The association between citrus consumption and melanoma risk in the UK Biobank.

BACKGROUND: Melanoma incidence has been dramatically increasing worldwide. Psoralen, a known photocarcinogen, is naturally abundant in citrus products, leading to the hypothesis that high citrus consumption may increase melanoma risk. OBJECTIVES: To investigate the association between total citrus consumption and melanoma risk, and the association between individual citrus products and melanoma risk, and to test for interactions between total citrus intake and established melanoma risk factors. METHODS: Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between citrus consumption and melanoma risk among 1592 cases and 197 372 controls from the UK Biobank cohort. Citrus consumption data were collected via five rounds of 24-h recall questionnaires. International Classification of Diseases codes were used to determine melanoma outcome. RESULTS: After adjusting for potential confounders, participants in the highest category of total citrus intake (> 2 servings per day) had a significantly increased risk of melanoma (OR 1·63, 95% CI 1·24-2·12) relative to those with no consumption. For individual citrus products, participants with the most orange and orange juice consumption (> 1 serving per day) had a significantly increased melanoma risk relative to those with no consumption (OR 1·79, 95% CI 1·07-2·78 and OR 1·54, 95% CI 1·10-2·10, respectively). Fair- or very fair-skinned participants with high citrus consumption had an even greater melanoma risk (OR 1·75, 95% CI 1·31-2·29). CONCLUSIONS: High citrus consumption was associated with an increased risk of melanoma in a large, prospective, population-based cohort. Further validation of these findings could lead to improved melanoma prevention strategies.

[A twelve-year-old teenager with bone pain and white papules]. / Douleurs osseuses et papules blanchâtres chez un adolescent de 12 ans.

Here we present a case report in which a teenager, with papules on the arm and back since the infancy, complained of back and right knee pain at the age of 12 years. The radiological examination led to the diagnosis of osteopoikilosis and melorheostosis. The Buschke-Ollendorff syndrome (BOS) associates osteopoikilosis (asymptomatic bone dysplasia) and disseminated dermatofibrosis. The BOS is rare, and its association with melorheostosis (another bone dysplasia in which pain and deformity may occur) makes the prognosis uncertain. This case report highlights the diagnosis problems related with bone pain in paediatrics. The purpose of this manuscript is to present the characteristics of two bone dysplasias: osteopoikilosis and melorheostosis, and to discuss the involvement of each one in the clinical picture of our patient.

[Ewing's tumor]. / La tumeur d'Ewing.

Ewing's tumor (ET) is a malignant bone tumor occurring in children and young adults. ET affects mainly bones of the central axis, and almost always involves soft tissue infiltration. The discovery of a unique genetic alteration, which is a reciprocal translocation most frequently resulting in the fusion of the EWS gene situated on chromosome 22 with the FLI-1 gene on chromosome 11, currently places ET among neuroectodermal tumors. Moreover, this translocation is a tumor-specific genetic marker at the basis of defining ET today and is used as a diagnostic and potentially prognostic tool complementary to imaging and histopathological work-up. Since the 1970 s, important progress has been made in the clinical management of ET patients. Multiagent chemotherapy in association with local treatment (surgery and/or radiation) has clearly improved outcome. The introduction of systemic treatment was justified by the frequent sub-clinical diffusion of apparently localized ET. Intensified therapeutic strategies have for the first time cured some metastatic ET patients, but at the cost of major side effects. Treatment is currently adapted as a result of a better definition of prognostic factors as well as a better assessment of its adverse effects. Improvement in global patient care and increased management of specific acute complications associated with ET (often interwoven with iatrogeneous effects) represent an important step towards improving the quality of life for ET patients as well as preventing long term complications. In the light of present studies, the majority of surviving adults today describe their health and quality of life as good. ET is a fascinating example of the progress made not only in the diagnostic and therapeutic approach to cancer but also in the comprehension of the mechanisms behind carcinogenesis, and consequently reflects the revolution of medicine over the last century.

Validity of self-reported mammography in low-income African-American women.

BACKGROUND: Mammography screening reduces mortality by 25% to 30% in women aged 50 to 69. Because mammography screening is often used less frequently than the recommended guidelines, many descriptive and intervention studies are underway to increase use of this important screening tool. Assessment of intervention effect is dependent on valid measurement of mammography use. Although several studies have shown a close correspondence between self-report and medical records, most had few minority participants. METHODS: The purpose of this report was to compare self-reported mammography and medical records of mammography status in a low-income African-American sample. A total of 229 low-income (at 150% of poverty or below) African-American women were interviewed regarding breast cancer screening. Response categories that assessed last mammogram were "within the last 12 months," "13-24 months," and "over 24 months," as well as date and location of last mammogram. Self-reported mammography was compared with medical records at the facility named by respondents. RESULTS: Comparison with self-report showed that only 49% to 60% of reported mammography use could be verified within categories. CONCLUSION: Self-report alone may not provide accurate rates of mammography compliance. Further research is necessary with ethnic and low-income women.

