Cancer of the prostate. 1: Promoting men's healthcare needs

This three-part series explores the nurse's role in promoting men's health with regard to cancer of the prostate. This article presents the incidence of prostatic cancer and its relationship to geographical environment. Diagnosis, early detection and screening are also discussed and the possible contribution of diet to the rising incidence of the disease is examined. In the next article health education models and the role of the nurse are described and recommendations for practice are offered.     

Primary healthcare workers: training needs in mental health

Particular attention is currently being given to the role of primary healthcare workers in supporting people with mental health problems in primary care (McFadyen et al, 1996). The aim of this study was to survey the views of primary healthcare workers regarding their previous mental health training and to identify their current perceived mental health training needs. A sample of 200 primary healthcare workers within Trent Health Region were interviewed using a short semi-structured interview schedule. Forty-six completed questionnaires were also received. An additional 22 respondents participated in exploratory in-depth interviews. Respondents included GPs, health visitors, practice nurses, district nurses, midwives and community psychiatric nurses. The need for further training in communication skills, particularly basic counselling skills, was highlighted. Respondents also perceived a need for additional training in coping with their own personal stress, the assessment and treatment of depression and stress/anxiety management in clients. Several themes which developed from the research were explored, including communication skills training, problems with collaborative working, coping with personal stress, the prevention of burnout and depression training. The reason why some respondents had no mental health training needs whatsoever was also addressed.     

Ladders in nursing careers. A program to meet community healthcare needs

Minnesota Project LINC (Ladders in Nursing Careers) is designed to meet statewide and community healthcare delivery needs by assisting healthcare employees to successfully complete their nursing education. In partnership with employers, this program removes many nontraditional student employee barriers to education (e.g., loss of income, educational expenses) and provides needed individual support services. As a result, employers are positioned proactively to address their community needs. Program planning, implementation, and an evaluation of Minnesota Project LINC (MN LINC) are discussed in this article.     

Cancer of the prostate: a nutritional disease?

Biotinidase deficiency is an autosomal recessively inherited disorder that results in the inability to recycle the vitamin biotin. The disorder can cause neurologic and cutaneous abnormalities that can be treated effectively with pharmacologic doses of biotin. We identified 21 mutations that cause profound biotinidase deficiency in 37 symptomatic children (30 different probands and 7 siblings), as well as provide relevant biochemical and clinical information for each child. The two most common mutations (G98:d7i3 and R538C) were found in 31 of 60 alleles (52%), whereas the remainder of the alleles are accounted for by the 19 other unique mutations. Serum samples were available from 18 children, of these 11 had no detectable cross-reacting material (CRM) to antibody prepared against normal human serum biotinidase, three had reduced quantities of CRM and four had normal quantities of CRM in serum. All of these mutations result in complete absence of biotinyl-transferase activity in serum. Two polymorphisms were also identified in normal individuals. It is apparent that a child who inherits any of these mutations, either in the homozygous state or in combination, can develop the clinical features of the disorder if untreated. There are, however, no clear genotype/phenotype correlations that would allow for the prediction of the type, severity, or age of onset of symptoms.     

Chemoprevention of prostate cancer: the Prostate Cancer Prevention Trial

The possible relationship between physeal diseases and physeal form prompted investigation of change in steepness of the physis in young foals. The distal and proximal aspects of the longbones were sawn sagittally in the right and frontally in the left bones. The slabs were washed to remove saw debris, arranged in order and inspected. The proximal physes had a flat or gently arched form, without obvious inclination. In the distal physes there were distinct inclinations. Inspection of an identical slab from the medial aspect of the distal radius of two series of foals of different breeds showed that the degree of inclination of the physis with respect to the long axis of the bone increased with age. In a further series of foals, the angle of inclination was measured from radiographs of identical sagittal and frontal slabs of the distal radius. A line drawn through the secondary spongiosa was produced to intersect a line drawn along the physis where it was mostly steeply inclined, and the angle measured. The angle decreased (physeal inclination increased) with increasing age, up to 35-90 days. The steepness in the lateral aspect of the physis was similar to that in the medial aspect, although evident in a different plane.     

Men's development and psychotherapy: A psychoanalytic perspective.

Addresses the issue of men's defensive autonomy by considering research on women's growth and development (e.g., C. Gilligan, 1982). The balancing of autonomy and affiliation as proposed by H. Kohut (1971) and W. S. Pollack (1983) is suggested as a solution for the developmental dilemmas between being relationally connected vs self-stabilizing that can lead to emotional distress in men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Customer driven mental healthcare and the role of the mental healthcare consultant.

