Emerging insights into peripartum cardiomyopathy

Peripartum cardiomyopathy (PPCM) is relatively common in the Hospital Albert Schweitzer (HAS) district of Haiti. This investigation was carried out to expand epidemiologic data aiming at identifying risk factors for PPCM in this population. The HAS District PPCM Registry with 74 PPCM patients, enrolled from 1 February 2000 to 1 September 2002, served to identify the PPCM patients involved in this study. Thirty-seven non-PPCM Haitian mothers from the HAS district served as controls in the case-control study I and 32 non-PPCM Haitian mothers from the HAS district served as controls for the case-control study II. Following informed consent, patients and controls participated in clinical examination, echocardiography, epidemiologic questionnaire interviews, and immunohaematologic testing. Findings revealed: increased parity in PPCM vs control mothers (4.6 vs 3.3, p = 0.0252); 47% of the PPCM mothers had their initial diagnosis with the 5th or more pregnancy; increased number of patients with some hospital prenatal care in PPCM vs control mothers (42% vs 0%, p = 0.00001); and increased valley unit PPCM vs control mothers with no formal schooling (54% vs 24%, p = 0.0054). However, when hill-unit controls were included, there was no statistical difference in this category. Taking drinking-water from the river was found in 11% of the valley PPCM mothers vs 0% of the valley control mothers (p = 0.0509). Although the first 59 PPCM cases identified came from the valley units, recent identification of PPCM mothers in the hill unit indicates similar incidence of PPCM in mothers of remote hill area compared to the valley mothers--approximately 1 per 350 to 400 livebirths. Although the cause of PPCM and reasons for increased incidence in the HAS district of Haiti remain unknown, initial data present emerging insights and avenues to pursue in subsequent studies.

A case of infectious tuberculosis on two long-haul aircraft flights: contact investigation

AIM

During a five-week period in 1996, a passenger with highly infectious tuberculosis travelled on five long-haul aircraft flights. We investigated passengers and crew on two of these flights to identify whether transmission of Mycobacterium tuberculosis had occurred.

METHODS

Crew and passengers were identified from airline and immigration records. Contacts were notified of their exposure and invited to attend their local public health clinic. At the clinic, a questionnaire was administered by a public health worker, and a Mantoux skin test was performed. When indicated, a second test was carried out twelve weeks later. Test positivity and conversion were defined according to the 1996 New Zealand tuberculosis control guidelines.

RESULTS

Data were obtained on 206 (87%) of the 238 contacts. Twenty four contacts had a positive Mantoux test result, four of which were conversions. All of these contacts had at least one other major risk factor for a positive result, such as a previous BCG vaccination (n=17) or having lived in a country in which tuberculosis is endemic (n=15). To our knowledge, no contacts have subsequently developed tuberculosis disease.

CONCLUSIONS

The investigation produced inconclusive evidence about the hypothesis that Mycobacterium tuberculosis was transmitted on one or both of these flights.

Use of hair dyes, hematopoietic neoplasms, and lymphomas: a literature review. II. Lymphomas and multiple myeloma

We review studies on hair dyes and lymphomas and multiple myeloma (MM). A computerized literature search for the years 1966 through 1996 was conducted. Data were extracted using a standardized form that recorded study design, study population, type of cases, comparison group, sources of data on personal exposure to hair dyes, method of data collection, type of exposure data collected, covariates, and results. This review identified 10 epidemiologic studies published in the English literature that examined personal use of hair dyes and lymphomas or MM. These studies include three evaluations of Hodgkin's disease, five of non-Hodgkin's lymphoma (NHL), two of lymphomas with type not specified, and six of MM. For Hodgkin's disease, one case-control study reported some positive associations with use of permanent hair dyes, whereas two cohort studies found no associations with ever use of hair dyes. For NHL and MM, several evaluations suggest associations with use of permanent dyes, particularly with duration, frequency, age at first use, and dark colors. However, these associations are not consistent within and between studies. For lymphomas with type not specified, one study was superseded by a more recent report with NHL specific data and a second study was limited by small numbers of exposed subjects. At this time, it is not possible to determine if the inconsistent associations between permanent hair dyes and NHL and MM reflect sampling variability or differences in methods between studies. Because an appreciable fraction of the population has potential exposure to permanent hair dyes, elucidation of such issues may be warranted with studies that include adequate numbers of exposed subjects and that elicit information on personal use of hair dyes over time.

