Physiotherapists' experiences of managing upper limb movement impairments due to breast cancer treatment.

Background: Physiotherapy is recommended for upper limb movement impairments (ULMI) following breast cancer treatment. There is limited research into the pathophysiology and management of ULMI. Care is provided in different health-care contexts by specialist and nonspecialist physiotherapists, with referrals set to increase. This study explores physiotherapists' experiences of managing ULMI. Design: Qualitative study using a hermeneutic phenomenological approach. Method: We interviewed six physiotherapists from various UK treatment settings. The data were analyzed using interpretative phenomenological analysis. Findings: Four master themes were identified: (1) lack of confidence surrounds various aspects of practice, influenced by limited evidence to guide treatment of ULMI, fear of causing harm, and working in a less-established area of physiotherapy; (2) increasing confidence in practice develops with experience, reinforcing perceptions of the benefits of physiotherapy; (3) physiotherapy is understood to empower and enable patients to regain their sense of self and quality of life; and (4) provision of care is perceived to be subject to many barriers. Conclusion: Physiotherapy for ULMI has professional challenges but is seen as beneficial, encompassing psychosocial and physical effects. Experiences in this area of practice suggest a need for increased professional support, further research to guide treatment, and better patient and health professional awareness of ULMI and the role of physiotherapy.

Unfair treatment, discrimination, and ambulatory blood pressure in black and white adolescents.

The authors tested the hypotheses that unfair treatment and its attribution to race, physical appearance, and peer group were related to elevated ambulatory blood pressure (ABP). During 2 school days, 207 Black and White adolescents wore an ABP monitor and answered questions about mood, posture, location, and activity level at the time of the ABP assessment. At a separate session, in-clinic resting blood pressure and perceptions of unfair treatment were measured. Multilevel mixed models showed that unfair treatment and its attribution to race were not associated with ABP. However, adolescents who indicated that the primary reason for unfair treatment was their physical appearance had elevated ABP. Feeling unfairly treated because of physical appearance may impact blood pressure uniquely during the adolescent transition.

Stability of children's and adolescents' hemodynamic responses to psychological challenge: a three-year longitudinal study of a multiethnic cohort of boys and girls.

This report evaluated (a) the temporal stability of hemodynamic responses to three tasks using impedance cardiography, and (b) the influence of aging on stress responses in a multi-ethnic pediatric sample. One hundred children 8 to 10 years old and 49 adolescents 15 to 17 years old were tested at study entry and on average 3 years later. Results showed that the composite task-induced changes in stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR), and pre-ejection period (PEP) were moderately stable across 3 years (rs = .36 to .51), with children showing greater stability in task-induced CO change than did adolescents. However, the magnitude of the participant's stress responses changed over time, varied by task, age group, and gender. These results suggest that hemodynamic responses to stress change with aging during childhood and adolescence and that they can be measured reliably.