Impact of the parenting style of foster parents on the behaviour problems of foster children.

BACKGROUND: Few studies have analysed the effects of the parenting style used by foster carers on children's behaviour problems. This study examines the role played by the quality of the emotional relationship with foster carers and the kind of discipline they use as regard internalizing and externalizing problems among foster children. METHODS: Participants were 104 foster children (56 boys and 48 girls) and their respective foster families. The Child Behaviour Checklist, the Affect and Communication Scale, and the Rules and Demands Scale were completed by foster parents. A series of linear regression analyses were performed using the stepwise method. RESULTS: The main findings were as follows: an authoritarian parenting style explained the internalizing problems presented by foster children (11% of the variance); criticism/rejection, authoritarian parenting and permissive parenting explained externalizing problems (37% of the variance); and criticism/rejection and authoritarian parenting explained total problems (29% of the variance). These results indicate that criticism/rejection on the part of foster parents, as well as the use of inappropriate parenting styles (authoritarian and permissive), has an important effect in relation to the behaviour problems of foster children. CONCLUSIONS: This highlights the key role that foster carers play in terms of tackling the behaviour problems that foster children present. The findings also suggest that preparation for fostering should focus especially on ways of helping foster parents both to acquire positive parenting strategies and to avoid authoritarian and permissive parenting.

Evaluation of DR and CR digital mammography systems based on phantom and breast dosimetry.

Digital mammography has been progressively introduced in screening centers, since recent evolution of CR and DR detectors. However, it is questionable which exposure conditions would be more suitable when these techniques are applied, in order to reduce the glandular breast doses, as they are related with induced carcinogenesis. Several exposures have been performed in CR and DR mammography units for comparing absorbed doses during quality control assessments and during screening, diagnosis and treatment. In the first case, the CIRS11A mammographic phantom has been used with standard exposure conditions (28 kV, AEC mode with blackening +0, 50:50 glandularity and 4.5 compressed breast thickness) in order to obtain reference values for the standard breast. After that, a sample population of 100 women per mammography unit has been registered for performing a dosimetry study during clinical conditions, using the SCREENDOSE software developed by the authors. Results show that there are significative differences among the mammography units, proving that this methodology could be used for obtaining an objective criterion during the selection of a mammography unit, related with a minimum image quality level for a given clinical use (screening, diagnosis or treatment).

Use of risk projection models to estimate mortality and incidence from radiation-induced breast cancer in screening programs.

The authors report on a method to calculate radiological risks, applicable to breast screening programs and other controlled medical exposures to ionizing radiation. In particular, it has been applied to make a risk assessment in the Valencian Breast Cancer Early Detection Program (VBCEDP) in Spain. This method is based on a parametric approach, through Markov processes, of hazard functions for radio-induced breast cancer incidence and mortality, with mean glandular breast dose, attained age and age-at-exposure as covariates. Excess relative risk functions of breast cancer mortality have been obtained from two different case-control studies exposed to ionizing radiation, with different follow-up time: the Canadian Fluoroscopy Cohort Study (1950--1987) and the Life Span Study (1950--1985 and 1950--1990), whereas relative risk functions for incidence have been obtained from the Life Span Study (1958--1993), the Massachusetts tuberculosis cohorts (1926--1985 and 1970--1985), the New York post-partum mastitis patients (1930--1981) and the Swedish benign breast disease cohort (1958--1987). Relative risks from these cohorts have been transported to the target population undergoing screening in the Valencian Community, a region in Spain with about four and a half million inhabitants. The SCREENRISK software has been developed to estimate radiological detriments in breast screening. Some hypotheses corresponding to different screening conditions have been considered in order to estimate the total risk associated with a woman who takes part in all screening rounds. In the case of the VBCEDP, the total radio-induced risk probability for fatal breast cancer is in a range between [5 x 10(-6), 6 x 10(-4)] versus the natural rate of dying from breast cancer in the Valencian Community which is 9.2 x 10(-3). The results show that these indicators could be included in quality control tests and could be adequate for making comparisons between several screening programs.

Modelling of the mammographic exposure conditions for radiological detriment study in the Valencian Breast Cancer Screening Programme.

Breast screening programmes are the best weapon to fight against breast cancer. Nevertheless, despite the benefits, this practice supposes a radiological risk that cannot be forgotten. In order to calculate breast glandular doses, different MCNP-4C2 models have been developed, simulating the exposure conditions. Radiological detriments have been transported from the population under study in the UNSCEAR 2000 to the Valencian Community, obtaining the detection-induced cancer ratio (DICR) for this population.

[Study of non-participation in the breast cancer screening program in the city of Valencia (Spain)]. / Estudio de la no participación en el programa de prevención de cáncer de mama en la ciudad de Valencia.

