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PubMed2002

Knowledge and beliefs among brothers and sons of men with prostate cancer.

OBJECTIVES: To describe prostate cancer knowledge and beliefs, important predictors of screening behavior, in first-degree relatives of men with prostate cancer and to compare the knowledge with beliefs about familial risk. METHODS: We sent a letter to 837 men with prostate cancer to invite their brothers and/or sons aged 40 to 70 years to participate in the study. Their first-degree relatives who responded received a survey to explore their prostate cancer family history, prostate cancer knowledge, self-efficacy, barriers to screening, perceived benefits, perceived vulnerability, social support, and sociodemographic and medical characteristics. RESULTS: Of 139 participants (age 53 +/- 9 years), 92% were white, and 27% had more than one relative with prostate cancer. Ninety-eight percent of men answered at least one half of the knowledge questions correctly. Older men responded correctly more often than did younger men. Physician recommendations did not appear to be associated with better knowledge about familial risk. Among the 105 subjects (76%) who knew about familial risk, only 65 (62%) believed they themselves were at higher risk of prostate cancer than the average American man. Most of the beliefs were favorable to screening. CONCLUSIONS: Prostate cancer knowledge appeared high, although, surprisingly, familial risk was not the best understood domain. Physician recommendations were not associated with better knowledge about familial risk. Many men underestimated their own risk of developing prostate cancer, even among those with good knowledge about familial risk.

Adult↗
PubMed1995

Cell transformation by c-Ha-rasVal12 oncogene is accompanied by a decrease in histone H1 zero and an increase in nucleosomal repeat length.

The activated c-Ha-rasVal12 oncogene is often involved in the genesis of human malignancies. We show here that in c-Ha-rasVal12 oncogene-transformed mouse NIH 3T3 fibroblasts the copy number and expression level of the mutant ras oncogene correlates with the degree of chromatin decondensation, as assessed by micrococcal nuclease (MNase) and DNase I digestion. MNase and DNase I analyses further revealed that the nucleosomal repeat lengths were different in the normal and ras oncogene-transformed cells, 162.3 bp and 178.1 bp, respectively. These chromatin changes were accompanied by alterations in the content of histone H1 zero. Furthermore, using DNase I as a probe, we discovered that serum stimulation of normal and transformed cells, synchronized by serum starvation, induces rapid reversible changes in the structure of bulk chromatin that may be linked to transcriptional activation. Our data thus indicate that cell transformation by ras is associated with specific changes in chromatin structure that make it more vulnerable, and prone to additional mutations characteristic of cancer development in vivo.

3T3 Cells↗
PubMed2004

Perceived barriers and benefits to cervical cancer screening in Latin America.

BACKGROUND: This article describes the results of studies on the barriers and benefits of cervical cancer screening from the perspective of women, men, and health providers in five Latin American countries and compares them to other findings from the literature. METHODS: Five separate qualitative studies (focus groups and interviews) were conducted among low-income women in Venezuela, Ecuador, Mexico, El Salvador, and Peru regarding barriers and benefits of cervical cancer screening. Views from health providers and men were also included. RESULTS: The main barriers identified by all participants are accessibility and availability of quality services, facilities that lack comfort and privacy, costs, and courtesy of providers, which interact with poor service delivery. Barriers that pertain to women's beliefs are anxiety borne by women awaiting test results, associated with negligence and fear of cancer (although not to a particular cancer or a particular procedure). Benefits of screening are peace of mind and being in control of their health, which then enable other life activities to continue unhindered. CONCLUSIONS: Except for the accessibility and availability of quality services, these results are consistent with findings from other studies in developed and developing countries. Barriers could be lifted if health service delivery was enhanced, for instance, through quality improvement techniques that are available at low cost. Women's anxiety over test results still needs to be further assessed to devise risk communication strategies that take into account broader cultural frameworks. It is to be noted that such strategies should permeate the way health services are provided for cervical cancer prevention regardless of the specific test used. Vulnerability perceived by low-income women with respect to their capacity to cope with diseases and trust the health services and how this affects their perceptions of risk and their behaviors have not been studied as yet.

