Marital adjustment in the context of female breast cancer: A systematic review

Objective: Breast cancer (BC) diagnosis and subsequent treatments present significant challenges and distress for both patients and their partners. This can lead to difficulties in marital relationships and, consequently, decreases in marital adjustment and psychosocial adaptation to BC for both partners. Our objective was to systematically review studies assessing marital adjustment in the context of female BC to understand which factors are associated with marital adjustment in both patients and partners, and characterize the measures employed to assess marital adjustment within these studies. Methods: This systematic review was conducted in accordance with PRISMA guidelines. English, peer-reviewed articles exploring factors associated with marital adjustment in the context of female BC were considered for inclusion. Results: Fourteen studies were included. Results evidenced that psychosocial variables play an important role on marital adjustment. Specifically, open and constructive communication, more social support, and supportive dyadic coping were found to be associated with higher levels of marital adjustment. Other variables such as self-efficacy, sexual functioning, and psychological adjustment were also positively associated with marital adjustment. Conclusions: Most studies evidenced an association between psychosocial variables and marital adjustment for both women and their partners. Some important dimensions such as communication patterns, coping strategies, and social support dynamics were identified as potential targets for psychological interventions. Some variables, however, were explored only in a few studies which limit our conclusions. Future studies should explore the role these variables and other relational and emotional variables play in promoting marital adjustment after BC

Dyadic dynamics of perceived social support in couples facing infertility

Is perceived social support from partner, family, and friends associated with increased infertility-related stress? While mens perceived support did not seem to influence their partners stress, womens perceptions of spousal and familial support can affect the way men deal with the challenge of infertility. Previous studies showed that low levels of social support are associated with poor psychosocial adjustment and treatment termination in women and men. Studies examining the impact of social support using the couple as unit of analysis are lacking. A cross-sectional sample of 613 Portuguese patients participated in the research, online over a 3-month period, and in a public fertility clinic over 11 months. The final sample comprised 213 married or cohabiting couples (191 from the fertility clinic) who were actively attempting to have a child, were seeking infertility treatment and had not undergone previous preimplantation genetic diagnosis. Perceived social support was assessed through the Multidimensional Scale of Perceived Social Support and infertility-related stress was assessed with the fertility problem inventory. Hypotheses were tested by applying the actorpartner interdependence model using structural equation modeling. Couples had been living together for an average (SD) of 6 3.5 years, and attempting a pregnancy for 3.8 2.6 years. Nearly half of the couples had undergone infertility treatment (41.3). Infertility stress was found to be associated with low family support for women ( 0.27, P .003), and low partner support for both men ( 0.29, P .001) and women ( 0.45, P .006). Both women and mens perceived friend support were not significantly related to male or female infertility stress. Men infertility stress was also associated with their partners low levels of partner ( 0.24, P .049) and family support ( 0.23, P .001). No significant partner effects were observed for women. Despite being related to actor effects alone (female partner and family support), the explained variance of the model in womens fertility stress was greater (R-2 21) than that (R-2 15.6) for the combined actor and partner effects in mens fertility stress (male partner support, female partner and family support). The study data are cross-sectional and the generalizability of results is limited by self-selection. The characteristics of non-participants in both the clinical and online samples were not available, the perception of infertility-specific supportive behaviors was not assessed and differential analyses according to infertility diagnosis were not included in this study. Our data underline the importance of partner support in alleviating the burden of infertility. Men may experience infertility indirectly through the impact that it has on their partners. Our findings reinforce the need to involve the male partner throughout the whole treatment process and for couple-based interventions when providing infertility counseling. Further prospective research should be aimed at investigating the male experience of infertility. This research was supported by a PhD scholarship from the Portuguese Foundation for Science and Technology granted to M.M. (FCT, SFRH/BD/44232/2008). The authors have no conflicts of interest to declare

Doses cumulativas de iodo radioativo no tratamento do carcinoma diferenciado de tireoide: sabendo a hora de parar

