Transtheoretical model: investigation of adolescents' sunbathing behaviour.

The incidence of malignant melanoma and non-melanoma skin cancers has increased rapidly in Sweden as well as in other western countries during the last 20 years. Adolescents are an important group in skin cancer prevention. Interventions targeting this group have been reported to affect knowledge and attitudes, but the effect on sun protection behaviour has been slight. The aim of this study was to investigate the applicability of the Transtheoretical Model (TTM) for skin cancer prevention for adolescents. A random sample of 1200 18-year-olds living in Stockholm County was selected from the national census registry. A questionnaire that included three of the major constructs of the TTM (i.e. stages of change, processes of change and decisional balance) was sent by mail. The majority of the teenagers were in the precontemplation stage for giving up intentional tanning. The relations between the stages of change and two other major constructs of the TTM, processes of change and decisional balance, were consistent with data on other health behaviours. The results may aid in developing successful skin cancer prevention programmes. The results give support for the stages of change measurement used in this study and that utilizing the TTM in skin cancer prevention may be appropriate.

Knowledge, attitudes and smoking behavior among Lao doctors.

The aim of this study was to describe the knowledge, attitudes and smoking behavior among doctors at Mahosot University Hospital in Lao PDR. A cross-sectional, descriptive study used a self-administered anonymous questionnaire. The study population comprised 164 doctors. Answers were retrieved from 151 (92%) of the doctors. The prevalence of smoking among male doctors was 35%, 16% smoked daily and 19% occasionally. None of the female doctors reported to have ever smoked. Out of the five diseases related to smoking, 5% of the doctors recognized all and 10% recognized only one. Doctors were significantly more likely to advise patients with symptoms related to smoking. However, approximately one in two doctors reported that they did not always counsel smokers with severe smoking related symptoms to stop smoking. Almost all doctors, independent of smoking behavior, perceived tobacco prevention to be important. The findings indicate a lack of comprehensive knowledge on tobacco related issues. Most doctors expressed a positive attitude towards tobacco prevention. An effort is needed to get doctors in Lao PDR to stop smoking engage in smoking assation support.

'You and your skin': a short-duration presentation of skin cancer prevention for teenagers.

The effectiveness of a short-duration presentation of the educational material 'You and Your Skin' was tested on 184 adolescents (age 13-15) at the Year 7 and 8 levels. A non-equivalent control group design was used with pre-testing and post-testing 3 months after the intervention. The intervention increased the students' knowledge of known risks factors for skin cancers. However, the students' attitudes to abstaining from sunbathing and tanning was not significantly affected. The effect of the intervention on the stage of change was primarily a progression from the precontemplation stage to the contemplation stage regarding avoiding the mid-day sun. We conclude that a brief presentation of the educational kit 'You and Your Skin' can be used to increase knowledge, but there is a need for a more extensive intervention effort to affect students' readiness to change their behavior and attitude towards sunbathing and tanning. Therefore, it is important to emphasize the necessity of using the educational kit as a multi-lesson programme with its several group exercises.

The unrecognised cost of cancer patients' unrelieved symptoms:a nationwide follow-up of their surviving partners.

We investigated if a cancer patient's unrelieved symptoms during the last 3 months of life increase the risk of long-term psychological morbidity of the surviving partner. All women (n=506) living in Sweden under 80 years of age, who lost their husband/partner owing to cancer of the prostate in 1996 or of the urinary bladder in 1995 or 1996 were asked to answer an anonymous postal questionnaire, 2-4 years after their loss. The widows' psychological morbidity was associated with the patient's unrelieved mental symptoms. When the patient was perceived to have been very anxious during last three months of life (compared to no observed symptoms) the relative risks for the widows' psychological morbidity were: 2.5 (1.4-4.3) for depression and 3.4 (1.4-8.2) for anxiety. When comparing reports of the patient's pain (much vs no), the relative risks were 0.8 (0.5-1.2) for widowhood depression, and 0.8 (0.4-1.7) for widowhood anxiety. The patients were found to have had adequate access to physical pain control but poor access to psychological symptom control. Efficiency in diagnosing and treating psychological complications of terminally ill cancer patients may not only improve their quality of life but possibly also prevent long-term psychological morbidity of their surviving partners.