Health care, including mental health care (MHC), is in the midst of revolutionary change. The simultaneous demands for increasing quality and constraining costs have necessitated the search for a new service delivery paradigm. The Total Quality Management model has been introduced into health care under the term Continuous Quality Improvement. In order to meet the demands being placed on it, MHC is beginning to introduce the "patient-customer" into its quality improvement programs. The transition to a customer driven framework will be a difficult one for many MHC practitioners. MHC consultants (i.e., consultants with knowledge of organizational processes and MHC issues) can facilitate this transition by helping MHC administrators and practitioners align around the goal of improved quality of care, defined in terms of both patient outcome and patient satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social crisis: Two needs.

Author comments that many of his fellow behavioral scientists respect or share Lirtzman's (American Psychologist, 1964, 19, 199) impassioned belief that psychologists, as individuals, and psychology, as a profession, should offer their skills and knowledge in the Negro civil rights battle threatening to puncture irreparably the arteries and veins of our country. But this adumbrates two additional issues or needs, at least paralleling in importance his exhortation that psychology commit some of its resources to an examination of the racial problem: (a) preventive solicitude, i.e., the need to become sensitized to a problem, not when it has reached maturity, but during its early childhood; and (b) total solicitude, i.e., the need to concern oneself, not only with dramatic and visible problems, but also with those of a more pedestrian and less perceptible complexion. The first, preventive solicitude, suggests that we belong at the vanguard of social problems, not at their rear when it may be too late for psychology to exert its influence. The second issue or need is total solicitude, referring to the wearisome but psychologically understandable tendency for individuals to attend, not to all the stimuli in their midst, but to the loudest. The author presents his views on psychology's role in these. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Impossible projects": Men's illusory solutions to the problem of work.

Describes a specific type of work disturbance encountered in clinical practice with male patients. The "impossible project" is characterized by grandiose, boundary-less content, intense absorption in solitary activity, and difficulty formulating and sustaining goal-directed work. It is the man's attempt to "patch over" significant ego deficits without fundamentally reworking the traumatic identification with his mother and the emotional absence of his father. The project is fantasized as providing a hitherto elusive masculine identity but also partakes of feelings of fraudulence and impossibility. The cases of 3 men (aged 14, 41, and 40 yrs) exemplify the impossible project and highlight the typical family constellations and developmental deficits of these men. How best to respond to the patient's work strivings as well as common transference paradigms are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A picture of locational--occupational diversity: an analysis of the needs of rural and remote healthcare workers when writing RHSET applications. Rural Health Support Education and Training

BACKGROUND: Knowledge about salmonellosis risk factors mainly comes from foodborne outbreaks, and we know little about sporadic cases epidemiology. However most of the cases are sporadic, specially children. This study aims to find out some of determinants of these cases. METHODS: A case-control study with incident cases and controls from the same base population (laboratory diagnosed cases). Cases were children 1-7 years old, affected by diarrhea with culture stools positive to Salmonella between december 1994 and december 1995. Controls from the same source, but positive culture to Campylobacter or viruses. We study food and other environmental risk factors. Odds ratio (OR) are calculated adjusted for age, sex, and year period (cool and cold) by logistic regression. RESULTS: Eating minced meat during three days before symptoms, OR 4.07 (1.20-13.8) and OR 5.63 (1.34-23.6); pets, OR 8.27 (1.96-34.9), and antibiotics the week before symptoms, OR 4.75 (0.84-27.0) were epidemiologically associated with salmonellosis diarrhea. CONCLUSIONS: Epidemiology of salmonellosis sporadic cases in children seems different to the foodborne associated cases and is more complex. Minced meat tree days before symptoms, antibiotics the week before symptoms, and pets could be a risk for this kind of cases. Future studies must also take account of this factors.     

Men's issues in doctoral training: A survey of counseling psychology programs.

The study of men and masculinity is an important clinical competency that needs to be integrated into psychology training. The extent to which the psychology of men has been integrated into applied psychology training programs is unclear. Using counseling psychology as an example of one discipline's integration, the authors examined current training in the psychology of men. One hundred 60 faculty members participated in this study. Results suggest that training practices in the psychology of men are limited in counseling psychology doctoral training programs; faculty interest in the psychology of men was positive, and faculty members viewed psychology of men as an important area of research and training in counseling psychology; and approximately 80% of the participants regard the psychology of men as a multicultural issue. A case vignette illustrates implications for training and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preparation of the international employee: Career and consultation needs.

