What do laypersons consider as a good death

Goals  This study was designed to understand laypersons’ attitude of good death. Materials and methods  A 53-item Good-Death Questionnaire (GDQ) was generated by applying “good-death principles” and past research on good death in Chinese people. Main results  A total of 184 adults completed the questionnaire. The Cronbach’s alpha for the GDQ was 0.96. Factor analysis produced five factors: autonomy and choice, wish fulfillment, death preparation, spiritual support and afterlife, and symptom control. Elderly people had higher scores in “autonomy” than people aged ≤40 (52.71 ± 5.94 vs. 56.71 ± 3.82, P = 0.012). Chaplains had higher scores in “death preparation” than volunteers (76.09 ± 4.44 vs. 70.46 ± 6.49, P = 0.011) and higher scores in “spiritual support” than volunteer and farmers–workers–businessmen (32.97 ± 2.49 vs. 28.08 ± 5.06 and 29.69 ± 5.05, P = 0.002). People with Buddhist religious belief had higher scores in “spiritual support” than people without religious belief (31.10 ± 3.99 vs. 25.73 ± 3.13; P < 0.001). Religious devotion was positively related to “death preparation” and “spiritual support.” People who had witnessed death had lower scores of “autonomy and choice” than the inexperienced (55.41 ± 4.81 vs. 57.06 ± 3.85; P = 0.032). Conclusions  Our results identified some major characteristics of good-death attitude among laypersons. Religious devotion has a positive impact on the attitude of good death.     

Prospective assessment of chemotherapy-induced peripheral neuropathy due to weekly paclitaxel in patients with advanced or metastatic breast cancer (CSP-HOR 02 study)

Goals of work  The aim of this study was to prospectively evaluate chemotherapy-induced peripheral neuropathy (CIPN) using a patient-based instrument, the Patient Neurotoxicity Questionnaire (PNQ) and a physician-based instrument, the National Cancer Institute-Common Toxicity Criteria (NCI-CTC) in patients with advanced or metastatic breast cancer who were treated with weekly paclitaxel. Materials and methods  CIPN symptoms were prospectively assessed in 35 patients using the PNQ, NCI-CTC, and the Functional Assessment of Cancer Therapy (FACT)-Taxane including neurotoxicity component (Ntx) at the baseline, and 8 and 16 weeks after starting chemotherapy. Results  For sensory neuropathy symptoms, the reported incidence of CIPN was significantly increased during active treatment in terms of both the PNQ and NCI-CTC assessments. In contrast, there was a notable increase of patient motor neuropathy symptoms that were elucidated only by the PNQ. The PNQ grades of CIPN were widely distributed in the patient population as compared with the NCI-CTC grades for both sensory and motor neuropathy. The sensory PNQ grade was correlated with sensory NCI-CTC grade (r = 0.58) and Ntx (r = 0.51), and the motor PNQ grade was correlated with Ntx (r = 0.57). Conclusions  The PNQ appears to be more sensitive and responsive than the NCI-CTC for CIPN; the PNQ appears to have diagnostic validity for evaluating CIPN in patients who are receiving neurotoxic chemotherapy.     

Associations between quality of life, fatigue, and cytokine levels in patients aged 50+ with acute myeloid leukemia

