Recent patterns of growth in radiation therapy facilities in the United States: a patterns of care study report.

The Patterns of Care Study conducted its seventh survey of radiation oncology facilities with megavoltage equipment. The aims were to identify the basic structural characteristics of the radiation oncology specialty, to allow comparison with previous surveys, to identify trends in the patterns of equipment and personnel usage, and to measure the capabilities of facilities to deliver modern radiotherapy. All radiation oncology facilities in the United States and Puerto Rico were surveyed. Multiple mailings and calls yielded identification of and responses from virtually all facilities doing megavoltage radiotherapy. The survey collected information on equipment, patient load, personnel, and types of procedures performed. The complete census was reviewed, summarized, and compared to previous surveys. Results for 1990 showed 1321 facilities, (938 hospital based, 350 freestanding, 33 federal), 492120 new patients, and 2397 treatment machines (1893 linear accelerators or betatrons and 504 cobalt machines). The number of facilities and total machines increased rapidly with most of the increase in facilities occurring in the freestanding category. The number of cobalt units declined, while the number of linear accelerators increased. The results also showed that 6% of facilities did not have the capability of simulating patients and 7% of facilities did not have treatment planning capability. Of all facilities 9% reported doing intraoperative radiation therapy and 18% doing hyperthermia. For recent years in the specialty of radiation oncology the number of facilities and treatment machines increased at a more rapid rate than the number of new patients.     

Cognitive deficits in progressive supranuclear palsy, Parkinson's disease, and multiple system atrophy in tests sensitive to frontal lobe dysfunction.

Groups of patients with idiopathic Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy or Steele-Richardson-Olszewski syndrome, matched for overall clinical disability, were compared using three computerised cognitive tests previously shown to be sensitive to frontal lobe dysfunction. On a test of planning based on the Tower of London task, all three groups were impaired, but in different ways. The groups with palsy and Parkinson's disease were slower in the measure of initial thinking time, whereas the group with multiple system atrophy was only slower in a measure of thinking time subsequent to the first move, resembling patients with frontal lobe damage. On a test of spatial working memory, each group showed deficits relative to their matched control groups, but the three groups differed in their strategy for dealing with this task. On a test of attentional set shifting, each group was again impaired, mainly at the extradimensional shifting stage, but the group with Steele-Richardson-Olszewski syndrome exhibited the greatest deficit. The results are compared with previous findings in patients with Alzheimer's disease or frontal lobe damage. It is concluded that these basal ganglia disorders share a distinctive pattern of cognitive deficits on tests of frontal lobe dysfunction, but there are differences in the exact nature of the impairments, in comparison not only with frontal lobe damage but also with one another.     

Inhalation toxicity studies with 1,3-butadiene. 3. Two year toxicity/carcinogenicity study in rats

Groups of 110 male and 110 female CD (Sprague-Dawley) rats were exposed to atmospheres containing 0 (control), 1000 or 8000 ppm v/v butadiene for 6 hr/day and 5 days/week. Ten of each sex from each group were killed at 52 weeks. The study was terminated when it was predicted that survival would drop to 20% to 25% (105 weeks for females and 111 weeks for males). High dose rats had wet, ruffled fur and showed slight incoordination during the first exposure each week. During the second year, mortality in both treated female groups was increased because of humanitarian sacrifice of animals with large subcutaneous masses, while increased mortality in the high dose males was accompanied by an increase of the severity of nephropathy. Body weight was slightly lower than controls in both sexes at the high dose, but statistically significant only over the first 12 weeks. There were no effects in hematological analyses or tests of neuromuscular function that definitely could be associated with treatment. Liver weights at both doses were increased in both sexes with no associated pathological change. Kidney weight was increased in males at the high dose, together with an increase in the severity of nephrosis. There were increases in the incidences of pancreatic exocrine adenoma (high dose, male); uterine sarcoma (both doses, female); Zymbal gland carcinoma (high dose, female); mammary tumors (both doses, female); thyroid follicular cell tumors; and testis Leydig-cell tumors (high dose). These data suggest that butadiene is a weak oncogen to the rat under the conditions of exposure used in this study.     

An industrial hygiene methodology developed in support of a retrospective morbidity case-control study.

An industrial hygiene methodology that was developed in support of an epidemiologic case-control study is described. This study was conducted to investigate a potentially increased incidence of colorectal cancer among employees who worked at a unit that manufactured polypropylene by a heavy diluent process. Retrospective epidemiologic case-control studies typically have exposure assessment problems because industrial hygiene monitoring data are often not available. Misleading job titles are another problem that can provide a poor framework for estimating exposures. In addition, a job title-based exposure assessment assumes individual work patterns are not important in assessing worker exposures, although this is contradictory to industrial hygiene experience. The design of the case-control study provided an innovative industrial hygiene approach to circumvent these typical exposure estimating problems. The industrial hygiene methodology of the case-control study included assessing historical exposures, developing an exposure estimating matrix, selecting candidate etiologic agents based on a joint toxicologic and industrial hygiene review, administering a work activity questionnaire, calculating exposure scores, and conducting a statistical analysis. The study design also provided an additional exposure measurement independent of the toxicologic and industrial hygiene review. This provided an opportunity to compare the likelihood of exposure misclassification and, as expected, showed that a more detailed exposure estimate resulted in less misclassification.     

