Smoking status, reading level, and knowledge of tobacco effects among low-income pregnant women.

BACKGROUND: Smoking during pregnancy increases the health risks of the unborn child as well as the mother. Although smoking rates for the population as a whole have declined drastically in the past generation, since 1992 there has been an increase in smoking among women, teenagers, and adults living in poverty. The purpose of this study was to assess reading level, tobacco knowledge, attitudes, and practices of tobacco use among pregnant adult and adolescent women in the public health system in north Louisiana. METHODS: A convenience sample of 600 pregnant women was interviewed in person in the Obstetrics Clinics at Louisiana State University Health Sciences Center at Shreveport and E.A. Conway in Monroe. The structured interview contained detailed questions about smoking practices, tobacco knowledge, and attitudes. Reading was assessed using the Rapid Estimate of Adult Literacy in Medicine. Smoking practices were assessed by self-report and verified by measuring urine cotinine levels. The Cochran-Mantel-Haenszel test was used to estimate the relationship between reading level and knowledge and attitude; multiple logistic regression was used to determine which variable(s) predicted current smoking practices. RESULTS: Knowledge about the effects of smoking and concern about the health effect of smoking on their baby varied significantly by reading level, with participants with higher reading levels having more knowledge and greater concern. Smoking practices did not vary by reading level even when race, age, and living with a smoker were controlled. Race was a significant determinant of smoking practices, with more white women reporting currently smoking during pregnancy than African Americans (34% vs 8%). CONCLUSIONS: Reading level was related to knowledge about health effects of smoking. Women with higher reading levels were also more concerned about the adverse health effects of smoking on themselves and their babies. However, reading level was not correlated with smoking prevalence. The most significant determinant of smoking was race (with whites smoking significantly more than African Americans).

Expression of platelet-derived growth factor-A mRNA in human placenta: effect of magnesium infusion in pre-eclampsia.

The expression of platelet-derived growth factor-A (PDGF-A) mRNA was examined in the cotyledons of normal human placentae and those from patients with pre-eclampsia. These patients exhibited pre-delivery blood pressure of 154+/-4/99+/-4 mmHg (mean+/-SEM) and met the criteria established for pre-eclampsia. During labour they received MgSO4 infusion for various time intervals (4-25 h). The PDGF-A message was quantitated to beta-actin by the solution hybridization nuclease protection assay. Since the two groups differed in two parameters (pre-eclampsia and MgSO4 treatment), the direct comparison was not feasible. An analysis of covariance revealed a significant difference in the message between the pre-eclamptic and control groups (P<0.01); the gestational age was not a significant covariate for either group but the time on MgSO4 in pre-eclampsia group was significant (P<0.002). A linear regression analysis of PDGF-A mRNA values for the pre-eclamptic group showed a time-dependent downregulation of the message by MgSO4 (P<0.01, r=- 0.796). These results show a uniform expression of PDGF-A mRNA in cotyledons of normal human placenta between 35 and 40 weeks of gestation. Furthermore, MgSO4 has an inhibitory effect on the expression of this message which may have aside from its anticonvulsive action beneficial effect on the function of pre-eclamptic placenta.

Intervention to increase mammography utilization in a public hospital.

OBJECTIVE: To study the effects of three approaches to increasing utilization of screening mammography in a public hospital setting in Northwest Louisiana. DESIGN: Randomized intervention study. POPULATION: Four hundred forty-five women aged 40 years and over, predominantly low-income and with low literacy skills, who had not had a mammogram in the preceding year. INTERVENTION: All interventions were chosen to motivate women to get a mammogram. Group 1 received a personal recommendation from one of the investigators. Group 2 received the recommendation plus an easy-to-read National Cancer Institute (NCI) brochure. Group 3 received the recommendation, the brochure, and a 12-minute interactive educational and motivational program, including a soap-opera-style video, developed in collaboration with women from the target population. MEASUREMENTS AND MAIN RESULTS: Mammography utilization was determined at 6 months and 2 years after intervention. A significant increase (p = .05) in mammography utilization was observed after the intervention designed in collaboration with patients (29%) as compared with recommendation alone (21%) or recommendation with brochure (18%) at 6 months. However, at 2 years the difference favoring the custom-made intervention was no longer significant. CONCLUSIONS: At 6 months there was at least a 30% increase in the mammography utilization rate in the group receiving the intervention designed in collaboration with patients as compared with those receiving the recommendation alone or recommendation with brochure. Giving patients an easy-to-read NCI brochure and a personal recommendation was no more effective than giving them a recommendation alone, suggesting that simply providing women in a public hospital with a low-literacy-level, culturally appropriate brochure is not sufficient to increase screening mammography rates. In a multivariate analysis, the only significant predictor of mammography use at 6 months was the custom-made intervention.

