What is the prevalence of fear of cancer recurrence in cancer survivors and patients? A systematic review and individual participant data meta-analysis

This study was supported by the Dutch Cancer Society (KWF) grant number 10936.Objective Care for fear of cancer recurrence (FCR) is considered the most common unmet need among cancer survivors. Yet the prevalence of FCR and predisposing factors remain inconclusive. To support targeted care, we provide a comprehensive overview of the prevalence and severity of FCR among cancer survivors and patients, as measured using the short form of the validated Fear of Cancer Recurrence Inventory (FCRI-SF). We also report on associations between FCR and clinical and demographic characteristics. Methods This is a systematic review and individual participant data (IPD) meta-analysis on the prevalence of FCR. In the review, we included all studies that used the FCRI-SF with adult (≥18 years) cancer survivors and patients. Date of search: 7 February 2020. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. Results IPD were requested from 87 unique studies and provided for 46 studies comprising 11,226 participants from 13 countries. 9311 respondents were included for the main analyses. On the FCRI-SF (range 0–36), 58.8% of respondents scored ≥13, 45.1% scored ≥16 and 19.2% scored ≥22. FCR decreased with age and women reported more FCR than men. FCR was found across cancer types and continents and for all time periods since cancer diagnosis. Conclusions FCR affects a considerable number of cancer survivors and patients. It is therefore important that healthcare providers discuss this issue with their patients and provide treatment when needed. Further research is needed to investigate how best to prevent and treat FCR and to identify other factors associated with FCR. The protocol was prospectively registered (PROSPERO CRD42020142185).Publisher PDFPeer reviewe

Approximation du calendrier des migrations multiples par un modèle stochastique

Kasparian Robert. An approximate schedule of multiple migrations through a stochastic model. The timing of migrations in the life time of an individual may be described approximately by a negative binomial law. This process to described by m(x) the average number of migrations before age x interpreted as an index of the cumulative probability of migration : the more frequent the number of past moves the larger is the probability of an additional move. This factor will depend upon the geographical division adopted to define the migration. In France it is approximately 0.25 for the most detailed breakdown into communes, and rises to 1.4 if the only moves between départements are considered. In a stationary population m(x) may easily be estimated from surveys, or preferably from answers to a question asked in census on changes of domicile during the previous twelve months. This makes it possible to draw the frequency function dm (r) p{x) = dx The main advantage of this model is that it provides a simple means, with a minimum amount of data, of estimating the principal parameters of the intensity and timing of successive migrations.Kasparian Robert. Approximation du calendrier des migrations multiples par un modèle stochastique. Le processus ponctuel des migrations dans la vie d'un individu peut être décrit avec une certaine approximation par une loi binominale négative. Ce processus est défini par la donnée d'une moyenne m (x) du nombre de migrations avant l'âge x et d'un paramètre interprété comme facteur d'« entraînement » de la probabilité de migrer : plus on a déjà migré, plus on risque de migrer encore. Ce facteur dépend du découpage géographique adopté pour définir la migration : en France, de 0,25 environ pour le découpage le plus fin en communes il passe à 1,4 si l'on prend en considération les changements de département. Par ailleurs, dans le cas d'un comportement stationnaire des différentes générations, il est aisé d'estimer m (x) par des sondages auprès de la population ou mieux, au cours d'un recensement par une question sur les changements de domicile au cours des douze derniers mois, ce qui permet de reconstituer la courbe de densité des migrations dm(x) p(x) = dx L'avantage d'un tel modèle est de fournir un moyen simple, et avec un minimum d'observations, de calculer les principales caractéristiques d'intensité et de calendrier des migrations successives.Kasparian Robert. Cálculo aproximado del calendario de migraciones multiples mediante un modelo estocástico. El proceso de las migraciones puntuales en la vida de un individuo, puede ser descrito aproximadamente, mediante una ley binomial negativa. Este proceso es definido рог la media aritmética m(x) del numero de migraciones anteriores a la edad x у рог un parámetro interpretado como factor de « acumulación » de la probabilidad de migrar, es decir : a mayor migración en el pasado, mayor riesgo de migrar en el futuro. Este factor dépende de la division geográfica adoptada para définir la migración : en Francia, su valor es de 0,25 si se toman las comunas y de 1,4 si se consideran los departamentos. Por otra parte, en el caso de un comportamiento estacionario de las diferentes generaciones, es fácil estimar m(x) mediante encuestas por muestreo о mejor aun, en el caso de un censo, mediante una pregunta acerca de los cambios de domicilio durante los últimos 12 meses, lo que permite reconstituir la curva de densidad de las migraciones dm (x) p(x) = dx Este modelo tiene la ventaja de proporcionar un método simple para calcular las principales caracteristicas de intensidad y de calendario de las migraciones, con un minimo de observaciones.Kasparian Robert. Approximation du calendrier des migrations multiples par un modèle stochastique. In: Population, 32ᵉ année, n°4-5, 1977. pp. 867-887

