Life satisfaction, sense of coherence and social support of Finnish breast cancer survivors – with special reference to perceived sexuality and rehabilitation

With continuing improvement in early detection and treatment of breast cancer, the number of breast cancer survivors is steadily increasing. As breast cancer is becoming more and more a chronic condition rather than a life-threatening illness, health care professionals must recognize and manage the long-term sequelae of the constellation of therapeutic modalities. The aim of the thesis was to evaluate the psychological and social factors affecting the overall life satisfaction and sense of coherence and to review the effects of rehabilitation of survivors of advanced cancer. The thesis is composed of four sub-studies: Study I assessed the life satisfaction and sense of coherence of breast cancer survivors. Study II explored perceived social support during breast cancer trajectory, study III estimated the perceived importance of and satisfaction with sex life, and study IV was a systematic review of the effects of rehabilitation of patients with advanced cancer. The data of the studies I-III is drawn from the Finnish nationwide Health and Social Support (HeSSup) -study. Women diagnosed with breast cancer are as satisfied with their lives as healthy controls, and they report significantly better life satisfaction and a stronger sense of coherence than women suffering from depression. There was a positive correlation between coherence and life satisfaction. The most important source of social support is spouse or partner. Breast cancer survivors felt dissatisfaction with their sex life and found it less important than those with hypertension, and healthy controls. Multidisciplinary rehabilitation can be seen to be an effective form of support for cancer even in the chronic stage of the disease. The identification of factors affecting the improvement of the overall life satisfaction of breast cancer survivors is an important public health challenge. Moreover, the results underline the importance of social support, sexuality and rehabilitation during the trajectory of breast cancer survivors, and the awareness of this knowledge among healthcare professionals’ should be enhanced.Rintasyövästä selviytyneiden määrä on kasvussa syövän hoitojen kehittymisen myötä, mikä edellyttää olemassa olevien tukimuotojen kehittämistä syöpähoitopolun aikana. Tämän väitöskirjatyön tavoitteena oli arvioida rintasyöpään sairastuneiden naisten elämäntyytyväisyyttä ja siihen vaikuttavia terveyteen liittyviä ja sosiaalisia tekijöitä. Tutkimustyö koostuu neljästä osatyöstä: ensimmäisen osatutkimuksen tarkoituksena oli arvioida rintasyöpää sairastaneiden naisten itse arvioitua elämäntyytyväisyyttä ja koherenssin tunnetta. Toinen osatutkimus tarkasteli rintasyöpään sairastuneiden sosiaalisen tuen saatavuutta ja lähteitä, kolmannessa osatutkimuksessa arvioitiin rintasyöpään sairastuneiden tyytyväisyyttä seksielämäänsä ja seksielämän tärkeyttä. Neljännessä osatutkimuksessa selvitettiin systemoidun kirjallisuuskatsauksen menetelmin kuntoutuksen vaikutuksia syöpää sairastavan tukimuotona. Kaikki kvantitatiiviset empiiriset osatyöt (I-III) toteutettiin vertailevan tutkimuksen menetelmin hyödyntäen kansallista Health and Social Support (HeSSup) -kohorttitutkimuksen aineistoa. Rintasyöpään sairastuneet naiset ovat yhtä tyytyväisiä elämäänsä kuin terveet verrokit: he arvioivat sekä elämäntyytyväisyytensä että koherenssin tunteensa merkitsevästi vahvemmaksi kuin masennuksesta kärsivät naiset. Koherenssin tunteen ja elämäntyytyväisyyden välillä havaittiin positiivinen korrelaatio. Sosiaalisen tuen suhteen tärkeimmässä roolissa tuen tarjoajana oli puoliso tai kumppani. Rintasyövän sairastuneet kokivat tyytymättömyyttä seksielämäänsä, ja pitivät sitä vähemmän tärkeänä kuin verenpainetautia sairastavat ja terveet verrokit. Merkittävää on, että monialaisen kuntoutuksen voidaan todeta olevan vaikuttava tukimuoto vielä kroonisessa vaiheessa sairautta. Rintasyövästä selviytyneiden kokonaisvaltaisen elämänlaadun ylläpitämiseen vaikuttavien tekijöiden tunnistaminen on tärkeä kansanterveyshaaste. Tutkimustuloksia voidaan hyödyntää rintasyöpää sairastavien ja sairastaneiden sekä heidän läheistensä monipuolisten tukimuotojen kehittämisessä. Erityistä huomiota tulee kiinnittää sosiaaliseen tukeen, kuntoutukseen ja seksuaalisen hyvinvoinnin huomioimiseen syöpähoitopolun aikana

Toisen asteen ammatillisessa koulutuksessa opiskelevien nuorten terveys ja terveyttä uhkaavat tekijät: systemaattinen kirjallisuuskatsaus

