Attitudes, beliefs, and knowledge as predictors of nonattendance in a Swedish population-based mammography screening program.

BACKGROUND: The effectiveness of mammography screening could be improved if factors that influence nonattendance were better understood. METHODS: We examined attitudes, beliefs, and knowledge in relation to nonattendance in a population-based mammography screening program, using a case-control design. Data were collected from November 1997 to March 1998 through telephone interviews with 434 nonattenders and 515 attenders identified in a population-based mammography register in central Sweden. The questions asked drew primarily upon the components constituting the Health Belief Model. RESULTS: Multivariate analysis showed that nonattendance was most common among women within the highest quartile of perceived emotional barriers, compared to women within the lowest quartile (OR = 4.81; 95% CI 2.96-7.82). Women who worried most about breast cancer were more likely to attend than those who worried least (OR = 0.09; 95% CI 0.02-0.31). Women with the highest scores of perceived benefits were more likely to attend than women with the lowest ones (OR = 0.35; 95% CI 0.08-0.75). Other factors associated with nonattendance were less knowledge about mammography and breast cancer, lack of advice from a health professional to participate, and very poor trust in health care. CONCLUSIONS: Our findings suggest that increased participation in outreach mammography screening programs can be achieved through enhancement of breast cancer awareness and possibly by reducing some of the modifiable barriers. mammography; mass screening; breast cancer; attitudes; Sweden.

[Oculoplastic surgery implies restoration to "normalcy". Cosmetic surgery is performed only for congenital malformations or disease]. / Ogonplastikkirurgi innebär ett återställande till det "normala". Kosmetisk kirurgi förekommer endast vid missbildning eller sjukdom.

Ophthalmic plastic or oculoplastic surgery is the current term for the surgical treatment of disorders of the eyelid, the lacrimal apparatus and the orbit. The most frequent causes are congenital malformations, malpositions, abnormal motility, tumors and injuries. A good functional result with the best possible appearance is the goal; cosmetic surgery is performed only when the underlying cause is a malformation or disease. Several specialties have qualifications relevant to this field or parts of it; this article describes the tasks of an ophthalmologist working in this field and what he can accomplish.

Asthmatic patients' views of a comprehensive asthma rehabilitation programme: a three-year follow-up.

BACKGROUND AND PURPOSE: Twenty-one asthmatic patients aged 27-59 years, with mild to moderate asthma, participated in a 10-week group rehabilitation programme covering physical training and theoretical and practical education in medication, self-management strategies and physiotherapy. This study was undertaken retrospectively to investigate (1) the patients' reasons for joining the programme, (2) their experiences of the programme, and (3) their ways of coping with disease-related problems before joining and three years after completion of the programme. METHODS: Patients were followed up every six months for three years and were interviewed after the three years. The semi-structured interviews were tape-recorded, transcribed and revised. RESULTS: The life-situation of most of the patients before the 10-week programme was characterized by helplessness at exacerbations, anxiety/insecurity about medications and their side-effects, and/or concern about future health. More than half of the subjects felt physical limitations in daily life or when exercising. All wished to increase their knowledge of asthma by joining the programme, but only nine patients expected asthma improvement. The experience that they were able to carry out physical exercise to a maximal intensity and that physical training improved their asthma, with increased knowledge about medications were mentioned by all as the most valuable effects of the programme. Moreover, most patients emphasized their increased ability in self-management strategies (stress reduction and breathing technique). The increased knowledge and improved practical skills contributed to a better life-situation after the rehabilitation. After the three years virtually all the patients' lives were characterized by improved self-management, increased physical activity and a sense of security. Almost half of them expressed a wish to take responsibility for the disease. CONCLUSIONS: In addition to medical therapy and education, physical training and techniques for relaxation and breathing should form part of the treatment of asthma.

Senile entropion - cure rate by retractor tightening and horizontal shortening.

PURPOSE: In order to clarify the efficiency of two operations aimed at curing the principal causes of senile entropion, a consecutive series of patients were examined. MATERIAL: In 19 lids, the lower lid retractors were tightened transcutaneously and in 45 a simultaneous horizontal lid shortening was performed. Surgery was uneventful in all cases. The patients were reexamined 7-53 months after surgery. RESULTS: In the group with mere retractor surgery were five recurrences; all lids that also had a horizontal shortening were satisfactorily cured. CONCLUSION: Lower eyelid retractor tightening with simultaneous horizontal shortening of the lid is recommended to correct senile operation with a lasting result.

Attitude to work and health problems among home care workers in settings with different degrees of institutionalization.

The relationship between different degrees of institutionalization in the care of the elderly (service house, home care, and a combination of both) and work-load, as well as staff feelings regarding psychosocial variables and health complaints, was investigated. Seventy-one staff members similar in background factors answered questionnaires semi-annually during a period of 3 years. The results revealed consistent and stable differences between the different settings. The staff in service houses had the highest documented and subjective work-load and were doubly at risk for neck pain, fatigue and nervousness, and with a five-fold risk of shoulder pain, in comparison with the staff in home care, with the mixed group in an intermediary position. The results indicate that work involving mixed tasks might lower the strain of dealing with highly dependent clients in a highly institutionalized environment. Generalizations are limited, because of small sample sizes and descriptive design, but the results were consistent and persisted over a 3-year period.

