Attitudes of 47 mothers of pediatric oncology patients toward genetic testing for cancer predisposition

PURPOSE: To assess attitudes toward testing for cancer susceptibility genes, we interviewed mothers of pediatric oncology patients about their cancer causation theories, interest in hypothetical predisposition testing for themselves and their healthy children, and anticipated impact of testing. PATIENTS AND METHODS: The subjects were 47 mothers of two or more living children, one of whom was 6 to 24 months postdiagnosis of cancer. Potential risks and benefits of hypothetical genetic predisposition testing for cancer susceptibility were described. A semistructured interview assessed the following: (1) recall of discussions with the pediatric oncologist about the possible role of heredity in causing the child's cancer; (2) mothers' personal theories of the etiology of their child's cancer; (3) family cancer history; (4) interest in genetic predisposition testing for themselves and unaffected (cancer-free) children; and (5) expected sequelae of testing. RESULTS: If genetic cancer predisposition tests were available, 51% of mothers would test themselves and 42% would test healthy children, even with no medical benefit. With established medical benefit, an additional 36% of mothers would seek testing for themselves and another 49% would test their healthy children. Interest in cancer predisposition testing among mothers extended far beyond those with significant family histories of cancer. Most mothers would consider minor children's wishes in the decision about testing and would tell children under age 18 their test results. CONCLUSION: As increasing numbers of cancer susceptibility genes are identified, parents of pediatric oncology patients may be receptive to opportunities to test themselves and their healthy children. Counseling will be important to aid in decisions about testing. Research is essential to evaluate the long-term impact of predisposition testing.     

Attitudes of general practitioners in Northern Ireland toward abortion and family planning

A survey of the attitudes and practices of general practitioners in Northern Ireland regarding contraception and abortion was carried out in 1994 and 1995 with a randomized sample of 154 physicians. The vast majority of doctors who received requests for contraceptives from their patients fulfilled those request (94%). Overall, 13% of the doctors said a married patient had requested an abortion in the past three months, and 34% had had a similar request from an unmarried patient. Two-thirds thought that a woman together with her physician should decide whether to terminate a pregnancy, 19% did not think the choice should be left with the woman and her physician and 13% were undecided. Sixty-six percent believed that a joint strategy of improving contraceptive use and reducing premarital intercourse is the best approach for preventing unwanted pregnancy among teenagers, 21% specified only improving contraceptive use and 13% indicated only reducing premarital intercourse.     

Attitudes of psychologists toward experimenter controls in research.

One hundred and twenty psychologists responded to a questionnaire concerning attitudes toward experimenter bias and related issues. Most respondents felt the area to be of considerable importance and that many facets of research appear to lack adequate experimenter-related controls. These controls and concerns are slow to appear in professional journals. Psychologists in perception, physiological, or animal research were much less concerned with the area and its implications than those in social, clinical, or personality areas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes toward traditional and nontraditional dissertation research: Survey of directors of clinical training.

Analyzed survey responses from 62 directors of clinical training. Respondents reported that many more of their clinical and nonclinical colleagues would support classical experimental and correlational methods for dissertations than would support nontraditional methods (phenomenological studies, surveys, library research, and case histories). Directors also rated traditional methods as producing data more valuable to the practitioner than data provided by nontraditional methods. A small but meaningful number of directors reported faculty acceptance of nontraditional approaches. Results are discussed in the context of doctoral research training and current concerns about the viability of traditional views of science for clinical psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group support interventions for women with breast cancer: Who benefits from what?

Research on the benefits of social support groups has been inconclusive. One reason is that individual differences in intervention responses have rarely been examined. The authors determined the extent to which individual difference variables moderated the effects of an information-based educational group and an emotion-focused peer discussion group on the mental and physical functioning of women with breast cancer (n?=?230). The authors administered the SF-36 (S. E. Ware, K. K. Snow, M. Kosinski, & B. Gandek, 1993), a multidimensional quality of life instrument, pre- and postintervention. Educational groups showed greater benefits on the physical functioning of women who started the study with more difficulties compared with less difficulties (e.g., lacked support or fewer personal resources). Peer discussion groups were helpful for women who lacked support from their partners or physicians but harmful for women who had high levels of support. Implications of these results for clinical interventions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Men and women in optometry. II. Attitudes toward career and family

BACKGROUND: Optometry has experienced a dramatic upward shift in the percentage of women entering the profession during the past 20 years. Our survey assessed the mechanisms for sustaining balance in professional and personal roles used by women optometrists and how these mechanisms may differ from those of their male colleagues. METHODS: A survey questionnaire was mailed to a large nationwide random sample of optometrists, composed of equal numbers of men and women. RESULTS: Data were analyzed from 353 men and 358 women; margin of error was +4%. Most of the respondents indicated they derived personal satisfaction from their career. A majority of both groups did not indicate that lack of time for their career was a source of frustration. However, significantly more women than men indicated some frustration in pursuing those activities that lead to career advancement. There were significant differences in response patterns of men and women about the effect of family, child care, and household work on their careers. CONCLUSIONS: Both men and women optometrists are satisfied with their careers and neither group feels compelled to choose between career and family. Optometrists do not fit into one pattern, but instead make individualized career choices on the basis of needs.     

