Fear of cancer recurrence : a qualitative systematic review and meta-synthesis of patients' experiences

Fear of cancer recurrence (FCR) is a significant issue for most cancer survivors, with nearly half of cancer survivors reporting it at moderate to high levels of intensity. We aimed to further explore the experience of having FCR from the point of view of patients by systematically reviewing qualitative studies. Following PRISMA guidelines, 87 qualitative studies were selected. All participants' quotes about FRC were extracted, then analysed using a conceptual framework based on the emotion-focused therapy theory of emotion schemes, which consist of experienced/implicit emotions, along with perceptual-situational, bodily-expressive, symbolic-conceptual and motivational-behavioral elements. According to participant descriptions, FCR was found to be an intense, difficult, multi-dimensional experience. Considering the diversity of experiences identified, it is useful to look at FCR as an emotional experience that extends along a continuum of adaptive and maladaptive responses. For some participants, FCR was described in trauma-like terms, including forms of re-experiencing, avoidance, negative thoughts and feelings, and arousal or reactivity related to cancer-related triggers or memories. Vivid metaphors expressing vulnerability and conflict also reflect the strong impact of FCR in patients' lives and can help therapists empathize with their clients

"I have always lived with the disease in the family": family adaptation to hereditary cancer-risk

BACKGROUND: Hereditary cancer syndromes have been conceptualized as a family level process. The present study explores the complexity and challenges of family adaptation to the hereditary cancer syndrome, in the context of genetic counseling and long-term cancer risk management and follow-up surveillance. METHODS: We performed semi-structured interviews with 13 participants with one of the following hereditary cancer syndromes: Lynch Syndrome, Hereditary Diffuse Gastric Cancer Syndrome, Hereditary Breast and Ovarian Cancer Syndrome, or Familial Adenomatous Polyposis. The interview was developed through a participatory approach with the involvement of healthcare professionals and individuals with first-hand experience of living with the hereditary cancer syndromes. RESULTS: The family is the main source of information and emotional support to deal with hereditary cancer syndromes. Multiple individual adaptation processes and communal coping networks interact, influencing the emotional and health-related behavior of family members. This is affected and affects the family’s communication and its’ members reactions to disclosure, with consequent changes in relationships. CONCLUSIONS: The systemic interdependent dynamics of family adaptation calls for family-centered care of genetic cancer syndromes

Developing an emotion-focused therapy model for fear of cancer recurrence : a case‐level task analysis

Fear of cancer recurrence (FCR) involves anxiety about the possible return or progression of the disease. It is common among people surviving cancer, covering a range of adaptive and maladaptive responses including clinical presentations of FCR, for which different psychological interventions have been developed, most within the cognitive‐behavioural paradigm. Recently, emotion‐focused therapy (EFT) has been proposed as an alternative and has been the subject of research focusing on the cancer population and cancer‐related issues, including FCR. In this study, we looked closely at a successful case from a larger exploratory study, carrying out a discovery‐phase task analysis aimed at identifying the main components of EFT–FCR. We found that this approach generally followed the usual structure of an EFT intervention, with four distinct phases. However, we identified some specific secondary processes (e.g., hypervigilance and catastrophising) and clarified the nature of the core pain in this presentation as existential (e.g., fear of dying)

Family adjustment to hereditary cancer syndromes: a systematic review

Hereditary cancer syndromes are inherited pathogenic genetic variants that significantly increase the risk of developing cancer. When individuals become aware of their increased probability of having cancer, the whole family is affected by this new reality and needs to adjust. However, adjustment to hereditary cancer syndromes has been mainly studied at an individual level, and research about familial adjustment remains dispersed and disorganized. To overcome this gap, this review aims to understand how families adjust to genetic testing and risk management, and to what extent the family’s adjustment influences the psychological response and risk management behaviors of mutation carriers. We conducted searches on the PubMed/Med Line, PsycInfo, SCOPUS, and Google Scholar databases and used the Mixed Methods Appraisal Tool (MMAT-v2018) to assess the methodological quality of each selected study. Thirty studies met the inclusion criteria. Most results highlighted the interdependent nature of adjustment of pathogenic variant carriers and their families. The way carriers adjust to the syndrome is highly dependent on family functioning and related to how family members react to the new genetic information, particularly partners and siblings. Couples who share their worries and communicate openly about cancer risk present a better long-term adjustment than couples who use protective buffering (not talking about it to avoid disturbing the partner) or emotional distancing. Parents need help dealing with disclosing genetic information to their children. These findings reinforce the importance of adopting a family-centered approach in the context of genetic counseling and the necessity of involving family members in research

Secreted extracellular vesicle molecular cargo as a novel liquid biopsy diagnostics of central nervous system diseases

Secreted extracellular vesicles (EVs) are heterogeneous cell-derived membranous granules which carry a large diversity of molecules and participate in intercellular communication by transferring these molecules to target cells by endocytosis. In the last decade, EVs role in several pathological conditions, from etiology to disease progression or therapy evasion, has been consolidated, including in central nervous system (CNS)-related disorders. For this review, we performed a systematic search of original works published, reporting the presence of molecular components expressed in the CNS via EVs, which have been purified from plasma, serum or cerebrospinal fluid. Our aim is to provide a list of molecular EV components that have been identified from both nonpathological conditions and the most common CNS-related disorders. We discuss the methods used to isolate and enrich EVs from specific CNS-cells and the relevance of its components in each disease context.This research was funded by the MindGaP-H2020-FETOPEN-2018-2020, Grant agreement ID: 829040. S.M.-R., C.C.-M., and J.P. hold a fellowship from MindGaP.info:eu-repo/semantics/publishedVersio