Effects on driving performance of visual field defects: a driving simulator study.

To elucidate the possible traffic safety risks induced by visual field defects, a method was developed based on a driving simulator. The capacity to detect stimuli of different sizes appearing in 24 different positions on the screen in front of the driver was measured. Two groups of normal subjects and a number of subjects with different visual field defects were studied. In the groups of normals, the median reaction times were fairly homogenous. There was a slight difference between central and peripheral stimuli, which was somewhat larger for the older subjects. Among the subjects with field defects, the individual variations were very dominant. Very few of these showed a capacity to compensate for their deficiency. In order to gain insight into possible compensatory mechanisms of these persons, eye movement recordings were made. The results indicate that the visual search pattern may be of importance in this respect. Some comparisons with respect to detection capacity were also made with one-eyed subjects and with optically generated field restrictions (spectacles and spectacle frames).

Radioimmunolocalization of human colonic cancer xenografts; aspects of extensive purification of monoclonal anti-CEA-antibodies.

Tumour-to-normal tissue ratios of i.p. injected 125I-labelled monoclonal antibodies (MAbs), reacting with CEA were determined in nude rats xenografted with human colonic cancer cells (LS 174 T). Two MAbs, I-38S1 and II-16, reactive with the GOLD 1-epitope on CEA were tested. MAb I-38S1 was also tested after additional purification using anion exchange chromatography (thereafter named AEC 38). In the external activity measurements, MAb AEC 38 showed significantly better tumour-to-liver ratios than did MAb II-16 on all 4 days after injection. MAb I-38S1 gave intermediate ratios but was significantly better than II-16 only on day 3. The mean tumour-to-blood ratios were 3.0, 2.6 and 1.5 and the mean tumour-to-liver ratios were 6.6, 4.8 and 3.5 for MAbs AEC 38, I-38S1 and II-16 respectively. Gamma camera registrations in 3 animals on 4 days showed good imaging properties for all three MAbs and the patterns of tissue uptake were consistent with those seen in the external measurements. Furthermore, histopathological and immunohistochemical determinations were performed, showing that MAb II-16 gave about the same spatial binding as the previously analysed MAb I-38S1. The results indicate that additional purification of MAbs using anion exchange chromatography may potentiate tumour uptake in this model.

Simulation of mechanisms of viral interference in influenza.

Biological interference among viral agents might have significant implications for disease prevention and therapy. Field data for influenza yield conflicting evidence concerning the independence of infection rates, or disease severity, for two co-circulating viruses. To examine the effects of several assumed modes of interference for influenza, simulations of a Monte Carlo micropopulation model of influenza epidemics have been performed. Model parameters were selected so that the simulated attack rates for each of two different viral strains matched actual field data. Rates of infection were compared for single agents and for two viruses with only behavioural interference. Other simulations included temporary immunity to the other virus for the duration of the infection, and/or reduced shedding of viral particles for dual infections. Simulated viral competition had little impact on epidemic severity, duration, or size distribution. Under the conditions studied, viral interference in natural populations would be difficult to infer from field observations of attack rates. Other simulations extended a partial immunity and/or reduced viral shedding during an infection with a second virus. These indicated that interference might be suggested by field data, but it could not be demonstrated conclusively. Still other simulations showed that for epidemics with much higher attack rates for both viruses, it would be relatively easy to demonstrate interference. However, in order to observe interference between influenza strains, it would be necessary to monitor on an almost daily basis, using a method of viral detection which would have to be both highly specific and also very sensitive.

An immunoassay for histamine based on monoclonal antibodies.

Monoclonal antibodies with high specificity for histamine as well as for 1-methylhistamine were obtained after immunization of mice with a conjugate where the histamine was coupled via its ring 1-nitrogen to dog serum albumin. An immunoassay was developed for the quantitation of histamine release from basophils and 1-methylhistamine release from mast cells after provocation. The test method is based on competitive inhibition between histamine and a labelled histamine conjugate for the antigen binding sites of the antibodies. The separation step is performed by the addition of solid phase bound anti-mouse subclass specific antibodies. The sensitivity of the assay is 2 micrograms/l for histamine and 0.1 micrograms/l for 1-methylhistamine. No cross-reactivity was obtained with other metabolites of histamine or with histidine. Serotonin and dopamine were detectable, but only in doses (mg/l) well above the normal concentration found in the circulation. The immunoassay has been evaluated for its capacity to measure histamine release in vitro. A good correlation with the conventional fluorometric assay was obtained when histamine released from allergen stimulated leucocytes from allergic patients was tested. Urinary samples from patients undergoing hyposensitization showed a mean excretion of 1-methylhistamine at a level of 131 mumol MeHi/mol creatinine. The release of histamine and 1-methylhistamine in vivo was examined in plasma samples taken during a bronchial provocation test. A significant elevation above the basal analyte level occurred ten minutes after provocation.

Tumor specificity of monoclonal antibodies to carcinoembryonic antigen. Immunohistochemical analysis.