Goals of work  Quality of life (QOL) is significantly impaired in patients with acute myeloid leukemia (AML), and fatigue is the most common and disabling symptom; effective treatment measures have yet to be found. Cytokines, biomarkers of inflammation, may moderate both health outcomes, but published data are limited. We looked at the role of cytokines in modulating QOL and fatigue in an older AML population. Patients and methods  We recruited 34 English-speaking patients (23 men, 11 women) aged 50 or older with AML within 1 year of diagnosis. QOL and fatigue were assessed with validated questionnaires. Blood was simultaneously drawn for quantitative measurement of a 13-cytokine panel. Repeat measurements were done 4–6 weeks later (n = 28 patients). Spearman correlations between health measures and cytokine levels were examined at baseline, as were changes in variables between time points. A potentially clinically important correlation was defined as an r ≥ 0.30. Results  At baseline, potentially clinically important correlations were noted between global QOL and interferon (IFN)-γ (r = −0.376, p = 0.031), interleukin (IL)-2 (r = −0.340, p = 0.053), IL-5 (r = −0.368, p = 0.035), IL-8 (r = −0.312, p = 0.077), and TNF-α (r = −0.326, p = 0.064). A similar correlation was observed between IL-6 and fatigue (r = 0.332, p = 0.059). Between time points, there were no potentially important correlations between changes in global QOL and any cytokine. However, potentially important correlations with fatigue were seen with both IL-5 (r = 0.344, p = 0.073) and IL-10 (r = 0.326, p = 0.091) between time points. Conclusions  These preliminary data provide support for a larger controlled study of cytokines, fatigue, and QOL in patients with AML.     

Maintenance of effects of a home-based physical activity program among breast cancer survivors

Purpose  Although physical activity (PA) adoption improves fitness and psychological well-being among cancer survivors, PA maintenance has not been examined. This paper presents follow-up of a home-based PA program for women treated for early-stage breast cancer. Materials and methods  Eighty-six sedentary women (mean age = 53.14 years, SD = 9.70) were randomly assigned to a PA or contact control group. The PA group received a 12-week telephone counseling program to adopt PA. Assessments were conducted at baseline, end-of-intervention (12 weeks), 6, and 9 months post-baseline. Results  When comparing change from end-of-intervention (12 weeks) between groups, a significant reduction was observed in minutes of PA at 6 months (t = −2.10, p < 0.05), but there was no decrease in intervention effect at 9 months (t = −0.19, p = 0.84). Similarly, post-intervention reductions in fatigue were lost at 6 months (t = 3.27, p < 0.01), but remained present at 9 months (t = 1.65, p = 0.10). PA group’s fitness improvements were maintained at both follow-ups (t = 1.04, p = 0.30 and t = 0.05, p = 0.96). The previously significant intervention effect on vigor was maintained at 6 months (t = 1.32, p = 0.19) but was significantly reduced at 9 months (t = −2.15, p < 0.05). PA participants were more likely to progress in motivational readiness at 6 (OR = 5.95, 95% CI = 2.30, 15.36) and 9 months (OR = 4.09, 95% CI = 1.69, 9.87); however, group differences in meeting PA guidelines were not maintained. Conclusion  Some positive effects of a home-based PA intervention for breast cancer patients were maintained at 6 and 9 months.     

Development and evaluation of a problem-focused psychosocial intervention for patients with head and neck cancer

Goals of the work  Patients with head and neck cancer have complex needs that affect many basic functions of life and contribute to substantial psychosocial problems. The aim of this study was to evaluate the effectiveness of a problem-focused intervention for patients with psychosocial dysfunction who had completed treatment for head and neck cancer. Patients and methods  Using a quasi-experimental design, 54 participants who were above pre-determined cutoff points for psychosocial dysfunction (hospital and depression scale, work and social adjustment scale) were given the opportunity to self-select into either the experimental group for the psychosocial intervention programme which was delivered in an individualised format, with bibliotherapy as an adjunct, or the control group for usual care. Main results  Analysis of covariance results demonstrated a reduction in psychological distress (anxiety, p = 0.001; depression, p = 0.005), improving social functioning (p = 0.048) and quality of life scores (p = <0.05) for the experimental group, all of which were sustained into the 3-month follow-up period. No such improvements were evident for the control group. Conclusions  This study suggests that head and neck cancer patients with post-treatment psychosocial dysfunction can benefit from a problem-focused psychosocial intervention. Such evidence can inform practice, policy and future research, aimed at improving post-treatment quality of life for patients with head and neck cancer.     

