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Biomedical subjects

S A Fox

Publications and source records attributed to S A Fox.

At least 37 records · Page 2Linked to original sources
PubMed1994

Screening mammography and older Hispanic women. Current status and issues.

BACKGROUND: Little is known about the screening behavior of older minority women, especially Hispanic women. Data from Los Angeles were compared to national data to examine any similarities and unique problems. METHODS: In 1990, 726 women from Los Angeles older than 65 years of age were surveyed by telephone after being identified through a probability sample or through Medicare listings. Mammography experience and knowledge and attitudes about screening were collected. Differences in mammography experience by racial/ethnic group were computed using the chi-square test. RESULTS: Hispanic women were not underscreened significantly compared with older white and black women. Approximately three quarters of Hispanics had had a mammogram in the previous 2 years, compared with 84% of blacks and 82% of whites. Income and education levels were more explanatory of underscreening than was race. For example, 50% of whites with incomes of less than $15,000 had been screened in the previous 2 years, compared with 71% of those with higher incomes. Hispanics, however, reported significantly more concerns about screening and getting breast cancer than did whites or blacks despite the Hispanics' lower incidence and mortality rates. Hispanics also reported more health insurance inadequacies and a poorer quality of life that may interfere with maintenance of screening behaviors. CONCLUSIONS: To maintain equal screening across racial/ethnic groups, national programs should focus on strategies that help Hispanics acculturate to achieve equal educational and other benefits. To decrease screening inequities within races and help realize the National Cancer Institute's Year 2000 goals, income and educational differences will need to be less pronounced.

Black or African American↗
PubMed1994

The importance of physician communication on breast cancer screening of older women.

BACKGROUND: Breast cancer screening rates, especially for mammography, continue to lag for older women, particularly for women older than 65 years. METHODS: We investigated the associations of key variables with reported rates of mammography and clinical breast examination in a sample of 972 women older than 50 years; 724 of them were older than 65 years. They were surveyed in late 1990 through 30-minute bilingual telephone interviews. RESULTS: Although it was hypothesized that race, age, health status, and physician-patient communication variables would influence utilization rates, only the communication variables (and two access variables) significantly predicted a recent mammogram or clinical breast examination. In particular, the style of the communication--the patient's report of the physician's enthusiasm for mammography when it was discussed with women at the office visit--influenced the women's screening behavior significantly. Women who perceived that their physicians had some enthusiasm for mammography were more than four and a half times more likely than women whose physicians had no or little enthusiasm for mammography to have had one within the previous year. Other findings were that about half of the Los Angeles, Calif, women in this study reported a recent mammogram, an increase from the one third who reported one in the previous survey of 1988; a decline in screening was not reported until after age 75 years. About a quarter of the study women, on the other hand, had never been screened despite the long-standing recommendation for regular screening of women older than 50 years and the risk of breast cancer increasing with age. Surprisingly, women at higher risk of breast cancer were not being screened any more systematically than women at lower risk. CONCLUSION: We conclude that improved physician-patient communication skills could be a highly effective and easy-to-learn strategy to increase overall screening rates.

Age Factors↗
PubMed1994

The effect of risk on changes in breast cancer screening rates in Los Angeles, 1988-1990.

BACKGROUND: Although there have been clear secular trends of increased use of some breast cancer screening modalities, such as mammography, it is less certain that similar trends have occurred among high risk women. METHODS: Population-based surveys were conducted in three socioeconomically diverse Los Angeles communities in 1988 and 1990. Trends in breast cancer screening behavior and key determinants of screening were compared separately for women with a family history of breast cancer, a personal history of benign breast disease, and for women without these risks. RESULTS: In two independent samples drawn in 1988 and 1990, women at a higher risk of breast cancer (positive family history) showed smaller increases in the prevalence of self-reported breast cancer screening than a comparison group of women without a family history of breast cancer or a history of benign breast disease. This was especially true for family-history-positive minority women and women aged 65 years and older, for whom screening actually decreased. In 1990, mammograms for the prior year were reported by only 39% of women with a positive family history, 54% of women with benign breast disease, and 35% of women without these risks. Trends in physicians' office visit discussions of breast cancer screening paralleled trends observed in screening behavior. CONCLUSIONS: Although breast cancer screening increased substantially among lower risk women, rates were unchanged for women at increased risk because of a family history of breast cancer. By identifying and counseling higher risk women, physicians can play an important role in promoting appropriate screening to this group.