Studied how 26 senior managers and 47 senior professional technical staff (recently repatriated) of 4 US owned multinational organizations viewed their international posting, specifically with respect to career path satisfaction. Results of satisfaction scales indicate that many Ss felt under-prepared for their international assignment. It is suggested that a comprehensive international employee development program should assess, provide feedback, and coach individuals on career path, culture shock and adjustment, and performance issues prior, during, and on return from the expatriate assignment. Results suggest that opportunities exist for individual and organizational intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Observations on the early detection of prostate cancer from the American Cancer Society National Prostate Cancer Detection Project

BACKGROUND: The American Cancer Society National Prostate Cancer Detection Project (ACS-NPCDP) was established in 1987. The experience of the ACS-NPCDP demonstrates the yield and impact of periodic examinations for the early detection of prostate cancer. METHODS: A cohort of 2999 well men ages 55-70 years was tested annually at 10 clinical centers by prostate specific antigen (PSA), transrectal ultrasound (TRUS), and digital rectal examination (DRE). Biopsies were performed on men with suspicious findings. Pathologic findings were reviewed. The initial study outcomes were the detection yield of multimodality testing and the comparative sensitivity and specificity of the different tests employed. Longer term outcomes included patient quality of life and survival. RESULTS: The cancer detection rate declined significantly across the years of intervention. DRE had lower sensitivity than TRUS or PSA, particularly in later years of follow-up. The specificity of TRUS was lower than that of DRE. Fewer than 9% of the cancers detected in this study were clinically advanced at the time of diagnosis. Ninety-four percent of patients in whom cancer was detected are alive after an average follow-up of 54 months. In one case, death occurred after surgery. Two deaths were attributed to prostate cancer, and eleven other deaths were unrelated to prostate cancer or its treatment. CONCLUSIONS: Results of the ACS-NPCDP indicate that a combined-modality approach to prostate cancer detection yields high levels of early detection with infrequent adverse outcomes. Continued follow-up is required to evaluate long term morbidity and mortality.     

The challenge to meet the mental health and biopsychosocial needs of the poor: expanded roles for hospital social workers in a changing healthcare environment

Despite the absence of coordinated federal health care reform, social workers in hospital settings have opportunities to identify, develop, advocate for, and facilitate access to innovative health care services, resulting in improved capacity to meet the mental health and biopsychosocial needs of the poor and, potentially, reduced hospital costs over time. There are opportunities for expanded roles for social workers in forging better linkages between hospital services and the community, developing an integrated biopsychosocial healthcare delivery system within hospitals and primary care settings, utilizing information systems as tools in an integrated system, and advocating for a client-centered approach to mental health services.     

Legal research techniques: What the psychologist needs to know.

Discusses the increasing importance of legal research for psychologists, the structure of the US judicial system, and the means by which relevant legal decisions can be retrieved. The use of 3 categories of legal materials is described: primary sources on case, statutory, and administrative law; finding tools such as case digests, computerized search services, and law journals; and secondary sources such as encyclopedias, texts, and specialized law/psychology or law/mental health journals. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Epilepsy needs revisited: a revised epilepsy needs document for the UK

We revisit epilepsy needs in the United Kingdom, and update our previous publication to take into account new epidemiological data, changes in investigation and treatment and trends in the organization of health and other caring agencies. This document attempts to define and quantify the scope, content and standards of services required, from primary care settings to specialized centres. Reference is also made to the role of other agencies.     

Roche-Mannheim: cornering the diagnosis-led healthcare market

In six patients affected by congenital ptosis, a disposable epidural anesthesia needle was used instead of a Wright needle for frontalis suspension surgery. For each of the patients in this study, the use of a disposable needle permitted smaller supra-brow area incisions with a minimal scar. The needle also created a smaller breach in the plane of levator aponeurosis and preaponeurotic fat, causing less tissue edema and bleeding than with a Wright needle.     

Men's gender role conflict and use of psychological defenses.

The authors hypothesized that men would report using psychological defenses to the degree they self-reported masculine gender role conflict. One hundred fifteen men completed the Gender Role Conflict Scale, the Defense Style Questionnaire, and the Defense Mechanism Inventory. Canonical correlations indicated that men experiencing greater rigidity about being successful, powerful, and competitive; expressing emotions; and expressing affection to other men used more immature psychological defenses and some degree of neurotic defenses. More specifically, these men tended to use defenses of turning against object and projection and tended not to use principalization and reversal. The discussion focuses on the effects of male gender role strain, implications for treatment, limitations, and future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Controlling varicella in the healthcare setting: the cost effectiveness of using varicella vaccine in healthcare workers

OBJECTIVE: To determine if varicella vaccination of healthcare workers would result in a net cost savings. DESIGN: A Markov-based decision analysis. SETTING: The analysis was based on a hypothetical population of healthcare workers. Data were obtained from exposure records of a tertiary-care hospital and from the literature. Workers were considered potentially susceptible if they had no past history of varicella. RESULTS: Vaccination of potentially susceptible workers would result in a net cost savings of $59 per person. Serological testing prior to vaccination resulted in smaller net savings. The results were robust across a wide range of assumptions. Importantly, however, the result was very dependent on infection control policy regarding work restrictions for vaccine recipients. If more than 3% of vaccinees were removed from work due to vaccine-associated rash, vaccination no longer would result in a net cost savings. CONCLUSION: Varicella vaccination of potentially susceptible healthcare workers can reduce costs and decrease morbidity. Infection control policy regarding work restrictions for vaccine recipients will play a key role in the feasibility of vaccination.