AIM: To determine the reasons for non-participation of women in a breast cancer screening program. METHODS: We performed an observational, cross-sectional study in women who were invited to participate in the breast cancer screening program in the city of Valencia and who failed to attend. The women were interviewed in their homes through a questionnaire consisting of 25 questions grouped as follows: knowledge of the program, reasons for nonparticipation, attitudes or beliefs and characteristics of the interviewees (socioeconomic and educational variables and age). A descriptive analysis was performed. Differences in the characteristics of women were evaluated through bivariate analysis. Multivariate analysis was performed through logistic regression. RESULTS: A total of 783 addresses were used, 411 questionnaires were completed and 361 were analyzed. The 50 questionnaires used in the pilot study were excluded because, as a consequence of this study, the questionnaire had been modified. Most of the women (93.4%) (CI: 90.3-95.7) remembered having an appointment. The main reason for not attending was being screened in another health service in 48.8% (CI: 43.6-53.9), followed by various personal reasons in 16.1% (CI: 12.3-19.9) and inability to keep the appointment at the specified time in 15.5% (CI: 11.8-19.2). Comparison of women in the middle and upper social classes with those in the lower classes revealed important differences. Middle and upper class women had a higher probability of knowing about the program and of being on hormone replacement therapy (HRT) and the most frequent reason for non-attendance was attendance at another program run by another health service. In lower class women the reasons for non-attendance were fear, not believing the program to be important to health and inability to keep the appointment at the specified time. In the multivariate analysis, the variables that entered the model were HRT, social class and education. Thus, middle or upper class women undergoing HRT and with secondary or higher education had a higher probability of being screened. CONCLUSIONS: The profile of non-participating women belongs on the one hand to those in the middle or upper social classes, undergoing HRT and being screened by other health services and, on the other, to a group of women of low social class, whose reason for non-participation is fear and timetable difficulties.

Estudio de la no participación en el programa de prevención de cáncer de mama en la ciudad de Valencia / Study of non-participation in the breast cancer screening program in the city of Valencia [Spain]

Objetivo: Conocer los motivos de no participación de las mujeres en el Programa poblacional de Prevención de Cáncer de Mama. Métodos: Es un estudio observacional transversal, en mujeres que fueron invitadas para participar en el Programa de Prevención de Cáncer de Mama en la ciudad de Valencia y no acudieron. Se realizó una entrevista con cuestionario en el domicilio con 25 preguntas, agrupadas en: conocimiento sobre el programa, motivos de la no participación, actitudes o creencias y características de las encuestadas (variables socioeconómicas, culturales y edad). Se analizaron las diferencias en las características de las mujeres con un análisis bivariante y multivariante mediante regresión logística. Resultados: Se utilizaron 783 direcciones, se obtuvieron 411 cuestionarios, y analizaron 361, y se excluyeron del análisis los 50 cuestionarios utilizados en la prueba piloto, ya que ésta produjo una modificación del cuestionario. El 93,4 por ciento (intervalo de confianza [IC] del 95 por ciento: 3-95,7) recordaba haber recibido una citación. El motivo principal de no participación fue estar estudiada por otros servicios sanitarios en el 48,8 por ciento (IC del 95 por ciento: 43,6-53,9), seguido de diversos motivos personales en el 16,1 por ciento (IC del 95 por ciento: 12,3-19,9) y del horario de citación que no les resultó adecuado en el 15,5 por ciento (IC del 95 por ciento:11,8-19,2). Analizando la clase social media y alta frente a la clase baja, se observan importantes diferencias: las mujeres de clase media o alta tenían mayor probabilidad de conocer el programa y llevar tratamiento hormonal sustitutivo (THS) y el motivo principal de no asistencia era el estar estudiada por otros servicios sanitarios y para las mujeres de la clase baja el temor, no considerarlo importante para su salud y problemas de accesibilidad horaria. En el análisis multivariante las variables que entraron en el modelo fueron: THS, la clase social y el nivel cultural; de tal forma que aquellas mujeres de clase social media o alta, que llevan THS y de nivel cultural medio o alto tienen mayor probabilidad de estar estudiadas. Conclusiones: El perfil de las mujeres que no participan, pertenece, por un lado, a la clase social media o alta, que toman THS y que están siendo revisadas por otros servicios sanitarios, y por otro, a un grupo de mujeres con nivel socioeconómico bajo y cuyo motivo de no participación es por temor o dificultades de horario. (AU)

Study of radiation induced cancers in a breast screening programme.

It is demonstrated that screening mammography programmes reduce breast cancer mortality considerably. Nevertheless, radiology techniques have an intrinsic risk, the most important being the late somatic effect of the induction of cancer. This study was carried out in order to evaluate the risk to the population produced by the Comunidad Valenciana Breast Screening Programme. All the calculations are carried out for two risk models, UNSCEAR 94 and NRPB 93. On the one hand, screening series detriments are investigated as a function of doses delivered and other parameters related to population structure and X ray equipment. On the other hand the radiation induced cancer probability for a woman who starts at 45 years and remains in the programme until 65 years old is calculated as a function of mammography units' doses and average compression breast thickness. Finally, risk comparison between a screening programme starting at 45 years old and another one starting at 50 years old is made.