Family Resilience in the Oncology Setting: Development of an Integrative Framework

Resilience is a concept that has received burgeoning interest in the last decades. Researchers have been fascinated by the ability of some individuals to bounce back from an adverse event and adapt to extremely challenging situations. More recently family resilience, namely the potential resources of the family’s system, has been considered due to numerous individual studies highlighting the crucial influence of relationships with significant others in mediating adaptation and recovery. In this article, a brief overview of the theoretical literature on individual and family resilience is presented. Following, current empirical literature on resilience in the context of oncology is evaluated. Although family resilience is considered a dynamic process unique to each family unit, some common resources and strengths that can help families face significant adversities, such as cancer, can be identified. This said to date there is no family resilience framework applied specifically to the cancer trajectory. Drawing from previous studies, we sought to provide a clinical resilience model for families living with cancer, with the aim of mapping those resources that can empower families to deal with prolonged adversity. This framework can serve as general guideline for health professionals in assessing family strengths, promoting specific family processes and facilitating adaptation to the cancer experience

Clinical, Cognitive and Behavioural Assessment in Children with Cerebellar Disorder

Cerebellar disorders are characterised clinically by specific signs and symptoms, often associated with neurodevelopmental disorder. While the clinical signs of cerebellar disorders are clearly recognisable in adults and have a precise anatomo-functional correlation, in children the semiotics are less clear and vary with age because of the particular nature of the cerebellum’s maturation. Unlike other structures of the central nervous system, this begins at a later stage of foetal development and extends over a longer period of time, even after birth. As a result, the typical signs of cerebellar dysfunction will only become evident when the cerebellar functions have become integrated into the complex circuits of the central nervous system. This means that poor motor coordination in the very early years of life may not necessarily correlate with cerebellar dysfunction, and this may also be encountered in healthy children. The cerebellum’s role in cognitive and emotional functions relies on its structure and the complexity of its connections. Cognitive and behavioral impairment in cerebellar disorders can be the results of acquired lesions or the action of genetic and environmental risk factors, to which the cerebellum is particularly vulnerable considering its pattern of development. In the pathological setting, early evidence of cerebellar damage may be very vague, due, partly, to spontaneous compensation phenomena and the vicarious role of the connecting structures (an expression of the brain’s plasticity). Careful clinical assessment will nonetheless enable appropriate instrumental procedures to be arranged. It is common knowledge that the contribution of neuroimaging is crucial for diagnosis of cerebellar conditions, and neurophysiological investigations can also have a significant role. The ultimate goal of clinicians is to combine clinical data and instrumental findings to formulate a precise diagnostic hypothesis, and thus request a specific genetic test in order to confirm their findings, wherever possible

Changes in tri-methylation profile of lysines 4 and 27 of histone H3 in bovine blastocysts after cryopreservation

Pregnancy rates from cryopreserved embryos remain lower than non-cryopreserved counterparts, even though these embryos appear morphologically normal. How epigenetic events, such as histone modifications, are affected by cryopreservation of embryos remains unknown. The current study evaluated the effect of conventional freezing/thawing of in vitro produced bovine blastocyst embryos on histone modifications, H3K4me3 and H3K27me3. At day 7 of in vitro culture, blastocyst stage embryos were either frozen by conventional freezing method (-0.5 °C/min in 1.5 M ethylene glycol; F/T group) or remained in culture for an additional 18 h (Ctrl). Frozen embryos were stored in liquid N2 for 14 days, thawed and placed in culture for 36 h for recovery. Control and re-expanded frozen-thawed blastocysts from both groups were fixed in 4% paraformaldehyde and stored in PBS +0.1% triton-X at 4 °C. Immunofluorescence, utilizing antibodies against H3K4me3 and H3K27me3, was conducted and staining intensity was analyzed as percentage of total DNA. Day 7 blastocyst development rate was 35.55% (352/990) with blastocyst recovery at 54.23% (77/142) 36 h post-thawing. Total cell numbers per blastocyst were not different amongst groups (117.8 ± 12.49 and 116.1 ± 14.69, F/T and Ctrl groups respectively). Global staining for the active mark, H3K4me3, was lower in F/T blastocysts compared to Ctrl (17.24 ± 2.80% vs. 34.95 ± 3.77%; P < 0.01). However, staining for the inhibitory mark, H3K27me3, was nearly 2-fold higher in F/T blastocysts (40.41 ± 3.83% vs. 21.29 ± 3.92%; P < 0.01). These results suggest that bovine blastocysts, subjected to conventional freezing methods, have altered histone modifications that may play a role in poor pregnancy rates.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenaçao de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Investigating cancer patient acceptance of Whole Body MRI

