Protracted volitional spawning of pinfish Lagodon rhomboides and changes in egg quality and fatty-acid composition throughout the spawning season.

Spawning performance of pinfish Lagodon rhomboides without use of hormonal aids was monitored over an extended season. Nearly three million eggs were obtained from 75 spawns collected over a 90-day consecutive period from a single population of four brood fish (1M:1F). A mean ± s.d. batch fecundity of 30·27 ± 22·64 eggs g-1 female was estimated with 98·0 ± 0·06% of the batch composed of floating eggs which were 1·04 ± 0·04 mm in diameter and 85·71 ± 27·59% fertile. Floating eggs successfully hatched 54·65 ± 29·13% of the time which yielded larvae that were 2·59 ± 0·24 mm in length. Fatty acids within floating eggs were largely represented by polyunsaturated fatty acids (45·30 ± 2·14% of total fatty acids) of which linoleic acid [(c18:2n-6cis) 3·49 ± 1·69% trifluoroacetic acid (TFA)] and docosahexaenoic acid (DHA) [(c22:6n-3) 28·47 ± 1·48% TFA] represented the majority of fatty acids for n-6 and n-3 polyunsaturated fatty acids, respectively. The strongest correlations between fatty acids and hatching success and larval survival to first feeding were observed for the DHA:EPA (eicosapentaenoic acid; c20:5n-3) ratio and total n-6 polyunsaturated fatty-acids levels, respectively. These data demonstrate potential for producers to rely on natural spawns for extensive egg production and provide a baseline for future development of natural spawning protocols of captive L. rhomboides.

Insights and Concerns of Patients and GPs Regarding Introduction of Universal Health Insurance in Ireland.

The implementation of a universal health insurance (UHI) model is a key political policy in Ireland. The objective here was to determine the understanding of general practitioners (GPs) and patients regarding UHI, its implementation and impact on both sets of stakeholders. Postal questionnaire to GPs, and opportunistic survey sampling of patients in two different GP practices were carried out. Response rates were 92.5% (patients) and 78% (GPs). 79.4% of patients (n = 418) and 96.7% of GPs (n = 149) have a 'poor' understanding of how UHI will be implemented. 89% (n = 493) of patients and 98.7% (n = 153) of GPs feel government communication about UHI has been 'poor'. 98.1% of GPs (n = 152) and 77.3% of patients (n = 383) are not confident that 'UHI will be ready for implementation by 2015'. Neither stakeholder group is confident in the government's ability to deliver UHI within the given timeframe. There is a lack of knowledge and consultation on proposals for its implementation.

Chordoma of the lumbar spine - a potential diagnosis not to be forgotten.

Chordoma is a rare, malignant neoplasm thought to develop from the notochord. It most commonly occurs in the base of the cranium or the sacro-coccygeal region but around 15-20% affect the vertebral body. Extra-lesional resection with or without adjuvant radiotherapy is generally accepted as the mainstay of treatment for this slow-growing tumour. We present a case whereby a patient with a solitary L3 vertebral body lesion causing caudal compression was treated with spinal decompression and posterior stabilisation. Pre-operative biopsy was not performed as the lesion was presumed to be a metastatic deposit from a co-existing renal mass. Intra-operative biopsy, however, identified the tumour to be chordoma of the L3 vertebral body which would have been more appropriately treated with 'en-bloc' excision. This case highlights the importance of pre-operative tissue diagnosis, and that, although rare (0.8 per 100,000), chordoma should always be considered.

Progress in cancer screening over a decade: results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys.