Adult↗
PubMed1994

Search for persistent enterovirus infection of muscle in inflammatory myopathies.

To investigate the hypothesis that the inflammatory muscle diseases (IMD) polymyositis (PM) and dermatomyositis (DM) may be due to a chronic, persistent enterovirus (EV) infection we sought to determine the prevalence of these viruses in muscle tissue using both nested polymerase chain reaction (PCR) and dot-blot hybridization assays. Thirty-six frozen muscle biopsies from 32 adult cases of IMD and 42 biopsies from 36 control subjects with other neuromuscular disorders were studied. Primers for PCR were chosen to conserved regions of the 5'-untranslated region of the EV genome. Constitutive Ableson tyrosine kinase (ABL) mRNA was detected by PCR to confirm the integrity of muscle RNA extracts. The sensitivity of the EV PCR was determined to be 40-400 copies (12.5-125 ag) of synthetic EV RNA transcript against a background of 1 microgram of cellular RNA. The specificity was assessed using a range of enteroviral and unrelated viral isolates extracted from cell cultures. Of the 78 samples tested, ABL mRNA was successfully detected in all but four samples. The time the biopsies spent in ultracold storage (1-73 months) did not appear to influence the integrity of extracted RNA. When assayed for EV RNA by nested PCR, none of 29 IMD cases (i.e., 28 PM and 1 DM) nor sequential biopsies from 3 PM patients were found to be positive. All 42 control biopsies were also negative for EV RNA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Mammography usage and the health belief model.

Regular screening mammograms for asymptomatic women are the most effective method for early detection of breast cancer. This study assessed the relative influence of Health Belief Model (HBM) constructs on prior mammography usage and the intention to obtain mammograms with data from a sample of 1,057 women over the age of 35 years residing in an urban community in the United States. Covariance structure analysis with latent variables was used initially to perform a confirmatory factor analysis of indicators of Socioeconomic Status (SES), Perceived Susceptibility, Perceived Barriers, Perceived Benefits, Cues to Action, Prior Mammography, and Future Intentions. Once a plausible factor structure was confirmed, a predictive path model was tested with Future Intentions and Prior Mammography as the outcome variables. Cues to Action, operationalized as a physician influence variable, particularly impacted Prior Mammography, and Perceived Susceptibility was the most powerful predictor of Future Intentions. SES only related significantly to Perceived Barriers, and Cues to Action, and did not directly influence Prior Mammography and Future Intentions. HBM predictor variables alone accounted for the relationship between previous mammography experience and intentions to obtain mammograms in the future. Health education implications and an applied outreach program are discussed.

Adult↗
PubMed1991

The effect of physician-patient communication on mammography utilization by different ethnic groups.

The differential utilization of screening mammography by racial/ethnic groups was examined through 35-minute bilingual, random digit dialed telephone interviews with 1,057 women over age 35 years. Results showed that 71% of hispanic women had never had a mammogram and that only 27% over age 50 years had had one in the year before the survey. White and black women over the age of 50 years were being screened more frequently with 34% of white women and 36% of black women having had a mammogram in the prior year. More than half of the hispanic women over age 50 years had never had a mammogram. Analyses showed that the most important variable that predicted whether women of all racial groups had a mammogram, at any time or within the last year, was whether their doctors had discussed mammography with them. The discussion did not need to be lengthy or complex. Hispanic women, however, were less likely to have physicians who discussed screening with them even though these women reported that they were just as motivated as other women to get a mammogram if their doctor referred them. Suggestions for what primary care physicians can do to increase mammography rates, especially among hispanic women, are discussed.

Adult↗
PubMed1991

The influence of ethnicity, socioeconomic status, and psychological barriers on use of mammography.

This study assessed the relative influence of psychological barriers, SES, and ethnic differences in mammography use for a community sample of 586 White, 227 Black, and 150 Hispanic women. Confirmatory factor analyses with latent variables indicated plausible factor structures for all groups on items related to barriers to mammography. Summed indicators of SES, fear of radiation, embarrassment, pain, anxiety, and cost concerns were correlated significantly with mammography use for the pooled group. Separate analyses by ethnicity indicated a substantial relationship between mammography use and cost concerns by White and Black women, and fear of pain by Black and Hispanic women. Use of mammography was associated more highly with SES among Hispanic women. Pooled logistic regression analyses controlling for SES and ethnicity showed that the psychological barriers, especially concern about cost, remained important independent predictors of mammography use. We explore sociocultural explanations for less mammography use by Hispanic women, especially those less acculturated.