Environmental tobacco smoke exposure of young children--attitudes and health-risk awareness in the Nordic countries.

AIMS: To assess attitudes towards environmental tobacco smoke (ETS) and health-risk awareness regarding the potential hazards of ETS for children among parents of young children in the Nordic countries. Also to investigate to what extent these factors are related to ETS exposure of the children. DESIGN: A cross-sectional community-based survey using an anonymous mailed questionnaire. PARTICIPANTS: Parents of children aged 3 years at the time of selection from a random sample of 5500 households in the Nordic countries (Sweden, Norway, Denmark, Iceland and Finland). MAIN OUTCOME MEASURES: Smoking status of parents, weekly ETS exposure of children within and outside the home, health-risk awareness and attitudes regarding the potential hazards of passive smoking. FINDINGS: Two in three parents who smoked did not recognize the increased risk for an inner ear infection and approximately 50% were not aware of the role of parental smoking in recruiting smokers. One in two smokers tended to agree or agreed that an act should be passed which forbids all indoor smoking in the vicinity of children. After adjustment for covariates, the level of health-risk awareness about ETS was significantly related to no ETS exposure within and outside the home. CONCLUSION: The main findings indicate that educating parents about the established health risks of ETS for their children may significantly reduce children's exposure to ETS. An increased effort is needed to educate parents who smoke on the potential health risks of ETS for their children.

Readiness to change sun-protective behaviour.

The incidence of malignant melanoma and non-melanoma skin cancers has increased rapidly in Sweden during the last 20 years. The best-known way to revert this trend is primary prevention. Matching health messages to readiness to change in the population may enhance the effect of community-based prevention. The aims of this study were to investigate readiness to change sun-protective behaviour in two groups (visitors to mobile screening units and beach-goers) and to test a single-item algorithm in assessing the stage of change in sun-protective behaviour. Seven hundred and forty-two visitors to the mobile screening units and 202 individuals on nearby beaches answered a short questionnaire. The assessment of readiness to change was based on stages of change in sun-protective behaviour modified from the Transtheoretical Model of Behaviour Change. As expected, the visitors to the screening units were more often in action/maintenance stages than the beach group for most sun-protective behaviours. In conclusion, the single-item algorithm method appears to be sensitive to assess readiness to change sun-protective behaviour, based on the Transtheoretical Model of Behaviour Change. This method can be incorporated into population surveys and may aid in developing successful skin cancer prevention programmes.

Emotional isolation: prevalence and the effect on well-being among 50-80-year-old prostate cancer patients.

OBJECTIVE: To investigate to what extent prostate cancer patients confide their emotional concerns, and whether having no one to confide in affects well-being. MATERIAL AND METHODS: A population-based study using epidemiological methods. A questionnaire was mailed to all 431 living prostate cancer patients aged 50-80 at the time of selection, diagnosed 1.5-2 years previously in Stockholm County, and 435 randomly selected men in the same age group. The questionnaire was completed anonymously. The main outcome measures included questions assessing the extent to which the men could share emotionally taxing feelings with their partner or others and questions assessing well-being. RESULTS: The questionnaire was returned by 79% of the patients and by 73% of the randomly selected men. Approximately one in five patients had no one to confide in. Of patients living with a partner, only one in 10 confided in someone other than their partner. Three out of 10 patients living in a relationship could not confide in their partner. Men having no one to confide in were less content with their life and reported poorer psychological and overall well-being compared with other men. The prostate cancer patients were not more likely to have someone to confide in than men in general. CONCLUSIONS: The results indicate that a lack of emotional support may be a problem for many prostate cancer patients and that the traditional psychosocial support offered to most cancer patients in Sweden may not reach male patients. There may be a need for a gender-adapted approach to emotional support.

