Heat, Disparities, and Health Outcomes in San Diego County's Diverse Climate Zones.

Climate variability and change are issues of growing public health importance. Numerous studies have documented risks of extreme heat on human health in different locations around the world. Strategies to prevent heat-related morbidity and reduce disparities are possible but require improved knowledge of health outcomes during hot days at a small-scale level as important within-city variability in local weather conditions, socio-demographic composition, and access to air conditioning (AC) may exist.

Outpatient clinic visits during heat waves: findings from a large family medicine clinical database.

Introduction: The purpose of this study was to determine whether heat waves are associated with increased frequency of clinic visits for ICD-9 codes of illnesses traditionally associated with heat waves.

Methods: During 4 years of family medicine clinic data between 2012 and 2016, we identified six heat wave events in San Diego County. For each heat wave event, we selected a control period in the same season that was twice as long.

Portal Vein Embolization as an Oncosurgical Strategy Prior to Major Hepatic Resection: Anatomic, Surgical, and Technical Considerations.

Preoperative portal vein embolization (PVE) is used to extend the indications for major hepatic resection, and it has become the standard of care for selected patients with hepatic malignancies treated at major hepatobiliary centers. To date, various techniques with different embolic materials have been used with similar results in the degree of liver hypertrophy. Regardless of the specific strategy used, both surgeons and interventional radiologists must be familiar with each other's techniques to be able to create the optimal plan for each individual patient.

The thyroid: review of imaging features and biopsy techniques with radiologic-pathologic correlation.

Knowledge of the normal and abnormal imaging appearances of the thyroid gland is essential for appropriate identification and diagnosis of thyroid lesions. Thyroid nodules are often detected incidentally at computed tomography, magnetic resonance imaging, and positron emission tomography; however, ultrasonography (US) is the most commonly used imaging modality for characterization of these nodules. US characteristics that increase the likelihood of malignancy in a thyroid nodule include microcalcifications, solid composition, and central vascularity.

Little tyrants or just plain tired: evaluating attributions for caregiving outcomes across the transition to parenthood.

There is now substantial evidence that parental attributions for power over negative caregiving outcomes play an important role in the intergenerational transmission of child maltreatment. Despite the substantial research and clinical significance of this construct, and the widely held assumption that it represents a trait-like attributional style, there is a lack of empirical support for its long-term stability, especially over the transition to parenthood. The present study examined the stability of 88 at-risk women's perceived power over caregiving failure from the 3rd trimester of their 1st pregnancy to 18 months postnatal.

Volumetric Examination of MS Plaques and Correlation with EDSS Ratings.

This study is a retrospective analysis of 17 patients with multiple sclerosis. The total volume of plaques from three different MR image sets of the brain was correlated with the EDSS ratings of the patients. Each of the correlations showed a positive relationship, but none was statistically significant.

Outcome of five years of accelerated surveillance in patients at high risk for inherited breast/ovarian cancer: report of a phase II trial.

Objective: To assess the outcome of accelerated patient surveillance in patients at high risk for inherited breast or ovarian cancer.

Methods: Using stringent inclusion criteria, 57 high-risk patients (7 positive for BRCA1/2 mutations, 39 mutation negative, and 11 unaffected) were recruited from a genetic testing protocol for inherited breast/ovarian cancer and were followed for 5 years (192.5 total patient years).

The effect of laboratory-induced depressed mood state on responses to pain.

Some researchers have suggested that a depressed mood state is associated with alterations in responses to pain. The authors examined cognitive, behavioral, and affective responses of 75 randomly assigned participants to depressed, neutral, or elated mood state induction conditions and subjected them to the cold-pressor task. Because they were unsuccessful in inducing elated moods, the authors used only the data for the depressed and neutral states as they measured pain threshold, tolerance, and unpleasantness during the test.

Diagnostic criteria for testing for BRCA1 and BRCA2: the experience of the Department of Defense Familial Breast/Ovarian Cancer Research Project.

