Factors related to noncompliance with screening mammogram appointments among low-income African-American women.

Despite current mammography recommendations, screening rates among African-American women are suboptimal. The purpose of this case-control study was to identify the psychological, demographic, and health care system barriers to screening mammography use among low-income African-American women. A total of 574 women with screening mammogram appointments at an urban hospital were interviewed to determine the predictors of mammogram appointment noncompliance. Predictor variables included: demographics; breast cancer knowledge, attitudes, beliefs, and screening practices; and type of health care provider making the referral. Age was inversely related to mammogram appointment noncompliance. Relative to women 40 to 49 years old, women 70 years of age and older were the least likely to miss their appointments (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.2, 0.5). Women referred for mammography by a physician's assistant or nurse practitioner were less likely to miss their appointments than women referred by a physician (OR, 0.3; 95% CI, 0.1, 0.8). Embarrassment, lack of breast symptoms, and forgetfulness also contributed to noncompliance. Key demographic, attitudinal, and health care system factors hinder low-income African-American women from obtaining screening mammograms. These findings have significant health education and policy implications for health care delivery to women in this population.

Improved formulas for the estimation of renal depth in adults.

Commercial techniques are available to calculate effective renal plasma flow (ERPF) or glomerular filtration rate (GFR) based on the percent injected dose in the kidney 1-2 or 2-3 min post-injection; renal depth is estimated by the Tonnesen equations. Since the Tonnesen equations were derived from ultrasound measurements obtained at an oblique angle in sitting patients, we compared the renal depths obtained from the Tonnesen equations with the renal depth measured by computed tomography in supine patients, the most common position for radionuclide renography. The renal depth, height, weight, age and sex were determined for 126 patients undergoing CT scanning. Patients with obvious renal or abdominal pathology were excluded. The Tonnesen equations significantly underestimated renal depth. Using stepwise linear regression analysis, we derived a set of equations based on age, height and weight and applied these prospectively to a new set of 75 patients. In addition, a second set of equations were derived for the new data. There was no difference in the results for the two equations. We then pooled both studies and derived a combined set of equations: right renal depth (mm) = 153.1 weight/height + 0.22 age + 0.77 and left renal depth (mm) = 161.7 weight/height + 0.27 age - 9.4, where weight is in kilograms and height is in centimeters. The correlation coefficients were 0.81 and 0.83 for the right and left kidneys respectively with standard errors of the estimate of 10.2 and 10.1 mm. These equations provide a much better estimate of renal depth in the supine patient than the Tonnesen equations.

CT- or sonography-guided biopsy of the liver in the presence of ascites: frequency of complications.

The presence of ascites has been considered a contraindication to percutaneous biopsy of the liver. To determine the validity of this assumption, we performed percutaneous biopsies of the liver under CT or sonographic guidance in 28 patients who had ascites and in 28 patients who did not have ascites and compared the complication rates in the two groups. Twenty-two patients (79%) in the group with ascites and 19 patients (68%) in the group without ascites had biopsies to determine the cause or extent of chronic liver disease. The remainder were oncologic patients who had biopsies to determine the cause of a focal hepatic mass. The complication rate in the patients who had ascites (32%) was less than that in the patients who did not have ascites (43%) (the difference did not reach statistical significance, p less than .30). In the ascites group, complications included transient hypotension (five patients), a mild-to-moderate fall in hematocrit (three patients), and a small leak of ascites from the biopsy site (one patient). In the control group, minor complications included transient hypotension (three patients), a mild-to-moderate fall in hematocrit (seven patients), and a small subcapsular hematoma (one patient). One major complication occurred in the control group: a patient required a blood transfusion because of the fall in his hematocrit. We conclude that the complication rate in liver biopsies guided by CT or sonography in the presence of ascites is not higher than similar biopsies done in the absence of ascites. Ascites should not be considered a contraindication for performing such biopsies.