[Bronchopulmonary dysplasia-associated pulmonary arterial hypertension of very preterm infants]

Bronchopulmonary dysplasia (BPD) of very preterm infants is a multifactorial chronic lung disease and its incidence has not decreased despite improvements in neonatal intensive care, including lung protective strategies. Pulmonary hypertension (PH) can complicate the course of BPD. Mortality in infants with BPD-associated PH is thought to be very high, but its incidence is unknown and a standard diagnostic and therapeutic strategy has not been well defined. In this article, we will first describe the current knowledge on the BPD-associated PH and the current treatments available for this pathology. We will then present the HTP-DBP Study, carried out in Paris (France) starting in 2012. The diagnosis of PH is suspected on echocardiographic criteria, but cardiac catheterization is considered the gold standard for diagnosis and evaluation of the severity of PH. Moreover, pulmonary vasoreactivity testing is used to guide the management of patients with PH. The pathogenesis of BPD-associated PH is poorly understood and even less is known about appropriate therapy. Today, optimizing ventilation and reducing the pulmonary vascular tone with specific pulmonary vasodilatator drugs are the main goals in treating HTP-associated DBP. Animal studies and a few clinical studies suggest that medications targeting the nitric oxide (NO) signaling pathway (NO inhalation, oral sildenafil citrate) could be effective treatments for BPD-associated PH, but they have not been approved for this indication. The HTP-DBP study is a French multicenter prospective observational study. The objective is to evaluate the frequency of BPD-associated PH, to describe its physiopathology, its severity (morbidity and mortality), and the effectiveness of current treatments.

La tumeur d'Ewing

Ewing's tumor (ET) is a malignant bone tumor occurring in children and young adults. ET affects mainly bones of the central axis, and almost always involves soft tissue infiltration. The discovery of a unique genetic alteration, which is a reciprocal translocation most frequently resulting in the fusion of the EWS gene situated on chromosome 22 with the FLI-1 gene on chromosome 11, currently places ET among neuroectodermal tumors. Moreover, this translocation is a tumor-specific genetic marker at the basis of defining ET today and is used as a diagnostic and potentially prognostic tool complementary to imaging and histopathological work-up. Since the 1970 s, important progress has been made in the clinical management of ET patients. Multiagent chemotherapy in association with local treatment (surgery and/or radiation) has clearly improved outcome. The introduction of systemic treatment was justified by the frequent sub-clinical diffusion of apparently localized ET. Intensified therapeutic strategies have for the first time cured some metastatic ET patients, but at the cost of major side effects. Treatment is currently adapted as a result of a better definition of prognostic factors as well as a better assessment of its adverse effects. Improvement in global patient care and increased management of specific acute complications associated with ET (often interwoven with iatrogeneous effects) represent an important step towards improving the quality of life for ET patients as well as preventing long term complications. In the light of present studies, the majority of surviving adults today describe their health and quality of life as good. ET is a fascinating example of the progress made not only in the diagnostic and therapeutic approach to cancer but also in the comprehension of the mechanisms behind carcinogenesis, and consequently reflects the revolution of medicine over the last century.

Douleurs osseuses et papules blanchâtres chez un adolescent de 12 ans

Here we present a case report in which a teenager, with papules on the arm and back since the infancy, complained of back and right knee pain at the age of 12 years. The radiological examination led to the diagnosis of osteopoikilosis and melorheostosis. The Buschke-Ollendorff syndrome (BOS) associates osteopoikilosis (asymptomatic bone dysplasia) and disseminated dermatofibrosis. The BOS is rare, and its association with melorheostosis (another bone dysplasia in which pain and deformity may occur) makes the prognosis uncertain. This case report highlights the diagnosis problems related with bone pain in paediatrics. The purpose of this manuscript is to present the characteristics of two bone dysplasias: osteopoikilosis and melorheostosis, and to discuss the involvement of each one in the clinical picture of our patient.

Involving minority and underrepresented women in clinical trials: the National Centers of Excellence in Women's Health

Recent attention to reducing health disparities among population groups has focused on the need to include in clinical studies, especially clinical trials, participants who represent the diversity of the populations to which study results will be applied. While scientists generally applaud the goal of broadening the characteristics of participants in clinical trials, they are faced with multiple challenges as they seek to include historically underrepresented populations in their research. This article examines the historical and sociocultural context of participation by underrepresented groups, especially women and minorities, in clinical trials, identifies major barriers and challenges facing researchers, and suggests strategies for meeting these challenges. The article draws upon the experiences of the investigators affiliated with the National Centers of Excellence of Women's Health (CoEs).

