Abortion Experiences and Perspectives Amongst Migrants and Refugees: A Systematic Review.

(1) Background: Access to abortion care is a crucial reproductive health right. Refugees and migrants may have restricted access to and utilisation of abortion care, associated with histories of displacement, precarious migrant and citizenship status and difficulty navigating unfamiliar host country healthcare systems. However, there is limited evidence on the abortion experiences and perspectives of refugees and migrants. Moreover, existing research has not been synthesised to identify trends informing sexual and reproductive care access among this marginalised population. This systematic review aimed to address this gap in the cumulative evidence on refugee and migrant experiences and perspectives of abortion in host countries. (2) Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the following databases for studies on refugee and migrant abortion attitudes, decision making and experiences: Embase, Medline, CINAHL, Web of Science, Sociological Abstracts, and Scopus. We also searched the grey literature on the same. Inclusion criteria specified qualitative studies involving migrant and/or refugee populations, examining their abortion experiences, attitudes or perspectives, written in English, published between January 2000 and December 2022. Two reviewers screened titles, abstracts and full-text articles, resulting in 27 articles included in the review, following consensus checks by two co-authors. The included studies were assessed for methodological quality using the Critical Appraisal Skills Programme tool. (3) Results: Abortion was stigmatised and generally considered impermissible and undesirable. However, participants discussed socioculturally determined 'exceptions' to this, positing circumstances where abortion was acceptable. There were striking differences in experiences between participants in higher-income settings and those in lower- and middle-income settings. Difficulties accessing care were ubiquitous but were heightened in lower-resource settings and among participants with precarious citizenship, financial and legal statuses. (4) Conclusions: The findings highlight the need for an international convention to guide policy and programming that acknowledges the specific abortion requirements of migrant and refugee communities, with attention to their financial, legal and social precarity.

Sexual and reproductive health and rights decision-making among Australian migrant and refugee youth: a group concept mapping study.

Sexual and reproductive health (SRH) is a human right. Young people, particularly from marginalised groups such as migrant and refugees, are vulnerable to compromised sexual and reproductive health and rights. In this study, we aimed to identify socioecological factors influencing migrant and refugee youth SRH decision-making and compare perspectives of youth with key stakeholders. Data were collected using Group Concept Mapping (GCM), a mixed-methods participatory approach. Participants included migrant and refugee young people, aged 16-26 from Western Sydney (n = 55), and key stakeholders comprising clinicians, service providers and researchers (n = 13). GCM involved participants brainstorming statements about how migrant and refugee youth make SRH decisions. Participants then sorted statements into groups based on similarity, and rated statements on importance and impact. Multidimensional scaling and hierarchical cluster analysis were used to cluster statements into concept maps that represented participants' perspectives. The resulting maps comprised six clusters representing main concepts informing decision-making. The most important clusters were 'healthy relationships' and 'safe-sex practices'. Youth rated healthy relationships more important than stakeholders did. This study reveals factors informing migrant and refugee youth's decision-making. Future policy should go beyond biomedical constructions of SRH to incorporate emotional and relational factors, which young people consider to be equally important and beneficial to their agency.

Migrant and refugee youth perspectives on sexual and reproductive health and rights in Australia: a systematic review.

Migrant and refugee youth (MRY) in Australia face specific experiences that inform their sexual and reproductive health and rights (SRHR). Migrant and refugee communities experience poor health outcomes and low service uptake. Additionally, youth are vulnerable to poor sexual health. This review examines the understandings and perspectives of MRY. A systematic review was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol is registered with PROSPERO: CRD42021241213. Nine databases were systematically searched. Inclusion criteria specified literature reporting on migrant and/or refugee youth perspectives and attitudes towards sexual and reproductive health; peer-reviewed qualitative, mixed-methods and/or quantitative studies or grey literature reports; records using Australian research; literature published in English between January 2000 and March 2021. Records that did not report on MRY and did not examine participant views or perspectives; were abstract-only, reviews, pamphlets, protocols, opinion pieces or letters; did not include Australian research; were published before 2000 and/or in a language other than English were excluded. Two reviewers screened titles, abstracts and full-text articles. The Mixed Method Appraisal Tool was used to assess studies' methodological quality. Thematic synthesis methods guided data extraction and analysis. Twenty-eight papers were included in the final review. Three themes were identified in MRY constructions of SRHR: (1) experiences of silence and shame; (2) understandings of and responses to SRHR risks; (3) navigation of relationships and sexual activity. Socioecological factors shaped MRY perspectives at individual, interpersonal, institutional and societal levels. Societal factors and interpersonal relationships significantly influenced decision making.