The tumor specificity of twelve different monoclonal antibodies (Mabs) against carcinoembryonic antigen (CEA) was assessed by immunohistochemistry. The Mabs had previously been classified into three specificity groups (I-III) on the basis of their reactivity with purified CEA-related antigens by ELISA. Mabs belonging to specificity group III (n = 4) did not cross-react with any CEA-related antigen, including normal cross-reactive antigen of 160 kD molecular weight (NCA-160 = meconium antigen). All Mabs, except one, gave positive immunohistochemical staining of 75-100% of individual tissue samples of colorectal carcinomas and gastric adenocarcinomas. However, when tested against different normal adult tissues, the Mabs displayed marked differences in reactivity. Group III Mabs stained normal colon epithelium, but not parenchymal cells in other organs or, with one exception, cells belonging to the granulocyte and/or macrophage series. Group I and II Mabs, in contrast, stained parenchymal cells in normal colon, submandibular salivary gland, placenta, and pancreas (group I Mab only). They also stained infiltrating and circulating granulocytes and/or macrophages. Lack of cross-reactivity with NCA-160 is the single-best criterion for selecting anti-CEA Mabs with a high degree of tumor specificity. To ensure tumor specificity, CEA-positive, NCA-160-negative Mabs should be checked by immunohistochemistry against cryostat sections of colorectal carcinoma, normal pancreas, submandibular salivary gland, spleen, and liver and for reactivity against circulating granulocytes.

Tolerability and pharmacokinetics of remoxipride after intramuscular administration.

A study was undertaken in seven schizophrenic patients to evaluate the tolerability and examine the pharmacokinetics of intramuscularly administered remoxipride after a single 200 mg dose and at steady state following repeated doses of 200 mg twice daily for one week. Comparisons of AUC, t1/2 and tmax using the Wilcoxon's signed rank test showed no significant difference between single dose and steady state indicating that the pharmacokinetics of intramuscular remoxipride were linear. The steady-state Cmax was found to be significantly larger than that after single dose and the increase was accounted for by the predicted accumulation factor, assuming linear kinetics. Although the inter-individual variability in plasma concentrations was large, the intra-individual variability was low as shown by the reproducibility of the single-dose and steady-state plasma curves. Remoxipride, administered intramuscularly, was well tolerated.

Laser-induced desorption of proteins.

Laser-induced desorption mass spectrometry has been applied to a number of proteins in the mass range 5000-150,000 u. The beam from an excimer-laser-pumped dye-laser at 266 nm has been focused to a spot of about 50 microns in diameter with irradiances in the 10(7) W/cm2 region. A linear time-of-flight mass spectrometer has been used for mass spectrometric measurements, where positive and negative secondary ions of large proteins have been studied. The effect of different experimental parameters on the protein ion-signal intensities are discussed.

Homogeneous penetration but heterogeneous binding of antibodies to carcinoembryonic antigen in human colon carcinoma HT-29 spheroids.

The monoclonal antibodies 38S1, directed against the carcinoembryonic antigen (CEA), were tested for penetration and binding in human colon carcinoma HT-29 spheroids. Penetration was studied with a method which has not previously been used in immunological investigations. The method, which allows unbound substances to be visualized, is based on freeze drying, vapour fixation, dry sectioning and dry autoradiography. The antibodies penetrated easily and all parts of the HT-29 spheroids seemed to be reached within 15 min. The penetration was even faster than in control glioma U-118MG spheroids that did not express CEA. Binding of the 38S1 antibodies was demonstrated after processing with conventional histology and autoradiography. The binding in the HT-29 spheroids was, after a 1-h incubation period, extremely heterogeneous and occurred mainly in the peripheral parts. More cells were binding the antibodies after 8-h and 32-h incubations and these cells were arranged in peripheral clusters. No binding at all was seen in the CEA-negative glioma spheroids. The distribution of CEA antigens in monolayers and in frozen sections of spheroids of HT-29 cells was analysed with immunohistochemical staining using polyclonal CEA antibodies. The CEA antigens were heterogeneously distributed in both spheroids and monolayers and were as heterogenous as the binding of the monoclonal antibodies in the living spheroids. Thus, the heterogeneous binding in the living spheroids was not due to penetration barriers, but instead to the heterogeneity in the CEA antigen expression.

In vitro studies of the biological effects of cigarette smoke condensate. III. Induction of SCE by some phenolic and related constituents derived from cigarette smoke. A study of structure-activity relationships.

Since our earlier studies of 23 individual weakly acidic constituents of cigarette smoke indicated that benzenes having vicinal oxygenation or a conjugated double bond induce sister-chromatid exchanges (SCE), we have now selected and examined a complementary set of 27 smoke constituents for their SCE-inducing properties. Of the 50 compounds tested in all, 23 were found to induce SCE, and these include all benzaldehydes but one and the majority of the compounds having a conjugated carbon-carbon double bond as well as several of the guaiacols. These groups of active compounds comprise important flavourants such as vanillin, ethylvanillin, isoeugenol and guaiacol. The structure-activity relationships encountered here may be useful in predicting the SCE-inducing activity of related compounds.