BACKGROUND: Screening to detect cancer early, an increasingly important cancer control activity, cannot be effective unless it is widely used. METHODS: Use of Pap smears, mammography, fecal occult blood tests (FOBTs), sigmoidoscopy, and digital rectal examination (DRE) was evaluated in the 1987, 1992, and 1998 National Health Interview Surveys. Levels and trends in screening use were examined by sex, age, and racial/ethnic group. The effects of income, educational level, and health care coverage were examined within age groups. Logistic regression analyses of 1998 data were used to develop a parsimonious, policy-relevant model. RESULTS: Use of all screening modalities increased over the period examined; for mammography and DRE, the increase was more rapid in the first half of the decade; for the Pap test and sigmoidoscopy, the increase was more rapid in the second half of the decade. Levels of colorectal cancer screening (both sigmoidoscopy and FOBTs) in 1998 were less than the level that prevailed a decade earlier for mammography. Patterns of change for all screening modalities differed between age, sex, and racial/ethnic groups, but prevalence of use during the study, within recommended time intervals, was consistently lower among groups with lower income and less education. Logistic regression analyses indicated that insurance coverage and, to a greater extent, usual source of care had strong independent associations with screening usage when age, sex, racial/ethnic group, and educational level were taken into account. CONCLUSIONS: While cancer screening is generally increasing in the United States, usage is relatively low for colorectal cancer screening and among groups that lack health insurance or a usual source of care.

Mirrored-self misidentification: two cases of focal onset dementia.

We present two patients in whom the mirror sign, the inability to recognize one's own reflected image, was a stable and persisting symptom signalling the onset of a progressive dementing illness. Extensive neuropsychological testing was conducted with both patients, with particular emphasis on face processing and the understanding of reflected space. Both patients were also investigated with structural imaging techniques (computed tomography and magnetic resonance imaging). Although the neuroimaging results were not strongly lateralizing for either patient, neuropsychological testing revealed striking right hemisphere dysfunction with relatively intact left hemisphere cognitive function in both patients. Of particular interest was the patients' dissociation on tests of face processing; one patient, FE, had significant face processing deficits while the other patient, TH, had relatively intact face processing. Further testing with TH revealed striking deficits in his ability to interpret reflected space. The results of the face processing tests are discussed in the context of current models of normal face processing, with particular emphasis on the affective component in face recognition. We propose that a combination of cognitive deficits underlie the mirror sign delusion, including perceptual, affective and reasoning impairments, and also discuss the contributions of cortical and subcortical lesions in these two patients and in delusions in general.

A national census of ambulance response times to emergency calls in Ireland.

BACKGROUND: Equity of access to appropriate pre-hospital emergency care is a core principle underlying an effective ambulance service. Care must be provided within a timeframe in which it is likely to be effective. A national census of response times to emergency and urgent calls in statutory ambulance services in Ireland was undertaken to assess current service provision. METHODS: A prospective census of response times to all emergency and urgent calls was carried out in the nine ambulance services in the country over a period of one week. The times for call receipt, activation, arrival at and departure from scene and arrival at hospital were analysed. Crew type, location of call and distance from ambulance base were detailed. The type of incident leading to the call was recorded but no further clinical information was gathered. Results-2426 emergency calls were received by the services during the week. Fourteen per cent took five minutes or longer to activate (range 5-33%). Thirty eight per cent of emergencies received a response within nine minutes (range 10-47%). Only 4.5% of emergency calls originating greater than five miles from an ambulance station were responded to within nine minutes (range 0-10%). Median patient care times for "on call" crews were three times longer than "on duty" crews. CONCLUSION: Without prioritized use of available resources, inappropriately delayed responses to critical incidents will continue. Recommendations are made to improve the effectiveness of emergency medical service utilisation.

A systems model of clinical preventive care: the case of breast cancer screening among older women. For the NCI Breast Cancer Screening Consortium.

BACKGROUND: In older women covered by Medicare, relationships among physician recommendation, mammography in the past 2 years, and clinical breast examination (CBE) in the past year were systematically explored with a variety of predisposing, enabling, and situational factors identified in the Systems Model of Clinical Preventive Care. METHODS: A population-based survey of women age 65 years and older was conducted in five National Cancer Institute's Breast Cancer Screening Consortium geographic areas. Analyses focused on women with a regular physician and site of care (n = 5318). RESULTS: Physician recommendation and mammography use declined with women's increasing age and increased with income, education, and insurance. CBE and mammography increased with number of physicians and breast cancer family history; mammography use decreased with worsening health status. Recommendations were higher among physicians who were younger, female, and internists. Family practitioners were older and male; women who saw family practitioners reported characteristics associated with decreased screening-lower income, education, and insurance-and seeing only one physician. CONCLUSIONS: Public policy and health system changes that create a uniform system of finance and service performance expectations may reduce the persistent discrepancy in physician recommendation and mammography use due to sociodemographics and physician specialty.