Safety and Feasibility of a Kinesiotape Application for Secondary Hand Lymphedema: A Case Series.

Background: The safety and feasibility of using kinesiotape as a short-term alternative treatment to compression garments or gloves for hand lymphedema have not been examined. The aim of this study was to examine if kinesiotape could maintain size and extracellular fluid (ECF) volume of the hand and forearm, as well as upper limb function and quality of life for women with secondary hand lymphedema. Methods and Results: Six women with secondary hand lymphedema underwent pretreatment measurements, including hand and digit size using a tape measure; ECF volume using bioimpedance spectroscopy; and patient-reported outcome measurements of upper limb function and quality of life. Kinesiotape was then applied to the dorsum of the hand and left for 48 h, during which participants were asked not to wear compression garments. Posttreatment measurements were completed after kinesiotape removal. Changes in measurements were compared to the smallest detectable change (SDC). Hand size did not change more than the SDC; however, a single affected digit increased in circumference by more than the SDC. Changes of the whole arm ECF volume were less than the SDC. The ECF volume of the dorsum of the hand increased in one and decreased in another participant. The forearm ECF volume decreased in two participants. Upper limb function and quality of life did not change. No adverse event was reported. Conclusion: Short-term kinesiotape use appears to be safe in maintaining the physical presentation of hand lymphedema. However, these results should be examined in a larger sample. The feasibility of using kinesiotape as an alternative treatment to compression requires further investigation. Clinical Trial Registration number: ACTRN12618001232224p, July 23, 2018 retrospectively registered.

Improving the quality of long-term care services in workforce dimension: expert views from Australia and South Korea.

BACKGROUND: The long-term care workforce is an essential factor in the provision of qualified long-term care services. Identifying workforce issues can help developing countries in East Asia and the Pacific prepare for the increase in the older population. Their experiences can be used as lessons for other countries. This study aimed to identify the workforce issues that should be addressed in order to provide high-quality long-term care services for older adults. METHODS: In-depth interviews and content analysis were conducted with a purposive sample of long-term care experts. There were eight participants from Australia and 14 from South Korea. The participants were questioned on important workforce issues to improve the quality of long-term care services. These were open-ended questions that comprised ideas derived from the literature. Major themes were systematically and comprehensively classified and coded to examine recurring comments and themes. RESULTS: The issues in the two countries were very similar: labor shortages, inadequate working conditions, insufficient career and staff training, and the need of counselors or consultants for finding proper services. There were also differences in terms of competency of the service operators and their corresponding multicultural competency. CONCLUSIONS: Providing high-quality long-term care service requires multipronged approaches to workforce capacity and work environment. An adequate and competent workforce should be established to match the service needs of the older population. To improve quality, better working conditions and improved motivation to work in care for older people should be considered. Concurrently, each country would need a workforce strategy tailored to different conditions and environments. This should include policies to induce an influx into the workforce.

The Role of Education in Breast Cancer Beliefs and Screening Practices Among Korean Women - A quantitative study.

INTRODUCTION: Cultural beliefs are influential factors that affect breast cancer screening practices among Korean women. The aim of this study was to examine the role of educational levels and compare the cultural beliefs associated with breast cancer screening practices among immigrant Korean women in Australia with those of their counterparts in Korea. METHODS: A secondary analysis based on data from convenience samples of 245 and 249 Korean women living in Australia and Korea, respectively. Data were collected by the Korean version of Breast Cancer Screening Beliefs Questionnaire. RESULTS: Educational level has a significant association with Korean women's cultural beliefs about breast cancer and breast cancer screening practices regardless of country of residence. DISCUSSION: Nurses working in multicultural societies should take cultural beliefs and the role of education into account while designing strategies to promote breast cancer screening practices among immigrant Korean women.

