Lifestyle differences between smokers,ex-smokers and non-smokers,and implications for their health

Abstract

Much evidence has been published in order to demonstrate that smoking cessation leads to a decrease in morbidity and mortality. Using data from the Health and Lifestyle Survey respondents were divided into three groups: smokers, ex-smokers and non-smokers and lifestyle characteristics such as diet and exercise were compared. Smokers were more likely to eat chips (French fries), fried food, butter and less likely to eat fresh fruit in winter, green vegetables and margarine high in polyunsaturated fats. Non-smokers were more likely than smokers and ex-smokers to take part in keepfit, jogging and swimming. Non-smokers in smoking households were more likely than non-smokers in non-smoking households to eat fried food, chips and butter and less likely to eat fruit in winter or margarine high in polyunsaturated fats. Results suggest that part of the assumed health benefits of smoking cessation are due to ex-smokers having a healthier diet than that of smokers.     

‘Use what God has given me’: Difference and disparity in breast reconstruction

African-American women are significantly less likely to undergo postmastectomy breast reconstruction compared to white women in the USA. These observed differences have been interpreted as evidence of a healthcare disparity. The current study examines breast reconstruction decision-making among African-American women, locating reconstruction decisions in a context of culture, racial inequality and biomedicalisation. Semi-structured interviews were conducted with 27 African-American women who underwent mastectomy for breast cancer to add patient-centred perspectives to existing conceptualisations of racial/ethnic differences in reconstruction. Participants were socio-demographically diverse, and resided in the New York metropolitan area. Data analysis was informed by grounded theory. Spiritually and culturally informed body ethics often guided surgery decisions. Participants expressed reservations about breast implants, preferring autologous procedures that use ‘what God has given’. For some, breast reconstruction restored a sense of normalcy after cancer; others challenged an imperative to reconstruct. Several participants redirected our focus on access to reconstruction toward access to alternatives, noting the low reimbursement for prostheses, or their unavailability in patients’ skin tones. We suggest that a framework of ‘stratified biomedicalization’ better addresses the complexities of race, class and gender that inform preference, access and recommendations for breast reconstruction, and focuses attention on access to high and low-tech interventions.     

The regulation of subjective well-being in cancer patients: An analysis of coping effectiveness

Abstract

The hypothesis that individual coping efforts affect subjective well-being in the face of severe chronic disease is examined with questionnaire data from N=332 cancer patients in a one-year longitudinal study. After depicting conceptual and methodological requirements for the analysis of coping effectiveness, the following five coping modes were investigated in the sample: Rumination, search for affiliation, threat minimization, search for information and search for meaning in religion. Results from a series of hierarchical regression analyses yielded findings that questioned the underlying assumption of a general uniform causal direction within coping-adjustment relationships. Threat minimization proved to be the only coping mode that obviously was “effective” in well-being regulation, that is, was revealed to be predictive of well-being changes over time and to be unaffected by prior levels of well-being. It is argued that the problem of causal directionality has to be carefully examined in future studies on coping effectiveness since interindividual differences in coping behaviors might be a consequence rather than the cause of differences in adjustment status.     

Risk-appraisal,outcome and self-efficacy expectancies: Cognitive factors in preventive behaviour related to cancer

Abstract

Health education often attempts to influence or persuade through risk-appraisal of impending danger or harm. Risk: appraisal implies cognitive processes concerning the severity of the threatening event and the probability of its occurrence. In two studies we investigated whether risk factors could adequately predict preventive behaviour with respect to cancer. The tint study concerned the health belief model. the second study the protection motivation theory. Protection motivation theory includes the health belief factors but also self-efficacy expectancy. The most important finding is that risk-appraisal does not predict preventive behaviour adequately: outcome expectancy and self-efficacy expectancy should be included in the prediction of preventive behaviour. In general, our findings suggest the superiority of the protection motivation theory to the health belief model in predicting preventive behaviour with respect to cancer.     

Impact of the telephone motivational interviewing on the colorectal cancer screening participation. A randomized controlled study

IntroductionWhile high participation rates ensure the cost-effectiveness of colorectal cancer screening programs, it is well known that postal requests do not achieve acceptable levels of participation.ObjectiveThis randomized controlled study aimed to test the impact of individualized phone counseling to prompt people aged 50 to 74 to take a colorectal cancer test.MethodTwo phone strategies were compared. The first involved computer-aided individualized counseling while the second was based on motivational interviewing. A total of 49,972 people were randomly assigned to a control group (CG) and to the individualized counseling (IC) and motivational interviewing (MI) telephone groups.ResultsA simple call doubled the participation rate per protocol (19.2% > 9.2%; p < .001; r = .131; OR = 2.374), and tripled it when the interview was conducted (30.4% > 9.2%; p < .001; r = .219; OR = 4.321). In an intention-to-treat analysis, the benefit of calling by phone remained even higher than postal requests (10% > 9.2%; p < .01; r = .014; OR = 1.103). However, there was no impact of the type of interview on participation rates.ConclusionThe results are discussed for future research.     