Inner-city hospital closures in Dublin: implications for general practice.

BACKGROUND: The Meath, Adelaide and National Children's Hospitals provided more than 300,000 ambulatory care episodes in 1996, half to residents of the adjacent inner-city postal districts. With the closure of the group in 1998, alternative care arrangements must now be provided. AIMS: This paper examines the socio-economic and primary care characteristics of the communities most affected. METHODS: Data on the 13 District Electoral Divisions surrounding the hospitals are drawn from a range of published sources. RESULTS: The populations affected include 52% in social classes 5 to 7, have an average Standardised Mortality Ratio of 122, have high levels of GMS eligibility and include special care issues such as drug dependency. A total of 38 GPs cover the area. Other markers of deprivation are summarised. CONCLUSION: The areas most affected by the closures have existing high levels of deprivation and social and medical need. Initiatives to respond to the closures must address these needs.

Models of face recognition and delusional misidentification: a critical review.

The "two-route model of face recognition" proposed by Bauer (1984) and adopted by Ellis and Young (1990), has become a widely accepted model in studies of face processing disorders, including both prosopagnosia and the delusional misidentification syndromes. We review the origin and application of the two-route model of face recognition in examining both the neuroanatomical pathways and the cognitive pathways to face recognition. With respect to the neuroanatomy, we conclude that face recognition is subserved by a single pathway, the ventral visual pathway, as there is no evidence to suggest that the dorsal visual pathway is capable of visual recognition or of providing an affective response to familiar stimuli. We demonstrate how operation of the ventral visual pathway and its connections to the amygdala can parsimoniously account for the findings in the literature on prosopagnosia and delusional misidentification syndromes. In addition, we propose a cognitive model of face processing stemming from the work of Bruce and Young (1986). Our model involves two pathways subsequent to the system responsible for face recognition: one pathway to a system containing semantic and biographical information about the seen face, and a second pathway to a system responsible for the generation of an affective response to faces that are familiar. We demonstrate how this cognitive model can explain the dissociations between overt and covert recognition observed in prosopagnosia and the Capgras delusion.

Use of cancer screening practices by Hispanic women: analyses by subgroup.

OBJECTIVES: This study compares the use of three cancer screening practices (Pap smear, mammogram, and clinical breast examination) 3 years prior to interview among five subgroups of Hispanic women, and examines whether sociodemographic; access; health behavior, perception, and knowledge; and acculturation factors predict screening practices for any subgroup. METHODS: Descriptive and multiple logistic regression analyses were conducted with data pooled from the 1990 and 1992 National Health Interview Surveys on women who reported that they were Hispanic. The study sample includes 2,391 respondents: 668 Mexican-American, 537 Mexican, 332 Puerto Rican, 143 Cuban, and 711 other Hispanic women. RESULTS: Subgroup profiles reveal differences in education, health insurance, use of English language, and screening use. Mexican women were the least likely to be screened with any procedure. Logistic regression results for each screening practice show that having a usual source of care was a positive predictor for obtaining each of the three screening practices within the last 3 years. Being married, being more than 50 years of age, and having knowledge of breast self-examination were all predictors of having a Pap smear. Having health insurance and ever having had a clinical breast examination and Pap smear were predictors of having a mammography, while age, knowledge of breast self-examination, ever having had a Pap smear and mammogram, and being a nonsmoker all predicted having a clinical breast examination. CONCLUSIONS: We conclude that access factors and prior screening are more strongly associated with current screening than are language and ethnic factors. Our data confirm that a disproportionate percentage of Hispanic women are low income and at risk of being underscreened. Our findings from a nationally representative sample of Hispanics have implications for provider practices, ethnic-specific community interventions, and future development of measures and data collection approaches.