Black or African American↗
PubMed1991

The impact of physician compliance on screening mammography for older women.

Screening mammography is underutilized, even for women older than 50 years for whom there is a general consensus that regular annual screening is appropriate and necessary. To evaluate reasons for this underutilization, we studied a random sample of 517 women in Los Angeles, Calif who were older than 50 years. All women were found to be underscreened, especially women older than 65 years. For example, approximately 35% of women 50 to 64 years old and 47% of women aged 65 years and older never had had even one mammogram. Analyses revealed that the most important factor that predicted whether a women ever had had a mammogram was whether her physician had talked to her about mammography. Women were between four and 12 times more likely, depending on their age group, to have had a mammogram at some time if their physicians discussed it with them. The discussions did not need to be lengthy or complex. These results indicate that physicians need to know that discussing screening mammography with their patients has a major impact on breast cancer screening behaviors.

Breast Neoplasms↗
PubMed1990

Improving the adherence of urban women to mammography guidelines: strategies for radiologists.

Only 16% of women over 40 years of age are being screened regularly with mammography. To learn what radiologists and technologists can do to increase patient adherence to the screening guidelines of the American Cancer Society, especially by poor, urban women, the authors surveyed patients at a county facility immediately after mammography to document the patients' experiences with technologists and the procedure. Analysis of these data led to the conclusion that the radiologist should encourage an expanded role for the technologist as a breast health educator. By incorporating the use of a well-designed patient brochure, technologists can greatly enhance their effectiveness by decreasing the patient's anxiety and increasing her understanding of the procedure and of the importance of screening. Radiologists need to appreciate the potential of an expanded technologist's role for increasing future referrals.

Breast Neoplasms↗
PubMed1989

Mammographic screening in southern California: 2 1/2-year longitudinal survey of fees.

The American Cancer Society sponsored a community-wide low-cost mammographic screening project in March 1986. One of the major goals was to effect a decrease in mammographic screening fees. To evaluate the effectiveness of the project, a telephone survey of 58 facilities was conducted six times over 2 1/2 years, beginning January 1986 and at 6-month intervals thereafter. The number of facilities offering lower fees for screening than for consultative mammography increased from two with a mean fee of $50.00 in January 1986 to 16 with a mean fee of $68.71 in July 1988. The trend for differentiating screening and consultative examination fees occurred at both hospital- and office-based practices, but fees were significantly lower in the office-based practices. There was also a statistically significant increase in the number of facilities accepting self-referred patients between January 1986 (15.5% of facilities) and July 1988 (34.5%). At the time of the last survey, 60% of office-based practices were accepting self-referred patients.

California↗
PubMed1988

The technology of mammography. Misunderstood and underutilized.

This article reviews milestones in the technological development of mammography since 1970. Mammography is particularly underutilized as a screening procedure for breast cancer and the reasons for its continued inappropriate and under use are explored. Although there are some known barriers to increased utilization among the female adult population, the majority of barriers reside within the domain of referring physicians. Remedies to address the low referral rates for screening mammography are outlined for federal agencies, radiology groups, mammography equipment companies, medical schools, and philanthropic groups. Until the developers of technological procedures such as mammography appreciate that the application of a technology and its appropriate utilization by professionals and the public are important to consider when the technology is developed, utilization rates may not do justice to the technology's potential.

Adult↗
PubMed1988

Underuse of screening mammography by family physicians.

Although the American College of Radiology, the National Cancer Institute, and the American Cancer Society recommend screening mammography for women more than 40 years old, there is little compliance with these recommendations. Primary-care physicians are often reluctant to refer patients for the procedure, whereas the patients are usually willing to undergo the procedure. This survey documents the underuse of screening mammography by family physicians who are members of the Michigan Academy of Family Physicians. The underuse of mammography by this physician sample was due to two main factors: The physicians perceived far more disadvantages than advantages with mammography and perceived problems (with, e.g., equipment, effectiveness, and patient acceptance) as pervasive. To change the attitudes and referral behavior of family physicians, one must take into account the specific, negative perceptions of the procedure and place an emphasis on the initial referral, since subsequent referrals are easier to implement.