Perceived positive and negative consequences after surviving cancer and their relation to quality of life

Surviving childhood cancer has multiple implications on both physical and psychological domains of the individual. However, its study and possible effects on health‐related quality of life (HRQoL) outcomes of adolescent survivors has been understudied. The objective of this study was twofold; to assess positive and negative cancer‐related consequences (psychosocial and physical) in a sample of adolescent cancer survivors and to explore their relationship with HRQoL outcomes. Forty‐one participants answered two questions about positive and negative consequences in the aftermath of cancer and filled in the KIDSCREEN‐52 self‐reported version. Data were analysed using mixed methods approach. Overall, 87.8% of the studied sample identified positive consequences and 63.4% negative consequences in survivorship. Four positive categories and five negative categories with regard to cancer‐related consequences were found. Changed perspectives in life narratives seem to be the positive consequence more related to HRQoL (physical well‐being, mood & emotions, autonomy, social support & peers), followed by useful life experience (physical well‐being, autonomy, social support & peers). Psychological impact was the most referred negative consequence with a significant detrimental effect on social support and peers HRQoL dimension. Even if the majority of survivors reported benefit finding in the aftermath of cancer, concomitant positive and negative consequences have been found. However, findings only reveal a significant relationship between positive narratives and HRQoL, and negative consequences do not seem to have a significant influence on overall HRQoL in survivorship.     

集体心理干预对癌症患者应对方式影响的研究

为了探索集体心理干预对癌症患者应对方式的影响,本研究在90名癌症患者中随机选取46人进行干预研究。为考察干预效果,在干预后分别以医学应对方式问卷各维度因子的前测得分为协变量,以医学应对方式问卷各维度因子的后测得分为因变量,进行2(分组:实验组、对照组)×2(性别:男、女)×3(年龄:低龄组、中龄组、高龄组)的三因素协方差分析。结果表明,经过集体心理干预的实验组在应对方式各分量表上的得分要显著高于对照组,集体心理干预在性别和年龄上不存在显著差异。研究结果表明集体心理干预能够有效地改善癌症患者的应对方式。     

Helpful processes in psychological therapy for patients with primary cancers: A qualitative interview study

Aims: The purpose of this study was to identify what patients with primary cancers found helpful in therapy. Method: In‐depth qualitative interviews were conducted with eight patients who had completed a course of psychological therapy within an NHS psychology service for cancer patients. Data were analysed using thematic analysis. Results: The participants identified a range of helpful processes in therapy: talking and expressing their feelings to someone outside of the family; forming a relationship with their therapist; normalisation through the therapists' expert knowledge; problem‐solving and CBT. Limitations: As with all qualitative studies, the small sample and size and dependence on participant recall limits generalisability of the findings. Implications: The findings of this study are consistent with a pluralistic perspective: that multiple therapeutic processes ‐ aligned to a range of different orientations ‐ can be of value to patients with primary cancers. This supports the provision of a range of therapeutic interventions and strategies for this patient group.     

宫颈癌根治术前预处理减少输尿管损伤及下肢静脉血栓临床观察

通过对术前考虑盆腔粘连可能比较严重的宫颈癌根治术（RH）术中穿着医用弹力袜行双下肢弹力加压,并经膀胱镜放置输尿管导管作预处理,减少下肢静脉血栓及输尿管损伤的临床效果。回顾性研究在我院行手术治疗的术前考虑盆腔粘连可能比较严重的宫颈癌患者364例,其中182例接受广泛子宫切除及盆腔淋巴结清扫术,术中穿着医用弹力袜行双下肢弹力加压,作为研究组,另182例单纯接受广泛子宫切除及盆腔淋巴结清扫术,未作预处理,作为对照组。结果研究组无一例损伤输尿管,对照组2例发生输尿管损伤（P ＜0．05）。因此,术前考虑盆腔粘连可能比较严重的 RH 术中穿着医用弹力袜行双下肢弹力加压,并经膀胱镜放置输尿管导管常规作预处理,可明显减少下肢静脉血栓、尿潴留及输尿管损伤,值得临床推广应用。