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Selasa, 01 Mei 2012

Emphasis On Making Psychosocial Care Part Of Routine Cancer Care Pays Off For Patients

Emphasis On Making Psychosocial Care Part Of Routine Cancer Care Pays Off For Patients

Main Category: Breast Cancer
Also Included In: Lung Cancer;Â Â Cancer / Oncology
Article Date: 01 May 2012 - 1:00 PDT

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Researchers at Moffitt Cancer Center have placed new emphasis on gathering data on cancer patient quality of life during both treatment and survivorship. Their focus is on gathering and using that data to develop interventions to improve the quality of life for patients in treatment and for cancer survivors.

Much of the quality of life and survivorship research is carried out by researchers in Moffitt's Department of Health Outcomes Behavior.

"Among the several research goals of the Department of Health Outcomes Behaviors is the evaluation and improvement of quality of life and quality of care," said department chair Thomas H. Brandon, Ph.D. "We aim to understand and improve a patient's quality of life throughout the disease course by identifying clinical practices and health outcomes that can inform our efforts to improve the quality of cancer care."

Quality of life should be considered

"The question of how well people are surviving cancer is as important as how long they survive cancer," said lead author Paul. B. Jacobsen, Ph.D., associate center director for Population Science, and Heather S.L. Jim, Ph.D., of Health Outcomes Behaviors. Their study on patient quality of life was published in a recent issue of Cancer Epidemiology, Biomarkers Prevention (2011; 20).

Assessment of quality of life factors is important, said the authors, but many of the measurements for assessing quality of life, particularly for cancer survivors, need development.

"Quality of life is a multidimensional construct about daily functioning - from physical to social - which is most often assessed by patient self-report," Jim said. "It is important that clinical trials include quality of life as an endpoint because if two treatments are found to work equally well, the treatment that offers the best quality of life for cancer survivors should be prescribed."

Prolonged fatigue after treatment

In a recent study published in CANCER, researchers from Moffitt found that when patients treated with chemotherapy or chemotherapy and radiation for breast cancer were compared to a control group who had not had cancer, the patients who had experienced chemotherapy and/or radiotherapy had more fatigue. These patients also had fatigue that lasted years after their therapy.

"This finding was contrary to our expectations," Jacobsen said. "Conventional thinking is that patients receiving chemotherapy would, over time, experience less fatigue and would eventually see their fatigue diminish to the levels of controls who had not had cancer, or to the level of fatigue they had prior to their chemotherapy."

One variable that could have affected the group with prolonged fatigue, noted the researchers, was a lack of supportive care, such as exercise and cognitive behavioral therapy. Interventions such as these could have an impact on patient fatigue and thus help improve quality of life, they noted.

Pain helped by psychosocial care

In a study published recently in the Journal of Clinical Oncology, Moffitt researchers who teamed with colleagues at five universities across the United States concluded that psychosocial interventions could have an effect on patient's pain severity during cancer treatment.

"Our study looked at randomized, controlled studies of psychosocial interventions for pain published between 1966 and 2010 in which pain was measured as an outcome for adults with cancer or those undergoing procedures to diagnose cancer," Jacobsen said.

When they analyzed 37 past studies, the researchers found that the most successful psychosocial, nonpharmacological interventions were skill-based or educational.

"Skill-based interventions focused on changing a patient's dysfunctional beliefs about pain and promoted the use of skills - such as distraction and relaxation - to manage it," explained Jacobsen. "We found that psychosocial interventions could improve pain severity and interference with daily activities."

Stigma affects quality of life of lung cancer patients

When Moffitt researchers Jacobsen and Brian D. Gonzalez, M.A., of Health Outcomes Behavior, studied depression among patients with lung cancer, they found that perceived stigma related to their disease corresponded to greater levels of depression, and that patients with depression had more "dysfunctional attitudes."

"Given its strong association with tobacco use, lung cancer may be viewed as a preventable disease, so patients might blame themselves and feel stigmatized," explained Jacobsen.

The aim of the study, according to Gonzalez, was to examine rates of social rejection, financial insecurity, internalized shame and social isolation, and develop psychosocial interventions for depression.

"Therapy that focuses on altering the patient's thoughts and feelings associated with their perceptions of stigma could prove effective in reducing symptoms of depression and improve patient quality of life," Gonzalez said.

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Smoke Incursion Can Be A Problem For Apartment Dwellers: Second-Hand Smoke Exposure Puts Children At Risk For Respiratory Diseases

Smoke Incursion Can Be A Problem For Apartment Dwellers: Second-Hand Smoke Exposure Puts Children At Risk For Respiratory Diseases

Main Category: Smoking / Quit Smoking
Also Included In: Pediatrics / Children's Health;Â Â Respiratory / Asthma
Article Date: 01 May 2012 - 1:00 PDT

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Noisy neighbors and broken-down elevators are common downsides of apartment living. You also can add unwanted tobacco smoke to the list of hazards, according to research presented at the Pediatric Academic Societies (PAS) annual meeting in Boston.

