Morphometric analysis of CD34-positive vessels in salivary gland adenoid cystic and mucoepidermoid carcinomas.

BACKGROUND: Carcinomas of the salivary glands are uncommon and morphologically a diverse group of malignancies. To evaluate the prognostic value of CD34 immunostaining of the vessels in adenoid cystic carcinoma (AdCC) and mucoepidermoid carcinoma (MEC), an automated image analysis method was used. METHOD: In a nationwide study, covering salivary gland cancer (SGC) patients in Finland 1991-1996, 37 AdCC and 18 MEC patients (M 25, F 30, age 25-90, mean 63) were included. In addition to clinical characteristics the size, shape, staining intensity and vessel density in CD34 immunostained histologic samples were measured. RESULTS: Altogether 4433 vessels were measured from AdCC and 2615 from MEC tumor. Of the total tumor vessels measured, 2651 were from patients who deceased with disease (Group I) and 4397 were from specimens derived from those who did not die of disease (Group II) during the 10-year follow-up. The staining intensity was significantly higher in MEC than in AdCC tumor (P = 0.0005). In MEC, the Group I patients had a higher staining intensity among high-grade patients compared with patients with low grade disease, whereas the tumors in Group II had a lower staining intensity among the high-grade compared with the low grade tumors (P = 0.018). A higher vessel density was found in patients with MEC in group II compared with group I (P = 0.017). CONCLUSIONS: The staining intensity of CD34 positive vessels in MEC was higher than in AdCC. In MEC, higher staining intensity of vessels in high-grade tumors and lower vessel density in all MEC patients, predicted poor survival.

Size, shape, structure, and direction of angiogenesis in laryngeal tumour development.

AIMS: Angiogenesis and vessel organisation in laryngeal tumour development and progression were examined to determine characteristics of biological and clinical relevance. METHODS: Automated quantitative image analysis was performed on 1451 factor VIII (FVIII) associated blood vessels with regard to occurrence, structure, size, shape, and staining intensity, in addition to vessel direction. RESULTS: Vessel numbers were increased in preneoplastic states and severe dysplasia, in addition to squamous cell carcinomas, being greater in poorly differentiated carcinomas. Small regular vessels predominated in benign conditions and large, irregular vessels in malignant neoplasms. Vessel distribution was related to degree of differentiation in squamous cell carcinomas, with circumferential angiogenesis occurring in well differentiated neoplasms, directional angiogenesis in moderately differentiated tumours, and aberrant angiogenesis in less well differentiated neoplasms. Alterations in vessel shape increased significantly with increasing degree of malignancy. Comparing the characteristics of individual vessels showed vessel shape abnormalities and the intensity of FVIII staining to increase with vessel size. CONCLUSIONS: Increased angiogenesis was an early event in laryngeal tumour development, with vessel structure, size, and shape related to the tumour growth pattern and behaviour.

Collagen matrix in development and progression of experimentally induced respiratory neoplasms in the hamster.

Intratracheal instillations of 7H-dibenzo(c, g)carbazole (DBC), a tobacco smoke component, into Syrian golden hamsters, resulted in preneoplastic lesions and benign and malignant respiratory neoplasms. Neoplastic progression was associated with specific changes in the extracellular matrix (ECM), dependent on the stage of tumor development. DBC-induced tracheobronchial squamous metaplasia was associated with an increase in collagen type I and type III deposition in the subepithelial ECM, as observed by computer-assisted image analysis of immunohistochemical staining for the aminoterminal propeptides of collagen type I (PINP) and collagen type III (PIIINP). Increased collagen matrix synthesis was detected in dysplasia by in situ hybridization of alpha1(I) mRNA for collagen I and alpha1(III) mRNA for collagen type III after continued exposure to DBC. In well-differentiated squamous cell carcinomas with an expansive growth pattern, collagen deposition increased, as did fiber size. In moderately differentiated neoplasms, basement membrane (BM) destruction and invasion was associated with a destructive growth pattern and decreases in collagen synthesis and the deposition of new collagen. Preserved deposition of mature collagen was detected by staining for the telopeptide of collagen type I propeptide. In less differentiated tumors, ECM development was minimal, with few and small fibers, possibly explaining the rapid development of these neoplasms. Transforming growth factor beta (TGFbeta1) immunoreactivity was increased in hyperplastic epithelium and well differentiated neoplasms and decreased in dysplasia and less differentiated squamous cell carcinomas, while TGFbeta2 and TGFbeta3 expression was also distinct in neoplastic cells. Collagen synthesis and epithelial differentiation were associated with an increased number of myofibroblasts in the ECM and with increased TGFbeta3 immunoreactivity in differentiated cells and in the matrix. The nature of the composition of the ECM was related to neoplastic growth and progression when analyzed by computer-associated image analysis, revealing alterations in collagen structure, size, and shape.

Morphometric characteristics of cell proliferation and p53 expression in development of experimentally induced respiratory tumors.

