Does the introduction of new technology change population demographics? Minimally invasive technologies and endometrial polyps

OBJECTIVE: To determine if the characteristics of women with endometrial polyps changed as minimally invasive modalities for diagnosis and surgical treatment were integrated to our clinical practice. MATERIALS AND METHODS: The pathologic reports of all women diagnosed with endometrial polyps in 1990 (220 patients) and 1996 (386 patients) were reviewed. The respective medical records were reviewed for anthropomorphic factors, bleeding pattern, diagnosis, and modality of surgical removal. Comparisons of dichotomous data and analysis of nominal variables with two or more categories were carried out with the chi(2) test. RESULTS: Differences in patient characteristics or pattern of bleeding were minimal. In both groups, endometrial polyps were more frequent in women with abnormal bleeding, reaching almost 80%. Diagnostic and therapeutic modalities were significantly different in 1990 vs. 1996. Diagnosis by ultrasound increased fivefold (3.6 vs. 16.8%) and operative hysteroscopy increased threefold (6.4 vs. 19.7). The frequency of incidental diagnosis of endometrial polyps at the time of hysterectomy decreased significantly. The most frequent modality of surgery done in 1990 was dilatation and curettage (44.6%), followed in frequency by endometrial biopsy and abdominal hysterectomy. In contrast, the most frequent modality in 1996 was hysteroscopic resection (36.8%), followed by dilatation and curettage (12.8%). CONCLUSIONS: The introduction of minimally invasive methods of diagnosis and treatment of endometrial polyps has not changed the overall patient population with this lesion.     

Cigarette smoking and perceived health in school dropouts: a comparison of Mexican American and non-Hispanic white adolescents

OBJECTIVE: To examine the relations between educational attainment and health (cigarette smoking and perceived health) in Hispanic adolescents. METHOD: Participants included 3,360 Mexican American and non-Hispanic white adolescents ranging in age from 12 to 21 years. The sample included school dropouts, academically at-risk students, and control students. RESULTS: School dropouts were 6.46 times more likely and academically at-risk students were 2.80 times more likely to smoke heavily than were control students. In addition, school dropouts reported poorer health than did their peers. Results suggest that the relation between educational attainment and perceived health is mediated by cigarette smoking. CONCLUSIONS: Increased awareness of educational attainment as a significant risk factor for smoking in Hispanic adolescents will enable smoking cessation services to be targeted more effectively.     

Pregnancy Discovery and Acceptance Among Low-Income Primiparous Women: A Multicultural Exploration

Objectives: As part of a larger study exploring psychosocial factors that influence self-care and use of health care services during pregnancy, we investigated the process of pregnancy discovery and acceptance among a culturally diverse group of women who had given birth to their first child in the year preceding data collection. Methods: Eighty-seven low-income women from four cultural groups (African American, Mexican, Puerto Rican, and white) participated in eight focus groups held in their communities. The focus groups were ethnically homogenous and stratified by early and late entry into prenatal care. A social influence model guided the development of focus group questions, and the study followed a participatory action research model, with community members involved in all phases of the research. Results: Issues that emerged from the focus groups as possible influences on timing of pregnancy recognition include the role of pregnancy signs and symptoms and pregnancy risk perception in the discovery process, the role of social network members in labeling and affirming the pregnancy, concerns about disclosure, planning status of the pregnancy, and perceived availability of choices for resolving an unintended pregnancy. Conclusions: The pregnancy discovery process is complex, and when protracted, can potentially result in delayed initiation of both prenatal care and healthful pregnancy behaviors. Enhancing our understanding of pregnancy discovery and acceptance has clear implications for primary and secondary prevention. Future research is needed to further explain the trajectory of pregnancy discovery and acceptance and its influence on health behaviors and pregnancy outcome.     

Diet and cancer prevention: the fiber first diet

Diet can play a major role in cancer prevention. The international differences in cancer incidence are largely accounted for by lifestyle practices that include nutrition, exercise, and alcohol and tobacco use. About 50% of cancer incidence and 35% of cancer mortality in the U.S., represented by cancers of the breast, prostate, pancreas, ovary, endometrium, and colon, are associated with Western dietary habits. Cancer of the stomach, currently a major disease in the Far East, relates to distinct, specific nutritional elements such as excessive salt intake. For these cancers, information is available on possible initiating genotoxic factors, promoting elements, and prophylactic agents. In general, the typical diet in the United States contains low levels of the potent carcinogenic agents, heterocyclic amines, formed during the cooking of meats. It provides only about half the potent appropriate fiber intake and is high in calories. About twice as many calories as would be desirable come from fat, certain kinds of which enhance the development of cancers. Other foods with functional properties, such as soy products and tea, can be beneficial. To achieve reduction in risk of certain cancers, diet must be optimized, primarily to reduce caloric intake and the fat component. The latter should be 20% or less of total caloric intake and fiber should be increased to 25- 35 g per day for adults. One approach to achieving these goals is the Fiber First Diet, a diet designed around adequate fiber intake from grains, especially cereals, vegetables, legumes, and fruits, which thereby reduces both calorie and fat intake. Such dietary improvements will not only reduce cancer and other chronic disease risks, but will contribute to a healthy life to an advanced age. A corollary benefit is a lower cost of medical care.      

Recurrent aphthous stomatitis.

Etiology and Epidemiology: The Greek term aphthai was initially used in relation to disorders of the mouth and is credited to Hippocrates (460-370 BC). Today, recurrent aphthous ulceration, or recurrent aphthous stomatitis (RAS), is recognized as the most common oral mucosal disease known to human beings. Considerable research attention has been devoted to elucidating the causes of RAS; local and systemic conditions, and genetic, immunologic, and infectious microbial factors all have been identified as potential etiopathogenic agents (Table 1). However, to date, no principal etiology has been discovered. Epidemiologic studies indicate that the prevalence of RAS is between 2% and 50% in the general population; most estimates fall between 5% and 25%. In selected groups, such as medical and dental students, it has been observed with a frequency as high as 50% to 60%. The peak age of onset for RAS is between 10 and 19 years. After childhood and adolescence, it may continue throughout the entire human lifespan without geographic or age-, sex-, or race-related preference.     

Depression of papillary muscle contractility by plasma incubated with pneumococci

Mechanisms of death in pneumococcal disease are poorly understood. We have previously shown that intravenous pneumococcal products in dogs caused a mean decrease in cardiac output of 58%. The present study used measurements of the force and rate of contraction of isolated rabbit papillary muscle to determine whether pneumococci (PNC) altered myocardial contractility. Nine papillary muscles were superfused with various solutions including Tyrode's, Tyrode's incubated with sonicated type 1 PNC, normal rabbit plasma, and rabbit plasma incubated with PNC. Compared to untreated Tyrode's solution, PNC-treated Tyrode's solution did not alter papillary muscle contractility. However, compared to untreated rabbit plasma, plasma incubated with PNC caused a mean decrease of 18% in the force of contraction and 16.7% in the maximum rate of force development in nine studies. We conclude that PNC do not directly affect papillary muscle contractility. However, the interaction of PNC and plasma does cause a decrease in rabbit papillary muscle contractility.