Prevalence of Raynaud phenomenon in the adult population of South Carolina.

A prevalence estimate for Raynaud phenomenon among adult residents of South Carolina was based on data obtained from respondents in a statewide health survey, followed by face-to-face interviews and clinical screening for Raynaud phenomenon, using a screening procedure developed by the authors. The survey obtained 5246 personal interviews from a probability sample of over 3000 households, and 494 survey subjects participated in the clinical screening. The prevalence estimates and their standard errors were computed using survey case weights, design-based estimation, and logistic modelling techniques. The prevalence of Raynaud phenomenon among adult residents of South Carolina was determined to be 3.5%, with a standard error of 0.6%. Prevalence was higher for females (4.3%, SE = 0.7%) than for males (2.7%, SE = 0.6%). These figures are much lower than most estimates in the existing literature on Raynaud phenomenon.

Demographic, social and clinical correlates of Raynaud phenomenon.

Our study has identified the demographic, social and clinical correlates of primary Raynaud phenomenon (RP) from a case-control study involving 235 subjects who were identified from a population-based prevalence survey of RP. All potential cases and a sampling of probable non-cases, identified by a screening questionnaire, were invited to a medical clinic for diagnostic testing and assignment of case or control status. Odds ratios (OR) for risk indicators for primary RP were estimated using multiple logistic regression to obtain 95% confidence intervals. The regression yielded statistically significant (p less than 0.05) positive associations for sex (OR = 3.0 for females versus males), self-reported alcohol use (OR = 1.1) and diastolic blood pressure (OR = 1.2) in those on antihypertensive medication. A significant (p = less than 0.01, OR = 0.4) negative association was found for Quetelet index (a measure of obesity). Near-significant or suggestive but non-significant negative associations were found between RP and marital status (p = 0.05, OR = 2.5), increased years of education and, for those on antihypertensive medication, higher systolic blood pressure (both p = 0.07).

Reference ranges for serum prostate-specific antigen in black and white men without cancer.

OBJECTIVES: To determine the age- and race-specific prostate-specific antigen (PSA) distributions in healthy men in central South Carolina and to compare these to data from other studies. METHODS: Two thousand ninety-two black men aged 40 to 69 years and white men aged 50 to 69 years from the general population in 11 counties of central South Carolina participated in a prostate cancer educational program. Seventy-two percent of the participants were black-about double the proportion in the general population-and 63% of the men (1319 of 2092) subsequently obtained a PSA determination from their own physician. The distribution of serum PSA was compared with distributions from the Olmsted County study and from the Walter Reed Army Medical Center/Center for Prostate Disease Research study. RESULTS: Older men without cancer had higher PSA levels. Regression analyses yielded an associated increase of about 3.3% per year. Reference ranges for normal PSA in men without cancer (based on their sample 95th percentiles) were zero to 1.9, 3.8, and 5.7 ng/mL in black men aged 40 to 49, 50 to 59, and 60 to 69 years, and zero to 2.7 and 4.9 mg/mL in white men aged 50 to 59 and 60 to 69 years, respectively. CONCLUSIONS: Reference ranges for normal serum PSA levels should take into account the population from which they are derived and to which they will be applied. Reference ranges that are useful in the general population can differ from those that are appropriate in a hospital setting. For the general population in central South Carolina, reference ranges for serum PSA levels are lower than previously published reference ranges, particularly among black men.

Hypertension in a population sample of female Punjabi Indians in Southall.

A population-based survey of female Punjabi Indians aged 11 and over now living in Southall, a district in west London, showed a steady and significant increase in blood pressure with increasing age. The crude population prevalence of hypertension, defined according to the criteria of the World Health Organisation, was 16%; for women over the age of 40 it was 62%. About two-thirds of those in the hypertensive range did not know of their high blood pressure. Among those who did know, up to 75% were receiving medical treatment for the condition.

Using elderly educators to increase colorectal cancer screening.

This article reports on the elderly educator method, a practical and economical intervention that was used for increasing the rate of return of fecal occult blood sampling in colorectal screening among 171 socioeconomically disadvantaged older persons. Two methods that used elderly educators had an overall response rate of more than 60%. Logistic regression shows a statistically significant difference between two methods that used elderly educators and two methods that did not.

Predictors of fecal occult blood screening among older socioeconomically disadvantaged Americans: a replication study.

