Gender differences in prevalence of myocardial infarction in rural West Texans

Background

Heart disease is the leading cause of death in the United States. Incidence rates of myocardial infarction (MI) in rural West Texas signify a lack of effective, risk-specific prevention programs. The purpose of this study was to identify gender-specific risk factors for MI in rural West Texans.

Subjects and methods

Hospital patient data for those with and without a history of MI were obtained from the Project FRONTIER database for rural West Texas counties. We used statistical software, such as SPSS, R, and WinBUGS to detect and understand the nature of MI risk factors. Statistical methods including t-tests, Chi-squared, logistic regression, and a Bayesian approach were utilized to analyze data.

Results

MI significant risk factors obtained for females were systolic blood pressure (p?=?0.002), diastolic blood pressure (p?=?0.004), pulse (p?=?0.015), and smoking (p?=?0.002). For males, these were glucose (p?=?0.022), age (p?=?0.050), body fat (p?=?0.034), and smoking (p?=?0.017). The mean risk parameter followed a normal distribution, while the precision parameter depicted skew for both sexes.

Conclusions

Gender-specific differences in MI risk factors exist, and incorporating such variables can guide relevant policymaking to reduce MI incidence in rural West Texans.

     

Cancer-related fatigue mediates the relationships between physical fitness and attendance and quality of life after participation in a clinical exercise program for survivors of cancer

Purpose

Cancer-related fatigue (CRF) is a common and limiting symptom reported by survivors of cancer, negatively impacting health-related quality of life (HRQoL). Exercise improves CRF, HRQoL, and physical fitness in survivors. Prospective research trials have shown that exercise-associated fitness improvements effects on HRQoL are mediated by CRF; however, this has not been investigated in a pragmatic real-world setting. This study utilizes data from a large heterogenous population of survivors participating in a clinical exercise program to investigate this mediation effect, as well as effects of program attendance.

Methods

Data were collected from 194 survivors completing the BfitBwell Cancer Exercise Program (July 2016–February 2020). Changes in HRQoL, CRF, and fitness were calculated and program attendance collected. Basic correlation analyses were performed. Linear regression analyses were performed to assess mediation by CRF.

Results

All measures of CRF, HRQoL, and physical fitness significantly improved following the exercise program. Improvements in physical fitness were significantly correlated with improvements in HRQoL (r?=?0.15–0.18), as was program attendance (r?=?0.26) and CRF (r?=?0.59). The effects of physical fitness and program attendance on HRQoL were at least partially mediated by the effects of CRF.

Conclusion

This study extends research findings on how exercise programs improve HRQoL in survivors of cancer to a real-world setting. Results indicate that clinical exercise programs should target reductions in CRF in survivors (during or after treatment) through improvements in physical fitness to improve HRQoL and that high attendance should be encouraged regardless of fitness changes.

     

Successful life navigation by former participants in a group for pregnant and parenting teens

Background: Teen motherhood has negative consequences for mother and child. The Mothers of Mount Sinai (MOMS) Program is a group that assembles weekly and is for pregnant/parenting teens to help them become competent parents, provide job training, and encourage education and reproductive health.

Methods: Former MOMS participants were recruited to complete a survey if they were over 18, and they participated in a summer job training component between 1995 and 2006. The survey included questions about participants' lives at start of MOMS and currently, including education, finances, and pregnancies.

Results: Thirty-one of 77 eligible former participants completed the survey, with mean elapsed time of 10.7 years since starting MOMS. Fifty-eight percent had graduated high school, 81% had graduated high school or obtained a GED, 55% had attended some college, and 13% had graduated college. Twenty-six women (84%) are currently employed with median income in the range of $20,000–35,000. Currently, more women are financially self-sufficient (45%) compared to when they started MOMS (7%) (McNemar chi square p?=?0.000). Eighteen women (58%) received cash assistance when they started MOMS; currently only one does, p?=?0.000. Twenty-three women (74%) did not become pregnant again before 20; only one had 2nd child during her teen years.

Conclusion: Active MOMS participants were shown to have made great advances in education, employment, finances, and delayed 2nd births. These participants were a highly motivated group, which could contribute to a bias in the positive program effect.     