[Treating tobacco addiction. Praxis and barriers amongst Icelandic general practitioners.].

OBJECTIVE: To assess praxis and identify the most common barriers for engaging in tobacco prevention in general practice in the Nordic countries. MATERIAL AND METHODS: All 167 practicing general practitioners in Iceland received a questionnaire at home assessing praxis and barriers for systematic involvement in tobacco prevention. RESULTS: The over all response rate was 77%. Few general practitioners asked patients if they smoked if the patient had no smoking related symptoms. Few supported patients who wanted to stop smoking. However, a big majority agreed that tobacco prevention was a part of their job. The main reasons for not engaging in tobacco prevention was lack of time and the feeling that the time spent may not be worth the effort since few patients quit. A big majority stated that they would prefer to reefer smokers to smoking cessation specialist. CONCLUSIONS: Smoking cessation expertise needs to be more accessible to Icelandic patients and doctors.

Improving the preservation of erectile function after external beam radiation therapy for prostate cancer.

BACKGROUND AND PURPOSE: To investigate whether the type of collimation technique, target dose and treated volume influence the prevalence of intact erectile function after external beam radiation therapy for localized prostate cancer. PATIENTS AND METHODS: A prospective study was conducted to assess erection stiffness before treatment and after follow-ups of 9-18 months and 4-5.5 years. Information was collected using the Radiumhemmet Scale of Sexual Function. RESULTS: Thirty-one men were 'potent' before the radiation. Fourteen of them were treated with a conventional collimator and 17 were given three-dimensional conformal therapy with the aid of a multileaf collimator. Preserved erectile function at 9-18 months was found in 17 of the 31 men (55%) and at the 4-5-year follow-up in five of 22 (23%). Preservation of potency was related to the treatment procedure but not to the treatment volume. CONCLUSIONS: Conformal therapy may increase the percentage of men preserving erectile function during radiotherapy for localized prostate cancer; it is possible that the differences to conventional therapy do not depend on treated volume.

[Do health personnel talk about passive smoking with parents of small children?]. / Snakker helsepersonell med småbarnsforeldre om passiv røyking?

INTRODUCTION: Almost seven out of ten parents who smoke state that they have never received information on passive smoking from health personnel when they bring their children in for routine medical examination. We examined what GPs, doctors and nurses at mother-and-child clinics and midwives reported. MATERIAL AND METHODS: A self-administered questionnaire focusing on practice as regards the matter of passive smoking and children was mailed to a representative sample of 1050 GPs, the senior midwives at Norway's 77 maternity departments, 492 senior public health nurses, and health personnel at 1024 mother-and-child clinics. The response rate varied from 71% (GPs) to 82% (senior midwives). RESULTS: 70% of the personnel at mother-and-child clinics less often than "always" ask about exposure to passive smoking. 60% of the senior midwives report that the department's personnel less than "to a large extent" allocate time to talk with parents about passive smoking. 40% of the GPs and 50% of the paediatricians say that they "never" bring up the matter of passive smoking when they examine small children and do not know whether members of the household smoke or not. The rest of the GPs bring up the matter in 46% of consultations and the rest of the paediatricians in 63% of consultations. When the child has symptoms that can be associated with passive smoking, the GPs discuss the parents' smoking habits in 88% of the consultations and paediatricians in 100% of consultations. INTERPRETATION: Only to a small extent do health personnel use their opportunities of motivating parents to change their smoking habits for the sake of the health of their children. Smoking is only brought up by professionals as a matter routine when the children develop symptoms of exposure to tobacco smoke.

[Why do health personnel neglect to talk about passive smoking with parents of small children?]. / Hvorfor unnlater helsepersonell å snakke med småbarnsforeldre om passiv røyking?