Socioeconomically disadvantaged elderly are less likely to participate in fecal occult blood testing (FOBT). A quasi-experimental design was used in this operational replication study to determine predictors at baseline of subsequent participation in FOBT. Sixty-five percent of the 211 participants in the replication study participated in FOBT, and 47% of the 171 participants in the original study participated in FOBT. Predictors for FOBT in the replication study were male gender, age of 65-75 years old, ability to go places without assistance, history of having had a digital rectal examination and FOBT. This replication study supports targeting socioeconomically disadvantaged populations for FOBT as well as females, persons 85 years and older, persons who need assistance in travel, and person who have not had FOBT before. The results show that socioeconomically disadvantaged persons will participate in FOBT when effective educational interventions that include adaptation for aging changes are used.

Knowledge of colorectal cancer among older persons.

Cancer screening is a national health priority, especially for colorectal cancer, the second leading cause of death due to cancer in the United States. The researchers measured colorectal cancer knowledge among 211 older Americans. A quasiexperimental pretest-posttest two-by-two factorial design was used to test the effect of knowledge on participation in fecal occult blood screening. The American Cancer Society's colorectal cancer educational slide-tape presentation served as the basis for all of the educational programs. Hemoccult II kits were distributed at no cost to the participants. Descriptive statistics, chi 2, and logistic regressions were used to analyze data. One-half of the participants had incomes below the poverty level. Almost one-half the subjects in the study sample stated that they had not received any information about colorectal cancer within the past year. Caucasians had more knowledge of colorectal cancer than African Americans [F(1, 78) = 7.92, p < 0.01] and persons with higher income had more knowledge than persons with less income [F(2, 76) = 3.01, p = 0.05]. Subjects showed significant increases in colorectal cancer knowledge 6 days after the colorectal cancer education program [t(79) = 2.59, p = 0.01] and this increased knowledge was a predictor of participation in free fecal occult blood screening [chi 2(1, n = 164) = 5.34, p = 0.02].

Teaching older adults by adapting for aging changes.

Few teaching programs are geared to meet the special learning needs of the elderly. This pilot study used a quasi-experimental pretest-posttest design to measure the effect of the Adaptation for Aging Changes (AAC) Method on fecal occult blood screening (FOBS) at meal sites for the elderly in the South. The AAC Method uses techniques that adjust the presentation to accommodate for normal aging changes and includes a demonstration of the procedure for collection of the stool blood test, memory reminders of the date to return the stool blood test, and written materials adapted to the 5th grade reading level. In addition, actual practice of the FOBS with the use of peanut butter was added to the AAC Method, making it the AAC with Practice Method (AACP) in two sites. The American Cancer Society's colorectal cancer educational slide-tape show served as the basis for all of the methods. Hemoccult II kits were distributed at no cost to the participants. Descriptive statistics, chi 2, and logistic regressions were used to analyze data from 135 Council on Aging meal sites' participants. The average age of the participants was 72 years; the average educational level was 8th grade; over half the sample was African-American; and half of the participants had incomes below the poverty level. Results support a significant increase in participation in FOBS in participants taught by the AACP Method [chi 2 (1, n = 56) = 5.34, p = 0.02; odds ratio = 6.2]. This research provides support for teaching that makes adaptations for aging changes, especially adaptations that include actual practice of the procedure.

Perceived benefits: a predictor of participation in prostate cancer screening.

Prostate cancer is the most frequently diagnosed major cancer and the second cause of cancer-related deaths among men. With early detection through screening and timely treatment, 9 out of 10 men will survive a minimum of 5 years. However, with late diagnoses, only 3 out of 10 men will have a 5-year minimum survival rate. Guided by a conceptual map, this correlational research examined perceived benefits as a predictor of participation in free prostate cancer screening. Perceived benefits are the personal belief and valuing of screening for early detection of prostate cancer. All subjects received one of four educational interventions: traditional, peer educator, client navigator, or combination. Participation in prostate cancer screening was measured by compliance with the American Cancer Society's Guidelines, which included a digital rectal exam (DRE) and/or a prostate-specific antigen (PSA) blood test. The purposive sample (n = 1,522) of men, ages 40 to 70 years, was recruited from randomly selected churches, barbershops, industries, housing projects, and car dealerships in a southeastern state. Seventy-two percent of the sample was African American. Predictors of participation in free prostate cancer screening were these: perceived benefits, being white, having at least a high school education, being married, and receiving the client navigator or combination educational intervention. The Benefits Scale was significant (p = 0.013, odds ratio (OR) = 1.059) as a predictor for participation in screening when all demographic variables and educational interventions were controlled. Practice implications for nursing are discussed and recommendations for future research are presented.

