Utilization of a telephone cancer information program by symptomatic people

People with undiagnosed symptoms of cancer who called the Cancer Information Service (CIS), a toll-free telephone information program, were surveyed about their experiences with the program and the effects it had on their post-call behavior. The findings indicate that 75 percent of respondents who had not contacted a health professional before their call to the CIS did so after their call and 40 percent shared the information they obtained with other people. People who contacted a health professional after their call, compared to those who did not, were more likely to have called the CIS specifically for a physician referral or because they did not know whom else to contact, to have friends with cancer, to have had their most important question answered by the CIS, to have health insurance, and to report the influence of other people on their health actions. Interestingly, only half the respondents reported that they definitely would have contacted a health professional had the CIS not been available. The CIS, therefore, might be a link between symptomatic people and appropriate health services. Even so, about one-third of the sample did not know what illness they had or were still awaiting the outcome of medical tests up to several months after their call. Although the CIS was not the only source of health information utilized by respondents, the data demonstrate the important role that telephone information serves in the secondary prevention of cancer and in the delivery of effective health programs.David G. Altman, Ph.D. is a Postdoctoral Fellow at the Stanford Center for Research in Disease Prevention.This research was supported by a dissertation grant from the National Center for Health Services Research, OASH (HS 05063). The author thanks Professors Ross F. Conner, Thomas J. Crawford, Tracey A. Revenson, and Carol K. Whalen for serving as dissertation committee members.     

Self- and other-awareness of the risk of HIV/AIDS in people with haemophilia and implications for behavioural change

Many people with haemophilia have been infected by HIV through the contamination of blood products they need for treatment of their bleeding. This study explored the perceptions of people with haemophilia of their own and others' risk of HIV/AIDS and their beliefs about others' perceptions of HIV/AIDS. The results have shown that many patients are not willing to disclose the existence of their haemophilia to certain categories of people and have a firm view of who should and should not know about their HIV antibody status. The patients' beliefs of others' perceptions of HIV and AIDS are associated with (a) their perceptions of risk for themselves and others and (b) with behavioural change to prevent the spread of HIV.     

'It's easier said than done': perspectives on mammography from women with intellectual disabilities

PURPOSE Women with intellectual disabilities (or mental retardation) are living longer, receiving primary care in the community, and have equal rates of breast cancer compared with women in the general population, but they have lower rates of mammography. Although several public campaigns have successfully raised the mammography rate for racial and ethnic minority women, they have not penetrated the community of women with intellectual disabilities. No research to date has explored potential barriers to mammography for these women by involving the women themselves as participants.METHODS We undertook a qualitative study to explore the perceptions and understanding of mammography for women with intellectual disabilities and some of the potential reasons they would or would not have the test. Twenty-seven intellectually disabled women were recruited through a variety of community groups and interviewed using a semistructured interview guide. Data were analyzed using qualitative techniques from grounded theory.RESULTS Participants in this study described being poorly prepared for mammography: they did not understand its purpose and were not prepared for the logistics of the experience. The latter was more upsetting to participants and contributed to their negative perceptions of mammography. Participants reported feeling unprepared and singled out for being unprepared, despite their desire to have at least 1 mammogram, as do other women their age.CONCLUSIONS Women with intellectual disabilities perceive mammography differently than do women who do not have intellectual disabilities, and their perception is informed by inadequate knowledge, anxiety, and inadequate preparation. These themes should be considered when planning cancer prevention interventions with this population and when counseling individual women in the clinical setting.     

LIVING IN ONE-PARENT FAMILIES: RELATIONSHIPS AND ATTITUDES OF 16-YEAR-OLDS

Summary The proportions of 16-year-olds in the National Child Development Study who are not living with both their natural parents in 1974 are examined and compared with proportions in earlier follow-ups. The children who have ever lived in one-parent families are selected for more detailed examination, such as the reasons for their parental situation, the age their families broke up and the ratio of motherless to fatherless at each age. The children's view of their relationship with their parents or new parent figures and their attitudes towards their own future marriage and family are considered and compared with those of children still living with both their own parents. The overall conclusion is that the differences in these respects between children in one and two-parent families are very slight, suggesting that the attitudes of children in one-parent families towards their future family life have not been greatly affected by their own childhood experiences.     

