An analysis of variables influencing the number of radiation overexposure events in Texas from 1970 to 2000.

Sources of radiation are used in a variety of modern work settings, including industrial, medical, research, and agricultural applications. Although regulatory controls exist to limit radiation exposures in these different settings, instances of radiation doses in excess of acceptable limits (referred to as overexposures) do occur. A unique study examined overexposure events in Texas over a 45-y period from 1956 to 2001. The primary purpose of the study was to characterize the factors associated with overexposure events. As part of this characterization, an interesting trend in the number of overexposures by year was observed, but not completely explained. The data revealed a dramatic increase in the number of overexposure events, followed by three apparent phases of decline. These declines are of particular interest because, while the increase and subsequent decrease in overexposures occurred, the number of permits to possess radiation sources in Texas generally increased over the same time period. This study focused on the identification of the factors that led to the trends in overexposure events. Data describing the reported overexposure events in Texas from 1970 to 2000 were obtained from the Texas Department of Health Bureau of Radiation Control (TDH BRC) and entered into a computerized database. With the assistance of senior members of the TDH BRC, the three primary factors influencing the number of overexposures were identified. These included domestic oil and gas exploration and production from 1970 to 2000, wherein sources of radiation are employed in various operations; the establishment of a training and certification requirement for industrial radiographers during the period of 1986 to 1988; and modification of the applicable regulations between 1992 and 1994. The generally accepted indicator of oil and gas exploration and production activity, known as "rig count," is the measure of the number of active oil and gas exploration and production platforms at any given time. Rig count is a parameter of particular interest in Texas because the state's economy is significantly tied to the market value of this important natural resource. The rig count parameter was shown to have a strong correlation with overexposure events (Pearson correlation coefficient of 0.82, p < 0.0001). Interestingly, the sources causing the overexposures indicate that the events stem primarily not from the oil and gas exploration activity itself, but rather from support activities in the form of industrial radiographic procedures. The number of overexposure events was also determined to be influenced by the imposition of the training requirement for radiographers and the modification of the applicable regulations (e.g., the elimination of the quarterly dose limit). The relative magnitude of these influences, however, was far overshadowed by the identified predominant predictor of rig count. The determination of rig count as the significant influencing factor in overexposure events is useful in possibly recognizing the potential for future occurrences of the same nature. This assessment also serves to highlight an apparent significant public health success story, as the number of overexposures per radioactive material licensee is shown to have declined significantly over the 30-y period of study. The factors contributing to this phenomenon are described to serve as a model for use in other settings.

Hysterectomy: beliefs and attitudes expressed by African-American women.

OBJECTIVE: Racial/ethnic differences in the rates of hysterectomy have been noted historically. The aim of this study was to explore the beliefs and attitudes of African-American women regarding hysterectomy recommended for non-life threatening conditions. METHODS: Women, aged 30-65 years, were recruited from public health clinics and community agencies for participation in focus groups guided by a semi-structured questionnaire. Transcripts were analyzed both manually and using NUD*IST software. RESULTS: Thirty-eight women participated in six focus groups. Hysterectomy had been recommended for 15% of the women. Four categories and 11 themes emerged from the sessions. Categories included: definitions of hysterectomy and medical indications; resources consulted in the decision-making process; outcomes of hysterectomy; and interactions with the health care community. CONCLUSION: It is important to assess a patient's perceptions and preferences regarding treatment options. The women in this study advocated the delay or avoidance of surgery, or the use of alternative methods of treatment in lieu of hysterectomy for non-cancerous conditions. Physicians who recommend hysterectomy should consider the attitudes, beliefs, and knowledge of patients.

Perceptions of hormone replacement therapy among African American women.