Serum and Erythrocyte Biomarkers of Nutrient Status Correlate with Short-Term Α-Carotene, Β-Carotene,Folate, and Vegetable Intakes Estimated by Food Frequency Questionnaire in Military Recruits

Objective: Food frequency questionnaires (FFQs) estimate habitual dietary intake and require evaluation in populations of interest in order to determine accuracy. Thus, the purpose of this study was to determine agreement between circulating biomarkers and FFQ estimated dietary intake in a military population consuming all meals in a dining facility over 12?weeks.

Methods: 2014 Block FFQs were administered and fasted blood samples were drawn to assess nutritional biomarkers at the end of a 12-week training period in male (n?=?141) and female (n?=?125) Marine recruits undergoing initial military training. FFQ estimates of alpha- and beta-carotene, folate, and fruit and vegetable intake and circulating concentrations of serum alpha- and beta-carotene and serum and erythrocyte folate were measured. Partial correlations were used in the full model, and weighted kappa coefficients were used to determine agreement between ranking quartiles of dietary intake estimates with corresponding biomarker status quartiles.

Results: Serum and dietary intake of alpha-carotene were positively associated in males (p?=?0.009) and females (p?<?0.001), as was serum and intake of beta-carotene (males, p?=?0.002; females, p?<?0.001). Alpha-carotene was positively associated with vegetable intake in males (p?=?0.02) and beta-carotene with vegetable intake in females (p?=?0.003). Serum folate in males (p?=?0.002) and erythrocyte folate in females (p?=?0.02) were associated with dietary folate intake. In females, the relationships between biomarker and dietary estimates yielded significant kappa coefficients. In males, a significant kappa coefficient was observed for erythrocyte folate and dietary intake of folate only. The kappa coefficient for serum and estimated intake of beta-carotene was not significant in males.

Conclusion: Twelve-week habitual intake of alpha-and beta-carotene and folate were correlated with circulating biomarkers in a military training population. The 2014 Block FFQ was able to accurately rank females into quartiles of nutrient status based on intake, while males were ranked less accurately than females.     

Associations Between Maternal Experiences of Discrimination and Biomarkers of Toxic Stress in School-Aged Children

Objective

To examine associations between maternal experiences of discrimination and child biomarkers of toxic stress in a multiethnic, urban sample of mothers and children (4–9 years).

Methods

Data were drawn from a cross-sectional study of maternal–child dyads (N?=?54) living in low-income neighborhoods in New Haven, Connecticut, USA. Mothers reported experiences of discrimination. Noninvasive biomarkers of toxic stress were collected to assess neuroendocrine (hair cortisol), immune (salivary cytokines, c-reactive protein), and cardiovascular (blood pressure) functioning in children.

Results

Maternal experiences of discrimination were associated with increased log-transformed salivary interleukin-6 (IL-6) levels in children (β?=?0.15, p?=?0.02).

Conclusions

Vicarious racism, or indirect exposure to discrimination experienced by caregivers, is associated with poor health outcomes for children. Immune pathways may be a biological mechanism through which racial discrimination “gets under the skin,” but additional research is needed to fully understand these relationships. Uncovering the physiological mechanisms linking vicarious racism with child health is an important step towards understanding possible early roots of racial and ethnic health inequities.

     

The Association of Measures of the Micro- and Macro-Vasculature with Selenium and GPx Activity in a Young Bi-Ethnic Population: The African-PREDICT Study

Abstract

Objective: Selenium plays an important physiological role as component for antioxidant selenoproteins such as glutathione peroxidase (GPx). Since oxidative stress contributes to hypertension development, it is likely that selenium deficiency may contribute to the burden of cardiovascular disease. To better understand the involvement of selenium and GPx in the early development of cardiovascular disease, we investigated in young, healthy black and white African men and women whether measures of the micro- and macrovasculature are related to selenium and GPx activity.

Methods: In young adults (N?=?394; aged 20–30?years) we determined serum selenium, GPx activity, microvascular measures (central retinal artery equivalent, central retinal vein equivalent, arteriolar-to-venular ratio [AVR], and estimated glomerular filtration rate [eGFR]), and macrovascular measures (pulse wave velocity, 24-hour pulse pressure [PP] and augmentation index [Aix]).