Nuorten terveyserot ovat kytköksissä koulutusryhmään: terveysvajeet ja -riskit koskettavat erityisesti toisen asteen ammatillisessa koulutuksessa opiskelevia nuoria. Myös sosioekonomisella asemalla ja koulutustasolla on merkitystä. Terveys on selkeästi heikointa niillä nuorilla, jotka jäävät kokonaan toisen asteen koulutuksen ulkopuolelle. Nuoruuden terveys ja terveyskäyttäytyminen vaikuttavat terveyteen vielä aikuisuudessa. Tämän systemaattisen kirjallisuuskatsauksen tavoitteena oli kuvata ammattiin opiskelevien nuorten terveyttä ja terveyttä uhkaavia tekijöitä. Katsaus toteutettiin Finkin mallin mukaisesti. Tiedonhakuun käytettiin Medic-, Julkari-, Cinahl Complete-, Google Scholar- ja PubMed-tietokantoja. Haut rajattiin koko tekstin saatavuuteen, suomen- tai englanninkielisiin sekä enintään 10 vuotta vanhoihin julkaisuihin. Lopulliseen katsaukseen hyväksyttiin kaikkiaan 13 tutkimusta. Tulosten mukaan terveyden koulutusryhmittäisiä eroja ilmenee erityisesti elintavoissa, terveysosaamisessa ja arjenhallinnassa. Ympäristöllä, perheellä ja vertaisilla on selkeä vaikutus nuorten terveyskäyttäytymiseen. Vaikka nuoret harjoittelevat itsenäistymistä ja omien valintojen tekemistä, he ovat edelleen erityisen riippuvaisia kasvuympäristöstään usealla terveyden ulottuvuudella. Terveyteen liittyvät heikkoudet korostuvat ammattiin opiskelevien nuorten ryhmässä. Tutkimusten mukaan terveyden riskit myös siirtyvät herkästi sukupolvelta toiselle. Terveyttä edistävien toimien kohdentaminen ja pyrkiminen huono-osaisuuden ylisukupolvisen kierteen katkaisemiseen ovat perusteltuja erityisesti kansanterveydellisestä näkökulmasta. Oikea-aikaisilla, tarveperustaisilla ja toiminnallisilla, sekä nuorten arkiympäristöihin, kuten kouluun, sijoittuvilla interventioilla voidaan tutkitusti vaikuttaa nuorten terveyskäyttäytymiseen ja terveyteen. Tutkimustiedon pohjalta voidaan kehittää ammattiin opiskelevien nuorten tiedonsaannin ja terveyden edistämisen menetelmiä niin alueellisesti kuin kansallisestikin

The importance of and satisfaction with sex life among breast cancer survivors in comparison with healthy female controls and women with mental depression or arterial hypertension : results from the Finnish nationwide HeSSup cohort study

Introduction Breast cancer (BC) and its treatment is associated with several physical and psychosocial changes that may influence sexuality for years after treatment. Women with BC show significantly greater rates of sexual dysfunction than do healthy women. The purpose of the study was to evaluate how a BC diagnosis associates with women's perceived sexuality and sexual satisfaction. Material and methods The data of the ongoing prospective Health and Social Support (HeSSup) survey was linked with national health registries. Respondents with registry data confirmed BC (n = 66), mental depression (n = 612), arterial hypertension (n = 873), and healthy women (n = 9731) formed the study population. The importance of and satisfaction with sex life were measured by a self-report questionnaire modified from the Schover's and colleagues' Sexual History Form. Results Women with BC considered sex life less important than did healthy women (p <0.001). They were significantly less satisfied with their sex life than healthy women (p = 0.01) and women with arterial hypertension (p = 0.04). Living single or educational level did not explain the differences between the groups. Conclusions BC survivors depreciate their sex life and experience dissatisfaction with it. Sexuality can be a critical issue for the quality of life of women surviving from BC, and hence, the area deserves major attention in BC survivorship care. Health care professionals should regularly include sexual functions in the assessment of BC survivors' wellbeing.Peer reviewe

The importance of and satisfaction with sex life among breast cancer survivors in comparison with healthy female controls and women with mental depression or arterial hypertension: results from the Finnish nationwide HeSSup cohort study

IntroductionBreast cancer (BC) and its treatment is associated with several physical and psychosocial changes that may influence sexuality for years after treatment. Women with BC show significantly greater rates of sexual dysfunction than do healthy women. The purpose of the study was to evaluate how a BC diagnosis associates with women’s perceived sexuality and sexual satisfaction.Material and methodsThe data of the ongoing prospective Health and Social Support (HeSSup) survey was linked with national health registries. Respondents with registry data confirmed BC (n = 66), mental depression (n = 612), arterial hypertension (n = 873), and healthy women (n = 9731) formed the study population. The importance of and satisfaction with sex life were measured by a self-report questionnaire modified from the Schover’s and colleagues’ Sexual History Form.ResultsWomen with BC considered sex life less important than did healthy women (p ConclusionsBC survivors depreciate their sex life and experience dissatisfaction with it. Sexuality can be a critical issue for the quality of life of women surviving from BC, and hence, the area deserves major attention in BC survivorship care. Health care professionals should regularly include sexual functions in the assessment of BC survivors’ wellbeing.</p