Development of a benefits and barriers scale for mammography utilization.

The purpose of this study was to refine scales to measure Health Belief Model concepts of benefits and barriers using the context of mammography screening. Both scales used a summated Likert format with five response options. Items were first subjected to content analysis by national experts. Data were then collected from a random sample of 581 women who were 35 years or over. Retest data were gathered on a subset of women approximately 4-6 weeks later. Construct validity was established using confirmatory factor analysis and exploratory factor analysis with results confirming independence of constructs. Construct validity was also tested by developing hypotheses based on theoretical relationships. Cronbach alpha reliability coefficients for the benefits scale was 0.79 and for the barriers scale was 0.73. Suggestions for further revisions are offered.

Predicting mammography and breast self-examination in African American women.

Breast cancer mortality is significantly greater in African American women than in their Caucasian counterparts. The purpose of this study was to identify variables associated with the breast cancer screening behaviors of mammography utilization and breast self-examination (BSE) in a convenience sample of low income African American women. A total of 328 African American women, living in a large midwestern metropolitan area, who were at < or = 150% of poverty level, and between the ages of 45 and 64 years were included in this study. Data were collected over a period of 18 months. Predisposing, enabling, and need variables from Anderson's theoretical framework included perceived susceptibility, benefits, barriers, confidence, knowledge, physician recommendation, demographic characteristics, and past experiences, as well as health-care and insurance information. Variables that significantly predicted mammography utilization included perceived barriers, mammography suggested by health-care professionals, recent thoughts about mammography, and a regular medical doctor. Variables that significantly predicted either frequency or proficiency of BSE included susceptibility, benefits, confidence, knowledge, barriers, and a regular physician. Implications for clinical practice include (a) recognizing predictors of screening among low-income African American women; (b) addressing culturally specific barriers, e.g., cancer fatalism, in order to increase compliance with screening; (c) establishing consistency in primary care providers; and (d) increasing confidence and knowledge through education.

Mammography in women > or = 50 years of age. Predisposing and enabling characteristics.

The purpose of this study was to identify the relationship of selected predisposing and enabling characteristics of women > or = 50 years of age to mammography utilization. Andersen and Aday's theoretical model for health services utilization guided data collection. Data were collected from a convenience sample of 161 women members of four urban churches, using a mailed survey. Results showed that 81% reported at least one mammogram and 24% had followed mammography guidelines for the preceding 3 years. Results of logistic regression analyses with variables having a bivariate significance of p < or = 0.01 showed that higher income was associated with both ever having a mammogram and adherence. Willingness to pay > $50 out of pocket for a mammogram was significant for 3 year adherence. Additionally, the sociodemographic variables of age and religion were associated with adherence, whereas a college education was highly significant (odds ratio = 13.78) for ever having a mammogram. Having a regular place for health care and having yearly Papanicolaou tests were associated with ever having a mammogram, but not adherence. Finally, intending to get a mammogram was associated with ever having a mammogram. In this study, belief and knowledge variables showed no association with utilization, and social influence had bivariate significance only for ever having a mammogram. This study suggests the importance of addressing economic and health-care delivery system factors to promote increased mammography utilization, particularly for older women.

Beliefs about medication and dietary compliance in people with heart failure: an instrument development study.

BACKGROUND: Sodium retention is often a precursor to hospitalization in people with heart failure (HF). Lack of compliance with medications and with dietary sodium restrictions affects sodium retention. OBJECTIVES: The purpose of this study was to evaluate the reliability and validity of the Beliefs about Medication Compliance Scale and the Beliefs about Dietary Compliance Scale. METHODS: The Beliefs about Medication Compliance Scale and the Beliefs about Dietary Compliance Scale are instruments we developed specifically to measure beliefs about compliance with behaviors that affect sodium retention in persons with HF. The scales, based on the Health Belief Model, were designed from a review of literature and from self-reports of people with HF. A convenience sample of 101 people with HF completed the scales. RESULTS: Internal consistency reliability was satisfactory. Factor analysis provided initial support for construct validity of the scales. CONCLUSIONS: Future testing of the scales is needed in more diverse populations. The scales can then be used to test interventions tailored to individual subjects' beliefs about compliance.