L'analyse longitudinale de la population active : une typologie des profils de carrière des générations françaises de 1911 à 1935

Kasparian (Robert). - A Longitudinal Analysis of the Active Population. A Typology of Career Profiles of Persons Born between 1911 and 1935 Resident in France in 1982 Longitudinal studies of working life are rare and often inadequate, because of the absence of relevant data. The "3b" survey carried out in 1981 opens new avenues for this type of study. The author suggests a method for exploiting the data yielded by the survey by analyzing the life courses of a series of cohorts, their transition between economic activity and unemployment and changes between jobs. The final object is the provide a typology of life courses. The new method is based on that developed by Courgeau and Lelièvre for the analysis of biographical data. The most important instrument is a table of entries into and exits from different employment situation, specific by age and sex, and (where the sample permits) by cohort. The parameters estimated are the probabilities of being in a given state, the average number of entries and exits, and the changes of entry and exit. Such tables have only been calculated for a few of the many situations which could, in theory, have been derived from the wealth of data yelded by the survey.Kasparian (Robert). - L'analyse longitudinale de la population active : une typologie des profils de carrière des résidents en France en 1982 et appartenant aux générations de 1911 à 1935 Les études longitudinales de la vie active sont encore rares et maigres, faute de sources d'information adaptées. L'enquête « 3B » de 1981 offre justement des possibilités nouvelles pour ce genre d'analyse. L'auteur propose donc une méthodologie d'exploitation de l'enquête « 3B » pour analyser, dans la vie d'une série de générations, les passages successifs entre situations d'emploi et de non-emploi et les passages d'une situation d'emploi à une autre. Le résultat final visé est une typologie des profils de carrière. La méthodologie proposée se base sur celle que Courgeau et Lelièvre ont développé pour analyser des données biographiques. L'instrument principal est la table d'entrée-sortie par situation d'emploi, par âge et par sexe (et, quand l'échantillon le permet, par génération). Les paramètres calculés sont les probabilités de présence dans un état donné, les nombres moyens d'entrées et de sorties, les quotients instantanés d'entrée et de sortie. De telles tables n'ont été calculées que pour quelques-unes des très nombreuses situations d'emploi ou de non-emploi que la richesse des données recueillies permettait théoriquement de distinguer.Kasparian (Robert) . - El análisis longitudinal de la población activa: una tipologia de los perfiles de carrera profesionál de los résidentes en Francia en 1982 y pertenecientes a las generaciones de 1911 a 1935 Los estudios longitudinales de la vida activa son aún escasos y pobres, por falta de fuentes de información bien adaptadas. La encuesta "3B" de 1981 ofrece posibilidades nue- vas para este tipo de análisis. El autor propone una metodologla de explotación de la encuesta "3B" para analizar, en la vida de una série de generaciones, las transiciones sucesivas de situaciones de empleo a situaciones de no-empleo y los pasos de una situación de empleo a otra. El resultado final es la elaboración de una tipologia de los perfiles de carrera. La metodologia propuesta se basa en la desarrollada por Courgeau y Lelièvre para el análisis de datos biográficos. El instrumento principal es la tabla de entrada-salida por situación de empleo, por edad y por sexo (y, cuando la muestra lo permite, por generación). Los paramétras calculados son las probabilidades de presencia en un estado concreto, las cifras médias de entradas y de salidas, los cocientes instantaneos de entrada y de salida. Estas tablas solamente han sido calculadas para algunas de las numerosas situaciones de empleo о de no-empleo que la diversidad de datos recogidos permitía teóricamente distinguir.Kasparian Robert. L'analyse longitudinale de la population active : une typologie des profils de carrière des générations françaises de 1911 à 1935. In: Population, 48ᵉ année, n°3, 1993. pp. 627-653

Population déplacée au Liban : 1975-1987; synthèse des rapports de recherche ...