Development and Validation of a Person-Centered Care Assessment Questionnaire for Daycare Centers for Older Adults.

Daycare services serve to prolong aging at home. This decreases both families' care burden and the government's financial burden. We identified key factors in the person-centered approach of South Korean daycare center workers to develop and validate a Korean person-centered care questionnaire. Twenty-one items were developed, and 10 expert interviews were conducted. The items were applied to 271 daycare center staff (19.2% male vs. 80.0% female, mean age = 50.68 ± 11.37 years) to evaluate their reliability and validity. Twenty items concerning intimate relationships and the environment, consumers' self-determination, and home-likeness domains were derived, explaining 40.28%, 10.44%, and 6.97% of the total variance, respectively. The overall tool's Cronbach's alpha was 0.905, demonstrating internal consistency. Inter-rater agreement ranged from 0.221 (fair) to 0.765 (good). This tool will be useful for individual staff members as well as for the National Health Insurance Service's evaluations of service quality at daycare centers.

Self-reported questionnaires for lymphoedema: a systematic review of measurement properties using COSMIN framework.

INTRODUCTION: Lymphoedema may develop as a result of numerous genetic and traumatic causes; however, treatment for cancer is the most common cause of its development in more economically developed nations. This systematic review critically appraised, compared and summarised the measurement properties of lymphoedema-specific self-reported questionnaires (SRQs) measuring various patient-reported outcomes including quality of life (QOL), function, morbidity, and symptoms. METHODS: Seven databases were searched to identify studies of the measurement properties of SRQs. Two review teams independently evaluated the quality of the individual studies using the risk of bias tool from the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). Measurement properties of the SRQs presented in the studies were then rated. Study level ratings were summarised for an SRQ if they were reported in multiple studies, and their overall quality of the evidence were then graded. RESULTS: Forty articles, reporting on 19 SRQs were identified from 8615 records. The focus of the 19 SRQs included eight on QOL, four on symptoms, two on function, and two on impairment. The other three SRQs were on illness perception, self-efficacy, and patient-relevant treatment benefit, respectively. Eight and three SRQs were upper limb and lower limb-specific, respectively, whereas seven questionnaires were for both upper and lower limb lymphoedema. One SRQ was developed for head and neck lymphoedema. According to the COSMIN framework, none of the SRQs reviewed had sufficient evidence to support all nine measurement properties. In lower limb questionnaires, the LYMQOL-leg has sufficient content, structural, and construct validity as well as internal consistency and reliability. For upper limb lymphoedema questionnaires, the Lymph-ICF-UL had sufficient content and construct validity as well as reliability. CONCLUSION: LYMQOL-leg SRQ is recommended with confidence for evaluation of QOL of people with lower limb lymphoedema while the Lymph-ICF-UL is recommended for evaluation of the QOL of the breast cancer-related lymphoedema with some confidence. In view of the high level of the indeterminate ratings of the measurement properties of the existing SRQs, further research is desirable.

Reliability and Validity of Physical Tools and Measurement Methods to Quantify Hand Swelling: A Systematic Review.

