Anxiety and compliance among women at high risk for breast cancer

The aim of this study was to investigate the association between symptoms of depression and general anxiety, patient's feelings of vulnerability to cancer, the anxiety experienced specifically in relation to various cancer-screeningprocedures, and compliance with these procedures among women atfamilial risk for breast cancer The data were obtained from 430 patients from the High Risk Clinic at the UCLA Revlon Breast Center who completed the State-Trait Anxiety Inventory and answered questions about their perceived vulnerability to breast cancer; the anxiety they experienced regarding undergoing pap smear tests, mammograms, and breast self-examinations (BSEs); and their compliance with these cancer-screening procedures. Correlations were used to estimate the association between feelings of anxiety and compliance. We found that women attending programs targeting those at familial risk for breast cancer suffer from significant symptoms of general anxiety. General anxiety was found to be related to anxiety regarding specific screening practices but not to women's perceived vulnerability to cancer In general, neither general nor screening-specific anxiety were found to be related to patients 'compliance with screening practices; however, significant associations were found between patient's feelings of anxiety regarding BSEs and their actual performing them. BSE appears to be the only procedure for which compliance is negatively associated with procedure-specific anxiety. We offer possible explanations for this relation and discuss the possible psychological impact that recommendations regarding BSEs may have on highly anxious at-risk women.

An exploratory study of social support: a cross-cultural comparison of Chinese-, Japanese-, and Anglo-American breast cancer patients

This paper investigated the nature of social support for Asian- and Anglo-American women post breast cancer treatment. Forty-six Anglo- and Asian-American (13 Anglo-American, 18 Chinese-American and 15 Japanese-American women) women were assessed 6 months to 3 years post-treatment. Assessments consisted of a semi-structured interview plus standardized psychological tests. Three major hypotheses were developed and tested in the study. Results showed: (1) Anglo-American women indicated a greater need for social support than either of the two Asian-American groups in 66% of the categories; (2) no differences were found between the three ethnic groups in receipt of emotional or tangible social support; and (3) the network size and composition differed significantly in 83% of the categories between the Anglo group and at least one of the Asian groups. These differences were in size, mode, and perceived adequacy of social support. Implications for culturally-based clinical practice which emerge from these findings are discussed.

Why do rich countries prefer free trade over free migration? The role of the modern welfare state

"According to traditional trade theory (Heckscher-Ohlin), free trade and free migration are equivalent measures of economic integration leading both to an equalization of factor prices. This prediction is in sharp opposition to the observed preference of rich countries for free trade over free migration. We provide an explanation for this inconsistency: the redistribution policies in the countries. Social welfare in countries with a relatively small number of low-skilled native workers is higher with free trade than with free migration due to redistribution of income towards immigrating workers."

Psychosocial outcomes of cancer: a comparative analysis of Hodgkin's disease and testicular cancer

PURPOSE

The psychosocial outcomes of testicular cancer and Hodgkin's disease were compared to test our hypotheses that more specific dysfunction and less hiding of symptoms would be found in the former group, as cancer visibly affects a sexual organ. Since those with Hodgkin's disease could more easily deny the disease, poorer psychosocial adjustment was predicted.

PATIENTS AND METHODS

The sample consists of 85 men with Hodgkin's disease and 88 men with testicular cancer (seminomatous, n = 39; or nonseminomatous, n = 49). They were interviewed once, at least 1 year following the end of treatment. Measures of sociodemographic characteristics, physical functioning, psychologic distress, and social outcomes were collected. Treatment data were collected from medical records.

RESULTS

Men with testicular cancer report more focused symptoms: less sexual enjoyment and poor health habits. Men with Hodgkin's disease report more generalized symptoms: fatigue, energy loss, and work impairment. Multivariate analysis indicates that most of these differences are site-related; independent effects of treatment on outcomes were found for more generalized symptoms. Contrary to expectations, both groups reported similar levels of infertility and erectile dysfunction.

CONCLUSION

The response to testicular cancer is site-specific, while the response to Hodgkin's disease is related to both site and treatment (stage-related).

Knowledge, concern, and satisfaction among augmentation mammaplasty patients

Eighty-five patients with augmentation mammaplasty were surveyed. Patients were polled about knowledge of risks, level of concern, awareness of media publicity, incidence of complications, and degree of satisfaction with breast implants. Sixty-one percent of the patients were satisfied or very satisfied with implants, whereas 32% were somewhat or very unsatisfied. Level of satisfaction was not related to knowledge of risks, but did correlate with having experienced side effects or complications. Virtually all patients were aware of recent media publicity about implants, and 90% of women perceived the publicity to be negative. Seventy-five percent of the patients expressed concern about implant safety. Even after exposure to negative publicity, however, < 10% of those surveyed regret having had the surgery and only 6% indicated they would like their implants removed. Overall, patients with augmentation mammaplasty perceive the benefits of implants greatly outweigh the risks.

Evaluation of psychosocial problems of the homebound cancer patient: I. Methodology and problem frequencies

Psychological problem frequencies of very ill, homebound cancer patients were studied using an instrument entitled "Psychosocial Problem Categories for Homebound Cancer Patients." This instrument contains thirteen major categories of problems and fifty individual problems. A total of 570 patient records were obtained from two visiting nurse agencies in two different counties. Records were rated by a pair of trained raters, with level of interrater reliability being r = 0.96. Intervention frequencies by visiting health care professionals were also assessed. Percentages are based on at least one mention of problem or intervention. The five most frequent problem categories included: 1) Somatic side effects, 30% of total problems, of which pain involved 13% of total problems, 2) Patient mood disturbance, 15% of total problems, 3) Equipment problems, 8% of total problems, 4) Family relationship impairment, 7% of total problems, and 5) Cognitive impairment, 6% of total problems. The three most frequent interventions included: 1) Instructor/reinforcement to patient/family, 22% of total interventions, 2) No intervention for problem, 17% of total interventions, and 3) Counseling/emotional support, 17% of total interventions. Because the assessment instrument showed high interrater reliabilities for the two demographically dissimilar patient populations, it may be adaptable to heterogeneous populations.