Surgical and nonsurgical management of primary and metastatic liver tumors.

The medical records of 267 patients who had liver tumors, primary and metastatic, from 1988 to 1995 were retrospectively reviewed. Two hundred thirteen patients (80%) had metastatic disease, and 54 patients (20%) had primary liver disease. Their clinical manifestations and laboratory values were evaluated as factors predictive of diagnosis and survival. There was a significant increase in the occurrence of upper abdominal pain, weight loss, extrahepatic symptoms due to the metastatic origin, and hepatomegaly. Metastases from colorectal primary lesions were synchronous in 34 patients and metachronous in 31 patients. Stomach, lung, and pancreatic primaries were more commonly synchronous. Breast metastases were more commonly metachronous. Elevated serum glutamic-oxaloecetic transaminase and alkaline phosphatase and decreased albumin were the most common liver test abnormalities at diagnosis. Carcinoembryonic antigen values were elevated in the majority of colon cancer patients. Eighty-one percent of patients with primary liver cancer had elevated levels of alpha-fetoprotein, 40 per cent were seropositive for hepatitis B, and 23 per cent were seropositive for hepatitis C. Seventy-nine patients (30%) underwent surgery for their cancer, 37 (47%) had resections, 38 (48%) were unresectable, and 4 (5%) underwent liver transplantation. The patients who underwent surgery had a 32 per cent 5-year survival rate compared to a 0 per cent 5-year survival in the patients who did not have surgery (p = 0.0001). The patients who had resections had a better survival rate than those deemed unresectable at surgery (62% versus 0% at 5-years with p = 0.0008). The perioperative morbidity rate was 16 per cent, with lobectomies having the best rate and trisegmentectomies having the worst. Perioperative mortality rate was zero for all liver resections. Hepatic resection and, in selected patients, liver transplantation are the only two available therapeutic modalities that produce long-term survival with a possible cure in patients with primary and metastatic liver tumor.

Suspected biliary complications after laparoscopic and open cholecystectomy leading to endoscopic cholangiography: a retrospective comparison.

To study how suspected postoperative biliary complications are influenced by surgical technique, we compared clinical profiles of 63 patients referred for ERCP after open (OC) and laparoscopic cholecystectomy (LC) over a four-year period. ERCP was not performed for postoperative pain alone and only six (9.5%) studies were normal. Referrals after LC were younger (mean 39.1 vs 53.6 years, P < 0.001) and ERCP was requested earlier (mean 71.6 vs 2360 days, P < 0.001) in the postoperative course. Choledocholithiasis (CDL) alone, the most common finding, was successfully managed with a single ERCP in 97.2% of cases. CDL after LC occurred in younger patients (35.5 vs 58.9 years, P < 0.01) who presented earlier (mean 98.6 days vs 5.1 years, P < 0.01), without biliary ductal dilatation (P < 0.01). Although CDL after LC was associated with higher ALT and bilirubin levels than after OC, the difference was not statistically significant. Cystic duct leaks (LC: six patients, OC: four patients) were typically associated with CDL after OC and 90% resolved with endoscopic therapy. Biliary ligation (four cases) was managed successfully with choledochojejunostomy. We conclude that findings at ERCP for suspected biliary obstruction or injury after OC or LC are similar and usually can be endoscopically managed. After LC, referrals currently are younger, present much earlier, and retained stones are less likely to be associated with ductal dilatation than after OC.