Multidisciplinary Women's health research: the national centers of excellence in women's health

Contemporary research increasingly needs to consider the value of a multidisciplinary approach in answering critical health questions. The current article outlines the need for multidisciplinary investigations specifically in reference to women's health, and addresses issues related to generating and sustaining interest in such an approach. In addition, the importance of resources and environment for facilitating multidisciplinary research and advocacy efforts for obtaining funding for this approach are discussed. Methodological issues pertinent to the operationalization of multidisciplinary research in women's health are also addressed, and lessons learned from the National Centers of Excellence in initiating multidisciplinary research in women's health are reviewed.

Development and psychometric testing of the Bakas Caregiving Outcomes Scale

BACKGROUND

Family caregivers of stroke survivors experience more depression, emotional problems, social inactivity, and general ill-health than noncaregiving individuals. While a number of instruments measure these variables in family caregivers, they are often too global, indicating the need for a situation-specific instrument measuring life changes resulting from providing care.

OBJECTIVES

To develop and psychometrically test the Bakas Caregiving Outcomes Scale (BCOS) measuring changes in family caregiving outcomes in the stroke population.

METHOD

48 items were developed, with 27 being judged as content valid by a panel of five experts. Psychometric testing with two convenience samples of family caregivers of stroke survivors (ns = 92, 104) was conducted using item analysis, Cronbach's alpha, factor analysis, and hierarchical multiple regression.

RESULTS

Item analysis in sample no. 1 resulted in a 12-item scale with alpha = .90. The scale was further shortened to a 10-item scale in sample no. 2 with alpha = .77. Unidimensionality was supported by factor analysis in both samples. Using hierarchical multiple regression, 63% of the variance of the 12-item BCOS in sample no. 1, and 45% of the variance of the 10-item BCOS in sample no. 2 was accounted for by the constructs in the conceptual model. Criterion-related validity was supported in both samples by significant correlations with the LIFE-3 and a criterion variable with the same response format as the BCOS. Significant BCOS correlations with the SF-36 Health Survey subscales in sample no. 2 provided further evidence of criterion-related validity.

CONCLUSION

The 10-item BCOS is a brief, easy to administer instrument that has evidence of reliability and validity in family caregivers of stroke survivors. The 10-item BCOS could serve as a valuable measure in research, as well as an assessment tool to identify family caregivers in need of intervention.

Predicting mammography and breast self-examination in African American women

Breast cancer mortality is significantly greater in African American women than in their Caucasian counterparts. The purpose of this study was to identify variables associated with the breast cancer screening behaviors of mammography utilization and breast self-examination (BSE) in a convenience sample of low income African American women. A total of 328 African American women, living in a large midwestern metropolitan area, who were at < or = 150% of poverty level, and between the ages of 45 and 64 years were included in this study. Data were collected over a period of 18 months. Predisposing, enabling, and need variables from Anderson's theoretical framework included perceived susceptibility, benefits, barriers, confidence, knowledge, physician recommendation, demographic characteristics, and past experiences, as well as health-care and insurance information. Variables that significantly predicted mammography utilization included perceived barriers, mammography suggested by health-care professionals, recent thoughts about mammography, and a regular medical doctor. Variables that significantly predicted either frequency or proficiency of BSE included susceptibility, benefits, confidence, knowledge, barriers, and a regular physician. Implications for clinical practice include (a) recognizing predictors of screening among low-income African American women; (b) addressing culturally specific barriers, e.g., cancer fatalism, in order to increase compliance with screening; (c) establishing consistency in primary care providers; and (d) increasing confidence and knowledge through education.

Tailoring interventions for health behavior change in breast cancer screening

PURPOSE

Health professionals continue to seek strategies to help individuals increase health-promoting behaviors and decrease those behaviors related to unhealthy lifestyles. Various health behavior theories currently guide interventions that focus on health behavior changes. Of these, a tailored approach uses individual data on beliefs and behavior to guide the content and delivery of interventions. The purpose of this paper is to explain the usefulness of theories in tailoring health promotion messages to increase health-protecting behaviors.