OBJECTIVE: Hand swelling may result from injury or trauma. Various physical assessment tools and measurement methods can be used to quantify the volume or size of the hand or fingers; however, the reliability and validity of each tool and measurement method have not been evaluated. The purpose of this study was to evaluate the reliability and validity of physical assessment tools and methods used to quantify hand and finger volume orsize. METHODS: MEDLINE, CINAHL, EMBASE, Web of Science, and Scopus were searched using key terms related to swelling, edema, volume, size, hand, measures, reliability, and validity. Cross-sectional or longitudinal studies that assessed reliability and/or validity of physical assessment tools or measurement methods to quantify hand swelling were included. Two examiners independently extracted data from the included articles and appraised the articles' quality using the Consensus-Based Standards for the Selection of Health Measurement Instruments methodology. Data extracted from studies analyzing reliability and validity were grouped by type of assessment tool and measurement method. RESULTS: Five physical assessment tools used for quantification of hand swelling were evaluated, including tape measure, water volumeter, bioimpedance spectroscopy, ring gauge, 3-dimensional techniques. All assessment tools had good to excellent reliability (ICC = 0.74 - 0.99), and moderate to high validity (Pearson coefficient = 0.58 - 0.99), for quantification of the volume or size of the hand or fingers. CONCLUSION: All measurement methods with these tools had good to excellent reliability and moderate to high validity. The evidence underpinning the figure-of-eight technique, which uses a tape measure, was the highest. Because these physical assessment tools and measurement methods assess different aspects and regions of the hand, which one is selected depends on the region of interest for assessment and the availability of tools. IMPACT: Reliable tools and measurement methods are available to measure the size or volume of the hand and fingers, either together or separately. The best tool will depend on the aim of assessment and tool availability. LAY SUMMARY: Hand swelling can occur with injuries, burns, or lymphedema. This review shows that tools are available to accurately measure swelling in any part of thehand.

Interchangeability of Two Electrode Placement Protocols Used by Bioimpedance Spectroscopy Devices in the Detection of Breast Cancer-Related Lymphedema.

Background: Bioimpedance spectroscopy (BIS) devices are routinely used in the assessment of breast cancer-related lymphedema (BCRL). The equipotential electrode placement is a commonly used protocol for the assessment of BCRL. However, the sternal notch electrode placement protocol is also in use. Whether these two protocols are interchangeable is not known. Methods and Results: Ethical approval was received from the institutional ethics committee at Tata Memorial Hospital, India. BIS measurements (whole-body right side and affected and unaffected arms) of 100 women with or at risk of BCRL were measured using equipotential and sternal notch protocols. Resistance at zero frequency (R0) was determined, and agreement of the absolute R0 values and the R0 ratio (unaffected/affected) between protocols was evaluated (Bland-Altman analysis and Passing-Bablok regression analysis). Mean absolute differences between protocols were very small for whole-body right side, affected arm, unaffected arm, and the interarm ratio at 0.23 ohms (95% confidence interval [CI]: -3.8 to 4.3), -5.7 ohms (95% CI: -7.5 to -3.9), -9.09 ohms (95% CI: -11.4 to -6.8), and -0.008 ohms (95% CI: -0.02 to 0.001), respectively. Limits of agreement (two standard deviation) between protocols were narrow for whole-body right side, affected arm, unaffected arm, and interarm ratio without any systematic or proportional differences for whole-body right side and the interarm ratio (5.8% to -5.6%, 3.7% to -7.4%, 3.5% to -8.2%, and 5.8% to -5.6%, respectively). Conclusion: The equipotential and sternal notch protocols could be used interchangeably in BCRL assessment. The Clinical Trial Registration number: CTRI/2017/12/010762.

Breast Cancer Perceptions and Screening Behaviours Among Korean Women in Australia.

Little is known about breast cancer screening behaviours among immigrant-Korean women in Australia. This study reported breast cancer screening status and whether demographic factors and cultural beliefs associated with their screening behaviours. A convenience sample of 258 Korean-Australian women completed the Korean version of the Breast Cancer Screening Beliefs Questionnaire. Only 16.9% paid special attention to their breasts monthly whereas 31.4% and 54.5% attended annual clinical breast examination and biannual mammograms respectively. Employment status and the length of stay in Australia are significant factors that affect women's breast cancer screening behaviour. Women who engaged in regular breast awareness and clinical breast examination had significantly higher scores on Knowledge of breast cancer subscale, whereas, those who attended mammography has significantly higher scores on Attitudes toward health check-ups. The research highlights that certain cultural and attitudinal issues are detrimental factors for breast cancer screening behaviour among Korean-Australian women.

Diagnosing Male Unilateral Upper Limb Lymphedema: Determination of Normatively Determined Thresholds Using Bioimpedance Spectroscopy.

