Bewältigungsverhalten bei Eltern von Kindern mit geistiger Behinderung: Quantitative und qualitative Untersuchung von Bewältigungsmustern

In der vorliegenden Untersuchung wurde überprüft, welche Bewältigungsstrategien Eltern von Kindern mit einer geistigen Behinderung in ihrem Alltag anwenden. Dabei lag der Fokus auf der Frage, welche Bewältigungsmuster, also Kombinationen verschiedener Strategien, unterschieden werden können, und wodurch diese gekennzeichnet sind. Das Bewältigungsverhalten wurde mit dem Fragebogen Soziale Orientierungen von Eltern behinderter Kinder (SOEBEK, Krause & Petermann, 1997) erhoben. Nach einer kurzen Einführung (Kapitel 1) fasst der Theorieteil der Arbeit (Kapitel 2) den gegenwärtigen Forschungsstand zur elterlichen Anpassung an die geistige Behinderung eines Kindes zusammen. Aus einer resilienzorientierten Perspektive ist es von Interesse, mit welchen Haltungen, kognitiven, emotionalen, aber auch Handlungsstrategien Eltern den Belastungen und Herausforderungen entgegentreten, die sich durch die geistige Behinderung ihres Kindes ergeben können. Der empirische Teil der Arbeit gliedert sich in drei Abschnitte. Im ersten Studienteil (Kapitel 3) wurden mittels Clusteranalysen bei den Eltern von 325 Kindern mit einer geistigen Behinderung verschiedene Muster von Bewältigungsverhalten differenziert. Anschließend wurde untersucht, welche weiteren Charakteristika Familien mit den jeweiligen Bewältigungsmustern aufweisen, sowohl soziodemographisch als auch hinsichtlich Familienfunktionalität, Familienkohärenzgefühl und Stressbelastung. Zur qualitativen Vertiefung der Ergebnisse wurden im zweiten Studienteil (Kapitel 4) teilstrukturierte Interviews mit den Eltern von fünf Kindern mit geistiger Behinderung durchgeführt, deren Bewältigungsstrategien den zuvor charakterisierten Mustern entsprachen. In einem dritten Untersuchungsteil (Kapitel 5) wurden Fachpersonen befragt, die in Beratungseinrichtungen für Eltern von Kindern mit geistiger Behinderung arbeiten. Ihnen wurden die zuvor analysierten Bewältigungsmuster vorgelegt und um eine Einschätzung des jeweiligen Beratungsbedarfs gebeten. Eine Integration der Ergebnisse aus den drei Studienteilen, im Sinne von Schlussfolgerungen für die Beratungspraxis schließt sich in Kapitel 6 an. Ein Fazit findet sich in Kapitel 7

Higher Incidence of Diabetes in Cancer Patients Compared to Cancer-Free Population Controls: A Systematic Review and Meta-Analysis

Background: Diabetes increases the risk of certain types of cancer. However, the literature regarding the incidence of diabetes after cancer diagnosis is inconsistent. We aimed to assess whether there was a higher incidence of diabetes among cancer patients by performing a systematic review and meta-analysis of results from cohort studies. Methods: A systematic electronic literature search was carried out from cohort studies regarding the incidence of diabetes in cancer patients, using the databases PubMed (MEDLINE), Embase, Web of Science, and the Cochrane Library. Random-effects meta-analyses were conducted to pool the estimates. Results: A total of 34 articles involving 360,971 cancer patients and 1,819,451 cancer-free controls were included in the meta-analysis. An increased pooled relative risk (RR) of 1.42 (95% confidence interval (CI): 1.30–1.54, I2 = 95, τ2 = 0.0551, p < 0.01) for diabetes in cancer patients was found compared with the cancer-free population. The highest relative risk was observed in the first year after cancer diagnosis (RR = 2.06; 95% CI 1.63–2.60). Conclusions: New-onset diabetes is positively associated with cancer, but this association varies according to cancer type. More prospective studies with large sample sizes and longer follow-up times are advocated to further examine the association and the underlying mechanisms

Higher Incidence of Diabetes in Cancer Patients Compared to Cancer-Free Population Controls: A Systematic Review and Meta-Analysis

Background: Diabetes increases the risk of certain types of cancer. However, the literature regarding the incidence of diabetes after cancer diagnosis is inconsistent. We aimed to assess whether there was a higher incidence of diabetes among cancer patients by performing a systematic review and meta-analysis of results from cohort studies. Methods: A systematic electronic literature search was carried out from cohort studies regarding the incidence of diabetes in cancer patients, using the databases PubMed (MEDLINE), Embase, Web of Science, and the Cochrane Library. Random-effects meta-analyses were conducted to pool the estimates. Results: A total of 34 articles involving 360,971 cancer patients and 1,819,451 cancer-free controls were included in the meta-analysis. An increased pooled relative risk (RR) of 1.42 (95% confidence interval (CI): 1.30–1.54, I2 = 95, τ2 = 0.0551, p < 0.01) for diabetes in cancer patients was found compared with the cancer-free population. The highest relative risk was observed in the first year after cancer diagnosis (RR = 2.06; 95% CI 1.63–2.60). Conclusions: New-onset diabetes is positively associated with cancer, but this association varies according to cancer type. More prospective studies with large sample sizes and longer follow-up times are advocated to further examine the association and the underlying mechanisms