Adult↗
PubMed1977

Epidemiologic pathology of gastric ulcer and gastric carcinoma among Japanese in Hawaii.

This case-control study of Hawaiian Japanese indicated that gastric ulcer in the proximal portion of the pyloric antrum has features similar to those of gastric cancer. Such ulcers occurred at sites most frequently and most severely affected by intestinal metaplasia, although metaplasia tended to be more extensive with cancer than with ulcer. Metaplastic mucosa was more vulnerable to the action of pepsin and acid than was normal mucosa. The risk of ulceration would rise when a sufficiently lagrge area of the antrum was intestinalized and when the corpus continued to produce significant quantities of these substances. This study showed a strong association between salt intake, ulcer, and metaplasia. Significant but less dramatic associations were demonstrated between metaplasia and the use of traditional Japanese foods and smoking. The question was raised as to whether salt promotes ulceration or whether it potentiates the action of a mutagen that causes intestinal metaplasia.

ABO Blood-Group System↗
PubMed1997

Deep-plane cervicofacial "hike": anatomic basis with dog-ear blepharoplasty.

The temporal and cheek areas are particularly vulnerable to sun damage and therefore to skin cancers. Rotation-advancement flaps are used commonly in the reconstruction of these regions following resection of skin cancers. Such flaps usually are modifications of the Mustardé, cervicofacial, and Juri flaps. The drawbacks to these flaps relate to a random, unpredictable perfusion with skin loss at the distal flap tip, a vertically oriented dog-ear that predictably is located on the cheek, and the risk of gravitational and cicatricial forces acting on the lower eyelid causing ectropion. The deep-plane technique for raising cheek flaps, as has been described recently for use in rhytidectomy, allows the plastic surgeon to address both drawbacks of the standard cervicofacial flaps. The vertical "hike" deep-plane approach addresses both drawbacks of the rotation-advancement flaps by including better perfusion and superior mobility after release of restraining ligaments. We describe the anatomic rationale for the deep-plane dissection of the cheek in cadaver studies and present our clinical technique with a vertical "hike" cheek advancement with removal of the horizontally oriented dog-ear as in a blepharoplasty. This single-stage technique will be called the deep-plane "hike" flap. The vertically advanced flap must be slightly overcorrected by anchoring the flap to the periosteum just above the recipient defect. This deep fixation removes all tension from the skin and prevents ectropion. This single-stage reconstruction affords excellent cosmetic results without compromising any future reconstructive efforts.

Aged↗
PubMed1990

Managing noncompliance in the 'difficult' medical patient: the contributions of insight. A case report.

Psychodynamics can interfere with medical compliance, especially in psychologically vulnerable patients. A case is presented of a cancer patient who developed a powerful transference reaction to her oncologist, jeopardizing her treatment for cancer. Strategies for integrating techniques of insight-oriented psychotherapy with those of supportive psychotherapy are discussed in managing such reactions and improving compliance.

Adenocarcinoma↗
PubMedDate not supplied

Macrophage-targeted photodynamic therapy.

Photodynamic therapy (PDT) uses light activatable molecules that after illumination produce reactive oxygen species and unwanted tissue destruction. PDT has dual selectivity due to control of light delivery and to some extent selective photosensitizer (PS) accumulation in tumors or other diseased tissue, additional targeted selectivity of PS for disease is necessary. The delivery of drugs to selected lesions can be enhanced by the preparation of targeted macromolecular conjugates that employ cell type specific targeting by ligand-receptor recognition. Macrophages and monocytes express a scavenger-receptor that is a high-capacity route for delivering molecules into endocytic compartments in a cell-type specific manner. We have shown that by attaching PS to scavenger-receptor ligands it is possible to get three logs of selective cell killing in macrophages while leaving non-macrophage cells unharmed. The capability to selectively kill macrophages has applications in treating cancer and in the detection and therapy of vulnerable atherosclerotic plaque and possibly for autoimmune disease and some infections.

