News and Articles on Health. Medical research topics.

Design
Analysis of individual patient data from 8 trials in which aspirin (doses ranged from 75–1,200 mg daily) was the interventional treatment used in cardiovascular risk reduction trials. None of the trials was designed to assess cancer incidence or deaths due to cancer. Trials were identified using public databases. All trials were randomized and had a mean scheduled treatment period of at least four years or more. Randomized allocation included aspirin versus no aspirin (no placebo given) or aspirin versus no aspirin in the presence of another antiplatelet or antithrombolytic agent (e.g., warfarin). Long-term (20-year) data was available for 3 trials using the United Kingdom’s national death certification and cancer registration systems.

Key Findings
Pooled analysis of 8 trials of aspirin showed a significant reduction in deaths due to cancer (674 deaths in 25,570 patients; OR 0.79, CI 0.68–0.92, P=0.003). Individual data available for 7 of the trials showed benefit was apparent only after 5 years’ follow-up (all cancers’ HR 0.66, CI 0.5–0.87; GI cancers HR=0.46, CI 0.27–0.77; P=0.003 for both sets of data). This latent effect was 5 years for esophageal, pancreatic, brain, and lung cancers. An even longer latency for measurable reduction in deaths was found for stomach, colorectal, and prostate cancers. The effect of aspirin was largely limited to adenocarcinomas. The benefit of aspirin was not related to the dose taken, gender, or smoking status. Benefit did appear to increase with age and duration of aspirin intervention used in the trial.

Practice Implications
Many publications have suggested a protective role of aspirin intake on cancers of the colon, stomach, and esophagus. This is the first publication that shows a significant reduction of overall cancer deaths. In addition to the strong evidence for protective effects against gastrointestinal cancers, there is supportive evidence from several observation studies of a reduction in the incidence of prostate, ovarian, lung, and brain cancers as well. The above publication found that deaths due to cancers overall was reduced by 20% for those using aspirin long-term, and upwards of 35% for lower gastrointestinal cancers specifically. This is compelling outcome data on the use of an inexpensive, relatively safe intervention.

There are a few salient points in this study that are useful to keep in mind for clinicians. First, the benefit of aspirin did not correlate with the dosage used, so that a minimum dose of 75 mg is expected to be sufficient to confer benefit. Second, the benefit of aspirin was a latent effect, with reductions in deaths beginning after 5 years of follow up. Third, the reduction in deaths correlated with the duration of aspirin consumption, with longer aspirin intervention correlating with greater benefit. There was no benefit seen in those who took aspirin for less than 5 years. Last, reduction in deaths was found for individuals with adenocarcinoma specifically, not other histological types.

AE-941 is a standardized, water-soluble shark cartilage extract. The precise composition of the extract is not disclosed, but there is presumption that proteins in the extract are responsible for its activity. In vitro, it has been shown to induce endothelial cell apoptosis, inhibit matrix metalloproteinases, and inhibit vascular endothelial growth factor. Given orally in a mouse, it has demonstrated antimetastatic activity.

This favorable in vitro and in vivo data led to an open-label phase I–II dose escalation study assessing AE-941 (30, 60, 120, and 240 ml/d) in 80 patients with NSCLC. In this small trial there was a statistically significant improvement in survival in patients with Stage III/IV NSCLC (n=48) receiving the higher doses. Median survival time for the high-dose group was 6.1 months vs. 4.6 months in the low dose group (P=0.26).

The current phase III trial of NSCLC is much larger and better controlled than the pilot study. Although recruitment was stopped before the target sample size of 756 patients was met, the final sample size of 384 patients was adequate for statistical analysis. At years 1, 3, and 5, the overall survival rate in the AE-941 group was 59%, 25%, and 14% respectively. In the placebo group, the overall survival rates at 1, 3, and 5 years were 61%, 21%, and 14% respectively. No secondary endpoints resulted in statistical benefit either. This multicenter trial included both academic and community clinics and was well controlled and designed.