Results: In multivariable-adjusted regression analyses, there were vasculoprotective associations between serum selenium and a microvascular measure (AVR [β?=?0.23; p?=?0.036]) in black African women and with a macrovascular measure (24-hour PP [β = ?0.15; p?=?0.048]) in white African women. In turn, GPx activity also showed a protective association with a microvascular measure (eGFR) in white African men (β?=?0.23; p?=?0.035), as well as with macrovascular measures (AIx, PP) in the black (β = ?0.25; p?=?0.027) and white African men (β = ?0.22; p?=?0.035), and black African women (β = ?0.32; p?=?0.001).

Conclusions: Collectively the findings suggest a protective role for the micronutrient selenium and GPx on both the micro- and macrovasculature in a young, healthy bi-ethnic population.     

Careless responding in internet-based quality of life assessments

Purpose

Quality of life (QoL) measurement relies upon participants providing meaningful responses, but not all respondents may pay sufficient attention when completing self-reported QoL measures. This study examined the impact of careless responding on the reliability and validity of Internet-based QoL assessments.

Methods

Internet panelists (n?=?2000) completed Patient-Reported Outcomes Measurement Information System (PROMIS®) short-forms (depression, fatigue, pain impact, applied cognitive abilities) and single-item QoL measures (global health, pain intensity) as part of a larger survey that included multiple checks of whether participants paid attention to the items. Latent class analysis was used to identify groups of non-careless and careless responders from the attentiveness checks. Analyses compared psychometric properties of the QoL measures (reliability of PROMIS short-forms, correlations among QoL scores, “known-groups” validity) between non-careless and careless responder groups. Whether person-fit statistics derived from PROMIS measures accurately discriminated careless and non-careless responders was also examined.

Results

About 7.4% of participants were classified as careless responders. No substantial differences in the reliability of PROMIS measures between non-careless and careless responder groups were observed. However, careless responding meaningfully and significantly affected the correlations among QoL domains, as well as the magnitude of differences in QoL between medical and disability groups (presence or absence of disability, depression diagnosis, chronic pain diagnosis). Person-fit statistics significantly and moderately distinguished between non-careless and careless responders.

Conclusions

The results support the importance of identifying and screening out careless responders to ensure high-quality self-report data in Internet-based QoL research.

     

Revisiting the healthy immigrant effect with diabetes risk in Canada: why race/ethnicity matters

ABSTRACT

Objective: Evidence shows that recent immigrants are healthier than the native-born population, a phenomenon known as the healthy immigrant effect. With increasing duration of stay, this health gap significantly narrows as immigrants’ health deteriorates to either resemble or become worse than the host population. However, little is known about the category of immigrants for whom this decline is most pronounced since the extant research largely considers immigrants as a homogeneous group, thus overlooking important racial/ethnic differences.

Design: Using data from the 2014 Canadian Community Health Survey (CCHS), we categorised immigrants by race/ethnicity and duration of stay in Canada and compared them to their native-born white Canadian counterparts on the likelihood of having a chronic health condition, using type 2 diabetes (T2D) as a case.

Results: In the base model, recent visible minority (i.e. non-white or non-Caucasian) immigrants and recent white immigrants were less likely than the native-born white Canadian population to have T2D (recent visible minority immigrants OR?=?0.46, CI?=?0.27–0.79, p?=?0.005; recent white immigrants OR?=?0.26, CI?=?0.11–0.64, p?=?0.003). The odds of having T2D were significantly higher for long-term immigrants than the native-born white Canadian population (long-term visible minority immigrants OR?=?1.59, CI?=?1.27–2.00, p?=?0.000; long-term white immigrants OR?=?1.74, CI?=?1.44–2.10, p?=?0.000). In the multivariate model, long-term visible minority immigrants were about 2.3 times more likely than their white Canadian born counterparts to have T2D (CI?=?1.86–2.96, p?=?0.000). Long-term visible minority immigrants were about 2.1 times more likely than long-term white immigrants to have T2D (CI?=?1.49–2.94, p?=?0.000)

Conclusion: Immigrants’ health deterioration varies significantly across ethnic categories in Canada. Interventions for facilitating the integration of visible minority immigrants may help reduce these health inequities.     

