Strategies to encourage mammography use among women in senior citizens' housing facilities.

BACKGROUND: This randomized trial evaluated the impact of mammography-enhancing interventions implemented in 40 senior citizens' housing facilities in Pennsylvania and North Carolina. METHODS: After stratification of the facilities according to the socioeconomic status and racial backgrounds of their residents, they were randomly assigned to one of four groups to receive the following: 1) standard care--a Medicare mammography benefit flier; 2) education--the flier and a community education program; 3) access--the flier, mammography appointments, and transportation; 4) combined--all interventions. Telephone surveys, conducted prior to any intervention, identified mammography-eligible women, who were re-surveyed six months later to ascertain mammography use. RESULTS: Logistic regression analyses identified mammography intention, age, and the interaction between ever having had mammography and being in the combined intervention group to be significant predictors of mammography use at six months. However, no significant main effect was found for any of the interventions. CONCLUSIONS: These results suggest that the combination of community-directed mammography education and access to mammography appointments encourages mammography use primarily by women who are already predisposed to having mammography. However, individually targeted and tailored interventions may be needed to encourage mammography use among women who have never had mammography and/or express no intention of having it done.

Reaching midlife and older smokers: tailored interventions for routine medical care.

BACKGROUND: Although older adults can achieve significant health benefits from smoking cessation, few programs have specifically targeted this population. This study tested the effectiveness of an office-based smoking cessation program tailored to midlife and older smokers. METHODS: This paper describes a randomized controlled trial comparing usual care with physician-delivered brief quit-smoking advice and counseling for midlife and older smokers (ages 50-74). Outpatient medical practices assigned to the Immediate Intervention (experimental) condition were trained to deliver brief quit-smoking advice and counseling. Delayed Intervention (control) practices followed usual care procedures. Thirty-nine practices accruing five or more patients per practice were included in the analyses. RESULTS: Using conservative measure of quitting, self-reported quit rates at 6-month follow-up were 15.41% for the Immediate Intervention group versus 8.16% of subjects in the Delayed Intervention group (P < 0.005). Baseline subject (N = 659) characteristics related to 6-month abstinence included number of previous quit attempts, quitting for 24 hr in the past year, desire to quit, confidence in quitting, perceived health benefits, and lower nicotine dependence. CONCLUSIONS: Smoking abstinence was significantly increased by training physicians and key office and clinical staff to intervene with older smokers. Brief interventions are tailored to this age cohort can be successfully and efficaciously integrated into routine care.

Phase II trial of topotecan in advanced or metastatic adenocarcinoma of the pancreas.

PURPOSE: A phase II trial of topotecan, an inhibitor of topoisomerase I, was conducted in patients with advanced or metastatic adenocarcinoma of the pancreas to determine the activity and toxicity of topotecan. PATIENTS AND MATERIALS: 35 patients, previously untreated with chemotherapy, received topotecan 1.5 mg/m2/d for five days intravenously and repeated every 21 days. Patients were assessed for response after 3 cycles. Those with either clinical response or stable disease received additional cycles of the drug until toxicity developed or disease progression occurred. RESULTS: Among 30 patients evaluable for response there were no complete responses and 3 partial responses (10%) for a total response rate of 10% (95% confidence interval = 0-20.6%). Stable disease for at least eight weeks was seen in 11 patients (36%). Median survival was 19 weeks (95% confidence interval 11 to 26 weeks). Therapy was generally well tolerated, with reversible granulocytopenia being the most common toxicity. CONCLUSION: Topotecan given on a 5 day, short infusion schedule, demonstrated limited activity in pancreatic carcinoma with minimal toxicity. Further exploration of topotecan in pancreatic carcinoma using different dosing schedules is warranted.

Influence of lobular development on breast epithelial-cell proliferation and steroid-hormone receptor content.

The development of the breast evolves through progressive formation of lobular structures. Lobules type 1 (Lob 1) are the most undifferentiated ones; they evolve to lobules type 2 (Lob 2), and those to type 3 (Lob 3), in response to mainly ovarian hormones. Although estradiol and progesterone act by binding to their specific receptors, their content in these structures and how they correlate with proliferative activity are not known. Normal breast tissues obtained from 40 reduction mammoplasties performed for cosmetic reasons in women free of mammary pathology were processed for light microscopy. Paraffin sections were immunoreacted with antibodies against estrogen receptor (ER), progesterone receptor (PgR), and proliferating cell nuclear antigen (PCNA). The number of cells positively labeled with each one of the three antibodies was quantitated in Lob 1, 2 and 3, and expressed as a percentage of the total number of cells. ER were positive in Lob 1 (21%) and Lob 2 (10%), but negative in Lob 3. PgR were positive in Lob 1 (66%) and 2 (68%), decreasing in Lob 3 (31%). The highest percentage of PCNA positive cells were found in Lob 1 (40%), decreasing in Lob 2 (33%) and Lob 3 (11%). These results indicate that the normal breast epithelium contains ER and PgR, but the former is at higher levels in Lob 1, which also expresses greater proliferative activity as demonstrated with PCNA.

The use of logistic models for the analysis of codon frequencies of DNA sequences in terms of explanatory variables.

The development of the regressive logistic model applicable to the analysis of codon frequencies of DNA sequences in terms of explanatory variables is presented. A codon is a triplet of nucleotides that code for an amino acid, and may be considered as a trivariate response (B1, B2, B3), where Bi (i = 1, 2, 3) is a categorical random variable with values A, C, G, T. The linear order of bases in the DNA and possible statistical dependence of the bases in a given codon make the regressive logistic model a suitable tool for the analysis of codon frequencies. A problem of structural zeros arises from the fact that the stopping codons (terminators) do not code for amino acids; this is solved by normalizing the likelihood function. Codon frequencies may also depend on the function of the gene and they are known to differ between genes of the same genome. Differences also occur between synonymous codons for the same amino acid. Thus, the use of covariates that differ between synonymous codons as well as covariates that are constant within codons of the same amino acid may be useful in explaining the frequencies. As an illustration, the method is applied to the human mitochondrial genome using the following as explanatory variables: (1) TSCORE, a measure of the number of single base mutations required for a given codon to become a terminator; (2) AARISK, an indicator of a codon's ability of changing by a single base substitution to triplets coding for amino acids with very different characteristics; (3) AVDIST, a measure of the typicality of the amino acid coded for by the triplets. The results indicate that models that incorporate dependency structure and covariates are to be preferred to either the models comprising covariates alone or dependency structure alone.