Use of hair dyes, hematopoietic neoplasms, and lymphomas: a literature review. I. Leukemias and myelodysplastic syndromes

We review published epidemiologic studies on personal use of hair dyes and leukemias and myelodysplastic syndromes (MDS). A subsequent article will review studies on lymphomas and multiple myeloma. A computerized literature search for the years 1966 through 1996 was completed using MEDLINE. Data were extracted using a standardized form that recorded study design, study population, type of cases, comparison group, sources of data on personal exposure to hair dyes, method of data collection, type of exposure data collected, covariates, and results. The above search identified 13 epidemiologic studies on the possible association between personal use of hair dyes and leukemias and MDS. Although there are some reports of positive associations, overall the evidence linking personal use of hair dyes to various leukemia and MDS subgroups is weak. One cannot definitively rule out an association, however, because of the methodologic limitations, such as small numbers of exposed cases and lack of detailed exposure information. Any further research would need much better assessment of hair dye use, including product type, color frequency, duration, and changes in use over time, and adequate statistical power.

Comparison of serum, cerebrospinal fluid and brain extracellular fluid pharmacokinetics of lamotrigine

We investigated the rate of penetration into and the intra-relationship between the serum, cerebrospinal fluid (CSF) and regional brain extracellular fluid (bECF) compartments following systemic administration of lamotrigine in rat. The serum pharmacokinetics were biphasic with an initial distribution phase, (half-life approximately 3 h), and then a prolonged elimination phase of over 30 h. The serum pharmacokinetics were linear over the range 10 - 40 mg kg(-1). Using direct sampling of CSF with concomitant serum sampling, the calculated penetration half-time into CSF was 0.42+/-0.15 h. At equilibrium, the CSF to total serum concentration ratio (0.61+/-0.02) was greater than the free to total serum concentration (0.39+/-0.01). Using in vivo recovery corrected microdialysis sampling in frontal cortex and hippocampus with concomitant serum sampling, the calculated penetration half-time of lamotrigine into bECF, 0.51+/-0.11 h, was similar to that for CSF and was not area or dose dependent. At equilibrium, the bECF to total serum concentration ratio (0.40+/-0.04) was similar to the free to total serum concentration (0.39+/-0.01), and did not differ between hippocampus and frontal cortex. The species specific serum kinetics can explain the prolonged action of lamotrigine in rat seizure models. Lamotrigine has a relatively slow penetration into both CSF and bECF compartments compared with antiepileptic drugs used in acute seizures. Furthermore, the free serum drug concentration is not the sole contributor to the CSF compartment, and the CSF concentration is an overestimate of the bECF concentration of lamotrigine.

Transforming growth factor-beta isoform expression in mature human healthy and carious molar teeth

Transforming growth factor (TGF)-beta isoforms have been implicated in cellular signalling during tooth development and repair, but little is known of their cellular localisation or distribution within the dental tissues in the mature tooth. This study investigated the presence of TGF-beta1, beta2 and beta3 isoforms in tissues of sound and carious human molar teeth, to understand better the expression of TGF-betas during health and disease. In healthy tissues, odontoblasts, cells of the cell rich layer, pulpal fibroblasts and endothelial cells were stained to varying degrees for all isoforms, with TGF-beta3 showing the greatest intensity and TGF-beta1 the weakest intensity. Similar patterns of staining were observed in carious teeth; however, TGF-beta1 showed significantly increased staining intensity within odontoblasts and pulpal cells of carious teeth (p < 0.001). Biochemical analysis showed greater amounts of TGF-beta1 in tertiary dentine than in primary dentine samples. The expression of TGF-betas in odontoblasts and the increased presence of TGF-beta1 in tertiary dentine suggest that these isoforms may be important in odontoblast behaviour and the modulation of the tissue response to injury.

Acute pediatric digoxin ingestion

Although most acute pediatric ingestions of digoxin or other related cardiac glycosides result in minimal or no symptoms, occasionally a child is symptomatic. Gastrointestinal complaints or first-degree AV block are the most common presenting symptoms. Children can generally be given a single dose of activated charcoal, observed, and discharged without any subsequent problems. However, some patients will be toxic and require monitoring, medication, and possibly digoxin-specific antibody fragments. The most important role of the clinician is to recognize the clinical manifestations and institute the appropriate therapy. As in the case presented, the history of an ingestion may not always be obtained initially. Thus, the physician should maintain a high index of suspicion for acute digoxin ingestion and order the appropriate confirmatory tests (eg, a digoxin level, a potassium level, and a 12-lead ECG) when necessary.

