A hard pill to swallow: a qualitative study of women’s experiences of adjuvant endocrine therapy for breast cancer

Objective: To explore women’s experiences of taking adjuvant endocrine therapy as a treatment for breast cancer and how their beliefs about the purpose of the medication, side effects experienced and interactions with health professionals might influence adherence. Design: Qualitative study using semistructured, one-to-one interviews. Setting: 2 hospitals from a single health board in Scotland. Participants: 30 women who had been prescribed tamoxifen or aromatase inhibitors (anastrozole or letrozole) and had been taking this medication for 1–5 years. Results: Women clearly wished to take their adjuvant endocrine therapy medication as prescribed, believing that it offered them protection against breast cancer recurrence. However, some women missed tablets and did not recognise that this could reduce the efficacy of the treatment. Women did not perceive that healthcare professionals were routinely or systematically monitoring their adherence. Side effects were common and impacted greatly on the women’s quality of life but did not always cause women to stop taking their medication, or to seek advice about reducing the side effects they experienced. Few were offered the opportunity to discuss the impact of side effects or the potential options available. Conclusions: Although most women in this study took adjuvant endocrine therapy as prescribed, many endured a range of side effects, often without seeking help. Advice, support and monitoring for adherence are not routinely offered in conventional follow-up settings. Women deserve more opportunity to discuss the pros, cons and impact of long-term adjuvant endocrine therapy. New service models are needed to support adherence, enhance quality of life and ultimately improve survival. These should ideally be community based, in order to promote self-management in the longer term

What do we know about who does and does not attend general health checks? Findings from a narrative scoping review

Background: General and preventive health checks are a key feature of contemporary policies of anticipatory care. Ensuring high and equitable uptake of such general health checks is essential to ensuring health gain and preventing health inequalities. This literature review explores the socio-demographic, clinical and social cognitive characteristics of those who do and do not engage with general health checks or preventive health checks for cardiovascular disease. Methods: An exploratory scoping study approach was employed. Databases searched included the British Nursing Index and Archive, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE), EMBASE, MEDLINE, PsycINFO and the Social Sciences Citation Index (SSCI). Titles and abstracts of 17463 papers were screened; 1171 papers were then independently assessed by two researchers. A review of full text was carried out by two of the authors resulting in 39 being included in the final review. Results: Those least likely to attend health checks were men on low incomes, low socio-economic status, unemployed or less well educated. In general, attenders were older than non-attenders. An individual's marital status was found to affect attendance rates with non-attenders more likely to be single. In general, white individuals were more likely to engage with services than individuals from other ethnic backgrounds. Non-attenders had a greater proportion of cardiovascular risk factors than attenders, and smokers were less likely to attend than non-smokers. The relationship between health beliefs and health behaviours appeared complex. Non-attenders were shown to value health less strongly, have low self-efficacy, feel less in control of their health and be less likely to believe in the efficacy of health checks. Conclusion: Routine health check-ups appear to be taken up inequitably, with gender, age, socio-demographic status and ethnicity all associated with differential service use. Furthermore, non-attenders appeared to have greater clinical need or risk factors suggesting that differential uptake may lead to sub-optimal health gain and contribute to inequalities via the inverse care law. Appropriate service redesign and interventions to encourage increased uptake among these groups is required

The Iowa Homemaker vol.3, no.11

Table of Contents Identity by Ruth Elaine Wilson, page 2 The Responsibility of American Women to Citizenship by Marcia M. Roberts, page 3 Hearth and Home by Amanda Jacobsen, page 4 A Parent “That Needeth Not to be Ashamed” by Thomas F. Vance, page 5 Corn – Greatest Crop of Iowa by Gertrude E. Murray, page 6 American Home Economics Association Meets by Lela Johnson, page 7 The Evolution of Home Economics at Iowa State by Ruth Elaine Wilson, page 7 Hints for the Spring Wardrobe by Grace L. Heidbreder and Helen Brennan, page 8 Etiquette for College Girl by Marcella Dewell, page 9 Who’s There and Where by Dryden Quist, page 1