Cathepsin D in breast secretions from women with breast cancer

A proteinase accumulated in breast secretions from women with breast cancer has been characterised. Inhibition of the proteolytic activity of breast secretions by pepstatin A showed that the main enzyme involved was an aspartyl proteinase. Determination of its cleavage specificity by SDS-PAGE and amino acid sequence analysis revealed that it was identical to that of cathepsin D, an aspartyl proteinase suggested to be involved in breast cancer development. The identity between both proteins was further confirmed by immunological analysis with monoclonal antibodies against cathepsin D. Quantification of cathepsin D in nipple fluids from 41 women with benign or malignant breast diseases and from 19 control women without breast pathology revealed the presence of variable amounts of this proteinase. The average concentration of cathepsin D in breast secretions from cancer-bearing breasts was 7.2 +/- 2.2 fmol micrograms of protein, which was significantly higher than those of nipple fluids from control women (2.9 +/- 0.6 fmol micrograms-1) (P = 0.04) or from patients with benign breast diseases (2.1 +/- 0.3 fmol micrograms-1) (P = 0.004). Though the number of cancer patients studied was small (n = 21), no correlations were found with cytosolic concentrations of cathepsin D or oestrogen receptors, neither with other parameters such as tumour size, histological grade, axillary node involvement or menopausal status.     

Psychological interventions and research in the oncology setting: An integrative framework.

Within the context of treatment outcome research in the oncology setting, the authors propose a model that integrates the models of responsibility developed by P. Brickman et al (see record 1982-30315-001), W. T. Powers's (1973) control theory, and E. T. Higgins's (1989) self-discrepancy theory. This integrative approach is patient-centered in its attempt to base an assessment of the psychotherapy or other interventions on an understanding of the patients' self-reference states as they interact with the treatment being assessed and the disorder for which interventions were attempted. The authors highlight some of the ways in which a purely medical treatment, such as chemotherapy, can evoke the type of patient distress whose treatment falls within the domain of psychologists. Cancer patients' internal reference states need to be considered in the respective outcome research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Occupation and breast cancer in women

During the practice of every gynaecologist there have been women whose only complaint have been pelvic pain. In recent years the pelvic pain occupies one of the leading positions as an indication for laparoscopy. The author has carried out observations over 69 patients with such problems. The phlogistic changes of the adnexa have been the most frequent endoscopic finding, followed by the endometriosis. The other pathological changes in the small pelvis combined with pelvic pain have been the varicose changes in the vascular net of the ovaries, the mesosalpinx and the parameters. The author recommends laparoscopy for objectivization of the changes in the small pelvis and for determining the appropriate medical approach.     

Risk factors for breast cancer in women with a breast cancer family history

For the study of the relationship of the pelviureteric system of one kidney to that of the contralateral one, bilateral cutaneous ureterostomy was performed in 14 dogs. The renal pelvis (RP) and ureter (U) of one side were distended separately with a balloon filled with saline in increments of 1 and 0.25 ml, respectively, and the pressure response of the contralateral RP and U was recorded. The test was repeated after anesthetization of the RP and U. RP distension with 1 ml of saline effected a pressure rise (P < 0.05) in the ipsilateral RP but no pressure response in the ipsilateral U or the contralateral RP or U (P > 0.05). RP distension with 2, 3, and 4 ml of saline induced a significant pressure rise in the ipsi- and contralateral RP but not in the ureters. Ureteric distension produced a pressure elevation (P < 0.05) on the ipsilateral U but had no effect on the contralateral U (P > 0.05) or on either of the renal pelves (P > 0.05). Distension of the anesthetized RP or U effected no pressure response in any of the ipsi- or contralateral RPs or Us. In conclusion, distension of the RP with large volumes led to an increase in pressure in the contralateral RP but not in the U. A reflex relationship is postulated to exist between the two renal pelves and to be mediated through a reflex we call the reno-renal pelvic reflex. It seems that this reflex acts to allow either of the kidneys to share an extra load of the other one by increasing the contractile activity of the RP, thus assumedly assisting the regulation of urine flow.     