The Department of Defense Familial Breast/Ovarian Cancer Research Project has offered genetic counseling and testing for BRCA1 and BRCA2 on a research basis to patients meeting specific diagnostic criteria, with risk for BRCA1 and BRCA2 mutations calculated based on the Couch model. In 2.5 years, 250 patients were evaluated and 101 patients met criteria requirements, including 33 who met criteria in more than one category.

Guidelines for evaluation of patients at risk for inherited breast and ovarian cancer: recommendations of the Department of Defense Familial Breast/Ovarian Cancer Research Project.

Patients at high risk for inherited breast and/or ovarian cancer are frequently encountered in all medical specialties. Department of Defense, Health Affairs funding as part of the Breast Cancer Education and Awareness Program was used to develop a comprehensive program for the identification, counseling, genetic testing, and long-term follow-up of such high-risk patients. This article reports the recommendations for high-risk patient management based on 4 years of evaluation and care, including discussions of the approach to counseling, indications for genetic testing, post-testing counseling, patient surveillance with examination, imagining, and laboratory testing, and suggested options for surgical and chemoprophylaxis as well as lifestyle modifications.

Breast cancer attitudes, knowledge, and screening behavior in women with and without a family history of breast cancer.

Women volunteers with or without a first-degree relative with breast cancer (FDR) were compared on several measures. Relative to the comparison group, women in the FDR group had more negative attitudes about breast cancer (including more anxiety about breast cancer), viewed their risk for getting breast cancer as greater (although they underestimated the actual risk), and were more likely to engage in appropriate screening behavior. A high percentage of women in both groups stated that they would want to have a genetic test for breast cancer if it were generally available.

The role of optimism in health-enhancing behavior.

Objective: To examine the relationship between levels of optimism and participation in health-enhancing behaviors.

Methods: A convenience sample of volunteers obtained from undergraduate psychology classes (N=118) completed self-report measures of optimism and current health habits. They also predicted their use of various health strategies should they be diagnosed with a life-threatening illness.

Can healthcare providers at a university health clinic predict patient satisfaction?

Patient satisfaction in university health settings has received little research attention, and it is unclear whether the issue is being addressed in college health clinics. Because providers may make their own evaluations of patient satisfaction in the absence of other information, the authors conducted a study to determine whether healthcare providers at a university health clinic could accurately assess patient satisfaction. Ten providers completed a 10-item questionnaire immediately following the medical encounter to rate their perceptions of selected patients' levels of satisfaction.

Barriers to effective cancer pain management: a review of the literature.

As many as 90% of patients with cancer-related pain can attain satisfactory relief through available pharmacological and medical means. However, as many as 45% of patients in the earlier stages of cancer and 75% of patients in the advanced stages experience at least some pain. Although published guidelines are available, the research literature suggests that health care providers continue to hold some negative misconceptions about cancer pain and its treatment.

Pain Patient Profile: a scale to measure psychological distress.

Objective: To evaluate the construct validity of the Pain Patient Profile (P-3), a brief self-report instrument designed to measure anxiety, depression, and somatization in patients presenting with pain.

Design: Comparison of P-3 scores with previously established measures of depression, anxiety, and somatization, and comparison of P-3 scores of pain patients with those of patients with diabetes.

Settings: Hospital-based outpatient pain clinic, family practice clinic, diabetes education group.

Psychological issues in genetic testing for breast cancer.

Genetic testing for inherited forms of breast cancer is currently available to individuals who want to learn their genetic status for the BRCA1 and BRCA2 genes. Although still largely limited to research programs, widespread commercial testing and incorporation of genetic testing into primary care practices will occur in the not too distant future. Despite the availability of this technology, treatment and prevention strategies offered to these often healthy women are limited and somewhat controversial.

The relative effectiveness of three reminder letters. On making and keeping mammogram appointments.

One hundred fifty women who had previously had at least one mammogram were sent one of three prompt letters informing them that they were due for screening. The letters were either reassuring, anxiety provoking, or the standard hospital prompt. Based on a review of the literature, we hypothesized that the reassuring letter would be most effective in motivating women to schedule and keep appointments, the anxiety-provoking letter would produce an intermediate level fo compliance, and the standard hospital letter would be least effective.