OBJECTIVE: To study, under controlled conditions, the applicability of automated image analysis of immunohistochemical markers as an indicator of development and progression in tobacco component-induced tumors in the respiratory tract. STUDY DESIGN: Amount, location, size, shape and intensity of staining of proliferating cell and p53 antigen in chemically induced precursors and squamous cell carcinoma of the hamster lung were determined by computer-assisted morphometry. RESULTS: The total expression of proliferating cell nuclear antigen (PCNA) and p53 expression increased consistently during the formation of papillomas and squamous cell carcinomas of the larynx, trachea, bronchi and lungs. Individual preneoplastic cells in epithelial dysplasia expressed PCNA staining, increasing with increasing cell size and optical density, indicating antibody- staining intensity, in relation to the increased degree of cellular atypia. In malignant tumors, cell size decreased with decreasing differentiation, while antibody staining intensity remained unchanged. The increased alterations in cell shape and percent PCNA-positive cells observed in dysplastic epithelium and squamous cell carcinomas were statistically significant using Spearman's correlation coefficient. Squamous cell carcinomas consisted of two tumor cell populations with different cell shapes, and PCNA and p53 staining intensity. Altering measurement conditions-antibody threshold levels, size of measured area and repeating measurements-showed computer-assisted image analysis to give sensitive, reliable and consistent results. CONCLUSION: Computer-assisted analysis of immunohistochemical staining showed high sensitivity and reproducibility; however, the results depended upon the method of study.

Stages of change in two modes of health-enhancing physical activity: methodological aspects and promotional implications.

Measurement scales for stages of change were developed and the stages were assessed in two specific modes of Health-Enhancing Physical Activity (HEPA) in a cross-sectional survey (N = 1516); representative samples were selected from three age groups, i.e. from three phases of adult life. Outdoor Aerobic Exercise (OAE) was used as an example of fitness activity; Everyday Commuting Activity (ECA) was selected to represent lifestyle physical activity. Scales used by the Prochaska team were modified for this study, and the stages of Precontemplation and Preparation were each divided into two new stages. Consistency of the stage measurement was moderate for OAE and good for ECA. As regards content validity, consistent associations were found between stage scores and contextual variables for both behaviors. The results show that, at a given time, a person can be in different stages in different modes of HEPA. Therefore, the behavior of interest must be specified before accurate information on the stages of change in a population can be obtained. The results also indicate the importance of contextual factors in HEPA promotion.

How to promote physical activity through individual counseling--a proposal for a practical model of counseling on health-related physical activity.

A model was developed to aid practical decision making in the counseling of health-related physical activity. The development was based on the following concepts and theories: (1) A wide concept of physical activity; (2) A logical sequence of the practitioner's work steps; (3) Personal aspect of the client; (4) The client's stages of adoption; (5) Determinants of physical activity; (6) Selected educational concepts; (7) Selected strategies of planned maintenance. The model provides the practitioner the main work steps of counseling to follow and detailed lists of potential factors in each step to be taken into account for effective counseling on health-related physical activity. An illustrative case history is given on the model's application. The model is shown to incorporate central behavioral strategies shown useful in promoting adherence to physical activity.

The versatile nature of physical activity--on the psychological, behavioural and contextual characteristics of health-related physical activity.

This paper presents a comprehensive characterisation of physical activity based on psychological, behavioural and contextual aspects. Based on the characterisation it suggests a promotional classification of physical activity into five categories. The categories are: 1, Occupational activity; 2, Lifestyle activity; 3, Recreation activity; 4, Fitness activity; and 5, Sport activity. Examples are given of activities in each category and of the related emotional aspects, outcome expectations, degree of personal choice and health benefits. The importance of the emotional component and the relevance of the outcome expectations are discussed and contextual considerations are presented on the basis of the promotional classification. The implications of the classification for the practice of health-enhancing physical activity promotion are discussed.

How to develop one's counseling--demonstration of the use of single-case studies as a practical tool for evaluating the outcomes of counseling.

The physical activity patterns of eight single cases of back patients are described across a series of counseling sessions and a 12-month follow-up. The cases demonstrate the variability of physical activity during the counseling period due to random influences in the patient's life and the possibility of total relapse of more complicated activity types after counseling. The simple behaviors like proper sitting, standing or lifting are shown to be better maintained in spite of the random influences in the patient's life. The single-case study method is demonstrated to serve as a practical tool for evaluating one's counseling in the promotion of health-related physical activity.

How can physical activity be changed--basic concepts and general principles in the promotion of health-related physical activity.

Basic concepts and general principles in the promotion of health-related physical activity are presented based on selected behavioral science theories, research findings and conceptual analysis. The concepts and principles selected include (1) a realistic and flexible concept of physical activity, (2) a pragmatic use of the determinants of physical activity, (3) targeting promotion to specific stages of adoption at a time, (4) a systematic facilitation of the change process by health communications and environmental changes, and (5) a stepwise organization of the promotional activities while respecting the target people's freedom of choice.

The process and methods of health counseling by primary health care personnel in Finland: a national survey.