Background: The use of bioimpedance spectroscopy (BIS) for the detection of unilateral upper limb lymphedema is growing. Currently, normatively determined diagnostic thresholds using bioimpedance are available for females only. It is unclear if they are suitable for males at risk of unilateral upper limb lymphedema. The aim of the present study was to determine normatively based bioimpedance thresholds for male unilateral upper limb lymphedema. Methods and Results: Impedance values (R0) for the upper limbs of 60 healthy adult male participants were assessed using BIS. As has been found in females, dominance was found to significantly impact on R0 values (p = 0.002); therefore, two diagnostic thresholds are required depending on the at-risk limb. Interlimb impedance thresholds were calculated, set at both two standard deviations (2SD) and three standard deviations (3SD) above the mean. The 3SD threshold for unilateral lymphedema in the upper limbs of males is 1.127 for the dominant at-risk limb and 1.094 for the nondominant at-risk limb. The 2SD threshold is 1.090 for the dominant at-risk limb and 1.058 for the nondominant at-risk limb. These differ from what has previously been found for females. Conclusions: This study is the first to establish normatively determined bioimpedance thresholds for male unilateral upper limb lymphedema. These thresholds should now be used to improve early detection of male unilateral upper limb lymphedema.

Prevalence and sociodemographic correlates of routine breast cancer screening practices among migrant-Australian women.

OBJECTIVE: To evaluate breast cancer screening (BCS) practice and explore the relationship between sociodemographic factors and breast awareness (BA), clinical breast examination (CBE) and mammography in migrant-Australian women. METHOD: Secondary analysis was performed on the pooled sample (n=1,744) from five cross-sectional studies of BCS rates among immigrant-Australian women, and the associated sociodemographic factors. RESULTS: Only 19% of women participated in routine BA, 27.4% of women in the target group of >40 year presented for an annual CBE, and 60.6% of women in the target group of 50-74 years received a biennial mammogram. Associated sociodemographic factors differed by modality except for length of Australian residency. In multivariable analysis, age, length of Australian residency, marital status, and employment status accounted for more than 50% of the variance in regular BA and CBE. CONCLUSION: These findings indicate suboptimal BCS rates persist among migrant-Australian women, and suggest the importance of certain sociodemographic factors in BCS practice. Implications for public health: Further education is required for BA and CBE practice in immigrant-Australian women, especially for those who have resided in Australia less than 12 years without a partner.

Validation of the Korean Version of the Breast Cancer Screening Beliefs Questionnaire.

BACKGROUND: Korean immigrant women have been consistently reported as having low participation in breast cancer screening practices. A valid and reliable instrument to explore factors that affect their cancer screening behaviors is essential. OBJECTIVE: The aim of this study was to report the psychometric properties of the Korean version of the Breast Cancer Screening Beliefs Questionnaire (BCSBQ). METHODS: A convenience sample of 249 Korean Australian women was recruited through a number of Korean community organizations in Sydney. RESULTS: Exploratory factor analysis supports a similar fit for the original 3-factor structure of our data set. A significant association was found between the attitudes of these women toward general health checkups and the frequency of their performance of the breast awareness practices and having mammograms. Furthermore, it was found that knowledge and perceptions about the breast cancer scales were significantly associated with education level and that barriers to mammographic screening were much less evident among women who engaged in the 3 screening practices. The results indicated that the Korean version of the BCSBQ had satisfactory validity and internal consistency. The Cronbach's α of the 3 subscales ranged between .80 and .88. CONCLUSION: The Korean version of the BCSBQ was confirmed to be a culturally appropriate, valid, and reliable instrument for assessing the beliefs, knowledge, and attitudes to breast cancer and breast cancer screening practices among women of Korean background living in Australia. IMPLICATION FOR PRACTICE: The Korean version of the BCBSQ can provide nurses with insights into the development of culturally sensitive breast health education programs.

Lymphedema following taxane-based chemotherapy in women with early breast cancer.

