Barriers to follow‐up of abnormal screening mammograms among low‐income minority women

Objective. To describe factors related to compliance diagnostic follow‐up among minority women of low socioeconomic status with abnormal screening mammograms.

Methods. A retrospective cross‐sectional survey using a structured telephone interview. Three cancer screening clinics at an urban inner‐city public hospital. All women with abnormal screening mammograms between September 1990 and January 1992 were eligible; women were interviewed in August 1992. Abnormal mammograms were those requiring specific, non‐routine clinical follow‐up; non‐compliance was defined as delayed follow‐up (four to six months after the date of the mammogram), or no follow‐up at the time of interview (more than 6 months after abnormal).

Results. Sixty‐two of 442 screened women had abnormal results; the overall rate of non‐compliance with follow‐up was 50%. Among the 42 (68%) women who agreed to be interviewed, non‐compliers were less likely to state that they had been told to receive follow‐up than compilers (65% versus 100%; p = 0.008). Non‐compliant women were less likely to have suspicious mammography interpretations (p = 0.05), and more likely to report barriers to follow‐up, such as cost of lost wages and medical care, system barriers, or fears, than compliant women (61.9% versus 9%, p = 0.01). There were no differences between the two groups for age, education, insurance, source of care, family history, knowledge or attitudes.

Conclusions. These preliminary results suggest that follow‐up of low income, minority women with abnormal screening mammograms could be enhanced by improved communication of results. Future studies should extend these findings with larger samples and in other settings and populations.     

Comparative study of hydrogen and aminopyrine clearance methods for determination of gastric mucosal blood flow in dogs

Effects of pentagastrin, histamine, PGI₂, and vasopressin on gastric mucosal blood flow (GMBF) in innervated stomachs of anesthetized dogs were measured by means of the hydrogen clearance method, using a contact electrode. The results were compared with findings obtained with the aminopyrine (AP) clearance method in Heidenhain pouch preparations. Pentagastrin at 2 and 8 g/kg/hr had no effects on GMBF, as measured by the hydrogen clearance method, but there was a marked increase in GMBF when the AP clearance method was used. Histamine at 40 or 160 g/kg/hr tended to reduce or significantly reduced GMBF when measured with the hydrogen clearance method, but there was a significant increase in GMBF with the AP clearance method. Both PGI₂ (3 or 30 g/kg/hr) and vasopressin (0.06 or 0.25 units/kg/hr) reduced GMBF as determined by both methods. These results indicate that the hydrogen clearance method is advantageous for detecting regional GMBF but is disadvantageous when attempting to detect the effects of agents which increase GMBF.The Editor wishes to express publicly his regrets to the authors that the editorial planned to highlight this paper will not appear until next month. He particularly apologizes for the long delay in publishing after the paper had been accepted in anticipation of the editorial to appear in the same issue.     

Tissue cultures from cerebrospinal fluid specimens in the study of human brain tumors.

The authors report a study in which 109 cerebrospinal fluid (CSF) specimens from patients with varying neurological disorders were incubated in tissue culture medium for 1, 3, and sometimes 7 days. Strict criteria for malignancy were applied to cells found at these intervals. In 35 patients with verified central nervous system neoplasms, eight cases had malignant cells and 11 others had "doubtful" cells by tissue-culture analysis. Thirty-three of these cases were also examined with standard millipore cytological techniques: six had malignant cells and four had "doubtful" cells. Of 50 cases with inflammatory or other non-neoplastic conditions, cells were cultured in 13. None was considered malignant by our criteria. Tissue culture of CSF has several potential benefits. Even with stringent criteria, it is possible to demonstrate the presence of unequivocally malignant cells in CSF by tissue culture. The systemic application of such criteria may eventually increase the positive identification of malignancies. Further, since these cells are growing, the degree of malignancy may be more accurately determined by a study of growth in culture. Such a study could not be done by conventional methods. Finally, tissue culture can help to guide therapy in certain instances in which a surgical biopsy cannot be obtained.     

