Australian clinicians and chemoprevention for women at high familial risk for breast cancer

<p>Abstract</p> <p>Objectives</p> <p>Effective chemoprevention strategies exist for women at high risk for breast cancer, yet uptake is low. Physician recommendation is an important determinant of uptake, but little is known about clinicians' attitudes to chemoprevention.</p> <p>Methods</p> <p>Focus groups were conducted with clinicians at five Family Cancer Centers in three Australian states. Discussions were recorded, transcribed and analyzed thematically.</p> <p>Results</p> <p>Twenty three clinicians, including genetic counselors, clinical geneticists, medical oncologists, breast surgeons and gynaecologic oncologists, participated in six focus groups in 2007. The identified barriers to the discussion of the use of tamoxifen and raloxifene for chemoprevention pertained to issues of evidence (evidence for efficacy not strong enough, side-effects outweigh benefits, oophorectomy superior for mutation carriers), practice (drugs not approved for chemoprevention by regulatory authorities and not government subsidized, chemoprevention not endorsed in national guidelines and not many women ask about it), and perception (clinicians not knowledgeable about chemoprevention and women thought to be opposed to hormonal treatments).</p> <p>Conclusion</p> <p>The study demonstrated limited enthusiasm for discussing breast cancer chemoprevention as a management option for women at high familial risk. Several options for increasing the likelihood of clinicians discussing chemoprevention were identified; maintaining up to date national guidelines on management of these women and education of clinicians about the drugs themselves, the legality of "off-label" prescribing, and the actual costs of chemopreventive medications.</p

Modern grandmothering

In our study, we aimed to describe the major roles and activities that Australian grandmothers undertake in relation to their grandchildren. Our study combied quantitative and qualitative approaches to enable us to both enumerate and describe these activities and roles

From trust on intimacy: a new inventory for examining Erikson's stages of psychosocial development

A new inventory for examining the first six of Erikson's psychosocial stages is described. The self-report questionnaire, developed in a pilot study of 97 adolescents and tested in a study of 622 adolescents, has 12 items for each subscale. Measures of reliability and validity are reported. It is concluded that the Erikson Psychosocial Stage Inventory (EPSI) is a useful measure for researchers interested in development from early adolescence and in mapping changes as a function of life events

Unsettled infant behaviour and health service use: A cross-sectional community survey in Melbourne, Australia

Aims: To investigate factors associated with health service use by women and their infants in Victoria, Australia. Methods: Cross-sectional screening survey of 875 women with 4-month-old infants attending immunisation clinics in five local government areas in Melbourne between May 2007 and August 2008. The self-report instrument assessed socio-demographic characteristics, unsettled infant behaviour, maternal mood (Edinburgh Postnatal Depression Scale) and, the outcome, health service use during the first 4 months post-partum. Results: Mothers and their infants used on average 2.8 different health services in the first 4 months post-partum (range 0–8). After adjustment for other factors, high health service use (defined as \u3e3 different services) was more common in mothers whose infants were unsettled with persistent crying, resistance to soothing and poor sleep. A one-point increase on the unsettled infant behaviour measure was associated with an 8% (2–14%) increase in the use of \u3e3 services, 9% (3–16%) in use of emergency departments, 7% (2–13%) in use of telephone helplines and 9% (3–14%) of parenting services. Poorer maternal mental health was also implicated with a one-point increase on the Edinburgh Postnatal Depression Scale associated with a 4% (0.4–8%) increase in the likelihood of using more than three services. Conclusions: Unsettled infant behaviour is associated with increased use of multiple health services. The high use of emergency departments by families with unsettled infants found in this study suggests that enhancement of primary health-care capacity might be required