Estrogen-replacement therapy in younger women with breast cancer

Approximately 25% of breast cancers occur in premenopausal women. In addition to local therapy, surgery or surgery plus irradiation, systemic chemotherapy administration has become the standard of care for all node-positive and many node-negative patients. Systemic adjuvant chemotherapy can result in ovarian dysfunction or failure. This renders many women prematurely estrogen deficient. The consequences of menopause, genitourinary atrophy, bone loss, and increased risk of cardiovascular disease, have not been routinely assessed in clinical trials. The risks of estrogen deficiency have not been assessed in comparison to improved disease-free and overall survival benefits of adjuvantly treated premenopausal breast cancer patients. Estrogen-replacement therapy in postmenopausal women has been shown to prevent osteoporosis and reduce fracture risk. The majority of studies also show a marked reduction in cardiovascular disease and mortality. Estrogen-replacement therapy has been considered a disease-prevention strategy rather than a therapeutic intervention. The risks and benefits of estrogen-replacement therapy in women with primary breast cancer are unknown. It is unknown how the well-known benefits accrued from reduction in skeletal and cardiovascular morbidity/mortality compare with the potential risks of increased breast cancer morbidity/mortality. Carefully designed prospective clinical trials with well-defined objectives and endpoints are required to learn if more harm than good is done by the withholding of estrogen therapy in breast cancer patients.     

Treatment failure and dietary habits in women with breast cancer

Although variously shaped urinary red cells have been reported in glomerulonephritic hematuria, no specific shapes with concrete definition have been proposed. This made morphological differentiation of hematuria vague and caused different results among different observers. To solve these problems and improve the diagnostic rate, we employed a uniquely shaped red cell, which only appeared in glomerulonephritic hematuria, as a probe for diagnosis. We studied 182 hematuria cases from 90 glomerulonephritic patients and 95 hematuria cases from 68 urological disease patients. Fresh urine was collected and observed by differential interference microscopy. The red cell, referred to as G1, has a distinctive doughnut-like shape with blebs and was highly specific for glomerulonephritic hematuria. Occurrence of G1 cells increased at lower pH an higher osmolality of urine. A presence of 5% or more G1 cells could be an indicator of glomerulonephritic hematuria. Specificity and sensitivity of this criterion were 100 and 73%. However, when only acidic concentrated urine (pH < or = 6.4, osmolality > or = 400 mosm/kg H2O) was used, the specificity and sensitivity increased to 100 and 99.2%, respectively. Glomerulonephritic and urological hematuria were correctly diagnosed by counting the urinary red cells with doughnut-like shape in acidic and concentrated urine. This method seems to be superior to others in diagnostic rate, simplicity and clarity.     

Breast cancer detection by daughters of women with breast cancer

The preferred therapy for genuine stress incontinence is surgery. The Burch procedure is considered by many to be the gold standard for surgical treatment of genuine stress incontinence. The Burch procedure requires the elevation of the anterior wall of the vagina to the level of the origin of the paravaginal fascia by suspension from Cooper's ligaments. The laparoscopic performance of the Burch procedure by suturing or by endoscopic stapler mesh technique results in a decrease in the length of hospital stay, faster recovery, much shorter catheterization and less scarring due to the smaller incisions. The laparoscopic procedure provides results similar to the open operation if a meticulous technique is used. Long-term follow-up will be necessary before these procedures can be generally offered as a therapeutic alternative.     

A hysteroscopic and anatomicopathological study in women with breast cancer

OBJECTIVE: To study the uterine mucosa of women with breast cancer in order to evaluate the frequency of endometrial diseases. EXPERIMENTAL DESIGN: Prospective, controlled study carried out from January to December 1996. SURROUNDINGS: Patients with breast cancer and normal controls from 4 out-patient university services in Porto Alegre, Brazil. PATIENTS: Postmenopausal women without hormonal therapy were compared: 67 of them with breast cancer and 101 normal controls. METHODS: Hysteroscopy followed by endometrial biopsy carried out in both groups as an out-patient procedure. RESULTS: In patients with breast cancer, 29.85% abnormal biopsies were found as follows: 10 endometrial polyps (15.0%), 8 with proliferative changes (11.9%), 1 case of cancer (1.5%), and one case of hyperplasia (1.5%). In the control group 8% abnormal morphological findings were found, as follows: 4 (4%) with endometrial polyps and 4 (4%) with proliferative changes. The differences in abnormal biopsies were statistically significant, mainly in patients with corporal mass index above 27.3. The sensibility of hysteroscopy was 82.14%; its specificity 97.16%; its predictive positive value 85.18% and its predictive negative value 96.48% in detecting endometrial activity, for a prevalence of 16.7% of endometrial activity. CONCLUSIONS: Endometrial evaluation must be included in the initial evaluation of patients with breast cancer, mainly if they were obese. Hysteroscopy, performed in out-patient basis, showed to be an adequate method to evaluate the uterine mucosa, helping to select the area of this cavity for biopsy.     

