hopkins Symptom Checklist-25 and a Camp Comparison Questionnaire.

RESULTS

There were significant decreases in symptom levels of anxiety and depression between the transit centre in Vietnam and the refugee camp in the Philippines. However, these changes were not related to changes in refugee camp conditions or social support within the camp.

CONCLUSIONS

Contrary to previous reports, levels of psychological distress among this group of Vietnamese refugees were not related to either refugee camp conditions or levels of social support within the camp.

The role of imaging in adult acute urinary tract infection

Imaging is required in only a minority of patients with urinary tract infection. Some patients who present with severe loin pain are imaged because ureteric colic is suspected. If urinary tract infection does not respond normally to antibiotics, imaging is undertaken to check for evidence of renal obstruction or sepsis. Finally, after the acute infection has been treated, imaging is required in some patients to check for factors pre-disposing to renal damage or to relapsing or recurrent infection. This review discusses the appropriate choice of imaging technique to use in each clinical situation and summarises the expected findings.

Do fifth graders' attitudes and intentions toward alcohol use predict seventh-grade use?

OBJECTIVE

To examine the relationship among children's perceptions of peer and parental attitudes toward alcohol use, fifth graders' attitudes toward alcohol use and intentions to use alcohol in junior high school, and alcohol use of these same children as seventh graders.

METHODS

Subjects completed questionnaires as fifth graders that assessed their perception of parents' and peers' attitudes toward alcohol use, children's attitudes toward alcohol use, and intentions to use alcohol in junior high school. They completed a survey in the seventh grade that assessed alcohol use.

RESULTS

Path analyses indicated that perceived peer and parental attitudes were directly related to children's fifth-grade attitudes toward alcohol use. Attitudes, in tum, were related to fifth-grade intentions, which were related to seventh-grade alcohol use. Peer and parental attitudes, and children's attitudes as fifth graders, were not directly related to later alcohol use.

CONCLUSIONS

Peer and parental attitudes toward alcohol use among fifth graders exert an indirect, rather than direct, influence on later alcohol use. Similarly, attitudes of fifth graders influence later alcohol use through their influence on intentions to use alcohol. Prevention programs should be targeted toward younger children prior to initiation of alcohol use and should address both peer and parental influences on attitudes and intentions to use alcohol.

The prevalence of psychiatric disorders among Vietnamese Amerasians: a pilot study

A pilot study of the prevalence rate of DSM-III psychiatric disorders among Vietnamese Amerasians prior to migration from Vietnam found current prevalence of such disorders to be lower than previously reported among Vietnamese refugees in the United States and Australia. Methodological and cultural factors contributing to the lower than expected prevalence rate are discussed, and implications for clinical assessments and future research are noted.

Sonographic abnormalities of the thyroid gland following radiotherapy in survivors of childhood Hodgkin's disease

The aims of this study were as follows. (1) To demonstrate the spectrum, frequency and changes on follow-up of sonographic abnormalities in the thyroid gland of survivors of Hodgkin's disease who had received radiotherapy to the neck in childhood. (2) To compare the sonographic findings with clinical examination and radionuclide imaging. (3) To investigate the association between the presence or absence of focal sonographic abnormalities with age at radiotherapy, the interval from radiotherapy, the presence of a raised thyroid stimulating hormone (TSH) and the length of time the TSH had been raised. 46 patients were scanned prospectively and rescanned at 6-18 months. The mean age at first sonography was 22.7 years, the median age at radiotherapy was 12.5 years, and the median interval post-radiation was 10.3 years. Sonographic abnormalities were seen in all 46 patients. 45 had diffuse atrophy and 30 had focal sonographic abnormalities. 18 patients developed new focal sonographic abnormalities on follow-up. Focal sonographic abnormalities were more commonly associated with longer duration of a raised TSH. Two patients had thyroid carcinoma. Sonographic abnormalities of the thyroid are common in patients following neck radiotherapy in childhood. Focal abnormalities are usually associated with a longer duration of raised TSH.

A comparative study of Vietnamese Amerasians, their non-Amerasian siblings, and unrelated, like-aged Vietnamese immigrants

OBJECTIVE

The authors compared the personal histories, levels of psychological distress, and adaptation to American life of Vietnamese Amerasians (N=140), their non-Amerasian siblings (N=71), and a group of unrelated, like-aged Vietnamese immigrants (N=118).

METHOD

Subjects completed two self-administered symptom checklists and provided demographic and personal history data.

RESULTS

Vietnamese Amerasians differed significantly from the other two groups on measures of alcohol use, number of hospitalizations, years of education, childhood trauma, perceived effects of trauma, and score on the Vietnamese Depression Scale. The Amerasians did not, however, differ on measures of social support or in their success at adapting to life in the United States.

