Cues to participation in prostate cancer screening: a theory for practice.

PURPOSE/OBJECTIVES: To develop and test the Cues to Participation in Prostate Cancer Screening Theory, which proposes that exposure to information from certain sources cues or triggers screening. DESIGN: Descriptive correlational. SETTING: 11 counties of a southeastern state. SAMPLE: Convenience sample of 1,867 men at risk for prostate cancer (72% African American; 28% Caucasian). METHODS: Recent exposure to prostate cancer information was measured. Men were offered free screening by prostate specific antigen (PSA) and digital rectal exam (DRE). MAIN RESEARCH VARIABLES: Demographic variables (race, age, education, income, and marital status), exposure (electronic media, print media, healthcare provider recommendation, and interpersonal interactions), and screening as measured by PSA and DRE. FINDINGS: Several major propositions of the Cues to Participation Theory were supported. General exposure to prostate cancer information significantly predicted screening participation. Hearing about prostate cancer from a healthcare provider was the best predictor of screening. CONCLUSIONS: Men's demographic characteristics should be considered when providing information about prostate cancer. Hearing about prostate cancer from family and friends was not significantly related to screening behavior. IMPLICATIONS FOR NURSING PRACTICE: The importance of recommendations for prostate cancer screening is underscored.

Perceived health status in African American and Caucasian men 40 to 70 years old.

There is limited data on the relationship between perceived health status and the demographic variables of education and income in African American men. A sample of 2,001 men (72% African Americans and 28% Caucasians) who were participating in prostate cancer screening was studied to identify predictors of men's health status. Data on the concepts of self-rated health status, age, race, education, income, living arrangements, and marital status were collected. Findings indicated that men who were more likely to report excellent health status were older Caucasians, had more than a high school education, an annual income over 25,021 dollars, were living with others, and were married. Men more likely to report fair health status were older African Americans, unmarried, had less than a high school education, had an annual income less than 9,600 dollars, were living alone, and were unmarried. Implications for targeting at-risk men are presented.

Reference ranges for serum prostate-specific antigen in black and white men without cancer.

OBJECTIVES: To determine the age- and race-specific prostate-specific antigen (PSA) distributions in healthy men in central South Carolina and to compare these to data from other studies. METHODS: Two thousand ninety-two black men aged 40 to 69 years and white men aged 50 to 69 years from the general population in 11 counties of central South Carolina participated in a prostate cancer educational program. Seventy-two percent of the participants were black-about double the proportion in the general population-and 63% of the men (1319 of 2092) subsequently obtained a PSA determination from their own physician. The distribution of serum PSA was compared with distributions from the Olmsted County study and from the Walter Reed Army Medical Center/Center for Prostate Disease Research study. RESULTS: Older men without cancer had higher PSA levels. Regression analyses yielded an associated increase of about 3.3% per year. Reference ranges for normal PSA in men without cancer (based on their sample 95th percentiles) were zero to 1.9, 3.8, and 5.7 ng/mL in black men aged 40 to 49, 50 to 59, and 60 to 69 years, and zero to 2.7 and 4.9 mg/mL in white men aged 50 to 59 and 60 to 69 years, respectively. CONCLUSIONS: Reference ranges for normal serum PSA levels should take into account the population from which they are derived and to which they will be applied. Reference ranges that are useful in the general population can differ from those that are appropriate in a hospital setting. For the general population in central South Carolina, reference ranges for serum PSA levels are lower than previously published reference ranges, particularly among black men.

Perceived benefits: a predictor of participation in prostate cancer screening.

Prostate cancer is the most frequently diagnosed major cancer and the second cause of cancer-related deaths among men. With early detection through screening and timely treatment, 9 out of 10 men will survive a minimum of 5 years. However, with late diagnoses, only 3 out of 10 men will have a 5-year minimum survival rate. Guided by a conceptual map, this correlational research examined perceived benefits as a predictor of participation in free prostate cancer screening. Perceived benefits are the personal belief and valuing of screening for early detection of prostate cancer. All subjects received one of four educational interventions: traditional, peer educator, client navigator, or combination. Participation in prostate cancer screening was measured by compliance with the American Cancer Society's Guidelines, which included a digital rectal exam (DRE) and/or a prostate-specific antigen (PSA) blood test. The purposive sample (n = 1,522) of men, ages 40 to 70 years, was recruited from randomly selected churches, barbershops, industries, housing projects, and car dealerships in a southeastern state. Seventy-two percent of the sample was African American. Predictors of participation in free prostate cancer screening were these: perceived benefits, being white, having at least a high school education, being married, and receiving the client navigator or combination educational intervention. The Benefits Scale was significant (p = 0.013, odds ratio (OR) = 1.059) as a predictor for participation in screening when all demographic variables and educational interventions were controlled. Practice implications for nursing are discussed and recommendations for future research are presented.