Hormone replacement therapy (HRT) is commonly prescribed for women to relieve symptoms associated with menopause. The medical community does not uniformly recommend HRT, and ethnic and cultural differences may influence a woman's decision to request and adhere to it. Thirty-eight African American women were enrolled in a qualitative study to investigate beliefs, attitudes, and knowledge about HRT. Data collected from six focus groups were part of Ethnicity, Needs, and Decisions of Women (ENDOW), a multisite project investigating decision making and hysterectomy. Participants, age 30 to 65 years, were recruited from community agencies and public health clinics. The women were aware of the medical indications for HRT and its risks and benefits. Although a majority of participants were past or current users, they expressed reservations about the use of HRT and wanted a better dialogue with health care providers, including information about alternative treatments.

The prevalence of suicidal behaviours in a group of HIV-positive men.

We studied a convenience sample of 54 HIV-positive men, recruited from HIV/AIDS community based service organizations. Data were collected on HIV risk factors and suicidal behaviours. Fifty-nine percent of the sample reported ever thinking about suicide, and 50% of those individuals reported attempting suicide at some point in their lives. Suicide ideation and attempts were more common among white participants. Suicidal behaviours were prevalent in this sample suggesting a need for mental health and suicide interventions targeted for this population.

The prevalence of partner violence in a group of HIV-infected men.

There is a paucity of literature regarding partner violence among males that identifies the sex and relationship of their partner(s). We studied a convenience sample of 54 HIV-infected men, recruited from HIV/AIDS service organizations. Using a standard questionnaire, we collected data on HIV risk behaviours and self-reports of acts of partner violence and forced sex. Physical violence perpetrated by a primary or a casual partner was reported by 39% and 17% of the sample, respectively. Life-time forced sex by a primary or casual partner was reported by 32% and 15% of the sample, respectively. Forced sex was more commonly reported by participants who were non-white and reported a higher number of primary partners in the previous 12 months. We recommend that health care providers be aware of the high rates of intimate partner violence among men infected or at risk of infection with HIV.

Perception of spousal abuse expressed by married Bangladeshi immigrant women in Houston, Texas, U.S.A.

Relocating from a homogeneous ethnic country into one that is heterogeneous may threaten one's self-identity, cause isolation, and trigger tension between a couple making the journey together. Most spousal abuse cannot be separated from the cultural, social, and economic contexts in which it occurs. An assessment of abuse in an immigrant community is impacted by stereotypes, cultural stigmas, and lack of knowledge or trust of available resources and services. A prevalence rate of 10% for spousal abuse was revealed in this study of 23 married female immigrants from Bangladesh residing in Houston, Texas. Using both a quantitative and qualitative design, women reported both mental/verbal and physical abuse, most frequently committed by the husband and in-laws. Commonalities exist with other immigrant groups, but characteristics unique to those from Bangladesh must be considered to effectively address abuse against women in this community.

Pilot study evaluating topical onion extract as treatment for postsurgical scars.

BACKGROUND: Post surgical scars can be erythematous, raised, pruritic and painful. Numerous modalities are available to improve the appearance and symptomatology of these scars. A topical onion gel extract is the newest in the armamentarium of scar treatments. The active ingredient in this gel is allium cepa. Published studies evaluating the usefulness of this gel in the treatment of scars are not available. OBJECTIVE: To evaluate the effectiveness of topical onion gel extract in improving the appearance and symptomatology of postsurgical scars and to compare the results of its use to those of a topical emollient ointment. METHODS: Seventeen patients with surgical scars resulting from Mohs surgery were assigned to 1 of 2 groups on the day of suture removal. Each group applied a designated topical product 3 times a day for 1 month. Photographic documentation and questionnaires using a visual analog scale were completed for each scar enrolled in the study. RESULTS: Using the Fischer's exact test, no statistically significant difference between pre- and posttreatment evaluations of scar erythema and pruritus in patients using topical onion extract gel was found. A statistically significant reduction in scar erythema was found in patients using a petrolatum based ointment. CONCLUSIONS: Scar hydration is an important factor in wound healing and can be achieved with topical petrolatum-based ointment. Topical onion gel extract was ineffective in improving scar erythema and pruritus in our patients.

Health care professionals' skills, beliefs, and expectations about screening for domestic violence in a border community.