Animals↗
PubMedDate not supplied

Changes in body image experienced by adolescents with cancer.

Cancer and its treatments affect adolescents' body image. However, it is not known what factors impinge on adolescents' perception of their body image. This multiple case study explored how 5 adolescents with cancer perceived their body image and the impact of this perception on their daily life. Adolescents described their body image as "I don't look normal," a theme that comprised 2 dimensions: "I look ugly" and "I look sick." For the adolescent with cancer, these 2 dimensions evoked feelings of being vulnerably exposed: "People look at me." Consequently, adolescents adopted a new set of coping strategies to help them manage their physical appearance and social interactions: "avoiding," "maintaining normality," "testing the waters," and "peer-shield" themes. Although the adolescents perceived their body image as altered, coping mechanisms enabled adolescents to think of themselves as normal and re-establish their social lives. The results of this small study suggest 2 potential nursing approaches to facilitate adolescents' adaptation to their new body image.

Adaptation, Psychological↗
PubMed2003

Health food store recommendations: implications for breast cancer patients.

BACKGROUND: Many breast cancer patients use complementary and alternative medicine (CAM). We aimed to determine what advice health food store employees present to individuals seeking treatment options for breast cancer. METHODS: Eight data gatherers asked employees of all retail health food stores in a major Canadian city, what they recommended for a patient with breast cancer. The data gatherers inquired about product safety, potential drug interactions, costs and efficacy. They also enquired about employee training related to the products. RESULTS: Thirty-four stores were examined. A total of 33 different products were recommended, none of which are supported by sufficient evidence of efficacy. The average cost of the products they recommended was 58.09 dollars (CAD) (minimum 5.28 dollars, median 32.99 dollars, maximum 600 dollars) per month. Twenty-three employees (68%) did not ask whether the patient took prescription medications. Fifteen employees (44%) recommended visiting a healthcare professional (naturopaths (9), physicians (5), nutritionists (1). Three employees (8.8%) discussed potential adverse effects of the products. Eight employees (23.5%) discussed the potential for drug interactions. Two employees (5.9%) suggested a possible cure with the products and one employee (2.9%) suggested discontinuing Tamoxifen. Four employees (11.8%) recommended lifestyle changes and three employees (8.8%) recommended books for further reading on the products. CONCLUSION: This study draws attention to the heterogeneity of advice provided by natural health food stores to individuals seeking treatments for breast cancer, and the safety and cost implications of some of the products recommended. Physicians should enquire carefully about the use of natural health food products by patients with breast cancer. Regulators need to consider regulations to protect vulnerable patients from incurring significant costs in their purchasing of natural health food products lacking evidence of benefit and of questionable safety.

Breast Neoplasms↗
PubMed2003

Influenza vaccination in elderly patients with advanced colorectal cancer.

PURPOSE: To examine influenza vaccination use in patients undergoing chemotherapy for advanced cancer. METHODS: All Medicare patients treated for stage IV colorectal cancer between 1993 and 1998 while living in one of the regions monitored by the Survival, Epidemiology, and End Results Program who were alive in the fall months and who survived at least 4 months with their cancer were considered eligible to have received vaccination. Their medical bills were analyzed to determine receipt of influenza vaccination and subsequent outcomes. RESULTS: Eligibility criteria were met by 1,225 patients who were undergoing chemotherapy during 1,577 person-years of observation. Overall, 39.7% of patients received influenza vaccination, increasing from 26% in 1993 to 43% in 1998. When vaccination was administered, it was provided by primary care physicians 68% of the time. Vaccinated patients were more likely to be white, of higher socioeconomic status, and to have more comorbidity. Fewer diagnoses of influenza and pneumonia infections were made in vaccinated patients while undergoing treatment. Those patients who were immunized also had fewer chemotherapy interruptions and were more likely to survive through to the beginning of the next fall (hazard ratio, 0.88; 95% confidence interval, 0.77 to 0.99). There was a trend toward decreased resource use among immunized patients. CONCLUSION: This study observed outcomes associated with influenza vaccination that are similar to those reported for patients without cancer. However, rates of immunization are relatively low, and disparities exist for vulnerable populations. As part of delivering high-quality care, oncologists should promote influenza vaccination for their patients who are undergoing treatment for advanced cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Preventive care for women in prison: a qualitative community health assessment of the Papanicolaou test and follow-up treatment at a California state women's prison.