The Iowa Homemaker vol.3, no.12

Table of Contents A Greeting to Iowa Homemakers by Dr. Louise Stanley, page 3 A New Book on “Meal Planning and Table Service” by Florence E. Busse, page 4 A Bill of Rights for the Child by Lulu R. Lancaster, page 4 Shrubs as a Garden Background by Juanita Beard, page 5 ‘Tis Egg Time Again by Beth Bailey McLean, page 6 The New Domestic System by Claude L. Benner, page 7 A Time Budget for the Homemaker by Ruth M. Lindquist, page 8 Figures That Do Not Lie by Mae L. Kelley, page 9 The Cooking of Meats by P. Mabel Nelson, page 10 The Psychology of Clothing by Eveleth Pedersen, page 11 Iowa State Women in Rural Schools by W. H. Lancelot, page 12 A Yarn about Yarns by Irene Christian, page 13 Tea Room Accounting by George M. Fuller, page 14 Who’s There and Where by Dryden Quist, page 15 Editorial, page 16 Homemaker as Citizen, page 17 The Eternal Question, page 18 Mrs. Purchaser Chooses Upholstery by Lucile Barta, page 1

The provision of NHS health checks in a community setting: an ethnographic account

Background: The UK National Health Service Health Checks programme aims to reduce avoidable cardiovascular deaths, disability and health inequalities in England. However, due to the reported lower uptake of screening in specific black and minority ethnic communities who are recognised as being more at risk of cardiovascular disease, there are concerns that NHS Health Checks may increase inequalities in health. This study aimed to examine the feasibility and acceptability of community outreach NHS Health Checks targeted at the Afro-Caribbean community. Methods: This paper reports findings from an ethnographic study including direct observation of four outreach events in four different community venues in inner-city Bristol, England and follow up semi-structured interviews with attendees (n = 16) and staff (n = 4). Interviews and field notes were transcribed, anonymized and analysed thematically using a process of constant comparison. Results: Analysis revealed the value of community assets (community engagement workers, churches, and community centres) to publicise the event and engage community members. People were motivated to attend for preventative reasons, often prompted by familial experience of cardiovascular disease. Attendees valued outreach NHS Health Checks, reinforcing or prompting some to make healthy lifestyle changes. The NHS Health Check provided an opportunity for attendees to raise other health concerns with health staff and to discuss their test results with peers. For some participants, the communication of test results, risk and lifestyle information was confusing and unwelcome. The findings additionally highlight the need to ensure community venues are fit for purpose in terms of assuring confidentiality. Conclusions: Outreach events provide evidence of how local health partnerships (family practice staff and health trainers) and community assets, including informal networks, can enhance the delivery of outreach NHS Health Checks and in promoting the health of targeted communities. To deliver NHS Health Checks effectively, the location and timing of events needs to be carefully considered and staff need to be provided with the appropriate training to ensure patients are supported and enabled to make lifestyle changes

The effect of ambient odour and sound on environmental evaluations.

As part of research on the effects of the environment on behaviour, the current thesis reported two studies examining evaluations made of the environment when aspects were changed. The hypothesis derived from Mehrabian and Russell's (1974) theory stated that changes in the environment would only affect evaluations when these changes influence the emotional (pleasure and arousal) states of the individual. Furthermore, changes in the complexity and familiarity within the environment influence emotional states and consequently evaluations. In contrast. Canter's (1977, 1983) theory predicts that evaluations are affected by the changes in the environment only when the goals of the individual also change simultaneously. The current thesis examined elements of the theories by asking participants to assess various aspects of their immediate physical environment in relation to their emotional states and goals while the sound and/or the odour-were manipulated. Participants in Study 1 were exposed to a "cut-grass" odour and "mower" sound, which were considered as being unidentifiable. During Study 2, a different set of participants was exposed to relatively identifiable stimuli consisting of a "coffee" odour and "cafeteria" sound. The goals were kept constant across the conditions as participants carried out the same tasks across the conditions, hi both studies participants were required to identify the sound and the odour and given a list of words to rate in terms of their relationship to the sound and odour in their environment. The studies revealed that the evaluations corresponding to the emotional states were a function of the whether the sound could be identified. The manipulation of the unidentifiable sound influenced the extent to which the environment was considered as being pleasant and marking participants to feel ill whereas the manipulation of the identifiable sound did not change these evaluations. However the evaluations were not a function of whether the odom- could be identified. Although the data from the studies provided support for some of the elements of Mehrabian and Russell's (1974), and Canter's (1983) theories, these theories do not adequately account for the differential effect of the sound and the odour manipulation. It was concluded that future research into the effects of the environment should consider the combined contribution of the emotional and purposive responses within a theoretical framework

Making sense of your reading list

A powerpoint generic library guide to finding and using reading lists. The guide includes slides on searching the catalogue and understanding what makes up a reference to a journal article, book and chapter in a book