Young women under 16 years with experience of sexual intercourse: who becomes pregnant?

BACKGROUND: The UK has the highest rate of teenage pregnancies in western Europe. Although there is a large body of literature focusing on predictors of conception among this age group, almost all the work compares those young women who have become pregnant with their peers, regardless of whether or not their peers have experienced sexual intercourse. OBJECTIVE: To compare 16-year-old young women who have become pregnant with their peers who also have experience of sexual intercourse, but who have not conceived. DESIGN: Analysis of data from the baseline and follow-up surveys conducted as part of a trial of sex education. SETTING AND PARTICIPANTS: Female school students aged 14-16 years from the East of Scotland. MAIN RESULTS: Young age of self and partner, and non-use of contraception, all at first intercourse, are most strongly associated with pregnancy. CONCLUSIONS: Those who engage in sexual intercourse at a relatively young age will often have had more opportunity to become pregnant than those whose sexual debut comes later. Similarly, the fact that those who use contraception at first intercourse have been less likely to conceive than those who do not could reflect the overall patterns of contraceptive use: young women who have used contraception at each occasion of intercourse will have had less chance to conceive than those who have not. Having a young partner at first intercourse suggests that, if this pattern continues, the couple may lack the resources needed to prevent a pregnancy due to the immaturity of both partners.     

HIV prevention and men who have sex with women and men in México: Findings from a qualitative study with HIV‐positive men

Unprotected sex between men is the major risk factor for HIV infection in México and many other Latin American countries. There is a substantial body of literature demonstrating that the relationship between sexual identity and sexual practice is not binary or causal — men who have sex with other men do not necessarily perceive themselves as gay — and there is increasing interest in HIV prevention with men who have sex with both men and women. In México, HIV prevention with men who have sex with women and men and who are not socially affiliated or identified with gay men is lacking. This paper explores the sexual histories and HIV‐risk perception of HIV‐positive Mexican men who indicated that they have sex with women in a screening interview and then in the context of an in‐depth interview also reported having had sex with men. We consider the sexual practices and sexual and social identities of these men, examining their explanations for having sex with other men, the strategies used to affirm their masculinity, the management of their sexual identity in their social networks, HIV‐risk perception before diagnosis and sexual practices after diagnosis. Recommendations are made to improve HIV prevention for men who have sex with men as well as women and who do not assume a gay or bisexual identity.     

Why do women have abortions?

Most respondents to a survey of abortion patients in 1987 said that more than one factor had contributed to their decision to have an abortion; the mean number of reasons was nearly four. Three-quarters said that having a baby would interfere with work, school or other responsibilities, about two-thirds said they could not afford to have a child and half said they did not want to be a single parent or had relationship problems. A multivariate analysis showed young teenagers to be 32 percent more likely than women 18 or over to say they were not mature enough to raise a child and 19 percent more likely to say their parents wanted them to have an abortion. Unmarried women were 17 percent more likely than currently married women to choose abortion to prevent others from knowing they had had sex or became pregnant. Of women who had an abortion at 16 or more weeks' gestation, 71 percent attributed their delay to not having realized they were pregnant or not having known soon enough the actual gestation of their pregnancy. Almost half were delayed because of trouble in arranging the abortion, usually because they needed time to raise money. One-third did not have an abortion earlier because they were afraid to tell their partner or parents that they were pregnant. A multivariate analysis revealed that respondents under age 18 were 39 percent more likely than older women to have delayed because they were afraid to tell their parents or partner.     

ACCESS TO A QUEENSLAND COMMUNITY HEALTH SERVICES CENTRE THROUGH COMMUNITY CARETAKERS

When persons needing health and welfare services do not know about available resources, their access to such services depends in part upon the people they have contact with in the community being knowledgeable and making appropriate referrals. Groups of community “caretakers” were surveyed to find their level of awareness of a community health services centre in their city. Most respondents were aware of the community health services centre but did not have a clear understanding of its objectives and functions. The community caretakers thought the centre could increase their knowledge of its functions by more personal contact by staff members with individuals and professional groups in the community and through increased press publicity, the issuing of brochures, cards and pamphlets.     

