Chinese Breast Cancer Screening Beliefs Questionnaire: development and psychometric testing with Chinese-Australian women

Title.  Chinese Breast Cancer Screening Beliefs Questionnaire: development andpsychometric testing with Chinese-Australian women.
Aim.  This paper is a report of the development and psychometric testing of the Chinese Breast Cancer Screening Beliefs Questionnaire, a culturally sensitive questionnaire for measuring Chinese-Australian women's beliefs, knowledge and attitudes towards breast cancer and breast screening practices.
Background.  Breast cancer is the leading cause of cancer morbidity among Chinese-Australian women. They are, however, 50% less likely to participate in all types of breast examination. A valid and reliable instrument to explore the breast cancer beliefs is essential for the development of interventions to promote breast cancer screening practices.
Method.  Items for the questionnaire were drawn from a literature review and in-depth interviews. A panel of professional experts and lay women evaluated face and content validity. The instrument was translated from English to Chinese using back-translation. In 2008, a total of 292 Chinese-Australian women aged 22–78 years who were resident of Australia were included in testing the instrument. Multi-trait analysis and Cronbach's alpha were used to assess internal consistency reliability and exploratory factor analysis assessed construct validity.
Results.  The final 13-item questionnaire had satisfactory validity and internal consistency. Cronbach's alpha for the total scale was 0·76, and for the three subscales ranged from 0·70 to 0·79. Exploratory factor analysis showed that the scale reduced to three factors.
Conclusion.  Preliminary data suggest that the Chinese Breast Cancer Screening Beliefs Questionnaire is a valid, reliable and culturally sensitive instrument for the measurement of Chinese-Australian women's beliefs, knowledge and attitudes about breast cancer and breast cancer screening.     

Comparing the Various Breast Cancer Screening Guidelines

Breast cancer is the second leading cause of death among women; early detection has been shown to reduce morbidity and mortality risk. Nurse practitioners’ roles are to screen patients for early detection to provide safe care. This article compares the evidence-based screening guidelines for breast cancer.     

Breast Cancer Screening in Premenopausal Women: Current Recommendations and Opportunities for Research

The American Cancer Society recommends periodic mammography, clinical breast examination and breast self-examination beginning at age 40 years for asymptomatic women at average risk of breast cancer. Although there is substantial evidence from meta-analyses and non-randomized studies to support these recommendations, individual randomized clinical trials of breast cancer screening have not demonstrated mortality reduction in women aged 40-49 years. The opportunity to study this issue further in the United States has been diminished by the high prevalence of screening already being conducted in that population of younger women. The International Union Against Cancer, the American Cancer Society and the National Cancer Institute of the United States have convened a series of workshops and planning meetings to consider the available data and outline plans for future research. Plans are being developed to conduct a randomized trial of mammography in women younger than 50 years in multiple European sites. Successful completion of this trial may provide critical data on efficacy of breast cancer screening in younger women.     

Screening Mammography and Breast Cancer Reduction: Examining the Evidence

Better treatment and awareness may explain much of the decline in breast cancer deaths in recent years, not mammography. For women without a family history of breast cancer, the risks of screening mammography may outweigh the benefits, particularly for women younger than age 50. Mammography carries the risk of overdiagnosis of tumors that would not have caused death. Nurse practitioners are advised to educate their patients on mammography risks and benefits while increasing their emphasis on the clinical symptoms of breast cancer and ways to reduce risk, including weight control, decreased alcohol use, and decreased use of menopausal estrogen.     

Social stressors associated with antepartum depressive symptoms in low-income African American women

ABSTRACT Objectives: To describe depressive symptomatology and examine the relationship between social stressors and depressive symptoms in pregnant African American women. Design and Sample: Cross‐sectional study of 119 women receiving care at 2 prenatal clinics in Northern California. Measures: Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES‐D). Social stress variables included discrimination, trauma exposure, social conflict, and economic stress. Results: In this sample, mean CES‐D score was 15.88. Forty‐two percent of the women had CES‐D scores ≥16 (possible risk), and 23% had CES‐D scores ≥23 (probable risk). There were significantly positive relationships between the social stress variables (discrimination, trauma exposure, social conflict, economic stress) and CES‐D scores. Stepwise multiple regression analysis indicated that together discrimination and social conflict accounted for 36% of the variance in antepartum depressive symptoms. Conclusions: Discrimination and social conflict are considerable sources of stress that contribute to levels of antepartum depressive symptoms in African American women. While the results reinforce the importance of universal prenatal screening, comprehensive strategies are also needed to help ameliorate the impact that social stressors such as discrimination and social conflict have on the mental health of pregnant African American women.     

Stress-related influences on blood pressure in African American women

The relationship of blood pressure status to three stress-related variables, anger, coping resources, and strain, was evaluated in 90 African American women. The majority of the participants (57%) were normotensive, 32% of the participants reported current use of hypertensive medication, and an additional 16% had a mean blood pressure greater than 140/90 mmHg but were not on hypertensive therapy. From an analysis using ANCOVA, participants in the latter group were found to have significantly higher scores on rational-cognitive coping resources, controlling for age, waist/hip ratio, and pack-years. No significant differences among the blood pressure groups were found in anger or personal strain. Fostering rational-cognitive coping skills, which represent the ability to problem-solve effectively and to set priorities, may be beneficial for African American women and should be evaluated further in a larger sample.     