A randomised control trial of parent and child training programmes (versus wait list control) for children with ADHD-type behaviours: A pilot study

ABSTRACT

Objective: A randomised control trial was conducted to assess whether the combined Incredible Years parent training and child training programmes (PT?+?CT) led to improvements in ADHD-type behaviours in children, when compared to a PT-only group and a Wait List Control (WLC) group. Method: Forty-five families with a child aged 3–7 years who displayed ADHD-type behaviours were referred for treatment and randomised to a combined treatment group (PT?+?CT; n?=?12), a PT group (n?=?19) or a WLC group (n?=?14). Programmes were delivered by community-based organisations. Short-term follow-up (six months) assessments were undertaken with parents and children based on parent reports of child behaviour and parent well-being and behaviour. A qualitative sub-study was also conducted with parent participants (n?=?8) and programme facilitators (n?=?5) to explore experiences and views of the combined programme. Results: Statistically significant differences were found between the PT group and the WLC group with regard to child hyperactivity (p?<?0.001) and pro-social skills (p?<?0.05). No significant differences were found between the combined group (PT?+?CT) and the PT group except for child hyperactivity (p?<?0.05), which was significantly lower in the PT-only group. Significant effects were found for PT?+?CT versus WLC on the Strengths and Difficulties Questionnaire Impact subscale only. Conclusion: These findings suggest that the combined treatment (PT?+?CT) produced little added benefit for child hyperactive/inattentive behaviour post-intervention despite the very positive views expressed by parents in the qualitative interviews. The PT training alone was more effective in tackling some core ADHD behaviours when compared to the WLC group, but a need for further more large-scale research is indicated. Trial Registration: ISRCTN82596506.     

Keeping Parent,Child, and Relationship in Mind: Clinical Effectiveness of a Trauma-informed,Multigenerational, Attachment-Based,Mother-Baby Partial Hospital Program in an Urban Safety Net Hospital

Purpose

The Hennepin Healthcare Mother-Baby Day Hospital is a partial hospital program for pregnant and postpartum women with moderate to severe psychiatric illness. Based in an urban safety net hospital, the Day Hospital provides trauma-informed, multigenerational, group-based therapy and psychiatric care. This report describes the program and preliminary data regarding maternal mental health and functioning at treatment entry and discharge.

Methods

Data include information on pregnant and postpartum women who were admitted to the Day Hospital between April 2013 and September 2019 and completed at least 4 days of treatment. We describe patient demographics and changes in mental health and maternal functioning.

Results

328 women consented to participation in research, representing 364 unique admissions. Primary diagnoses included major depression (55.6%; n?=?202); generalized anxiety (36.4%; n?=?132); bipolar spectrum (28%; n?=?102); and trauma-related disorders (20.6%; n?=?75). Patients reported significant improvements (p?<?0.001) in self-report scales assessing depression, anxiety, and maternal functioning.

Conclusions

A mother-baby day hospital based in an urban safety net hospital is effective in improving mental health and parenting functioning in perinatal women with moderate to severe psychiatric illness. The high acuity and prevalence of comorbid depression, anxiety, bipolar spectrum, and trauma-related disorders support the need for trauma-informed, multigenerational approaches that address perinatal mental health and attachment-based parenting support.

     

Adherence to the Mediterranean diet and weight status in children: the role of parental feeding practices

Abstract

The study examines Parental Feeding Practices (PFP) in relation to adherence to the Mediterranean Diet (MD) and children’s weight status. It’s a cross-sectional study of 402 parents (68.4% mothers), with children aged 2–12 years. Parents completed the Comprehensive Parental Feeding Questionnaire and the Mediterranean Diet Quality Index for children and adolescents (KIDMED), evaluating children’s adherence to the MD. Logistic regression showed that in children aged 2–<6 years, “emotion regulation/food as reward” and “pressure” decrease MD adherence (OR?=?0.186, p?<?0.0001 and OR?=?0.496, p?=?0.004), and “monitoring” decrease excess body weight (OR?=?0.284, p?=?0.009). In older children (6–12 years), “healthy eating guidance” and “monitoring” increase MD adherence (OR?=?3.262, p?=?0.001 and OR?=?3.147, p?<?0.0001), “child control” decreases MD adherence (OR?=?0.587, p?=?0.049), “pressure” decrease excess body weight (OR?=?0.495, p?<?0.0001) and “restriction” increase excess body weight (OR?=?1.784, p?=?0.015). “Healthy eating guidance” and “monitoring” seem to be the best PFP employed, in terms of children’s MD adherence and weight status.     