The relationship of selected variables to breast cancer detection behaviors in women 35 and older.

The purpose of this study was to identify the relationship between selected variables and the practice of breast self-examination (BSE), mammography, and professional breast examination (PBE). In addition, the relationship between the behaviors was examined using a probability sample of 322 women ages 35 and older. The women were contacted by telephone via random digit dialing, and data were collected through mailed questionnaires. Results supported a relationship between BSE and attitudinal variables of health motivation, social influence, susceptibility, barriers, confidence, and knowledge (R2 = 0.29). Additionally, the variables of knowledge, social influence, and health motivation related to compliance with mammography, and the variable of health motivation related to compliance with PBE.

Results of a nurse-delivered intervention on proficiency and nodule detection with breast self-examination.

PURPOSE/OBJECTIVES: To determine group differences in breast self-examination (BSE) frequency, proficiency, and nodule detection as a result of belief and/or informational interventions. DESIGN: Prospective, randomized, experimental design using a control group and three intervention groups. Data on outcome measures were collected one year following intervention to determine intervention effect on BSE outcome measures. SAMPLE: Women without breast cancer ranging in age from 35-88 years. METHODS: Graduate research assistants conducted in-home interviews and completed intervention delivery and data collection using a standardized protocol for each experimental group. Interventions included counseling about beliefs regarding BSE and informational counseling with BSE demonstration. A second in-home interview was conducted one year after the intervention to determine its effect on BSE outcome measures. MAIN RESEARCH VARIABLES: Self-recorded frequency, observer-rated proficiency scores, and nodule detection scores. FINDINGS: The group receiving both the belief and information interventions had significantly higher frequency (t = 2.22, p < or = 0.05) and higher proficiency scores (t = 3.22, p < or = 0.01) for BSE than the control group. The control group had significantly lower rates than the belief/information group for observed proficiency of BSE (t = 7.72, p < or = 0.01) and for nodule detection (t = 8.91, p < or = 0.01). CONCLUSIONS: The intervention consisting of information, BSE demonstration, and follow-up demonstration significantly increased logged frequency, logged proficiency, observed proficiency, and nodule detection one year postintervention. The group receiving both the belief intervention and information intervention demonstrated the highest nodule detection. IMPLICATIONS FOR NURSING PRACTICE: BSE teaching should include assessment and discussion about belief toward breast cancer and BSE while providing instruction with return demonstration.

Beliefs about breast cancer and mammography by behavioral stage.

PURPOSE/OBJECTIVES: To explore the relationships of Health Belief Model (HBM) variables and the Trans-theoretical Model with regard to behavioral stage of mammography adoption. DESIGN: Descriptive, correlational. SETTING: Large midwestern city. SAMPLE: 405 women over age 40 obtained through random digit dialing. Subjects had agreed to participate in a larger intervention study. METHODS: Data were collected during in-home interviews. Subjects completed six scales developed from the HBM and answered questions related to mammography compliance. MAIN RESEARCH VARIABLES: Perceptions of breast cancer susceptibility and seriousness, perceived benefits of and barriers to mammography, motivation to stay healthy, and perceived control over health; degree of mammography compliance. FINDINGS: Women complaint with mammography guidelines had significantly higher scores on seriousness, benefits, health motivation, and control as well as significantly lower scores on barriers. In addition, scores on susceptibility, seriousness, benefits, barriers, and health motivation were significantly different across stages of mammography (precontemplation, contemplation, and action/maintenance). CONCLUSIONS: Interventions should target attitudes about susceptibility and seriousness of breast cancer in women who do not comply with established guidelines for mammography. Women who are not in compliance and have no plans to seek mammography would benefit from additional emphasis on mammography benefits and from removal of barriers. Health motivation also must be addressed in noncompliant women. IMPLICATIONS FOR NURSING PRACTICE: These results promise to expand the understanding of a person's motivation to change health-seeking behaviors, specifically obtaining routine screening mammograms. Further research using this new framework is needed to substantiate these results with a cross section of women.

The effects of standard care counseling or telephone/in-person counseling on beliefs, knowledge, and behavior related to mammography screening.