Cancer prevalence and survivorship issues: analyses of the 1992 National Health Interview Survey.

BACKGROUND/METHODS: Relatively little is known about the size and makeup of the growing population of cancer survivors or about the social implications of a diagnosis of cancer. To explore these issues, we analyzed cancer survivorship information from the 1992 National Health Interview Survey (NHIS), and resulting cancer prevalence estimates were compared with those derived from cancer registry data. RESULTS: According to the NHIS, there were an estimated 7.2 million adult survivors of cancer-excluding nonmelanoma skin cancer-in 1992, representing 3.9% of the U.S. adult population. Comparisons with prevalence estimates from cancer registry data suggest that cancer is underreported in the NHIS. Nearly three fifths (58.0%) of cancer survivors self-identified on the NHIS reported that their cancer was first detected when they noticed something wrong and went to a doctor. The majority (55.7%) of cancer survivors had obtained a second opinion or multiple opinions regarding their treatment. Most (58.0%) had received patient educational materials from a health care provider. However, relatively few had received counseling or participated in support groups (14.2%), contacted cancer organizations after their diagnosis (10.9%), or participated in a research study or clinical trial as part of their cancer treatment (4.7%). One ninth (10.7%) of the survivors had been denied health or life insurance coverage because of their cancer. Nearly one fifth (18.2%) of the cancer survivors who worked before or after their cancer was diagnosed experienced employment problems because of their cancer. CONCLUSIONS: While cancer appears to be underreported on the 1992 NHIS, the survey provides valuable information about the medical, insurance, and employment experience of cancer survivors selected from a nationally representative sample of U.S. households.

The relationship of socio-economic status and access to minimum expected therapy among female breast cancer patients in the National Cancer Institute Black-White Cancer Survival Study.

Black women are more likely to be diagnosed with later stage breast cancer and have higher mortality rates from breast cancer than white women. To determine whether cancer treatment varies for white and black women, we analyzed data from the National Cancer Institute (NCI) Black-White Cancer Survival Study (BWCSS). Data from hospital medical records, central review of histology slides, and patient interviews on 861 breast cancer cases (in situ and invasive) were examined. Minimum expected therapy was defined for each disease stage as a basic minimum course of treatment that incorporated current practice, state-of-the-art knowledge, and recommendations advanced by NIH Consensus Conferences up to and including the one held in 1985. Patients in this study were diagnosed during 1985-1986. Using logistic regression techniques, those who received at least the minimum expected therapy were compared to those who did not. Thirty-six percent of the patients with late stage disease did not receive minimum expected therapy compared to four percent of the patients with early stage disease. Older women and women with no usual source of care were significantly less likely to receive minimum expected therapy. Overall, 21% of black women did not receive minimum expected therapy compared to 15% of white women.

Low income, race, and the use of mammography.

OBJECTIVE: To describe national trends in mammography use by race and income and to test whether higher use of mammography among low-income African American women than low-income white women can be explained by health insurance coverage, usual place of health care, or place of residence. DATA SOURCES/STUDY SETTING: Data from five years of the National Health Interview Survey spanning the period 1987-1994. STUDY DESIGN: Trends in the percentage of women 50-64 years of age with a mammogram within the past two years were analyzed by race and income. Data for 1993-1994 were pooled, and with logistic regression analysis, variation in use of recent mammography for low-income women was investigated. Independent variables are age, race, family income, education, health insurance coverage, place of usual source of health care, metropolitan residence, and geographic region. DATA COLLECTION/EXTRACTION METHODS: The National Health Interview Survey is a cross-sectional national survey conducted by the National Center for Health Statistics. Data are collected through household interviews. [Editor's note: in keeping with HSR policy, the term black is used to conform to its use in the surveys studied. In other references to race, the term African American is used.] PRINCIPAL FINDINGS: Among women 50-64 years of age use of recent mammograms increased rapidly between 1987 and 1991 for all groups of women, and between 1991 and 1994 the increases slowed. However, increases between 1991 and 1994 have been more rapid among low-income black women than among low-income white women. In 1993-1994, low-income black women were about one-third more likely than low-income white women to report mammography within the past two years. This difference could not be explained by health insurance coverage, usual source of health care, metropolitan status, or region of residence. CONCLUSIONS: These results, which provide some evidence of success for screening programs targeted to the poor, raise the question of why low-income black women appear to be to more likely than low-income white women to have benefited from recent efforts to promote mammography. Continued evaluation of mammography programs focused on women who are underserved as well as the monitoring of trends and variations in service use by race and income are needed.

