Thesis (Ph.D.)--University of Nebraska-Lincoln, 2008. / Title from title screen (site viewed Feb. 17, 2009). PDF text: iv, 173 p. ; 687 K. UMI publication number: AAT 3325857. Includes bibliographical references. Also available in microfilm and microfiche formats.

Two hundred and three patients participated in a study designed to evaluate a structured learning package for teaching competent breast self-examination (BSE) at a Screening Center. The package consisted of modeling, practice without feedback on a breast model, and limited practice and feedback on the patients' own breasts. Performance proficiency was evaluated by an observer as the number of BSE's steps correctly practiced during pre and post-training evaluations. A questionnaire to gather information about patients history, knowledge, and attitudes toward BSE and breast cancer was also used. Results show that more than 80% of the patients who could improve did so in most steps of both components, visual inspection and palpation. In addition, only 31% of the patients performed a perfect and complete BSE immediately after the teaching session. The two steps patients failed the most were checking the axillary-tail and covering the complete breast. A corrective procedure to improve the teaching package is discussed.

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Community Medicine / Master / Master of Public Health

No description available.

MBBCh Department of Surgery University of the Witwatersrand 08 March 2017 / Background: Breast cancer recurrence is a major clinical event and represents a principal cause of breast cancer related death. A discordance rate between receptor status of primary and matched recurrence tumours has been reported in the literature but the extent of this in our population is unknown. Repeating Immuno-histochemistry (IHC) and fluorescent in-situ hybridization (FISH) studies have financial and workforce implications in a resource-constrained environment. However, the results of these receptor studies have prognostic implications. Therefore it is important to determine the extent of change in receptors in the recurrence. Aim: To compare the hormone receptor profile between breast cancer primary and matched loco-regional recurrence and to ascertain the extent of receptor discordance. Methods: All patients who presented to the respective breast care facilities for breast cancer recurrences between 2006 and 2014 were identified using the mammography department records. The specimens for each patient were scrutinized. Oestrogen receptor (ER) and progesterone receptor (PgR) status as well as the Human Epidermal growth factor type 2 receptor (HER2) receptor statuses were noted for each patient and a comparison was made between primary and matching recurrence, with loss and gain being noted. Results: In the analysis, significant discordance was found for matching hormone receptor status. Discordance in oestrogen receptor status occurred in 14.3% of cases: change occurred both from ER-positive to -negative and vice versa. For progesterone receptor status this occurred in 25.7% of cases. A discordance of 14.8% was noted for HER2 receptor status. These results are not dissimilar to what has been previously reported in the literature. Of note, adverse receptor discordance: positive to negative was noted in a total of 19 receptors (ER 4; PgR 11; HER2 4) Conclusion: These results confirm the phenomenon of receptor discordance between breast cancer primary and recurrence. The results support the necessity of confirming receptor status on all loco-regional recurrent disease. This reinforces the importance of obtaining a confirmatory biopsy in patients where recurrence is suspected and therefore allowing the appropriate targeted therapy to be selected. / MT2017