It is essential as practitioners that we stay apprised of new information on natural agents that are reputed to have anticancer effects. We should neither be swayed by the popular press nor be dismissive of ideas before all of the evidence is assessed. Shark cartilage is one example of a promising product in vitro that has just not proven itself in large clinical studies. While still sold on the market, there is insufficient evidence to warrant its use, and evidence provides direct refutation of its use in NSCLC. Of course, the supplement also takes an ecologic toll on the shark population, a separate but valid concern regarding its widespread use. The National Cancer Institute provides a comprehensive listing of all of the clinical trial data on the various shark cartilage products.

Limitations
AE-941 is a complex natural product, not a single agent. The company claims it is standardized, although there is no methodology or component breakdown to ensure replication or even consistency from batch to batch. The current study did not disclose batch numbers, so this is an unanswered question regarding the current study. The dose may not have been adequate, although the dose used in the study, 240 ml/d, was the highest level yet tested in a phase I study. The tolerable upper dose has not been set. Lastly, when given orally components in AE-941 may be broken down by digestion before reaching the bloodstream. Without any blood parameters of either ingredients or other blood markers to track, it is unclear whether AE-941 was adequately absorbed intact.

Design
Multicenter, randomized, double-blinded, placebo-controlled phase III trial. Three hundred seventy-nine patients with unresectable stage III non-small cell lung cancer (NSCLC) were enrolled between June 5, 2000, and February 6, 2006. All patients received chemotherapy, including a platinum-based agent, and radiotherapy. Patients were randomly assigned in a 1:1 ratio to receive either 120 ml of AE-941 (Neovastat) (n=188) or an equal dose of placebo (n=191) orally twice daily. The groups were stratified for stage (IIIA or IIIB), chemotherapy regimen, and gender. Assessment of tumor status with computed tomography (CT) was made at baseline, before thoracic radiotherapy (which began day 50), and at 6 weeks post radiotherapy. The primary endpoint was overall survival. Secondary endpoints included time to progression (TTP), progression-free survival (PFS), tumor response rate, and toxic effects.

Key Findings
There was no statistically significant difference in overall survival in those taking AE-941 versus placebo: 14.4 months (95% CI=12.6–17.9 months) vs. 15.6 months (95% CI=13.8–18.1 months). There was also no statistically significant difference between the AE-941 and placebo groups in any of the the secondary endpoints of the trial. Median TTP=11.3 months (95% CI =9.0–16.8 months) in AE-941 vs. 10.7 months (95% CI=9.5–21.6 months) in the placebo group. Similar results were obtained for progression-free survival.

Practice Implications
The use of shark cartilage as an alternative cancer treatment has been touted in lay media for many years. In 1992 William Lane published Sharks Don’t Get Cancer: How Shark Cartilage Could Save Your Life, which coincided with a product he sold, shark cartilage extract (Benefin). The use of shark cartilage is an interesting story of the best and worst in the marketing and development of natural agents. While a product was being sold on the market, much of the scientific community dismissed its use out of hand based on hyperbole and lack of evidence. Meanwhile, there was diligent pursuit of evidence of its anticancer activity by the Canadian pharmaceutical company Aeterna Zentaris, owners of AE-941 (Neovastat).

Up until 2003, AE-941 appeared to be a legitimately promising agent, with data accumulating on its anticancer effects both in vitro and in vivo. This included a 2002 study of advanced cancers that showed a cohort of renal cell cancer patients (n=22) had improved survival in the high-dose (240 ml/d) group compared with the low-dose (60 ml/d) group (16.3 vs. 7.1 months). However, a phase III study presented at the annual meeting of the American Society of Clinical Oncology (ASCO) in 2003 reported there was no benefit to overall survival when used as a sole agent in patients with kidney cancer refractory to immunotherapy.