Growing evidence indicates that women in prison are particularly vulnerable to many negative health outcomes, including cervical cancer. The Papanicolaou (Pap) test is an effective tool to screen for this disease. To determine what is and is not working with the Pap test and follow-up treatment, we performed qualitative interviews with women prisoners and key informants at a California state women's prison. Our assessment revealed that the process of administering Pap tests at this institution was not meeting the health care needs of the women interviewed. Women reported having negative experiences during the test and with their health care providers. Additionally the prison's culture and infrastructure create obstacles that hinder prisoners from receiving quality care and providers from delivering that care. In response, women prisoners use self-and community advocacy to meet their health care needs and cope with these challenges.

Adaptation, Psychological↗
PubMed1999

Health problems of lesbian women.

Lesbians are visible to society, health care providers, and researchers as women, not as an identified sub-group of women. Lesbian invisibility contributes to their collective increased vulnerability, as evidenced by decreased societal and environmental resource availability, threats to social connectedness, and barriers in accessing health care. The factors that have led to increased vulnerability have shown up in risks of violence, cancer, HIV/AIDS, and chemical dependency among lesbians.

Female↗
PubMed2001

Alcohol and hepatitis C.

Infection with the hepatitis C virus (HCV) has become a leading cause of scarring of the liver (i.e., fibrosis) and cirrhosis in the United States. HCV-related cirrhosis (with its associated complications, such as liver cancer) is a major cause of death, although it develops slowly and occurs only in approximately one-third of HCV-infected patients. Alcohol can exacerbate HCV infection and the associated liver damage by causing oxidative stress and promoting fibrosis, thereby accelerating disease progression to cirrhosis. Furthermore, alcohol may exacerbate the side-effects associated with current antiviral treatment of HCV infection and impair the body's immune defense against the virus. Of the HCV-infected people who do not consume alcohol, only a minority progresses to severe liver disease and requires antiviral treatment. Because alcohol potentiates the fibrosis- and cancer-inducing actions of HCV, alcoholics are particularly vulnerable to HCV infection and most in need of treatment.

Alcoholism↗
PubMed1982

Population studies of polymorphism in drug oxidation and its relevance to carcinogenesis.

Metabolic oxidation plays a central role in both the detoxication and chemical activation of many environmental procarcinogens. A plethora of in vitro data suggests that metabolic activation and subsequent DNA covalent binding of such substances vary widely between individuals. The need for a simple test in vivo of human variability in metabolic oxidation is apparent, not only to help understand the variation in disposition of many drugs and other chemicals, but also as an aid to predicting individual cancer risk from metabolically activated procarcinogens. Current methodology has failed to provide such information for a number of reasons, which are discussed. A genetic polymorphism affecting the metabolic disposition and biological effects of a number of drugs is described. Persons can be phenotyped as either extensive or poor metabolizers, using the drug debrisoquine. The measured variable, urinary 'metabolic ratio', which is distributed across these two phenotypes with values of 0.1 to 200, gives a clear indication of the metabolic behaviour of many drugs and, possibly therefore, of certain procarcinogens. Accordingly, two groups of cancer patients were investigated with debrisoquine, namely Nigerians with hepatocellular and related tumours and white smokers with bronchial carcinoma in the United Kingdom. These preliminary studies are suggestive of a phenotype component in relative cancer risk, poor metabolizers appearing to be less vulnerable. Animal model data seem to confirm a relationship between aflatoxin B1 metabolism and DNA binding and polymorphic debrisoquine oxidation. It is concluded that the biological consequences of ingesting exogenous chemicals may be better understood from studies of discrete, genetically determined steps in their interaction with living systems.