PURPOSE/OBJECTIVES: To determine the most effective methods of increasing mammography adherence while also considering ease of intervention delivery in evolving healthcare systems. DESIGN: Experimental. SETTING: Women from a health maintenance organization and a large general medicine practice. SAMPLE: Women 50-85 years of age who had not had breast cancer and did not have a mammogram within the last 15 months. METHODS: Once consent and baseline information were obtained, women were randomized to receive in-person, telephone, or no mammography counseling. MAIN RESEARCH VARIABLES: Mammography adherence, perception of susceptibility to breast cancer, and benefits, barriers to, and knowledge of mammography. FINDINGS: Compared to standard care, telephone counseling was more than twice as effective at increasing mammography adherence, whereas in-person counseling resulted in almost three times the mammography adherence postintervention. Both telephone and in-person counseling are successful in changing perceived susceptibility, knowledge, barriers, and benefits. CONCLUSION: Both telephone and in-person counseling interventions were successful in changing beliefs, which, in turn, increased mammography adherence. IMPLICATIONS FOR NURSING PRACTICE: Interventions based on altering beliefs are effective for increasing mammography adherence.

Improving depressive symptoms among caregivers of patients with cancer: results of a randomized clinical trial.

PURPOSE/OBJECTIVES: Determine the impact of a 16-week supportive nursing intervention on caregivers of patients with newly diagnosed cancer. DESIGN: Randomized clinical trial. SETTING: Two midwestern cancer treatment sites. SAMPLE: Caregivers of newly diagnosed patients. Patients' mean age was 55.73 years; 55% had breast cancer, and 76% were female. Caregivers' mean age was 52.44 years, and 50% were female. 125 dyads consented to participate; 89 dyads completed the study. METHODS: A nursing intervention was delivered to the experimental group that emphasized symptom monitoring/management, education, emotional support, coordination of services, and caregiver preparation to care. Nurses made a total of nine contacts, five in person and four by telephone, over 16 weeks. Centers for Epidemiological Studies-Depression (CES-D) and a symptom inventory were used. Medical record audits were conducted retrospectively. MAIN RESEARCH VARIABLES: Patient and caregiver depression scores and patient symptom experience. FINDINGS: Baseline caregiver depression and the number of patient symptoms at baseline, 9, and 24 weeks were significant predictors of caregiver depression at 9 and 24 weeks. However, no main effect of the experimental condition existed on caregiver depression. At the final observation, a nonsignificant inverse relationship was found between the number of interventions and depression scores for caregivers. CONCLUSIONS: The intervention appeared to be more effective in slowing the rate of deterioration of depressive symptoms than in decreasing levels of depression in this sample of caregivers. Determining the effectiveness of this intervention in decreasing caregiver depression was difficult because caregivers with higher levels of depression were more likely to withdraw from the study. IMPLICATIONS FOR NURSING PRACTICE: Nurses must be vigilant in monitoring caregivers for signs of depression and must intervene to provide emotional support and make appropriate referrals for follow-up care to promote positive outcomes for patients and caregivers.

Instrument development for health belief model constructs.

Research was conducted to develop valid and reliable scales to test the Health Belief Model (HBM). The dependent variable chosen for scale development was frequency of breast self-examination. Independent variables were constructs related to the HBM: susceptibility, seriousness, benefits, barriers, and health motivation. Analyses for construct validity and theory testing included factor analysis and multiple regression. Chronbach Alpha and Pearson r were used to compute reliabilities. Scales that were judged valid and reliable were susceptibility, seriousness, benefits, barriers, and health motivation.

School problems and teacher responsibilities in juvenile rheumatoid arthritis.

Juvenile rheumatoid arthritis (JRA) may cause a variety of school problems. Twenty-four children with JRA, 24 of their parents, and 14 of their teachers completed questionnaires regarding the frequency of 40 potential school problems and the extent of the teacher's responsibility in helping children deal with 28 medical, academic, or social issues. Though respondents viewed school problems as occurring infrequently, parents and children more frequently than teachers noted that problems occurred (p less than .05). Children felt problems with self-concept and peer relationships occurred most frequently, while parents and teachers emphasized physical health and activity-related problems. Children's ratings regarding extent of teacher's responsibility were lower than those of parents' or teachers' ratings (p less than .05). While parents and teachers viewed the teacher as responsible for helping children deal with psychosocial issues, children felt that teachers should deal primarily with academic areas. Children viewed teachers as being responsible for withholding information about arthritis from their classmates, and did not want their teacher to encourage peer interaction. Results indicate major differences exist between perceptions of children with JRA, and their parents and teachers, regarding frequency of problems and extent of the teacher's responsibility. Since children may resist assistance from teachers in psychosocial areas, their views should be considered before planning interventions to resolve such problems.

Crosscultural comparison on nursing image.