BACKGROUND: Health personnel make only moderate efforts at motivating parents to establish a smoke-free indoor environment for babies and infants. It is only when children show symptoms of exposure to tobacco smoke that they routinely raise the question of passive smoking during consultations with the parents. We wanted to find out why so many neglect to raise the matter when there is still time to prevent injury to the child. MATERIAL AND METHODS: A pre-categorised questionnaire on possible obstacles to involvement in the matter was mailed to a representative sample of 1050 GPs, the senior midwives at Norway's 77 maternity departments, 492 senior public health nurses, and personnel at 1024 mother-and-child clinics. The response rate varied from 71% (GPs) to 82% (senior midwives). RESULTS: Public health nurses, midwives and doctors at the clinics regard it as part of their work to talk to parents about the possible effects of passive smoking on their children's health. The obstacles are a feeling of embarrassment at raising the matter, and not knowing how to talk to the parents about the problem. Even so, a clear majority experience a positive response from smoking parents when they discuss how to prevent the children from inhaling tobacco smoke. Among the GPs the main reason for not raising the matter is lack of time, followed by embarrassment at taking it up and lack of knowledge about the health risks. INTERPRETATION: Health personnel seem to need training in conversation techniques in this connection.

To what extent do parents strive to protect their children from environmental tobacco smoke in the Nordic countries? A population-based study.

OBJECTIVE: To assess to what extent Nordic parents strive to protect their children from environmental tobacco smoke (ETS) at home. DESIGN: A cross-sectional study using an anonymous questionnaire. SUBJECTS AND SETTING: A stratified, random sample of 5500 households containing a child born during 1992, including 1500 households in Denmark and 1000 households in each of the countries of Finland, Iceland, Norway, and Sweden. MAIN OUTCOME MEASURES: Smoking status of parents, prevalence and magnitude of weekly ETS exposure, rules regarding smoking in the home. RESULTS: 82% of current smokers reported having tried to change their smoking behaviour for the sake of their children. Of all parents who answered the questionnaire, 75% reported having introduced some rules to limit ETS in their home. In households where at least one parent smoked, 57% reported that children were exposed to ETS at home. Child exposure to ETS was most prevalent in single-parent households and in households in which parents had lower levels of education. However, these parents were not less likely than other smoking parents to report having tried to change their smoking behaviour for the sake of their children. CONCLUSION: Environmental tobacco smoke at home is still a problem for many children in the Nordic countries. However, most smoking parents reported having made efforts to change their smoking behaviour for the sake of their children; and in approximately half of all households containing at least one daily smoker, parents reported protecting their children from ETS exposure in the home. Although actual exposure may be higher owing to possible under-reporting of ETS, our results indicate a general awareness in the Nordic countries of the potential negative effects of ETS on children.

Children's residential exposure to environmental tobacco smoke varies greatly between the Nordic countries.

OBJECTIVE: To assess similarities and differences in the Nordic countries regarding ETS (environmental tobacco smoke) exposure in young children. DESIGN: A population-based cross-sectional study comprising a randomly selected sample of 5,500 households which included a child born in 1992. Data were collected using a mailed anonymous questionnaire. RESULTS: While the prevalence of household smoking was similar in all countries, there was a great difference between the countries with regard to child ETS exposure. Finnish parents were more likely than all other Nordic parents to protect their children from ETS and the situation was worst in Denmark and Iceland, where almost half of all households, and nine out of ten households containing daily smokers, exposed their children. Approximately eight out of ten current and former smokers in all countries stated that they had made efforts to change their smoking habits because of their children.

'Potency': the validation of information from a self-administered questionnaire using objective measurements of night-time erections and test-retest reliability.

