Моральний аспект у детективних романах А. Конана Дойля і А. Крісті

Objectives: To investigate whether posttraumatic stress symptoms (PTSS) are related to attentional bias towards cancer-related stimuli among parents of children recently diagnosed with cancer. Methods: Sixty-two parents completed questionnaires measuring PTSS, depression, and anxiety and the emotional Stroop task via the Internet. The emotional Stroop task included cancer-related words, cardiovascular disease-related words, and neutral words. Results: Participants were split in two groups based on the median of PTSS: High-PTSS and Low-PTSS. There was a significant interaction between word-type and group and a planned contrast test of this interaction indicated that the High-PTSS group had longer response latencies on cancer-related words compared to the other word-type and group combinations. Conclusions: Findings suggest that PTSS are related to attentional bias towards cancer-related stimuli among parents of children recently diagnosed with cancer. Implications of this finding for the understanding of PTSS in this population, future research, and clinical practice are discussed

Интеллигенция и народ: фактор менталитета

Материалы III междунар. науч. конф., 22-23 мая 2003 г

Sexual dysfunction in young adult survivors of childhood cancer - A population-based study

AbstractObjectiveTo determine the prevalence of sexual dysfunction and to identify the factors associated with sexual dysfunction in young adult childhood cancer survivors.MethodsAll survivors of childhood cancer (aged 19–40 years) in Sweden were invited to this population-based study, and 2546 men and women (59%) participated. Sexual function was examined with the PROMIS Sexual Function and Satisfaction Measure. Logistic regression was used to assess the differences between survivors and a general population sample (n = 819) and to identify the factors associated with sexual dysfunction in survivors.ResultsSexual dysfunction in at least one domain was reported by 57% of female and 35% of male survivors. Among females, dysfunction was most common for Sexual interest (36%), Orgasm – ability (32%) and Vulvar discomfort – labial (19%). Among males, dysfunction was most common for the domains satisfaction with sex life (20%), Sexual interest (14%) and Erectile function (9%). Compared with the general population, male survivors more frequently reported sexual dysfunction in ≥2 domains (OR = 1.67, 95% CI: 1.03–2.71), with an increased likelihood of dysfunction regarding Orgasm – ability (OR = 1.82; 95% CI: 1.01–3.28) and Erectile function (OR = 2.30; 95% CI: 1.18–4.49). Female survivors reported more dysfunction regarding Orgasm – pleasure (9% versus 5%, OR = 1.86; 95% CI: 1.11–3.13). A more intensive cancer treatment, emotional distress and body image disturbance were associated with sexual dysfunction in survivors.ConclusionsThe findings underscore the need for routine assessment of sexual health in follow-up care of childhood cancer survivors and highlight that those treated with more intensive cancer treatment and who experience concurrent psychological concerns may benefit from targeted screening and interventions.</p

総会抄録

<p>Subcategories and categories are presented in alphabetical order.</p

Neurocognitive impairment, employment, and social status in radiotherapy-treated adult survivors of childhood brain tumors

Background. Little is known of the cognitive functions, employment, and social status in adult survivors of childhood brain tumor (BT). We aimed to determine the long-term neurocognitive profile of radiotherapy-treated adult survivors of childhood BT and the relationship between cognitive functions and employment and social status.Methods. Neurocognitive profiles of survivors were assessed in a Finnish national cohort of 71 radiotherapy-treated survivors of childhood BT (median follow-up time: 21 years [range: 5-33 years]) using a cross-sectional design. Neurocognitive outcomes were compared to control (n = 45) and normative values. Tumor- and treatment-related data were collected from the patient files. Information on employment and social status was gathered.Results. Survivors' (median age: 27 years [range: 16-43 years]) median verbal and performance intelligence quotient (IQ) was 90 (range: 49-121) and 87 (range: 43-119), respectively. The cognitive domains with the greatest impairment were executive functions (median z score, 3.5 SD [range: -25.0 to 1.3 SD]), and processing speed and attention (median z score, -2.5 SD [range: -24.9 to 0.5 SD]). Executive functions were associated with employment, educational level, living independently, having an intimate relationship, and having a driving license. Processing speed and attention were related to educational level, living independently, having an intimate relationship, and having a driving license. Performance IQ was associated with educational level and employment status. Working memory was associated with educational level and living independently.Conclusions. Radiotherapy-treated adult survivors of childhood BT experience significant neurocognitive impairment, which is associated with difficulties related to employment and social status.</p