HIV prevention and men who have sex with women and men in México: findings from a qualitative study with HIV-positive men

Unprotected sex between men is the major risk factor for HIV infection in México and many other Latin American countries. There is a substantial body of literature demonstrating that the relationship between sexual identity and sexual practice is not binary or causal -- men who have sex with other men do not necessarily perceive themselves as gay -- and there is increasing interest in HIV prevention with men who have sex with both men and women. In México, HIV prevention with men who have sex with women and men and who are not socially affiliated or identified with gay men is lacking. This paper explores the sexual histories and HIV-risk perception of HIV-positive Mexican men who indicated that they have sex with women in a screening interview and then in the context of an in-depth interview also reported having had sex with men. We consider the sexual practices and sexual and social identities of these men, examining their explanations for having sex with other men, the strategies used to affirm their masculinity, the management of their sexual identity in their social networks, HIV-risk perception before diagnosis and sexual practices after diagnosis. Recommendations are made to improve HIV prevention for men who have sex with men as well as women and who do not assume a gay or bisexual identity.     

What physicians can learn from consumers of dietary supplements.

BACKGROUND: Many Americans consume dietary supplements, including vitamins, minerals, herbs, and amino acids. Government regulation of dietary supplements is limited, and patients typically do not consult with their physicians regarding the use of supplements. METHODS: We conducted a qualitative study to describe patients' decisions about the use of dietary supplements and the communication they have with their physicians about such use. Four focus groups of customers from 3 local suburban health food stores were interviewed. RESULTS: The customers in the health food stores we investigated were motivated to pursue wellness and wanted to take responsibility for their health. They would welcome a partnership with their physicians, but generally believed that physicians are closed-minded and have little knowledge about dietary supplements. These consumers determined the effectiveness of dietary supplements through personal study and subjective experimentation. CONCLUSIONS: The health food store customers in our study were self-informed consumers who did not consult their physicians about their use of dietary supplements, because they did not believe that physicians were knowledgeable about or interested in supplements. An open-minded patient-centered approach would help physicians provide better care for patients who use dietary supplements.     

Transsexuals who have not undergone surgery: A follow-up study

Transsexuals who had not undergone surgery, although it had been offered to them providing they fulfilled the usual requirements, were classified into various subgroups, measured according to their attitude towards sex reassignment surgery: they were transsexuals with an unaltered wish for surgery, transsexuals who were ambivalent towards surgery (hesitating patients), and transsexuals who had relinquished their wish for surgery and lived in the initial gender role. Whereas transsexuals with an unaltered wish for surgery did not differ substantially from transsexuals who had had surgery, the hesitating patients were noticeably older, more often married, more often had children of their own, their partnerships were of long duration, and exclusively with partners of the opposite biological sex. These characteristics were seen when the diagnosis was first made. They can therefore be considered prognositic criteria for this subgroup. Transsexuals who relinquished their wish for surgery did not differ substantially from transsexuals with an unaltered wish for surgery. The reasons for relinquishing the wish for surgery were indivdual or could not be clearly established. At the time of follow-up, all transsexuals who had not undergone surgery indicated that they were experiencing the same degree of difficulty with respect to social adjustment as at the time of diagnosis. Slight improvements were seen in patients with an unaltered wish for surgery. Significant changes were seen only in transsexuals who had surgery. Transsexuals who have not had surgery and have no present wish for it are in the minority. Hesitating patients have a particular need for psychotherapy.The study was supported by a grant from the Wilhelm-Sander-Stiftung.Dedicated to Prof. D. Ploog for his 65th birthday.     

What are the occupational implications of thalassaemia?

The thalassaemias are a heterogeneous group of inherited haemoglobin disorders. With modern treatment, most patients with severe disease survive to adult life. If they have no complications, and their general health is good, then the condition should have little impact on their fitness for work, though exposure to agents that are toxic or suppress the bone marrow should be avoided. Most patients with thalassaemia have minor disease and are asymptomatic. Their condition generally has no effects on their fitness to work. Pre-employment screening for thalassaemia is not justified.     