CONCLUSIONS

Despite multiple disadvantages, Vietnamese Amerasians appear to be adapting to life in the United States as well as other like-aged Vietnamese immigrants.

Premigratory expectations and postmigratory mental health symptoms in Vietnamese Amerasians

OBJECTIVE

To determine the relationship between premigratory expectations for one's future life in the United States and postmigratory symptoms of anxiety and depression in a group of Vietnamese Amerasians.

METHOD

A cohort of 161 Vietnamese Amerasian migrants was assessed prior to departure from Vietnam using the Hopkins Symptom Checklist-25 (HSCL-25), the Vietnamese Depression Scale, and an Expectations Questionnaire. After migration to the United States, subjects were reassessed using the HSCL-25 and the Vietnamese Depression Scale.

RESULTS

Premigratory expectations for support from the Vietnamese community in the United States were associated with significantly higher scores on the HSCL-25 Depression scale. Of subjects reassessed in the United States, 20% scored in the clinical range for depression.

CONCLUSIONS

Like-ethnic community support is critically important in preventing depressive symptoms among Vietnamese Amerasian migrants. Clinicians working with Amerasians should target those with unrealistically high expectations for preventive intervention and should approach Vietnamese community leaders to mobilize support for recently arrived Amerasians.

Demographic, psychosocial, and objective risk factors related to perceived risk of skin cancer

BACKGROUND AND METHODS

The present study examined the ways in which demographic, psychosocial, and objective risk factors were related to perceived risk of skin cancer among 384 hospital employees who participated in a screening program. It was hypothesized that pyschosocial risk factors would account for a significant portion of the variance in risk perception beyond that accounted for by the other risk factors.

RESULTS

The risk factors accounted for approximately 44% of the variance in risk perception. Psychosocial risk factors accounted for a statistically significant portion of the variance in risk perception beyond that accounted for by other risk factors. Worry, family history of skin cancer, and race/ethnicity were most strongly related to perceived risk.

CONCLUSIONS

Results are discussed in terms of the need for educational programs that emphasize the relationship between level of risk and skin cancer and provide specific information regarding steps that can be taken to prevent skin cancer.

Contractile responses and structure of small bronchi isolated from rats after 20 months' exposure to ozone

Short-term exposure to high concentrations of ozone has been shown to increase airway responsiveness in normal humans and in all laboratory animal species studied to date. While our knowledge concerning the pulmonary effects of single exposures to ozone has increased rapidly over recent years, the effects of repeated exposures are less understood. The goal of the present study was to determine whether airway responsiveness is increased after near-lifetime exposure to ozone. Airway segments representing approximately eighth generation airways were isolated from Fischer 344 rats of both genders that had been exposed for 6 hr per day, 5 days per week for 20 months to 0, 0.12, 0.5, or 1.0 parts per million (ppm) ozone. Circumferential tension development was measured in isolated airways in response to bethanechol, acetylcholine, and electrical field stimulation. Responsiveness of the airways to the contractile stimuli was described by the effective dose or frequency that elicited half-maximum contraction (ED50) and the maximum response. Since ozone exposure is associated with remodeling of peripheral airways, smooth muscle area was determined and tension responses were normalized to the area measurements. Before normalization of tension data to smooth muscle area, neither the ED50 nor maximum response of small bronchi to the contractile stimuli was altered after chronic ozone exposure. Smooth muscle area was greater in airways isolated from animals that had been exposed to 0.5 ppm ozone. After accounting for smooth muscle area, maximum responses of the small bronchi isolated from male rats were significantly reduced after 0.12 and 0.5 ppm ozone. Although not significant statistically, a similar trend was observed in airways isolated from female rats. These results suggest that the increase in airway responsiveness associated with acute ozone exposure does not persist during near-lifetime exposure. Although the mechanism responsible for the adaptation to the effects of O3 on airway responsiveness is unknown, the results indicate that smooth muscle cell function was compromised by the chronic exposure. The mechanism(s) responsible for mediating this effect and the relevance of these results to humans remains to be determined.