Attaining health for all through community partnerships: principles of the census-based, impact-oriented (CBIO) approach to primary health care developed in Bolivia, South America

This article describes a flexible primary health care methodology which was developed by Andean Rural Health Care and its colleagues in Bolivia, South America. This methodology, the census-based, impact-oriented (CBIO) approach to primary health care, involves determining local health priorities as defined both by locally acquired epidemiologic information and by the local people themselves. The CBIO approach to primary health care is now functioning successfully at seven program sites in Bolivia, which together serve 75,000 people in urban and rural communities in three distinct cultural and ecological regions of the country. High levels of coverage of basic health services can be achieved through a system of 'epidemographic' surveillance of all families and through home delivery, when needed, of priority services to those at risk. When the services provided are based on local health priorities, when they are provided in a technically effective manner, and when the community has a strong partnership in planning, implementation and evaluation, then the CBIO approach to primary health care will lead to measurable health improvements as defined by changes in population-based rates of mortality and illness in the community. On the basis of our experience, we believe that the CBIO approach offers great potential for strengthening the effectiveness of local health programs in impoverished communities around the world in a way which fosters community ownership and, hence, long-term sustainability.

Halothane as a neuroprotectant during constant stimulation of the perforant path

PURPOSE

To determine the neuroprotective effects of halothane during constant stimulation of the perforant path.

METHODS

Male Sprague-Dawley rats had electrodes implanted into the perforant path and dentate granule cell layer under halothane anaesthesia (1-2% in oxygen). They were then divided into four groups. In group 1 (n = 9), the perforant path was stimulated at 20 Hz for 2 h under halothane anaesthesia (1-2%). In group 2 (n = 3), the animals were unstimulated but maintained under halothane anaesthesia (1-2%) for 2 h with the electrodes in place. Both groups 1 and 2 had the electrodes removed and were then allowed to recover fully from the anaesthetic. In groups 3 and 4, the electrodes were held in place with dental acrylic. Both of these groups were allowed to recover fully from anaesthesia. In group 3 (n = 3), 24-48 h after recovery from anaesthesia, the perforant path was stimulated at 20 Hz for 2 h. Group 4 (n = 3) received no stimulation. After 14-17 days, the rats were killed, and morphometry and cell counts were performed on the hippocampi from rats in groups 1 and 2.

RESULTS

Cell densities were not significantly different between control (group 2), unstimulated rats, and animals stimulated under halothane anaesthesia (group 1). Stimulation in the unanaesthetised rats resulted in severe neuronal loss in hilus, CA1, and CA3.

CONCLUSIONS

Halothane protects hippocampal neurons against damage induced by constant stimulation of the perforant path.

Occult pneumonias: empiric chest radiographs in febrile children with leukocytosis

STUDY OBJECTIVE

We sought to determine the incidence of radiographic findings of pneumonia in highly febrile children with leukocytosis and no clinical evidence of pneumonia or other major infectious source.

METHODS

We conducted a prospective cohort study at a large urban pediatric hospital. Clinical practice guidelines for the use of chest radiography in febrile children were established by the emergency medicine attending staff. All records of emergency department patients with leukocytosis (WBC count >/= 20, 000/mm3), triage temperature 39.0 degreesC or higher, age 5 years or less were reviewed daily for 12 months. Physicians completed a questionnaire to note the diagnosis, the presence of respiratory symptoms and signs, and the reason for the chest radiograph (if one was obtained). Patients were excluded for immunodeficiency, chronic lung disease, or major bacterial sources of infection other than pneumonia. Pneumonia was defined by an attending radiologist's reading of the radiograph.

RESULTS

We studied 278 patients. Chest radiographs were obtained in 225 for the following reasons: 79 because of respiratory findings suggestive of pneumonia and 146 because of leukocytosis and no identifiable major source of infection. Fifty-three patients did not undergo radiography. Pneumonia was found in 32 of 79 (40%; 95% confidence interval, 20% to 52%) of those with findings suggestive of pneumonia and in 38 of 146 (26%; 95% confidence interval, 19% to 34%) of those without clinical evidence of pneumonia. If patients who did not have a radiograph are assumed to not have pneumonia, the minimum estimate of occult pneumonia was 38 of 199 patients (19%; 95% confidence interval, 14% to 25%).