The current study, which is much larger and better controlled than any previously published trials, now provides sufficient evidence to refute the use of shark cartilage in patients with NSCLC, and to dampen any enthusiasm of its use as an anticancer agent in general.

In July 2010, Trichopoulou et al reported a lower risk of breast cancer in menopausal women with greater adherence to a Mediterranean diet. Their study followed 14,807 women for almost 10 years, during which time 240 participants were diagnosed with breast cancer. Diet was assessed and scored in respect to conformity to a Mediterranean diet. A marginally significant inverse association was seen in postmenopausal women, with a 22% decrease in risk for every 2-point difference in scoring. (HR=0.78 for every 2 points; 95% CI: 0.62, 0.98; P for interaction by menopausal status = 0.05).
Canadian generic viagra
A 2008 meta-analysis looked at how the Mediterranean diet affected overall mortality. When data from 8 cohorts (514,816 subjects and 33,576 deaths) were evaluated, researchers found that a 2-point increase in the diet adherence score reduced risk of mortality by about 9% (RR 0.91; 95% CI: 0.89–0.94), mortality from cancer by 6% and incidence of Parkinson’s or Alzheimer’s disease by 13%.

Cancer isn’t the only disease benefited by following the Mediterranean diet. High adherence is associated with a 40% decreased risk for coronary heart disease. A 1-point increase in relative Mediterranean diet score was associated with a 6% reduced risk of CHD.6 It is fascinating how much these diet scores have been quantified. A June 2009 paper tells us that for each unit increase in a Mediterranean diet adherence score, C-reactive protein decreased by 3.1% (95% CI: 0.5–5.7%) and IL-6 dropped by 1.9% (95% CI: 0.5–3.4%).

When we look at any of these Mediterranean studies, the men and women who eat foods closest to the Mediterranean diet are about 20% less likely to die over the course of the study from heart disease, cancer, or any other cause.

When we look at any of these Mediterranean studies, the men and women who eat foods closest to the Mediterranean diet are about 10–20% less likely to die over the course of the study from heart disease, cancer, or any other cause.

Perhaps the most intriguing of these studies is one that appeared in June 2009 in the British Medical Journal in which Trichopoulou et al looked at data from the Greek Cohort of the EPIC study, following 23,349 men and women not previously diagnosed with cancer, coronary heart disease, or diabetes and compared Mediterranean diet adherence to mortality from any cause. A 13% decrease in mortality was seen for every 2-point increase in diet adherence score. Through careful statistical analysis these researchers were able to tell us how much each component of the diet contributed to the overall effect seen in their study:

Moderate ethanol consumption: 23.5%,
Low consumption of meat and meat products: 16.6%
High vegetable consumption: 16.2%
High fruit and nut consumption: 11.2%
High monounsaturated to saturated lipid ratio: 10.6%
High legume consumption: 9.7%

In this particular study the attributes of high cereal consumption and low dairy consumption had only minimal effects on morality. Surprisingly high fish and seafood consumption appeared to cause a non-significant increase in mortality. These later findings are to date anomalies, and fish and seafood are still considered valuable and beneficial attributes of the diet.

Design
Dietary and lifestyle information were collected at recruitment. A scoring system was used to estimate degree of adherence to a Mediterranean style diet. The association between diet adherence and gastric cancer risk by location and type was calculated.

Participants
The study included 485,044 subjects (144,577 men) aged 35-70 years old from 10 European countries who were part of the European Prospective Investigation into Cancer and Nutrition (EPIC) Cohort. Mean follow-up was 8.9 years.

Scoring
An 18-unit relative Mediterranean diet score was utilized that rated 9 key components of the Mediterranean diet and allowed estimation of a score for relative Mediterranean diet adherence.

Primary Outcome Measures
Cases of primary gastric adenocarcinoma, their location, and histologic types were recorded.

