Recognizing hypochondriasis in primary care.

Between 5% and 9% of primary care patients exhibit hypochondriacal symptoms. Hypochondriasis may be primary or secondary to panic disorder or depression. Despite negative diagnostic findings and clinician reassurance, hypochondriacal patients manifest disease conviction, disease phobia, or both. Primary care providers, in collaboration with mental health care providers, can provide optimal treatment for patients with hypochondriasis. The use of various intervention phases and selective serotonergic reuptake inhibitors provide the most favorable patient outcomes.

Difficulty in reaching low-income women for screening mammography.

Low-income women have a high mortality from breast cancer. Yet, they participate in breast cancer early detection screening programs less than women in the general population. An intervention study to improve screening mammography rates of low-income women participating in Tennessee's TennCare program (state Medicaid and Medicare program) revealed significant barriers to reaching these women. Intervention methods included mail, telephone calls, and home visits. Results indicate that only 38 percent of the women could be contacted for a baseline survey. Reasons for noncontact included absence from home (39 percent), having moved (22 percent), refusal to participate (17 percent), having no physical domicile (15 percent), language barriers (4 percent), and miscellaneous other factors (4 percent). Women with telephones tended to have a relatively higher economic status and were more successfully reached than women without telephones. These findings provide useful insights for future program planning and research design.

Stages of change and the intake of dietary fat in African-American women: improving stage assignment using the Eating Styles Questionnaire.

OBJECTIVE: To develop an algorithm for determining the stage of change for dietary fat intake in African-American women. DESIGN: We examined the relationships between stage of change, dietary fat intake, and associated eating behaviors and developed an assessment tool for placing subjects in their appropriate stage of change. SUBJECTS: Working class and middle-income African-American women in Nashville, Tenn; 174 in study 1 and 208 in study 2. STATISTICAL ANALYSES: Fat and fiber intake by stage of change was examined using multivariate analysis of variance. Hierarchical cluster analysis was performed using Ward's method. RESULTS: A significant difference in fat intake was noted between women trying to change their intake and those not trying to change in study 1 (P < .001) and study 2 (P < .03). Of those trying to change, only 34% (study 1) and 9% (study 2) of subjects reported fat intakes below the Healthy People 2000 goal of 30% of energy from fat. In study 1, cluster analysis identified 14 groups of foods that significantly separated subjects into not trying, noncompliant, and compliant categories. Compliant subjects ate out less; ate fewer snack foods and less chicken, meat, and fat; and ate more fruits, vegetables, breakfast foods, and low-fat products. These results led to development of the Eating Styles Questionnaire (study 2), which facilitated more appropriate placement of the noncompliant group in stages of change for dietary fat intake. APPLICATIONS/CONCLUSIONS: These data support the stage construct of the Transtheoretical Model for dietary fat reduction in African-American women. Moreover, the Eating Styles Questionnaire (ESQ) can improve determination of stage of change for this group of women. The ESQ can be used to diagnose the eating styles that contribute to a high-fat intake and help in the design of interventions to lower fat intakes.

Cancer rate differentials between blacks and whites in three metropolitan areas: a 10-year comparison.

This article compares cancer rate differentials for 1989-1993 and 1979-1981 between black and whites in Los Angeles, Nashville, and Atlanta, In Los Angeles and Atlanta, the black/white relative risk of lung cancer incidence has increased. While the relative risk for prostate cancer has decreased, blacks still show an excess incidence. White women still show a higher incidence of breast cancer, but the risk is closer to one. In all three cities, the excesses of black male lung cancer and female breast cancer mortalities have increased. The excess of black prostate cancer mortality increased in Atlanta and Nashville but decreased in Los Angeles. The excess of black cervical cancer mortality fell in Los Angeles and Atlanta but rose in Nashville. These results indicate a continuing need to develop and implement culturally sensitive interventions targeted at the black population.

Dietary factors and cancers of breast, endometrium, and ovary: strategies for modifying fat intake in African American women.