Factors associated with poor general health after stem-cell transplantation

Aims To describe functional status (FS), general health (GH) and symptom distress (SD) from admission to 1 year post-SCT and to identify medical, demographic, and/or patient-reported outcome variables associated with patient-perceived GH. Material and methods Forty-one patients (27 women) with a median age of 44 (18–65) years answered three questionnaires (SIP, SWED-QUAL, and SFID-SCT) from admission to 1 year post-SCT. Results At discharge, 59% of the patients reported poor FS and GH, and 24% reported >10 simultaneous symptoms. After 1 year post-SCT, 22% still reported poor FS, 32% poor GH, and 12% >10 simultaneous symptoms. Compared with admission, significantly larger proportions of the patients reported poor GH at discharge (20 vs 59%, p = .001), poor FS at 6 months (24 vs 59%, p = .004), and poor GH [The number of symptoms was found to be significantly associated with poor GH at discharge (OR 1.330, p = .009) and at 1 year post-SCT (OR 2.000, p = .010)]. Patients reporting “poor GH” at discharge and at 1 year post-SCT reported a median of 7 and 10 symptoms, respectively. Patients with “good GH” reported a median of three symptoms both at T1 and T4. “Tiredness”, “anxiety”, “mouth dryness”, “loss of appetite”, and “diarrhoea” were reported by a larger proportion of the patients reporting “poor GH”. Conclusions The results confirm that some patients who have undergone a SCT have a negatively affected life situation. The study indicates that actively asking for symptoms and applying the best treatment for symptom alleviation are among the most important measures that SCT teams can take to help the patients perceive better general health and an improved life situation.     

Physical activity correlates and barriers in head and neck cancer patients

Purpose Our study purpose was to determine physical activity correlates and barriers among head and neck cancer patients. Materials and methods Fifty-nine (response rate = 91%) head and neck cancer patients from an academic oncology clinic enrolled in a cross-sectional study utilizing chart review and self-administered questionnaire. Results The majority were men (83%) and white (92%) with mean age of 58 ± 12.8 years and mean months since diagnosis of 18.6 ± 51.9. The strongest bivariate correlates of physical activity included enjoyment (r = 0.41; p = 0.002), symptom index (r = −0.36; p = 0.006), alcohol use (r = 0.36; p = 0.007), task self-efficacy (r = 0.33; p = 0.013), perceived barriers (r = −0.27; p = 0.047), and comorbidity score (r = −0.27; p = 0.042). Stepwise regression demonstrated independent associations with physical activity for enjoyment (β = 0.38; p = 0.002) and symptom index (β = −0.33; p = 0.006; R ² = 0.28). The most prevalent barriers significantly associated with physical activity included dry mouth or throat (r = −0.32; p = 0.016), fatigue (r = −0.27; p = 0.043), drainage in mouth or throat (r = −0.41; p = 0.002), difficulty eating (r = −0.32; p = 0.015), shortness of breath (r = −0.30; p = 0.024), and muscle weakness (r = −0.29; p = 0.033). Conclusions Our results showed that the strongest independent correlates of physical activity were social cognitive (i.e., enjoyment) and treatment-related (i.e., symptom index). Treatment-related activity barriers were frequent and significantly associated with reduced activity. Efforts to enhance exercise adherence in head and neck cancer patients should focus on optimizing enjoyment and managing treatment-related barriers.     

A patient-reported outcome instrument to assess the impact of oropharyngeal mucositis on health-related quality of life: a longitudinal psychometric evaluation