Predictors of fecal occult blood screening among older socioeconomically disadvantaged Americans: a replication study.

Socioeconomically disadvantaged elderly are less likely to participate in fecal occult blood testing (FOBT). A quasi-experimental design was used in this operational replication study to determine predictors at baseline of subsequent participation in FOBT. Sixty-five percent of the 211 participants in the replication study participated in FOBT, and 47% of the 171 participants in the original study participated in FOBT. Predictors for FOBT in the replication study were male gender, age of 65-75 years old, ability to go places without assistance, history of having had a digital rectal examination and FOBT. This replication study supports targeting socioeconomically disadvantaged populations for FOBT as well as females, persons 85 years and older, persons who need assistance in travel, and person who have not had FOBT before. The results show that socioeconomically disadvantaged persons will participate in FOBT when effective educational interventions that include adaptation for aging changes are used.

The impact of prostate cancer knowledge on cancer screening.

PURPOSE/OBJECTIVES: To test the effect of knowledge on participation in prostate cancer screening. DESIGN: Quasi-experimental design; PRECEDE framework. SAMPLE: 319 men, 82% African American. METHODS: Prostate cancer knowledge was measured with a Prostate Cancer Knowledge Questionnaire prior to a community-based educational program. Men were referred to their personal physicians for a free prostate cancer screening. Results were sent to the Prostate Cancer Project. MAIN RESEARCH VARIABLES: Prostate cancer knowledge and participation in free prostate screening with a digital rectal examination and prostate specific antigen. FINDINGS: Prostate cancer knowledge was a predictor in participation in screening (p = 0.05). IMPLICATIONS FOR NURSING PRACTICE: Nurses need to target educational interventions for African American men, who have the highest incidence of and mortality rates for prostate cancer, to significantly reduce mortality rates. This study documented the importance of providing educational programs to increase participation in prostate cancer screening.

Underreporting and misclassification of maternal mortality in Taiwan.

BACKGROUND: Underreporting and misclassification of maternal deaths are universal. The purposes of this study were to quantify the level of underestimation of maternal mortality and to analyze possible factors that contribute to underreporting and misclassification of maternal mortality. METHODS: An interview census of all registered deaths that occurred during 1984-1988 in women of reproductive age was undertaken in Taiwan. Pregnancy-related deaths were screened from all collected questionnaires and death certificates by the researchers. The screened pregnancy-related deaths were then reviewed and evaluated by obstetrician-gynecologists; a cause of each death was assigned. RESULTS: For the five years, on average, the rate of underreporting of maternal mortality is 58.38% and the correct/confirmed rate of classification is 53.28%. Underreported and misclassified maternal deaths are more likely for women aged 20-24, with stillbirth and fetal death, care sought for non-obstetric reasons, care received in private hospitals and clinics, occurrence in the home, certification by non-obstetrician-gynecologists and court doctors, and death from non-obstetric causes. CONCLUSIONS: This study shows the limitations of official vital registration and concludes that dependence on death certificates alone to identify maternal deaths is incomplete and incorrect.

PIP: This study determines the reliability of death certificate information on maternal mortality in Taiwan. A file was constructed of death certificates of all females 10-49 years old who died during 1984-88 in Taiwan. Trained public health nurses and midwives interviewed family members of deceased persons. Cause of death was taken from the death certificate. Obstetricians-gynecologists determined whether a pregnancy-related death was due to obstetric or unrelated causes, according to the International Classification of Disease-9, Clinical Modification codes. Based on the physicians reviews, 520 women died during pregnancy or within 42 days postpartum, of which 246 were nonmaternal deaths. 173 of the 274 deaths were previously determined by the routine procedure of death certificate reporting to be maternal deaths. Obstetrician-gynecologists identified 101 deaths as maternal deaths. 146 of the 173 certificate maternal deaths were verified as maternal deaths. 27 deaths were minor misclassifications. The adjusted proportion of maternal deaths was 54.8% rather than 34.6%. The greatest rate of underreporting was 86.59% in 1988. The smallest rate of underreporting was 39.29% in 1987. The official death certificate maternal group had a significantly higher percentage of women 30-34 years old. The underreported group had a significantly higher percentage of women 20-24 years old. The underreported group had a higher proportion of stillbirths and fetal deaths among mothers who died. The reported group had higher proportions of deaths from hypertension, embolism, hemorrhage, and more mothers who sought care at clinics and hospitals. The misclassified group had more information provided by physicians and family. Underreporting is attributed to confusing coding criteria, neglect of physicians, incomplete information, specific indicators, and avoidance of blame.