CONCLUSION

Empiric chest radiographs in highly febrile children with leukocytosis and no findings of pneumonia frequently reveal occult pneumonias. Chest radiography should be considered a routine diagnostic test in children with a temperature of 39 degreesC or greater and WBC count of 20,000/mm3 or greater without an alternative major source of infection.

A comprehensive assessment of the quality of immunization services in one major area of Dhaka City, Bangladesh

This report assesses the quality of service inputs, service processes and service outcomes (with the exception of coverage and effectiveness) for immunization services in Zone 3 of Dhaka City. The results indicate that in general, the providers of immunization services are knowledgeable, friendly and give technically appropriate immunizations. Client ratings of the quality of services are quite good. Access is 90% for childhood immunizations and 89% for tetanus toxoid (TT) immunizations for women with a child < 1 year old. Three areas were identified as needing attention: frequently missed opportunities for the promotion or provision of immunizations; uneven distribution and utilization of immunization sites, and some fundamental weaknesses of the TT immunization programme (lack of awareness among women of reproductive age about the importance of TT immunization, low access to it among women of reproductive age who do not have a child < 1 year of age, and confusion among women and service providers about the purpose of TT immunization and the dosage schedule). Efforts to monitor and strengthen the quality of EPI activities will facilitate further decline in the numbers of deaths and illnesses from vaccine-preventable diseases. The approaches used in this study and the typology for quality assessment are widely applicable elsewhere.

The census-based, impact-oriented approach: its effectiveness in promoting child health in Bolivia

This paper describes the effectiveness for child health of a primary health care approach developed in Bolivia by Andean Rural Health Care and its colleagues, the census-based, impact-oriented (CBIO) approach. Here, we describe selected achievements, including child survival service coverage, mortality impact, and the level of resources required to attain these results. As a result of first identifying the entire programme population through visits at least biannually to all homes and then targeting selected high-impact services to those at highest risk of death, the mortality levels of children under five years of age in the established programme areas was one-third to one-half of mortality levels in comparison areas. Card-documented coverage for the complete series of all the standard six childhood immunizations among children 12-23 months of age was 78%, and card-documented coverage for three nutritional monitorings during the previous 12 months among the same group of children was 80%. Coverage rates in comparison areas for similar services was less than 21%. The local annual recurring cost of this approach was US $8.57 for each person (of all ages) in the programme population. This cost includes the provision of primary care services for all age groups as well as targeted child survival services. This cost is well within the affordable range for many, if not most, developing countries. Manpower costs for field staff in Bolivia are relatively high, so in countries with lower salary scales, the overall recurring cost could be substantially less. An Expert Review Panel reviewed the CBIO approach and found it to be worthy of replication, particularly if stronger community involvement and greater reliance on volunteer or minimally paid staff could be attained. The results of this approach are sufficiently promising to merit implementation and evaluation in other sites, including sites beyond Bolivia.

Tetanus toxoid immunization coverage among women in zone 3 of Dhaka city: the challenge of reaching all women of reproductive age in urban Bangladesh

Neonatal tetanus is still an important public health problem in both urban and rural Bangladesh, with an estimated 41,000 cases occurring annually. This article analyses the coverage of tetanus toxoid (TT) immunizations among women of reproductive age in Zone 3 of Dhaka City in 1995. Although 85% of women with a child under 1 year of age had received two TT immunizations, only 11% of women of reproductive age had obtained the complete series of five TT immunizations and only 52% of women of reproductive age had received one or more TT immunizations. Access to TT immunization, as defined by having had at least one such immunization, was lower among women aged over 30 years and also among those aged under 20 years, especially those who were not yet married or who had not yet become pregnant. Characteristics associated with TT immunization status included the following: educational level of the woman, distance from the nearest immunization centre, and level of contact with family planning field workers. Additional characteristics that influenced women's TT immunization status included age, marital and working status, recency of migration from rural to urban area, and number of children. The relationships were complex and varied depending on the number of TT immunizations received (one or two) and on the type of analysis being carried out (bivariate or multivariate). The findings point to the need for a broad-based campaign to promote access to TT immunization as well as to promote the completion of all five TT doses in Bangladesh. Reducing missed opportunities for promotion of immunization as well as targeting home visitation of women in need of additional immunizations constitute further approaches to improving coverage. Although TT coverage rates were only marginally lower among women in slum households, such women were more likely than those in non-slum households to be pregnant and hence more likely to bear a baby at risk of neonatal tetanus. Furthermore, the environment of slum households, where deliveries normally take place, is more conducive to the development of neonatal tetanus among unprotected neonates; a strategy of focusing on slum households is therefore also needed.