Key Findings
Participants whose diets scored higher, and therefore most closely matched the Mediterranean Diet, had decreased risk of gastric adenocarcinoma compared to those with low adherence scores. The hazard ratio for those with high adherence compared to low adherence was 0.67; thus their risk for developing cancer was about a third lower. Scores did not affect anatomic location or histologic types. For every 1-unit diet score increase, as calculated by the researchers, the risk for gastric adenocarcinoma decreased by approximately 6%.

Practice Implications
It is time for us to actively encourage patients to adhere as closely as possible to a Mediterranean style diet. This study is just one of a series of recent papers that have looked at the correlation between specific diseases and adherence to a Mediterranean style diet, studies that consistently find benefit.

Components of the Mediterranean diet have already been individually shown to affect gastric cancer risk. González et al reported in 2006 that meat consumption affected gastric cancer risk and found that total red and processed meat intakes were associated with an increased risk of gastric non-cardia cancer, especially in H. pylori antibody-positive subjects.

González, in another 2006 paper, reported on fruit and vegetable consumption and risk of gastric cancers. A possible negative relationship was seen between total vegetable intake (HR 0.66; 95% CI 0.35–1.22 per 100 g increase) and onion and garlic intake (HR 0.70; 95% CI 0.38–1.29 per 10 g increase) with risk of intestinal cancer. Nonsignificant negative associations were seen between citrus fruit intake and the cardia site (HR 0.77; 95% CI 0.47–1.22 per 100 g increase) and a nonsignificant negative association for vegetable intake and for citrus intake (calibrated HRs 0.72; 95% CI 0.32–1.64 and 0.77; 95% CI 0.46–1.28 per 100 and 50 g increase, respectively) and esophageal adenocarcinoma. Citrus fruit consumption may have a role in the protection against cardia gastric carcinoma and esophageal adenocarcinoma.

A 2007 paper found that cereal consumption had a much stronger effect against gastric cancer than fruit or vegetables. High intakes of cereal fiber reduced gastric cancer risk by about 31% [adjusted HR for the highest versus lowest quartile of cereal fiber 0.69, 0.48–0.99].

Reliabilities of the final version of the CSBS-C
The internal consistencies of the 17-item three-factor scale in the final item pool were then calculated again. Again, data showed satisfactory reliabilities, with Cronbach alpha ranged from .72 to .90.

Discussion
Current data showed that psychometric properties of the CSBS-C demonstrated satisfactory reliability and validity. The test-retest reliabilities assessed by structural equation modeling suggested the scores of the three-factor scale were stable over time. The structure of the CSBS-C measurement examined by confirmatory factor analysis demonstrated reasonable model fits indicating satisfactory construct validity. In addition, the scores of the final 17-item three-factor scale revealed good internal consistencies to assess cancer screening beliefs in general. These convergence evidence from current data demonstrated that the structure of the CSBS-C scale was consistent to the theoretical constructs with satisfactory reliabilities and validities. Furthermore, current results supported evidence-based psychometric properties of the scale to measure cancer screening beliefs among a Chinese worksite middle-aged population including both males and females.

The descriptive results of the current study showed that participants on average scored high on perceived screening benefit, moderate on barriers towards cancer screenings, and moderate on perceived risk of cancers. The findings indicated that, in general, participants in the study might believe cancer screenings were beneficial and themselves being at similar risk of getting cancers compared with other people their age, yet at the same time also perceive moderate barriers towards various cancer screenings. How middle-aged adults weight the benefits and concerns of cancer screenings and potential consequences of finding out having cancers, and how health care providers could address the various screening barriers to encourage screening non-adherent adults to obtain regular cancer screenings might warrant further research and discussions.

One thing to note is that the CSBS-C scale was developed and tested among middle-age, relatively highly educated Chinese participants. Therefore, generalization of the study results needs to consider these factors. Nevertheless, this instrument serves as an important tool developed specifically for Chinese population measuring general cancer screening related beliefs.