Goals of work  An oropharyngeal mucositis (OM)-specific health-related quality of life measure (OMQoL) has been developed to assess the impact of OM from the perspective of patients. The current paper describes the convergent, concurrent, and known-group validities and responsiveness in relation to clinical and health outcomes. Materials and methods  A multicenter approach was used, and 137 patients treated with different cancer therapies completed the OMQoL and the European Organization for Research and Treatment of Cancer Quality of Life questionnaire [EORTC QLQ-C30 (Ch)] twice over a 4-week period or weekly over a 7-week period, along with concurrent measures of OM and its related symptoms. Main results  The OM-related symptom scores correlated highly with the OMQoL, confirming its convergent validity (r = −0.724–−0.971, p < 0.01). Moderate correlations between the subscales of the OMQoL and EORTC QLQ-C30 (Ch) were indicative of good concurrent validity (r = 0.450–0.724, p < 0.01). The OMQoL was able to distinguish between patients with different severities of OM (p < 0.01) and types of cancer therapy (p < 0.01), providing evidence of good known-group validity. The changes in effects sizes corresponding to changes in OM curves indicate that the OMQoL is responsive to changes in OM status. Conclusions  These findings suggest that the OMQoL has very good psychometric properties and can be used as a health-related quality of life assessment for cancer patients with OM. Much work is still needed in strengthening the psychometric qualities and interpretability of the OMQoL by demonstrating its ability to detect outcome changes over time.     

Health-related quality of life 18 months after breast cancer: comparison with the general population of Queensland, Australia

Goals of work  Health-related quality of life (HRQoL) was compared between urban breast cancer survivors (BCS) and the general female population in urban Queensland, and correlates were identified. Materials and methods  HRQoL data were collected at 6, 12, and 18 months post-diagnosis from a population-based sample of 287 women, aged 74 years or younger, diagnosed with breast cancer in 2002. The urban comparison group was drawn from a population-based survey conducted in 2004 and included 675 women aged 30–74 years with no prior history of breast cancer. The Functional Assessment of Cancer Therapy-General questionnaire was used to measure HRQoL in both groups. Main results  Younger (<50 years) BCS reported lower HRQoL at 6 months (mean, 80.2 vs 86.8) but were comparable to the general population by 12 months post-diagnosis (mean = 87.3). In contrast, HRQoL of older (50+ years) BCS at 6 months (mean = 87.1) was comparable to their general population peers (mean = 86.0) and was clinically better 18 months post-diagnosis (mean = 91.0). Compared with the general population, physical and emotional well-being among younger BCS was impaired at 6 months post-diagnosis (mean, 24.9 vs 21.0 and 21.0 vs 18.0, respectively) and did not improve over time for emotional well-being (mean = 18.8). These results persisted after adjustment for treatment-related factors, although receiving chemotherapy was an important correlate of HRQoL among younger BCS at 6 months post-diagnosis (−14.9). Conclusions  This study not only shows that the HRQoL of BCS improves between 6 and 18 months post-diagnosis but also suggests that emotional well-being among younger BCS may benefit from targeted intervention.     

Co-morbidity and functional deficits independently contribute to quality of life before chemotherapy in elderly cancer patients

Goal of the work The quality of life (QoL) of patients with cancer is a major area of concern for both patients and their physicians. The independent contribution of functional impairment and co-morbidity to QoL is unclear. Materials and methods We investigated initial global QoL in 477 patients: 195 cancer patients aged 60 years or older (group A), 152 cancer patients below the age of 60 years (group B), admitted as inpatients for chemotherapy initiation and 130 patients aged 60 years or older admitted for non-cancer-related disorders (group C). Global QoL was assessed by the EORTC-QLQ-C30 subscale, functional status by the Karnofsky Performance Scale (KPS) and the Instrumental Activities of Daily Living (IADL) scale, and co-morbidity by the Cumulative Illness Rating Scale (CIRS). Results In multivariate analyses, global QoL is significantly associated with KPS, IADL and co-morbidity in group A (r ² = 0.27), with KPS and IADL in group B (r ² = 0.23), and with age, KPS and IADL in group C (r ² = 0.38). Conclusions IADL contributes to global QoL in addition to the known effect of KPS. In addition, co-morbidity independently influences global QoL in elderly cancer patients.     