Childhood CNS tumours : Health and functional outcomes in adult survivors, and follow-up needs of patients and parents

Childhood central nervous system (CNS) tumour patients represent a high-risk population regarding tumour- and treatment-related late effects. The overall purpose of the present thesis was to gain increased knowledge about the long-term consequences for survivors and their parents after a CNS tumour diagnosis in childhood. The thesis comprises four studies specifically addressing: health and functional status of adult survivors, health care needs of adult survivors, the influence of illness characteristics on parental distress, and the impact of illness on families of adult survivors. Study I covered 321 parents (182 mothers, 139 fathers) of children diagnosed with CNS tumours, bone tumours, acute lymphoblastic leukaemia (ALL), or acute myeloid leukaemia (AML), and who were treated at one of two Swedish sites. The Studies II-IV are population-based, and involve an entire nation-wide cohort of all Swedish survivors meeting the inclusion criteria. These studies were based on data from 531 ≥18 years old childhood CNS tumour survivors, for whom >5 years had passed since time of diagnosis, 556 of their parents, and 996 general population controls, stratified by sex and age. The studies used a cross-sectional design and are based on quantitative self-report data. Parental distress was assessed by the Parental Psychological Distress in Cancer, health and functional outcomes by the Health Utilities Index Mark2/3, and family impact by the Impact on Family Scale. Health care needs were assessed by a multidimensional questionnaire. When followed-up at a median time of 16 years after diagnosis, comparisons with control subjects confirm persistent disability in multiple functional domains in adult survivors of childhood CNS tumours. Specifically, survivors showed disability in domains of sensation, mobility, and cognition, whereas indices of emotion and pain were unaffected compared to control subjects. In comparison with male survivors, females showed poorer overall health and functional status. Furthermore, two fifths of survivors were found to have unmet health care needs in adult life, particularly regarding psychosocial services and illness education. Survivors with health-related disability had greater health care needs in adult life, and more unmet such needs. Findings on parental distress suggest that distress reactions are influenced by diagnosis-related factors such as great uncertainty about late effects, as parents of children treated for CNS and bone tumours showed heightened vulnerability to distress. The illness-related impact on families of adult CNS tumour survivors was subsequently addressed. At the group level, the conditions of families of adult survivors appeared to be mildly to moderately influenced by the child s past illness, although a subgroup of parents reported adverse family consequences even at this late stage of follow-up. In conclusion, outcomes show that the consequences of cancer extend into adult life by compromising survivors functional ability a finding that underscores the importance of extended long-term follow-up continuing into adulthood. Addressing identified unmet health care needs in extended follow-up increases the quality of comprehensive care for this patient population. Furthermore, parents of CNS tumour patients indicate exceptional needs for supportive measures and enhanced information, an issue that needs attention in order to reduce avoidable illness-related distress and long-term adverse family consequences

Siblings of children diagnosed with cancer : being faced with a moral dilemma

In this study, we explore how siblings of children diagnosed with cancer describe the implications of cancer experience in interaction with other young people. Seven focus groups were performed with 30 siblings, 14–23 years at the time of study. Data were analysed using inductive thematic analysis. We applied the theoretical framework of ecological system theory and sociological perspective of childhood. Two themes were identified: family relations and maintaining normality. Family relations covered experiences of loneliness, neglect and changed family relationships. Siblings described being faced with a moral dilemma, where, on the one hand, it was difficult to handle the clash of being aware of their parents’ struggle and the severity of the illness; and on the other hand, refraining from claiming attention and support, resulting in experiencing loneliness and unmet needs. Maintaining normality involved descriptions of a strive for ‘normality,’ where the brother’s/sister’s cancer didn’t dominate. The results show how a sister’s/brother’s cancer disrupts the family system and the relations between microsystems, including school and friends. Young siblings should be recognized as independent agents, who have rights to be listened to. The health care system should create possibilities for siblings to express their own needs and provide appropriate support