This article describes domestic violence education of health professionals and determines association between screening behavior and preparedness, outcome expectations, and beliefs about how and when to screen. A survey was mailed to all primary care physicians, dentists, and nurse practitioners in El Paso, Texas (n = 561). Return rate was 34.4%. Using linear regression, differences (p < 0.05) were found between dentists and others in percentage of patients screened, education, preparedness, and beliefs. Education had a positive association (p < 0.001) with preparedness, beliefs about when to screen, and outcome expectations, and a negative association with beliefs about how to screen. Preparedness, beliefs, and realistic outcome expectations had a positive association (p < 0.02) with percentage of female patients screened. Education about domestic violence is important in increasing preparedness and influencing beliefs about when to screen and what outcomes can be expected. Educational programs should include not only information, but also skills training to increase perceptions of preparedness.

Preparedness of health care practitioners to screen women for domestic violence in a border community.

Health care professionals do not always screen patients for domestic abuse. In the absence of screening, the likelihood of misdiagnoses and prescriptions contraindicated for symptoms of abuse survivors is increased. Several factors may contribute to the lack of routine and uniform screening, including a lack of educational preparedness. The qualitative findings presented here are part of a larger quantitative study investigating the skills, beliefs, and expectations about screening for domestic abuse among physicians, dentists, and nurse practitioners from a border community in southwest Texas. Practitioners requested specific information to enhance educational preparedness and improve clinical practice for their abused patients.

Decision making, beliefs, and attitudes toward hysterectomy: a focus group study with medically underserved women in Texas.

Variations in hysterectomy rates have been associated with assorted physician and patient characteristics, and the disproportionate rate of hysterectomies in African American women has been attributed to a higher prevalence of leiomyomas. The role of women's beliefs and attitudes toward hysterectomy and participation in decision making for medical treatment has not been explored as a source of variance. The purposes of this qualitative study were to explore these constructs in a triethnic sample of women to understand beliefs, attitudes, and decision-making preferences among underserved women; to facilitate development of a quantitative survey; and to inform development of interventions to assist women with such medical decisions. Twenty-three focus groups were conducted with 148 women from community sites and public health clinics. Thirteen self-identified lesbians participated in three groups. Analysis of audiotaped transcripts yielded four main themes: perceived outcomes of hysterectomy, perceived views of men/partners, opinions about healthcare providers, decision-making process. Across groups, the women expressed similar expectations from hysterectomy, differing only in the degree to which dimensions were emphasized. The women thought men perceived women with hysterectomy as less desirable for reasons unrelated to childbearing. Attitudes toward physicians were negative except among Hispanic women. All women expressed a strong desire to be involved in elective treatment decisions and would discuss their choice with important others. Implications for intervention development include enhancing women's skills and confidence to evaluate treatment options and to interact with physicians around treatment choices and creation of portable educational components for important others.

Association between familial autoimmune diseases and recurrent spontaneous abortions.

PROBLEM: To examine the aggregation of autoimmune disease in the families of women experiencing recurrent spontaneous abortions. METHOD: The 95 participants in this case-control study were recruited from Magee Womens Hospital, Pittsburgh, Pennsylvania from June 1988 to May 1991. The women having recurrent spontaneous abortions (N = 45) reported at least three early fetal losses, and the controls (N = 50) reported a minimum of three pregnancies with at least two live births and no more than one induced or involuntary pregnancy loss. Data from the participants and from their first-degree and second-degree relatives were obtained by questionnaire and verified by a repeated interview, if necessary. RESULTS: The prevalence of arthritis, thyroid disease, and diabetes mellitus was increased among the relatives of women having recurrent spontaneous abortions compared to normally fertile couples. Several autoimmune diseases occurred concurrently in family members of patients, but not in the family members of normally fertile couples. CONCLUSIONS: Autoimmune diseases occur more frequently in the families of women who have experienced recurrent spontaneous abortions. Both types of diseases involve genes in the class II region of the major histocompatibility complex.