A abordagem CTS no currículo do curso técnico em informática integrado ao ensino médio no IFRR

Esta pesquisa propõe analisar como é abordado os conceitos de Ciência, Tecnologia e Sociedade (CTS) nos componentes curriculares do Projeto Pedagógico (PPC) do Curso Técnico em Informática Integrado ao Ensino Médio, ofertado pelo Instituto Federal de Educação, Ciência e Tecnologia de Roraima (IFRR). Para alcançar o proposto, fez-se um estudo teórico embasado nos autores que tratam sobre os conceitos de CTS, em seguida estudou-se sobre a legislação que rege a oferta de curso técnico integrado ao ensino médio e os Parâmetros Curriculares Nacionais do Ensino Médio (PCNEM) (2000). Após esses estudos, realizou-se uma análise do PPC do curso em questão, buscando visualizar se há inclusão dos conceitos de CTS no currículo e quais disciplinas e orientações metodológicas são utilizadas para abordar esses conceitos. Concluiu-se que o currículo do curso analisado, apesar de conter questões voltadas à formação de um sujeito crítico e com tomada de decisão consciente sobre a sua realidade, não apresenta de forma objetiva uma preocupação metodológica quanto ao fazer docente direcionado ao uso dos conceitos de CTS. Diante dessa realidade observada, sugerimos a criação de ações direcionadas a formação continuada dos professores com vistas a orientação e inclusão dos conceitos de CTS no currículo do curso

Escolha do tipo de parto: fatores relatados por puérperas

Objetivo: Conhecer os fatores relatados por puérperas que concorreram na escolha do tipo de parto.Métodos: Pesquisa qualitativa, desenvolvida com 25 puérperas em um Hospital Universitário de Mato Grosso do Sul, entre setembro e novembro de 2014. Utilizou-se a entrevista semiestruturada para a coleta de dados e o Discurso do Sujeito Coletivo para organizar e tabular os depoimentos.Resultados: Os Discursos dos Sujeitos Coletivos resultaram nas categorias: Desejo pelo tipo de parto realizado; Respeito pelo tipo de parto escolhido e Fatores que influenciaram a escolha. A maioria das mulheres entrevistadas (76%) manifestou preferência pelo parto normal devido à recuperação rápida, menor dor e sofrimento.Conclusões: Concorreram na escolha do tipo de parto: influência da família, experiências prévias com parto, interação profissional – cliente e informações via internet, o que reforça a importância da educação em saúde desde o pré-natal, destacando a necessidade de instrumentalizar a mulher para realizar uma escolha consciente.Palavras-chave: Parto normal. Cesárea. Tomada de decisões. Saúde da mulher. Objetivos de Desenvolvimento do Milênio

The tissue-type plasminogen activator-plasminogen activator inhibitor 1 complex promotes neurovascular injury in brain trauma: evidence from mice and humans

The neurovascular unit provides a dynamic interface between the circulation and central nervous system. Disruption of neurovascular integrity occurs in numerous brain pathologies including neurotrauma and ischaemic stroke. Tissue plasminogen activator is a serine protease that converts plasminogen to plasmin, a protease that dissolves blood clots. Besides its role in fibrinolysis, tissue plasminogen activator is abundantly expressed in the brain where it mediates extracellular proteolysis. However, proteolytically active tissue plasminogen activator also promotes neurovascular disruption after ischaemic stroke; the molecular mechanisms of this process are still unclear. Tissue plasminogen activator is naturally inhibited by serine protease inhibitors (serpins): plasminogen activator inhibitor-1, neuroserpin or protease nexin-1 that results in the formation of serpin:protease complexes. Proteases and serpin:protease complexes are cleared through high-affinity binding to low-density lipoprotein receptors, but their binding to these receptors can also transmit extracellular signals across the plasma membrane. The matrix metalloproteinases are the second major proteolytic system in the mammalian brain, and like tissue plasminogen activators are pivotal to neurological function but can also degrade structures of the neurovascular unit after injury. Herein, we show that tissue plasminogen activator potentiates neurovascular damage in a dose-dependent manner in a mouse model of neurotrauma. Surprisingly, inhibition of activity following administration of plasminogen activator inhibitor-1 significantly increased cerebrovascular permeability. This led to our finding that formation of complexes between tissue plasminogen activator and plasminogen activator inhibitor-1 in the brain parenchyma facilitates post-traumatic cerebrovascular damage. We demonstrate that following trauma, the complex binds to low-density lipoprotein receptors, triggering the induction of matrix metalloproteinase-3. Accordingly, pharmacological inhibition of matrix metalloproteinase-3 attenuates neurovascular permeability and improves neurological function in injured mice. Our results are clinically relevant, because concentrations of tissue plasminogen activator: plasminogen activator inhibitor-1 complex and matrix metalloproteinase-3 are significantly elevated in cerebrospinal fluid of trauma patients and correlate with neurological outcome. In a separate study, we found that matrix metalloproteinase-3 and albumin, a marker of cerebrovascular damage, were significantly increased in brain tissue of patients with neurotrauma. Perturbation of neurovascular homeostasis causing oedema, inflammation and cell death is an important cause of acute and long-term neurological dysfunction after trauma. A role for the tissue plasminogen activator-matrix metalloproteinase axis in promoting neurovascular disruption after neurotrauma has not been described thus far. Targeting tissue plasminogen activator: plasminogen activator inhibitor-1 complex signalling or downstream matrix metalloproteinase-3 induction may provide viable therapeutic strategies to reduce cerebrovascular permeability after neurotraum