Modification of dietary fat and fiber could help prevent cancers of the breast, endometrium, and ovary that are prevalent in African-American women. Dietary intervention programs aimed at reducing fat intake have had mixed results in this population. The transtheoretic model is proposed for achieving dietary change. Strategies for changing health behaviors in African-American women include heightening sensitivity to cultural values among health educators and the use of multiple strategies to reinforce messages. To stimulate healthier eating, it is important to incorporate the distinct habitual eating patterns into innovative intervention methods, using effective behavioral change methods.

Understanding trichotillomania.

1. Trichotillomania is characterized by recurrent pulling of one's hair, resulting in significant hair loss. 2. Trichotillomania involves many hours each day of pulling hair or thinking about pulling hair. 3. Treatment includes five phases: accurate assessment and diagnosis, client education, self-monitoring, self-management, and self-maintenance.

Breast and cervical cancer screening among low-income women: impact of a simple centralized HMO intervention.

In 1994, it was estimated that about 44,500 American women would die from breast cancer and 7000 women from cervical cancer. While early detection methods (screening mammography, breast examinations, and pap smears) have proven to be effective means of decreasing these cancers, they are underused by all groups. In particular, low-income women use them least, resulting in their lower survival and higher mortality rates than the rest of the population. This article quantifies the effect of a simple intervention undertaken by a health maintenance organization (HMO) serving the indigent to improve breast and cervical cancer screening rates. The HMO mailed personal letters and newsletter articles to women members > or = 40 years about the need for cancer prevention. Articles also were printed in the monthly HMO newsletters to providers about the benefits of using these early detection methods. A review of provider claims from 574 women showed that baseline utilization rates for screening mammograms and pap smears before the intervention in year 1 (1990) were 14% and 16.4%, respectively. After the intervention, in years 2 and 3, mammograms had increased to 41% and pap smears to 38% for both years, indicating a levelling off effect of the intervention by year 3. These data show that while a significant improvement in screening behaviors was achieved, the intervention impact was limited to only about one third of the sample on the long term. Further, data do not indicate whether behavioral change was initiated as the member or provider level. More research is needed to increase overall screening behavior among the indigent and their physicians. The results reported here provide a baseline against which more intensive interventions can be measured in this setting.

Effects of physical stress on peroxide scavengers in normal and sickle cell trait erythrocytes.

Sickle cell trait subjects are potentially at risk with microvascular complications frequently associated with high altitude and extreme exertion. Studies conducted in our laboratory suggest that exposure of sickle cell trait subjects to treadmill exercise resulted in an increase not only in the susceptibility of red blood cells to oxidation but also in the density of RBC membrane. The trend of increased susceptibility of red cells to oxidation as a consequence of exercise was associated with relatively excessive production of H2O2, inefficient breakdown of H2O2 by GSH-Px- and catalase-catalyzed reactions, and inability/failure to show a transitory increase in the activity of reduced nicotinamide adenine dinucleotide phosphate (NADPH)-generating enzymes.

Effects of physical stress on complete blood count and venous blood gas profile of individuals with sickle cell trait.

The association between sickle cell trait (SCT) and adverse effects of exercise has been controversial. While individuals with SCT are at higher risk of sudden death, the mechanism for this outcome remains to be elucidated. In order to shed light on this controversy, we have monitored venous blood count and blood gas parameter values in normal and SCT subjects during treadmill exercise. White and red blood cell counts and hemoglobin changed significantly over time in both the SCT and normal groups, with peak exercise values different from pre-exercise or post-exercise values. Red blood cell counts showed significant group-time interaction; increase in count during exercise was accentuated in SCT subjects. All blood gas parameters showed significant changes over time in both groups. O2 content was significantly higher in SCT than AA at all time intervals. O2 saturation, pO2 and CO binding to hemoglobin showed significant group-time interaction. Furthermore, O2 saturation for the combined groups was significantly greater at peak exercise and at rest than before exercise. It is possible that treadmill exercise causes microvascular shunting in SCT subjects, leading to a decrease in the peripheral utilization of oxygen.

Unilateral moyamoya disease, intracranial aneurysm, and a pituitary adenoma: a case report.

A case of unilateral moyamoya disease is reported in an adult, associated with an aneurysm of the circle of Willis and a nonfunctional pituitary adenoma. A review of the literature is discussed. Young individuals presenting with signs of acute cerebrovascular changes of undetermined cause should be evaluated for moyamoya disease.