Needs of developing the skills of palliative care at the oncology ward

Background To clarify the prevalence and severity of the symptoms, 203 consecutive patients with breast, prostate and other cancers treated mainly for palliation were surveyed. Materials and methods The series includes 116 men and 87 women with the mean age of 65 years (range 27–86 years). The patients filled-up the Edmonton Symptom Assessment System (ESAS) questionnaire with 11 items describing cancer-related symptoms in the visual analogue scale (VAS). Results Altogether, 98% of the patients reported at least 1 of the 10 symptoms. There was a significant difference in the score frequencies between the 10 symptoms (p = 0.0001), fatigue receiving the highest frequency (50.8%) of the high scores. Fatigue was also the single most frequent symptom reported by 86.3% of the patients, followed by pain at effort (71.5%), sleeplessness (71.1%) and depression (59.0%). The most disturbing syndrome was pain (n = 48, 23.9%), followed by fatigue (n = 28, 13.9%), depression (9.5%) and dyspnoea (6.0%). Altogether, 75% had more than 5 symptoms and 10% reported all 10 symptoms. The total number of symptoms was not significantly associated with sex (p = 0.781) or age (p = 0.062), but it was associated with the diagnostic group; patients with breast cancer (n = 41) and those with prostate cancer (n = 44) reported fewer symptoms than the patients with other cancers (n = 116)(p = 0.023, Kruskal–Wallis). Conclusions Symptoms related to cancer are common among patients treated with palliative indication, but if not specifically surveyed, may remain un-detected and un-treated. ESAS as a clinical tool brings more symptoms to the attention of the physicians and helps in getting a comprehensive insight into the patient’s problems.     

Health behaviors of Australian colorectal cancer survivors,compared with noncancer population controls

Goal  A better understanding of health behaviors after a cancer diagnosis is important, as these behaviors are related to physical functioning, disease recurrence, development of second primary cancers, and risk of other chronic diseases. Body weight and health behaviors (smoking status, alcohol consumption, and physical activity) were examined in a population-based sample of colorectal cancer survivors and compared to a matched population group. Materials and methods  Data were collected by telephone interviews pre-diagnosis (retrospectively reported), 6 and 12 months post-diagnosis for colorectal cancer survivors (n = 1,250). Comparison data were from a population-based cancer risk survey (n = 6,277). Results  Colorectal cancer survivors were most likely to be overweight/obese pre-diagnosis (66%) than at 6 months (54%) or 12 months post-diagnosis (61%). There was little variation from 6 to 12 months in the proportion of current smokers (7% and 8%, respectively) or high-risk drinkers (both 22%). The greatest changes were for physical activity, with 53% of survivor’s sufficiently active pre-diagnosis, 32% at 6 months, and 38% at 12 months post-diagnosis. At 12 months, colorectal cancer survivors were more likely than the comparison group to be: underweight (OR = 2.14, 95% CI = 1.38–3.31); a former smoker (OR = 1.44, 95% CI = 1.26–1.63); a low-risk (OR = 1.25, 95% CI = 1.09–1.44) or high-risk drinker (OR = 1.70, 95% CI = 1.43–2.03); and insufficiently active (OR = 1.57, 95% CI = 1.34–1.83) or inactive (OR = 2.76, 95% CI = 2.39–3.19). However, colorectal cancer survivors were significantly less likely to be a current smoker (OR = 0.68, 95% CI = 0.54–0.85). Conclusions  Our findings show particular scope for physical activity interventions for colorectal cancer survivors. Improving the general health of cancer survivors should help to decrease morbidity in this population and associated health system expenditure.     