Studies have shown that tobacco smoke can seep from one apartment into another. The extent to which this happens, however, is unclear.

Researchers from the American Academy of Pediatrics Julius B. Richmond Center of Excellence surveyed a nationally representative sample of adults living in apartments to examine factors associated with unwanted tobacco smoke. The center, named for a former U.S. surgeon general, is committed to protecting children from tobacco and secondhand smoke.

Apartment dwellers were asked whether they experienced smoke incursion, which was defined as smelling tobacco smoke in their building and/or unit. They also were asked if they had children and if their apartment building had any smoking restrictions. Only respondents who reported that no one had smoked in their home for the previous three months were included in the study.

Results showed that nearly one-third of the 323 eligible respondents reported smelling tobacco smoke in their buildings, and half of these residents reported smelling smoke in their own units. In particular, residents with children were more likely to smell smoke in their building than those with no children (41 percent vs. 26 percent).

Survey results also showed that 38 percent of those who reported smelling smoke said they did so weekly, while 12 percent smelled smoke daily.

"A significant number of residents of multi-unit housing are being unwillingly exposed to tobacco smoke, in some cases on a daily basis, and children seem to be especially vulnerable," said lead author Karen M. Wilson, MD, MPH, FAAP, section head, pediatric hospital medicine at Children's Hospital Colorado and assistant professor of pediatrics, University of Colorado School of Medicine. "This exposure could put children at risk for respiratory diseases and illness if it is persistent or if the child has a significant respiratory illness such as asthma or cystic fibrosis."

"A smoke-free building protects the shared indoor air that all residents, including infants and children, are forced to breathe. Every parent needs to hear about this research because it could be their infant or child who is exposed next," said Jonathan P. Winickoff, MD, MPH, FAAP, associate professor in pediatrics, MassGeneral Hospital for Children, Boston.

Residents receiving government housing subsidies also were more likely to smell smoke.

"Options for such housing are limited, and residents forced to experience smoke exposure in their buildings may not have the option to move to a smoke-free complex," Dr. Wilson added.

Partial measures, such as limiting common area smoking, appeared to be ineffective at protecting nonsmokers from exposure in their own units. As long as smoking was allowed in the individual units of a building, higher rates of exposure were reported. Only completely smoke-free buildings were associated with lower incursion rates.

"This finding supports grassroots efforts by multi-unit housing resident groups, apartment managers and owners to make buildings smoke-free for the comfort, health and safety of their residents, and because of the far lower costs associated with managing nonsmoking apartments," Dr. Wilson concluded.

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Racial Differences Found In Care Of Children With Abdominal Pain In ED

Racial Differences Found In Care Of Children With Abdominal Pain In ED

Main Category: GastroIntestinal / Gastroenterology
Also Included In: Pediatrics / Children's Health;Â Â Pain / Anesthetics
Article Date: 01 May 2012 - 1:00 PDT

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Black children are less likely than white children to receive medication for abdominal pain in the emergency department (ED) even when they report severe pain, according to a study to be presented Saturday, April 28, at the Pediatric Academic Societies (PAS) annual meeting in Boston.

"The emergency department serves as our nation's health care safety net, where all children can receive care regardless of their insurance status, ability to pay or race," said lead author Tiffani J. Johnson, MD, pediatric emergency medicine fellow at Children's Hospital of Pittsburgh and a postdoctoral scholar at RAND-University of Pittsburgh. "It is concerning to find that black children are less likely than white children to receive pain medication for treatment of their abdominal pain."

Dr. Johnson and her colleagues analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for patients who went to the ED for abdominal pain from 2006-2009. The NHAMCS is conducted by the Centers for Disease Control and Prevention National Center for Health Statistics.

In addition to the administration of pain medication, researchers looked at the use of diagnostic tests, length of stay, how often patients returned to the ED after 72 hours, and admission rates for 2,298 patients younger than age 21, representing 8.1 million patients. They compared these outcomes in white (53 percent of patients), black (23 percent) and Hispanic (21 percent) children.

Results showed that black and Hispanic children were more likely to stay in the ED for more than six hours compared to white children. However, there were no racial differences in what tests were performed to evaluate the cause of abdominal pain or hospital admission rates.

"All children deserve equal access to high-quality health care," said Dr. Johnson. "Identifying racial differences in the care of children is an important first step in improving the quality and equity of care that children receive in the emergency department. We need to do more research to help understand why these differences exist."