Health care professionals' perceptions of seriously ill women.

Physicians, psychologists, and nurses read one of four vignettes describing a woman who had received one of four diagnoses--breast cancer, lung cancer, heart attack, or severe burn--and indicated on the Profile of Mood States (McNair, Lorr, & Droppleman, 1971) how they perceived the woman had been feeling during the past week. They then answered 10 questions about the woman's recovery and about their own anticipated behaviors while interacting with her. A number of differences emerged between professional groups in terms of their expectations for patients regardless of diagnosis.

The relative effectiveness of three reminder letters on making and keeping mammogram appointments.

One hundred fifty women who had previously had at least one mammogram were sent one of three prompt letters informing them that they were due for screening. The letters were either reassuring, anxiety provoking, or the standard hospital prompt. Based on a review of the literature, we hypothesized that the reassuring letter would be most effective in motivating women to schedule and keep appointments, the anxiety-provoking letter would produce an intermediate level of compliance, and the standard hospital letter would be least effective.

Report from a National Cancer Institute (USA) workshop on quality of life assessment in cancer clinical trials.

To promote the inclusion of quality of life (QOL) end-points in clinical research on cancer, the National Cancer Institute (USA) sponsored a workshop on QOL assessment in cancer clinical trials in July, 1990. Experts in clinical trials and QOL research formed four working groups to identify current areas of cancer treatment in which QOL end-points are most important; to discuss methodologic problems in QOL assessment; to address common problems in implementing clinical studies with QOL end-points; and to consider statistical issues in design, implementation, and data analysis. Recommendations made by the working groups are summarized in this paper.

The effects of self-reinforcement and peer-reinforcement on the practice of breast self-examination.

Four months after learning breast self-examination (BSE), 169 sorority women assigned to one of three conditions (No Reinforcement, Self-Reinforcement or Peer-Reinforcement) were compared on BSE frequency subsequent to the training. Participants in both of the reinforcement conditions had agreed to a specified reward after each month's BSE, which was either self-delivered (Self-Reinforcement condition) or delivered by a partner (Peer-Reinforcement condition). Analysis of covariance revealed a significant difference among conditions and a Newman-Keuls test demonstrated that participants in both reinforcement conditions reported more months of BSE than those in the No Reinforcement condition.

Family history of breast cancer and screening behavior: an inverted U-shaped curve?

There are conflicting reports regarding the association between breast cancer risk factors, especially family history, and early detection/screening behavior. While some studies have reported that women at higher risk for breast cancer engage in more screening behavior than those at lower risk, others have found no relationship between the two variables, and still other studies have found the opposite effect--less screening in high risk women as compared to lower risk women. It is suggested that these conflicting results might be explained by including anxiety or fear as a mediating factor in the relationship between risk status and screening behavior.

Comparing methods of reporting breast self-examination compliance.

Women volunteers (N = 32) learning breast self-examination (BSE) in one of several small group workshops were asked to practice BSE on a monthly basis and reported BSE practice for the following 6 months. Each workshop was randomly assigned to one of three methods of reporting subsequent instances of BSE: (a) retrospective reporting in which they were called by the experimenter and asked how many times they performed BSE; (b) monthly written reports, in which they mailed in a card after each month's practice of BSE; and (c) an oil-and-tissue method in which, in addition to the card, they mailed in a tissue that they had used to blot oil used as a lubricant in BSE. Rates of self-reported BSE for the three methods were compared, showing no differences between the oil-and-tissue method and the monthly written report method, with rates for both methods significantly lower than for the retrospective report method.

Breast self-examination and mammography among university staff and faculty.

Women faculty and staff (N = 201) answered a series of questions about breast self-examination (BSE) and mammography. Although all subjects indicated familiarity with BSE, and two-thirds of them knew it should be practiced monthly, only 31% actually did so. Women who learned BSE from physicians or other health professionals reported more frequent BSE than those who learned from other sources.