Factors important in promoting mammography screening among Canadian women.

Among women aged 50 to 69 years, regular screening by mammography in combination with clinical examination, can substantially decrease the morbidity and mortality associated with breast cancer by facilitating early detection. Unfortunately, many Canadian women are not screened in accordance with current guidelines. Research to date is based primarily on large surveys conducted in the United States and less is known about the relevance of specific barriers to mammography screening among Canadian women. Multivariate results from the 1994-95 National Population Health Survey (NPHS) indicate that younger (40-49) and older (70+) women, those who are socioeconomically disadvantaged, and minority women are least likely to report having had a mammogram. Conversely, women with positive health behaviours, high social support, and positive mental health attributes are more likely to participate in mammography screening. These findings are discussed in terms of the implications for developing successful intervention programs for Canadian women and for setting priorities for further research.

Transcriptional activation of the interleukin-8 gene by platelet-activating factor in human peripheral blood monocytes.

Interleukin-8 (IL-8) is a member of the chemokine family and a potent neutrophil chemoattractant and activator. It is produced by a variety of cell types during inflammation. In the present work, we examined the regulation of IL-8 gene expression in monocytes by the pro-inflammatory lipid mediator, platelet-activating factor (PAF). Stimulation of human peripheral blood monocytes with PAF augmented their release of IL-8. The enhancement of IL-8 secretion was associated with an increase in IL-8 mRNA expression. PAF induced a concentration- and time-dependent augmentation of IL-8 mRNA accumulation. The response was maximal at PAF concentrations of 10-100 nM. The increased mRNA expression was evident after 1.5 hr of stimulation and persisted for 6 hr. Stimulation of monocytes with PAF, followed by arrest of de novo transcription with actinomycin D, indicated that PAF only marginally increased the stability of IL-8 mRNA. However, in vitro nuclear transcription demonstrated that the enhancement of IL-8 mRNA expression occurred mainly at the transcriptional level. The PAF-induced increase in IL-8 mRNA levels could be blocked with a PAF receptor antagonist. These results show, for the first time, that IL-8 gene expression and protein production can be upregulated by PAF. This interaction could be important in the development and amplification of the inflammatory response.

Recurrent psychiatric hospitalization.

Undue emphasis has been placed on rising rates of readmission to psychiatric facilities. After a decade of preoccupation with discharge rates, readmission statistics have been singled out in the last 15 years as the key factor for assessing hospital effectiveness. A study of a group of patients at high risk for recurrent hospitalization revealed that these patients were characterized more by features relating to environmental supports than by diagnosis. The operational definition for recurrent hospitalization (five or more admissions during the 2-year period preceding the latest admission) was effective in identifying this group; this is the first reported instance in which the definition has specified a certain number of admissions within a time-limited period. The findings of this study, as well as of an analysis of case histories and consumer opinion, led to the design of a pilot program for persons undergoing recurrent hospitalization. Readmission statistics are useless or misleading as measures of hospital effectiveness and efficiency; what matters is the way the former patients function in the community after discharge. Rather than simply trying to reduce the readmission rate psychiatric facilities should be examining the types of persons who are hospitalized recurrently to develop programs aimed at improving the functioning of these people in the community.