Disclosure of diagnosis and treatment among early stage prostate cancer survivors

Objective

Increased long-term survival rates have led to a greater focus on the health-related quality of life (HRQL) of prostate cancer survivors. This study assessed the motivations of prostate cancer survivors for disclosing their diagnosis and treatment to close others, and their perceptions of their own and others’ responses to the disclosure.

Methods

Prostate cancer survivors (N = 35) who were 24–36 months post-treatment for localized disease completed a semi-structured telephone interview. Open-ended questions concerning disclosure of men's diagnosis and treatment and their perceptions of their own and others’ reactions to the disclosure were included.

Results

Regarding men's motivations for disclosing their diagnosis and treatment, men reported that they were seeking social support (SS) and that others had a ‘right to know.’ Further, the receipt of emotional support and feeling a sense of positive emotions were common following disclosure about their diagnosis and treatment. Participants reported continuing to discuss their treatment side effects 2–3 years post-treatment.

Conclusion

Prostate cancer survivors reported an overall positive and supportive response following the disclosure of their diagnosis and treatment. Further examination of the relationship between SS and HRQL will be necessary to identify interventions to enhance the well-being of this growing population of survivors.

Practice implications

Providers need to be aware of the extent and long-term nature of the side effects following treatment for prostate cancer. If providers encourage men to talk about their diagnosis, treatment, and side effects, providers may better understand men's experience with the disease, and men may be more likely to accept these commonly experienced changes, as well as seek treatment for them. These efforts may result in improved quality of life for survivors of prostate cancer.     

The role of physical activity in the prevention of osteoporosis in postmenopausal women—An update

Context and objective

Osteoporosis causes an increase in bone fragility. Its clinical significance mainly refers to (hip) fractures secondary to (low or moderate) trauma. In Europe and North America about 6% of men and 21% of women aged 50–84 years are classified to have osteoporosis. Although it is well accepted that exercise is essential for the management of osteoporosis, the exact role of physical activity in the primary and secondary prevention of osteoporotic fractures is still controversial.

Methods

The MEDLINE database and reference lists of selected publications were systematically searched for randomized controlled trials and prospective cohort studies, respectively, published since January 2000 regarding the association of physical activity and osteoporosis in postmenopausal women.

Results

Two prospective cohort studies indicate the clinical relevance of this association by showing an inverse relationship between physical activity and the risk of hip fracture. There is convincing evidence that physical activity effectively slows bone loss in postmenopausal women in a dose-dependent manner. Exercise programs may increase bone mineral density.

Conclusion

In order to maximize the goals of public health most effective, individually adapted, intense, high impact exercise programs are needed. However, they may be complicated to communicate and adherence on the population level may be hard to achieve. These programs must be weighed against popular and applicable existing programs (e.g. aerobic classes, Tai Chi, and walking) which appear to be easier to adhere to but appear to be less effective in the prevention of osteoporotic fractures in the individual postmenopausal women.     

Tailored information about cancer risk and screening: A systematic review

Objective

To study interventions that provide people with information about cancer risk and about screening that is tailored to their personal characteristics. We assess the tailoring characteristics, theory base and effects on risk perception, knowledge and screening behavior of these interventions.

Methods

A systematic literature review in this field was performed. PubMed, EMBASE, PsychINFO, CINAHL and Cochrane databases were searched. Forty studies fulfilled all inclusion criteria. Methodological quality was assessed and a best evidence synthesis conducted for the 28 randomized controlled trials without co-intervention or with similar co-intervention in intervention and control group.

Results

Most included studies evaluated an intervention aiming to promote cancer screening. The majority of articles (30) evaluated information that was tailored based on variables related to behavior change, sometimes combined with cancer risk factors. Ten other articles described an intervention that tailored information based on risk factors only.

Conclusion

Information that was tailored based on behavior change variables increased realistic perception of cancer risks and knowledge of cancer compared to generic information. Also, information tailored to individuals’ risk factors increased realistic risk perception compared to generic information.

Practice implications

To improve cancer risk perception and knowledge health providers could better give patients information about cancer risk and screening that is tailored to their personal characteristics than generic information.     

EMAS position statement: Bone densitometry screening for osteoporosis

Introduction

Osteoporosis and its consequent fractures is a major public health problem.

