Publications

Low income, older, minority women are at high risk for underutilization of screening mammography. One strategy for increasing utilization is to conduct interventions targeting local and state health departments where a majority of these women seek health care. A prerequisite for conducting effective screening programs is to obtain current and accurate information on baseline screening rates to understand the nature and scope of the problem and to plan appropriate intervention strategies. The sample consisted of 3240 women who were 50+ years of age from 2 hospitals and 2 comprehensive health centers operated by the Los Angeles County Department of Health Services. Reviews of medical records indicated that only 21% of the sample had received a mammogram in the 12 months prior to the clinic visit on which they were sampled and 23% of the sample received a mammogram in the following 9 months. Approximately 5% of the total sample received a repeat mammogram in the 21-month period over which they were tracked. Prospective independent predictors of screening were age, number of visits to primary care clinics, number of visits to specialty care clinics, and history of breast abnormalities. The results underscore the importance of implementing programs to increase mammography implementing programs to increase mammography screening within public facilities serving low income multiethnic women. An important finding is that a large number of older women are seen in specialty clinics, which represents an untapped resource for increasing screening in this population. Innovative interventions targeting such specialty clinics could substantially contribute to increasing screening rates. A comprehensive approach targeting system, physician, and patient barriers is recommended.

The purpose of this study was to determine the prevalence and progression of pulmonary hypertension over a 5-year follow-up period in 28 patients with systemic lupus erythematosus (SLE) who were originally enrolled in an echocardiographic study of pulmonary hypertension in 1985 and 1986. Twenty healthy volunteers without cardiac or pulmonary disease participated as normal controls. Each patient and control underwent a complete Doppler echocardiographic study. Doppler echocardiographic recordings of tricuspid insufficiency, with saline contrast enhancement when necessary, were used to calculate pulmonary artery systolic pressure according to the modified Bernoulli equation. Doppler echocardiographic measurement of cardiac output was performed at rest for each subject, and pulmonary resistance was calculated by dividing the pulmonary artery systolic pressure by the cardiac output. These results were compared to results of the original studies to detect serial changes in pulmonary pressure and pulmonary resistance; results were also compared to the group of normal controls. The prevalence of pulmonary hypertension increased from 14% at the first study to 43% at follow-up. A significant increase in mean systolic pulmonary artery pressure was detected in the SLE patients during the follow-up period: 23.4 vs 27.5 mm Hg (p < 0.005). In addition, a significantly higher pulmonary artery pressure was detected in the SLE patients compared with the normal controls (p < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Non-insulin-dependent diabetes mellitus (NIDDM) affects about 5% of the world population. The disease presents a polygenic mode of inheritance, but mechanisms and genes involved in late-onset NIDDM are largely unknown. We report the association of a single heterozygous Gly to Ser missense mutation in the glucagon receptor gene with late-onset NIDDM. This mutation was highly associated with NIDDM in a pooled set of French and Sardinian patients (chi 2 = 14.4, P = 0.0001) and showed some evidence for linkage to diabetes in 18 sibships from 9 French pedigrees (chi 2 = 6.63, P < 0.01). Receptor binding studies using cultured cells expressing the Gly40Ser mutation demonstrate that this mutation results in a receptor which binds glucagon with a three-fold lower affinity compared to the wild type receptor.

Metal fume concentrations inside the welding helmet and in the personal breathing zone in 23 experimental welding exposures were studied to explore whether welding helmet use substantially attenuates exposure to airborne metal fume. Observations produced a mean ratio of inside to outside metal fume concentrations of 0.9 +/- S.D. 0.2 with a highly variable effect. Iron fume concentration was inversely correlated with this ratio, representing greater helmet-associated attenuation with heavier exposure (r = -0.70, p < 0.001). In contrast to previous reports, these data suggest that welding helmet use provides marginal and highly variable reductions in fume exposure and cannot substitute for standard respiratory protection.