NADH-methemoglobin reductase (cytochrome b5 reductase) levels in two groups of American blacks and whites.

BACKGROUND: Sickle cell trait, glucose-6-phosphate dehydrogenase (G6PD) deficiency and alpha-thalassemia trait are common genetic abnormalities among the American Black population. Under oxidative stress, the presence of any of these conditions would predispose the hemoglobin (Hb) to oxidation resulting in accelerated methemoglobin (metHb) formation. It was hypothesized that red cells phenotypic for these genetic variants should have more or different levels of metHb reductase (cytochrome b5 reductase) activity. METHODS: To test this hypothesis, we measured the red cell metHb reductase activity in 558 male subjects (316 Blacks and 242 Whites), by the procedure described by Beutler. All Black patients also had G6PD spot test and Hb electrophoresis. In addition, all patients had a complete blood count (CBC). If the hematocrit was < 35% a reticulocyte count was also done. Patients with corrected reticulocyte (retic count X hematocrit/45) index over 2% were excluded regardless of other findings. RESULTS: The results showed that Blacks had different metHb reductase activity levels than Whites (mean = 3.19 vs 2.89 IU/gHb, respectively with p = 0.03). However, the differences in metHb reductase activities in patients with sickle cell trait, G6PD deficiency, and low MCV < 80 micron3 (presumptively having alpha-thalassemia) in small subgroups did not reach statistical significance (p = 0.2), although, all 3 groups were comprised of small numbers. CONCLUSIONS: It is concluded that American Blacks have significantly different metHb reductase activity. The different metHb reductase activity in Blacks seems to be unrelated to the presence of G6PD deficiency, sickle cell trait, or alpha-thalassemia and it may be the result of genetic polymorphism. However, our study samples do not exactly represent the cross-sections of the Black and White populations. In addition, all patients were male in this study. Therefore, this study should be confirmed using larger and more population-representative samples. The clinical significance of this problem is not clear at this time.

Tobacco use among male high school athletes.

PURPOSE: The purpose of this study was to compare tobacco use among high school male athletes with their nonathlete counterparts. We hypothesized that there was an inverse correlation between the intensity level of the sport and frequency of tobacco use. METHODS: Students were surveyed at seven high schools in northwest Louisiana using a 109-item questionnaire. Of the 1,200 males tested, 83% participated in one or more sports. The mean age was 15.8, and mean grade level was 10th. Sixty-seven percent were white, 27% African-American (AA), and 6% other. RESULTS: Forty-one percent of the adolescent males tested were one or more tobacco products, 31% reported cigarette smoking, 21% chewed tobacco, and 18% used snuff. Eleven percent reported using all three tobacco products. Race was a significant determinant of tobacco use, with whites being more likely to use each of the three tobacco products (P < .001). Medium- and high-intensity athletes were significantly (P < .01) less likely to be heavy smokers than athletes participating in low-intensity sports and nonathletes. However, athletes of each intensity sport used chewing tobacco and snuff at significantly higher rates (P < .001) than nonathletes. When race and grade point average were controlled, sports intensity was a significant predictor of smokeless tobacco use but not overall smoking behavior. Both AA and white high school male athletes at all sport intensity levels were using chewing tobacco and snuff at a rate higher at least 1.5 times that of their nonathlete counterparts. CONCLUSIONS: In our study, high school males' sports participation was a predictor of smokeless tobacco use but not overall smoking behavior. Although the probability of AA high school athletes using smokeless tobacco was low compared to whites, the pattern of use was similar across intensity levels of sports.

Detection of the proto-oncogene eIF4E in surgical margins may predict recurrence in head and neck cancer.