The importance of ion channels for macrophage and microglial activation in vitro

Microglia, the resident macrophages of the central nervous system (CNS), are activated rapidly in response to neuronal injury. In the search for factors which regulate inflammation resulting from pathology in the CNS, it is logical to focus on changes in the local environment which occur following neuronal death. These include transient alterations in transmembrane ion gradients. Electrophysiological studies have provided information on the range of ion channels expressed by macrophages and microglia in vitro. The purpose of this study was to focus on the biology of macrophages and the role ion channels play in determining their activity. We show that potassium channels are unlikely to be involved in the generation of nitric oxide by activated macrophages and microglial cell lines in vitro. Chloride channels are more likely to contribute to this response. Our results question the functional importance of the observed differences between the potassium channel expression in vitro of macrophages and microglia.

Childhood immunization coverage in zone 3 of Dhaka City: the challenge of reaching impoverished households in urban Bangladesh

A household survey of 651 children aged 12-23 months in Zone 3 of Dhaka City carried out in 1995 revealed that 51% of them had fully completed the series of childhood immunizations. Immunization coverage in slum households was only half that in non-slum households. Apart from residence in a slum household, other characteristics strongly associated with the completion of the entire series of childhood immunizations included the following: educational level of the mother, number of children in the family household, mother's employment status, distance from the nearest immunization site, and number of home visits from family-planning field workers. The findings point to the need to improve childhood immunization promotion and service delivery among slum populations. Two promising strategies for improving coverage are to reduce the number of missed opportunities for immunization promotion during encounters between health workers and clients, and to identify through visits to households those children who need additional immunizations. In the long run, increasing the educational level of women will provide a strong stimulus for improving childhood immunization coverage in the population.

Dietary habits, pregnancy weight gain and birthweights in a highland population of Kenya

In a prospective study of the effects of micro-nutrient supplementation during pregnancy in a cohort of healthy, non-anaemic antenatal outpatients of a small hospital in highland Kenya, research was also carried out on dietary habits, weight gain and birth-weights. Participants were enrolled at a mean gestation of 29 weeks (s.d.2.37). Special consideration was given to the dietary intake of the micronutrients most important to erythropoiesis, namely iron, folate and vitamin C (the main promotor of iron absorption). It was found that 74% consumed an inferior diet with regard to these micronutrients. The mean birth-weight of infants born to participants was 3178 grams (s.d. 398 grams). Only two variables were found to be significantly associated with birth-weight; mothers' weight gain on enrollment and mothers' weight gain during one month of the last trimester (p < 0.05). It appears that the dietary intake during pregnancy in this population was lacking in important micronutrients, and it is recommended that antenatal clinics prioritise nutrition education during pregnancy.

A comparative study of fluoride-releasing composite resin and glass ionomer materials used as fissure sealants

OBJECTIVES

The objectives of the study were to investigate the clinical use of two fluoride-releasing fissure sealants and to study fluoride release under laboratory conditions.

METHODS

In the clinical part of the study the two materials, FluroShield and Baseline, were applied to matched contralateral caries-free first permanent molars in 86 children aged 7-8 years. In the laboratory study fluoride release from each material was measured using a model cavity system.

RESULTS

After 3 years FluroShield was intact on 70% of teeth. Retention was significantly better on lower molars than upper molars. Baseline was lost from all except two teeth within 6 months. After 3 years, caries had affected four teeth sealed with FluroShield and 24 teeth sealed with Baseline; this difference was highly significant. The laboratory study showed that FluroShield released twice as much fluoride over 9 days than did Baseline. Long term studies using FluroShield showed a small steady fluoride release over 6 months.

CONCLUSIONS

The conclusion of the study was that FluroShield was a much more effective fissure sealant than Baseline. The clinical performance of FluroShield was comparable to that of other inert composite resin sealants and superior to that of fluoride-releasing sealants used previously.

