A comparison of the psychological burden of PET/MRI and PET/CT scans and association to initial state anxiety and previous imaging experiences.

OBJECTIVE: To investigate the level of psychological burden experienced by patients undergoing positron emission tomography (PET)/MRI scanning compared with PET/CT. METHODS: 100 adult patients referred for PET/CT and underwent PET/MRI scanning were eligible. Initial state, psychological burden of PET/CT and PET/MRI, scan satisfaction and preference were assessed using a purpose-designed questionnaire, comprising 61 five-point Likert scale questions and a three-point tick box question indicating preference between PET/CT and PET/MRI. State anxiety was assessed using the state portion of the State Trait Anxiety Inventory. Wilcoxon signed-rank tests compared psychological burden experienced by participants following PET/CT and PET/MRI scan. RESULTS: A greater level of psychological burden was experienced by patients during PET/MRI than PET/CT p ≤ 0.001, consistent with patients' preference for PET/CT over PET/MRI (p = 0.013). There was a significant relationship between PET/CT psychological burden and initial state (r = 0.386, p ≤ 0.001). No significant relationship was identified between Initial state and psychological burden of PET MRI (r = -0.089; p = 217). There was a significant relationship between psychological burden of PET/CT and PET/MRI (r = 0.354; p = 0.001). CONCLUSION: Patients' experience increased psychological burden during PET/MRI compared with PET/CT. Previous scanning experiences and patients' interactions prior to and during PET/MRI improved patient satisfaction. Interventions could be implemented to improve imaging outcome. ADVANCES IN KNOWLEDGE: This study provides evidence for the increased psychological burden of PET/MRI compared with PET/CT, and that people prefer the PET/CT procedure. We have shown that the patients who expressed a preference for PET/MRI demonstrated significantly lower psychological burden for that procedure than those that preferred PET/CT, which indicates that the benefit of reduced psychological burden could be facilitated by an appropriate intervention.

Aequorin variants with improved bioluminescence properties.

The photoprotein aequorin has been widely used as a bioluminescent label in immunoassays, for the determination of calcium concentrations in vivo, and as a reporter in cellular imaging. It is composed of apoaequorin (189 amino acid residues), the imidazopyrazine chromophore coelenterazine and molecular oxygen. The emission characteristics of aequorin can be changed by rational design of the protein to introduce mutations in its structure, as well as by substituting different coelenterazine analogues to yield semi-synthetic aequorins. Variants of aequorin were created by mutating residues His16, Met19, Tyr82, Trp86, Trp108, Phe113 and Tyr132. Forty-two aequorin mutants were prepared and combined with 10 different coelenterazine analogues in a search for proteins with different emission wavelengths, altered decay kinetics and improved stability. This spectral tuning strategy resulted in semi-synthetic photoprotein mutants with significantly altered bioluminescent properties.

Health status and sociodemographic characteristics of adults receiving a cystic fibrosis diagnosis after age 18 years.

OBJECTIVES: An increasing percentage of cystic fibrosis (CF) diagnoses are occurring in adulthood. The purpose of this study was to explore how age at diagnosis may be associated with selected disease and sociodemographic characteristics. DESIGN: The 1996 Cystic Fibrosis Foundation (CFF) Patient Registry data were analyzed to test for associations between age at diagnosis and selected variables. All cases involved individuals > or = 18 years who were represented in the CFF Patient Registry for 1996. Patients were assigned to one of two groups: those diagnosed with CF after age 18 years (n = 786) and those diagnosed before 18 years (n = 6,641). RESULTS: In 1996, the incidence of late diagnosis was 7.8%, and the prevalence was 10.9%. The mean age of late diagnosis was 27 years. Respiratory symptoms most frequently led to late diagnosis. Patients receiving a late CF diagnosis were less likely to have alleles for Delta F508. There was no correlation between age at diagnosis and percent predicted FEV(1), although patients in the late-diagnosis group were an average of 10 years older than those in the early-diagnosis group. Late diagnosis was associated with fewer complications, fewer hospitalizations, less oxygen use, fewer courses of home IV treatment, and less enzyme use. Women were most often diagnosed late. Men displayed more diversity in conditions leading to diagnosis. Psychosocially, those patients receiving late diagnoses were more likely to be college graduates, married, and employed full time. For those adults who died in 1996, there was a positive association between their age at diagnosis and age at death. CONCLUSION: Those patients diagnosed with CF as adults differ, both medically and psychosocially, from those diagnosed at a younger age; these differences have implications for diagnosis, treatment, and education.