Animals↗
PubMed1997

Mammalian G1 and G2 phase checkpoints.

This present review explores the mechanisms for DNA damage induced G1 and G2 arrest in mammalian cells. The complexity of the TP53 pathway is attested to by the variety of genes regulated by TP53, many of which require further investigation to bring their importance into focus. One gene intensely studied, p21, has been linked to the G1 arrest mechanism and may, like TP53, be involved in some aspect of DNA repair. The outcome of TP53 activation for cell survival is equally complex and relies much upon cellular context and the type of DNA damaging agent employed. Although TP53 may participate in sensing DNA damage, additional components are likely to be required. Much of the focus on defining the mechanism of G2 arrest in mammalian cells has concentrated on the cyclin B1/CDC2 kinase. Activation of this kinase is suppressed by DNA damage, and this may result from the imposition of inhibitory phosphorylations on the CDC2 kinase as well as downregulation of cyclin B1 levels. The logical point where the G2 checkpoint interacts with the CDC2-CDC25C autocatalytic loop to prevent CDC2 activation remains to be defined and could involve inhibition of CDC25C-CDC2 interaction. It is hoped that moving upstream of CDC2 towards the point where DNA damage is sensed by the cell will uncover homologues of yeast components implicated in G2 checkpoint control. The finding that certain G2 checkpoint abrogators preferentially synergize with DNA damaging agents in cells with defective TP53 provides a potential pharmacological route through which TP53 defective cells might be targeted for destruction. Further exploration of this vulnerability might prove useful for future anti-cancer drug discovery efforts.

Animals↗
PubMed1998

The aetiology of malnutrition in hospital.

Malnutrition is a largely unrecognised problem in hospitals. Older people, people with cancer, respiratory disease and gastrointestinal problems are particularly vulnerable.

Hospitalization↗
PubMed2005

Risk perception, optimistic bias, and readiness to change sun related behaviour.

BACKGROUND: The incidence of skin cancer has had a rapid increase in Sweden during the last 20 years. Sun exposure is an important preventable risk factor for skin cancer. It is essential to develop interventions to change people's exposure to the sun. The perception of own susceptibility to harm is essential in theories about self-protective behaviour. The aim of the present paper was to examine the associations between different risk perceptions, sun-related behaviour, readiness to change, and optimism bias. METHOD: A total of 722 visitors of a mobile skin cancer screening unit answered a questionnaire in the summer of 2001. The campaign was conducted at five different locations in Sweden. RESULTS: The participants in this study seemed to have realistic believes about the contribution of solar radiation to the risk of developing skin cancer, however, they seriously underestimated skin cancer incidence in the population and the impact of skin cancer on general health. CONCLUSION: People concerned about skin cancer seem to be aware of the fact that sun exposure is an important risk factor for skin cancer, but they fail to use this information in a consistent way to formulate a judgment of their own vulnerability to harm. People need to be informed about the high incidence of skin cancer, the personal risk factors of skin cancer, and the fact that unintentional as well as intentional sun exposure increases the risk of developing skin cancer.

Adolescent↗
PubMed1981

Psychosocial impact of gynecologic cancer.

The stress that a cancer diagnosis places on a patient and family is frequently aggravated by management and treatment, unless considerable attention is paid to psychologic and social coping and adaptational issues. Cancer arouses feelings of helplessness, dependency, guilt, alienation, and vulnerability, and depending on the stage of illness and on the degree of therapeutic mutilation of genital organs, long-term suffering may ensue unless attention is paid to the support-systems available to the patient. Support includes information sharing, exploring fears and fantasies, helping patients feel some element of control, and, not infrequently, putting patients in touch with others who had adapted to the experience. Considerable attention is now being paid to sexual counseling in recognition of the need for intimate bonding that exists in people. The physician's responsibility in cancer management is to provide resource directly or by referral in order to maintain the morale system of the patient and family over a long time period.

Body Image↗