Arteriovenous fistula. A potential complication of venipuncture.

We describe a very unusual complication of venipuncture: an arteriovenous fistula between the brachial artery and median cubital vein. The clinical presentation and treatment of arteriovenous fistulas and methods of preventing this complication are reviewed.

Women's attitudes toward screening mammography.

Although mammography has been proven an effective tool in screening asymptomatic women, it has been underused because of poor physician and patient compliance. At a university mammography clinic in Southern California, we administered questionnaires to 381 asymptomatic women to determine what women perceived to be incentives and deterrents to mammography. A factor analysis grouped the incentives into five factors, in decreasing significance: "doctor's recommendation," "personal experience," "media," "others' recommendation," and "breast symptoms." Similarly, we grouped the deterrents according to five factors, in decreasing significance: "cost," "fear of medical intervention," "unnecessary screening," "time demands," and "transportation difficulties." We compared the relative significance of these incentive and deterrent factors for demographics, aspects of the doctor-patient relationship, and individual characteristics. Younger, married women rated incentives, particularly "personal experience," higher and deterrents lower in general than older, unmarried women who had more concerns about "cost." However, all demographic groups rated "doctor's recommendation" as the highest incentive, and we found few differences among races or socioeconomic status for any factor. Women whose physicians had initiated the discussion of mammography viewed the doctor's recommendation as a greater incentive than women who had to initiate the discussion about mammography. Women under the care of gynecologists saw the doctor's recommendation as a greater incentive than women under any other specialists' care. Gynecologists initiated the discussion of mammography and recommended screening more often than other specialists. Women with the following individual characteristics identified more incentives to mammography: knew someone with breast or other cancer, estimated themselves to be at high risk for breast cancer, or had at least one previous mammogram.(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of women on the health care-seeking behavior of men.

BACKGROUND: Gender and social relationships are believed to have a strong influence on health care attitudes and behavior. This study was designed to determine the effect of the gender of closely associated persons on the health care-seeking behavior of persons of the opposite sex. METHODS: We developed a 14-item questionnaire that requested information on social and demographic characteristics, health status, and influences on the decision to seek health care, and administered it to 314 consecutive patients seen at two family medicine clinics in San Diego, California. Data were analyzed by means of one way analysis of variance for continuous variables and the chi-square test for categorical variables. Additionally, data were analyzed by means of a multivariant logistic regression model that calculated odds ratios and 95% confidence intervals. RESULTS: Men were 2.7 times more likely than women to be influenced to seek health care by a member of the opposite sex (95% CI, 1.6 to 4.6). Married patients were 2.4 times more likely than unmarried patients to be influenced to seek health care by a member of the opposite sex (95% CI, 1.4 to 4.3). CONCLUSIONS: Women exert an important influence on the decisions of men to seek health care.

Breast self-examination in the primary care setting.

Very little is known about breast self-examination (BSE), a health practice that has been found to be associated with better clinical and pathological breast cancer outcomes. Using data obtained from a sample of 260 women frequenting three primary care centers, this study investigates rates of BSE and how such rates are affected by social and medical factors. Results indicate that BSE practices are influenced to some extent by a woman's race and level of education, while they are significantly affected by her religion. In contrast, there was no evidence to suggest that a woman's knowledge of breast cancer risk factors, or her own level of risk for the disease, affect the extent to which she is likely to self-examine. These findings suggest the need to confirm these social influences on BSE practice using a larger, population based sample. Moreover, the values and attitudes affecting differential rates of BSE performance should be further investigated.

Does Beano prevent gas? A double-blind crossover study of oral alpha-galactosidase to treat dietary oligosaccharide intolerance.

BACKGROUND: Beano, an over-the-counter oral solution of alpha-galactosidase, is used to prevent flatus and other gastrointestinal symptoms resulting from a high-fiber diet. The efficacy of this product, however, has not yet been adequately evaluated. METHODS: Nineteen subjects were randomized into two groups and fed test meals of meatless chili. At the first test meal, group 1 received eight drops of alpha-galactosidase solution and group 2 received eight drops of placebo. After the meal, subjects were asked to keep a careful record of gastrointestinal symptoms, including occurrences of intestinal gas passage, for the next 6 hours. One week later, an identical test meal was served to each study subject and the solutions were reversed. Again subjects recorded their symptoms for the next 6 hours. Data were analyzed by means of paired t tests. RESULTS: The number of flatulence events per hour was significantly less in the group treated with alpha-galactosidase than placebo over the 6-hour follow-up period (F = 2.87, P = .016). When the two groups were compared at each follow-up interval, this difference was statistically significant only for the 5th hour after ingesting the test meal (t = 2.19, P = .04). No differences between the two groups were found in the extent of bloating or pain following the meal. CONCLUSIONS: Oral alpha-galactosidase solution is efficacious, at least in some patients, for the prophylaxis of gastrointestinal intolerance of oligosaccharides.

Effect of influenza vaccine in patients receiving long-term warfarin therapy.

The effect of influenza vaccine on anticoagulant response in 12 patients receiving long-term warfarin therapy was studied. Study criteria required that all patients have stable prothrombin times and be on stable warfarin dosages before immunization. Patients were immunized with 1982-83 trivalent influenza vaccine (subvirion), types A and B 0.5 mL i.m. on day 0 of the study. Prothrombin times were determined on days--7, 0, 2, 5, 7, 14, and 21, and results were reported as ratios with control values. Influenza immunization produced a small but significant increase in the prothrombin-time ratio. Before immunization the mean ratio was 1.68, and the mean ratio increased to 1.81 after immunization. The maximal increase occurred on day 14 and represented a 7.6% increase over the baseline (day 0) value. The prothrombin-time ratio was not influenced by warfarin sodium dosage (less than or equal to 5 mg/day versus greater than 5 mg/day) or by the sex of the patient. During the 1984-85 influenza season, an additional 26 patients were immunized with the 1984-85 trivalent influenza vaccine (subvirion), types A and B. The prothrombin-time ratio on days 0 and 14 were not significantly different in these patients. Although the administration of influenza vaccine to patients receiving long-term treatment with warfarin appears to be safe, patients should be monitored after immunization for possible increases in anticoagulant response.