Imaging breast cancer

Imaging has a significant role in diagnosing, treating, and monitoring breast cancer. Advances in this field are having a great impact in the clinical management of this disease. Breast cancer has now become an "outpatient cancer". This article describes the role and advances of imaging in breast cancer.     

Does a Low Glycaemic Index (GI) Diet Cost More during Pregnancy?

The aim of this study was to examine the monetary cost of dietary change among pregnant women before and after receiving low glycaemic index (GI) dietary advice. The pregnant women in this study were a subgroup of participants in the Pregnancy and Glycaemic Index Outcomes (PREGGIO) study. Twenty women from the low GI dietary advice group, who had completed their pregnancies, were randomly chosen. All these women had completed three day food records at 12–16 weeks and again around 36 weeks of gestation. Consumer food prices were applied to recorded dietary intake data. The mean ± SD GI of the diet reduced from 55.1 ± 4.3 to 51.6 ± 3.9 (p = 0.003). The daily cost of the diet (AUD) was 9.1 ± 2.7 at enrolment and 9.5 ± 2.1 prior to delivery was not significantly different (p = 0.52). There were also no significant differences in the daily energy intake (p = 0.2) or the daily cost per MJ (p = 0.16). Women were able to follow low GI dietary advice during pregnancy with no significant increase in the daily costs.     

Identity and stammering: negotiating hesitation,side‐stepping repetition,and sometimes avoiding deviation

Individuals who experience speech dysfluency are often stigmatised because their speech acts differ from the communicative norm. This article is located in and seeks to further the identity debates in exploring how individuals who are subject to the intermittent emergence of a stigmatised characteristic manage this randomised personal discrediting in their identity work. Through a series of focus groups and semi‐structured interviews participants grudgingly report their management approaches which include concealing, drafting in unwitting others, role‐playing and segregating self from their stammer. In describing how they manage their stammer they detail their use of the social space in a number of ways, including as a hiding place; a site for ‘it’ (the stammer); a gap in which to switch words; and a different area in which to perform. This study offers important insights, increasing our understanding of the often hidden negotiations of identity work and the sometime ingenious use of space in the management of a social stigma.     

Social vulnerability and reactions to caregiving in daughters and daughters‐in‐law caring for disabled aging parents

Variables that have been conceptually linked with social vulnerability—income, educational level, employment, cessation of work to provide care, marital status, social support, and health—were used to predict four categories of reaction to caregiving in 159 daughters and daughters‐in‐law caring for their disabled aging parents. Social support, income, and health best predicted negative reactions to caregiving; social support alone best predicted feelings of family abandonment, impact on health, and impact on schedule. Compared with daughters and daughters‐in‐law who had not quit work to provide care, those who had quit work were significantly older, had lower incomes and fewer social supports, and were more involved in care. The results suggest that quitting work may be a precursor to social isolation that places the caregiver at increased risk for social vulnerability and negative reaction to caregiving. The implications of the findings for health care policy are discussed.     

Promoting positive well‐being in employed mothers: A pilot study

In this quasi‐experimental pilot study, women who were returning to work within 6 months after the birth of a first baby were assigned to participate in a control group (n = 13) or a six‐session small group intervention (n = 18). The content of the group intervention was developed based on a stress and coping framework (Lazarus & Folkman, 1984).”; The experimental and control groups were surveyed at 2 months after their return to employment and on their baby's first birthday on measures of well‐being in marriage, work, and parenting. Repeated measures analysis of covariance was used to examine differences over time between the experimental and control group with length of maternity leave and number of hours worked as covariates. Participants in the intervention reported increasing levels of marital satisfaction over time, whereas the control group experienced a decline in marital satisfaction over time (p = .04). Implications for practice and research are presented.     

Effect of hysterectomy status on polyp detection rates at screening flexible sigmoidoscopy

BACKGROUND: Flexible sigmoidoscopy with polypectomy reduces the incidence of colorectal cancer by removal of premalignant lesions. Factors that reduce the area examined by flexible sigmoidoscopy may reduce its benefit. The aim of this study was to determine whether hysterectomy affects completion and polyp detection rates at flexible sigmoidoscopy. METHODS: Within the setting of a multicenter, prospective, controlled trial of screening flexible sigmoidoscopy, patient and examination variables were compared by appropriate statistical methods for women between the ages of 55 and 64 years with and without a history of a hysterectomy. RESULTS: One quarter of women participants had undergone a hysterectomy. These women were more likely to have incomplete examinations (risk ratio [RR] of incomplete examination, 1.53; 95% CI [1.4, 1.6]). Flexible sigmoidoscopy was more difficult (p < 0.001), more painful (p < 0.001), and less extensive (46 cm vs. 48 cm insertion on average; p < 0.0001) in women who had undergone a hysterectomy. There was a significant trend toward lower relative detection rates of polyps and adenomas at more proximal sites (rectum, sigmoid colon, and proximal to sigmoid; respectively, p = 0.008, p = 0.009) in this group. CONCLUSIONS: Women who have undergone a hysterectomy have less extensive flexible sigmoidoscopy examinations, which are more difficult and more painful, than women without a hysterectomy. Hysterectomy is associated with a reduction in polyp detection rate in the sigmoid colon. This modality of screening may be less effective in women who have undergone a hysterectomy.     

The Maxi Stabil 3: validation of an aneroid device according to a modified British Hypertension Society protocol

BACKGROUND: Measuring blood pressure with mercury-independent alternatives is rapidly gaining attention. Mercury will be phased out of clinical use as a result of environmental, health and safety concerns and it is of vital importance that any alternative to mercury has to be of a recognized standard. We assessed the accuracy of the Maxi Stabil 3 aneroid device in an adult population according to a modified British Hypertension Society protocol (with the low systolic category changed from less than 90 mmHg to less than 100 mmHg). POPULATION: Eighty-five subjects were recruited from among staff and patients at Guy's and St Thomas' Hospitals, London, UK. METHODS: The aneroid device was connected in parallel to two mercury sphygmomanometers. Nine sequential same-arm measurements were taken from each subject by two trained observers, alternating between mercury sphygmomanometry and the aneroid device. Simultaneous mercury readings were also recorded for additional analysis. RESULTS: The device achieved an A grade for both systolic and diastolic pressures and fulfilled the requirements of the Association for the Advancement of Medical Instrumentation. The mean and standard deviation for systolic and diastolic pressures respectively were -0.6 (4.6) mmHg and -1.3 (3.5) mmHg in sequential analysis, and -1.3 (2.2) mmHg and -1.9 (2.7) mmHg in simultaneous analysis. CONCLUSION: The Maxi Stabil aneroid device can be recommended for use in an adult population.