Cancer prognosis in black Americans: a mini-review.

There is significant disparity of cancer outcome (incidence, survival, and mortality) for black Americans when compared with white Americans. The extent of disease is inversely associated with survival and directly associated with mortality rates. Blacks, who tend to be diagnosed at later stages of cancer than their white counterparts, may have a poorer outcome even when diagnosed within the same stage. Socioeconomic status and class have been shown to be significant predictors of poor outcome, and blacks are disproportionately represented among the poor and disadvantaged. Some studies continue to show significant "race" effects after controlling for income, a result likely due to unmeasured related variables. Possible solutions are discussed that deal primarily with promotion of cultural and class- sensitive educational interventions and efforts aimed at overcoming barriers to early and effective prevention and treatment. A more comprehensive plan based on providing opportunities for upward mobility is likely to be the ultimate solution, but this will require national governmental commitment, which is not presently evident.

Elucidation of sialyltransferase as a tumour marker.

The report describes results of separation of sialyltransferase isoenzymes by electrofocusing plasma from healthy volunteers and patients having different types of malignant tumour. Extensive modification of the technique was adopted in determining enzyme activity, such as elution of gel strips with the buffer pH corresponding to the gel focusing point; assessment of the effect of different pH on endogenous incorporation of radioactivity to desialated fetuin; and quantitative analysis of protein present in each gel band for calculation of enzyme activity. Plasma from normal individuals showed the existence of 5 sialyltransferase isoenzymes at pI 4.8, 5.5, 6.3, 6.8 and 7.5. There were higher isoenzyme activities in plasma samples from patients afflicted with malignancy of lungs and colon in comparison to normal pattern. Endometrial and breast cancer patients also showed elevated levels of the enzyme which could be controlled by surgery and combined therapies with cytotoxic drugs and radiation, respectively. The observations suggest the potential use of sialyltransferase as a tool for tumour diagnosis, and are discussed in relation to prognosis of the disease in the course of therapy.

Plasma lipid-bound sialic acid alterations in neoplastic diseases.

Plasma lipid-bound sialic acid (LSA) was assayed in normal volunteers, patients with non-malignant diseases, and a variety of cancer patients. Mean plasma LSA in 50 normal volunteers, 16 patients with non-malignant diseases, 54 breast cancer, 17 lung cancer, 15 colon cancer, 7 ovarian cancer, 5 prostate cancer, 4 leukemia, 4 gastrointestinal, 3 thyroid cancer, 3 pancreas cancer and 2 adrenal cancer patients were 17.7, 23.2, 58, 85, 56.7, 46.2, 56.7, 53.3, 31.1, 33.2 and 119.5 mg/dl, respectively. None of the normal volunteers had elevated plasma LSA values. Plasma LSA level was not significantly different in male and female volunteers. Two out of 114 different cancer patients had plasma LSA levels within normal range exhibiting 98.2% sensitivity of the assay. Plasma LSA, which is relatively simple to assay, may be used as a tumor marker in wide variety of neoplastic diseases.

Bone marrow transplantation: a review.

Bone marrow transplantation represents the technical application of basic immunologic principles to the treatment of a variety of neoplastic and allied disorders that originate in the bone marrow. The results have improved during the past 15 years, being most striking for the treatment of the acute and chronic leukemias. The promise of autologous bone marrow transplantation for the treatment of leukemias and solid tumors is awaiting the perfection of techniques for the effective removal of residual neoplastic cells as well as more effective therapy. The use of this technique at its present stage of development for the treatment of benign hematologic disorders, which cause severe morbidity (ie, thalassemia or sickle cell anemia), is controversial, raises serious ethical issues, and cannot be recommended routinely at this time. Complications of bone marrow transplantation such as graft rejection, graft-versus-host disease, and opportunistic infections are discussed.

Plasma sialyltransferase as a tumor marker.