In summary, current study indicated that the CSBS-C is reliable and valid for assessing beliefs towards cancer screenings in general among Chinese population. The scores of the CSBS-C demonstrated both good reliabilities and appropriate validities consisted with existing social and behavioral theoretical constructs (perceived pros, cons, and susceptibility). It provides a multidimensional measurement to assess general cancer screening related beliefs. The brief inventory (17 items) makes it practical for future adoptions. Current findings also shed light on issues related to screening related barriers (concerns of finding out having cancers, the mentality of rather not knowing having cancers, etc.). Public health programs that aim to encourage screenings should consider these potential mental barriers associated with cancer screening. On the other hand, health promotion and preventive programs might take advantage of the relatively high perceived benefits of cancer screening to install values of early detection. Specifically, for Chinese population, emphasizing values of family such as “screening for family” might worth more attention. Information obtained from the CSBS-C can help researchers establish evidence-based priorities for encouraging cancer screenings. The CSBS-C with the proven psychometric properties has implication on future application to the development and evaluation of cancer prevention programs delivered to Chinese population.

Test-Retest Reliabilities
Structural equation models were then used to test separately whether each of the three factors hypothesized remained stable over time. The path from initial to follow-up perceived benefits of cancer screenings (pros) was significant (coefficient=.30; p<.001); suggesting that participants’ perceived screening benefits were stable over time. All items, except one (Pros_9), had significant loading weights to the “PROS” factor. Excluding Pros_9, model fit index for the remaining 8 items were satisfactory; with χ2 (99) = 312.12, RMSEA=.09 (90% CI=.08, .10), GFI=.90, IFI=.93, TLI=.91, and CFI=.93. Similarly, the path from initial to follow-up perceived cons was significant (coefficient = .75; p<.001); revealed stabled scores on perceived screening barriers. All items were loaded significantly to the “CONS” factor, except one item (Cons_7) showed negative estimates at follow-up and thus were removed. The model with the remaining 6-items fit well, with χ2 (48) = 125.81, RMSEA=.08 (90% CI=.06, .09), GFI=.92, IFI=.92, TLI=.89, and CFI=.92. Finally, the path from initial to follow-up perceived risk was also significant (coefficient = .71; p<.001), indicating participants’ perceived risk of getting cancer was stable overtime as well. The model also fits well with all items loaded significantly (χ2(6) = 11.59, RMSEA=.06 [90% CI=.00, .11], GFI=.99, IFI=.99, TLI=.97, and CFI=.99).

Confirmatory Factor Analysis (CFA)
The CFA was then applied to test the remaining 17-item three-factor model. The structure of item loadings was consistent with the intended theoretical constructs. All items measuring perceived benefits of cancer screening in general or early detection were loaded to “PROS” factor, and those measuring perceived barriers to cancer screening were loaded to “CONS” factor. In addition, items measuring perceived cancer risk were loaded to “RISK” factor. Although chi-square test was significant, the ratio of chi-square and degree of freedom was small (272 / 116=2.34), indicating good model fit (Bollen, 1989). The values of Comparative Fit Index (CFI), Incremental Fit Index (IFI), and Non-Normed Fit Index (NNFI) or Tucker-Lewis Index (TLI) were .92, .92, and .90, respectively, demonstrating adequate fit (Byrne, 1998). Furthermore, the Root Means Square Error of Approximation (RMSEA=.07; 90% CI= [.06, .08]) was small, which also indicated a good fit (Raykov, 2001).

Based on Bagozzi and Yi’ criterion (Bagozzi & Yi, 1988), all of the factor loadings, standard errors, and t ratios indicated a good fit of internal structure of model, with items of significant coefficients. The results revealed (1) no coefficients with theory contradicting signs; and (2) all standard errors seem small as indicated by large t-ratios. All t values were significantly greater than 1.96 based on Joreskog and Sorbom’s criterion (Joreskog & Sorbom, 1996). Examination of the factor coefficients revealed that all were substantially loaded by the corresponding factors. Finally, there were no negative variance estimates in the latent variable and the error covariance matrices. These results revealed no obvious mis-specifications, and supported that the hypothesized model was satisfactory. Findings supported that the CSBS-C assessed three theoretical constructs.