The impact of prostate cancer knowledge on cancer screening.

PURPOSE/OBJECTIVES: To test the effect of knowledge on participation in prostate cancer screening. DESIGN: Quasi-experimental design; PRECEDE framework. SAMPLE: 319 men, 82% African American. METHODS: Prostate cancer knowledge was measured with a Prostate Cancer Knowledge Questionnaire prior to a community-based educational program. Men were referred to their personal physicians for a free prostate cancer screening. Results were sent to the Prostate Cancer Project. MAIN RESEARCH VARIABLES: Prostate cancer knowledge and participation in free prostate screening with a digital rectal examination and prostate specific antigen. FINDINGS: Prostate cancer knowledge was a predictor in participation in screening (p = 0.05). IMPLICATIONS FOR NURSING PRACTICE: Nurses need to target educational interventions for African American men, who have the highest incidence of and mortality rates for prostate cancer, to significantly reduce mortality rates. This study documented the importance of providing educational programs to increase participation in prostate cancer screening.

Cues to participation in prostate cancer screening: a theory for practice.

PURPOSE/OBJECTIVES: To develop and test the Cues to Participation in Prostate Cancer Screening Theory, which proposes that exposure to information from certain sources cues or triggers screening. DESIGN: Descriptive correlational. SETTING: 11 counties of a southeastern state. SAMPLE: Convenience sample of 1,867 men at risk for prostate cancer (72% African American; 28% Caucasian). METHODS: Recent exposure to prostate cancer information was measured. Men were offered free screening by prostate specific antigen (PSA) and digital rectal exam (DRE). MAIN RESEARCH VARIABLES: Demographic variables (race, age, education, income, and marital status), exposure (electronic media, print media, healthcare provider recommendation, and interpersonal interactions), and screening as measured by PSA and DRE. FINDINGS: Several major propositions of the Cues to Participation Theory were supported. General exposure to prostate cancer information significantly predicted screening participation. Hearing about prostate cancer from a healthcare provider was the best predictor of screening. CONCLUSIONS: Men's demographic characteristics should be considered when providing information about prostate cancer. Hearing about prostate cancer from family and friends was not significantly related to screening behavior. IMPLICATIONS FOR NURSING PRACTICE: The importance of recommendations for prostate cancer screening is underscored.

Diagnosis of Raynaud's phenomenon assisted by color charts.

A simple questionnaire, combined with color charts consisting of a 12-point color scale and a series of photographs illustrating blanching and cyanosis, has been developed to assist in the diagnosis of Raynaud's phenomenon (RP). The value of the color charts alone was first tested on a group of 48 patients with RP in whom the RP attacks were witnessed by the investigators (gold standard) and on a group of 246 RP negative subjects; the results showed a sensitivity of 90% and a specificity of 100%. A short RP diagnostic test was then devised by combining the questionnaire and color chart responses, which increased the sensitivity to 100% in our gold standard group of RP positive subjects. Further evaluation of this RP diagnostic test on a sample of 325 subjects whose RP status was unknown demonstrated that the majority could be classified as clearly RP positive or negative with only 4 subjects in the intermediate category.

Psychophysiological studies in schizophrenic patients selected on the basis of a "genetic marker".

Psychophysiological studies in schizophrenics have generally resulted in contradictory and inconclusive reports. The purpose of the present study was to determine whether a better psychophysiological separation of schizophrenic and control subjects could be accomplished by selecting them on the basis of a biological marker: the high plexus visualization score (PVS). Finger blood flow, skin temperature and electrodermal recovery rates were studied in 64 male schizophrenics (33 high PVS and 31 low PVS) and 24 male controls (10 high PVS and 14 low PVS) matched for age. All control subjects and 30 of the schizophrenics (16 high PVS and 14 low PVS) had been drug-free for at least 1 month. They were studied in a sound attenuated, temperature controlled room under 12 experimental conditions. The results demonstrate that, as predicted, schizophrenics with high PVS have the lowest finger blood flow rates, the lowest skin temperatures and the slowest GSR recovery rates of all groups studied. The largest difference in all three variables was found between high PVS schizophrenics and high PVS controls. The blood flow rates and the skin temperature were higher and the electrodermal responses were fewer in patients taking medications than in those receiving placebos. A suggestion of a bimodal distribution into "responders" and "non-responders" was apparent only in patients receiving medications.

