Rosalie F. Young

Breast cancer screening barriers and mammography completion in older minority women

AbstractObjectives. The study tested a behavioral and structural barriers model of breast cancer screening, while seeking to determine age effects of behavioral barriers, in order to identify the factors that inhibit screening among older, minority women. Methods. 405 older African-American women eligible for a federally funded cancer screening program were enrolled in the study. Participants were administered an intake questionnaire and followed for 3 months to determine mammography use. Results. Three months after enrollment in the program, 79% had not received breast cancer screening. The oldest cohort had significantly lower rates of mammography (just 16% of screened women were ≥60, p<0.05). Behavioral barriers (knowledge/information deficits, cancer risk perception, cancer fears) inhibited mammography in the oldest group; their breast cancer information deficits included less knowledge of breast cancer risk, treatment, and survivability (all p<0.001). Conclusions. Older women, with greater breast cancer risk than younger cohorts, should be targeted as a high need population for cancer screening. Even when financial and insurance barriers are removed mammography rates are 1/3 those of women <50. Since failure to be screened is related to knowledge and information barriers, health care providers have the potential to educate their older patients and subsequently increase the likelihood they will have regular cancer screening.

Strategies of Coping and Postinstitutional Outcomes

This study investigated the relationship between diverse self-reported coping strategies and well-being among 253 older adults entering 14 long-term care facilities. Data were also obtained about the nature of coping and the stability of coping strategies from the preinstitutional to three-months postinstitutional period. Results based on a 22-item coping scale revealed three underlying coping dimensions: instrumental, affective, and escape.

Relative androgenicity, blood pressure levels, and cardiovascular risk factors in young healthy women

To test the hypothesis that androgens may play a role in the pathogenesis of atherosclerosis and hypertension, we investigated the association of delta 5 dehydroepiandrosterone sulfate [DHEAS]) and delta 4 (free testosterone [FT]) androgens with the resting, seated blood pressure (BP) levels and cardiovascular risk factors in 280 young, healthy women 18 to 24 years of age. After application of multiple regression analysis, systolic BP was positively and independently correlated with the ratio of dehydroepiandrosterone sulfate to free testosterone (DHEAS/FT), fasting insulin levels, and the diastolic BP with DHEAS/FT only. The DHEAS/FT ratio proved to be a stronger predictor of the BP levels than either hormone alone. Further, uric acid concentrations and HDL/total cholesterol ratio were independently correlated with both FT and body mass index in these young women. Serum triglycerides were independently correlated with FT and central body fat distribution. These data suggest that serum androgen concentrations are important independent predictors of cardiovascular risk factors and that the ratio of dehydroepiandrosterone sulfate to free testosterone ratio is an independent predictor of blood pressure levels in young women.

Health status, health problems and practices among refugees from the Middle East, Eastern Europe and Southeast Asia.

Recent refugees from Poland, Romania, Iraq, and Vietnam were extensively interviewed to assess their health, health care utilization and health service use barriers. Two hundred seventy-seven recent arrivals from these countries and sixty-three previously arrived Laotians comprised the sample. Results from a 195 item bilingual questionnaire indicated good overall health and little evidence of serious physical health symptoms. Dental health was the area of greatest reported need. Prenatal care and mental health services were additional areas of need noted by researchers. Barriers to health service utilization were primarily language related. There were major differences in both health problems and health service utilization among the four groups surveyed.

The family-illness intermesh: Theoretical aspects and their application☆

Illness analysis, according to one aspect of the Parsons deviance framework, proposes dysfunction to the family system and society. Largely accepted for many years, there are important deficiencies of the conceptualization which are not present in another theoretical stance. This latter formulation focuses on adaptive responses of families to stress and can be envisioned as adding an emphasis on mutuality of family-illness encounters. It is offered as a tool for theoretical enrichment which can supplement the original framework, broaden the analytic base and be applied in clinical settings by practitioners in medical and therapy fields who wish to investigate positive versus negative consequences of the family-illness intermesh.

Age, medical advice about cardiac risk reduction, and patient compliance.