Before data were analyzed using SPSS 14.0 software, all items were examined to ensure reflection of positive expressions in their corresponding scales. Listwise deletion was used to exclude missing data. Descriptive statistics, item-total correlation, and Cronbach’s alpha coefficients were calculated for each construct.

Structural equation models were used to test separately whether each of the three factors remained stable over time. Items with low loading were dropped. Confirmatory factor analysis was then applied to examine the proposed three-factor model. The purpose of this process was to confirm if there was sufficient empirical evidence suggesting that the model, as specified, might be a viable representation of the true relationships between observed and latent variables (Mueller, 1996). Judgments about model fit were made jointly by assessing the ratio of chi-square to degrees of freedom (χ2/df), root mean square error of approximate (RMSEA), non-normed fit index (NNFI) or Tucker-Lewis Index (TLI), incremental fit index (IFI), and comparative fit index (CFI). The criteria used to determine if the model fit the data were the χ2/df less than three (Bollen, 1989), RMSEA no more than .08 (Raykov, 2001), and values of NNFI, IFI, and CFI at least .90 (Byrne, 1998). Factor loadings were considered statistically significant if the ratio of the factor loading to its standard error was greater than 1.96 or less than -1.96 (Joreskog & Sorbom, 1996). Finally, reliabilities of each of the factors in the cancer screening belief scale were calculated.

Cialis Canada pharmacy

Results
A total of 450 survey were distributed to employee and their family members aged 40 and over among the ten participating worksites in Taiwan. Among these people, 375 participants completed and returned their consent form and initial surveys (83%). At the one-month follow up, 304 participants were reached and completed a follow-up survey (81%). Among these, 272 participants completed all items in the cancer screening belief section of the survey and thus were included in the following reliability and validity analyses.

Demographics
The mean age of the participants was 48.18 (SD=8.79), most of them were married (93.3%). About 58.8% were male. Over half of the participants had a college education level or higher (54.0%), and 78.6% had a full time job. Most people (88.9%) indicated their general health condition as “fair” (39.0%) or “good” (49.9%). Even though near half (49.9%) of the participants indicated they had someone in their family who had been diagnosed with cancer of any types, over 90% of the participants rated their perceived risk of getting cancers in the next five years as either the same (49%), low (22%), or very low (20.4%) compared to others in their ages.

Initial Reliabilities
The initial reliabilities for the three constructs measured in the initial 19-item pool showed satisfactory internal consistencies, with Cronbach alphas all greater than .70. The corrected item-total correlations of all the items were greater than .20, and ranged from .32 to .80, indicating that all the pros, cons, and perceived risk items showed sufficient correlations with other items in their corresponding constructs (see Table 1). The correlation matrix among items is available upon request.

Development of the Initial Items
The initial item pool of beliefs related to cancer screenings in general were developed based on items published in Hou’s previously validate cancer screening belief inventory specifically developed for cervical smear test among Chinese women (CSBI). Items were reworded carefully from the CSBI to reflect statements that would apply to cancer screening beliefs in general. For example, the term “cervical smear test” was replaced with a general term “cancer screening”, if the statement can apply to cancer screening in general or early detection overall. Items specifically relate to gender or cervical smear test were removed.