BACKGROUND: Taxanes can cause fluid accumulation by increasing extracellular fluid (ECF). Taxane-based regimens are standard of care for early breast cancer, but it is unknown whether they increase the risk of lymphedema. The aim of this study was to describe the incidence of lymphedema, generalized limb edema, and associated symptoms in women receiving adjuvant taxane-based chemotherapy. METHODS AND RESULTS: Women (n=63) recruited after axillary surgery for early breast cancer were assessed prior to anthracycline-based, prior to taxane-based chemotherapy, and 3 weeks and 6 months after completing taxane-based chemotherapy. At each assessment, the inter-limb ECF ratios and intra-limb intracellular fluid to ECF ratios were determined using bioimpedance spectroscopy. Inter-limb arm volume ratios were calculated from arm circumferences measurements. Self-rated symptoms of swelling and pain in the arm on the side of surgery were recorded. In the 53 women who completed assessments, taxane-based chemotherapy increased the ECF volume in both upper and lower limbs, which was not observed after anthracycline-based chemotherapy. The arm on the side of surgery was preferentially affected, indicated by elevated ECF ratios at 3 weeks and 6 months after completing taxane-based chemotherapy with 32% and 23% meeting the criteria for lymphedema at these time-points, respectively. Edema resolved by 6 months following completion of chemotherapy except in the arm on the side of surgery. CONCLUSION: The incidence of lymphedema in the arm on the side of surgery following taxane-based chemotherapy was increased persisting at least 6 months after ceasing chemotherapy. However, generalized swelling in the legs and opposite arm resolved by 6 months after chemotherapy.

Transient swelling versus lymphoedema in the first year following surgery for breast cancer.

PURPOSE: The aim was to better understand the incidence, time course and risk factors for swelling in the arm on the side of surgery over the first year following surgery for breast cancer. METHOD: Women (n = 160) were assessed 1 month following surgery and then randomised to the exercise or control group. Reassessment occurred 3, 9 and 15 months following surgery. Potential risk factors for swelling included age, body mass index, side of surgery and surgical and medical treatments for their breast cancer, physical measures of shoulder range of motion and strength, inter-limb arm circumference difference and the group to which they were randomised. Swelling was determined using bioimpedance spectroscopy with reference to previously established cut-offs for lymphoedema. RESULTS: The number of women with swelling at 3, 9 and 15 months was 15, 15 and 13, respectively; however, at 15 months only 5/13 presented with swelling in either of the preceding assessments. The risk of swelling increased at 3, 9 and 15 months for each centimetre increase in the baseline inter-limb difference in sum of arm circumferences by 1.30, 1.17 and 1.14. In addition, risk of swelling at 3 months was 2.6 times greater for women in the control group; at 9 months, 7 times greater for women who had taxane-based chemotherapy; and at 15 months, the risk increased 1.16 times for each day the drain was in situ. CONCLUSION: Swelling in the first year is likely to be transient, and factors including exercise and taxane chemotherapy affect the risk of developing swelling.

Prospective transcriptomic pathway analysis of human lymphatic vascular insufficiency: identification and validation of a circulating biomarker panel.

BACKGROUND: In our previous transcriptional profiling of a murine model, we have identified a remarkably small number of specific pathways with altered expression in lymphedema. In this investigation, we utilized microarray-based transcriptomics of human skin for an unbiased a priori prospective candidate identification, with subsequent validation of these candidates through direct serum assay. The resulting multi-analyte biomarker panel sensitively should sensitively discriminate human lymphedema subjects from normal individuals. METHODS AND FINDINGS: We enrolled 63 lymphedema subjects and 27 normals in our attempt to discover protein analytes that can distinguish diseased individuals from controls. To minimize technical and biologically irrelevant variation, we first identified potential candidates by performing transcriptional microarray analysis on paired diseased and normal skin specimens sampled from the same individuals. We focused our attention on genes with corresponding protein products that are secreted and took these candidates forward to a protein multiplex assay applied to diseased and normal subjects. We developed a logistic regression-based model on an eventual group of six proteins and validated our system on a separate cohort of study subjects. The area under the receiver operating characteristic curve was calculated to be 0.87 (95% CI : 0.75 to 0.97). CONCLUSIONS: We have developed an accurate bioassay utilizing proteins representing four central pathogenetic modalities of the disease: lymphangiogenesis, inflammation, fibrosis, and lipid metabolism, suggesting that these proteins are directly related to the pathogenesis of the tissue pathology in lymphatic vascular insufficiency. Further studies are warranted to determine whether this newly-identified biomarker panel will possess utility as an instrument for in vitro diagnosis of early and latent disease; the ultimate applicability to risk stratification, quantitation of disease burden, and response to therapy can easily be envisioned.