OVERVIEW

A brief overview of current popular theories that focus on individual behavior is presented, followed by illustrations of a tailored intervention approach for breast cancer screening. Applications of the tailored intervention approach in ongoing studies to increase breast cancer screening are described.

CLINICAL IMPLICATIONS

Clinical implications of the ongoing projects suggest practical and widespread utility of tailoring health-promoting messages to increase healthy lifestyles. The tailored approach may be used by a multidisciplinary team to focus on the individual's unique factors to impact behavior change rather than to deliver the same standard message to all individuals.

Beliefs about medication and dietary compliance in people with heart failure: an instrument development study

BACKGROUND

Sodium retention is often a precursor to hospitalization in people with heart failure (HF). Lack of compliance with medications and with dietary sodium restrictions affects sodium retention.

OBJECTIVES

The purpose of this study was to evaluate the reliability and validity of the Beliefs about Medication Compliance Scale and the Beliefs about Dietary Compliance Scale.

METHODS

The Beliefs about Medication Compliance Scale and the Beliefs about Dietary Compliance Scale are instruments we developed specifically to measure beliefs about compliance with behaviors that affect sodium retention in persons with HF. The scales, based on the Health Belief Model, were designed from a review of literature and from self-reports of people with HF. A convenience sample of 101 people with HF completed the scales.

RESULTS

Internal consistency reliability was satisfactory. Factor analysis provided initial support for construct validity of the scales.

CONCLUSIONS

Future testing of the scales is needed in more diverse populations. The scales can then be used to test interventions tailored to individual subjects' beliefs about compliance.

Recent mammography in women aged 35 and older: predisposing variables

Early detection through regular mammography screening is the most effective way to decrease mortality from breast cancer. Our purpose in writing this report was to identify factors that influenced women to adhere to mammography guidelines within the year prior to the study. A sample of 581 women aged 35 years and older was used. Data were collected during in-home interviews led by graduate research assistants. Results indicated that the predisposing variables of seriousness, benefits, health motivation, control, knowledge of breast cancer and mammography guidelines, socioeconomic status, age, physician recommendation for mammography, and prior breast symptoms were significantly related to having had recent mammography.

Effect of interventions on stage of mammography adoption

Mammography has been found significantly to impact mortality in women; however, compliance is still problematic. A theoretical model which combined Health Belief Model (HBM) constructs with stage of mammography adoption was used to investigate the effect of an individualized belief and/or informational intervention on mammography compliance. A control group and three intervention groups (belief, information, and belief and information) were used. A probability sample of 405 women ages 40-88 years without a prior history of breast cancer was randomly assigned to groups. Subjects in the intervention group received individually tailored messages to alter beliefs or provider information related to mammography screening. Women in the combined belief/information group were over two times more likely to have been compliant with mammography 1 year postintervention than those in the control. In addition, groups who received the belief intervention had significantly more women that went from a lower to a higher stage of mammography adoption.

Development of a benefits and barriers scale for mammography utilization

The purpose of this study was to refine scales to measure Health Belief Model concepts of benefits and barriers using the context of mammography screening. Both scales used a summated Likert format with five response options. Items were first subjected to content analysis by national experts. Data were then collected from a random sample of 581 women who were 35 years or over. Retest data were gathered on a subset of women approximately 4-6 weeks later. Construct validity was established using confirmatory factor analysis and exploratory factor analysis with results confirming independence of constructs. Construct validity was also tested by developing hypotheses based on theoretical relationships. Cronbach alpha reliability coefficients for the benefits scale was 0.79 and for the barriers scale was 0.73. Suggestions for further revisions are offered.

Relationship of age to mammography compliance

Mammography use varies by age, with older women showing decreased use. The purpose of this research was to identify variables that affect screening use within two different age groups of women, those younger than 50 and those 50 and older. Predictor variables were identified using the Health Belief Model and Theory of Reasoned Action and included susceptibility, seriousness, benefits, barriers, health motivation, control, social influence, and experiential/demographic variables. A probability sample of 581 women aged 35 and older was included for analyses. Two measures of mammography compliance were tested: compliance with American Cancer Society (ACS) guidelines for the 5 years before the study and compliance with the ACS guidelines for the year before the study. An in-home interview was conducted by graduate research assistants. Compliance rates were significantly lower for women 50 and older than they were for younger women for both the 5-year compliance and the single year of compliance. Barriers were more significant for older women. Having a mammography suggested by a health care professional was most important in the older group, indicating that less weight may be given to personal decision making by this population. Higher socioeconomic status was significant with older but not younger women. For older women, interventions need to be directed toward both the physician and the individual woman. Programs that provide knowledge and address cost issues may be the most important primary components for younger women.