The effect of massage on pain in cancer patients.

Evaluating the effectiveness of nursing interventions in decreasing pain is a top priority for clinical research. Unfortunately, most of the research on cancer pain relief has been limited to treatment studies involving the administration of analgesics. Research is needed to determine which nonanalgesic methods of pain control are effective and under what conditions. Consequently, an experimental study was designed to test the effectiveness of massage as an intervention for cancer pain. Twenty-eight patients were randomly assigned to a massage or control group. The patients in the massage group were given a 10 minute massage to the back; the patients in the control group were visited for 10 minutes. For males, there was a significant decrease in pain level immediately after the massage. For females, there was not a significant decrease in pain level immediately after the massage. There were no significant differences between pain 1 hour and 2 hours after the massage in comparison with the initial pain for males or females. Massage was shown to be an effective short-term nursing intervention for pain in males in this sample.

Incidence and prevalence of cleft lip and palate: what we think we know.

The descriptive epidemiology of the spectrum of orofacial cleft disorders has many methodologic problems, including (1) casefinding using data sources such as birth certificates, fetal death certificates, and hospital records that often produce ascertainment bias, selection bias, or both and (2) the multiple comparisons problem (i.e., the chance occurrence of statistically significant findings). The resultant incidence and prevalence rates from studies with inadequate designs or inadequate data are limited and may be misleading. A variety of reasons is advanced to explain the wide discrepancies in reported statistics on orofacial clefting from different geographic areas, ethnic groups, and time periods. Specific recommendations are offered for producing better epidemiologic data. An example of how higher quality descriptive statistics can be used for future hypothesis testing is also provided.

Digital pressure responses to cooling in patients with suspected early vs definite scleroderma (systemic sclerosis) vs primary Raynaud's phenomenon.

OBJECTIVE: To compare digital vascular responses to local finger cooling in 4 groups of subjects: patients with definite scleroderma (SD, systemic sclerosis) meeting ARA criteria (n = 16), patients with suspected early SD (n = 12), patients with primary Raynaud's phenomenon (RP) (n = 23) and a control group of 29 healthy subjects. METHODS: Their digital systolic pressures were measured at 30, 20, 15 and 10 degrees C finger cuff temperature, in a room kept at 18 degrees C. RESULTS: The results of the digital pressure measurements showed a clearcut difference between the SD, primary RP and control groups, but there was no difference between patients with definite SD and those with suspected early SD. CONCLUSION: Under our experimental conditions, digital pressure response to local cooling separates groups of patients with primary RP and those with secondary RP related to SD from each other and from controls. The similarity between digital pressure responses of patients with suspected early SD and those with definite SD, suggests an early organic involvement of the digital vasculature in SD.

The John Henryism and Framingham type A scales. Measurement properties in elderly blacks and whites.

In 1984-1985, the authors interviewed 1,017 participants in the Charleston Heart Study in Charleston County, South Carolina to investigate the measurement properties of the Framingham Type A Scale in elderly blacks and whites and those of the John Henryism Scale for Active Coping, which was originally designed for use in black populations. They conclude that the Framingham Type A and John Henryism scales do in fact measure two quite different behavior patterns, and do have different correlates in elderly blacks and whites. The results are of particular interest since the Charleston Heart Study sample includes an oversampling of high socioeconomic status black males (n = 69). In this respect, it is unique among long-term cardiovascular studies and provides the opportunity to estimate separate race and socioeconomic status effects, as well as to examine their interaction.

Prevalence of Raynaud phenomenon in the general population. A preliminary study by questionnaire.

A short questionnaire inquiring about cold sensitivity of the fingers was administered to 1752 randomly selected subjects in a probability sample drawn from the adult population of the state of South Carolina. The overall prevalence of reported cold sensitivity was approximately 10% and showed no sex or race difference. A female preponderance was revealed only after subjects exposed to vibrating tools were excluded, and then only in the white group. Estimates of the prevalence of Raynaud phenomenon were obtained using the following criteria: cold sensitive subjects reporting white and/or blue color changes: 4.6%; cold sensitivity leading to medical consultation: 3.0%; combination of the two criteria above: 1.9%.