Aim

To formulate a position statement on the use of bone densitometry in screening postmenopausal women for osteoporosis and in their management.

Materials and methods

Literature review and consensus of expert opinion.

Results and conclusions

Bone densitometry has an important role in screening postmenopausal women for osteoporosis. For higher sensitivity and specificity, there may be a stronger case for screening in later life, depending on the extent to which risk factors add to the value of bone mineral density tests.     

A questionnaire on treatment satisfaction and disease specific knowledge among patients with acute coronary syndrome. II: Insights for patient education and quality improvement

Objective

Secondary prevention for coronary heart disease is achieved by pharmaceutical control of risk factors and patients’ own self management behaviour. To comply with longterm treatment patients need sufficient knowledge of their condition and should be satisfied with acute care. Therefore a questionnaire measuring both issues was constructed.

Methods and results

Latent class analysis applied in a sample of over 2000 patients suffering from acute coronary syndrome revealed 4 configurative patterns of knowledge and 5 distinct patterns of (dis-)satisfaction. Nearly 50% of all patients displayed insufficient knowledge upon discharge. Deficits clustered around misinformation on necessary lifestyle changes versus dysfunctional strategies for future emergency situations. Satisfaction and disease specific knowledge were interrelated in complex patterns.

Conclusions

Disease specific knowledge and satisfaction with treatment proved to be psychometrically valid indicators of the quality of the treatment process that might also have an impact on outcome.

Practice implications

A validated questionnaire is ready for routine administration after discharge of patients with acute coronary syndrome from acute hospital care. Patient education efforts and quality improvement in treatment centres might be effectively monitored using this questionnaire.     

Lycopene for the prevention and treatment of benign prostatic hyperplasia and prostate cancer: a systematic review

Background

Prostate cancer is a leading cancer affecting men worldwide. Benign prostatic hyperplasia (BPH) is a common disease of the prostate affecting men as they age, and a risk factor for developing prostate cancer. Lycopene is a member of the carotenoid family, whose strong anti-oxidant properties have been hypothesised to assist in the prevention and treatment of BPH and prostate cancer. The aim of this systematic review was to examine the effectiveness of lycopene for the prevention and treatment of BPH and prostate cancer.

Methods

A search of the MEDLINE, EMBASE, AMED (Allied and Complementary Medicine) and the Cochrane Library databases was performed for published randomised controlled trials (RCTs) comparing lycopene to placebo (or other interventions) for the treatment of BPH and prostate cancer. All included studies were assessed for methodological quality using the Cochrane Collaboration's risk of bias tool.

Results

Eight RCTs met the inclusion criteria for this systematic review. All included studies were heterogeneous with respect to their design and implementation of lycopene. Methodological quality of three studies was assessed as posing a ‘high’ risk of bias, two a ‘low’ risk of bias and the remaining three an ‘unclear’ risk of bias. Meta-analysis of four studies identified no significant decrease in the incidence of BPH (RR (relative risk) = 0.95, 95%CI 0.63, 1.44) or prostate cancer diagnosis (RR = 0.92, 95%CI 0.66, 1.29) between men randomised to receive lycopene and the comparison group. Meta-analysis of two studies indicated a decrease in PSA levels in men diagnosed with prostate cancer, who received lycopene (MD (mean difference) = −1.58, 95%CI −2.61, −0.55).

Conclusions

Given the limited number of RCTs published, and the varying quality of existing studies, it is not possible to support, or refute, the use of lycopene for the prevention or treatment of BPH or prostate cancer.     

A systematic review of menopausal symptom management decision aid trials

Objective

To systematically review the literature regarding the effects of menopausal symptom management decision aids.

Methods

Using pre-designated inclusion and exclusion criteria, relevant articles were located using the PubMed.gov online search engine and reviewing reference lists of relevant articles. Full-text, English-language, peer-reviewed articles relevant to testing decision aids in uncontrolled trials (UCT) and randomized controlled trials (RCT) were reviewed.