The association between post-diagnosis health behaviors and long-term quality of life in survivors of ductal carcinoma in situ: a population-based longitudinal cohort study

Purpose

Women diagnosed with ductal carcinoma in situ (DCIS) often experience adverse changes in health-related behaviors following diagnosis. The impact of health behaviors on long-term quality of life (QoL) in DCIS survivors has not been investigated.

Methods

We examined the association of post-diagnosis body mass index (BMI), physical activity, alcohol, and smoking with QoL among 1448 DCIS survivors aged 20–74 enrolled in the population-based Wisconsin in situ Cohort from 1997 to 2006. Health behaviors and QoL were self-reported during biennial post-diagnosis interviews. Physical and mental QoL were measured using the validated SF-36 questionnaire. Generalized linear regression was used to determine the association between behaviors and QoL with adjustment for confounders. Lagged behavior variables were used to predict QoL during follow-up and avoid reverse causation.

Results

Women reported 3,536 QoL observations over an average 7.9 years of follow-up. Women maintaining a healthy BMI had on average a significantly higher summary measure score of physical QoL than obese women (normal versus obese: β?=?3.02; 2.18, 3.85). Physical QoL scores were also elevated among those who were physically active (5?+?h/week vs. none: β?=?1.96; 0.72, 3.20), those consuming at least seven drinks/week of alcohol (vs. none; β?=?1.40; 0.39, 2.41), and nonsmokers (vs. current smokers: β?=?1.80; 0.89, 2.71). Summary measures of mental QoL were significantly higher among women who were moderately physically active (up to 2 h/week vs. none: β?=?1.11; 0.30, 1.92) and nonsmokers (vs. current smokers: β?=?1.49;0.45, 2.53).

Conclusions

Our results demonstrate that maintaining healthy behaviors following DCIS treatment is associated with modest improvements in long-term QoL. These results inform interventions aimed at promoting healthy behaviors and optimizing QoL in DCIS survivors.

     

Associations between sitting time and quality of life in a population-based sample of kidney cancer survivors

BackgroundAdverse health effects of sedentary behaviour on cancer risk and health outcomes in cancer survivors have been reported but few studies have examined quality of life (QoL) and no study has focused on kidney cancer survivors (KCS). The purpose of this study was to estimate the prevalence of sitting time among KCS and to determine any associations with QoL.MethodsAll 1985 KCS diagnosed between 1996 and 2010 identified through a Canadian provincial Registry were mailed a survey that consisted of the modified domain-specific sitting time questionnaire, the Godin Leisure Time Exercise Questionnaire and several Functional Assessment of Cancer Therapy (FACT) QoL scales. Standard demographic and medical variables were also reported.ResultsCompleted surveys were received from 540 KCS. The mean hours of sitting time were 8.0 ± 4.7 for a work-day and 6.5 ± 3.8 for a non-work day. After adjustment for key covariates, analyses of covariance indicated that the only significant relationship was an unexpected positive association between sitting time on a work day and emotional well-being (p = 0.019). Moreover, the only variable to moderate these associations was age, with younger KCS under age 60 showing the expected negative associations between sitting time and physical and functional aspects of QoL.ConclusionKCS sit for a significant amount of time on work days and non-work days, however, there were few associations with QoL. Future observational studies and randomized controlled trials are warranted to examine sitting time and health outcomes among KCS.     

Higher Waist Circumference Is Related to Lower Plasma Polyunsaturated Fatty Acids in Healthy Participants: Metabolic Implications

Objective: We evaluated whether the relationship between waist circumference (WC) and cardiometabolic risk is related to usual diet and plasma fatty acid composition.

