Objective risk, subjective risk, and colorectal cancer screening among a clinic sample

Among cancers, colorectal (CRC) is the third most incident and the second most lethal. Although screening for the disease has been shown to be effective in reducing morbidity and mortality, screening rates remain low. Risk of disease has been shown to increase screening uptake, but different types of risk may influence intent to screen, screening in a timely manner, or participating in screening at all. A cross-sectional design was used to select a diverse sample of CRC asymptomatic patients 50 or more years of age (N=104) visiting one of three Midwestern medical clinics. Results showed a positive relationship between receipt of CRC screening and planning to screen for CRC in the future. Objective risk factors (personal/family history and having a primary care physician) were associated with CRC screening uptake and screening within the time intervals recommended by professional screening guidelines, but subjective risk did not obtain significance for screening participation. Both objective (primary care physician) and subjective risk (long-term comparative risk, knowledge) were associated with future plans to screen. Findings suggest that CRC screening behaviors may be differentially influenced by type of risk.     

Factors associated with intentions for colorectal cancer screenings in a Chinese sample

This study investigated factors associated with intention to screen for colorectal cancer among Chinese people age 40 yr. and older. In-depth individual interviews were conducted. Participants were recruited from urban middle-class communities in Taichung, Taiwan through homogeneous, criterion, and snowball sampling strategies (N=32). Immersion and crystallization techniques were used in data analysis. Member check was used to ensure data quality. Analysis showed that factors related to intentions to have fecal occult blood tests were influenced by the inconvenience (61%) and the unpleasant screening procedure (29%), while participants' gastrointestinal symptoms or family history (32%) and physicians' recommendation or patients' self-health conditions (25%) were more important to intentions for a flexible sigmoidoscopy or colonoscopy screening. This study suggests tailoring strategies and messages to encourage use of various screening. Unique cultural issues, such as avoidance of facing problems (28%), embarrassment (23%), or lack of acceptance of preventive behaviors (16%), were also discussed with recommendations provided.     

A pilot evaluation of the efficacy of a couple-tailored print intervention on colorectal cancer screening practices among non-adherent couples

The objective of this study was to evaluate the efficacy of a couple-tailored print (CTP) intervention on colorectal cancer screening (CRCS), CRCS intentions, and on knowledge and attitudes among couples in which neither partner is on schedule with regard to CRCS. A total of 168 married couples with both members non-adherent with CRCS were randomly assigned to receive either a CTP pamphlet accompanied by a generic print (GP) pamphlet or a GP pamphlet only. Couples completed measures of CRCS, intentions, relational perspective on CRCS, discussions about CRCS, spouse support for CRCS, spouse influence strategies, CRC knowledge, perceived CRC risk, and CRCS benefits and barriers. Results indicated there was no significant benefit of CTP vs. GP on CRCS, but there was a significant increase in CRCS intentions in CTP compared with GP. There was also a significant increase in relationship perspective on CRCS, a significant increase in husbands’ support of their wives’ CRCS, and a significant increase in CRCS benefits in CTP. In summary, CTP did not increase CRCS practices but increased intentions and perceived benefits of CRCS as well as improving couples’ ability to view CRCS as having benefit for the marital relationship.     

Normative data on a battery of neuropsychological tests in the Han Chinese population

In order to develop normative data of a battery of neuropsychological tests in the mainland Chinese population, we examined the performance of 15 neuropsychological tests in 465 healthy subjects (231 males and 234 females) in a population‐based cohort study. The years of education were ranged between 1 and 23 years, and ages were ranged between 16 and 75 years old. The 15 neuropsychological tests cover five domains of neurocognitive functions including attention and speed of information processing, memory and learning, verbal function, visual constructive abilities, and executive function. We also assessed the effects of gender, age, educational attainment on the performance of these neuropsychological tests. The results showed that, as expected, educational attainment and age are the two main factors affecting performance in these tests. Educational attainment has the strongest predictive effect on all tests, while the majority of tests selected in this study are also affected by age at examination to varying degrees. The presented normative data will be useful for future studies in related clinical research, and be of value in transcultural neuropsychological studies.     

Use of carbon monoxide breath validation in assessing exposure to cigarette smoke in a worksite population

Assessed the usefulness of carbon monoxide (CO) breath validation of self-reported smoking status in a large worksite population (N = 4,647). CO assessment was performed as part of a baseline survey procedure. CO levels differed substantially in relation to self-reported smoking status and amount smoked. Correcting for ambient exposure (estimated by mean CO levels among never smokers) produced more satisfactory results than uncorrected CO levels. Striking company differences were observed in mean CO exposures among self-reported never smokers. An unexpected finding was that 17.1% of current smokers reported smoking less than daily. Although the CO measure was excellent in detecting moderate and heavy smokers, it was inadequate in detecting occasional and light smokers. If detection of occasional or lighter smoking is critical to the purposes of the study, the more expensive (but more accurate) cotinine measure is preferred.     