OBJECTIVE: Evaluate the efficacy of cumulative doses (CDs) of 131I-iodide therapy (RIT) in differentiated thyroid cancer (DTC). SUBJECTS AND METHODS: The probability of progressive disease according to CDs was evaluated in patients < 45 years old and &gt; 45 years old and correlated to tumor-node-metastasis (TNM), thyroglobulin values, histological types and variants, age, and zduration of the disease. RESULTS: At the end of a follow-up period of 69 ± 56 months, 85 out of 150 DTC patients submitted to fixed doses RIT had no evidence of disease, 47 had stable disease and 18 had progressive disease. Higher CDs were used in the more aggressive variants (p < 0.0001), higher TNM stages (p < 0.0001), and follicular carcinomas (p = 0.0034). Probability of disease progression was higher with CDs &gt; 600 mCi in patients &gt; 45 years old and with CDs &gt; 800 mCi in patients < 45 years. CONCLUSION: Although some patients may still respond to high CDs, the impact of further RIT should be carefully evaluated and other treatment strategies may be warranted.OBJETIVO: Avaliar a eficácia de doses cumulativas (DCs) da terapia com iodeto-131I (RIT) no câncer diferenciado de tiroide (CDT). SUJEITOS E MÉTODOS: A probabilidade de doença em progressão conforme a DC foi calculada em pacientes com idade < 45 e &gt; 45 anos e correlacionada com o TNM, valores de tiroglobulina sérica, tipos histológicos e variantes, idade e tempo de doença. RESULTADOS: Ao final de um seguimento de 69 ± 56 meses, 85 dos 150 pacientes CDT submetidos a doses fixas de RIT não tinham evidência de doença, 47 tinham doença estável e 18, doença progressiva. DCs mais elevadas foram usadas nas variantes agressivas (p < 0,0001), maior estágio TNM (p < 0,0001) e nos carcinomas foliculares (p = 0,0034). A probabilidade de doença em progressão foi maior com DCs &gt; 600 mCi em pacientes &gt; 45 anos e com DCs &gt; 800 mCi em pacientes < 45 anos. CONCLUSÃO: Apesar de alguns pacientes ainda responderem a altas DCs, o impacto de RITs deve ser cuidadosamente avaliado e outras estratégias terapêuticas devem ser consideradas.80781

Cumulative Doses Of Radioiodine In The Treatment Of Differentiated Thyroid Carcinoma: Knowing When To Stop.

Evaluate the efficacy of cumulative doses (CDs) of 131I-iodide therapy (RIT) in differentiated thyroid cancer (DTC). The probability of progressive disease according to CDs was evaluated in patients 45 years old and correlated to tumor-node-metastasis (TNM), thyroglobulin values, histological types and variants, age, and zduration of the disease. At the end of a follow-up period of 69 ± 56 months, 85 out of 150 DTC patients submitted to fixed doses RIT had no evidence of disease, 47 had stable disease and 18 had progressive disease. Higher CDs were used in the more aggressive variants (p 600 mCi in patients > 45 years old and with CDs > 800 mCi in patients < 45 years. Although some patients may still respond to high CDs, the impact of further RIT should be carefully evaluated and other treatment strategies may be warranted.54807-1

Rarity of monodominance in hyperdiverse Amazonian forests.

Tropical forests are known for their high diversity. Yet, forest patches do occur in the tropics where a single tree species is dominant. Such "monodominant" forests are known from all of the main tropical regions. For Amazonia, we sampled the occurrence of monodominance in a massive, basin-wide database of forest-inventory plots from the Amazon Tree Diversity Network (ATDN). Utilizing a simple defining metric of at least half of the trees ≥ 10 cm diameter belonging to one species, we found only a few occurrences of monodominance in Amazonia, and the phenomenon was not significantly linked to previously hypothesized life history traits such wood density, seed mass, ectomycorrhizal associations, or Rhizobium nodulation. In our analysis, coppicing (the formation of sprouts at the base of the tree or on roots) was the only trait significantly linked to monodominance. While at specific locales coppicing or ectomycorrhizal associations may confer a considerable advantage to a tree species and lead to its monodominance, very few species have these traits. Mining of the ATDN dataset suggests that monodominance is quite rare in Amazonia, and may be linked primarily to edaphic factors