Interventions to promote physical activity among African American women

The lack of routine physical activity among African American women places them at risk for negative health outcomes associated with inactivity. The number of studies focused on African American women has increased dramatically in the past decade. This review examined the intervention research literature testing strategies to increase activity among African American women. Eighteen studies with 1,623 subjects were retrieved. Diverse interventions, settings, and measures were reported. Common methodologic weaknesses included lack of randomization of subjects, single-group design, instruments without documented validity and reliability, significant attrition, and questionable timing of outcome variable measurement. Strategies to design and deliver culturally appropriate interventions are reviewed. Suggestions for future research, such as examining intragroup differences and communal resources, are provided.     

Recruitment of African American women to a walking program: eligibility, ineligibility, and attrition during screening

The purposes of this study were to identify strategies successful in the recruitment of African American (AA) women to a home-based walking program and to examine factors that contribute to attrition, eligibility, and ineligibility during the recruitment screening protocol. Of the 696 women who contacted the researchers, 281 (40.4%) women enrolled in the study, 227 (32.6%) were lost to attrition, and 188 (27%) were ineligible. Those not enrolled due to attrition during screening or ineligibility reported more family risk for cardiovascular disease (CVD) and lived in neighborhoods with higher poverty. Although our recruitment strategies may have been successful in attracting low-income AA women, we were not as successful in preventing their attrition during the screening protocol, particularly for those living in poorer neighborhoods.     

Impact of Contralateral Breast Shielding on the Risk of Developing Radiation-induced Cancer from Full-field Digital Mammography Screening

ObjectiveThe objective of this study was to investigate the impact of contralateral breast shielding on the risk of developing radiation-induced cancer from four-view full-field digital mammography (FFDM) screening.MethodsA poly methyl methacrylate-polyethylene breast phantom and adult ATOM dosimetry phantom were used to measure organ dose on four FFDM machines using craniocaudal and mediolateral oblique projections for each breast. A lead rubber shield of 0.25 mm equivalent lead thickness was used to protect the contralateral breast. Organs dose, effective dose, and effective risk were calculated. For effective risk estimations, the impact of the shield was considered for the routine screening views.ResultsThe contralateral breast dose was reduced by more than 95%. For each FFDM machine, contralateral breast dose reduction in μGy were 35.20 reduced to 1.93, 41.40 reduced to 0.01, 22.85 reduced to 1.24, and 22.76 reduced to 1.66. Effective risk reduction was significant (P < .05). For all FFDM machines, a small reduction was identified in sternum bone marrow dose due to the use of contralateral breast shield.ConclusionsThe results of the study demonstrate the value of a contralateral breast shield. More research is required to determine whether such a shield has clinical utility.     

广州某2所医院护士乳腺癌及早期筛查认知状况调查

目的 了解广州市三级甲等医院护士乳腺癌及早期筛查知识的认知状况和获取相关信息的来源.方法 采用乳腺癌及早期筛查知识问卷和有关信息来源的问卷对广州市某2所三级甲等医院100名护士进行调查.结果 本组护士对特殊的月经史、长期服用雌激素、高脂饮食是乳腺癌高危因素和乳腺癌的早期临床表现认知率较高,达到80%以上.但对长期主动或被动吸烟和酗酒是乳腺癌的危险因素知晓率较低;86%以上的护士认为乳腺自我检查、乳房钼靶检查、乳房临床检查能早期发现乳腺癌.文化程度较高者,相关知识认知率较高(P<0.01).目前护士获取乳腺癌相关信息的主要途径是书籍和杂志,而她们最想通过专业讲座(61%)去进一步了解相关专业知识.结论 加强护士群体对乳腺癌及其早期筛查知识的深入学习,培养护士这一特殊群体,使其充分发挥乳腺癌防治宣传者的角色.     

Experiences of African American Mothers Following the Death of Their Infants

ObjectiveTo explore the lived experiences of African American mothers after the death of their infants.DesignQualitative, interpretive phenomenologic study.SettingNortheast Louisiana.ParticipantsSeven self-identified African American women whose infants died during the first year of life; the women’s ages ranged from 18 to 38 years at the time of the infant’s death.MethodsHeidegger’s interpretive phenomenologic approach guided the data collection and analysis. The women were interviewed using in-depth questioning to determine the meaning of the infant loss experience and their subsequent efforts to cope.ResultsSix themes represented the experiences of loss for the mothers: Shattered Dreams, Questioning God, Dissociation, Paralyzing Fear, Left in the Dark, and Uniqueness of Grieving. Three themes affected the women’s efforts to cope after their loss: Authentic Presence, Spiritual Empowerment, and Disconnectedness.ConclusionAfrican American women who experienced infant death described intense feelings of loss, guilt, and isolation. These negative emotions can potentially affect their physical and psychological health. These findings may help health care providers develop culturally sensitive understanding of African American mothers’ experiences of loss and equip providers to provide holistic assessment, appropriate support, and treatment for these vulnerable women.