Population based cancer survivorship research:: Experiences from Germany and the Netherlands

Research into the well-being of cancer survivors in the post-treatment phase can face the potential challenge of identifying and recruiting survivors. Population-based cancer registries can address this challenge. Through linkage with national and state cancer registries, Germany and the Netherlands have a long history of conducting population-based survivorship studies. The CAESAR study from Germany and the PROFILES registry from the Netherlands are examples of large and comprehensive population-based survivorship studies assessing the wellbeing of (long-term) cancer survivors. This paper briefly describes the contributions studies such as CAESAR and PROFILES have made to cancer survivorship research at the patient, clinical, research, and societal level. Potential barriers associated with population-based survivorship research and directions are also discussed

Age‐specific prevalence and determinants of depression in long‐term breast cancer survivors compared to female population controls

BACKGROUND: Depression is more prevalent in breast cancer (BC) survivors than in the general population. However, little is known about depression in long‐term survivors. Study objectives were: (1) to compare the age‐specific prevalence of depressive symptoms (a) in BC survivors vs female population controls, (b) in disease‐free BC survivors vs BC survivors with self‐reported recurrence vs controls, and (2) to explore determinants of depression in BC survivors. METHODS: About 3010 BC survivors (stage I‐III, 5‐16 years post‐diagnosis), and 1005 population controls were recruited in German multi‐regional population‐based studies. Depression was assessed by the Geriatric Depression Scale‐15. Prevalence of mild/severe and severe depression only were estimated via logistic regression, controlling for age and education. Multinomial logistic regression was used to explore determinants of mild and severe depression. RESULTS: Compared with population controls, BC survivors were more likely to report mild/severe depression (30.4% vs 23.8%, p = .0003), adjusted for age and education. At all age groups &lt;80 years, prevalence of both mild/severe and severe depression only was significantly higher in BC survivors, while BC survivors ≥80 years reported severe depression less frequently than controls. BC survivors with recurrence reported significantly higher prevalence of mild/severe depression than disease‐free survivors and controls, but prevalence in disease‐free survivors and controls was comparable. Age, income, living independently, recurrence, and BMI were significant determinants of mild depression in BC survivors. Age, education, employment, income, recurrence, and BMI were significant determinants of severe depression. CONCLUSIONS: Long‐term BC survivors &lt;80 years report significantly higher prevalence of depressive symptoms than controls, which might be explained by recurrence and individual factors. The findings suggest that depression in BC survivors is common, and even more after BC recurrence. Clinicians should routinize screening and normalize referral to psychological care

Age‐specific prevalence and determinants of depression in long‐term breast cancer survivors compared to female population controls

BACKGROUND: Depression is more prevalent in breast cancer (BC) survivors than in the general population. However, little is known about depression in long‐term survivors. Study objectives were: (1) to compare the age‐specific prevalence of depressive symptoms (a) in BC survivors vs female population controls, (b) in disease‐free BC survivors vs BC survivors with self‐reported recurrence vs controls, and (2) to explore determinants of depression in BC survivors. METHODS: About 3010 BC survivors (stage I‐III, 5‐16 years post‐diagnosis), and 1005 population controls were recruited in German multi‐regional population‐based studies. Depression was assessed by the Geriatric Depression Scale‐15. Prevalence of mild/severe and severe depression only were estimated via logistic regression, controlling for age and education. Multinomial logistic regression was used to explore determinants of mild and severe depression. RESULTS: Compared with population controls, BC survivors were more likely to report mild/severe depression (30.4% vs 23.8%, p = .0003), adjusted for age and education. At all age groups &lt;80 years, prevalence of both mild/severe and severe depression only was significantly higher in BC survivors, while BC survivors ≥80 years reported severe depression less frequently than controls. BC survivors with recurrence reported significantly higher prevalence of mild/severe depression than disease‐free survivors and controls, but prevalence in disease‐free survivors and controls was comparable. Age, income, living independently, recurrence, and BMI were significant determinants of mild depression in BC survivors. Age, education, employment, income, recurrence, and BMI were significant determinants of severe depression. CONCLUSIONS: Long‐term BC survivors &lt;80 years report significantly higher prevalence of depressive symptoms than controls, which might be explained by recurrence and individual factors. The findings suggest that depression in BC survivors is common, and even more after BC recurrence. Clinicians should routinize screening and normalize referral to psychological care