Results

The 18 articles represented 15 trials focused on natural health products decision aids (1 UCT, 1 RCT) or hormone therapy decision aids (1 UCT, 12 RCT). Whereas the natural health products aid was intended for women deciding about menopausal symptom management strategies, decision aids for hormone therapy were intended for a broader group of menopausal women and included indications for symptom management, prevention of heart disease, and prevention of osteoporosis. Many trials occurred prior to two pivotal events: the 2002 announcement of the Women's Health Initiative findings and the 2006 publication of the International Patient Decision Aids Standards. Study limitations may help explain contradictory findings for outcomes such as decisional conflict, decisional confidence, decisional satisfaction, knowledge and values, and decisions.

Conclusions

There is a relatively scant contemporary literature related to menopausal symptom management decision aids. Additional methodologically sound studies are needed to develop and subsequently test decision aids that are based on (a) contemporary knowledge regarding the wide array of available therapies and (b) international standards for decision aids that include consideration of women's values and preferences.     

Prevalence of osteoporosis,vertebral fractures and hypovitaminosis D in postmenopausal women living in a rural environment

Objectives

First, to study the difference between two groups of postmenopausal women living in different population centres (rural vs urban) in the prevalence of osteoporosis, fragility fractures and factors which may influence them: hypovitaminosis D, bone mineral density, coexistence of other diseases which predispose to their appearance; secondly, to observe the influence of low socioeconomic status, categorised as poverty.

Study design

1229 postmenopausal women were studied, of whom 390 (31.7%), were living in rural areas and 839 (68.3%), in urban areas. Data regarding risk factors related to osteoporosis were obtained, and, among other biochemical measures, 25 hydroxyvitamin D and parathyroid hormone were determined. Bone densitometry was carried out in the lumbar spine and proximal femur, as well as lateral X-rays of the dorsal and lumbar spine.

Results

The women who lived in rural areas were older, shorter, heavier and had a higher body mass index than those from urban areas. Among the women from rural areas there was a higher prevalence of poverty, and higher levels of obesity, arterial hypertension and diabetes mellitus were observed, as well as a higher prevalence of densitometric osteoporosis. The rural women had lower values of bone mineral density in the lumbar spine and a higher prevalence of vertebral fractures and hypovitaminosis D. The variables which were associated independently with living in rural areas were poverty, obesity, vertebral fractures, BMD in the lumbar spine and levels of 25 hydroxyvitamin D.

Conclusions

In our study, postmenopausal women who live in rural populations have more poverty, lower values of vitamin D, lower BMD in the lumbar spine and a higher prevalence of vertebral fractures and of osteoporosis. The higher prevalence of obesity, arterial hypertension and diabetes mellitus observed in these women may be adjuvant factors, all fostered by their socioeconomic state of poverty.     

Shelter from the storm; men with chronic pain and narratives from the rehabilitation clinic

Objective

To examine the meaning of participating at a rehabilitation clinic in the lives of men with chronic pain.

Methods

The material consists of qualitative interviews with 10 Norwegian men with chronic neck pain, and was analyzed using narrative method, combined with a gender sensitive perspective.

Results

With references to ‘identification of a cause’ and ‘rebuilding physical strength’, the significance of medical expertise initially seemed to be linked to restoring bodily function. In the men's individual lives, however, the meaning of being in rehabilitation extended far beyond achieving manifest treatment goals and was also linked to profound human needs, such as to (re)build a self, to be comforted and connected to others.

Conclusion

As rehabilitation clinics may provide a legitimate space in which men's experiences of pain are ‘housed’, they may constitute significant sources for restitution work, as well as significant shelters against social accusation that they are not really sick.

Practice implications

We suggest that health professionals should be aware of the social significance rehabilitation clinics may represent for men living with chronic pain.     

A preliminary investigation of 4 to 11-year-old children's knowledge and understanding of stress

Objective

To examine children's knowledge, understanding and experience of stress from 4 to 11 years of age across four age groups (4–5, 6–7, 8–9, and 10–11 years old).

Methods

A semi-structured interview format was used to elicit information from 50 children about their understanding and experience of stress.

Results

Most children were able to define stress, with older children providing more complex responses. Many children had indirect and/or personal experience of stress. Younger children were more likely than older children to report that there was nothing people could do to stop stress; children reported using both adaptive and maladaptive coping strategies to deal with stress.

Conclusion

Some young children have a basic understanding of stress and many have experience of stress; both understanding and experience develop with age.

Practice Implications

The research has potential implications for provider-patient communication, particularly within preventative health education and clinically within the field of childhood post-traumatic stress disorder (PTSD).     

