Do Turkish nursing and midwifery students teach breast self-examination to their relatives?

AIM: To describe health beliefs and breast self-examination (BSE) practice of Turkish female nursing and midwifery students and extent of teaching the screening method to their mothers, sisters and relatives. DESIGN: In this definition survey, data were obtained from 113 nursing and midwifery students (n = 113) in third and fourth class and their mothers, sisters and other relatives in Turkey. METHODS: Data were collected using a personal data form, a knowledge evaluation form for BSE (Maurer 1997) and the Champion's Health Belief Model Scale. Number percentage, Chi-square test were used in the evaluation of the data. RESULTS: Students learned breast cancer and BSE in their lessons one or two years previously. Knowledge level scores of the students were 52.3 ± 9.6 (min:25,max: 75). Rate of having regular BSE was 32.7%. When health belief scale assessed; the average of susceptibility was 7.52 ± 2.62, seriousness was 21.8 ± 5.30, benefit was 16.7±4.45, barrier was 22.3 ± 6.44, confidence was 40.3 ± 6.67 and medical motivation was 26.6 ± 4.22. The rate of having regular BSE and benefit, barrier scores were compared, they were statistically significant difference(p < 0.05). The majority (106, 91.3%) gave BSE training to their mother and sisters, and 42.6% (48) to relatives, 6.2% (7) to friends, and 5.4% (6) to patients. CONCLUSIONS: Knowledge about breast cancer and BSE repetition training programs should be planned for nursing/midwifery students, to increasae their sensitivity, beliefs and attitudes, and medical motivation for BSE.

Determination of sunburn and skin cancer risk of outpatients in a dermatology polyclinic.

Public health experts and medical professionals continue to issue warnings to people about the dangers of ultraviolet (UV) radiation fromthe sun, tanning beds, and sun lamps. Skin cancer is more common than any other type of cancer and exposure to sun is known to contribute to all three major types, namely, basal-cell carcinoma, squamous-cell carcinoma and cutaneous melanoma. While skin cancer has been associated with sunburn, moderate tanning may also exert an influence. Seven steps to safer sunning are avoiding the sun, using a sunscreen, wearing a hat, wearing sunglasses, covering up, avoiding artificial tanning, and checking skin regularly. The present study was performed to examine the knowledge, attitudes, and risk factors of individuals concerning skin cancer. A descriptive survey was conducted among 475 patients randomly selected from the Dermatology Polyclinic of Ege University. A self-administered questionnaire was used to investigate their knowledge about skin cancer. A total of 297 female and 178 male participants were questioned, with a mean age of 32.48 +15.12. Some 36.8% had skin type II and 39.8% type III. The most common hair and eye color were brown, respectively at 56.0% and 58.7%. 79.8% had a mole(s), 19.2% had birthmark. A total of 8 of the 475 participants consulted for sunburns (1.7%). Glasses were the most popular preventive behaviour (28.8%). A total of 56 of the 475 outpatients questioned did not use any protective measure. Individuals need to be better educated on the dangers of the sun and sun protection as well as skin cancer.

Knowledge, attitudes, risk factors, and early detection of cancer relevant to the schoolteachers in Izmir, Turkey.

BACKGROUND: Teachers are the population of interest because of the important role they play in education and possibly in prevention of cancer. The purpose of the research is to describe knowledge, attitudes, risk factors and early detection relevant to cancer of schoolteachers. METHODS: A descriptive survey is conducted among 358 schoolteachers who are randomly selected from the eight schools in Izmir, Turkey. A self-administered questionnaire is used to investigate their knowledge in cancer, risk factors, attitudes, and early detection of cancer. RESULTS: Knowledge in cancer and symptoms are assessed using the data collected from a series of simple questions. Potential scores ranged from 0 to 15. CONCLUSIONS: In the sample, scores are distributed around a mean of 7.43 +/- 2.87. Risk factors and early detection associated with cancer are generally low.

Pharmacological management of agitation in emergency settings.

OBJECTIVE: To review, firstly, published studies comparing classic antipsychotics, benzodiazepines, and/or combination of both; and secondly, available data on the use of atypical antipsychotic medications in controlling agitation and aggressive behaviour seen in psychiatric patients in emergency. METHOD: In the first review, studies comparing antipsychotics, benzodiazepines, and combination of both; and in the second review, efficacy trials of atypical antipsychotics that include an active and/or inactive comparator for the treatment of acute agitation were identified and reviewed. Data from clinical trials meeting the inclusion criteria were summarised by recording improvement rates, definition of improvement, and timing of defined improvement for individual studies. RESULTS: In the first review, 11 trials were identified meeting the inclusion criteria, eight with a blind design. The total number of subjects was 701. These studies taken together suggest that combination treatment may be superior to the either agent alone with higher improvement rates and lower incidence of extrapyramidal side effects. In the review of atypical antipsychotic agents as acute antiagitation compounds, five studies were identified, three with a blind design. The total number of subjects was 711, of which 15% (104) was assigned to the placebo arm. This review found atypical antipsychotics to be as effective as the classic ones and more advantageous in many aspects. CONCLUSION: Atypical antipsychotics such as risperidone, ziprasidone, and olanzapine with or without benzodiazepines should be considered first in the treatment of acute agitation. If these agents are not available the combination of a classic antipsychotic and a benzodiazepine would be a reasonable alternative. An oral treatment should always be offered first for building up an alliance with the patient and suggesting an internal rather than external locus of control.