Quality of life of breast cancer patients in the course of adjuvant radiotherapy

Goals of the work In cancer patients, there is an ongoing interest in evaluating the impact of therapeutic interventions on health-related quality of life (hrqol). However, only a few longitudinal studies are published being able to measure the influence of therapy for the patients’ quality of life. Based on these data, our aim was to evaluate changes of hrqol during the course of adjuvant radiotherapy in breast cancer patients with special focus on subgroup analysis. Materials and methods Sixty-one women undergoing radiotherapy after breast conserving surgery were asked to answer the EORTC Quality of life questionnaire (EORTC-QOL-C30) three times: at the beginning of radiotherapy, in the forth week and 6 weeks after the end of treatment. To identify patients with changes of their qol during the observation time, the function scale “Global health status/Quality of life” was used enabling us to classify three subgroups: (1) unchanged hrqol (NC), (2) increasing hrqol (INC), (3) decreasing of hrqol (DEC). Main results Patients with an increasing hrqol (N = 25) demonstrated a significant increase in the role as well as in the emotional functioning scales. In patients with a decreasing hrqol (N = 15), no changes in any of the function scales were found, while a significant decrease in their cognitive functioning was observed in patients with no change in hrqol (N = 21). Conclusions Although the interpretation of these data is difficult because only a few data are available to compare our results, it could be demonstrated that emotional support and the ability to maintain a daily routine in additionally irradiated breast cancer patients is important to optimise hrqol. If hrqol decreases during the course of radiotherapy, the function scales of the EORTC-QOL-C30 seem to be insensitive to reflect this decrease.     

Mirtazapine improves sleep and lowers anxiety and depression in cancer patients: superiority over imipramine

Goals of the work  This study aimed to compare the effectiveness of mirtazapine and imipramine on not only the distressing symptoms of cancer patients such as pain, nausea, vomiting, appetite loss, and sleep disturbances but also depressive and anxiety symptoms. Materials and methods  Fifty-three patients with cancer who were diagnosed with major depressive disorder, anxiety disorder, or adjustment disorder were included. Twenty patients on mirtazapine, 13 patients on imipramine, and 20 patients in the control group without medication were interviewed during three visits (baseline, third week, and sixth week). Pain, nausea, vomiting, appetite loss, and sleep disturbances were evaluated with self-assessment single-symptom scales during each visit. The patients were also asked to complete the Hospital Anxiety Depression Scale (HADS) during each visit. Main results  There were no significant differences among the three visits in the mirtazapine, imipramine, or control groups in terms of pain, nausea, vomiting, or appetite loss. For the initial, middle, and late insomnia, only the mirtazapine group showed improvements (p = 0.001, p = 0.001, p = 0.003). There were also significant differences in the mean total (p = 0.03), anxiety (p = 0.003), and depression (p = 0.025) scores of HADS among the three visits for patients taking mirtazapine. There were no significant differences for HADS scores from the baseline to the end point for patients taking imipramine or control group patients. Conclusion  Our findings suggest that mirtazapine is effective for resolving insomnia as well as anxiety and depressive symptoms in cancer patients. However, more systematic research, such as placebo-controlled studies, is needed.     

Depression in general intensive care unit survivors: a systematic review

Purpose  To critically review data on the prevalence of depressive symptoms in general intensive care unit (ICU) survivors, risk factors for these symptoms, and their impact on health-related quality of life (HRQOL). Methods  We conducted a systematic review using Medline, EMBASE, Cochrane Library, CINAHL, PsycINFO, and a hand-search of 13 journals. Results  Fourteen studies were eligible. The median point prevalence of “clinically significant” depressive symptoms was 28% (total n = 1,213). Neither sex nor age were consistent risk factors for post-ICU depression, and severity of illness at ICU admission was consistently not a risk factor. Early post-ICU depressive symptoms were a strong risk factor for subsequent depressive symptoms. Post-ICU depressive symptoms were associated with substantially lower HRQOL. Conclusions  Depressive symptoms are common in general ICU survivors and negatively impact HRQOL. Future studies should address how factors related to individual patients, critical illness and post-ICU recovery are associated with depression in ICU survivors.     