Prevalence and predictors of symptoms of anxiety and depression, and comorbid symptoms of distress in parents of childhood cancer survivors and bereaved parents five years after end of treatment or a child's death

BACKGROUND: Symptoms of anxiety and depression and their comorbidity in parents of children diagnosed with cancer, particularly later in the cancer trajectory, need further study. The aim was to investigate the prevalence and predictors of symptoms of anxiety and depression in parents of childhood cancer survivors and bereaved parents, five years after end of treatment or a child's death and to investigate comorbidity between symptoms of anxiety, depression and posttraumatic stress. MATERIAL AND METHODS: Participants were 132 parents (68 mothers, 64 fathers) of survivors and 37 bereaved parents (20 mothers, 17 fathers). Chi-square test and t-test were used to explore differences in symptoms of anxiety and depression. Comorbidity was explored using Pearson's correlations and Chi-square test. Multivariable hierarchical linear regressions were used to identify predictors of symptoms of anxiety and depression. RESULTS: In parents of survivors, 20% reported anxiety and 14% reported depression. Corresponding figures among bereaved parents were 30% and 35%. Among parents of survivors reporting clinically relevant anxiety and depression, a larger proportion were mothers than fathers. No such difference was found among bereaved parents. Symptoms of anxiety, depression and posttraumatic stress were highly correlated (all r ≥ 0.65, p &lt; .001). Comorbid symptoms were reported by 7-11% of parents of survivors and 14-24% of bereaved parents. In multivariable analyses, more severe symptoms of depression were associated with anxiety, posttraumatic stress and distress related to previous stressful life events. Being a mother, symptoms of depression and posttraumatic stress were associated with more severe symptoms of anxiety. CONCLUSION: A subset of parents report clinically elevated symptoms of anxiety and depression, comorbid anxiety, depression and posttraumatic stress. Experiencing distress related to previous stressful life events as well as concurrent comorbidity were associated with more severe psychological distress at five years after end of treatment/a child's death. These results deserve further attention in research and clinical care

A Balancing Act: Working and Caring for a Child with Cancer

Parenting a child with cancer creates numerous additional care demands that may lead to increased difficulties in balancing work and family responsibilities. Still, there is limited knowledge of how parents cope with both parenthood and paid work after a child’s cancer diagnosis. The aim of the study was to explore mothers’ and fathers’ experiences of balancing the dual roles of work and parenthood following a child’s cancer diagnosis. Nine focus groups with in total 32 parents of children with cancer in Sweden were conducted. The data was analysed using qualitative content analysis. Three categories were identified: Shifts in the importance of the parent role and the work role, Influence of context and conditions on the balance of roles, and Long-term unbalance of roles. Parents expressed an increased appreciation of time spent with family, but also emphasized the importance of work to counterbalance the sometimes overwhelming parenting demands. The pre-existing financial situation, work situation, and employer behaviour were important factors influencing the parents’ ability to balance work and family. Traditional gender roles influenced how couples divided responsibilities and reflected on their experiences. Mothers and fathers were also met with different expectations, which highlights the need for the healthcare to consider their communication with caregivers. Importantly, the parents expressed how the child’s illness affected their ability to balance work and family for a long time, while the understanding and support from others had steadily declined. Enabling parents to care for their ill child without sacrificing their own career is of utmost importance, and future research should focus on identifying which factors facilitate for parents to achieve a sustainable work-life balance