Geographic variation in the prevalence of Raynaud's phenomenon: a 5 region comparison.

OBJECTIVE: To determine the population based prevalence of Raynaud's phenomenon (RP) in 5 geographic regions: one in South Carolina, USA, and 4 in France; to explore the relationship of RP to the climate; to investigate possible risk factors; and to describe the characteristics of RP+ subjects in the general population. METHODS: The study consisted of 2 phases: a telephone survey of a randomly drawn sample of households, with 10,149 completed interviews; these were followed by a face to face interview and clinical evaluation (n = 1,534), including diagnosis of RP. The same methodology was used in all 5 regions: for recruitment of subjects, criteria for RP, method of RP diagnosis, and for gathering additional information. RESULTS: The prevalence of RP was found to be related to the climate. The relationship between RP and climate was complicated, however, by the fact that many subjects had moved between climate zones. The relationship of RP to a cold climate became more evident after taking the migration patterns into account: the majority of RP+ subjects in the 2 coldest regions had lived all their lives in the same or a similar climate zone; the majority of RP+ subjects in the 2 warmest regions had previously lived in a colder climate. Other factors associated with RP were family history of RP, cardiovascular diseases, older age, a low body mass index, use of vibrating tools, and outings of a day or more. The classical triphasic RP was rarely encountered in the general population and the most frequently observed signs and symptoms during an RP attack were blanching accompanied by numbness. CONCLUSION: In addition to being a triggering factor for RP attacks, cold also appears to be an etiologic factor in the pathogenesis of RP. A subclinical cold injury, more likely to occur in colder climates, may be responsible for the "local fault" that has been implicated in the pathogenesis of RP and, in association with other risk factors, may predispose subjects to develop clinical RP.

Development of questionnaires to measure psychosocial influences on children's physical activity.

BACKGROUND: The purpose of this study was to develop and validate questionnaires used to measure psychosocial determinants of physical activity in preadolescent children. METHODS: Three theory-based questionnaires and a measure of after-school physical activity were administered to 422 fifth-grade students. A cross-validation design was employed for psychometric development of the scales, including factor analysis, reliability, and validation by correlating scale scores with intention to be physically active and after-school physical activity. RESULTS: The Social Influences scale contained a single factor. The Self-Efficacy scale contained three factors: support seeking, barriers, and positive alternatives. The Beliefs scale contained two factors: social outcomes and physical activity outcomes. Reliability coefficients ranged from about 0.50 to 0.78. Significant correlations were obtained between all six scales and intention in the development sample, and between five scales and intention in the validation sample. Significant correlations were obtained between social influence and self-efficacy barriers and physical activity in the development sample, and between social influences and physical activity in the validation sample. CONCLUSIONS: Three scales to measure psychosocial determinants of physical activity were refined for use with rural, predominantly African-American, preadolescent children, and shown to be both reliable and valid. Factor analysis resulted in interpretable subscales that may be used as variables. These preliminary results provide support for using the scales to measure influences on activity in children.

Digital vascular responses to cooling in subjects with cold sensitivity, primary Raynaud's phenomenon, or scleroderma spectrum disorders.

