Next of kin's experiences of sudden and unexpected death from stroke : a study of narratives.

BACKGROUND: Death always evokes feelings in those close to the afflicted person. When death comes suddenly the time for preparation is minimal and the next of kin have to cope with the situation despite their own sorrow. The suddenness is found to be stressful for the next of kin and communication both with healthcare professionals and information about what has happened has been found helpful. The aim of this study was to illuminate the experiences of next of kin from the sudden and unexpected death of a relative from acute stroke. METHODS: Data was collected over a 12-month period in 2009-2010. Twelve next of kin of patients cared for in stroke units who died suddenly and unexpectedly from stroke were interviewed using a narrative method. The narratives were analyzed using narrative thematic analysis. RESULTS: Three themes emerged showing facets of next of kin's experiences of a relative's sudden and unexpected death from stroke: Divided feelings about the sudden and unexpected death; Perception of time and directed attention when keeping vigil; Contradictions and arbitrary memories when searching for understanding. CONCLUSIONS: To have to live in the aftermath of severe stroke is absolute horror in people's imagination and death is seen as the lesser of two evils. The sudden and unexpected death totally pervades the next of kin's life, directs their attention to the dying person and even causes them to forget themselves and their own needs, and leads to difficulties in information intake. It is a challenge for the healthcare professionals to be able to identify the individual needs of the next of kin in this situation

The Role of Vaccination in the Prevention of Head and Neck Cancer

Human papillomavirus (HPV) is the main cause of cervical cancer and is also associated with head and neck cancer. The effect of prophylactic HPV vaccines on premalignant head and neck lesions is not measurable, but it is universally believed that HPV vaccines are able to prevent a considerable number of oropharyngeal cancers and a small proportion of oral cavity and larynx cancers. Recent studies on the effect of HPV vaccination on oral HPV infections provide further support of this hypothesis. The question then remains whether current vaccination programmes, in which only girls are vaccinated against HPV infections, should be extended to boys to increase the impact on future head and neck cancers. This question is particularly relevant because the burden of oropharyngeal cancer is on the rise in the United States and several other countries and it is disproportionally higher in men. The extension of a girls’ only HPV vaccination programme to a sex-neutral programme depends on a number of factors including herd effects received from the girls’ only programme and the price of the vaccine. HPV infection models predict a substantial impact of sex-neutral vaccination on future cancer in men and women when the coverage of the girls’ only vaccination programme is only 40–70%. At a higher uptake of 80%, a main argument in favour of sex-neutral vaccination is that it leads to near elimination of HPV16 and HPV18, thought to be responsible for the majority of the HPV-related head and neck cancers. Financial barriers to sex-neutral vaccination have been largely removed in countries that were successful in negotiating a low price for the vaccine