Population-based randomized controlled trial of a stage-targeted physical activity intervention

Background: Intervention trials with self-selected participants have shown that mailed stage-targeted print materials can increase participation in physical activity in the short term. We examined the effects of a mailed stage-targeted print intervention designed to promote physical activity, in a random sample of adults living in a regional city.Method: Participants (n = 462, 40–60 years of age) were randomly allocated to an intervention in - 227) or control group (n - 235). Measures included validated 2-week physical activity recall and stage of motivational readiness for physical activity. The intervention consisted of a single mailing of a letter and full-color stage-targeted booklets (specific to precontemplation, contemplation, preparation, and action/maintenance) 1 week postbaseline. Follow-up interviews were conducted at 2 and 6 months postbaseline.Results: After 2 months, participants in the intervention group were significantly More likely to meet the current American College of Sports Medicine/Centers for Disease Control and Prevention recommendation for sufficient physical activity than those in the control group (adjusted odds ratio [OR] - 2.40; 95% confidence interval [CI] = 1.44–3.99). After 6 months, intervention participants who reported receiving and reading the intervention materials were significantly more likely to be meeting the sufficient physical activity criterion compared with the control group (adjusted OR = 2.03; 95% Cl = 1.16–3.56).Conclusions: The stage-targeted print intervention was effective in promoting short-term increases in physical activity and was most effective for participants who recognized and used the materials. This low-cost, generalizable intervention has demonstrated potential as a practical population-based physical activity promotion strategy. Further research is required before widespread dissemination would be justified, as additional strategies may be required to ensure sustained change. This project was supported by a National Heart Foundation of Australia Research Project Grant. David Crawford was supported by a Nutrition Research fellowship from the National Heart Foundation.     

Adherence to published guidelines for the management of menorrhagia in women undergoing second generation endometrial ablation.

Second-generation endometrial ablation techniques provide an effective surgical treatment option for women with menorrhagia. Their ease of use might result in inappropriate surgical treatment without previous medical therapy. We sought to establish local compliance with national guidelines following the recent introduction of second generation ablation techniques into routine practice. We collected data at the time of ablation on the preceding medical management of women undergoing either microwave endometrial ablation or thermal balloon ablation. One hundred and thirty-two consecutive women underwent second-generation endometrial ablation. At least one medical treatment (range 1-5) was used before ablation in 86% of women. The majority (86%) of women undergoing a second-generation endometrial ablation technique received at least one effective medical therapy before surgical intervention, indicating a high level of compliance with published guidelines.     

Cricopharyngeal Crohn's disease

We report a case of Crohn's disease of the cricopharyngeal oesophagus which presented with complete dysphagia and was successfully treated by balloon dilatation. We can find no previous reports of such a case.     

Staff members' acceptance of the introduction of workplace smoking bans in the Australian public service

The acceptability to employees of workplace smoking bans is an important factor in their introduction and in subsequent compliance. This study describes the acceptance by affected staff members before the ban on smoking in Australian public-service premises. Four thousand, two hundred and fifteen (79% of those who were approached) public servants were surveyed from areas of six departments across three states. Twenty-five per cent of the sample were current smokers. Support for the bans was strong, with 76% of the sample approving over all. Approval among smokers was less, with 40% of smokers approving, compared with 82% of ex-smokers and 90% of "never" smokers. Thus, the results show a generally favourable attitudinal milieu among employees who were facing an impending ban on smoking, and far-from-unanimous opposition from smokers. Among smokers, acceptance of the bans was predictable from the attitudes towards smoking acceptance of the bans was predictable from the attitudes towards smoking in general, and from the perceived impact of the bans on smokers. The existence of restrictions on smoking at the time of the survey was associated with slightly higher levels of approval of the impending total ban, especially when the restrictions were not seen as being imposed on the respondents by others.     

Effects of intracerebral implants of steroid hormones on scent marking in the ovariectomized female gerbil (Meriones unguiculatus)

The effects of intracerebral implants of steroid hormones on scent marking in the female gerbil (Meriones unguiculatus) were studied in two experiments. In Experiment 1 various steroids were implanted alone or in combination into the preoptic and anterior hypothalamic area of ovariectomized females. Unilateral implants of testosterone + estrogen, estrogen, estrogen + progesterone, testosterone and testosterone + progesterone stimulated a significant level of marking when compared to controls. Experiment 2 utilized bilateral implants of estrogen dissolved in paraffin in order to explore the distribution hormone sensitive areas in the brain which might be important in the regulation of scent marking in the female gerbil. Pellets of estrogen-paraffin were implanted stereotaxically into either the anterior hypothalamus, preoptic area, septum, hippocampus, thalamus, amygdala or anterior olfactory nucleus of ovariectomized females. Total dosage of hormone implanted was 8.2–8.4 μg. A significant level of marking resulted in animals receiving implants into the anterior hypothalamus, preoptic area and septum when compared to controls. Marking appeared at about the same rate in each of these groups; however, the level of marking attained differed. By the last trial, anterior hypothalamic implanted animals were marking significantly more often than animals in either the preoptic or septum groups. Although there was no evidence of ieakage from the brain, the data suggested that some rapid diffusion of hormone, largely restricted to the brain, was taking place or that the three areas were differentially responsive to the hormone. The data do indicate that some localization of function does exist with respect to regulation of scent marking in the female.