Comparative evaluation of serum levels of main minerals and postmenopausal osteoporosis

Objective

The purpose of this study was to determine the relationship between serum main minerals and postmenopausal osteoporosis.

Study design

A total of 728 postmenopausal women were included in this study. Women were separated into two groups according to presence or absence of osteoporosis (OP). BMD was measured in total femur (TF), femoral neck (FN) and lumbar spine (L1–L4) by dual-energy X-ray absorptiometry. Risk factors for OP were recorded by using a structured questionnaire.

Main outcome measures

Women's blood were collected and serum concentrations of iron, copper, zinc, sodium, potassium, magnesium, calcium, ionized calcium, inorganic phosphorus were measured.

Results

Low serum copper levels were significantly associated with OP according to BMD values for TF, FN and L1–L4. There was a significant relationship between low serum zinc levels and OP for L1–L4 spines. Low iron serum levels were also significantly associated with OP in BMD measurements of TF. Low serum magnesium levels had significant association with OP of L1–L4 spines and TF. Serum levels of calcium, ionized calcium, potassium, sodium and inorganic phosphorus were not associated with OP.

Conclusions

In postmenopausal women, the low serum levels of copper, zinc, iron and magnesium appear to be an important risk factor for OP.     

The impact of a depression awareness campaign on mental health literacy and mental morbidity among gay men

Background

High prevalences of depression and suicidality have been found among gay men. This paper assesses the possible impact of Blues-out, a depression awareness campaign based on the European Alliance Against Depression targeting the gay/lesbian community in Geneva, Switzerland.

Methods

In 2007 and 2011, pre- and post-intervention surveys were conducted among two distinct samples of gay men in Geneva, recruited by probability-based time–space sampling. Effect sizes and net percent changes are reported for mental health literacy and mental health outcomes in 2007 and 2011 as well as among men aware and unaware of Blues-out in 2011.

Results

43% of the respondents correctly recognized depression in 2011 with no change vis-à-vis 2007. Despite small effect sizes, significant net decreases (from −18% to −28%) were seen in lifetime suicide plans, 12-month suicidal ideation, lifetime depression, and 4-week psychological distress between 2007 and 2011. These decreases were not accompanied by changes in any of the numerous items on attitudes/knowledge, found only when comparing men aware and unaware of Blues-out in 2011. More men aware of Blues-out found specialists and psychological therapies helpful than their counterparts and correctly identified depression and gay men's greater risk for depression.

Limitations

Community-level assessment with no control.

Conclusions

Although improvement in depression recognition and decrease in suicide attempts could not be replicated unequivocally in this adapted intervention among gay men, there are indications that this evidence-based depression awareness campaign may have lessened suicidality and mental morbidity and improved mental health literacy and help-seeking.     

A feasibility study to evaluate breast cancer patients’ knowledge of their diagnosis and treatment

Objective

To evaluate the feasibility of an electronic survey to assess patients’ knowledge of their breast cancer and treatment, and interest in receiving a medical summary.

Methods

Women undergoing breast cancer treatment completed an interviewer-administered electronic survey in person or by telephone. Medical records were abstracted to evaluate knowledge accuracy.

Results

Among 38 eligible patients approached for the study, 35 (92%) participated and 33 (94%) completed the survey. Participants’ perceived knowledge tended to be greater than their actual knowledge. Reporting of clinicopathologic features was most accurate for stage (91%) and lymph node status (88%), and least accurate for tumor size (61%), type (61%), and grade (33%). Accurate reporting of tumor receptor over-expression varied from 76% (estrogen receptor) to 39% (progesterone receptor). Many patients correctly recalled general treatment modalities and details of surgery; fewer recalled details of radiation and chemotherapy. Importantly, nearly all (32/33) were interested in receiving a breast cancer medical summary.

Conclusion

An electronic survey is feasible to assess breast cancer patients’ knowledge. This data suggest that patients have gaps in knowledge and would like a personalized medical summary.

Practice implications

Larger studies are needed to validate and characterize knowledge gaps, and test interventions to improve physician–patient information sharing.     

