Parental reactions in childhood cancer: distress, risk and resilience

Parents of children with cancer encounter an exceptionally difficult life experience. Acute and long-lasting distress adds to the initial traumatic experience of being told that a family member suffers from a potentially fatal illness. This thesis investigates the determinants of short and long-term psychological effects in parents in two Nordic sites with different routines for care and follow-up. A general aim was increased knowledge and understanding of parental reactions and psychosocial follow-up needs of families. Study I examined the significance of individual strengths for parental resilience against distress by studying the relationships between Sense of Coherence (SOC) and illness-specific and generic distress symptoms. We also studied whether parental gender, level of education, and use of professional psychological support influenced that relationship. Data were collected from 190 parents of 126 childhood cancer (CC) survivors, and 208 parents from the general population. SOC was assessed using the SOC-13 questionnaire. Distress outcomes were measured using the multi-dimensional Parental Psychosocial Distress in Cancer (PPD-C) questionnaire, which covers uncertainty, loss of control, self-esteem, anxiety, disease-related fear, loneliness, sleep disturbances, depression, and psychological and physical distress. Non-pathological psychiatric symptoms were screened for using the General Health Questionnaire (GHQ-12). Study II, included 328 parents of 211 CC patients at one of two sites, either in Sweden or Iceland, and 208 control parents. We studied occurrence of cancer-related parental reactions, and compared distress symptoms in the two national samples. A goal was to identify of nation-, site- and organisation-related determinants of parental experiences. Outcomes were evaluated against non-clinical norm data. Study I provided support for the hypothesis about a protective influence of SOC, and that SOC is associated with resilience also in this population. Influence of SOC was strongest regarding general psychiatric symptoms, physical and psychological stress symptoms, anxiety and depression, although low SOC was associated with more severe distress general. Influence of SOC was stronger among mothers. Study II showed that both in the Swedish and the Icelandic groups, distress exceeded the level of a non-clinical norm group. In adjusted analyses comparing parent outcomes Icelandic parents scored significantly higher in distress on 5 of 11 PPD-C subscales. Significant differences, primarily concerning illness-specific distress, and uncertainty due to unmet informational needs, were found between parents at the two sites. The findings in this thesis indicate that parental resilience to cancer-related distress varies with identifiable strength factors. This suggests that a strengths-oriented approach facilitates understanding of the kind of factors that govern parental adjustment to childhood cancer. Addressing resilience instead of pathology helps identifying parents at risk and in need of intensified psychosocial support. Distress and needs for illness-related information was more prominent among parents at the smaller Icelandic site. This finding indicates a need for routines to meet parental uncertainty, adapted to conditions prevailing at a low-influx centre with limited resources for specialised psychosocial follow-up. Differences between study groups indicate that compensatory measures in local/national and/or site-related arrangements for care, surveillance and information are possible means by which parental psycho-social services can be improved. Differences in this study in parental outcomes may partly be due to the larger centre having more favourable preconditions for providing a multifaceted caring context, including parental fellowship where informal mutual support and shared information contribute to resilience against illness-related distress

