Physical activity and quality of life after radical prostatectomy

Background:

There are significant post-surgical reductions in health-related quality of life (HRQOL) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP). Physical activity (PA) interventions have improved treatment outcomes for PCa patients undergoing radiation and hormone therapy, but PA effects have not previously been examined in the RP setting. This study examined the relationship between preoperative PA levels and postoperative HRQOL outcomes in PCa patients treated with RP.

Methods:

Sixty patients were interviewed regarding lifetime PA and completed preoperative (2 weeks prior to surgery) and postoperative (4 weeks after surgery) HRQOL questionnaires. Aerobic fitness testing was conducted on a subsample of 22 patients.

Results:

Higher levels of total past-year PA and occupational PA significantly correlated with lesser HRQOL declines from presurgery to 4 weeks post-surgery (Beta = −0.364, p = 0.037 and Beta = −0.243, p = 0.089, respectively) in models adjusted for age, postoperative questionnaire completion date, Gleason score and education. Past-year occupational PA was highly positively correlated with past-year total PA (r = 0.785, p < 0.001). Lifetime total PA was correlated with estimated VO₂ max (r = 0.486, p = 0.026) in the 22 patients who were aerobically tested. Lifetime and past-year PA volumes were not correlated with waist circumference or body mass index.

Interpretation:

Declines in HRQOL after RP may be reduced in patients with higher preoperative levels of self-reported PA. These findings require further study with larger samples to confirm results. If confirmed, findings suggest exercise preoperatively may improve HRQOL outcomes after RP.     

The efficiency and effectiveness of utilizing diagrams in interviews: an assessment of participatory diagramming and graphic elicitation

Background  

This paper focuses on measuring the efficiency and effectiveness of two diagramming methods employed in key informant interviews with clinicians and health care administrators. The two methods are 'participatory diagramming', where the respondent creates a diagram that assists in their communication of answers, and 'graphic elicitation', where a researcher-prepared diagram is used to stimulate data collection.     

Perceived risk and adherence to breast cancer screening guidelines among women with a familial history of breast cancer: A review of the literature

ObjectivesA small positive association has been consistently demonstrated between perceived breast cancer risk and mammography use. Evidence specific to women with familial breast cancer risk has not been previously reviewed.MethodsA literature search was conducted. 186 studies were identified for abstract/full-text review, of which 10 articles were included. Manual searching identified 10 additional articles. Twenty articles examining the association between perceived breast cancer risk and adherence to mammography, clinical breast examination (CBE) or breast self-examination (BSE) guidelines among women with familial breast cancer risk were reviewed. Studies were classified according to screening modality, categorized by finding and ordered by year of publication. Studies assessing mammography were further classified according to the applied method of measuring perceived risk.ResultsOur review found a weak positive association between higher perceived risk and adherence to mammography guidelines among women with familial breast cancer risk. Consistent associations between perceived risk and adherence to CBE and BSE guidelines were not observed.ConclusionsOur ability to understand the relationship between perceived breast cancer risk and adherence to breast screening guidelines is limited, because most previous research is cross-sectional. Future studies with prospective methodologies that use consistent measurement methods and are adequately powered are warranted.     

The UCLA-University of Utah epidemiologic survey of autism: Recurrent infections

Two hundred and forty-one children with autism were ascertained and diagnosed (DSM-III criteria) in an epidemiologic survey of Utah. Pediatric and other pertinent medical records were abstracted for 233 patients and 66 of their siblings without autism for otitis media, upper respiratory, and other infections. A significantly greater number of children with autism had recurrent otitis media, upper respiratory and other infections than their nonautistic siblings. A greater number of children with autisru with recurrent infections had lower IQ scores, seizures, hearing deficits, delayed motor milestones, poorer speech, congenital anomalies, feeding problems, vomiting, diarrhea, and other types of infections than children with autism with mild or no infections. The only significant pre-, peri-, or postnatal risk factors between children with autism with recurrent, mild or no infection was an increase in the maternal-fetal incompatibility (ABO or Rh) in the recurrent infection group. Half the families with more than one child with autism had recurrent infections and 72% of those children with concurrent diseases which effect the CNS had recurrent infections. Methodological limitations are discussed.

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Zusammenfassung 241 Kinder mit Autismus wurden im Rahmen einer epidemiologischen Untersuchung von Utah rekrutiert und diagnostiziert (DSM-III-Kriterien). Pädiatrische und andere relevante medizinische Befunde im Hinblick auf Otitis media, Infektionen der oberen Luftwege und andere Infektionen wurden 233 Patienten und 66 ihrer Geschwister ohne Autismus jeweils zusammengefaßt. Eine signifikant größere Anzahl von Kindern mit Autismus hatten rezidivierende Otitiden, Infektionen der oberen Luftwege und andere Infektionen im Vergleich zu ihren Geschwistern ohne Autismus. Eine größere Anzahl der autistischen Kinder mitrezidivierenden Infekten wiesen niedrigere IQ-Werte auf, Anfälle, Hörstörungen, motorische Retardierung, schlechtere Sprache, kongenitale Anomalien, Ernährungsprobleme, Erbrechen, Durchfälle und andere Arten von Infektionen als diejenigen autistischen Kinder mit nur leichten bzw. keinen Infektionen. Der einzige signifikante prä-, peri-oder post-natale Risikofaktor, durch den sich Kinder mit Autismusund rezidivierenden Infekten von solchen mit leichten oder keinen Infekten unterschieden, war eine erhöhte Rate an maternal-fetaler Inkompatibilität (ABO oder Rh) in der Gruppe mit rezidivierenden Infekten. Die Hälfte der Familien mit mehr als einem Kind mit Autismus hatten rezidivierende Infekte, und 72% der Kinder mit zusätzlichen Krankheiten mit Auswirkungen auf das ZNS hatten rezidivierende Infekte. Die methodischen Grenzen werden aufgezeigt.