Circulating uncarboxylated matrix Gla protein,a marker of vitamin K status,as a risk factor of cardiovascular disease

Objectives

Vitamin K plays a pivotal role in the synthesis of Matrix Gla protein (MGP), a calcification inhibitor in vascular tissue. Vascular calcification has become an important predictor of cardiovascular disease. The aim of the current study was to examine the potential association of circulating desphospho-carboxylated and -uncarboxylated MGP (dp-cMGP and dp-ucMGP), reflecting vitamin K status, with the incidence of cardiovascular events and disease (CVD) in older individuals.

Study design

The study was conducted in 577 community-dwelling older men and women of the Longitudinal Aging Study Amsterdam (LASA), aged >55 year, who were free of cardiovascular disease at baseline. Multivariate Cox proportional hazards models were used to analyze the data.

Main outcome measures

Incidence of CVD.

Results

After a mean follow-up of 5.6 ± 1.2 year, we identified 40 incident cases of CVD. After adjustment for classical confounders and vitamin D status, we observed a more than 2-fold significantly higher risk of CVD for the highest tertile of dp-ucMGP with a HR of 2.69 (95% CI, 1.09–6.62) as compared with the lowest tertile. Plasma dp-cMGP was not associated with the risk of CVD.

Conclusions

Vitamin K insufficiency, as assessed by high plasma dp-ucMGP concentrations is associated with an increased risk for cardiovascular disease independent of classical risk factors and vitamin D status. Larger epidemiological studies on dp-ucMGP and CVD incidence are needed followed by clinical trials to test whether vitamin K-rich diets will lead to a decreased risk for cardiovascular events.     

The impact of genetic counseling on knowledge and emotional responses in Spanish population with family history of breast cancer

Objective

To assess a genetic counseling intervention measuring the distress, cancer risk perception, anxiety, worry and level of knowledge in people with familial history of breast cancer.

Methods

One group pre- and post-test design. A total of 212 individuals completed a baseline questionnaire, 88.6% completed a second questionnaire one month later and 75.4% six months later.

Results

Counseling intervention significantly increased the knowledge level of the individuals who received genetic education and significantly decreased the cancer worry levels. Persons with low perception of their cancer risk also had low worry levels. There were no significant changes over time in cancer risk perception or in quality of life.

Conclusion

Counseling in a high risk population seems to decrease cancer worry and to increase cancer knowledge thus enabling a counselee to take well-informed decisions. Furthermore, according to our results, such interventions do not increase anxiety and do not modify the quality of life, but do not adjust their cancer risk perception.

Practice implications

Providing individuals at increased risk of breast cancer genetic services seem to enhance their understanding of breast cancer without causing adverse psychological effects or changes in their quality of life, and it could improve their preventive behaviours.     

A review of smoking cessation interventions for smokers aged 50 and older

Objectives

Cigarette smoking poses substantial health risks at any age, but is particularly dangerous for older smokers, who are already at heightened risk for various health conditions. Studies suggest that older smokers are motivated to quit and succeed, but few of these have been randomized controlled trials. There is a need to systematically evaluate the research on effective interventions in older smokers.

Methods

We followed PRISMA guidelines in the development of this systematic review, which included randomized controlled trials of cessation interventions with smokers aged 50 or older.

Results

We found 740 unique titles matching specified search criteria; 13 met final eligibility criteria. Nearly all the cessation treatments combined counseling with other strategies. Eight studies provided smoking cessation medications. None of the studies used newer forms of technology such as web- or text-based interventions. Nine of the 13 studies reported a significant intervention effect at one or more time points, with three studies reporting sustained treatment effects at 12 mos or longer. In general, more intensive interventions and those with combined approaches including medications and follow-up counseling achieved the best outcomes.

Conclusion

The quit rates from these studies and the relative effectiveness of different intervention approaches are consistent with the general smoking cessation literature. However, in most studies, treatment effects were of short duration, and absolute quit rates were low, leaving the vast majority of older smokers at high risk for smoking-related health conditions. This systematic review suggests a need for additional research to design and test future interventions specifically tailored for older smokers.     

Patient education in groups increases knowledge of osteoporosis and adherence to treatment: A two-year randomized controlled trial

Objective

Non-adherence to pharmacological treatment in osteoporosis is a well-recognized problem. We hypothesized that a group-based educational programme would increase patients’ knowledge and level of adherence with medical treatment.