Conceptual ratings for 'Nurse' and 'Feminine' were investigated across 30 language/culture communities. Data were from Osgood's Atlas of Affective Meanings, which contains ratings of 1200 males from each culture on 620 concepts, using Semantic Differentials. The study provides important information regarding the image of nurses crossculturally and the close link between nursing and femininity. In general, both 'Nurse' and Feminine' were perceived to be good and active, yet weak. A crosscultural view of the nurse as impotent may limit nursing's ability to deliver health care.

The relationship of attitudes, knowledge, and social support to breast-feeding.

Although more women are initiating breast-feeding, few continue for more than 1-3 months into the postpartum period. The current report studied the relationship of attitudes, social support, experimental and demographic variables, and knowledge to length of breast-feeding. A totaL of 102 women were included in the study and were followed for 1 year. Perceived attitudes toward breast-feeding, selected demographic variables, and past experiences were related to length of breast-feeding.

Public values and beliefs toward nursing as a career.

The purpose of this study was to compare the perceptions of "ideal career" and "nursing as a career." The goal was to provide information for development of innovative recruitment strategies. The sample of 1,116 included college freshmen, students in grades 6 through 12, parents, school nurses, teachers, and counselors. Data were analyzed by t test and analysis of variance to determine differences in attitudes between "ideal career" and "nursing as a career." Similar perceptions for both were opportunities for employment, application of intellectual abilities, caring for people, and an opportunity for academic and scholastic achievement. An "ideal career" was seen as more financially rewarding, more respected, and more powerful than nursing, and as providing more opportunities for leadership, for making decisions, for obtaining and applying knowledge, and for working in a safe environment. Recommendations include strategies to improve recruitment and retention of nurses.

Development of a Russian satisfaction with Prenatal Care Scale.

Patient satisfaction with health services is used as a measure of the quality of patient care received. The emphasis on accountability and patient as consumer has contributed to the growing interest in studying patient satisfaction. Patient satisfaction with prenatal care services has not been extensively studied including instrumentation to develop a satisfaction scale. The purpose of this study was to develop a reliable and valid scale to measure satisfaction with prenatal care services in St. Petersburg, Russia, using the 6 satisfaction dimensions in Aday and Andersen's Theoretical Framework (1974). It was conducted under the auspices of the World Health Organization, Healthy Cities Project. Although the study was conducted internationally, it provides a basis for further testing of reliability and validity in the United States. A convenience sample of 397 women with uncomplicated pregnancies and normal deliveries was studied (86% response rate). Content, construct, and predictive validity, and reliability testing using Cronbach's alpha was conducted. The scale was found to be an adequate and theoretically sound measure of satisfaction with prenatal care services in Russia. However, rather than the 6 hypothesized satisfaction dimensions, Russian women identified 2 satisfaction subscales or measures for quality of prenatal care received. One was, as hypothesized, convenience, and the other was the doctor's behavior.

[Bronchopulmonary dysplasia-associated pulmonary arterial hypertension of very preterm infants]. / Hypertension artérielle pulmonaire des anciens grands prématurés bronchodysplasiques.

Bronchopulmonary dysplasia (BPD) of very preterm infants is a multifactorial chronic lung disease and its incidence has not decreased despite improvements in neonatal intensive care, including lung protective strategies. Pulmonary hypertension (PH) can complicate the course of BPD. Mortality in infants with BPD-associated PH is thought to be very high, but its incidence is unknown and a standard diagnostic and therapeutic strategy has not been well defined. In this article, we will first describe the current knowledge on the BPD-associated PH and the current treatments available for this pathology. We will then present the HTP-DBP Study, carried out in Paris (France) starting in 2012. The diagnosis of PH is suspected on echocardiographic criteria, but cardiac catheterization is considered the gold standard for diagnosis and evaluation of the severity of PH. Moreover, pulmonary vasoreactivity testing is used to guide the management of patients with PH. The pathogenesis of BPD-associated PH is poorly understood and even less is known about appropriate therapy. Today, optimizing ventilation and reducing the pulmonary vascular tone with specific pulmonary vasodilatator drugs are the main goals in treating HTP-associated DBP. Animal studies and a few clinical studies suggest that medications targeting the nitric oxide (NO) signaling pathway (NO inhalation, oral sildenafil citrate) could be effective treatments for BPD-associated PH, but they have not been approved for this indication. The HTP-DBP study is a French multicenter prospective observational study. The objective is to evaluate the frequency of BPD-associated PH, to describe its physiopathology, its severity (morbidity and mortality), and the effectiveness of current treatments.