Skagafjörður Lowland

Land is limited resource and therefore land has become more valuable than ever. Land use is changing, cities are growing bigger and that demands more land for urbanisation. Increased understanding of human impact on nature and environment underlines importance of sustainable land use and planning. In that perspective the importance of landscape analysis and understanding of interaction of nature factors and human activities becomes more and more significant. The aim of the project is to clarify the situation of the stable area and its surroundings with special focus on formation, vegetation diverse, current and past land use. This is done to strengthen judgements regarding future land use and possible sustainable development of the area. The assessed area is spectacular in many ways it's wetland and has been mostly recognised for rich bird life and is partly a nature reserve area. Stakeholders interested in future management and development of the area are the Municipality, the Riding Club and nature based activities. It is important to give all stakeholders a formal opportunity to express their opinions and they where involved in all phases of the procedure of the analysis and judgements. Landscape Character Assessment (LCA) was based on methodology described in the Scottish LCA. The key principles of the LCA approach is that the emphasis is placed on landscape character and the division between the process of characterisation and the making of judgements to inform decisions. The roles of both objective and subjective approach is recognised in the progress and the potential for application at different scales. Judgements are based on the results of the characterisation process. The conclusion from this character analysis was the platform for preparation of proposals about planning, land use and design of the surrounding. Notice has been taken of the ideas from stakeholders and those who has interest in the future use of the area.Mark är en begränsad resurs och i takt med att markanvändningen ändrats har dess värde ökat. Städer växer och behovet av mark ökar i takt med urbaniseringen. Ökad förståelse för människans påverkan av naturen och miljön understryker nödvändigheten av långsiktighet i markanvändning och planering. I detta perspektiv blir betydelsen av landskapsanalys och förståelse för samspelet mellan naturen och människan mer viktig. Syftet med projektet är att förtydliga användningen runt stallområdet och dess närmiljö med fokus på platsens utformning, vegetation samt nuvarande och tidigare användning av marken i området. Detta görs för att förtydliga beslut gällande framtida skötsel och möjlig utveckling av platsen. Det utvärderade området är speciellt på många sätt, bland annat är det väletablerade våtlandet erkänt för sitt rika fågelliv och är delvis naturreservat Mark aktörer som är intresserade av den framtida skötseln och utveckling av området är kommunen, ridklubben och naturbaserade aktiviteter. Den utförda landskapsanalysen baseras på den metod som beskrivs av the Scottish LCA, (Landscape character assessment). Nyckelprinciperna för denna metod är att fokus läggs på landskapskaraktären samt gör en uppdelning av bedömningen i en objektiv samt en subjektiv del för att kunna ta informerade beslut. Den upgiften av både objektive och subjektive synsätt är känd i framsteget och resurser för framställning i olika skalor. Beslut baseras på resultatet av landskapsanalysen. Resultatet från den här landskapskaraktärsanalysen tillsammans med de framtida aktörers intressen utgör grunden för de förslag gällande planering, markanvändning och design för området som läggs fram i detta arbete

Effect of coronary calcification on diagnostic accuracy of the 64 row computed tomography coronary angiography.

Þekkt er að kalk í kransæðum veldur truflunum í tölvusneiðmyndarannsókn (TS) sem torveldar mat á kransæðaþrengslum. Markmið rannsóknarinnar var að meta nánar áhrif kalks í kransæðum á greiningargildi 64 sneiða TS á kransæðum í íslensku þýði, með hjartaþræðingu sem viðmið. Þessi afturskyggna rannsókn náði til 417 einstaklinga sem bæði höfðu komið í TS-kransæðarannsókn og hjartaþræðingu með 6 mánaða millibili. Einstaklingum var skipt eftir Agatston-skori (kalkmagn í kransæðum): [0], [0,1-10], [10,1-100], [100,1-400], [400,1-750] og [>750]. Hæfni TS-kransæðarannsóknar til að greina ≥50% kransæðaþrengingu var metin með hjartaþræðingu sem viðmið. Þá voru tengsl á milli Agatston-skors og ≥50% kransæðaþrengingar skoðuð. Alls voru rannsökuð 1668 kransæðasvæði í 417 einstaklingum (68,6% karlar og meðalaldur 60,2 ± 8,9 ár). Agatston-skor var að meðaltali 420 (spönn frá 0-4275). Næmi tölvusneiðmyndarannsóknar við greiningu ≥50% kransæðaþrengingar í kransæð var 70,1%, sértæki 79,9%, jákvætt forspárgildi 55,4% og neikvætt forspárgildi 88,2%. Neikvætt forspárgildi lækkaði úr 93,0% fyrir Agatston-skor núll og niður í 78,3% fyrir Agatston-skor ˃>750. Agatston-skor 363 spáði best fyrir um ≥50% kransæðaþrengingu með 49,6% næmi. Greiningargildi TS-kransæðarannsóknar er almennt gott með háu neikvæðu forspárgildi og sértæki. Kalk hefur töluverð áhrif á greiningargildið en neikvætt forspárgildi skerðist lítið fyrir Agatston-skor allt að 400. Agatston-skor er ekki gott til að spá fyrir um ≥50% kransæðaþrengingu í þessu þýði. Ekkert ákveðið Agatston-skor gildi fannst sem spáði fyrir um ónothæfa æðarannsókn með TS.Coronary artery calcium is known to complicate the evaluation of stenoses using computer tomography (CT). The aim of this study was to analyze the effect of coronary calcification on the diagnostic accuracy of CT coronary angiography in an Icelandic population. The study was a retrospective analysis of 417 consecutive subjects that underwent CT coronary angiography and subsequent conventional coronary angiography within 6 months. Subjects were divided based on total Agatston score: 0, 0.1-10, 10.1-100, 100.1-400, 400.1-750 and >750. Sensitivity, specificity, positive and negative predictive values were calculated for ≥50% stenoses diagnosed with the CT, using the conventional coronary angiography as a reference. Correlation between Agatston score and ≥50% stenoses was calculated. A total of 1668 coronary artery segments in 417 individuals were evaluated (68.6% men, mean age 60.2 ± 8.9). The total mean Agatston score was 420 (range from 0-4275). CT detected >50% stenoses with a sensitivity of 70.1%, specificity of 79.9% and positive and negative predictive values of 55.4% and 88.2%, respectively. The negative predictive value was 93.0% for Agatston score zero but 78.3% for Agatston score ˃750. An Agatston score threshold of 363 predicted ≥50% coronary stenoses with 49.6% sensitivity. Diagnostic accuracy is moderate with good negtive predictive value and specificity. Although coronary calcification reduces diagnostic accuracy, negative predictive value is only mildly affected for Agatston score as high as 400. Agatston score is not a good predictor of ≥50% coronary artery stenoses. No particular Agatston score cut-off level was identified to indicate whether CT angiography was useless or not