OBJECTIVE: To define differences in digital vascular responses to cooling and to determine their usefulness for the differential diagnosis of 4 groups of subjects: patients with primary Raynaud's phenomenon (RP) (n = 96), patients with RP associated with scleroderma (systemic sclerosis, SSc) spectrum disorders (SSc spectrum RP) (n = 108), subjects complaining of cold sensitivity of the fingers (n = 88), and RP negative controls (n = 120). METHODS: Digital systolic blood pressure, digital blood flow, and digital skin temperature were measured in a temperature controlled room at 18 or 23 degrees C; the effect of local finger cooling was tested at 30, 20, 15, and 10 degrees C. RESULTS: Digital blood pressure responses clearly differentiate the 4 diagnostic groups from each other. By contrast, blood flow and skin temperature measurements, although showing different group means, fail to reach statistical significance due to a large variance. Digital pressure responses have high sensitivity and specificity for distinguishing not only between patients with RP and controls, but also between the 2 types of RP. A relative digital systolic pressure (digital systolic pressure over brachial systolic pressure) of less than 70% at low local finger cooling temperatures (15 and 10 degrees C) has a sensitivity of 97.1% in differentiating SSc spectrum RP from primary RP. A zero reopening pressure shows a specificity of 100% at 30 degrees C and 81.7% at 20 degrees C to separate the 2 groups. The zero reopening pressure is seldom associated with clinically visible RP (10.3% among SSc spectrum RP, 4.3% among primary RP). Although the study was not designed to investigate drug effects, our data from patients who failed to abstain from vasodilators, as instructed, show they have a protective effect at 15 and 10 degrees C. CONCLUSION: The digital pressure response to cooling is a useful test for RP and cold sensitive subjects. It has high sensitivity and specificity to differentiate between SSc spectrum RP and primary RP and between primary RP and cold sensitive subjects. Our preliminary data on vasodilator use suggest that the digital pressure response to cooling may also be useful in RP treatment studies.

Teaching older adults by adapting for aging changes.

Few teaching programs are geared to meet the special learning needs of the elderly. This pilot study used a quasi-experimental pretest-posttest design to measure the effect of the Adaptation for Aging Changes (AAC) Method on fecal occult blood screening (FOBS) at meal sites for the elderly in the South. The AAC Method uses techniques that adjust the presentation to accommodate for normal aging changes and includes a demonstration of the procedure for collection of the stool blood test, memory reminders of the date to return the stool blood test, and written materials adapted to the 5th grade reading level. In addition, actual practice of the FOBS with the use of peanut butter was added to the AAC Method, making it the AAC with Practice Method (AACP) in two sites. The American Cancer Society's colorectal cancer educational slide-tape show served as the basis for all of the methods. Hemoccult II kits were distributed at no cost to the participants. Descriptive statistics, chi 2, and logistic regressions were used to analyze data from 135 Council on Aging meal sites' participants. The average age of the participants was 72 years; the average educational level was 8th grade; over half the sample was African-American; and half of the participants had incomes below the poverty level. Results support a significant increase in participation in FOBS in participants taught by the AACP Method [chi 2 (1, n = 56) = 5.34, p = 0.02; odds ratio = 6.2]. This research provides support for teaching that makes adaptations for aging changes, especially adaptations that include actual practice of the procedure.

Digital pressure responses to cooling in patients with suspected early vs definite scleroderma (systemic sclerosis) vs primary Raynaud's phenomenon.

OBJECTIVE: To compare digital vascular responses to local finger cooling in 4 groups of subjects: patients with definite scleroderma (SD, systemic sclerosis) meeting ARA criteria (n = 16), patients with suspected early SD (n = 12), patients with primary Raynaud's phenomenon (RP) (n = 23) and a control group of 29 healthy subjects. METHODS: Their digital systolic pressures were measured at 30, 20, 15 and 10 degrees C finger cuff temperature, in a room kept at 18 degrees C. RESULTS: The results of the digital pressure measurements showed a clearcut difference between the SD, primary RP and control groups, but there was no difference between patients with definite SD and those with suspected early SD. CONCLUSION: Under our experimental conditions, digital pressure response to local cooling separates groups of patients with primary RP and those with secondary RP related to SD from each other and from controls. The similarity between digital pressure responses of patients with suspected early SD and those with definite SD, suggests an early organic involvement of the digital vasculature in SD.

Using elderly educators to increase colorectal cancer screening.

This article reports on the elderly educator method, a practical and economical intervention that was used for increasing the rate of return of fecal occult blood sampling in colorectal screening among 171 socioeconomically disadvantaged older persons. Two methods that used elderly educators had an overall response rate of more than 60%. Logistic regression shows a statistically significant difference between two methods that used elderly educators and two methods that did not.

Geographic variation in the prevalence of Raynaud's phenomenon: Charleston, SC, USA, vs Tarentaise, Savoie, France.

We estimated the prevalence of Raynaud's phenomenon (RP) in the general population of 2 geographic areas, Charleston County, South Carolina, USA, and Tarentaise, Savoie, France, using the same methodology in both countries. The first phase of the study, consisting of the telephone survey of a randomly drawn sample of households, yielded 2086 completed interviews in Charleston and 2000 in Tarentaise. Cold sensitivity or unusual digital color changes were reported by 17.9% of the subjects in Charleston and by 31.3% in Tarentaise. In the second phase of the study the diagnosis of RP was made by a medical team. Based on these results, the estimated prevalence of RP is 5.0% (0.8% SE) in Charleston (women 5.7%, men 4.3%) and 16.8% (2.0% SE) in Tarentaise (women 20.1%, men 13.5%).