Divizijska organizacijska struktura pripada klasičnom organizacijskom oblikovanju na kojemu počiva suvremeno oblikovanje organizacije, a koriste ju organizacije koje rastu i šire svoj proizvodni asortiman i čije potrebe funkcijska organizacijska struktura više ne zadovoljava. Oblikovanju divizijske organizacijske strukture prethode procesi diversifikacije, divizionalizacije i decentralizacije, a ključno je oblikovanje divizija kao zasebnih dijelova koji se formiraju prema proizvodu, teritoriju ili kategoriji potrošača. Javlja se u tri oblika: predmetna organizacijska struktura, teritorijalna organizacijska struktura i organizacijska struktura orijentirana potrošačima. Divizije su tako oblikovane prema predmetu proizvodnje, teritoriju na kojem organizacija posluje i prema kategorijama kupaca. Prednosti su divizijske organizacijske strukture usredotočenost na proizvode, regije ili kupce, te visoka autonomija koja omogućuje odlučivanje bez čekanja odluka s vrha. Uz prednosti, svaka struktura ima i svoje nedostatke, a u divizijskoj su to visoki troškovi zbog paralelnog obavljanja poslova istih poslovnih funkcija u divizijama te potreba za visokokvalificiranom radnom snagom, a javlja se i otežano upravljanje s vrha. Svaka organizacija ima različite potrebe pa divizijska organizacijska struktura neće odgovarati svima, no uz pravilno iskorištavanje njezinih prednosti može organizaciji donijeti optimalne rezultate. U radu su prikazana tri primjera divizijske organizacijske strukture: Sunce koncern d.d., Procter & Gamble i Podravka d.d.Divisional organisation structure is classic organisation design which is modern organisation design base and it is used by organisations in stages of growth and production program expansion. Their needs are no longer met by functional organisational structure. Processes of diversification, divisionalization and decentralisation precede the designing of divisional organisation structure and the key is on forming divisions as autonomous parts designed by product, territory or customers categories. It exists in three forms; production organisation structure, territorial organisation structure and customer-oriented organisation structure. Divisions are designed according to products, territory on which organisation operates or customer categories. The advantages of divisional organisation structure are focusing on products, territory and customers and high level of autonomy which ensures decision making without waiting for top management confirmation. Alongside this advantages, there are several different disadvantages every organisational structure has and in divisional organisational structure they include high costs caused by parallel tasks of the same business functions in different divisions. High costs are also caused by the need of highly educated staff, and some difficulties occur in keeping the control from the top of the organisation. Every organisation has different needs so divisional organisation structure will not suit every organisation. Nevertheless, rightful use of advantages of this organisational structure can bring optimal results for the organisation that is using it. Three examples of the divisional organisation structure can be found in paper: Sunce koncern d.d., Procter & Gamble and Podravka d.d

An Observational Study of Dialogue about Uncertainty in Clinician-Family Counseling Conversations Following Prenatal Diagnosis of Complex Congenital Heart Disease

Objective: Families who receive a prenatal diagnosis of complex congenital heart disease (cCHD) often experience severe psychological distress and identify uncertainty as a key source of that distress. This study examined clinician-family conversations during initial fetal cardiology consultations to identify the topics of uncertainty discussed. Methods: In this observational, qualitative study, initial fetal cardiology consultations were audio-recorded, transcribed verbatim, and coded by two independent coders. A codebook was inductively and deductively developed and applied. This content analysis focused on uncertainty-related codes and associated themes. Results: During 19 consultations including five clinicians, 13 different cardiac diagnoses were discussed (seven with high mortality risk). Median consultation length was 37 min (IQR: 26–51), with only 11% of words spoken by families. On average, 51% of total words spoken focused on uncertainty in relation to cardiac diagnosis, etiology, comorbidities, prognosis, childbirth, therapeutics, and logistics. Family-initiated discussion on uncertainty largely focused on childbirth and pregnancy and postpartum logistics. Conclusions: Half of dialogue within initial fetal cardiology encounters discussed uncertainty surrounding prenatally diagnosed cCHD. Parent and clinician perspectives should be gathered on the essential content and optimal delivery of uncertainty-related topics. Innovation: This study is conceptually and methodologically innovative as one of the first to examine audio-recorded dialogue between fetal cardiology clinicians and families