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Résumé 241 enfants avec autisme furent repérés et diagnostiques (critères DSM III) dans une étude épidémiologique de l'Utah. Les données pédiatriques et autres données médicales pertinentes furent relevées pour 233 patients et 66 des membres de la fratrie, sans autisme, pour des infections de l'oreille moyenne, de l'appareil respiratoire supérieur et d'autres infections. Un nombre significativement plus grand d'enfants autistes présentait plus d'otites moyennes récurrentes, d'infections de l'appareil respiratoire supérieur ainsi que d'autres infections que les membres de leur fratrie non autistes. Les enfants autistes, présentant des infections récurrentes, avaient des scores au Q.I. plus bas, plus de crises d'épilepsie, de déficits auditifs, de retards moteurs, une parole plus pauvre, plus d'anomalies congénitales, de problèmes de nourriture, vomissements, diarrhées et d'autres types d'infections que les enfants autistes avec des infections légères ou pas d'infection. Les seuls facteurs de risques significatifs péri ou post-nataux pour les enfants autistes, avec infections récurrentes légères ou non, étaient un accroissement de l'incompatibilités maternelle foetale (ABO ou Rh) dans le groupe avec une infection récurrente. La moitié des sujets dans les families avec plus d'un enfant avec autisme avait des infections récurrentes et 72% de ces enfants avec des maladies touchant le système nerveux central avaient des infections récurrentes. Les limites méthodologiques sont discutées.

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Work was done at the the Division of Mental Retardation and Chlld Psychiatry, Department of Psychiatry, University of California at Los Angeles and the University of Utah Salt Lake City, Utah     

The UCLA-University of Utah epidemiologic survey of autism: recurrence risk estimates and genetic counseling

The authors recently reported, in this journal, an epidemiologic survey of autism in Utah. Twenty (9.7%) of the 207 families ascertained had more than one autistic child. Analyses of these data revealed that autism is 215 times more frequent among the siblings of autistic patients than in the general population. The overall recurrence risk estimate (the chance that each sibling born after an autistic child will develop autism) is 8.6%. If the first autistic child is a male the recurrence risk estimate is 7%, and if a female 14.5%. These new recurrence risk estimates should be made available to all individuals who have autistic children and are interested in family planning.     

A qualitative study examining psychosocial distress, coping, and social support across the stages and phases of epithelial ovarian cancer

Ovarian cancer patients experience high levels of anxiety and depression, yet there is little research regarding coping and support of this population. In this study we examined the experiences of women during diagnosis and treatment via 30 semistructured interviews. The interviews were analyzed qualitatively, and five main themes were evident: (1) extreme blunting; (2) having a "forgotten cancer"; (3) traumatic surprise of diagnosis; (4) highs and lows of health care; and (5) support gap experienced postdiagnosis. Currently, there is no readily accessible psychosocial/educational information source for these patients. It is likely that a telephone intervention would be the most effective solution.     

QOLLTI-F: measuring family carer quality of life

BACKGROUND: The primary goal of palliative care is to optimize the quality of life (QOL) of people living with a life-threatening illness and that of their families. While there have been important advances in measurement of the QOL of palliative care patients, little attention has been paid to the QOL of their carers (family caregivers). To develop and deliver the most effective services to these carers, their QOL needs to be measured with acceptable and psychometrically sound instruments that have content validity. METHODS: This study reports three phases of the development and testing of such a measure: QOLLTI-F, Quality of Life in Life Threatening Illness--Family Carer Version, simultaneously in English and French. Participants were carers from 12 Canadian palliative care services who were asked to complete QOLLTI-F on three occasions. RESULTS: The final version of QOLLTI-F consists of 16 items. It was deemed acceptable by the vast majority of carers and a longer, 24-item version was completed in a median of 12 min. Content validity was assured by inclusion of all domains reported by carers to be important to their QOL: state of carer, patient wellbeing, quality of care, outlook, environment, finances and relationships. Construct validity was demonstrated, as principal components analysis indicated that the 16 items did indeed reflect these seven domains. Furthermore, the seven domain scores predicted 53% of the variance in global QOL, although the QOLLTI-F Total score predicted less well (43%). The test-retest reliability for the QOLLTI-F Total score was 0.77-0.80 and ranged from 0.50 to 0.79 for the seven domain scores. All QOLLTI-F scores were shown to be significantly different between days the carers considered bad, average and good, demonstrating responsiveness to change, with the exception of the Financial Concerns submeasure, which did not distinguish between average and good days. CONCLUSIONS: QOLLTI-F is unique in that in measuring one person's QOL (the carer's) it includes their perception of the condition of another (the patient). This attests to the close relationship between the two. It is also unique in that its content is derived from a qualitative study asking carers what is important to their own QOL, rather than focusing on the changes or burdens related to caregiving. QOLLTI-F also has the advantage of being briefer than other carer QOL measures. It contains measures of seven different domains that are determinants of carer QOL, in addition to a summary score. All these measures are valid, reliable and responsive to change in QOL.