OBJECTIVE: To assess the validity and reliability of a questionnaire assessing 'physiological potency'. PATIENTS AND METHODS: The study comprised 89 patients with prostate cancer and 43 men without; the latter were attending a consultation clinic because of problems with erection. All men answered three questions assessing erectile rigidity during sexual activity, morning and spontaneous erections. In the questionnaire, 'potency' was defined as erectile rigidity 'sufficient for intercourse most of the time' or better. 'Potency' in one or more of the three aspects of erection was defined as 'physiological potency'. The patients with prostate cancer answered the questionnaire twice with a 3-week interval. The men attending the consultation clinic underwent two nights of erectile monitoring (using the RigiScan device) and the minimum criterion for RigiScan potency was defined as 55% rigidity at both tip and base. RESULTS: The test-retest assessment showed 93% conformity in the questionnaire diagnosis of 'physiological potency/impotence' between the tests. The sensitivity and specificity of the questionnaire assessment compared with the RigiScan method were 40% and 100%, respectively, when the question assessing sexually stimulated erectile rigidity was used alone. Using 'physiological potency', the sensitivity increased to about 60% without jeopardizing the specificity, and when men reporting depression were excluded from the analysis, the sensitivity increased to about 80%. CONCLUSIONS: The test-retest reliability of the questionnaire was satisfactory. Using questions in a self-administered questionnaire, 'physiological impotence' can be diagnosed with complete and 'physiological potency' with 60-80% sensitivity. The sensitivity of the self-assessment for 'potency' depended on the number of questions asked and the proportion of men reporting depression.

Urinary and bowel symptoms in men with and without prostate cancer: results from an observational study in the Stockholm area.

OBJECTIVES: To investigate the prevalence of urinary and bowel symptoms in population-based groups of men with and without prostate cancer. METHODS: A self-administered questionnaire, assessing 5 urinary and 3 bowel symptoms, was sent to the 431 men diagnosed as having prostate cancer in the Stockholm area in 1992 who were still alive in October 1993 and to 435 randomly selected control subjects with an age distribution matching men with newly diagnosed prostate cancer in the same area. The results were evaluated as ratios of proportions. RESULTS: Among the prostate cancer patients, all urinary and bowel symptoms assessed were more common and the risk of having the various symptoms was 1.3-4.5 times that of the controls. The risks of having leakage of urine after radical prostatectomy and bowel urgency after external beam radiation therapy were fourfold when compared with the control group. We noted an increased risk ratio of proportions of leakage of faeces after radical prostatectomy and this risk was significantly increased when men with any of 11 specified diseases were excluded from the analysis to reduce confounding. CONCLUSIONS: Prostate cancer and its treatment affects urinary and bowel functions. The increased risk of having leakage of faeces after radical prostatectomy may be a chance phenomenon due to few patients subjected to surgery, but warrants further investigation.

Factors associated with waning sexual function among elderly men and prostate cancer patients.

PURPOSE: We identified factors that affect sexual function in men 50 to 80 years old and, therefore, may confound the comparison among groups of elderly men. In particular, we identified factors that may influence a comparison between prostate cancer patients and the general population, or confound the relationship when comparing subgroups of patients in nonrandomized studies. MATERIALS AND METHODS: A questionnaire, including the Radiumhemmet Scale of Sexual Function and modules assessing potential risk factors for waning sexual function, was sent to 431 patients 50 to 80 years old with prostate cancer diagnosed 1.5 to 2 years previously in the Stockholm area (Sweden) and a reference group of 435 age matched randomly selected men. RESULTS: Factors associated with physiological impotence included prostate cancer (relative risk 1.9), diabetes mellitus (relative risk 2.3), myocardial infarction (relative risk 1.5), medication with diuretics (relative risk 1.5), hydrogen blockers (relative risk 2.3) and warfarin type anticoagulants (relative risk 1.7). Patients treated for prostate cancer were more likely to be physiologically impotent compared to those with no initial treatment, and this was true for all treatment protocols after adjustment for confounding factors. Men treated with radical prostatectomy were more likely to be physiologically impotent than men treated with external beam radiation therapy (relative risk 1.5). CONCLUSIONS: Waning sexual function in the prostate cancer patients was largely due to side effects of the treatment and this could not be explained by confounding factors. In particular, confounding could not explain the greater risk of impotence after radical prostatectomy compared to external beam radiation therapy.