Modeling adherence to colorectal cancer screening.

BACKGROUND: An explanatory framework referred to as the Preventive Health Model was used to identify factors associated with prospective adherence to colorectal cancer screening. METHODS: Data on sociodemographic, psychosocial, social influence, and program factors were collected via telephone survey for 501 older adult members of an independent practice association-type health maintenance organization. Subjects were later mailed fecal occult blood tests for completion and return. Adherence was defined as the return of the tests within 90 days. RESULTS: Structural analysis shows that for men (N = 145), perceived self-efficacy (OR = 1.4), salience and coherence of testing (OR = 2.3 for a 5-point increment on a 30-point scale), and exposure to health education interventions (OR = 6.8) were significant independent predictors of intention to adhere and of adherence. Among women (N = 185), predictors were age (OR = 1.8) and salience and coherence of testing (OR = 1.8 for a 5-point increment on a 30-point scale). CONCLUSIONS: These findings indicate that for both men and women, adherence is influenced strongly by the extent to which the behavior is judged to make sense in everyday life. It also appears that additional education and encouragement may persuade men and younger women to participate in screening.

Women's health issues: a review of the current literature in the social work journals, 1985-1992.

To assess the ways in which social work is addressing issues in women's health care, the profession's journals from 1985-1992 were searched, yielding 36 articles. Over half addressed issues of reproduction and sexuality including pregnancy, family planning, abortion, substance abuse in pregnancy, and fetal protection policies. Remaining articles addressed medical diagnoses; including AIDS/HIV/STDs, cancer, illnesses associated with aging, PMS, Turner's Syndrome, and chronic fatigue syndrome. Foci, methodologies, and recommendations are discussed and the authors critically analyze the articles' reflections of the status of women's health as a social work concern.

PIP: The extent to which the social work profession is addressing women's health issues was assessed through a review of social work journals for the period 1985-92. Located were 36 articles in 11 journals, 19 of which covered reproductive health issues and 17 of which focused on medical diagnoses. The articles on reproduction fell into the following subcategories: pregnancy (6); family planning (5); abortion (4); substance abuse during pregnancy (2); and fetal protection policies (1). The articles on medical diagnoses covered the following conditions: acquired immunodeficiency syndrome and other sexually transmitted diseases (6); breast cancer (4); aging (3); premenstrual syndrome (2); chronic fatigue syndrome (1); and Turner's syndrome (1). The preponderance of articles on reproduction suggests that social workers have adopted the hegemonic view of women as defined primarily by their reproductive role. Moreover, most of the articles reflected the disease perspective characteristic of the medical model. Notably absent were analyses of current health policies and structural phenomena (e.g., lack of employment opportunities or day care facilities) that impact on women's health. Urged is a reorientation of social work toward a more active role in redefining women's health needs.

Screening for colorectal neoplasia: physicians' adherence to complete diagnostic evaluation.

This prospective study was done in a health maintenance organization colorectal cancer screening program to determine whether 166 persons found to have abnormal fecal occult blood test results typically underwent complete diagnostic evaluation (i.e., either colonoscopy or barium enema x-ray plus flexible sigmoidoscopy). Chart audit data show that 137 (82%) subjects contacted a physician to discuss follow-up. A complete diagnostic evaluation was recommended to only 52 (38%) patients who talked with a physician. Forty-two (81%) patients who were advised to get a complete diagnostic evaluation actually complied. Significant differences in clinical findings were observed for patients who did and did not have a complete diagnostic evaluation.