Twenty items were drafted in the initial item pool, reflecting three theoretical constructs (factors). These constructs were derived from existing models of health behavior and inherent in the original CSBI (Hou & Luh, 2005). These included perceived pros and cons from the Transtheoretical Model (Prochaska, Norcross, & Diclemente, 1994), and perceived risk (susceptibility) from the Health Belief Model (Rosenstock & Krischt, 1974). Scale items were drafted in English, translated into Chinese, and then back translated. Items on the two English versions were compared for consistencies. The draft was then given to an expert panel (including three cancer researchers, two health care professionals, and three lay Chinese adults) to evaluate the item clarity, relevancy, comprehensiveness, and literacy demand. One item was identified as redundant thus was removed from the initial item pool. Comments and suggestions were used to further refine these belief statements in order to enhance clarity and readability.
Viagra Australia
Study Sample and Procedure
The study participants were selected from a convenient sample of worksite population and their family member age 40 years and older. Participants in the study were recruited from a Fecal Occult Blood Test (FOBT) screening trial for colorectal cancers screenings. Each participant was asked to complete a survey with items measuring their beliefs related to cancer screenings in general (the 19-item CSBS-C scale), along with their screening history, knowledge related to colorectal cancers screenings, as well as demographics. A total of ten worksites in one of the major cities in Taiwan participated in the study. The questionnaires were administered by the researchers, with the assistance of managers or supervisors from each participating worksite. Follow-up surveys were administered to all participants, after one month of the initial survey, when the researchers went to the same study sites and collect their stool test result cards. The detailed process on the actual fecal occult blood test trial is documented elsewhere (Hou & Chen, 2004). Data on cancer screening beliefs in general were analyzed in the current study to assess the internal consistencies, stability (test-retest reliability), and structure validity of the three factors which measured in the CSBS-C scale.

According to the 2006 World Population Data Sheet (Population Reference Bureau, 2006), China ranked number one among the top ten World’s largest countries in population. China has about 4.4 times the population compared with that in the U. S. (1,311 versus 299 millions). Asian is also among the highest growing group in the United States. In 1990, there were 6.9 million Asians living in the U.S. Between 1990 and 2000, the Asian population grew by 3.3 million to 10.2 million. This is represents a growth of 48% compared to 13% for the total U.S. population (U. S. Census Bureau, 2003). About a quarter of the U.S. Asian population was of Chinese origin (U.S. Census Bureau, 2005). Despite these facts, Asians, the fastest growing population both in the U. S. and around the world, have received the least attention of all ethnic populations in cancer control research studies or targeted intervention programs by the national government. One of the major reasons for this lack of attention is the paucity of disaggregated and accurate Asian data (Kagawa-Singer & Pourat, 2000). Aggregated data imply a lack of need for targeted screening programs or public policies for these populations. Therefore, it is important to understand factors influencing cancer screening utilization among this population, Chinese in particular, in order to develop appropriate and effective cancer screening promotion and educational programs. It is also important to develop and validate a Chinese version of the cancer screening belief instrument in order to better understand and reach this group in a culturally sensitive and linguistically appropriate way.

Generic viagra Canada pharmacy

To date, there have been some published articles providing systematic efforts on developing and validating instruments used for measuring cancer screening beliefs related to cancers of specific types. Several studies have reported on scale development for mammography screening related belief (Champion, 1995; Champion & Scott, 1997; Rakowski, Fulton, Feldam, 1993). Rakowski et al. (1997) tried to extend perceived pros and cons from decisional balance constructs to both mammography and cervical smear compliance (Rakowski, Clark, Pearlman, Ehrich, Rimer, Goldstein, et al., 1997). Hou and Luh (2005) were among the first that developed and validated a theory-based screening belief inventory specifically to cervical smear screening and for Chinese women (Hou & Luh, 2005). Results from their Cervical Smear Belief Inventory (CSBI) showed that many of the psychometric scores of the inventory had satisfactory reliability and validity. Nevertheless, most of the validated belief scales available apply to cancer of specific type. There remains a need to have similar scales being validated that could to be used to assess beliefs related to cancer screening in general for broader applications among Asians such as Chinese.