Background: Whole Body magnetic resonance imaging (WB-MRI) enables early cancer detection, without exposing the patient to ionizing radiation. Our aim was to investigate patients’ acceptance of WB-MRI as a procedure for cancer staging and follow up. Materials and methods: 135 oncologic subjects participated to the study. An ad hoc questionnaire was administered before and after WB-MRI, to assess patient's confidence and concerns about WB-MRI, psychological reactions, experience and perceived utility of the procedure. Results: Before undergoing WB-MRI, about 58% of the patients were concerned for cancer progression outcome. 80.4% felt that they were given good information about the exam and the most informed group also perceived and higher level of utility of WB-MRI and no risk. Among people reporting discomfort with the exam (51.9%) the main reasons were noise and exam duration. Despite this, 80% of patients expressed high levels of satisfaction, and the majority (69%) judged WB-MRI more acceptable than other diagnostic exams. Patients who believed to have received more information before the exam rated their global satisfaction higher. Conclusion: Our results show that WB-MRI examinations were well-accepted and perceived with high levels of satisfaction by most patients. WB-MRI appears to be equally or more tolerable than other total body imaging modalities (e.g. PET, CT), especially if they receive enough information from the radiologist

Becoming mothers after cancer: Resilience as a protective factor for prenatal attachment and for negative moods during pregnancy

Background: Resilience can be defined as the ability to positively deal with adverse conditions, to overcome difficulties while maintaining relatively good psychological and physical health. Although few studies have explored the psychological aspects of cancer during pregnancy it is plausible that a diagnosis of cancer might interfere with factors that are necessary to deal positively with an ongoing or future gestation. We aim to investigate the possible protective role of resilience in the construction of prenatal attachment and in the intensity of negative moods in pregnant women with a previous or concomitant cancer diagnosis. Methods: 26 pregnant women (25 with breast cancer, 1 with hepatic PEComa) have been enrolled during the last trimester of pregnancy. 20 had a pregnancy after cancer diagnosis, while 6 had cancer occurring during pregnancy. After informed consent, women filled out: the Resilience Scale for Adults, the Prenatal Attachment Inventory, and the Profile of Mood States. Results: Analyses showed positive correlations between resilience factors and prenatal attachment and negative correlations between resilience factors and negative mood states. In particular there was a significant correlation between Social resources and (a) quality of prenatal attachment (r= .44,p= .046), (b) intensity of attachment (r= .45,p= .036); a correlation between Planned future and (a) anxiety (r= -.52,p= .016), (b) fatigue (r= -.43,p= .046); a correlation between Family cohesion and (a) anxiety (r= -.71,p< .001), (b) depression (r= -.56,p= .006), (c) anger (r= -.67,p= .001); a correlation between Social resources and (a) anxiety (r= .45,p= .001). Conclusions: These preliminary data indicate that, it is important to assess resilience and family support in pregnant women with current or past experience of oncological diagnosis. Detailed analysis of which strategies and resources are activated will provide vital information for targeted interventions

Understanding Patients' Preferences : A Systematic Review of Psychological Instruments Used in Patients' Preference and Decision Studies

Background Research has been mainly focused on how to elicit patient preferences, with less attention on why patients form certain preferences. Objectives To assess which psychological instruments are currently used and which psychological constructs are known to have an impact on patients' preferences and health-related decisions including the formation of preferences and preference heterogeneity. Methods A systematic database search was undertaken to identify relevant studies. From the selected studies, the following information was extracted: study objectives, study population, design, psychological dimensions investigated, and instruments used to measure psychological variables. Results Thirty-three studies were identified that described the association between a psychological construct, measured using a validated instrument, and patients' preferences or health-related decisions. We identified 33 psychological instruments and 18 constructs, and categorized the instruments into 5 groups, namely, motivational factors, cognitive factors, individual differences, emotion and mood, and health beliefs. Conclusions This review provides an overview of the psychological factors and related instruments in the context of patients' preferences and decisions in healthcaresettings. Our results indicate that measures of health literacy, numeracy, and locus of control have an impact on health-related preferences and decisions. Within the category of constructs that could explain preference and decision heterogeneity, health locus of control is a strong predictor of decisions in several healthcare contexts and is useful to consider when designing a patient preference study. Future research should continue to explore the association of psychological constructs with preference formation and heterogeneity to build on these initial recommendations.IMI-PREFE