Unaccompanied status as a risk factor in Vietnamese Amerasians

This study prospectively evaluates the relationship between unaccompanied status and levels of psychological distress in a group of Vietnamese Amerasians both prior to, and during, migration. Its objective was to determine whether unaccompanied migrant status functions as an independent post-departure risk factor for psychological distress, or if unaccompanied migrants are already at increased risk for, and have higher levels of, psychological distress prior to departure and the acquisition of unaccompanied status. Seventy-five Vietnamese Amerasian youth were evaluated at two points during their migration utilizing Felsman's Personal Information Form, the Hopkins Symptom Checklist-25, and the Youth Self-Report. The first assessment was conducted prior to migration at the Amerasian Transit Center in Vietnam, and the second during migration at the Philippine Refugee Processing Center. Unaccompanied Amerasians were found to have significantly higher risk levels for, and significantly more symptoms of, psychological distress prior to migration than accompanied Amerasians. During migration the difference in levels of psychological distress between accompanied and unaccompanied Amerasians increased beyond that attributable to predeparture risk levels alone. This significant differential increase in levels of psychological distress among unaccompanied Amerasians is attributable to unaccompanied status. Unaccompanied migrant status thus appears to function both as an independent postdeparture risk factor for psychological distress and also as a marker for increased levels of risk and psychological distress prior to migration.

Breast cancer screening behaviors and intentions among asymptomatic women 50 years of age and older

We examined predictors of (1) compliance with yearly mammography and clinical breast examination (CBE) and (2) intention to obtain mammography and CBE within the following year. Subjects were 312 asymptomatic female hospital employees, 50 years or older, who had participated in a free worksite breast cancer screening program. Mammograms and CBEs had been obtained by 79% and 76% of the subjects, respectively, during the preceding 12 months. The majority of the subjects indicated that they were very/extremely likely to obtain a mammogram and CBE in the next 12 months (88% and 87%, respectively). Multivariate analyses showed that perceived barriers to and physician recommendation of mammography were the strongest predictors of both breast cancer screening behaviors and intentions. Recency of participation in the educational component of the screening program was related to both compliance with mammography in the past 12 months and intention to obtain CBE in the next year. Having a first-degree female relative with a history of breast cancer was related to compliance with CBE in the past 12 months. Perceived efficacy of mammography was related to intention to obtain both mammography and CBE in the next year, and number of reasons for mammography was related to intention to obtain mammography in the next year. Our results suggest that physicians play a key role in motivating women to comply with breast cancer screening and that reducing barriers to obtaining mammography may increase use further.

Development of a risk profile for intentions to use alcohol among fifth and sixth graders

OBJECTIVE

The relationship between intentions to use alcohol and risk factors was examined among fifth and sixth graders.

METHOD

Subjects completed a questionnaire that assessed intentions to use alcohol and eight risk factors. Risk factors included peer and parental use and attitudes toward use, sensation seeking, tolerance of deviance, rejection of parental authority, and family cohesion.

RESULTS

Multivariate analyses showed that the risk factors were able to discriminate between those who intended to use alcohol and those who did not. Family factors showed stronger relationships to intentions among fifth graders, and peer factors were more strongly related to intentions among sixth graders.

CONCLUSIONS

Risk factors can be used to target preadolescents who may be at risk for early alcohol use, and programs that attempt to prevent early initiation of alcohol use among adolescents can be designed.

A pilot study of abuse among Vietnamese Amerasians

This report describes a pilot study of the prevalence of physical and sexual abuse, and current levels of psychological distress correlated with a history of abuse, in a group of Vietnamese Amerasians bound for the United States. A sample of Vietnamese Amerasians, part of a larger cohort originally selected in Vietnam, was assessed in the Philippines. Subjects completed a self-administered questionnaire regarding a history of physical and/or sexual abuse and three other self-administered questionnaires: the Hopkins Symptom Checklist-25, the Vietnamese Depression Scale, and the Youth Self Report. A history of physical and/or sexual abuse was reported by 22% of male and 18% of female Amerasians. Abused male Amerasians reported significantly higher levels of psychological distress than nonabused male Amerasians, while abused and nonabused female Amerasians did not differ in their levels of psychological distress.

Career satisfaction among psychiatrists in Texas

We examined present and anticipated future levels of career satisfaction among psychiatrists in the greater Houston area. We gathered data by means of an anonymous questionnaire. The strongest univariate correlations between background variables and current and anticipated future levels of career satisfaction were found with age, years in practice, and source of professional income. Major threats to the quality of psychiatric practice were identified as changes in third-party reimbursement/managed care, competition from nonphysician mental health practitioners, and the national economy. Psychiatrists least satisfied with their current careers and most pessimistic about the future were found to be older with more years' experience and deriving their professional income chiefly from private practice. Much of their dissatisfaction appeared to relate to changes in third-party reimbursement/managed care and increasing competition from nonphysician mental health professionals.

