The impact of PET scanning on management of paediatric oncology patients.

PURPOSE: Limited information is available on the use of positron emission tomography (PET) in paediatric oncology. The aim of this study was to review the impact of PET on the management of paediatric patients scanned over a 10-year period. METHODS: One hundred and sixty-five consecutive oncology patients aged 11 months to 17 years were included. Two hundred and thirty-seven scans were performed. Diagnoses included lymphoma (60 patients), central nervous system (CNS) tumour (59), sarcoma (19), plexiform neurofibroma with suspected malignant change (13) and other tumours (14). A questionnaire was sent to the referring clinician to determine whether the PET scan had altered management and whether overall the PET scan was thought to be helpful. RESULTS: One hundred and eighty-nine (80%) questionnaires for 126 patients were returned (63 relating to lymphoma, 62 to CNS tumours, 30 to sarcoma, 16 to plexiform neurofibroma and 18 to other tumours). PET changed disease management in 46 (24%) cases and was helpful in 141 (75%) cases. PET findings were verified by histology, clinical follow-up or other investigations in 141 cases (75%). The returned questionnaires indicated that PET had led to a management change in 20 (32%) lymphoma cases, nine (15%) CNS tumours, four (13%) sarcomas, nine (56%) plexiform neurofibromas and four (22%) cases of other tumours. PET was thought to be helpful in 47 (75%) lymphoma cases, 48 (77%) CNS tumours, 24 (80%) sarcomas, 11 (69%) neurofibromas and 11 (61%) cases of other tumours. PET findings were verified in 44 (70%) lymphoma cases, 53 (85%) CNS tumours, 21 (70%) sarcomas, 12 (75%) neurofibromas and 11 (61%) other tumour cases. CONCLUSION: PET imaging of children with cancer is accurate and practical. PET alters management and is deemed helpful (with or without management change) in a significant number of patients, and the results are comparable with the figures published for the adult oncology population.

[Socioeconomic cost-effectiveness analysis--occupational rehabilitation between effectiveness and social compatibility]. / Sozial- und wirtschaftswissenschaftliche Kosten-Nutzen-Analyse--Berufliche Rehabilitation zwischen Effizienz und Sozialverträglichkeit.

The fundamental question in case of planning projects of the state is which pros and cons are involved in their realization. Public projects take up a lot of social resources which hence are no longer available for other purposes--especially when you look at existing budgetary limits. A decision in favour of one specific project always implies a decision against some other project. A classical method to evaluate public projects is the cost-benefit analysis, which leads a shadowy existence owing to its difficulties in practical application (first and foremost in identifying and quantifying). In this article a possible application for cost-benefit analysis is demonstrated on the example of an institution for initial vocational training of young people with disabilities or at risk of becoming disabled. The main point here is to widen the focus from simply looking at fiscal expenses, revenues and savings towards also taking notice of social, psychological and health orientated facts. In this view it is very consequent to enlarge the "normal" economic balance sheet by drawing up a special social balance sheet which illustrates advantages and disadvantages difficult to measure at a monetary basis. A comprehensive decision basis is thereby achieved considering "both sides of the medal".

Counterfactuals and motivation: mood as input to affective enjoyment and preparation.

Two studies demonstrated that moods, in interaction with motivational goals, can influence counterfactual thinking (mental simulations of 'what might have been'). This was shown for performances on laboratory tasks (Study 1) and for real-life course exams (Study 2). In Study 1, with enjoyment goals, participants in good moods generated the greatest number of downward (worse than actuality) counterfactuals; with performance goals, participants in bad moods generated the greatest number of upward (better than actuality) counterfactuals. Downward counterfactuals in good moods with enjoyment goals was reflected in concern with affective motives, positive moods and low preparation. Upward counterfactuals in bad moods with performance goals was reflected in concern with preparative motives, negative moods and high preparation. In Study 2, affective and preparative goals were manipulated directly, mirroring Study 1. After success, participants with affective goals generated the greatest number of downward counterfactuals, which was reflected in high enjoyment, positive moods and low preparation. After failure, participants with preparative goals generated the greatest number of upward counterfactuals, which was reflected in concern with performance, negative moods and high preparation. Discussion centres on implications for counterfactuals, self-motives and mood-as-input research.

Changes in the association of low birth weight with socioeconomic status in Hawaii: 1970-1990.