A stratified random sample of 53 Finnish health centers was selected, and representative samples of their physicians, nurses and physiotherapists were surveyed by questionnaire on the frequency of their use of health education methods in health counseling and their perception of the ease vs. difficulty of implementing the stages of the process of lifestyle counseling. Overall, the assessment of the enabling and reinforcing factors in client health behavior (social relationships and physical environment), the translation of these factors into a behavior change program and the evaluation of such programs were seen as difficult by all three categories of health care professionals. The implementation stage of lifestyle counseling was, however, generally rated as easy, although quite a limited selection of education methods and self-evident motivational prompts were used. The physiotherapists regarded the process of lifestyle counseling in their specialty, exercise counseling, as easier to conduct and they used a more varied selection of methods than the other health care personnel groups. The findings indicate a need for further in-service education for Finnish health center professionals on health education methods as well as a need for the restructuring of the care system to allow better opportunities for the full realization of the process of health counseling.

New computerized Finnish speech in noise test and binaural hearing.

Aided and unaided binaural versus monaural recognition of speech has been studied with more or less laborious methods when speech and noise sources are spatially separated. The efficacy of the new Finnish speech in noise test to show binaural advantage was evaluated in free field conditions. Thirteen subjects with normal hearing were tested measuring speech recognition thresholds in noise (SRTN) in anechoic chambre with different situations of spatial separation of speech and noise sources monaurally and binaurally. The noise source was fixed above the head (treating both ears similarly) and equidistant speech was delivered at different azimuths. SRTNs with mixed speech and noise without spatial separation served as normalizing reference. Differencies in SRTNs consistently followed the changing head and pinna shadow effects on the speech-to-noise ratio with a smaller binaural advantage. This new test seems to give quite economically the same results as those of previous more sophisticated investigations on speech recognition in free field situations.

Is long-term maintenance of health-related physical activity possible? An analysis of concepts and evidence.

The phenomenon of maintenance of health-related physical activity is explored through an analysis of the underlying concepts and of the existing empirical evidence. The following targets were used for the analysis: (1) the concept of health-related physical activity, (2) the concept of maintenance, (3) common manifestations of maintenance in everyday living, (4) the promotional and behavioral characteristics of health-related physical activity, (5) the known determinants of free-living physical activity, and (6) intervention trials on physical activity in free-living groups. The analyses revealed the inherent resistance to adoption and maintenance of physical activity, particularly that of high-intensity and program-centered activities, the persistence, however, of many simple everyday routines and habits, the multiple determinants discovered for free-living physical activity and a few empirical demonstrations of the successful promotion of the maintenance of physical activity over a year or two. The promotion of the maintenance of health-related physical activity seems thus a distinct possibility provided that (1) the promotional situation is analyzed thoroughly, (2) the activity is chosen carefully with an emphasis on moderation in intensity and integration into the participant's life-style, (3) multiple promotional contacts are used, and (4) support from the participant's social and physical environment is provided. There is a need for more research on the maintenance of health-related physical activity using the stages of change models, behavior modification principles, self-control concepts, the concept of intrinsic motivation and the Relapse model. The method of analysis used here could apply to other health-related behaviors as well.

Strengths and weaknesses in health counseling in Finnish primary health care.

Representative samples of Finnish health centres and of their physicians, nurses and physiotherapists were selected for a comprehensive survey on the professionals' work characteristics, health education attitudes and counseling practices. The main objectives of the study were to study the degree of implementation of patient counseling, with special reference to the national goals in health policy and to analyze the determinants of counseling practices in terms of predisposing, enabling and reinforcing factors. Broadly defined patient counseling was frequent in the contacts with all 3 professional groups and no differences in counseling frequency were found between different sizes of health centres. However, the objective of implementing counseling in every patient contact, with the incorporation of guidance regarding healthy living habits in it, recommended in the national health policy goals, was only partially realized. There were distinct differences between the 3 professional groups in counseling attitudes, topics, methods and purposes. These differences reflect, to a great extent, the differences in the professional tasks and the basic training between the 3 groups and also differences in the characteristics of patient contacts. These findings indicate a need for further in-service training in the methods of patients counseling, as well as restructuring the health care delivery system to allow more time for counseling, better continuity between contacts and more co-work between the members of primary care teams.

Changing community health behaviors: a model for program development and management.

A model has been proposed to improve program development and management of behavior change programs with large-scale community impact. It can be applied to epidemiologic problems of which lifestyle is an important component, such as heart disease, adolescent pregnancy, hypertension, weight control, and cancer control and prevention programs. The model combines two previously existing models: one indicating that program development is an ongoing cyclical process which starts with uncertainty yet can progress to institutionalization with suitable testing; and the second model indicating that program management within each developmental cycle progresses through specific phases which can be hampered by plateaus and setbacks. Nine systems are essential for program development and operations: education (philosophy, objectives, and content), communications, reward, intervention, program process, program development, and program evaluation. These systems can be used as a guide to facilitate selection from the many guidelines recommended in the literature, and to ensure coordination of innovative program elements.