Attention-deficit hyperactivity disorder subtypes and comorbid disruptive behaviour disorders in a child and adolescent mental health clinic.

OBJECTIVE: To assess demographic characteristics and patterns of comorbid disruptive behavior disorders (oppositional defiant disorder [ODD] or conduct disorder [CD]) in subtypes of attention-deficit hyperactivity disorder (ADHD). METHOD: One hundred youths consecutively referred to a community child and adolescent mental health clinic and subsequently diagnosed with ADHD by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria were evaluated. The diagnosis was made by a child psychiatrist and was based on information from physicians, parents, teachers, and diagnostic interviews with the youth and their parents. RESULTS: The major findings were: 1) ADHD combined (C) type was diagnosed in 78% of the subjects, while 15% had inattentive (1) type and 7% had hyperactive-impulsive (HI) type; and 2) patterns of comorbid disruptive behavioural disorders significantly differed among subtypes. Specifically, subjects with the I type showed lower rates of comorbid ODD than those with the C type (33% and 85%; P < 0.001) and HI type (33% and 100%; P = 0.005); subjects with the HI type displayed a higher prevalence of CD than those with the I type (57% and 0%; P = 0.005) and C type (57% and 8%; P = 0.003). These results should be considered tentative because the reliability of the diagnostic procedures was not formally assessed and the number of subjects in the I and HI groups was small. CONCLUSION: ADHD subtypes showed significant differences in the distribution of comorbid disruptive behaviour disorders. These results support the utility of ADHD subtypes but should be replicated with a larger sample of I and HI type subjects using more rigorous diagnostic methods.

Repeated use of psychiatric emergency services by children.

In this study, the repeat utilization of child psychiatric emergency services was examined. There are patients who use psychiatric emergency services repeatedly, and these patients represent a significant proportion of child psychiatric emergencies seen in emergency rooms. Repeat patients were more likely to threaten to harm others, have a diagnosis of adjustment disorder, conduct or oppositional disorder and be under the care of a child welfare agency. They were significantly more likely than the one-time patients to be less compliant with outpatient follow-up, admitted to hospital more often, needed more social support and had greater difficulty remaining in a residential treatment setting. Intervention in the emergency room did not appear to change the way they used emergency services.

Treatment outcome for children and adolescents with conversion disorder.

This paper describes the clinical impressions of conversion disorders developed after long term in-depth clinical work with 137 children and adolescents and their families. Almost half of the 89 patients who were directly treated and followed by the author through an integrative child and family therapy approach recovered less than two weeks after the initiation of the treatment. Only three out of 89 patients required longer than four weeks for recovery. The rest responded well to the therapy and recovered with two to four weeks of treatment. Factors associated with positive treatment outcome are: younger age of patient, healthy personality characteristics, lack of psychopathology, insight and treatment compliance, healthy family functioning, acceptance by the family of the psychological nature of the illness, positive feelings towards the child and the family by the staff, lack of internal conflict and inflexible neurotic defences, and early therapeutic interventions. It was found that child and adolescent patients with conversion disorders responded quite well to an integrative, condensed treatment approach.

Adolescent couple suicide: literature review.

A suicide pact is a mutual arrangement between two people to kill themselves at the same time, usually in the same place. A summary of the highlights from a literature survey on suicide pacts with a major focus on high risk factors is presented in this paper. The victims of suicide pacts are usually the spouses over age 50. The instigator is usually a depressed male with a history of self-destructive behaviour. In many cases the presence of an overdependent relationship, and a threat to the maintenance of closeness are strongly associated with the attempt. Since there were no adolescent couple suicide pacts in the literature, a case of a serious adolescent couple suicide attempt assessed and treated by the authors is reported here. The dynamics of this case are compared to the findings, the studies and case reports on adult suicide pacts.

An integrative treatment approach to child and adolescent suicidal behavior.

The suicide rate for adolescents has tripled during the last 30 years in North America and many Western countries. Although some high risk factors have been defined, the literature is weak on the prevention and treatment issues. This article defines an integrative treatment approach for self-destructive behavior. This model attempts to integrate the well-recognized theoretical and therapeutic approaches such as biologic, psychodynamic, behavioral, cognitive, self-directed, strategic, experiential, and systemic frameworks. In the integrative approach, the therapist integrates the use of drug therapy and child, group, milieu, and family therapy, depending on the needs of each child. After a brief presentation of the author's comprehensive, in-depth study with 139 suicidal children and adolescents, the commonly seen family reactions to suicidal behavior were described. Family stage reactions of shock and fear, panic and action, guilt, resentment, reparation, and partial recovery are defined with case examples. The complementary nature of the supportive and therapeutic work for the families of suicidal children and adolescents with other preventative and therapeutic interventions is highlighted.

Emotional aspects of arm or leg amputation in children.

A clinical study of nine children between the ages of 4 and 15, who had undergone arm or leg amputation is presented. The emotional reactions of all those involved - the child, family, and the treatment team - are described. Amputation creates extreme stress in all participants in the procedure. Some similarities were found in the defensive mechanisms and stages experienced by the child, the family and the members of the treatment team.