“I Just Want You to Hear That Term”: Characterizing Language Used in Fetal Cardiology Consultations

The way clinicians communicate with parents during pregnancy about congenital heart disease (CHD) can significantly influence parental understanding of and psychological response to the diagnosis. A necessary first step to improving communication used in fetal cardiology consultations is to understand and describe the language currently used, which this paper aims to do. Nineteen initial fetal cardiology consultations with parents were audio-recorded, transcribed verbatim, and coded by two independent coders. A codebook was inductively developed and applied to all transcripts. The finalized coding was used to characterize fetal cardiologists’ language. We identified four discourse styles employed in fetal cardiology consultations: small talk, medical, plain, and person-centered. Plain language was used to define and emphasize the meaning of medical language. Person-centered language was used to emphasize the baby as a whole person. Each consultation included all four discourse styles, with plain and medical used most frequently. Person-centered was used less frequently and mostly occurred near the end of the encounters; whether this is the ideal balance of discourse styles is unknown. Clinicians also used person-centered language (as opposed to disease-centered language), which is recommended by medical societies. Future studies should investigate the ideal balance of discourse styles and the effects of clinician discourse styles on family outcomes, including parents’ decision-making, psychological adjustment, and quality of life

The Cost of Neurodevelopmental Disability : Scoping Review of Economic Evaluation Methods

The provision of effective care models for children with neurodevelopmental delay or disability can be challenging in resource constrained healthcare systems. Economic evaluations have an important role in informing resource allocation decisions. This review systematically examined the scope and methods of economic models evaluating interventions for supporting neurodevelopment among children with common neurodevelopmental disorders and identified methods of economic models and presented policy implications. This scoping review employed the Arksey and O’Malley framework and aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Four electronic databases were systematically searched to identify eligible model-based economic evaluations of neurodevelopmental care models published since 2000. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to assess quality of reporting. Data were systematically extracted, tabulated, and qualitatively synthesised across diagnostic categories. Searches identified 1431 unique articles. Twelve studies used a decision analytic model to evaluate care for neurodevelopmental disorders and were included in the review. Included studies focused on attention-deficit/hyperactivity disorder (ADHD, n=6), autism spectrum disorder (ASD, n=3), cerebral palsy (n=2), and dyslexia (n=1). The most used decision analytic modelling approach was a Markov model (n=6), followed by a decision tree (n=3), and a combination of decision tree and Markov model (n=3). Most studies (n=7) adopted a societal perspective for reporting costs. None of the reviewed studies modelled impact on families and caregivers. Four studies reported cost-savings, three identified greater quality of life, and three identified cost increases.</p

Economic Justification for Neurodevelopmental Support for Children With Congenital Heart Disease: A Scoping Review of Economic-Modelling and Recommendations for Future Practice

BackgroundCongenital heart disease is associated with neurodevelopmental delay and disability. The allocation of appropriate resources to support children with heart conditions to live their best life, not only prevent their death, requires contributions from many disciplines including health economics. This review systematically examined scope and methods of economic models evaluating interventions for supporting neurodevelopment in common neurodevelopment-associated conditions.MethodsThe Arksey and O’Malley framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews were used. Four electronic databases were systematically searched to identify model-based economic evaluations of neurodevelopmental clinical care models since 2000. Data were systematically extracted, tabulated, and qualitatively synthesised. The Consolidated Health Economic Evaluation Reporting Standards checklist was used to assess reporting.ResultsFrom 1,431 unique articles, 12 studies used a decision analytic model and were included. Despite considerable disease burden, children with congenital heart disease were notably absent from the neurodevelopment economic literature, which instead focused on attention-deficit/hyperactivity disorder (n=6), autism spectrum disorder (n=3), cerebral palsy (n=2), and dyslexia (n=1). Decision analytic modelling approaches used were Markov models (n=6), decision trees (n=3), or combination of both (n=3). Most studies (n=7) adopted societal cost perspective. None modelled family/caregiver impact. Four studies reported cost-savings, three identified greater quality-of-life, and three identified cost increases.ConclusionThis study highlights that congenital heart disease-specific economic modelling remains a high priority for informing public resource allocation for neurodevelopmental support. Recommendations for discussion also include clinical care model and economic modelling implications, including longer time-horizons, and third-party/family impacts