This study examines rates of low birth weight (LBW) in the state of Hawaii and changes in the association of LBW with socioeconomic status from 1970 to 1990. The analysis is based on aggregate data for census tracts. Rates of low birth weight were calculated for each census tract. Relative socioeconomic scores were calculated from average household income and years of education. The results show that (1) there was a decrease in the rate of low birth weight infants in Hawaii; and (2) that the correlation between socioeconomic status and low birth weight was substantially reduced, though a significant correlation remains. The paper suggests likely ceiling effects, but that the progressive public health policies and expansion of access to primary health care in Hawaii during this period played a major role in reducing the rate of low birth weight infants and in decreasing socioeconomic inequality on this important health indicator.

Chiropractic scope of practice: what the law allows--update 1993.

OBJECTIVE: To determine on a state by state, province by province basis what diagnostic and treatment procedures are allowed by statute in the various practice acts. DESIGN: A survey administered by mail. SUBJECTS: All state and provincial licensing boards. RESULTS: The response rate to the survey was 90%. More than 50% of the responding licensing boards allow chiropractors to order or perform clinical lab procedures, conduct components of a routine physical exam, examine the female pelvis, perform rectal exams, and conduct electromyographic, electrocardiographic and nerve conduction studies. More than 80% can perform a variety of X-ray procedures, use thermography, administer a vascularizer (Doppler) and order CT or MRI studies. More than 90% of the respondents permit chiropractors to employ some form of physiotherapy, adjust soft tissue or extremities, supplement with vitamins and conduct impairment ratings. CONCLUSIONS: These findings demonstrate that the chiropractic profession offers a broad range of diagnostic and treatment procedures.

[Occupational rehabilitation of psychiatrically handicapped patients in Leningrad, USSR: a visit to the Bechterew Psychoneurologic Institute]. / Berufliche Rehabilitation psychisch Behinderter in Leningrad, UdSSR.: Ein Besuch am psychoneurologischen Institut Bechterew.

With reference to a recent reader on rehabilitation for the chronically mentally ill in the German Democratic Republic and the USSR the authors travelled to Leningrad, USSR, to learn about the efforts to integrate rather than add up multidisciplinary approaches to work rehabilitation. The authors found a sheltered workshop for about 400 patients where much of the principles of work rehabilitation obviously work: flexible and manyfold work, well adapted to the varying standards of the patients both unskilled workers and patients with academic background. The workshop being one branch of the nationally significant Bechterev Institute for Psychiatry and Neurology also transfers patients to the general workforce where rehabilitation patients are paid a 125% salary. Both the optimistic atmosphere and the economically self supporting shop give good reason to learn more about rehabilitation for the chronically ill in the USSR and the efforts to progress.

Compliance by Samoans in Hawaii with service norms in pediatric primary care.

American Samoans are one in a number of Pacific Basin groups for which the U.S. Government provides health care assistance and one in a large number of recent immigrant groups to the United States. Although these groups often have health care beliefs inconsistent with Western primary care, their compliance with basic provider expectations (such as appointment keeping and appropriate emergency room use) remains largely unstudied. In the case of Samoans in Hawaii, concern is often expressed that a group much in need of health care (pediatric hospitalization and acute illness visit rates are high) often seems "out-of-sync" with Western health care. Four measures of noncompliance were studied in the Hawaii pediatric primary care residency training program. Enrolled Samoan patients were compared with an aggregation of more established ethnic groups. Four matched case-control studies controlled for socioeconomic status and the presence or absence of medical insurance and a home telephone. Samoans were more likely than the comparison group to miss health maintenance appointments, to drop in without an appointment, and to use the emergency room for nonurgent problems when a same-day-notice clinic visit would have usually sufficed.

[Cooperation barriers in psychiatric and psychosocial after care: organizational and sociologic aspects]. / Kooperationshindernisse bei psychiatrischer und psychosozialer Nachsorge: Organisatorische und soziologische Aspekte.

Community based out-care systems for the long term patient has been a concern ever since deinstitutionalization and rehabilitation became a task in the 60's. Much of our efforts failed. Here we try to make the point of organizational factors and their impact on motivation and cooperative incentives both for the staff in the wards, and in the community based clinics. Exchange theory is offered as a base to outline better planning.

[After care services for psychiatric patients: organizational problems and perspectives exemplified by the service area of Honolulu, Hawaii, USA--initial status, empirical results]. / Nachsorgende Dienste für psychiatrische Patienten: Organisatorische Probleme und Perspektiven am Beispiel des Versorgungsgebietes Honolulu, USA--Ausgangssituation, empirische Ergebnisse.