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Parental Example May Be Responsible For Some Violent Teen Behavior

Parental Example May Be Responsible For Some Violent Teen Behavior

Main Category: Psychology / Psychiatry
Also Included In: Pediatrics / Children's Health
Article Date: 01 May 2012 - 1:00 PDT

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While it may be cute when a 3-year-old imitates his parent's bad behavior, when adolescents do so, it's no longer a laughing matter.

Teens who fight may be modeling what they see adult relatives do or have parents with pro-fighting attitudes, according to a study presented at the Pediatric Academic Societies (PAS) annual meeting in Boston.

"Parents and other adults in the family have a substantial influence on adolescents' engagement in fighting," said Rashmi Shetgiri, MD, FAAP, lead author of the study. "Interventions to prevent fighting, therefore, should involve parents and teens."

Dr. Shetgiri, assistant professor of pediatrics at University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, and her colleagues conducted 12 focus groups with 65 middle and high school students to discuss why youths fight and how violence can be prevented. Groups were divided by race/ethnicity and whether students were fighters or nonfighters based on self-report.

Youths said they fight to defend themselves or others, to gain or maintain respect, to respond to verbal insults or because they are angry due to other stressors. Girls also cited gossip or jealousy as reasons for fighting.

The discussions showed that parental attitudes toward fighting and parental role modeling of aggressive behavior influence youth fighting. Family attitudes also may prevent youths from fighting. Many Latino students, for example, noted that their parents condoned fighting only when physically attacked and said not wanting to hurt or embarrass their parents could prevent them from fighting.

Peers also can have a positive or negative influence on fighting by de-escalating situations or encouraging violence.

The conversations also revealed that nonfighters use various strategies to avoid confrontations such as walking away, ignoring insults or joking to diffuse tension. Fighters, however, said they are unable to ignore insults and are aware of few other conflict-resolution methods.

Potential interventions suggested by youths include anger and stress management programs led by young adults who have overcome violence, and doctors counseling youths about the consequences of fighting.

"Our study suggested that there may be differences between boys and girls, and racial/ethnic groups in risk and protective factors for fighting," Dr. Shetgiri concluded. "This has important implications for violence prevention programs and individuals working with violent teens."

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Youths With Special Needs At Risk For Depression When Ostracized By Peers

Youths With Special Needs At Risk For Depression When Ostracized By Peers

Main Category: Pediatrics / Children's Health
Also Included In: Depression;Â Â Psychology / Psychiatry
Article Date: 01 May 2012 - 1:00 PDT

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The challenges that come with battling a chronic medical condition or developmental disability are enough to get a young person down. But being left out, ignored or bullied by their peers is the main reason youths with special health care needs report symptoms of anxiety or depression, according to a study to be presented at the Pediatric Academic Societies (PAS) annual meeting in Boston.

Being bullied has been shown to increase students' risk for academic and emotional problems. Little research has been done specifically on how being a victim of bullying affects youths with special needs.

In this study, researchers led by Margaret Ellis McKenna, MD, senior fellow in developmental-behavioral pediatrics at Medical University of South Carolina, investigated the impact of bullying, ostracism and diagnosis of a chronic medical condition on the emotional well-being of youths with special health care needs.

Participants ages 8-17 years were recruited from a children's hospital during routine visits with their physicians. A total of 109 youths and their parents/guardians completed questionnaires that screen for symptoms of anxiety and depression. Youths also completed a screening tool that assessed whether they had been bullied or excluded by their peers.

The main categories of youths' diagnoses included attention-deficit/hyperactivity disorder (39 percent), cystic fibrosis (22 percent), type 1 or 2 diabetes (19 percent), sickle cell disease (11 percent), obesity (11 percent), learning disability (11 percent), autism spectrum disorder (9 percent) and short stature (6 percent). Several children had a combination of these diagnoses.

Results of the youths' answers on the questionnaires showed that being bullied and/or ostracized were the strongest predictors of increased symptoms of depression or anxiety. When looking at both parent and child reports, ostracism was the strongest indicator of these symptoms.

"What is notable about these findings is that despite all the many challenges these children face in relation to their chronic medical or developmental diagnosis, being bullied or excluded by their peers were the factors most likely to predict whether or not they reported symptoms of depression," Dr. McKenna said.

"Professionals need to be particularly alert in screening for the presence of being bullied or ostracized in this already vulnerable group of students," she added.

In addition, schools should have clear policies to prevent and address bullying and ostracism, Dr. McKenna suggested, as well as programs that promote a culture of inclusion and sense of belonging for all students.

