Cocaine use and risky injection and sexual behaviors

The association between cocaine use (crack and injection cocaine) and risky behaviors for human immunodeficiency virus (HIV) infection was investigated among participants in a multi-site study at drug treatment and non-drug treatment sites in Worcester, Massachusetts. Cocaine use was more prevalent among young, African-American men. Compared to heroin injectors cocaine injectors had higher risk injection and sexual behaviors. Among non-injectors, crack users were more likely to have multiple partners and receive money or drugs for sex. Cocaine use, either injected or smoked as crack, should be considered a high risk behavior for HIV infection.

The use of the CAGE questionnaire in a cohort of homosexually active men

The prevalence and correlates of alcohol-related problems measured by the CAGE questionnaire were investigated in a population of 249 homosexually active men at a Boston community health center. Two hundred eight men (79.4%) reported alcohol use during the past 6 months and 22.9% (27.4% of alcohol users) were CAGE positive (two or more positive responses). Increased frequency of alcohol use was strongly associated with CAGE positivity (p < .001). Controlling for frequency of alcohol use, cigarette smoking was independently associated with a positive CAGE score. Other substance use and demographic variables were not independently associated with CAGE problems.

Impact of a breast cancer screening community intervention

BACKGROUND

Efforts to detect breast cancer in its early stages are necessary to reduce breast cancer-associated mortality. This study evaluated the impact of a multicomponent intervention implemented between 1987 and 1990 to increase a community's utilization of breast cancer screening by women over 50 years of age.

METHODS

The study used a pretest/post-test two-community design, with one community assigned as the intervention community and the other as the comparison. The intervention consisted of a comprehensive physician involvement component and a community education effort. To assess the overall impact of the interventions, we measured women's participation in screening via random digit dial telephone surveys at three time points, each approximately 18 months apart.

RESULTS

Over the course of the study, there were dramatic improvements in breast cancer screening participation in both communities. However, the intervention city showed more improvement in selected variables than did the comparison community in the early phases of the project between baseline and midpoint. These included increased advice by physicians to have mammograms, increased awareness that screening is necessary in the absence of symptoms, increased awareness that many women over 50 have mammograms, decreased perception of barriers to clinical breast exam, and an increase in the proportion of women having a clinical breast exam. In addition, significantly fewer women in the intervention city than in the comparison city reported never having had a mammogram at midpoint.

CONCLUSIONS

The findings demonstrate limited impact of a community intervention during a period of increasing adoption of mammography screening, in part, due to this rapidly rising secular trend. Additionally, increased activities in the comparison community were documented. Therefore, as incidence of screening increases, targeted activities aimed at population subgroups are warranted, and evaluation designs need to include multiple comparison groups or broader geographic random samples.

Changes in mammography use: economic, need, and service factors

OBJECTIVES

The purpose of this study was to document changes in mammography use between 1987 and 1990 and assess the relationship of use to selected economic, need, and health system factors.

METHODS

Independent random-digit-dialed telephone surveys of women between 52 and 75 years of age were conducted.

RESULTS

Between 1987 and 1990, the proportion of women who had had a mammogram in the past year increased from 31% to 51%. Though income was significantly related to overall patterns of use, it was not associated with recent mammogram use in 1990. Women with a family history of breast cancer reported greater use at both times, as did women who reported having a regular physician (particularly a gynecologist or internist). When all other variables were controlled for, women were over nine times more likely to have had multiple and recent mammograms in 1990 than in 1987.

CONCLUSIONS

Mammography use dramatically increased between 1987 and 1990. There were strong relationships between the type of regular physician and mammography screening and between economic and personal history and repeated and recent mammography use.

The risk factors of age and family history and their relationship to screening mammography utilization

OBJECTIVE

To study the association of two well known risk factors for breast cancer and the association of knowledge of those risk factors with mammography utilization.

DESIGN

Cross sectional: two independent random telephone surveys.

SETTING

Two Northeastern metropolitan communities surveyed in 1987 and in 1989.

PARTICIPANTS

Women without breast cancer who spoke English and who were between 45 and 75 years of age.

MAIN OUTCOME MEASURES

The two risk factors measured were a family history of breast cancer and being 65 or older. Participants were surveyed about their knowledge of risk factors, presence of risk factors, selected beliefs, attitudes, reinforcing factors and mammography use. Results were analyzed for women 50-75.

RESULTS

There was a substantial increase in mammography use over the 2-year period. Having a positive family history or being older is not associated with increased mammography utilization. Knowledge that family history and/or age are risks is associated with increased utilization. However, knowledge of risk factors is not associated with having those risks. Older women have lower utilization than younger women regardless of their knowledge of age as a risk. Increased physician recommendation is associated with increased utilization.