An alternative explanation for the apparent elevated relative mortality and morbidity risks associated with exposure to environmental tobacco smoke

Insofar as industrial and other blue collar workers are more likely to bring home toxic materials on their person, and also are more likely to smoke than those in other occupations, members of a household are more likely to be subject to paraoccupational exposure and belong to lower socioeconomic strata if the household contains a smoker than if the household does not contain a smoker. Thus observed differences in risk of mortality or morbidity ascribed to ETS on the basis of a comparison of households with and without smokers may be partly or entirely due to differences in paraoccupational exposure and socioeconomic strata. Similarly, differences in mortality and morbidity ascribed to paraoccupational exposure may be partly or entirely due to differences in ETS exposure that are also related to social class and to types of occupation. Unfortunately, there are no data now in existence that could help determine separately the effects of these major confounded variables. There exists, then, a situation in which two explanations are advanced for respiratory diseases among members of a household, each based on similar study populations but focused on different major risk variables: ETS on the one hand, socioeconomic status and paraoccupational exposure on the other. Properly focused investigations need to be initiated.

The human archain gene, ARCN1, has highly conserved homologs in rice and Drosophila

A novel human gene, ARCN1, has been identified in chromosome band 11q23.3. It maps approximately 50 kb telomeric to MLL, a gene that is disrupted in a number of leukemia-associated translocation chromosomes. cDNA clones representing ARCN1 hybridize to 4-kb mRNA species present in all tissues tested. Sequencing of cDNAs suggests that at least two forms of mRNA with alternative 5' ends are present within the cell. The mRNA with the longest open reading frame gives rise to a protein of 57 kDa. Although the sequence reported is novel, remarkable similarity is observed with two predicted protein sequences from partial DNA sequences generated by rice (Oryza sativa) and fruit fly (Drosophila melanogaster) genome projects. The degree of sequence conservation is comparable to that observed for highly conserved structural proteins, such as heat shock protein HSP70, and is greater than that of gamma-tubulin and heat shock protein HSP60. A more distant relationship to the group of clathrin-associated proteins suggests a possible role in vesicle structure or trafficking. In view of its ancient pedigree and a potential involvement in cellular architecture, we propose that the ARCN1 protein be named archain.

Reactionary dentinogenesis

Reactionary dentinogenesis is the secretion of a tertiary dentine matrix by surviving odontoblast cells in response to an appropriate stimulus. Whilst this stimulus may be exogenous in nature, it may also be from endogenous tissue components released from the matrix during pathological processes. Implantation of isolated dentine extracellular matrix components in unexposed cavities of ferret teeth led to stimulation of underlying odontoblasts and a response of reactionary dentinogenesis. Affinity chromatography of the active components prior to implantation and assay for growth factors indicated that this material contained significant amounts of TGF-beta 1, a growth factor previously shown to influence odontoblast differentiation and secretory behavior. Reactionary dentinogenesis during dental caries probably results from solubilization of growth factors, TGF-beta in particular, from the dentine matrix which then are responsible for initiating the stimulatory effect on the odontoblasts. Compositional differences in tertiary dentine matrices beneath carious lesions in human teeth have also been shown indicating modulation of odontoblast secretion during reactionary and reparative dentinogenesis.

Perceived risk of cancer and practice of cancer prevention behaviors among employees in an oncology center

METHODS

A survey of oncology center employees was conducted to determine those factors associated with perceived risk of cancer and compliance with preventive care guidelines. Five hundred six employees participated in the survey.

RESULTS

The average perceived absolute risk of developing cancer in the next 20 years was 29%. Perceived risk for cancer was higher among women than men. Among men, only current smoking and duration of employment, adjusting for age, were significantly associated with the perceived risk of developing cancer. For women, in addition to smoking, personal experience with cancer among family and friends and perceived health status were significantly associated with the perceived risk of cancer. The practice of cancer preventive behaviors was unrelated to personal risk perception. Less than one-fourth of participants age 40 years and older had a sigmoidoscopy in the last 3 years and less than one-third reported having had their stool checked for blood. The majority of women had a pap smear in the past 10 years; 89% had a pap smear in the past 3 years. Eighty-eight percent of women over 40 and 94% of women over 50 had ever had a mammogram; the majority of these women had had mammograms in the past two years.

CONCLUSION

Perceived risk of developing cancer was significantly higher than in projected probabilities based on the incidence of cancer in the United States. Despite the high perceived risk of developing cancer, the practice of colon cancer screening was low. Factors other than perception of personal risk of cancer may be important in encouraging participation in screening programs.