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Senin, 30 April 2012

Anxiety, Depression Often Go Hand-in-Hand With Arthritis

Anxiety, Depression Often Go Hand-in-Hand With Arthritis

Man massaging elbow in pain

MONDAY, April 30 (HealthDay News) -- Depression or anxiety affect one-third of Americans with arthritis who are aged 45 or older, a new study shows.

Researchers from the U.S. Centers for Disease Control and Prevention also found that even though anxiety is nearly twice as common as depression among people with arthritis, doctors tend to focus more on depression in these patients.

[Read: Treat Rheumatoid Arthritis Early and Aggressively.]

The study included nearly 1,800 people with arthritis or other rheumatic conditions who took part in the CDC's Arthritis Conditions and Health Effects Survey. Among the study participants, 31 percent reported anxiety and 18 percent reported depression.

One-third of the patients reported at least one of the two conditions and 84 percent of those with depression also had anxiety. Only half of those with anxiety or depression sought mental health treatment in the previous year, according to the study, which was published in the April 30 issue of the journal Arthritis Care amp; Research.

"Given their high prevalence and the effective treatment options that are available, we suggest that all people with arthritis be screened for anxiety and depression," study leader Dr. Louise Murphy, of the Arthritis Program at the CDC, said in a journal news release.

[Read: Higher Cancer Rate Seen in Children With Juvenile Arthritis.]

"With so many arthritis patients not seeking mental health treatment, health care providers are missing an intervention opportunity that could improve the quality of life for those with arthritis," she added.

In the United States, 27 million people age 25 and older have osteoarthritis, and 1.3 million adults have rheumatoid arthritis, according to the American College of Rheumatology.

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases offers advice on how to live with arthritis.

Pacifiers Don't Discourage Breast-Feeding

Pacifiers Don't Discourage Breast-Feeding

By Maureen Salamon
HealthDay Reporter

MONDAY, April 30 (HealthDay News) -- Widely held wisdom that pacifier use among newborns interferes with breast-feeding is wrong, a new small study suggests.

Analyzing feeding data on nearly 2,250 infants born between June 2010 and August 2011, Oregon Health amp; Science University researchers learned that limiting use of pacifiers -- also known as binkies, corks and soothers -- may actually increase babies' consumption of formula during the birth hospitalization.

"The overarching belief persists that pacifiers interfere with breast-feeding, even though research hasn't concretely showed they cause a problem," said study co-author Dr. Laura Kair, a resident in pediatrics at the university's Doernbecher Children's Hospital. "We like to rely on our best evidence as physicians, so when we see these results jibe better with our own personal experience than evidence-based practice in our field, it makes us take [note]."

[Read: Wider Breast-Feeding Could Save Babies' Lives.]

Kair and co-author Dr. Carrie Phillipi, medical director of the hospital's mother-baby unit, are scheduled to present their findings Monday at the Pediatric Academic Societies' annual meeting in Boston.

Seeking to determine if eliminating routine pacifier distribution on the hospital's mother-baby unit would increase the rate of exclusive breast-feeding, Kair and Phillipi learned that this rate actually dropped significantly -- from 79 percent to 68 percent -- after pacifiers were restricted.

Additionally, the proportion of breast-fed newborns receiving supplemental formula rose from 18 percent before the policy change to 28 percent afterward, while the percentage of babies fed only formula remained statistically unchanged.

To encourage exclusive breast-feeding, which benefits both mothers and babies, the World Health Organization and the United Nations Children's Fund (UNICEF) recommend that hospitals caring for newborns follow their "Ten Steps to Successful Breastfeeding" -- one of which states that pacifiers should not be provided to breast-feeding babies. Hospitals hoping to achieve the status of "Baby-Friendly Hospitals" often follow this recommendation, Phillipi said.

"Parents come to us looking for advice," Phillipi said. "Our hope in publicizing this study is to stimulate a conversation about the topic, especially as many hospitals are thinking of removing pacifiers to become Baby Friendly."

[Read: Many Women Say No to Breast-Feeding for 6 Months.]

Dr. Richard Schanler, chair of the American Academy of Pediatrics' breast-feeding section, noted that the study did not offer information about how newborns were comforted who did not receive pacifiers or how hospital staff members were educated about this issue during the research.

"You cannot draw conclusions to change health care practices from this type of study," said Schanler, also associate chairman of the department of pediatrics at Cohen Children's Medical Center of New York, in New Hyde Park.

Phillipi acknowledged that the study's results are difficult to apply to individual cases, but "we're really hoping to bring this conversation to a different level . . . so we're able to give parents the best evidence possible. Our overall goal is to improve breast-feeding rates . . . we know it's the best nutrition for babies."

Research presented at scientific meetings is considered preliminary because it hasn't yet been peer-reviewed or published in a medical journal.

More information

The U.S. Office on Women's Health has more about breast-feeding.