The role of emotions in time to presentation for symptoms suggestive of cancer: a systematic literature review of quantitative studies.

BACKGROUND: Emotions may be important in patients' decisions to seek medical help for symptoms suggestive of cancer. OBJECTIVES: The aim of this systematic literature review was to examine quantitative literature on the influence of emotion on patients' help-seeking for symptoms suggestive of cancer. The objectives were to identify the following: (a) which types of emotions influence help-seeking behaviour, (b) whether these form a barrier or trigger for seeking medical help and (c) how the role of emotions varies between different cancers and populations. METHODS: We searched four electronic databases and conducted a narrative synthesis. Inclusion criteria were studies that reported primary, quantitative research that examined any emotion specific to symptom appraisal or help-seeking for symptoms suggestive of cancer. RESULTS: Thirty-three papers were included. The studies were heterogeneous in their methods and quality, and very few had emotion as the main focus of the research. Studies reported a limited range of emotions, mainly related to fear and worry. The impact of emotions appears mixed, sometimes acting as a barrier to consultation whilst at other times being a trigger or being unrelated to time to presentation. It is plausible that different emotions play different roles at different times prior to presentation. CONCLUSIONS: This systematic review provides some quantitative evidence for the role of emotions in help-seeking behaviour. However, it also highlighted widespread methodological, definition and design issues among the existing literature. The conflicting results around the role of emotions on time to presentation may be due to the lack of definition of each specific emotion.This paper presents independent research funded by the National Institute for Health Research Programme Grants for Applied Research programme (RP-PG-0608-10045). The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health. FMW was funded by a NIHR clinical lectureship then an NIHR Clinical Scientist Award.This is the author accepted manuscript. The final version is available at http://dx.doi.org/10.1002/pon.383

Psychosocial factors that influence men's help-seeking for cancer symptoms: A systematic synthesis of mixed methods research

Objective Effectiveness of cancer control partly depends upon early identification and treatment. Men appear to be more likely to delay help-seeking for symptoms, resulting in later diagnosis. This review aims to provide a mixed research synthesis of the psychosocial barriers to and facilitators of help-seeking for cancer symptoms among men. Methods Systematic methods were followed, including a predefined research question and search strategy. Searches retrieved 7131 international records from online databases: MEDLINE (n = 3011), PubMed (n = 471), SCOPUS (n = 896), Informit (n = 131), PsychINFO (n = 347), and Web of Science (n = 2275). Forty studies were eligible for inclusion in the review (25 qualitative studies, 11 quantitative studies, and 4 mixed-method studies). Results There was strong observational evidence for several psychosocial barriers to men's help-seeking behaviour: low cancer knowledge and inaccurate symptom interpretation, embarrassment and fear, and conformity to masculine gender role norms. The strongest facilitating factor associated with men's help-seeking behaviour was encouragement and support of spouses and family members. The majority of research was qualitative and used small samples, making generalisations to the wider population difficult. Conclusions Men's help-seeking for cancer symptoms is influenced by several psychosocial factors, which, in part, may be gender-specific. Health promotion initiatives to improve help-seeking behaviour among men should aim to increase cancer knowledge, reduce embarrassment and fear, address social norms deterring timely help-seeking, and acknowledge informal help-seeking with spouses and family members. Increasing the theoretical grounding of research could aid cohesion across the research area and the design of effective health promotion interventions

Life satisfaction of women of working age shortly after breast cancer surgery

PURPOSE: To explore, among women of working age, satisfaction with life as a whole and with different life domains, and its associations with social and health variables, shortly after breast cancer surgery. METHODS: This cross-sectional study included 605 women, aged 20–63 years, who had had breast cancer surgery with no distant metastasis, pre-surgical chemotherapy, or previous breast cancer. Associations between LiSat-11 and demographic and social factors as well as health- and treatment-related variables were analysed by multivariable logistic regression. RESULTS: Compared with Swedish reference levels, the women were, after breast cancer surgery, less satisfied with life, particularly sexual life. Women working shortly after breast cancer surgery were more often satisfied with life in provision domains compared with the reference population. Although most included variables showed associations with satisfaction, after adjustment for all significantly associated variables, only six variables—having children, being in work, having emotional and informational social support, and having good physical and emotional functioning—were positively associated with satisfaction with life as a whole. The odds ratios for satisfaction were higher in most life domains if the woman had social support and good emotional and cognitive functioning. CONCLUSIONS: One month after breast cancer surgery, satisfaction with different life domains was associated primarily with social support and health-related functioning. However, this soon after surgery, treatment-related variables showed no significant associations with life satisfaction. These results are useful for planning interventions to enhance e.g. social support and emotional as well as cognitive functioning

Pure red cell aplasia in swedish children : Clinical features, epidemiological and etiological aspects of transient erythroblastopenia of childhood and Diamond-Blackfan anemia