Reading, Demographic, Social and Psychological Factors Related to Pre-adolescent Smoking and Non-smoking Behaviors and Attitudes

The purpose of this study was to examine reading, demographic, social and psychological factors related to pre-adolescent smoking and non-smoking behaviors and attitudes. The school-home humanistic education program was implemented in a large, urban public school system. It stressed responsible decision-making, increased self-esteem and the inter-relationships among the acquisition of knowledge of the consequences of smoking, personal feelings, family relationships and behavior. The results showed that family involvement was necessary to affect smoking attitudes and behaviors. Of all the variables studied, reading had a most pervasive relationship. Peer influence and self-esteem also were related to smoking knowledge, smoking attitude, future smoking intentions and the "purchase" of cigarettes. Two of several conclusions drawn from the results are: 1. Family involvement is necessary to affect attitudes and behaviors. 2. Health education research that does not investigate the relationship between program outcomes and reading achievement may be misleading.     

Prolonged travel time to neonatal intensive care unit does not affect content of parental visiting: a controlled prospective study.

Decreased local obstetric care appears to be increasing the rate of premature births to rural populations. With increased numbers of premature and complicated births in rural populations, understanding the impact of the Neonatal Intensive Care Unit (NICU) environment on the development of parent-child relationships becomes critical. NICU infants appear to be at increased risk for failure to thrive, child abuse, and neglect. Some reports suggest that the frequency of parental visits to the NICU can predict infants likely to be at risk. Because rural parents visiting infants hospitalized in urban centers are likely to visit less often, understanding this possible relationship is critical. In this controlled prospective study, three groups of parents were observed visiting their hospitalized infants: (1) those visiting "in house" while the mother was still hospitalized; (2) those whose visits required one hour or less in travel time; and (3) those whose visits required more than one hour in travel time. Results showed that travel time influenced the frequency of visits, with fewer visits from those living furthest from the NICU. However, those visiting from greater distances stayed with their infants longer so that there was no difference in the total visiting time over a two-week period. Direct observations of the visits by both mothers and fathers showed no differences in the content of parent-child interactions among groups. Thus, visit frequency alone must be viewed cautiously as a potential indicator of failure to bond with a hospitalized infant, especially in settings serving rural populations.     

The abortion debate: can this chronic public illness be cured?

Abortion has provided one of the most noxious, disturbing, and unending of all American moral and legal struggles. The issue forces us to think about the most difficult kind of ethical issues, e.g., the moral status of the fetus and the meaning of human "life" and "personhood." The win-at-all-costs attitude among the leading advocacy groups has created gross stereotypes. While most arguments heard today were also heard prior to the Roe vs. Wade decision, the tone has radically changed. Better organization has meant hotter rhetoric and a nastier public style. We need to move the abortion debate along; it is now as stagnate as it is nasty. We need creative discussion and realistic compromise. The pre-Roe arguments in favor of choice have changed. Then, the movement to legalize abortion rested on the following: 1) illegal abortions were killing and maiming women; 2) women should have a backup to ineffective contraception; 3) the number of unwanted pregnancies should be reduced; only wanted children should be born, as a matter of child welfare; 4) women should have the right to make the abortion decision; 5) everything possible should be done to change the economic and domestic circumstances forcing women into unwanted pregnancies. The argument benefited women, children, and society. The many abortion myths that have since taken prominence cloud an already difficult issue. The ongoing tension rests with the conflict between the moral and legal issues. Is it possible to combine legal freedom and seriousness about the moral questions? Only if we recognize the equality of both positions' moral traditions, accept public discussion, the need for compromise, the need to do everything possible to change the economic and social circumstance leading to the abortion choice, and the need for meaningful counseling of women considering abortion.     

"Congenital" hematic cyst of the orbit.

A case of true hematic cyst of the orbit in a 10-year-old girl, apparently resulting from birth trauma, is presented. Ultrasonic and clinical features believed to aid the examiner in correctly diagnosing such a lesion are presented. While apparently unique among reported cases, "congenital" hematic cysts of the orbit undoubtedly occur occasionally and the possibility of this entity should be considered in appropriate circumstances.