Attitudes of internship directors toward preinternship training and clinical training models.

A survey of 179 internship directors revealed considerable dissatisfaction concerning university preparation in clinical skills. Interns are seen by many as not well prepared in assessment or psychotherapeutic activities, and university training in these areas frequently failed to improve over 3 yrs. Nevertheless, there was little sentiment to abandon the scientist/practitioner training model in favor of either university-based PsyD programs or free-standing professional schools. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic delay and related factors in women with breast cancer

Experiments were undertaken in order to verify whether or not a strong magnetic field would have any biological effects on the cell growth, viability and radiation response of mammalian cells. Magnetic field exposures were conducted using a superconducting magnet with freshly-isolated human peripheral blood T-lymphocytes maintained at their normal growing temperature of 37 degrees C. The static magnetic fields with intensities up to 6.3-tesla (T) exerted little influence on the cell growth and viability of actively-growing T-lymphocytes under normal cell-culture conditions. On the other hand, the T cells exposed to the magnetic fields (4 T-6.3 T) during PHA stimulation were inhibited in their cell growth when compared to controls. The effects of the magnetic fields with intensities up to 2 T on cell growth properties, however, were minimal in this system. Also, the radiosensitivity of T-lymphocytes previously exposed to the strong magnetic fields was more sensitive than that of control cells. These results suggest that exposure to a static magnetic field of 4 T or stronger might lead to physiological and growth abnormalities at the cellular level.     

Effects of psychosocial interventions with adult cancer patients: A meta-analysis of randomized experiments.

Meta-analytic methods were used to synthesize the results of published randomized, controlled-outcome studies of psychosocial interventions with adult cancer patients. Forty-five studies reporting 62 treatment control comparisons were identified. Samples were predominantly White, female, and from the United States. Beneficial effect size ds were .24 for emotional adjustment measures, .19 for functional adjustment measures, .26 for measures of treatment- and disease-related symptoms, and .28 for compound and global measures. The effect size of .17 found for medical measures was not statistically significant for the few reporting studies. Effect sizes for treatment-control comparisons did not significantly differ among several categories of treatment: behavioral interventions, nonbehavioral counseling and therapy, informational and educational methods, organized social support provided by other patients, and other nonhospice interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support and survival among women with breast cancer

BACKGROUND: Two recently reported randomized trials, one among patients with advanced breast cancer and the other among patients with early stage melanoma, suggested that social support may affect survival favorably. This study assesses relationships of social support indicators with 7-year survival among women diagnosed with localized or regional stage breast cancer. METHODS: All newly diagnosed patients with surgically treated localized or regional disease in seven Quebec City hospitals in 1984 were considered for this analysis. Among 235 eligible patients, 224 (95%) participated in a home interview 3 months after surgery. This interview provided information on the use of confidants in the 3 months after surgery. Data on disease and treatment characteristics were abstracted from patients' medical records. RESULTS: Compared with women who used no confidant in the 3 months after surgery, the hazard ratio for the 7-year period was 0.61 (95% confidence interval [CI], 0.33-1.12) among those who had used at least one confidant, 0.54 (95% CI, 0.28-1.06) in women who used two or more types of confidant, and 0.51 (95% CI, 0.22-1.18) among those whose confidants included either physician or nurse. These results were adjusted for age, presence of invaded axillary lymph nodes, adjuvant radiotherapy, and adjuvant systemic therapy (hormone or chemotherapy). CONCLUSION: These results support the view that social support may be associated with longer survival among women with localized or regional stage breast cancer.     

Cytosol cathepsin D in Thai women with breast cancer

The necessity of screening high-risk patients with breast cancer who may require more intensive systemic therapy especially in the node negative subgroup was generally accepted. Cathepsin D, an estrogen induced protease, has been shown to be implicated in the proliferation and invasion of breast cancers. Retrospective assessment of cytosol cathepsin D in 151 primary breast cancers was done together with ER, PR and other clinico-pathological parameters. No significant relationship was shown between cathepsin D concentrations or cathepsin D status using median value of 56 pmol/mg protein as cutoff level with most studied parameters. High cathepsin D status was found in 47 per cent of patients with fibrocystic disease of breast and 30 per cent in node-negative, ER-PR negative tumors. Survival analysis after 5 or 10 year follow-up and evaluation in a larger scale are necessary before including cytosol cathepsin D measurement as a routine clinical investigation for breast cancers.