M.Fam.Med., Faculty of Health Sciences, University of the Witwatersrand, 2011

Thesis (MPH) -- University of Limpopo (Medunsa Campus),2013. / Introduction HIV positive post natal women on a PMTCT program who have opted for exclusive breastfeeding are experiencing pressures from families to give solids, water based fluids, traditional medicines, and complimentary medicines as early as the first 48 hours of life of a newborn baby. The early feeding practice is in contradiction with the PMTCT recommended six months of exclusive breastfeeding or formula feeding Aim The aim of the study was to explore the influence of the family on adherence to exclusive breastfeeding among post natal women on PMTCT programme Objectives of the study were: To explore the influence of the family on adherence to exclusive breastfeeding among women on PMTCT Programme in Extension 8 clinic. To explore the ways in which women on PMTCT programme in Extension 8 clinic deal with the family influences on exclusive breastfeeding. Methodology Focus group discussions (FGDs) and in-depth interviews (IDls) were conducted with post natal women enrolled in the PMTCT program of a community health centre at the Steve Tshwete Local Municipality in Mpumalanga. A focus group guide developed by researcher in English and translated to IsiZulu was used to conduct the FGDS and IDls with 40 HIV positive women who opted for exclusive breastfeeding. A total of five FGDs and seven IDls $J were conducted. . Data analysis The data was analyzed using contents analysis which allowed the categories to emerge from the data. Data analysis began with the verbatim transcription of the transcript in IsiZulu which were later translated into English. This was followed by the identification and definition of emerging themes and the development of a code list. The initial application on themes on the transcripts was done manually to identify themes and subthemes, and new themes that emerged during this process were defined and added to the code list,transcriptswererecoded if a new theme emerged or if a theme was redefined. The fmal code list was adapted from seven codes to thirteen codes. The transcripts were then imported to NVivo 9 and the researcher started applying the codes to the remaining transcripts. Findings The study found that though it was a norm that babies must be given solids, water, traditional, and complementary medicines, most participants adhered to exclusive feeding. Good infant feeding coun~elling, and good knowledge and understanding of MTCT also served as a strong motivation for participants to adhere to their feeding options. The study also found that the family interfered in infant feeding throughout the exclusive breastfeeding life of the babies. Even when families supported exclusive breastfeeding, they still wanted the mother to give solids and water. The data suggest that the concept of exclusive breastfeeding is not well understood by the family and is contextualised as meaning breastfeeding. The data further show that participants had some fears and uncertainties about exclusive breast feeding, and lived in constant fear that they might infect their babies with HIV and that they were starving the babies. In addition, participants had fears of the consequences of delaying and or ignoring cultural practices. Conclusion: The study concludes that the family interfered in infant feeding throughout the exclusive breastfeeding life of the babies. They struggled to understand exclusive breastfeeding concept and expected the mother to give the baby solids and water because it was a norm. Recommendations ~ Given that the family lacks understanding of exclusive breastfeeding, it is recommended that the family be involved in the education and counselling for exclusive infant feeding practices to promote knowledge and understanding ofMTCT ofHIV. Involving the family in PMTCT will also highlight the risks of some of the cultural practices in transmission of HIV to the baby.

The primary objectives of this study were to determine the initiation and prevalence, up to six months post-partum, of breast-feeding amongst Perth women and to identify factors that influence the initiation and duration of breast-feeding. A self-administered baseline questionnaire was completed by 556 mothers prior to discharge. Those mothers who were breast-feeding at the time of completing the baseline questionnaire were followed-up by telephone interview at 2, 6, 10, 14, 18 and 24 weeks postpartum, or until they ceased to breast-feed.In total, 88.1% of mothers commenced breast-feeding whilst in hospital. On discharge from hospital 83.8% of women were breast-feeding either fully (77.7%) or partially (6.1%) but by six months this figure had decreased to 49.9% of mothers breast-feeding.Multivariate logistic regression analysis was used to determine which factors were associated with the initiation of breast-feeding. There was a strong association between the father's reported preference for breast-feeding and the initiation of breast-feeding (OR=10.18). The Cox's proportional hazards model was used to estimate the effect of independent variables on the duration of breast-feeding. The factor most strongly associated with breast-feeding duration was intended duration. Women who intended to breast-feed for less than four months were more likely to stop breast-feeding at any time compared with women who intended to breast-feed for at least four months (RR=5.01).The results of this study suggest that breast-feeding initiation and duration rates in Perth have remained relatively stable over the last decade. However, breast-feeding duration continues to fall well short of the target of 80% of infants being either partially or fully breast-fed at six months. Recommendations are made for interventions which actively promote increased breast-feeding duration. In particular, ++ / emphasis should be placed on those strategies which will influence intended duration; influence the attitudes and beliefs of the mother's support network, particularly partners; and promote breast-feeding as the social norm.