Increasing attendance at colorectal cancer screening: testing the efficacy of a mailed, psychoeducational intervention in a community sample of older adults.

This article describes a trial of a psychoeducational intervention designed to modify negative attitudes toward flexible sigmoidoscopy screening and thereby increase screening attendance. The intervention materials addressed the multiple barriers shown to be associated with participation in earlier studies. Adults ages 55-64 (N = 2,966), in a "harder-to-reach" group were randomized either to receive an intervention brochure or to a standard invitation group. Attitudes and expectations were assessed by questionnaire, and attendance at the clinic was recorded. Compared with controls, the intervention group had less negative attitudes, anticipated a more positive experience, and had a 3.6% higher level of attendance. These results indicate that psychoeducational interventions can provide an effective means of modifying attitudes and increasing rates of screening attendance.     

Limits of the processing view in accounting for dissociations among memory measures in a clinical population

In three experiments, we examined the performance of patients with schizophrenia on implicit and explicit memory tests that have been shown to involve predominantly data-driven or predominantly conceptually driven processes. In Experiment 1, we compared the implicit tests of category production (conceptually driven)and word identification (data driven) and found that schizophrenic patients’ performance on these tests did not differ from that of normal subjects. In Experiment 2, a comparison of the category-production and explicit cued-recall tests, both of which involve conceptual processes, showed that schizophrenic patients were impaired on the cued-recall test but not on the category-production test. In Experiment 3, a comparison of the word-identification and explicit graphemic cued-recall tests, both of which involve data-driven processes, showed that patients were impaired on the cued-recall test but not on the word-identification test. The results of both Experiments 2 and 3 revealed a dissociation between implicit and explicit test performance under conditions in which the two tests involve similar- types of processes. These results support theoretical views that distinguish implicit from explicit modes of retrieval.     

A survey of smoking status and cancer risk perceptions among participants attending a hospital-based head and neck screening program

Abstract Screening for head and neck cancer is underutilized. Given that lack of knowledge of the risk factors may partially account for screening underutilization. we surveyed subjective risk and knowledge of risk factors for head and neck cancer among 124 individuals who attended a free. hospital-based head and neck cancer screening. Few participants were current smokers. Most attendees perceived their risk as similar to others of their age and sex. Personal health habits comprised almost all of the risk-decreasing factors, yet less than half of the risk-increasing factors. generated. Personal habits were less frequently endorsed than factors such as pollution and heredity. Those who mentioned a risk behavior, or a family cancer history, reported higher subjective risk. Those who mentioned a personal health habit reported lower subjective risk. Results highlight needed efforts to increase screening among high-risk individuals through targeted education messages.     

Assessment of quality of life in a multicultural cancer patient population

Quality of life (QOL) is increasingly assessed in cancer patients. In this article, the authors examined the psychometric performance of a commonly used QOL questionnaire, the Quality of Life Questionnaire--Cancer 30 (QLQ-C30; N. K. Aaronson et al., 1993), in multiethnic cancer patients. Content validation studies in patients and clinicians identified possible new items. Multiple-group confirmatory factor analysis supported equivalent structure across ethnic groups (Caucasians and Asian/Pacific Islanders [APIs]). A higher order QOL factor appeared to directly affect functioning scales and symptom count. Exploratory factor analysis examined effects of new items. Ten factors were extracted, 6 consistent with the original instrument and 4 reflecting potentially new aspects of QOL: Positive Social Support, Coping, Existential Well-Being, and Sexuality/Intimacy. The QLQ-C30 appears appropriate for use in API cancer patients. Further work needs to ensure that it includes all important domains.     

Development and preliminary validation of a Chinese version of the Buss-Perry Aggression Questionnaire in a population of Hong Kong Chinese

I developed a Chinese version of the Aggression Questionnaire (Buss & Perry, 1992) by translating scale items into Chinese and subjecting them to standard validation procedures. I used confirmatory factor analysis via structural equation modeling to compare several measurement models. Models based on Buss and Perry's (1992) original four-factor (29-item) scale failed to replicate in the Chinese sample; however, the construct validity of Bryant and Smith's (2001) abridged version of the Aggression Questionnaire received strong overall support. The new 12-item scale demonstrated good fit to the data and adequate internal reliability. Evidence for criterion validity was provided by the scale's sensitivity to differing levels of aggression in males and females. Convergent and discriminant validity received partial support from the pattern of correlations with a measure of anger rumination. Linguistic and metric equivalence were supported by high correlation coefficients between scores on Chinese and English versions of the scale completed by bilingual Chinese on separate occasions. Consistent replications of these preliminary results across three independent samples suggest that the Chinese version of the Aggression Questionnaire may be useful for clinical assessment and cross-cultural research.     