Sexual desire, erection, orgasm and ejaculatory functions and their importance to elderly Swedish men: a population-based study.

Relevant information for clinical decision-making in a wide spectrum of diseases includes the extent to which sexual function is intact, how important it is to preserve sexual capacity and whether waning sexual function causes distress. Little information is available on elderly men. We aimed to obtain this basic information. Radiumhemmet's Scale of Sexual Function was posted to 435 randomly selected men aged 50-80 years. Assessments included sexual desire, erectile capacity, orgasm and ejaculation and to what extent waning sexual function distressed the men. The questions were answered anonymously. Information was obtained from 319 men (73%). Of these, 83% stated that sex was 'very important', 'important' or a 'spice to life'. Physiological potency for men aged 50-59, 60-69 and 70-80 amounted to 97%, 76% and 51% respectively. Among the oldest men (70-80 years), 46% reported orgasm at least once a month. Over 80% of all men who reported some level of erection stated that it was of importance to them to maintain the present level of erection stiffness. Most men who reported waning sexual function (compared with their youth) stated that this distressed them. Sex is important to elderly men. Even among the 70-80-year-olds, an intact sexual desire, erection and orgasm are common and it is considered important to preserve them. Sexual function should be considered in the clinical assessment of elderly men.

Waning sexual function--the most important disease-specific distress for patients with prostate cancer.

The objective was to investigate how prostate cancer and its treatment affects sexual, urinary and bowel functions and to what extent eventual complications cause distress. A questionnaire was sent to 431 men aged 50-80 years with prostate cancer diagnosed in 1992 in the Stockholm area (Sweden) and 435 randomly selected men with a similar age distribution. Sexual function, as compared with their youth, was diminished in a majority of all men. The prostate cancer patients were, however, more likely to report low frequency and/or intensity in all aspects of sexual function. A majority of the men were distressed by a waning sexual capacity. The proportion of men with prostate cancer who were severely distressed owing to a decline in sexual function was larger than in the reference group. The willingness to trade off an intact sexual function for long-term survival varied considerably among the men in the reference group. Urinary and bowel symptoms were less common than a waning sexual function in both groups, and few appeared to be severely distressed by urinary or bowel symptoms. A decline in sexual functions was the most common cause of disease-specific distress in men with prostate cancer.

Decreased sexual capacity after external radiation therapy for prostate cancer impairs quality of life.

PURPOSE: The aim of this study was to assess to what extent patients treated with radiation therapy for prostate cancer experience change in sexual functioning and to what extent this effects quality of life. METHODS AND MATERIALS: Information was provided by 53 men treated with radiation therapy for localized prostate cancer. Assessment was made with the "Radiumhemmets Scale of Sexual Functioning," which measures sexual desire, erectile capacity, orgasm, and to what extent a decrease in any of these aspects of sexual functioning affects quality of life. Function before treatment was assessed retrospectively. RESULTS: Sexual desire diminished among 77% after treatment. The erection stiffness decreased in 77%. Before external radiation therapy, 66% had an erection usually sufficient for intercourse. Half of the men lost this ability after treatment. Of those retaining orgasm after treatment, 47% reported a decreased orgasmic pleasure and 91% a reduced ejaculation volume. Of all men, 50% reported that quality of life had decreased much or very much due to a decline in the erectile capacity following external radiation therapy. CONCLUSION: The results of the present study indicate that external radiation therapy for prostate cancer is associated with a reduction in sexual desire, erectile capacity, and organism functions. In a majority of patients this reduces quality of life. Previously, we may have underestimated the importance an intact sexual function has for the quality of life in this patient category of elderly men.