Women diagnosed with breast cancer and who have the disease surgically treated by mastectomy experience a health crisis. This thesis focused on the behaviours, feelings and attitudes of women during their breast cancer and mastectomy experiences. The overall purpose was to identify therapeutic factors that can be used by health professionals to improve the psychological and physiological well-being of women with this disease. The conceptual scaffolding for the thesis was drawn from the fields of perceptual psychology and decision-making. The thesis was supported by a study that examined specific areas concerning the breast cancer and mastectomy experience. These areas were self-perceptions, the psychological milieu resulting from a breast cancer diagnosis, and post-mastectomy breast restoration decision-making. The population included: a prosthesis group of 64 women who had mastectomies and wore external breast prostheses, a reconstruction group of 31 women who had mastectomies and underwent breast reconstructions, a control A group of 75 women who had not experienced mastectomy, and a control B group of 65 women who also had not experienced mastectomy. Self-perceptions: The perceptions of the prosthesis, reconstruction and control A groups regarding their body-image, self-concept, total self-image, and self-esteem were compared by using Polivy's (1977) Body-Image Scale and Rosenberg's (1965) Self-Esteem Scale. The body-image, total self-image, and self-esteem mean scores indicated that the prosthesis and reconstruction groups had more positive feelings regarding their bodies than did the control group. There were no significant differences in self-concept among the three groups. These findings challenge a common assumption that mastectomy automatically results in psychiatric morbidity caused by an altered body-image and suggest that health professionals should not make assumptions about how a woman will psychologically respond to mastectomy. Quality of life perceptions were compared among the prosthesis, reconstruction and control B groups using the Ferrans and Powers (1985) Quality of Life Index. The mean scores of the prosthesis and reconstruction groups were higher than the control group's scores, with higher scores indicating more positive quality of life perceptions. The findings suggest that the women in the mastectomy samples had found ways to cope with their health crises. Over time, they learned not to define all existence in terms of a cancer diagnosis and had gained or maintained a positive perspective on life. Post-mastectomy attitudes in the prosthesis and the reconstruction groups were compared. Using the Mastectomy Attitude Scale the results indicated that both groups were satisfied with their bodies, had a positive outlook towards their lives, implied that sexuality entailed more than having breasts, and felt that mastectomy treatment was necessary to save their lives. Neither group concealed that they had a mastectomy, nor were the women prone to discuss their mastectomy experiences. The findings from the study indicate that the women post-mastectomy already had or developed positive attitudes towards themselves and life in general and the method chosen for breast restoration had no apparent impact on these attitudes. The self-perception data indicated that women do adjust and cope with breast cancer surgically treated by mastectomy. These women should be encouraged by health professionals to develop a helping relationship with other women who are newly diagnosed with the disease. This alliance could engender hope in those women who are beginning their journey along a similar road to survival. More hope for these women and less fatalism would decrease their sense of crisis and facilitate their abilities to take an active part in the decision-making processes relating to their treatment. Psychological Milieu: The women in the prosthesis and the reconstruction groups were interviewed about their breast cancer and mastectomy experiences. The findings supported the premise that receiving a diagnosis of breast cancer plunged the women into a health crisis and caused an instant disruption to their lives. The women found that they had to suddenly deal with several complex issues all at the same time, such as what must be done in the immediate future to treat the cancer, as well as the more frightening issues of the meaning of the illness on their ultimate life expectancy. All of this turmoil played havoc with their ability to make informed decisions regarding their breast cancer treatment alternatives. This finding suggests the need for more individualised interventions and support for women when they are making decisions during this stressful period. Health professionals need to keep in mind that simply hearing the word "cancer" often prevents a person from assimilating the complete diagnosis, indicated treatments, and possible prognosis. Therefore, care-givers must be prepared to repeat and elaborate upon information previously given to the affected individual and the family. Breast Restoration Decision-Making: To evaluate the prosthesis and the reconstruction groups' abilities to undertake competent breast restoration decision-making, a 5 Stage process was devised, modelled after Janis and Mann's (1977) seven criteria for competent decision-making. Analysis of the data revealed that both groups displayed passive information seeking behaviour in relation to breast restoration alternatives. They had either no knowledge or limited knowledge regarding the alternatives. Their lack of knowledge was due either to (1) anxiety about their disease, or (2) deficiencies in the interpersonal skills of individuals presenting information to them, or (3) the perceptions that they had insufficient time to gather information, or (4) a combination of these factors. Because the prosthesis and the reconstruction groups were under stress they used coping styles to accomplish decision-making. To measure their coping styles five categories were defined, based on Janis and Mann's (1977) conflict model of emergency decisionmaking and Simon's (1957) notion of "bounded rationality". Two styles emerged. The prosthesis group used the "Sideliner" style that allowed the women to make a quick, conflict-free decision. They were not aware of alternative choices resulting in their decision-making experience being uncomplicated and effortless. The reconstruction group used the "Contented" style that also allowed them an uncomplicated and effortless decision-making experience. The women decided that breast reconstruction was their only viable option. Many of them did not even think that they had made a decision about an alternative because of the strong salience towards breast reconstruction. A breast restoration decision-making model has been developed and proposed for women to use when considering their alternatives. This model offers to health professionals and women a realistic and useable decision-making process that can be implemented when individuals are experiencing a health crisis. The model can be modified and used for numerous situations that require decisions regarding treatment alternatives. This inquiry has demonstrated that there is a need for a specific health professional to assist women newly diagnosed with breast cancer. This individual would assume several roles that include one of advocacy for the women, and the important role of ensuring that these individuals have the information and knowledge to make competent decisions regarding their breast cancer treatments.