During the past decades much effort has been taken to encourage community - based treatment and service for mental patients, and to reduce the share of the large custodial institutions within mental health care systems. Both in the United States and in W-Germany (FRG) there has been a growing awareness that major inadequacies occur especially with providing community--based out-care for the seriously mentally ill. Much of these inadequacies refer to those released from the mental hospital with such needs as help to structure their everyday lives, adequate housing, nutrition, support for the families and neighborhoods involved, financial support, and further treatment. Part 1 delines the growing awareness of these problems with reference to the expectations of "reformists" both for the U.S. and the F.R.G. The paper then describes empirical data about the care given to patients released from the psychiatric hospital within a 90 days' period in the State of Hawaii, U.S.A. It also gives a structural description of agencies involved in the aftercare services, and relates this both to the empirical findings and reformists' views on aftercare needs.

Racial and socioeconomic status differences in survival of colorectal cancer patients in Hawaii.

The study reported here examines the survival experience up to 84 months of patients from the five major racial groups in Hawaii diagnosed with colorectal cancer during the years between 1960 and 1974 based on data in the Hawaii Tumor Registry. Previous research in Hawaii showed that racial differences in survival existed even after adjusting for sex, age at diagnosis, stage of the disease at diagnosis, and normal life expectancy. In this paper, socioeconomic status differences between racial groups are hypothesized as a possible explanation for these survival differences. The results show that socioeconomic status did account for some survival differences between racial groups beyond what could be explained by the other variables. After adjusting for all the covariates, the only statistically significant racial differences which remained were higher survival rates for the Japanese patients compared with the rates for the Hawaiian and Filipino patients. Socioeconomic status was not found, however, to have a statistically significant effect on survival independent of race or the other variables examined. Reasons for the modest effects of socioeconomic status in this study are discussed.

Racial survival patterns for lung cancer in Hawaii.

From 1960 through 1974, the Hawaii Tumor Registry identified 1895 cases of lung cancer with either small cell or non-small cell carcinoma among the five main racial groups in the islands. There were 650 Caucasians, 549 Japanese, 362 Hawaiian, 173 Filipino and 161 Chinese patients. Analysis revealed that Caucasians with non-small cell carcinoma had a significantly poorer five-year survival rate than Chinese, Filipino, or Japanese patients after simultaneous adjustment for differences in sex, age at diagnosis, stage, and socioeconomic status. Men, older patients, patients with regional or distant disease, and patients in a middle or low socioeconomic status also did worse than the others. When the 170 patients with small cell carcinoma were compared with 1725 patients with non-small cell carcinoma, patients with small cell carcinoma had significantly poorer survival rates after five years.

Differences in lung cancer risk from smoking among Japanese, Chinese and Hawaiian women in Hawaii.

The age-adjusted lung cancer incidence rates among Japanese, Chinese and Hawaiian women in Hawaii do not correlate to their respective cigarette smoking exposures. We conducted a case-control study to determine the lung cancer risk associated with smoking among these three ethnic groups of women by reviewing the medical records of 176 Japanese, 67 Chinese and 132 Hawaiian lung cancer patients diagnosed from 1968 to 1978. Smoking histories, as well as socioeconomic indexes, for these cases were compared to those of 2,404 sex- and race-matched controls from the general population. Controlling for age and socioeconomic index, we found that lung cancer risk associated with smoking was greatest for Hawaiian (O.R.=10.5), less for Japanese (O.R.=4.9) and least for Chinese women (O.R.=1.8). While smoking was associated with a significant increase in lung cancer risk for all histologies among Japanese and Hawaiian woman, the risk was much greater for epidermoid and small-cell types than for adenocarcinoma. Among Chinese women, epidermoid and small-cell lung cancer were the only histologies showing a significant association with smoking. There was some suggestion that increased lung cancer risk was associated with a higher socioeconomic index after controlling for age and smoking, at least among Japanese born in Japan and Hawaiians with adenocarcinoma. The population risk for lung cancer attributable to smoking was found to be 79% for Hawaiian women, but only 44% for Japanese and merely 11% for Chinese women. Thus, we concluded that the majority of lung cancer occurring in Japanese and particularly Chinese women in Hawaii is due to factors other than cigarette smoking.