Influence of family disharmony and parental alcohol use on adolescent social skills, self-efficacy, and alcohol use

Deficits in social skills have been found to be related to adolescent substance use. Little effort has been devoted to understanding how family factors influence the acquisition of these skills. This study examined the manner in which family disharmony and parental alcohol use affect adolescent alcohol use through their influence on the acquisition of social skills and self-efficacy regarding one's ability to utilize these skills. It was hypothesized that family disharmony and parental alcohol use directly influenced usage and affected usage indirectly through their influence on acquisition of social skills. Social skills were also hypothesized to affect usage directly and to affect usage indirectly by influencing beliefs regarding one's ability to implement these skills. Results indicated that family disharmony was directly related to adolescent alcohol use and social skills. Parental alcohol use was related only to adolescent usages, not to social skills. Social skills were related to self-efficacy, which was related to alcohol use but was not directly related to usage. Results are discussed in terms of the importance of family influences on adolescent alcohol use, the importance of including families in prevention efforts, and the importance of the acquisition of self-efficacy relative to social skills.

Post-operative serial prostate-specific antigen and transrectal ultrasound for staging incidental carcinoma of the prostate

OBJECTIVES

To examine the value of post-operative serum prostate-specific antigen (PSA), PSA density, incremental change in serial serum PSA (PSA slope) and transrectal ultrasound (TRUS) in the assessment of residual malignancy after the diagnosis of clinically unsuspected prostatic adenocarcinoma at transurethral resection of the prostate (TURP).

PATIENTS AND METHODS

Forty-eight untreated patients with incidental carcinoma of the prostate, demonstrated at TURP for a clinically benign gland, were evaluated post-operatively with serum PSA and TRUS with multiple systematic prostatic biopsies. Prostatic volume was determined from TRUS measurements and PSA density was defined as serum PSA divided by gland volume. Those patients who did not undergo further treatment were monitored with serial PSA levels, and PSA slope was calculated as the overall annual percentage increase in serum PSA.

RESULTS

Among 36 patients staged T1A (A1), 11 (31%) had histologically proven residual carcinoma, and five of the 12 patients (42%) with T1B (A2) disease had no residual disease on biopsy. Serum PSA levels following TURP were greater in those patients with residual disease than those without (P = 0.001), but at a cut-off of 4.0 ng/mL--providing a sensitivity of 89%--the specificity of PSA alone was 57%. PSA density had an 83% sensitivity and a 67% specificity with a cut-off of 0.15 ng/mL/cm3. TRUS had a sensitivity of 63% and a specificity of 52%. An incremental rise in PSA exceeding 20% per year in untreated patients gave a sensitivity of 90% and specificity of 79% for biopsy proven residual malignancy.

CONCLUSION

This study demonstrates the inaccuracy of staging incidental prostatic malignancy by TURP. Although the performance of PSA density is better than that of PSA alone, the reliability of both are limited by the lack of specificity, and TRUS imaging lacks both sensitivity and specificity. The PSA slope has sufficient sensitivity and specificity to distinguish reliably most patients with biopsy proven residual malignancy. Although ultrasound-guided systematic biopsies provide a means for confirming residual malignancy, they may not be indicated in all patients with incidental carcinoma: for such patients, PSA progression may provide a rational basis for subsequent treatment.

Skin cancer prevention and early detection intentions and behavior

This longitudinal study examined predictors of (1) skin cancer prevention and early detection intentions and (2) compliance with recommendation for medical follow-up for suspicious skin lesions. Subjects were 324 hospital employees who were at increased risk for skin cancer and who participated in a worksite skin cancer screening program. Based on behavioral self-regulation theory and the Health Belief Model, multivariate analyses showed that optimism, perceived risk, reasons for doing skin self-examination (SSE), and SSE frequency prior to screening were the best predictors of intentions to engage in future health promotion behaviors (i.e., monthly SSE, regular sunscreen use, and participation in a skin cancer screening program the following year). Although our results also showed that optimism, reasons for doing SSE, and SSE frequency were the best predictors of compliance with medical follow-up, these three variables accounted for only a small amount of the variance in compliance with recommended follow-up care.

Breast cancer screening: racial/ethnic differences in behaviors and beliefs

Racial/ethnic differences in breast cancer screening behaviors and beliefs were examined in 259 asymptomatic women, 50 years old or older, who participated in a no-cost worksite breast cancer screening program. Hispanics were more likely than African Americans to report having had mammography in the past year. Caucasians and Hispanics were more likely than African Americans to report having had a clinical breast examination in the past year. African Americans to report having had a clinical breast examination in the past year. African Americans and Hispanics were more likely to practice monthly breast self-examination than were Caucasians. African Americans were more likely to report cancer-related fears and worries as barriers to mammography, whereas Caucasians were more likely to report being too busy, inconvenience, and procrastination as barriers. African Americans also were more likely to evaluate their physicians and other health professionals positively than were Caucasians. These results suggest a need to make a special effort to address cancer-related fears as barriers to screening among African Americans, and time-related barriers to screening among Caucasians.