This study examined the psychometric properties of the Cancer Screening Belief Scale – Chinese version (CSBS-C), a modified instrument adapted from the previous Cervical Smear Belief Inventory (CSBI) developed by Hou and Luh (2005) among Chinese women (Hou & Luh, 2005). This paper describes the reliability and validity of the scores of CSBS-C on assessing theory-based constructs related to belief towards cancer screening among a Chinese worksite population that includes both men and women. The main output of the study is to provide an English-Chinese bilingual measurement tool that has satisfactory reliable and valid psychometrics. Such tool is necessary for researchers and health care practitioners to reach Chinese communities in a culturally sensitive and linguistically appropriate way.

Objective: To develop and validate a culturally sensitive scale measuring cancer screening beliefs for Chinese; and to examine the validity and reliability of the scores of the new instrument (CSBS-C).
Methods: A modified instrument measuring cancer screening beliefs in general was developed, adapting from the previous Cervical Smear Belief Inventory (CSBI) developed by Hou and Luh (2005) among Chinese women, and tested among a Chinese worksite population in Taiwan. Items consisted in the CSBS-C were carefully reworded from Hou’s previously validated CSBI to reflect statements that would apply to cancer screening beliefs in general. Participants were asked to complete the self-administered screening belief items at baseline and one month follow-up (follow-up rate = 81%). Structural equation modeling (SEM) was used to assess the stability of the scores of the three-factor scale measured over time. Confirmatory factor analysis (CFA) was then used to validate these hypothesized theoretical constructs (factors). Results: SEM analysis revealed that the standardized coefficients of the three factors measured over time ranged from .30 to .75, indicating reasonable stabilities, and all three models revealed acceptable model fits (RMSEA=.06 ~ .09; GFI=.90~.99; IFI=.92~.99; TLI=.89~.97; and CFI=.92~.99). The final version of the CSBS-C, validated by CFA, consisted of 17 items that were clustered into three subscales: pros (eight items), cons (six items), and perceived cancer risks (three items); with all items loaded consistently and significantly with their corresponding factors (p<.001). Internal consistency ranged from 0.72 to 0.90.
Generic viagra Canadian pharmacy
Conclusion: Evidence showed that psychometric properties of the CSBS-C demonstrated satisfactory reliability and validity. The instrument with its side-by-side English-Chinese comparison provides researchers and practitioners a valuable tool to reach Chinese population in a culturally sensitive and linguistically appropriate way.

Introduction
Cancers is the number one cause of death among Asian Americans (Kagawa-Singer & Pourat, 2000) as well as in many countries in Asia such as Taiwan. Although cancer statistics data in the U.S. show that in general, Asians tend to have lower incidences or mortalities comparing with other racial/ethnic groups, recent studies involving cancer mortality data find that death rates for Asians are often understated. Similarly, the U. S. Cancer Statistics Working Group comments that incidence data for Asians may be underestimated, although those data are generally reliable for whites and blacks. One major reason suspected is possibly due to racial misclassification or differences in cancer registry operations (U. S. Cancer Statistics Working Group, 2003).

Although cancer screenings for cervical, breast, and colorectal cancers have been proven to be effective to detect cancers early and significantly reduce cancer mortality, Asians is the group least likely to receive cancer screenings of any kind (U. S. Cancer Statistics Working Group, 2003). According to American Cancer Society’s most recent report based on nation-wide surveillance surveys, only 59% of the Asians reported a mammography within the past 2 years, comparing to 70% among Whites (American Cancer Society, 2006). Only 68% of Asians reported a cervical smear test within the past three years, as compared to 80%, 82%, and 75% for White, African American, and Hispanic or Latina women, respectively. Disparities in colorectal cancer screening rates were observed across racial or ethnic groups, with Asians still ranked at the bottom. Only 14% of the Asian overall had a fecal occult blood test (FOBT) in the past year, and 25% had an endoscopy in the past 5 years (American Cancer Society, 2006). These low cancer screening rates may lead to cancers being identified at more advanced stages, less effective treatments, and higher cancer mortalities.