Effects of a procedural/belief intervention on breast self-examination performance

The purpose of this study was to test the effect of a theoretically based nurse-delivered intervention on BSE behavior. A 2 x 2 prospective, randomized, factorial design yielded four groups: control, belief intervention, procedural intervention, and procedural/belief intervention. A total of 301 women were randomly selected from a target population. One year following intervention, significant differences in self-reported proficiency, observer-rated proficiency, and sensitivity (lump detection) were found between the Procedural and Control Group and the Procedural/Belief and Control Group. Significant increases were found on observer-rated proficiency and sensitivity for the Procedural/Belief Group when compared to the Belief Group. In addition, a significant increase was found in the Procedural/Belief Group on nodule detection, when compared to the Procedural Group alone.

Breast self-examination in women 65 and older

Studies of breast self-examination (BSE) in older women have revealed deficiencies in both frequency and proficiency of practice. Current data from an ongoing study indicate that practice is sufficiently poor as to make the detection of lumps difficult. Interventions to increase frequency and proficiency, however, have been encouraging. Several studies are reporting significant improvement in practice following specific strategies. Barriers such as forgetting and embarrassment need to be addressed when attempting to increase frequency and proficiency. The efficiency of BSE cannot be adequately addressed until women are trained at a proficient level.

The relationship of attitudes, knowledge, and social support to breast-feeding

Although more women are initiating breast-feeding, few continue for more than 1-3 months into the postpartum period. The current report studied the relationship of attitudes, social support, experimental and demographic variables, and knowledge to length of breast-feeding. A totaL of 102 women were included in the study and were followed for 1 year. Perceived attitudes toward breast-feeding, selected demographic variables, and past experiences were related to length of breast-feeding.

The role of breast self-examination in breast cancer screening

The efficacy of breast self-examination (BSE) behavior cannot be adequately evaluated until BSE proficiency is considered. Previous research supports the role of attitudinal and teaching interventions in increasing skills and frequency for BSE behavior, but more research using age-appropriate women and adequate outcome measures is needed. A preliminary analysis of data from 301 randomly selected women who were followed for 1 year after an initial teaching and/or attitudinal intervention is reported. Significant differences were obtained for attitudes toward breast cancer screening between scores before and after intervention using paired t test. Significant changes in proficiency and frequency also occurred after intervention, as well as percentage increases in nine individual BSE steps. Return demonstration scores and nodule detection are reported. Perceived barriers and confidence were significantly related to both frequency and proficiency 1 year postintervention using regression analysis. Knowledge was related to proficiency measures. Preliminary data suggest that BSE practice can be significantly improved through individually tailored attitudinal and teaching interventions.

Public Values and Beliefs Toward Nursing as a Career

The purpose of this study was to compare the perceptions of "ideal career" and "nursing as a career." The goal was to provide information for development of innovative recruitment strategies. The sample of 1,116 included college freshmen, students in grades 6 through 12, parents, school nurses, teachers, and counselors. Data were analyzed by t test and analysis of variance to determine differences in attitudes between "ideal career" and "nursing as a career." Similar perceptions for both were opportunities for employment, application of intellectual abilities, caring for people, and an opportunity for academic and scholastic achievement. An "ideal career" was seen as more financially rewarding, more respected, and more powerful than nursing, and as providing more opportunities for leadership, for making decisions, for obtaining and applying knowledge, and for working in a safe environment. Recommendations include strategies to improve recruitment and retention of nurses.

Cross-cultural comparison of images of nurses and physicians

This study investigates attitudes related to the image of nurses and physicians across 30 cultures, using six concepts. Significant differences were found between physician and nurse with respect to power. Moreover, although the physician was highly correlated with knowledge and independence the nurse was correlated with kindness. Nurses' ability to influence health care decision-making may be limited if they are viewed as powerless, and they must address this deficit in their public image.