Adherence to continuous screening for colorectal neoplasia.

Continuous screening is defined as the periodic provision of an opportunity for diagnostic testing to a population of individuals who are asymptomatic and at increased risk for disease. If screening is offered periodically irrespective of response to an earlier screening invitation, this situation may be referred to as serial screening. When continuous screening is made available only to individuals who had tested previously, population member response is referred to as repeat screening. This study assessed adherence to serial- and repeat-colorectal cancer screening among older adult members of an independent practice association-type health maintenance organization (HMO) in two consecutive rounds of screening. In the first screening round, fecal occult blood tests (FOBTs) were sent to 1,565 subjects who were randomly assigned to receive usual care or behavioral interventions intended to encourage testing. Overall, 647 (41%) subjects completed and returned their tests. In the second screening round, FOBTs were mailed again to all subjects; however, the interventions were discontinued. Logistic regression analysis results shows that first-round testing was a significant independent predictor of serial adherence for subjects older than 65 years of age (odds ratio[OR] = 10.8) and those younger than 65 years of age (OR = 10.9); and a significant negative association between exposure to first-round intervention and serial adherence (OR = 0.5) was found among younger subjects. Among first-round adherers, age was significantly and positively related to repeat adherence (OR = 1.6). However, exposure to first-round intervention and having an abnormal FOBT result were significantly and negatively associated with repeat adherence (OR = 0.5 and OR = 0.4, respectively). The results of this study reported here indicate that previous screening is a strong predictor of serial adherence, and special efforts may be required to achieve high levels of serial and repeat adherence among younger adults. Additional research is needed to understand why persons with abnormal screening test results are unlikely to engage in repeat screening.

Behavioral interventions to increase adherence in colorectal cancer screening.

This investigation was a randomized controlled trial to determine the impact of health education interventions on the return of mailed fecal occult blood (FOB) tests (FOBT adherence) in a colorectal cancer screening program. The study sample included 2,201 men and women aged 50 to 74 years who were members of an Independent Practice Association (IPA)-type health maintenance organization (HMO). Subjects were randomly assigned to a "usual care" Control Group (advance letter, screening kit, reminder letter), and Treatment Groups 1 (usual care + reminder call), 2 (usual care + self-held screening booklet + reminder call), or 3 (usual care + self-held screening booklet + instruction call + reminder call). Bivariate analysis revealed significant differences in adherence (P less than .001) across study groups: Control Group (27%), Group 1 (37%), Group 2 (37%), Group 3 (48%). In addition, a significant positive association between age and adherence (P less than .001) was found. Logistic regression analysis revealed an interaction between sex and treatment. Adherence among men in all treatment groups increased significantly (P less than .0001) in relation to Control Group males. Men in Group 3 also were more likely to adhere than those in Group 2 (P less than .01) or Group 1 (P less than .01). Among women, adherence was significantly higher in Group 3 than in Group 2 (P less than .03), Group 1 (P less than .025), or the Control Group (P = .0008). The primary reason cited for nonadherence was perceived inconvenience of the FOB testing procedure.

Factors influencing admission to a community mental health center.

The hypothesis that persistent social problems increase chances of subsequent admission for service applicants to a community mental health center was not supported. Reexamination of data suggested that social involvement is a criterion which delineates predictors of admission. Findings indicate that persons more constrained by ongoing social commitments are unlikely to establish or maintain treatment relationships with a psychiatric facility. Conversely, persons without constraining social positions are much more likely to establish a continuing relationship with institutional psychiatry. Marital status, parenthood, and employment are found to be indicative of crucial involvement. Discussion focuses on the implications of findings for operation of a community mental health center.