Social support and breast cancer : A comparatory study of breast cancer survivors, women with mental depression, women with hypertension and healthy female controls

Objectives: Among breast cancer (BC) survivors, inadequate social support (SS) is associated with a significant increase in cancer-related mortality and reduction in quality of life (QoL). The aim of the study was to explore perceived SS during BC trajectory by comparing BC survivors, women with depression, women with arterial hypertension, and healthy female controls to each other, and to compare perceived balance of receiving and providing SS. Material and methods: The data of ongoing prospective postal survey was linked with national health registries. Respondents with BC (n = 64), depression (n = 471), arterial hypertension (n = 841) and healthy controls (n = 6274) formed the study population. SS was measured by a Sarason's 6-item shortened version of the Social Support Questionnaire (SSQ). The modified Antonucci's (1986) social support convoy model of the network of individuals was used to measure the dominating direction of SS. Results: The main provider of SS for all participants combined was the spouse or partner (94.3%), close relative (12.0%) and friends (5.4%). In all groups, particularly in the BC and arterial hypertension group, spouse or partner was seen as the most important supporter. The group suffering from depression reported significantly less SS in each domain of appraisal (p <0.001). In total, 24.6% of all respondents reported receipt dominance of SS. Conclusion: SS is a well-known determinant of wellbeing. Our study lends support to the spouse's or the partner's central role during the recovery phase of BC. Identification of factors improving the overall QoL of BC survivors is an important public health challenge. (C) 2017 Elsevier Ltd. All rights reserved.Peer reviewe

NUOTe: Nuoret, nikotiini ja terveys : terveyden edistämisen koulutuskokonaisuus verkossa

NUOTe: Nuoret, nikotiini ja terveys – Terveyden edistämisen koulutuskokonaisuus verkossa oli Turun ylemmän ammattikorkeakoulun kehittämisprojekti. Kehittämisprojektin toimeksiantajat olivat Lounais-Suomen Syöpäyhdistyksen NIKO-hanke ja Turun ammattikorkeakoulun Terveyden ja hyvinvoinnin -sektori

Influencing adolescents' attitudes towards nicotine products: A systematic review

Background and aim: Use of nicotine can harm adolescents' brains and increase risk for future addiction to other drugs. Several international studies show that an acceptable attitude towards nicotine products increases the initiation or use of the products. Adolescents have limited or distorted knowledge about nicotine products. Many of them have a positive image of the properties and effects of nicotine products, which increases the chances of smoking or using snus. Yet, we know little about the relationship between youth nicotine use, youth attitudes towards nicotine products and the interventions to influence these attitudes. This systematic review synthesised adolescents' attitudes towards nicotine products and the ways to influence them. Methods: Systematic searches were carried out from PubMed, MEDLINE, CINAHL, and MEDIC databases and were targeted to randomised controlled trial (RCT) studies published in 2010-2021. Results: A total of seven RCT studies were reviewed with a total population (age range 9-17 years, adolescents 11-17 years) of 15,974. Findings were classified into four categories: school-based interventions, tobacco prevention campaigns, advertisements' influence on adolescents' opinions towards nicotine products, and their responses to cigarette pack warnings. Conclusion: Based on this systematic literature review, particularly school-based interventions have an effect on adolescents' attitudes towards smoking and preventing them from starting to smoke, when they are targeted before the age of puberty. School-based interventions should be further implemented and strengthened, as the school has been shown to have significant potential to support youth's health. There is a need for further information about the most effective interventions in the different age groups and the qualitative studies on the topic.</p

Systematic review on women's values and preferences concerning breast cancer screening and diagnostic services

Background: There is still lack of consensus on the benefit‐harm balance of breast cancer screening. In this scenario, women's values and preferences are crucial for developing health‐related recommendations. In the context of the European Commission Initiative on Breast Cancer, we conducted a systematic review to inform the European Breast Guidelines. Methods: We searched Medline and included primary studies assessing women's values and preferences regarding breast cancer screening and diagnosis decision making. We used a thematic approach to synthesise relevant data. The quality of evidence was determined with GRADE, including GRADE CERQual for qualitative research. Results: We included 22 individual studies. Women were willing to accept the psychological and physical burden of breast cancer screening and a significant risk of overdiagnosis and false‐positive mammography findings, in return for the benefit of earlier diagnosis. The anxiety engendered by the delay in getting results of diagnostic tests was highlighted as a significant burden, emphasising the need for rapid and efficient screening services, and clear and efficient communication. The confidence in the findings was low to moderate for screening and moderate for diagnosis, predominantly because of methodological limitations, lack of adequate understanding of the outcomes by participants, and indirectness. Conclusions: Women value more the possibility of an earlier diagnosis over the risks of a false‐positive result or overdiagnosis. Concerns remain that women may not understand the concept of overdiagnosis. Women highly value time efficient screening processes and rapid result delivery and will accept some discomfort for the peace of mind screening may provide