This study investigated the physicians role in proffering appropriate medical advice to aged patients and the patients role in complying with that advice. Heart disease, which takes a major health toll among the aged but is amenable to risk reduction practices, exemplifies a condition that offers physicians the opportunity to play an important health promotion role. The advice given by physicians to 246 heart patients and their compliance with the advice is the subject of this article. Data were obtained from a longitudinal study of recovering myocardial infarction patients aged 60 and over (n = 204), and a comparison group of patients aged 45-59 (n = 42). The patient cohorts were similar in health and demographic factors. Findings from interviews conducted six weeks after hospital discharge indicated major age differences in cardiac risk reduction advice given by physicians, but no age effects of patient compliance with the medical advice. Neither preinfarction nor postinfarction cardiac health were factors in compliance. Findings suggest that older patients are systematically denied the opportunity for lessening risk of future heart problems by adopting behavioral changes, despite a lack of evidence that aged heart patients will not adhere to medical advice to engage in these changes. Suggestions are given for interventive efforts directed at both physicians and patients.

Primary Care of Overweight Children: The Importance of Parent Weight and Attitudes about Overweight: A MetroNet Study

Purpose: The purpose of this study was to identify the association of parents’ weight and attitude about their childsweight with the childsbody mass index (BMI) status. Design: Cross-sectional, clinic-based study in a practice-based research network. Methods: One hundred seventy-one parents or adults accompanying children aged 5 to 17 years to a primary care visit in 4 family medicine centers completed a questionnaire. Parent/adult overweight status and attitudes were compared with child overweight status. Results: Forty-eight percent of children were overweight or obese (BMI ≥ the 85th percentile) as were 56% of mothers and 77% of fathers (BMI ≥ 25 kg/m2). Child and parent overweight were significantly associated, as were mother overweight and beliefs about child overweight status. Children aged 5 to 13 years were more likely to be overweight than those aged ≥14 years. Conclusions: Parents of overweight children are often overweight and many do not recognize that their children are overweight. Suggestions are made for primary care physicians to engage parents of overweight children in family weight control efforts.

Elders, families, and illness

Abstract While it is clear that illness of an elderly family member affects the family in many ways, there are few models of the family-illness intermesh. This article presents conceptual approaches to the issue that are related to health of elders. They are based on assumptions of mutality in the family-illness encounter; i.e. that while illness affects the family unit the latter also affects the course of, and outcomes from, an illness episode. The first model that is introduced to conceptualize the family illness encounter at later life proposes a complex set of interactions. The second model builds upon the first and proposes, (a) a dyadic focus and, (b) diversity in family response patterns. The models were empirically tested among families dealing with heart problems of an elder. The tests verified mutuality in the family illness interface as well as showing the diversity of dyadic responses. They suggest a complex set of interactions that constitute the family illness encounter at later life.

Nursing home admission of female Alzheimer’s patients: family care aspects

This study examined patterns of nursing home admission for males and females with Alzheimers disease. It also examined reasons why women may be less likely to remain in home and family-based care. A 2-year, four-wave follow-up study was conducted among 573 patients and their family caregivers. Results from logistic regression analyses showed that females and males were institutionalized for different reasons. Men were institutionalized primarily for medical and caregiving need factors. Women showed less physical and less cognitive impairment, and their model of placement showed more importance of family caregiving patterns.

Testing a Symmetrical Model of Caregiving Outcomes During Recovery from Heart Attacks

This study focused on predictors of psychological distress among caregivers to elderly patients with heart disease using a symmetrical model of caregiving stress. Based on a 1-year longitudinal study of 104 caregiver-care receiver dyads, findings indicate that caregivers continue to face challenges a year after the initial heart attack. Psychological distress of the recovering heart patient plays an important role in predicting caregiver psychological distress. In contrast, patient cardiac symptoms and functional limitations showed no effects. Among caregiver characteristics, physical health, prior psychological distress, and caregiver burden were significant predictors of caregiver psychological distress. Finally, caregiving hours displayed an unexpected negative direct effect on caregiver distress. However, the indirect effect of caregiving hours on distress (via burden) was in the expected positive direction. These data support the usefulness of symmetrical models that consider characteristics of both members of the caregiving dyad in predicting caregiving outcomes.