Frequency of cervical and breast cancer screening rates in a multi-ethnic female college sample

This exploratory study examined frequency of self-reported cervical and breast cancer screening rates in a multiethnic sample of 331 female university students. In general, rates of lifetime screening were fairly low, with only 41% reporting having ever had a PAP examination and 44% reporting having undergone at least one clinical breast examination. Screening rates differed by ethnicity. Non-Hispanic White and African-American women had higher screening rates than Asian/Pacific Islander and Latina women. The significantly lower rate of screening among the latter groups is of particular concern given the higher cancer mortality rates typically observed in those groups.     

A structural model of the relationships among stress, coping, benefit-finding and quality of life in persons diagnosed with colorectal cancer

This study has used the structural equation modelling to examine the role of benefit-finding (BF) in the context of the stress and coping model. In the study, 1276 individuals diagnosed with colorectal cancer completed a written questionnaire and telephone interview at around 4.5 months (on average) and 12 months post-diagnosis. Analyses revealed that the final model fit the data, where stress, coping and BF accounted for 63% of the variance in Time 1 quality of life (QOL). Threat appraisal, coping resources, avoidant coping and BF directly impacted on Time 1 QOL, while threat appraisal, social support and approach coping directly impacted on BF. Approach coping and BF had differential relationships with stress, coping resources and outcomes, indicating that BF may not be a meaning-based coping strategy, as proposed by Folkman [Folkman, S. (1997). Positive psychological states and coping with severe stress. Social Science and Medicine, 45, 1207–1221]. Theoretical and clinical implications are discussed.     

Evoking analogue subtypes of panic attacks in a nonclinical population using carbon dioxide-enriched air

The increasing recognition that panic attacks are heterogeneous phenomena necessitates better and more objective criteria to define and examine what constitutes a panic attack. The central aim of the present study was to classify subtypes of panic attacks (i.e. prototypic, cognitive, and non-fearful) in a nonclinical sample (N = 96) based on the concordance/discordance between subjective and physiological responding to multiple inhalations of 20 and 13% CO2-enriched air. Results show that a substantial proportion of this nonclinical sample (55.2%) responded to the CO2 challenge in a manner consistent with clinical and research definitions of different subtypes of panic attacks. The implications of this dimensional approach for discriminating subtypes of panic in the laboratory are discussed as a means to better understand the phenomenology and nature of panic attacks.     

A population-based 2-year longitudinal study of insomnia disorder in a Chinese population in Hong Kong

There is a paucity of literature examining the longitudinal course of insomnia using standardized diagnostic criteria. This study aims to evaluate the persistence, remission, relapse, and incidence rates of insomnia symptoms and insomnia disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th edition (DSM-IV and DSM-5). A total of 398 community dwellers were interviewed annually over two years using the Brief Insomnia Questionnaire, a validated questionnaire for deriving insomnia diagnoses. Normal sleepers were defined according to the DSM-5 quantitative criteria as having insomnia symptoms at most twice per week. Estimates were weighted against population age and sex distribution. Persistence for two consecutive years was 26.3, 26.4, and 23.0% for insomnia symptoms, DSM-IV, and DSM-5 insomnia disorders; remission rate was 55.8, 22.9, and 26.1%, relapse rate was 21.8, 1.3, and 0%, while incidence rate was 62.4, 19.6, and 4.5%. The common trajectories for DSM-IV insomnia disorder were to remain the same (26.4%), followed by a change to insomnia symptoms at the second year (25.7%), and at the third year (17.3%). For DSM-5 insomnia disorder, a change to insomnia symptoms at the second year was the commonest (28.3%), followed by continuing the same (23.0%), and a change to insomnia symptoms at the third year (14.0%). Over a two-year naturalistic follow-up, persistence of insomnia disorder was roughly 25%. Changes from insomnia disorder to insomnia symptoms were common; however, remission only occurred in about 25%, highlighting the chronic course of insomnia, perhaps due to a lack of treatment, under-treatment, or resistance to treatment. Incidence of insomnia symptoms was 62.4%, suggesting a high risk of developing insomnia in the general population.     

Examination of the screening properties of the personality diagnostic questionnaire 4+ (PDQ-4+) in a prison population

There is a high prevalence of personality disorder in most prison populations. Many pass through the system undiagnosed. A screening instrument would improve identification. This study examined the screening properties of the Personality Diagnostic Questionnaire-4+ (PDQ-4+) in prisoners convicted of violent and sexual offenses. A sample of British prisoners completed the self-report PDQ-4+ and were interviewed using the Structured Clinical Interview for DSM-IV Axis II disorders. When used to generate a total score, the PDQ-4+ had an acceptable overall accuracy as measured by the area under the Receiver Operating Characteristics (ROC) curve. The PDQ-4+ appears to have the properties suitable for use as a screening instrument, particularly when screening for the presence or absence of personality disorder rather than for individual personality disorder categories. A graph is presented from which choices of cut-off score for different combinations of sensitivity and specificity can be made. A cut off total score of 25 or above yielded near optimal sensitivity and specificity. The suggested cut off score for this population is lower than that previously suggested.