Head and neck squamous cell cancers (HNSCC) have a high local recurrence rate due to incomplete tumor resection. The use of molecular markers to establish surgical margins may decrease local recurrence. Surgical margins are determined by histopathologic analysis on frozen sections. We postulate that genetic and molecular changes precede gross histologic alterations. Tumor markers may improve the reliability of pathology examination, but those evaluated to date lack the sensitivity needed for routine clinical use. Western blot analysis showed elevated eIF4E in all 26 HNSCC in contrast to its low expression in benign lesions. Surgical margins were analysed for eIF4E in 23 patients. Twelve patients showed elevated eIF4E in histologically negative margins. Cancer has recurred in 5 of the 12 patients as opposed to none of the 11 patients with eIF4E negative margins (P= 0.02, Log rank test). This is the first report of eIF4E in HNSCC, as a sensitive and specific marker for HNSCC, with potential for defining clear resection margins. The correlation between elevated levels of eIF4E at the margins and recurrence highlights its ability to detect malignant cells prior to clear-cut alterations in morphology. The accuracy and simplicity of these assays underscore the usefulness of eIF4E in managing HNSCC.

Literacy in patients with a chronic disease: systemic lupus erythematosus and the reading level of patient education materials.

OBJECTIVE: (1) To assess literacy in a sample of patients with systemic lupus erythematosus (SLE); (2) to evaluate the reading level of patient education materials specific to SLE; and (3) to compare patient literacy levels to the readability of materials written for patients with SLE. METHODS: Rapid Estimate of Adult Literacy in Medicine, a reading recognition test, was given to 94 patients with SLE. Socioeconomic status was assessed using Nam-Powers. Patient education materials frequently used with these patients were assessed for readability grade level. RESULTS: The patients with SLE were reading on an average 7th-8th grade level; their average educational level (last grade completed in school) was 11.9. The average socioeconomic status (SES) according to the Nam-Powers assessment was 43, indicating high school completed, no college, an income range of $5000-$10,000, and occupations such as household workers and laborers. Multiple linear regression revealed that race and education correlated with reading (p < 0.001), but age, sex, and SES did not. The readability of surveyed SLE patient education materials ranged from 7th-15th grade level. Eighty-nine percent were written at a 9th grade level or above and were therefore inappropriate for about half the patients surveyed. CONCLUSION: Reading skills below high school level existed for 48% of patients surveyed, yet only 11% of SLE patient education materials were written below a 9th grade level. Current SLE patient education materials are written on too high a level for many patients. Identifying patients with low literacy may help provide more appropriate patient education and better medical care.

Knowledge and attitude on screening mammography among low-literate, low-income women.

BACKGROUND: Low-income women utilize screening mammography less frequently, present at more advanced stages of disease, and have higher breast cancer mortality rates then women with higher incomes. The purpose of this study was to examine the relationship of reading ability to the knowledge and attitudes that low-income women have regarding screening mammography. METHODS: A convenience sample of 445 women were interviewed for this study. These women, age 40 years and older, had not had a mammogram in the past year. They were waiting to see a doctor in one of two outpatient clinics at Louisiana State University Medical Center in Shreveport when they were interviewed. A structured questionnaire assessed mammography knowledge and attitudes. Each patient's reading ability was assessed with the Rapid Estimate of Adult Literacy in Medicine (REALM). RESULTS: The women interviewed had a mean age of 56 years. Sixty-nine percent were African American, and 97% lived in households with annual incomes of less than $20,000. On the average, the highest grade completed in school was tenth grade. The average reading level was fourth to sixth grade, with 76% reading below a 9th-grade level. Lower reading ability correlated significantly with less mammography knowledge (P < 0.0001). A lack of accurate information about mammography was prevalent among low-level readers. Thirty-nine percent of women reading at or below a third-grade level did not know why women are given mammograms, compared with 12% of those reading at or above a ninth-grade level. Cost was a great concern in general, but cost concerns did not vary by reading level; 41% of all participants were very concerned about cost. CONCLUSIONS: Limited literacy skills and lack of knowledge about screening mammography may contribute considerably to the underutilization of screening mammograms in low-income women. Screening for reading level may identify a subset of low-income patients who could benefit from specialized education. These results could help guide effective educational interventions and better provider-patient communication about screening mammography for low-literate, low-income women.

Metastatic disease in the cerebellum. The LSU experience in 1981-1993.