Breast and cervical cancer screening interventions: an assessment of the literature.

An extensive body of intervention research to promote breast and cervical cancer screening has accumulated over the last three decades, but its coverage and comprehensiveness have not been assessed. We evaluated published reports of these interventions and propose a framework of critical elements for authors and researchers to use when contributing to this literature. We identified all articles describing breast and cervical cancer screening interventions published between January 1960 and May 1997 in the United States and abstracted specified critical elements in the broad areas of: (a) needs assessment; (b) intervention study design; and (c) analysis methods and study outcomes from each article using a template developed for that purpose. Fifty-eight studies met our criteria for inclusion. Thirty-eight focused exclusively on breast cancer screening, 7 promoted cervical cancer screening, and 13 were designed to promote screening for both cancers. The amount of detail reported varied among the 58 studies. All studies reported the outcome measures used to assess the effectiveness of the intervention, yet only 40% of the studies reported the investigators' original hypotheses or research questions. Needs assessment data were reported in 84% of the studies. Data sources ranged from national surveys to local intervention baseline surveys. Population characteristics reported also varied, with most studies reporting age and race of the study population (78 and 71%, respectively), and fewer studies reporting income and education (53 and 38%, respectively). As the field of behavioral intervention research progressed, we found that more recent studies included and reported many of the parameters we had identified as critical. If this trend continues, it will enhance the reproducibility of studies, enable comparisons between interventions, and provide a reference point for measuring progress in this area. To facilitate this trend toward uniform reporting, we propose an evaluative framework of critical elements for authors to use when developing and reporting their research. The comprehensive assessment of literature that this article provides should be useful background to investigators planning and reporting cancer control interventions, to funding agencies choosing and guiding quality research, and to publishers to help them enhance the quality and utility of their publications.

Tobacco use among multi-ethnic Latino populations.

OBJECTIVES: To examine tobacco use among New York City resident Latin Americans from different countries of origin and with different levels of acculturation reflected by language use. DESIGN: Effective health promotion programs, particularly those aimed at smoking cessation and prevention, require careful investigation into possible cultural and societal factors influencing predictors and barriers to preventive health behavior. National data characterizing cigarette smoking behavior among broadly defined racial/ethnic groups (e.g., black, Hispanic) have rarely examined the extent or importance of cultural variation and acculturation within and among ethnic groups. This report addresses these issues. METHODS: In this study, we examine self-reported cigarette smoking behavior from a 1992 telephone survey of a quota sample of Puerto Rican, Dominican, Colombian, and Ecuadorian Hispanics living in New York City. We compare results from these data with results from a random sample of New York City Hispanics from the Tobacco Use Supplement to the 1992-93 Current Population Survey. RESULTS: Both data sets demonstrated that Puerto Ricans were significantly more likely to be current smokers and ever smokers than the other three Latino groups. Among Hispanic women in the quota sample, those who chose to complete the interview in English were much more likely to report ever smoking than those women who chose to complete the interview in Spanish. CONCLUSIONS: The relationship between smoking behavior and acculturation (as measured by language usage) appears to be complex and sensitive to methodological issues of sampling and interview language.

The impact of social class on the use of cancer screening within three racial/ethnic groups in the United States.