CONCLUSION

Since knowing that a factor is a risk and having a physician recommend mammography are each associated with increased use, we conclude that the primary care physicians' role in increasing mammography utilization is critical.

Work-site nutrition intervention and employees' dietary habits: the Treatwell program

In a randomized, controlled study of the Treatwell work-site nutrition intervention program, which focused on promoting eating patterns low in fat and high in fiber, 16 work sites from Massachusetts and Rhode Island were recruited to participate and randomly assigned to either an intervention or a control condition. The intervention included direct education and environmental programming tailored to each work site; control work sites received no intervention. A cohort of workers randomly sampled from each site was surveyed both prior to and following the intervention. Dietary patterns were assessed using a semiquantitative food frequency questionnaire. Adjusting for work site, the decrease in mean dietary fat intake was 1.1% of total calories more in intervention sites than in control sites (P less than .005). Mean changes in dietary fiber intake between intervention and control sites did not differ. This study provides evidence that a work-site nutrition intervention program can effectively influence the dietary habits of workers.

Interval adherence to mammography screening guidelines

The objectives of this research were to document adherence to mammography screening guidelines among women over 50 years of age and to investigate factors related to adherence. Selected sociodemographic variables--personal breast health history, provider-related variables, and medical care utilization--were studied. Data were collected through a random digit dial telephone survey of 693 women from two geographic areas. While 48% had had a mammogram in the last year, only 20% reported at least two recent mammograms at yearly intervals. Adherence was significantly associated with having a higher income, being white, being 51 to 64 years old and having had breast symptoms and/or a family history of breast cancer. Additionally, women who had a regular physician, higher frequency of clinical breast examination, and a recent physician visit were more adherent. Women enrolled in Health Maintenance Organizations (HMOs) and/or covered by commercial plans were more adherent than women with no insurance or with entitlement coverage only. These relationships were generally maintained in multivariate analysis. While this study is consistent with others that demonstrate increasing adoption of mammographic screening, it also illustrates that the goal of regular screening according to guidelines has yet to be achieved.

Oxygen consumption and guanosine diphosphate binding by fetal brown adipose tissue in diabetic pregnancy

Oxygen consumption and 3H-guanosine diphosphate (GDP) binding were determined in brown adipocytes and mitochondria from 28-day gestation fetuses of alloxan-diabetic rabbit does and saline-injected controls. Maternal diabetes was classified as severe or mild determined by whether maternal blood glucose values were greater or less than 200 mg/dL, respectively, at death. Basal oxygen consumption and adipocyte diameters did not vary among groups. A significant reduction in maximal norepinephrine (NE) stimulated O2 consumption by fetal brown adipose tissue (BAT) cells was seen in offspring of severely diabetic pregnancies when compared with control values (248 +/- 53 +/- v482 +/- 32 microL O2/10(6) cells/h; P less than .005). In contrast, a significant increase in maximal NE-stimulated O2 consumption by fetal BAT cells occurred in offspring of mild diabetic pregnancies (807 +/- 60, P less than .001 v controls). A highly significant inverse correlation between serum glucose levels and maximal O2 consumption by fetal BAT was observed in fetuses from mild and severe diabetic pregnancies (r = -.98, P less than .005), and there was no correlation between these two parameters in offspring of normal pregnancies. A significant inverse correlation was observed between maximal O2 consumption by fetal BAT cells and serum insulin levels in offspring of both control and diabetic pregnancy (r = -.74; P less than .02). Tissue cytochrome oxidase activity was lower in offspring of severely affected diabetic does, indicating a reduction in BAT mitochondrial content compared with controls. BAT mitochondria from fetuses of severely diabetic does exhibited reduced 3H-GDP capacity, which was 2.5-fold lower than controls.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of vitamin C supplementation on blood and hair levels of cadmium, lead, and mercury

Fifty-two adult male subjects were randomly assigned to one of three possible treatment groups: supplemental ascorbic acid at one of two levels, 500 mg or 1000 mg, or a placebo. Hair and blood samples were taken before vitamin C or placebo supplementation was started and at monthly intervals thereafter for three months. Samples were analyzed for cadmium, lead, and mercury. Results indicate that vitamin C did not significantly affect levels of these metals in either hair or blood samples.

Scheuermann's disease or spinal osteochondrosis: its frequency and relationship with spondylosis

Spinal osteochondrosis, previously known as Scheuermann's disease and spinal osteochondritis, is common and is probably becoming increasingly prevalent. Its incidence in patients whose primary complaint was of backache was shown to be twice as great as that in the general population. There was also a significantly higher incidence of lower lumbar spondylosis in patients with previous osteochondrosis compared with those without. Osteochondrosis is thereby shown to be an important aetiological factor in spondylosis.