Methods: This cross-sectional study included 226 health professionals from 20 to 59?years old. Anthropometric features, oxidative stress, inflammatory markers, and plasma fatty acid profile were assessed. Dietary intake was evaluated with a semi-quantitative food frequency questionnaire, the quality of dietary habits by Healthy Eating Index, and insulin resistance by homeostasis model assessment–insulin resistance and triglyceride-glucose index.

Results: Higher WC was associated with lower concentrations of high-density lipoprotein cholesterol (p?=?0.000) and adiponectin (p?=?0.000) and higher uric acid levels (p?=?0.011). Plasma polyunsaturated fatty acid (PUFA) levels were negatively associated with weight (p?=?0.046), systolic blood pressure (p?=?0.035), fasting glucose (p?=?0.000), triglyceride-glucose index (p?=?0.023), and IL-1β (p?=?0.037). Individuals with elevated WC consumed more calories (p?=?0.002), niacin (p?=?0.002), and pyridoxine (p?=?0.017), but less calcium (p?=?0.001), phosphorus (p?=?0.016), and vitamin B2 (p?=?0.011). In addition, individuals with higher WC denoted lower PUFA concentrations (p?=?0.036).

Conclusion: The results suggest that participants with higher WC have lower plasma PUFA concentrations and higher levels of saturated fatty acids. This could be related to metabolic and inflammatory changes that could trigger increased risk of metabolic syndrome and cardiovascular disease.     

The impact of transvenous cardioverter-defibrillator implantation on quality of life,depression and optimism in dialysis patients: report on the secondary outcome of QOL in the randomized controlled ICD2 trial

Rationale

The impact of prophylactic implantable cardioverter-defibrillator (ICD) implantation on the psychological well-being of patients on dialysis is unknown.

Objective

We aimed to identify the effect of primary ICD implantation on quality of life (QoL), mood and dispositional optimism in patients undergoing dialysis.

Methods and results

We performed a prespecified subanalysis of the randomized controlled ICD2 trial. In total, 177 patients on chronic dialysis, with an age of 55–81 years, and a left ventricular ejection fraction of?≥?35%, were included in the per-protocol analysis. Eighty patients received an ICD for primary prevention, and 91 patients received standard care. The Short Form-36 (SF-36), Geriatric Depression Scale-15 (GDS-15), Revised Life Orientation Test (LOT-R) questionnaires were administered prior to ICD implantation (T0), and at 1-year follow-up (T1) to assess QoL, depression and optimism, respectively. The patients were predominantly male (76.0%), with a median age of 67 years. Hemodialysis was the predominant mode of dialysis (70.2%). The GDS-15 score difference (T1 ? T0) was 0.5 (2.1) in the ICD group compared with 0.3 (2.2) in the control group (mean difference ? 0.3; 95% CI ? 1.1 to 0.6; P?=?0.58). The LOT-R score difference was ? 0.2 (4.1) in the ICD group compared with ? 1.5 (4.0) in the control group (mean difference ? 1.1 (0.8); 95% CI ? 2.6 to 0.4; P?=?0.17). The mean difference scores of all subscales of the SF-36 were not significantly different between randomization groups.

Conclusions

In our population of patients on dialysis, ICD implantation did not affect QoL, mood or dispositional optimism significantly during 1-year follow-up.

Clinical Trial Registration

Unique identifier: ISRCTN20479861. http://www.controlled-trials.com.

     

Serum Albumin at Diagnosis is an Independent Predictor of Early Mortality in Veteran Patients with Esophageal Cancer

Aims: To identify independent factors that could predict mortality within 6 months in a cohort of patients with esophageal cancer.

Methods: Esophageal cancer patients were grouped into early (≤6 months, n?=?41) and late (>6 months, n?=?81) mortality groups. 52 variables were analyzed by univariable analysis (UA). A multivariable (MVA) regression model was created to identify predictors of early mortality.

Results: When comparing early and late mortality groups, there was no difference in age, BMI, race, histology, or anatomic location between the two groups. UA demonstrated that the early mortality group had a lower mean albumin level (3.3?±?0.1?g/dl vs. 3.8?±?0.1?g/dl; P?<?0.001), poorer ECOG performance status (1.9?±?0.2 vs. 1.1?±?0.1, P?=?0.02), higher WBC count (9.6?±?0.7 K/µL vs. 8.2?±?0.3 K/µL, P?=?0.04), and were less likely to receive surgery (2.4% vs. 22.2%; P?=?0.003), neoadjuvant treatment (4.9% vs. 28.4%; P?=?0.009) and definitive chemoradiation (7.3% vs. 27.2%; P?=?0.01). MVA revealed that only low albumin at diagnosis was an independent predictor of survival (P?=?0.016).