Despite the consistent and strong association of social class with health status, the extent to which racial/ethnic disparities in cancer screening reflect social class is rarely addressed. We hypothesized that the use of cancer screening is positively correlated with social class for black, white and Hispanic Americans. Data from the 1987 and 1992 National Health Interview Survey Cancer Control Supplements were compared for each racial/ethnic group by income, education, age, and gender. For each racial/ethnic group, individuals with less education or income are less likely to be screened. Although specific subgroups increased their use of screening modalities between 1987 and 1992, older black Americans who were poor or had less education reported less screening than similar older white Americans. Although social class is a powerful explanatory variable for younger Americans, racial disparities in cancer screening persist among older black Americans.

The association between health care coverage and the use of cancer screening tests. Results from the 1992 National Health Interview Survey.

OBJECTIVES: The authors investigated whether utilization of six different cancer screening tests (mammography, clinical breast exam, Pap smear, Fecal Occult Blood Test, and Digital rectal exam) varied according to type of health care coverage. METHODS: Data on the use of cancer screening tests and coverage in two age groups from a 1992 nationally representative cross-sectional survey of approximately 9,400 adults were analyzed. Multiple logistic regression analysis was used to estimate proportions of persons screened according to type and extent of coverage, adjusted for socioeconomic, demographic, and health status characteristics. RESULTS: Persons aged 40 to 64 years with Medicaid coverage were equally as likely to receive five of six cancer screening tests as those with private fee-for-service coverage, and both groups were much more likely to be screened (70% higher for all six tests) than those who had no coverage. In contrast, persons aged 65 years and older who had supplemental private fee-for-service insurance in addition to Medicare were more likely to receive five of six tests than those with Medicare and Medicaid or those with Medicare only. For all six screening tests, managed care enrollees at all ages were approximately 10% more likely to be screened than persons enrolled in private fee-for-service plans. Fecal Occult Blood Test (25% versus 20%) and digital rectal exams (44% versus 38%) in persons aged 40 to 64 years and mammography (59% versus 48%) and Fecal Occult Blood Test screening (38% versus 30%) in the elderly were significantly more frequent for persons in managed care plans. CONCLUSIONS: The extent of fee-for-service insurance coverage in the traditional indemnity US health care system was positively associated with the use of cancer screening tests. The authors found less difference in use of cancer screening between managed care and fee-for-service care in 1992 than we expected based on earlier research comparing use of preventive services in health maintenance organizations with fee-for-service care.

The effect of Medicare reimbursement for screening mammography on utilization and payment. National Cancer Institute Breast Cancer Screening Consortium.

OBJECTIVE: In January 1991, Medicare extended its mammography benefit to reimburse for breast cancer screening mammograms. In 1991 and again in 1993, the National Cancer Institute Breast Cancer Screening Consortium (BCSC) conducted a survey to test the hypothesis that this benefit would increase mammography use among women over the age of 65. METHODS: The authors analyzed data on non-Hispanic white women ages 65 to 74 living in 11 geographic areas targeted by the BCSC for an earlier study--six that had received cancer screening educational interventions and five control subsites--to measure the impact of the newly adopted Medicare benefit on the use of mammography and use of Medicare to reimburse mammography costs. RESULTS: The data show little overall increase between 1991 and 1993 in reported mammography use among respondents to the survey. However, in six intervention and five control subsites there was an increase in the percentage of women who reported using public payment sources to at least partially reimburse the cost of mammograms. In three intervention subsites, the increase from 1991 to 1993 in the percentage of women using public sources of payment was greater than in the corresponding control subsites. CONCLUSIONS: These findings suggest that public health interventions are more likely to succeed when educational promotion accompanies a financial benefit.

Socioeconomic status and breast cancer mortality, 1989 through 1993: an analysis of education data from death certificates.

OBJECTIVES: This study examined whether more highly educated women were at greater risk of dying of breast cancer during 1989 through 1993. METHODS: Breast cancer mortality rates were calculated through death certificates and Current Population Survey data. RESULTS: Breast cancer mortality rates were highest among women with 12 and with 16 or more years of education. Non-Hispanic Black women had the highest mortality rates and Asian women the lowest. Positive relationships between mortality and education were found for Hispanic women as well as non-Hispanic Black and Asian women. CONCLUSIONS: The previously seen positive relationship between breast cancer mortality and education was found among US women of color but not non-Hispanic White women.