Psychological side-effects of the mass screening on cervical cancer

The results are reported of a study on the psychological side-effects of mass screening for cervical cancer in Rotterdam. The reactions of participants towards a positive smear and towards the treatment which followed the positive smear were analysed. Women who had problems with a positive smear and with a serious disorder which necessitated an operation and hospitalization had problems with the treatment. However, most women who underwent the operation did not have lasting problems of either a psychological or somatic nature. Women who had been treated by their G.P.s or by a gynaecologist in most cases did not have problems with their treatment. The final conclusion was that mass screening for cervical cancer in Rotterdam caused psychological side-effects to occur among women with a positive smear. However, for the majority of women with a positive smear they were not of a lasting or serious nature.     

Dietary and weight control practices among persons with hypertension: findings from the 1986 Behavioral Risk Factor Surveys

The National Heart, Lung, and Blood Institute has concluded that reducing sodium intake, controlling weight, and moderating alcohol consumption can help patients with hypertension control their blood pressure. To determine whether such patients have adopted recommended dietary practices, we analyzed data collected in 1986 from telephone surveys of adults in 26 states (no. = 34,395). The self-reported dietary practices that we evaluated were: use of table salt, alcohol consumption, and weight control practices. In comparison with persons who did not have hypertension (no. = 26,848), those with hypertension who were receiving pharmacological therapy ("treated hypertensives," no. = 5,025) were more likely to report limiting their use of table salt (odds ratio [OR] = 2.5) and were less likely to have their weight controlled (OR = 0.4). Although overweight persons with hypertension were more likely than persons with normal blood pressure to attempt to lose weight, most have not included exercise in their weight loss efforts. There was no difference between persons who do not have hypertension and treated patients with hypertension in their use of alcohol. Untreated persons with hypertension (no. = 2,378) were less likely to limit their use of table salt and less likely to moderate their use of alcohol than treated persons with hypertension but otherwise reported similar dietary practices. Dietetic practitioners may need to emphasize moderation of alcohol use and the use of physical activity to lose weight when counseling patients with hypertension.     

Personal Experiences of Pregnancy and Fertility in Individuals with Spinal Cord Injury

Individuals with spinal cord injuries (SCIs) often face a number of barriers in family planning and pregnancy. These barriers can be structural (i.e. inaccessible health care provider offices and providers unfamiliar with fertility, pregnancy, and SCI) or social (i.e. friends, family, and even providers suggesting that individuals with SCI should not have children), and can affect both men and women. Additionally, much of the information about SCI and pregnancy is from a medical perspective and the psychosocial aspects of pregnancy for individuals with SCI have not been considered. 253 men and women with SCI were asked about the information they received about SCI and pregnancy, where they received this information, and how their SCI affected their family planning. The responses shared in this study can be used to inform individuals who work with people with SCI to better assist their clients or patients who have sustained SCI and are considering pregnancy.     

Normalization in families raising a child who is medically fragile/technology dependent and developmentally delayed

The authors combined and analyzed parent data from two field studies examining family experiences in raising children who were both medically fragile and developmentally delayed or disabled to compare these families' experiences to published attributes of normalization. Normalization is usually considered a useful conceptual and coping strategy for families of children with chronic conditions, but it has not been examined in families whose children have both complex physical and developmental disabilities. Developmental delays compounded the effects of the children's physical chronic conditions, severely affecting how families organized and managed their daily lives, with the result that families did not fit currently established attributes of normalization. Instead, parents recognized normal and positive aspects of their lives while acknowledging the profound challenges that their families faced. Parents concluded that it was possible to have a good life that was not necessarily normal by usual standards.     

Improving long-term outcome after stroke--the views of patients and carers

Stroke is a major cause of long-term disability, often with devastating consequences for individuals and their families. Suggestions for alleviating these problems have come from professionals, but patients and carers have not specifically been asked their views on how to improve outcome. The results show that most care and support came from informal sources, formal services were poorly targeted and a third of carers were under considerable strain. Recommendations are made for improving services and support for patients and their carers.