Distress mediates the relationship between cognitive appraisal of medical care and benefit finding/posttraumatic growth in long-term cancer survivors

BACKGROUND: The objective of this study was to ascertain long-term cancer survivors' (LTCS') appraisal of medical care and how these perceptions may influence their health and well-being, including benefit finding (BF) and posttraumatic growth (PTG). METHODS: In total, 6952 LTCS from a multiregional population-based study in Germany completed the Benefit Finding Scale, the Posttraumatic Growth Inventory, the Questionnaire on Stress in Cancer, and self-designed questions on cognitive appraisal of medical care. The authors explored the mediating role of distress between medical care appraisal and BF and PTG and the possible moderation of time since diagnosis in this relationship. RESULTS: LTCS' medical care appraisals (“no unresolved/untreated symptoms,” “satisfaction with cancer care,” and “satisfaction with care for other diseases”) were positively associated with BF. PTG was positively associated with “no unresolved/untreated symptoms” and negatively associated with “satisfaction with care for other diseases.” Cancer distress partially mediated the associations between appraisals of medical care and BF, between “no unresolved/untreated symptoms” and PTG and between “satisfaction with care for other diseases” and PTG; whereas it totally mediated the association between “satisfaction with cancer care” and PTG. Time was a significant moderator in the model; the negative indirect effect of cognitive appraisal on BF and PTG through cancer distress weakened with longer time since diagnosis. CONCLUSIONS: Cancer survivors' medical care appraisal is associated with their perceptions of BF and PTG through distress. Therefore, distress screening could be part of the regular workup to identify distressed cancer survivors who are not satisfied with medical care; these survivors may benefit from interventions to reduce distress and increase BF and PTG

Clinical and sociodemographic determinants of disease-specific health-related quality of life in long-term breast cancer survivors

PURPOSE: It is important to monitor disease-specific health-related quality of life (HRQoL) in breast cancer (BC) survivors to identify potential unmet supportive care needs. However, previous studies were characterized by small samples of mostly short-term survivors and were limited to certain age ranges, stages and/or treatments. METHODS: We used data from 3045 long-term BC survivors (5–15 years post-diagnosis) recruited in a German multi-regional population-based study. We assessed disease-specific HRQoL with the EORTC QLQ-BR23, scoring from 0 to 100. Differences in functioning and symptoms according to age at survey, self-reported treatments, stage, and disease status (disease-free vs. active disease) were assessed with multiple regression. Active disease was defined as any self-report of recurrence, metastasis or second primary cancer after the index cancer. RESULTS: Older BC survivors reported a higher body image and a better future perspective, but lower sexual functioning. Survivors aged 30–49 years who had breast-conserving therapy or mastectomy with breast reconstruction reported a better body image compared to those who had mastectomy only. We also found differences in symptoms according to treatments in some age groups. Stage at diagnosis was not associated with HRQoL overall and in most age subgroups. Disease-free BC survivors aged 30–79 years reported a better future perspective and less systemic therapy side effects than those with active disease. CONCLUION: Several treatment-associated symptoms and functioning detriments were found 5–15 years after diagnosis. The results emphasize the need of a comprehensive, individualized survivorship care, recognizing differential needs of long-term BC survivors according to age, treatment modalities, and disease status

Prevalence of benefit finding and posttraumatic growth in long-term cancer survivors: results from a multi-regional population-based survey in Germany

BACKGROUND: Cancer studies reported mixed results on benefit finding (BF) and posttraumatic growth (PTG) prevalence and few were focused on long-term survivors. METHODS: BF and PTG were assessed in a multi-regional population-based study in Germany with 6952 breast, colorectal and prostate cancer survivors, using the Benefit Finding Scale and Posttraumatic Growth Inventory. We calculated the age-adjusted prevalence, stratified by demographical and clinical characteristics. RESULTS: Overall, 66.0% of cancer survivors indicated moderate-to-high BF, and 20.5% moderate-to-high PTG. Age-adjusted prevalence of BF and PTG differed according to cancer type (breast &gt; colorectal &gt; prostate) and sex (female &gt; male). BF and PTG prevalence were higher in younger than in older respondents; the age-adjusted prevalence was higher in respondents who survived more years after diagnosis. The strength and direction of associations of age-adjusted prevalence with cancer stage, disease recurrence, and time since diagnosis varied according to cancer type and sex. CONCLUSIONS: A substantial proportion of long-term cancer survivors reported moderate-to-high BF and PTG. However, the prevalence was lower in older and male cancer survivors, and during the earlier years after cancer diagnosis. Further longitudinal studies on PTG and BF in cancer survivors are warranted to address heterogeneity in survivors’ experience after cancer diagnosis