Reliability and concurrent validity of the perometer for measuring hand volume in women with and without lymphedema.

BACKGROUND: Lymphedema of hand after breast cancer treatment causes significant loss of hand function. Although there are several ways of assessing limb volume, measuring hand volume has been problematic due to technical difficulties associated with assessment of finger volumes. The aim of this study was to investigate the criterion validity and reliability of Perometer™ for measuring hand volume in woman with and without lymphedema. METHODS AND RESULTS: Hand volume of forty women with (n = 20) and without lymphedema (n = 20) was assessed twice by one rater and once by another rater using the Perometer, and once by one rater using the water volumetry method. Intra- and inter-rater reliability was determined from the intraclass correlation coefficients and Percent Close Agreement. Agreement between the Perometer and water volumetry was determined using a limit of agreement and Lin's concordance correlation. The Perometer had high intra [ICC(2,1) = 0.989 (95% CI: 0.98-0.99)] and inter-rater reliability [ICC(2,1) = 0.993 (95% CI: 0.99-1.0)]. Percent close agreement revealed that 80% of the measures were within 9 ml for inter-rater reliability and within 15 ml for intra-rater reliability. In addition, there was high concordance between hand volumes obtained with the Perometer and water volumetry method (R(c) = 0.88). However, the Perometer overestimated the volume of hand compared to water volumetry method (bias: 7.5%). CONCLUSIONS: The Perometer can be used with high reliability to measure hand volume but caution should be exercised when data are compared with measures derived from the water volumetry method.

Segmental measurement of breast cancer-related arm lymphoedema using perometry and bioimpedance spectroscopy.

PURPOSE: To determine if bioimpedance spectroscopy (BIS) could detect localised lymphoedema of the arm and to compare BIS measurements with equivalent measures of limb volume by perometry. METHODS: Women with mild to severe upper limb lymphoedema (n = 29) and women with no history of lymphoedema (n = 11) participated. Commencing at the ulnar styloid of the wrist, 4 × 10 cm segment measurements were made of each arm using both BIS and perometry. RESULTS: Average BIS inter-limb ratios for the total arm and each arm segment were higher than comparable perometry measures in women with lymphoedema, but similar to perometry measures for women without lymphoedema. Limits of agreement analysis showed that the mean difference between methods varied according to segment measured, ranging from 8.5% for the uppermost segment of the arm to 16.6% for the forearm segment just below the elbow. For all limb segments, there was a positive bias towards BIS measurements, which increased as lymphoedema severity increased. CONCLUSION: BIS can be used for localised measurement of lymphoedema. Because it is specific to extracellular fluid, BIS is more sensitive to localised lymphoedema than perometry.

Effect of air travel on lymphedema risk in women with history of breast cancer.

To assess the impact of air travel on swelling of the 'at risk' arm of women treated for breast cancer. Women treated for breast cancer from Canada (n = 60) and from within Australia (n = 12) attending a dragon boat regatta in Queensland, Australia participated. Women were measured within 2 weeks prior to their flight, on arrival in Queensland and, for 40 women travelling from Canada, measured again 6 weeks following return to Canada. Changes to extracellular fluid were measured using a single-frequency bioimpedance device (BIA). Each arm was measured separately using a standardized protocol to obtain the inter-limb impedance ratio. An increase in the ratio indicates accumulated fluid. Information regarding medical management of participants' breast cancer, use of compression garment and history of exercise were also obtained. For most women (95%), air travel did not adversely affect the impedance ratio. The BIA ratio of long-haul travellers was 1.007 +/- 0.065 prior to the flight and 1.006 +/- 0.087 following the flight. The ratio of short-haul travellers was 0.994 +/- 0.033 and following the flight was 1.001 +/- 0.038. Air travel did not cause significant change in BIA ratio in the 'at-risk' arm for the majority of breast cancer survivors who participated in dragon boat racing. Further research is required to determine whether these findings are generalizable to the population of women who have been treated for breast cancer.