Adult↗
PubMed1987

Mammography screening: successes and problems in implementing widespread use in the United States.

Deterrents to the use of screening mammography include perceived risks of radiation, perceived "unnecessary" biopsies and overdiagnosis, and high cost. In addition, physicians and patients have attitudinal barriers that do not reflect objective realities. Professional and public education efforts are needed to enable women and their physicians to develop a more sophisticated understanding of the usefulness of screening mammography and the role played by the radiologist. As part of their efforts to increase the implementation of screening mammography, the American College of Radiology has developed a Mammography Accreditation Program for radiological facilities and has produced a free Mammography Resource Kit for radiologists, while the American Cancer Society has undertaken the support of local and national campaigns to establish screening programs at reduced cost. Both organizations continue to strive in partnership to increase the acceptance of screening throughout the United States.

Allied Health Personnel↗
PubMed1984

Amine oxidase activities in brown adipose tissue of the rat: identification of semicarbazide-sensitive (clorgyline-resistant) activity at the fat cell membrane.

Amine oxidase activity, previously described in homogenates of brown adipose tissue of the rat, has now been investigated in preparations of isolated fat cells. It was found that the specific activities of both monoamine oxidase A (MAO) and of the semicarbazide-sensitive clorgyline-resistant amine oxidase (SSAO) were higher in isolated fat cells than in the original whole tissue. Brown adipocytes therefore represent a major source of both these enzymes. In plasma membranes prepared from these isolated brown fat cells by borate extraction there was a similar enrichment of activity of SSAO and of the plasma membrane marker enzyme, phosphodiesterase I. However in preparations of cell membranes made by binding the cells to polycation-coated beads, enrichment of phosphodiesterase I activity was much greater than that of SSAO. It is suggested that the disposition of the enzyme within the cell membrane may account for the discrepancy in these results, i.e. the sidedness of the membrane may be important. Histochemical visualization of enzyme activity in whole tissue at the ultrastructural level was undertaken. Positive staining of mitochondria was achieved in the presence of the MAO substrate, tryptamine. Staining around the edges of the brown fat cells was observed with the SSAO substrates, tyramine and benzylamine. Staining was largely absent when substrate was omitted or after pretreatment with the irreversible SSAO inhibitor, hydralazine and the slowly reversible inhibitor, semicarbazide. It is not definitely proven that this staining represents sites of enzyme activity but the results are consistent with evidence from other studies indicating that SSAO in brown adipose tissue of the rat may be found predominantly at the fat cell surface.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue, Brown↗
PubMed1984

Comparative effects of some non-steroidal anti-inflammatory drugs on the ultrastructural integrity and prostaglandin levels in the rat gastric mucosa: relationship to drug uptake.

Studies were performed in fasted rats to establish if the propensity of 4 non-steroidal anti-inflammatory (NSAI) drugs to elicit varying degrees of gastric mucosal damage following oral administration is related to their rate of absorption by the mucosal and subsequent inhibitory effects on prostaglandin (PG) production in vivo. Aspirin (200 mg/kg p.o.) and indomethacin (10 mg/kg p.o.) produced ultrastructural signs of damage at 10-60 min to the surface mucous cells, parietal cells and endothelial cells of sub-mucosal capillaries coincident with the relatively rapid absorption of the radiolabelled drugs and reduction in the mucosal content of PGE2 and 6-keto PGF1 alpha determined by gas chromatography/mass spectrometry. Azapropazone (100 mg/kg p.o.) failed to elicit mucosal damage either ultrastructurally or even visually up to 23 h after dosing and did not affect the content of PG's even though the drug was present in the mucosa in sufficient concentration to elicit reduction in prostaglandin synthesis in vitro. Benoxaprofen (110 mg/kg p.o.) reduced the content of PGE2 and somewhat variably, that of 6-keto PGF1 alpha, was more slowly absorbed c.f. aspirin and indomethacin, but failed to elicit appreciable mucosal damage. These results show that while reduction in PG synthesis is a factor in the development of damage by ulcerogenic drugs, it appears that the rate of absorption or other biochemical effects (including e.g. influences on the production of oxyradicals or 5-lipoxygenase products of eicosanoid metabolism) may contribute to the relatively low irritancy of drugs such as azapropazone or benoxaprofen.

Animals↗