Neoplastic transformations are accompanied by an alteration in the composition of cell membrane glycoproteins, major structural components of the cell surface. Plasma sialyltransferase enzyme is involved in the transfer of sialic acid residues from cytosine monophosphate (CMP) sialic acid to a suitable acceptor. In the present study plasma sialyltransferase was assayed using a radiometric method, which measured the transfer of radioactivity from (14C) CMP sialic acid to desialated fetuin. Plasma sialyltransferase was measured in 127 normal and 91 cancer patients. The mean plasma sialyltransferase in the normal volunteers was 837 units (CPM/25 microliters plasma/hr). The mean plasma sialytransferase in 26 breast cancer patients, 22 lung cancer patients, 20 colon cancer patients, 5 ovarian cancer patients, 4 cervix cancer patients, 5 pancreas cancer patients, 6 prostate cancer patients, and 3 gastrointestinal tract cancer patients was 1710, 1406, 1344, 1227, 1233, 1406, 1250, and 1426 units, respectively. No significant difference was observed with respect to age. In 32 treated breast cancer patients the mean value was 757 units. Serial determinations in 17 patients correlated well with tumor burden. However, in 2 patients the plasma enzyme level did not correspond to tumor mass. These results indicate that plasma sialyltransferase is significantly elevated in patients with a variety of cancers. Plasma sialyltransferase determination may be useful in the followup of patients with a variety of cancers.

Plasma sialic acid alterations in neoplastic diseases.

The several types of neoplastic transformations are accompanied by alterations in the composition of cell glycoproteins, which are major structural components of cell surfaces. One such observed alteration is in the level of sialic acid on the cell surface. In the present investigation, plasma sialic acid levels were measured in normal volunteers and neoplastic patients using thiobarbituric acid spectrophotometric methods. The mean plasma sialic acid level from 124 normal volunteers was 3.0 mumol/ml. The mean for 20 non-malignant patients was 3.2 mumol/ml. Such observed mean values of sialic acid were 3.7 mumol/ml in 64 breast cancer patients, 5.1 mumol/ml in 22 lung cancer patients, 4.1 mumol/ml in 20 colon patients, and 5.0 mumol/ml in 26 patients having ovarian, cervix, pancreas, prostate, thyroid, uterine, squamous cell, esophageal and endometrial cancers. Serial determinations of plasma sialic acid in 15 patients correlated well with the progression and regression of disease. These results indicate that plasma sialic acid levels are elevated over control levels in the different types of cancer patients studied. Assay of plasma sialic acid is not sensitive enough to be used for screening, but could be used as a prognostic determinant in a variety of neoplastic conditions.

Cryptococcal pneumonia in a patient with sickle cell disease.

We present the findings in a patient having sickle cell disease who developed multilobar pneumonia. Cultures of bronchial aspirates and histologic specimens grew Cryptococcus neoformans. There was neither spontaneous clearing of the infection nor a response to bactericidal antibiotics. The patient had no underlying malignant neoplasm or immunodeficiency as indicated by history, physical examination, and specialized tests of humoral and cell-mediated immunity.

Correlation between plasma carcinoembryonic antigen (CEA) and sialyltransferase as tumor marker.

Plasma carcinoembryonic antigen (CEA) and sialyltransferase levels were assayed in 21 cancer patients to correlate them in response to therapy. Plasma sialyltransferase and CEA level correlated well in 10 colon, 4 breast and 1 lung cancer patients in response to therapy. There was a negative correlation in one colon cancer, 3 breast cancer and 2 lung cancer patients. Plasma sialyltransferase was a better marker for breast and lung cancer. CEA was a good marker for colon cancer.

Possible role of the carbohydrate residues in the display of the MN blood group determinants by glycophorin A.

Heterozygous glycophorin AM,N and homozygous glycophorin AM were reductively methylated with 13C-enriched formaldehyde in the presence of cyanoborohydride. Total reductive methylation modified the five lysine residues, and the N-terminal amino acid residues (serine and leucine) of glycophorins AM and AN, respectively. The 13C resonances of the incorporated labels were monitored as a function of the degree of glycosylation of the glycoprotein. While minimal, if any, structural changes were observed near the N-terminal amino acid upon removal of alpha-D-N-acetylneuraminic acid residues, gross structural changes were observed when most of the oligosaccharide chains were removed. We also found that progressive methylation of the lysine residues of glycophorin AM may influence either the chemical shift of one of the nonequivalent methyl groups of the N alpha, N-[13C]dimethyl serine residue, or one of the two states of glycophorin AM.