The effects of parenting a child diagnosed with cancer : distress, resilience and vital exhaustion. Living with death in your face

Study I Aim. Studies of parental reactions to a child’s cancer have traditionally been carried out within the framework of psychiatry and psychopathology. We studied the significance of individual resource factors strengthening parents’ resilience to long-term cancer-related distress, a focus that has rarely been used. Participants and methods. The two-nation Nordic sample included 333 parents; 159 of whom had experienced a child’s cancer, and 174 reference parents. We studied the sense of coherence (SOC) using the SOC-13 questionnaire. For assessing distress reactions we used a primarily illness-specific 11-dimensional Parental Psychosocial Distress in Cancer (PPD- C) self-report questionnaire developed for use with parents of childhood cancer patients, and the General Health Questionnaire (GHQ). Resilience was defined as absence of/less severe distress. Results. Low SOC was significantly associated with more severe distress in all dimensions of the PPD-C and GHQ. The influence of SOC varied with parents’ gender, showing a stronger modifying influence among mothers. Mothers and fathers also differed in their utilization of professional psychosocial support when confronted with the child’s cancer. Conclusion. Parental resilience to cancer-related distress varies with identifiable strength factors. A strengths-oriented approach helps in understanding parental adjustment to childhood cancer. Addressing resilience helps to identify parents at risk and in need of professional support when faced with a child’s cancer. Study II Aim. Determining the incidence of disease-related distress symptoms in parents from two treatment sites: a large specialized childhood cancer (CC) center in Sweden and a smaller pediatric unit in Iceland. The two groups were compared by considering differences in center type and care organization. Methods. Participants were 306 parents of 188 CC patients, in- or off-treatment. Illness- specific distress was assessed using the multi-dimensional Parental Psychosocial Distress in Cancer (PPD-C) questionnaire. General psychiatric symptoms were assessed using the General Health Questionnaire (GHQ-12). Swedish and Icelandic groups were compared and outcomes studied with regard to site characteristics. Parents in the general population served as a reference group. Results. Distress outcomes in both clinical groups exceeded the levels of the reference group. Systematic differences were evident between the parent groups, Icelandic parents scoring higher on 5 of the 11 distress subscales in the PPD-C and in a majority of the illness-specific domains

The distribution of four trace elements (Fe, Mn, Cu, Zn) in forage and the relation to scrapie in Iceland