Methods

A total of 300 patients (32 men aged 65 ± 9 years and 268 women aged 63 ± 8 years), recently diagnosed with osteoporosis, were randomised to either an osteoporosis school programme (four classes of 8-12 participants over four weeks) or a control group. Teaching was multidisciplinary, based on patients’ experiences and background and designed to encourage empowerment. Patients’ knowledge about osteoporosis and adherence to treatment was assessed with self-completed questionnaires at baseline and after 3, 12, and 24 months.

Results

There were no significant differences at baseline between the two groups with respect to knowledge score or level of adherence. At two years’ follow-up, the improvement in knowledge score was 2 [0-4] points (median [25-75 percentiles]) in the school group and 0 [−2 to 2] in controls (p < 0.001) and self-reported adherence to pharmacological therapy was significantly higher in the school group (92%) compared to the control group (80%), p < 0.001.

Conclusion

The programme increased knowledge about osteoporosis and increased self-reported adherence to pharmacological treatment over a period of two years.     

Age discrimination in osteoporosis screening—Data from the Aalborg University Hospital Record for Osteoporosis Risk Assessment (AURORA)

Background

Old age carries a markedly increased risk of osteoporotic fractures with subsequent disability, dependency and premature death. Timely detection and treatment reduces fracture risk and particular attention should be drawn to age.

Objective

To assess the impact of age on referral for osteoporosis screening.

Setting and Methods

Dual energy X-ray Absorptiometry (DXA) at the Osteoporosis Clinic in North Denmark was reorganised from 2010. Risk factors, anthropometry and bone mineral density were recorded and considered in the reply and recommendations to the referring doctor. We report data from the 8,131 consecutive evaluations in 7914 individuals at the Osteoporosis Clinic from January 1st 2010 through December 31st 2012.

Results

Risk factor data were available in >96% and DXA in 98%. Population DXA frequency decreased markedly after the 7th decade and was performed yearly in 1.2% of the population aged >80 years in North Denmark. The >80 years group had more fragility fractures and lower T-scores (p < 0.001) compared to those below 80 years of age, and age >80 years was a dominant risk factor for fragility fracture (OR 2.4, 95% CI 2.0–2.9; p < 0.001) and for having diagnosed osteoporosis by DXA (OR 2.1, 95% CI 1.7, 2.5; p < 0.001).

Conclusion

Referral for osteoporosis screening decreased after the 7th decade despite the finding that high age carried the highest risk of osteoporosis by DXA and by fragility fracture. Osteoporosis is a disease of aging, but it is apparently not recognised as such. This is likely to cause undertreatment among the old.     

The knowledge of osteoporosis risk factors in a Greek female population

OBJECTIVES: The social and economic burden of osteoporosis is important since it concerns a continuously aging population, while the disease is silent until the emergence of fractures. Aim of the study was to assess female population knowledge about osteoporosis risk factors and to identify the risk factors of the studied population. METHODS: A sample of 99 (aged: 61.59+/-9.61 years) women under treatment for osteoporosis or osteopenia answered the questionnaire provided by their pharmacists and were included in the study's analysis. Various parameters on osteoporosis awareness and risk factor knowledge of the population sample studied were analyzed. RESULTS: It was revealed that 96% of the participants knew osteoporosis definition and sources of this knowledge were one or more of the following: doctors (86.3%), mass media (20%) and friends or relatives (13.7%). It was found that the older age was associated with less knowledge (OR=0.93, CI: 0.88-0.97, p=0.004), and higher education with increased knowledge (OR=1.68, CI: 1.10-2.55, p=0.014) about osteoporosis. 56.4% of the participants were aware of at least one osteoporosis risk factor. In multivariate analysis, it was revealed that the participants who referred increased milk products consumption in childhood (OR=3.72, CI: 1.34-10.36, p=0.012) and current performance of physical activity (OR=13.06, CI: 3.22-53.05, p<0.001) were more likely to be informed about osteoporosis risk factors; age >61 years was associated with decreased knowledge of risk factors (OR=0.27, CI: 0.09-0.82, p=0.018). CONCLUSIONS: This study implies that a higher degree of participant's health education may result in the avoidance of osteoporosis risk factors. Increasing knowledge of osteoporosis should be a priority for future intervention programs in order to promote specific behavioural strategies for osteoporosis prevention.