Background: Anemia due to impaired erythropoiesis is a rare condition that is more common in children than in adults. Pure red cell aplasia (PRCA) is the term used to denote anemia due to failure of the bone marrow that affects only the erythropoietic cell line. PRCA exists in two forms only presented in children. One is a usually chronic, congenital disorder called congenital hypoplastic anemia or Diamond-Blackfan anemia (DBA), while the other is an acquired, transient condition called transient crythroblastopenia of childhood (TEC). DBA is a macrocytic anemia, the severity of which can be either mild or serious. It is usually diagnosed in early infancy, and its pathophysiological mechanism is not yet known. Congenital malformations are seen in about 40% of the cases and there is evidence both of autosomal dominant and of recessive inheritance of the disease, although most cases are sporadic. About 50% respond to cortisone, while the rest depend on erythrocyte transfusions, which in the long-term will lead to iron overload and consequently a risk for hemosiderosis and organ dysfunction. TEC was described as a distinct entity in 1970. It is an acquired self-limited disorder of unknown etiology and pathophysiology, affecting otherwise healthy young children, usually six months to four years of age. The disease presents with a significant normocytic anemia and reticulocytopenia due to reduced erythropoiesis in bone marrow. Spontaneous recovery within a few weeks from diagnosis is usual and the disease does not recur. Objectives and methods: The objectives of the work presented in this thesis were to estimate the incidences of TEC and DBA, to describe the common pattern of TEC and DBA in Sweden, to study some specific viruses as possible causes of TEC, to study the treatment and outcome of patients with DBA, and to identify possible prognostic features of DBA. Information on patients with TEC and DBA, respectively, was collected from all pediatric departments in Sweden in two different population- based surveys. Specimens were obtained for viral diagnostics in a third prospective study of 10 patients with TEC from five Swedish pediatric departments. Materials, results and conclusions: TEC was diagnosed in 53 cases during the years 1987 to 1989 in children less than 10 years of age. Almost all (51/53) were less than 3 years of age. In this group, the incidence was 4.3/105/year, which means 15-20 cases per year in Sweden. A meta-analysis showed that data from the present study were comparable to those previously reported. There were four pairs of siblings, including one pair of identical female twins among these children. This is a much higher familial occurrence than expected. The probability of finding 4 pairs of siblings with this disease in 50 families is less than one in a million, if the disease does not contain a hereditary component. The findings indicate that TEC involves hereditary factors, and they suggest that inheritance is autosomal dominant (Papers 1 and 11). During the years 1994 to 1998, 10 consecutive cases of TEC were prospectively included in a study of etiological aspects of the disease, with special reference to human parvovirus B 19 (B 19), human herpesvirus 6 (F1HV-6), cytomegalovirus (CMV) and Epstein-Barr virus (EBV). An acute EBV infection was revealed in one child, but no other IgM positivity was found at presentation. Some cases were IgG positive at presentation (HHV-6 (2 cases), EBV (1 case) and CWV (1 case)), but it was not possible to determine in any of these cases when the child had been infected. No child gave positive results for B 19 or HEIV-6 from PCR performed on sera and bone marrow collected at presentation. Cultures for virus on bone marrow, stools, and aspirates from the nasopharynx were negative in all cases but one, who showed rotavirus in stool. These results suggest that neither HHV-6, B 19, EBV, nor CMV is a single causative agent of TEC (Paper Ill). Finally, all cases with DBA diagnosed in children born in Sweden 1980 to 1997 were identified. Twenty patients (10 boys and 10 girls) were included, and the incidence was calculated to be 10.6/106 live births, which is twice the incidence reported from England in 1996. A balanced reciprocal X;19 translocation was identified in one child. This suggested that DBA is linked to the 19q-chromosome region. This linkage was later confirmed by others in 25% of DBA-cases and it has recently been shown that at least 3 different genes, one of which has been identified, can independently be responsible for DBA when mutated. The clinical course and the treatment of DBA were the same as those reported in the literature. No prognostic factors could be identified. The final outcome was 55% transfusion-dependent children, one of whom subsequently underwent a successful bone marrow transplant. All transfusion-dependent patients were also treated with desferrioxamine in order to reduce iron overload. The compliance is high, but iron-overload, with its risk for related complications, is seen despite regular chelation therapy. (Papers IV and V)

Introduktion av nyanställd personal : – en empirisk undersökning om hur två förvaltningar inom en kommun genomför introduktion av nyanställd personal

Syftet med denna uppsats är att beskriva och analysera hur introduktion av nyanställd personal genomförs på två förvaltningar inom en kommun. Undersökningen syftar även till att ta del av de nyanställdas upplevelser av sin introduktion. För att uppnå syftet har undersökningens utgångspunkt varit att besvara frågeställningarna: Hur ser förvaltningarnas introduktion av nyanställd personal ut? samt hur har de nyanställda på förvaltningarna upplevt sin introduktion? Genom kvalitativ metod har material samlats in med hjälp av intervjuer, observation och dokumentanalys. Intervjupersonerna bestod av en introduktionsansvarig samt tre nyanställda på vardera förvaltning och sammanlagt har åtta intervjuer genomförts. Observationen genomfördes under en introduktionsdag som anordnades av kommunen och dokumentanalys gjordes på förvaltningarnas dokument om introduktion av nyanställd personal.     Enligt förvaltningarna är introduktion av nyanställd personal viktig för att ge den nyanställde en helhetsbild av kommunen och den aktuella förvaltningens verksamhet samt för att förstå sin del i dess sammanhang. Vidare menar de introduktionsansvariga att det är viktigt att den nyanställde känner sig hemma på arbetsplatsen för att kunna utföra ett bra arbete. De nyanställda anser att förvaltningarnas introduktion av nyanställd personal fungerar bra men det framkommer en del bristande områden som skulle kunna förbättras för att förvaltningarna ska lyckas ännu bättre med sin introduktion av nyanställd personal.