General perceived self-efficacy: validation analysis in Greek cancer patients

Goals of work  The present study aims to validate the General Perceived Self-efficacy Scale (GSE) in Greek cancer patients. Materials and methods  The scale was administered twice, with a 3-day interval, to 99 advanced cancer patients. The patients also completed the Anxiety Subscale from the Greek Hospital Depression and Anxiety Scale. Main results  Factor analyses identified a one-factor solution, explaining 74.6% of the variance. The Greek version of the GSE had a Cronbach’s alpha of 0.927. Validity as performed using known-group analysis showed good results. Satisfactory construct validity was supported by the correlation analysis between the GSE and anxiety (r = −0.507, p < 0.0005). Interitem correlations was also satisfactory at p < 0.0005. Conclusions  These psychometric properties of the Greek version of the GSE showed that it is a valid and reliable measured when administered to cancer patients.     

Effects of educational intervention on nurses’ knowledge, attitudes, and behavioral intentions toward supplying artificial nutrition and hydration to terminal cancer patients

Introduction  This study aimed to investigate the effects of educational intervention on nurses’ knowledge, attitudes, and behavioral intentions regarding supplying artificial nutrition and hydration (ANH) to terminal cancer patients. Materials and methods  A quasi-experimental design was adopted. A structured questionnaire evaluated the effects of educational intervention. From April to June 2005, 88 nurses were enrolled in the gastroenterology, general surgery, and intensive care unit of Taipei Veterans General Hospital in Taiwan. The nurses were randomly assigned into experimental and control groups in equal numbers (44 nurses in each group). After the experimental and control groups completed the pretest, the experimental group participated in a 50-min lecture. Both groups received a post-test 2 weeks after the lecture. Results  This study showed that prior to educational intervention, nurses have possessed experiences of ANH use in routine caring for terminal cancer patients. However, due to the lack of knowledge about supplying ANH to terminal cancer patients, the nurses trended toward the negative behavioral intention, although they realized the burdens of ANH in these patients. After educational intervention, mean scores of knowledge, attitudes and behavioral intentions of the experimental group increased significantly (z = −5.255, p < 0.001; t = −5.191, p < 0.001; z = −3.274, p ≦ 0.001). Mean score changes of knowledge and attitude between these two groups reached significant differences (t = −7.306, p < 0.001; t = −4.165, p < 0.001), but no significant difference was observed in the mean score change of behavioral intention (z = −1.943, p > 0.05). Conclusion  The educational intervention remarkably improved nurses’ knowledge and attitudes regarding supplying terminal cancer patients with ANH. As for the changes in the behavioral intentions, it requires long-term moral and ethical training and communication. The results of this research emphasized the importance of educational interventions, which should be considered seriously in future reference nursing education program.     

Headache and cognitive profile in children: a cross-sectional controlled study

We investigated whether children affected by tension-type headache and migraine without aura, compared with a healthy control group that was matched by age, culturally and socioeconomically display a diverse intellectual functioning and have a separate “cognitive profile”. A cross-sectional study was conducted from January 2006 to November 2008 at “Sapienza University” in Rome. A total of 134 children were diagnosed as being affected by either migraine without aura (93) or tension-type headache (41). On the basis of our exclusion/inclusion criteria, we enrolled 82 of these 134 children, 63 of whom were affected by migraine without aura and 19 by tension-type headache. On entry, cognitive functions were assessed in both the affected subjects and the control group by the Wechsler Intelligence Scale for Children-revised. Significant differences were found between the headache and control groups in the mean total intelligence quotient and verbal intelligence quotient scores (p < 0.001). Significant negative correlations were found between the total intelligence quotient, verbal intelligence quotient, performance intelligence quotient and the frequency of attacks (r = −0.55 and p < 0.001, r = −0.61 and p < 0.001, r = −0.29 and p < 0.01, respectively), as well as between the total intelligence quotient score and the age at headache onset (r = 0.234, p < 0.05). Our results suggest that the cognitive profile of children affected by headache should be assessed at the first child neurology outpatient observation. From a therapeutic point of view, although within a normal range, the abilities most likely to be less brilliant in such children are verbal skills.