Conclusion: Albumin level at diagnosis is an independent predictor of early mortality and might be used with other variables to provide prognostic information for patients and to guide treatment.     

Associations between young children’s exposure to household violence and behavioural problems: Evidence from a rural Kenyan sample

ABSTRACT

Little is known about how young children in low- and middle-income countries (LMICs) experience violence in their homes, and how different types of household violence may affect child development. This study reports on levels of exposure to household violence and associations with child behavioural outcomes in preschool-aged children in western Kenya. A sample of 465 caregivers, whose children (n?=?497) attended early learning centres supported by an international NGO, were enrolled in the study. Caregivers reported on exposure to intimate partner violence (IPV), household discipline practices, attitudes about gender roles, and child behavioural outcomes. Multivariable analysis showed significant predictive effects of IPV (regression coefficient?=?1.35, SE?=?0.54, p?=?0.01) and harsh psychological child discipline (regression coefficient?=?0.74, SE?=?0.22, p?=?0.001), but not physical discipline (regression coefficient?=?0.42, SE?=?0.24, p?=?0.08), on worse child behavioural problems. These findings indicate that child exposure to violence in different forms is highly prevalent, and associated with poorer outcomes in young children. Community-based programmes focused on parenting and early child development are well-positioned to address household violence in LMIC settings, but must be supported to provide a broader understanding of violence and its immediate and long-term consequences.     

Psychosocial standards of care for children with cancer and their families: A national survey of pediatric oncology social workers

ABSTRACT

In 2015, an interdisciplinary group of psychosocial experts developed The Standards of Psychosocial Care for Children with Cancer and Their Families. This paper presents data from a national survey of pediatric oncology social workers and their experiences in delivering psychosocial care to children and families. In total, 107 social workers from 81 cancer institutions participated in a 25-item online survey that mirrored the 15 Standards for Psychosocial Care. Both closed and open-ended questions were included.

Social work participants reported that psychosocial support is being provided at most cancer centers surveyed, primarily by social workers and child life specialists, addressing adaptation to the cancer diagnosis, treatment, and transitions into survivorship or end-of-life care and bereavement. While social workers reported offering comprehensive services throughout the cancer trajectory, many of the 2015 Standards are not being systematically implemented. Areas for improvement include funding for psychosocial support staff and programs, incorporation of standardized assessment measures, assessment for financial burden throughout treatment and beyond, consistent access to psychology and psychiatry, integrated care for parents and siblings, and more inclusion of palliative care services from time of diagnosis.     

Association between prognostic awareness and quality of life in patients with advanced cancer

Purpose

Despite the current guidelines supporting open communication about serious news, the evidence about the impact of prognostic awareness on the quality of life in cancer patients is not clear. The aim of this study was to assess the association between quality of life and prognostic awareness in patients with advanced cancer.

Methods

This was a cross-sectional study which involved patients (n?=?129) with incurable advanced cancer (estimated by oncologist using 12-month surprise question). Data were collected at oncology departments at 3 hospitals using structured interview in which patients were asked about their quality of life (using Integrated Palliative Outcome Scale—IPOS and a single-item global measure), prognostic awareness, information needs and demographics.

Results

Only 16% of the sample was completely aware of prognosis and 57% was partially aware. Accurate prognostic awareness was significantly associated (p?=?0.02) with lower level of quality of life between (when measured by both the IPOS and the single-item scale) patients with accurate prognostic awareness (M?=?37.1; 10.4) and partially aware (M?=?31.9; 9.1) and unaware patients (M?=?30; 7.4). Detailed analysis showed that significant difference between groups was found only for physical symptoms subscales (p?=?0.002), not for emotional and communication subscales.

Conclusion

Prognostic awareness was found to be negatively associated with physical domain of quality of life, but not with emotional and communication domains. More research is needed on personality factors that might influence the development of prognostic awareness and quality of life.