Knowledge of colorectal cancer among older persons.

Cancer screening is a national health priority, especially for colorectal cancer, the second leading cause of death due to cancer in the United States. The researchers measured colorectal cancer knowledge among 211 older Americans. A quasiexperimental pretest-posttest two-by-two factorial design was used to test the effect of knowledge on participation in fecal occult blood screening. The American Cancer Society's colorectal cancer educational slide-tape presentation served as the basis for all of the educational programs. Hemoccult II kits were distributed at no cost to the participants. Descriptive statistics, chi 2, and logistic regressions were used to analyze data. One-half of the participants had incomes below the poverty level. Almost one-half the subjects in the study sample stated that they had not received any information about colorectal cancer within the past year. Caucasians had more knowledge of colorectal cancer than African Americans [F(1, 78) = 7.92, p < 0.01] and persons with higher income had more knowledge than persons with less income [F(2, 76) = 3.01, p = 0.05]. Subjects showed significant increases in colorectal cancer knowledge 6 days after the colorectal cancer education program [t(79) = 2.59, p = 0.01] and this increased knowledge was a predictor of participation in free fecal occult blood screening [chi 2(1, n = 164) = 5.34, p = 0.02].

Craniofacial screening profile: quick screening for congenital malformations.

The correct identification of syndromes and other congenital malformations at an early age is critical for the child, family and care providers. Most specialists who conduct large screenings of young children are not adequately trained to recognize signs and symptoms that should lead to appropriate referral to the clinical geneticist and/or diagnostic team. A systematic approach for recognizing important signs is presented here; a Craniofacial Screening Profile. Following a brief training program, the Profile was validated by 39 speech-language pathologists in screening 3,539 kindergarten and first grade children. The results were excellent (specificity was 99.6%), demonstrating that with limited training, specialists can effectively screen for important signs and symptoms of a major group of syndromes and other congenital malformations.

Demographic, social and clinical correlates of Raynaud phenomenon.

Our study has identified the demographic, social and clinical correlates of primary Raynaud phenomenon (RP) from a case-control study involving 235 subjects who were identified from a population-based prevalence survey of RP. All potential cases and a sampling of probable non-cases, identified by a screening questionnaire, were invited to a medical clinic for diagnostic testing and assignment of case or control status. Odds ratios (OR) for risk indicators for primary RP were estimated using multiple logistic regression to obtain 95% confidence intervals. The regression yielded statistically significant (p less than 0.05) positive associations for sex (OR = 3.0 for females versus males), self-reported alcohol use (OR = 1.1) and diastolic blood pressure (OR = 1.2) in those on antihypertensive medication. A significant (p = less than 0.01, OR = 0.4) negative association was found for Quetelet index (a measure of obesity). Near-significant or suggestive but non-significant negative associations were found between RP and marital status (p = 0.05, OR = 2.5), increased years of education and, for those on antihypertensive medication, higher systolic blood pressure (both p = 0.07).

The effect of massage on pain in cancer patients.

Evaluating the effectiveness of nursing interventions in decreasing pain is a top priority for clinical research. Unfortunately, most of the research on cancer pain relief has been limited to treatment studies involving the administration of analgesics. Research is needed to determine which nonanalgesic methods of pain control are effective and under what conditions. Consequently, an experimental study was designed to test the effectiveness of massage as an intervention for cancer pain. Twenty-eight patients were randomly assigned to a massage or control group. The patients in the massage group were given a 10 minute massage to the back; the patients in the control group were visited for 10 minutes. For males, there was a significant decrease in pain level immediately after the massage. For females, there was not a significant decrease in pain level immediately after the massage. There were no significant differences between pain 1 hour and 2 hours after the massage in comparison with the initial pain for males or females. Massage was shown to be an effective short-term nursing intervention for pain in males in this sample.

Major clinical diagnoses found among patients with Raynaud phenomenon from the general population.

This study of 62 individuals with Raynaud phenomenon (RP) drawn from the general population of South Carolina shows a profile of associated diseases that is different from the one reported from hospital based studies. We found that connective tissue diseases affect a much smaller fraction of patients with RP than previously reported. Compared to RP negative controls, our RP positive group was found to suffer more frequently from a variety of diseases, both RP related and not RP related.