We retrospectively determined the outcome of management of metastatic disease in the cerebellum (MDC) in 45 patients because MDC is considered to be more immediately life-threatening than metastases in other intracranial locations. Treatment consisted of tumor resection and radiotherapy (RR; n = 11) or of radiotherapy alone (RA; n = 34). Significant differences in the median survival (15 months for RR and 3 months for RA, p = 0.005) and in survival rates at 1 year (61 +/- 30% for RR and 9 +/- 10% for RA, p < 0.001) and at 2 years (15 +/- 22% for RR and 0% for RA, p < 0.05) were noted. This combined management program of surgery followed by radiotherapy for MDC produced a worthwhile gain in survival.

Flexible fiberoptic rhinoscopy in the diagnosis of nasal polyps in cystic fibrosis.

The incidence of nasal polyps in patients with CF in various studies varies from 6.7% to 48%. Fiberoptic rhinoscopy, a safe and minimally invasive diagnostic procedure, has the major advantage over routine physical examination of the nares because of the ability to examine the nose beyond the nasal vestibule. In examinations of both nostrils of 34 patients with CF age 4-30 years, nasal polyps were detected by rhinoscopic examination, but missed by physical examination in 17 (25%) of the nostrils. In 7% (5/64) of the nostrils in this series, rhinoscopy ruled out polyps that were reportedly identified on physician examination. This study confirms that even a careful physical examination of the nose is often inadequate to uncover significant nasal pathology such as nasal polyps.

Dose-response study and threshold estimation of griseofulvin-induced aneuploidy during female mouse meiosis I and II.

The relative sensitivity of the two meiotic divisions of mouse oogenesis to griseofulvin (GF)-induced aneuploidy was investigated. The first meiotic division was studied by administering GF 4 h after human chorionic gonadotrophin (HCG) injection and analyzing metaphase II (MII) oocytes, whereas study of the second meiotic division involved treating the females 10 h after HCG and analyzing one-cell (1-Cl) zygotes. Data from previous studies have shown that these treatment times represented the most sensitive times for aneuploidy induction during meioses I and II. The statistical analyses of the data showed that the dose-response curves for aneuploidy induction did not differ quantitatively or qualitatively between the two meiotic divisions. The percentages of hyperploid MII oocytes and 1-Cl zygotes were significantly higher (P < 0.001) than in the controls for all doses except 125 mg/kg GF. The highest percentages of hyperploid cells were found after administering 1500 mg/kg GF. However, these percentages were not different (P > 0.05) from those observed after 500 or 1000 mg/kg GF, suggesting saturation of the GF aneuploid target(s). These results suggest that the relative sensitivity to GF-induced aneuploidy between the two meiotic divisions of oogenesis are similar. They also suggest the presence of a lower (125 mg/kg) and an upper 500 mg/kg) threshold for GF-induced aneuploidy.

Laparoscopic tubal sterilization in obese women: experience from a teaching institution.

To determine whether laparoscopy presents any significant risks for tubal sterilization in obese women, we retrospectively reviewed the records of 248 consecutive patients who had laparoscopic tubal sterilization between January and December 1991 at our institution. The 147 obese women were compared with the 101 nonobese women as controls for the study parameters. Two methods of closed laparoscopy were used as interval procedures, with similar proportions in obese and nonobese women. We observed no complications in any patient, and there were not significant differences in the mean operating time and estimated blood loss between the two groups of women. We concluded that laparoscopy should be considered safe and laparoscopic tubal sterilization can be performed in obese women with the same efficiency, morbidity rate, and length of hospitalization as in nonobese women.

Sellar emptiness on routine magnetic resonance imaging.

Magnetic resonance imaging (MRI) has provided a clear view of the sella turcica and the pituitary gland, even on "routine" procedures that invariably include the sagittal T1-weighted sequence. A pituitary gland that does not fully occupy the sella is a common observation, even in normal individuals. Terms such as "empty sella" and "partially empty sella" have become more commonly used, occasionally giving rise to some confusion regarding their clinical significance. In a prospective study of 50 "near-normal" patients, based exclusively on the midsagittal T1-weighted image, we have found a statistically significant increase in sellar emptiness with age, a phenomenon that is more prominent in women. The finding of an empty or partially empty sella on routine MRI of the brain is therefore usually of no clinical significance.