<p>Abstract</p> <p>Background</p> <p>Previous studies indicated that the iron (Fe)/manganese (Mn) ratio in forage of sheep was significantly higher on scrapie-afflicted farms than on farms in other scrapie categories. This study was conducted to examine whether Fe and Mn in forage of sheep varied in general according to the scrapie status of different areas in the country. Copper (Cu) and zinc (Zn) were also included because of a possible relation to scrapie.</p> <p>Methods</p> <p>The country was subdivided into seven Areas (I-VII). Three Areas (I, IV, VII) were designated scrapie-free (never diagnosed or eradicated) and three as scrapie-endemic (II, III, VI); status of Area V was taken as unsettled. Of the harvest 2007 1552 samples were analysed from 344 farms all over the country, mostly grass silage from plastic bales (>90%) and from the first cut (70% or more). Results were expressed as mg kg^-1dry matter.</p> <p>Results</p> <p>Fe varied enormously from less than 100 mg kg^-1to 5000 mg kg^-1. Mn varied nearly thirtyfold (17-470 mg kg^-1). Fe concentration was significantly lower in Area I than in Areas II, V and VI. Mn concentration was significantly higher in Areas I, IV and VII than in Areas II, III, V and VI. The Fe/Mn ratio was significantly less in Area I than in the other areas (except Area IV). Mean Cu concentration was 6.6-8.3 mg kg^-1and the mean Zn concentration was 24-29 mg kg^-1. They differed significantly in some areas.</p> <p>Conclusions</p> <p>1) Fe tended to be in lower amounts in sheep forage in scrapie-free than in endemic areas; 2) Mn was in higher amounts in forage in scrapie-free than endemic areas; 3) the Fe/Mn ratio was lower in scrapie-free than in endemic areas; 4) the Fe/Mn ratio may possibly be used as an indicator of scrapie status; 5) Cu and Zn in sheep forage were not related to scrapie; 6) further study on the role of Fe and Mn in the occurrence of scrapie in Iceland is needed.</p

Pedagogical Knowledge in Social Studies

Dentro del marco teórico sobre “Desarrollo del conocimiento en la enseñanza” este artículo realiza una comparación entre profesores expertos y profesores principiantes de ciencias sociales, a través de un estudio cualitativo de un estudio de caso de dos profesores, uno veterano (Harry) y otro principiante (Chris). El estudio muestra las diferencias que existen en el dominio de la materia y, especialmente, en el “conocimiento didáctico del contenido”. Estas diferencias motivan que las formas que tienen de enseñar la materia y, especialmente, la flexibilidad para narrar la materia y seleccionar la metodología adecuada. Las implicaciones para la formación del profesorado apuntan a la necesidad de aprender las materias en términos de sus contenidos didácticos.In the theoretical framework about “Growth of Knowledge in Teaching” this paper does a comparison by contrasting the pedagogical content knowledge of two social studies teachers, a veteran teacher (Harry) and a novice (Chris). We are interested in the ways in which the expert teacher know his subject matter and can do things in the classroom that the novice teacher cannot do. The most dramatic differences between the novice and the expert are that the expert has pedagogical content knowledge that enables him to see the larger picture in several ways and he has the flexibility to select a teaching method thas does justice to the topic. The implication for teacher education is that more focus should be on pedagogical content knowledge.Grupo de Investigación FORCE (Formación Centrada en la Escuela). Universidad de Granad

Conocimiento didáctico en Ciencias Sociales

Dentro del marco teórico sobre “Desarrollo del conocimiento en la enseñanza” este artículo realiza una comparación entre profesores expertos y profesores principiantes de ciencias sociales, a través de un estudio cualitativo de un estudio de caso de dos profesores, uno veterano (Harry) y otro principiante (Chris). El estudio muestra las diferencias que existen en el dominio de la materia y, especialmente, en el “conocimiento didáctico del contenido”. Estas diferencias motivan que las formas que tienen de enseñar la materia y, especialmente, la flexibilidad para narrar la materia y seleccionar la metodología adecuada. Las implicaciones para la formación del profesorado apuntan a la necesidad de aprender las materias en términos de sus contenidos didácticos