Exploring the experiences of teenagers with cochlear implants

Objectives: Teenage cochlear implant users’ perceptions of deafness, surgery, fitting of the device and life as a cochlear implant wearer were explored in order to gain a more comprehensive understanding of teenagers’ experiences of living with the device.

Methods: Semi-structured in-depth interviews were undertaken and analysed using thematic analysis. Ten teenagers aged 14–16 years with at least one cochlear implant were interviewed.

Results: Seven teenagers experienced great pre-operative anxiety and two reported significant post-operative pain. Four of the teenagers described a mismatch between their expectations and the disappointing reality of adjusting to the device. However, all the teenagers reported an enhanced sense of well-being as a result of being able to interact more easily with their world around them. The teenagers differed in the extent to which they identified with the hearing and deaf world.

Discussion: Despite the early challenges, over time the teenagers experienced many functional and psychosocial benefits. Most felt their lives were now easier as a result of the cochlear implant(s). They described complex, flexible identities.

Conclusions: By giving prominence to the teenagers’ voices this study has added new knowledge concerning their experience of surgery. The findings also more fully revealed the challenges of adjusting to the device and the impact of having a cochlear implant on the teenagers’ identities. Clinical recommendations are made to address the gaps in service highlighted by these findings.     

Adolescents’ perceptions of sexual health education programs: An integrative review

IntroductionAdolescents are key stakeholders in sexual health education, yet they are rarely consulted when developing sexual health programs. Their voices are integral to improving the delivery of relevant and appropriate school-based sexual health education to promote safer adolescent sexual behaviors.MethodsAn integrative review was conducted utilizing three databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete, PubMed, and Education Resources Information Center (ERIC). The PRISMA and matrix method were used to search the literature and synthesize the findings from 16 articles regarding adolescent perceptions of school-based sexual health education.ResultsThe main themes that emerged from this review included: (a) factors influencing adolescent perceptions of sexual health education programs, (b) characteristics of good sexual health education programs, and (c) areas of improvement in sexual health education programs.ConclusionAdolescents overwhelmingly requested honest, comprehensive content delivered by nonjudgmental, well-educated health professionals in a comfortable environment.     

Survival patterns in teenagers and young adults with cancer in the United Kingdom: Comparisons with younger and older age groups

AimsWe aimed to describe and compare survival in teenagers and young adults (TYAs) with cancer to that of younger children and older adults, to identify sub-populations at greater or lesser risk of death.MethodsWe compared survival in cancer patients diagnosed in the United Kingdom aged 13–24 years (TYAs) to those aged 0–12 (children) and 25–49 years (adults) using the National Cancer Data Repository. All cases had a first cancer diagnosis between 1st January 2001 and 31st December 2005 with censor date 31st December 2010 or death if earlier.ResultsWe found six distinct statistically significant survival patterns. In pattern 1, the younger the age-group the better the 1- and 5-year survival (acute lymphoid leukaemia, carcinoma of ovary and melanoma). In pattern 2, TYAs had a worse 5-year survival than both children and young adults (bone and soft tissues sarcomas). In pattern 3, TYAs had a worse 1-year survival but no difference at 5-years (carcinoma of cervix and female breast). In pattern 4, TYAs had better 1-year survival than adults, but no difference at 5 years (carcinoma of liver and intrahepatic bile ducts, germ cell tumours of extra-gonadal sites). In pattern 5, the younger the age-group the better the 5-year survival, but the difference developed after 1-year (acute myeloid leukaemia, carcinoma of colon and rectum). In pattern 6, there was no difference in 1- and 5-year survival between TYAs and adults (testicular germ cell tumours, ovarian germ cell tumours and carcinoma of thyroid).ConclusionTYAs with specific cancer diagnoses can be grouped according to 1- and 5-year survival patterns compared to children and young adults. To further improve survival for TYAs, age-specific biology, pharmacology, proteomics, genomics, clinician and patient behaviour studies embedded within clinical trials are required.     

儿童及青少年患者靶向抗肿瘤药皮肤不良反应的系统评价

摘 要 目的：系统评价儿童及青少年患者应用靶向抗肿瘤药的皮肤不良反应,为后续研究及临床实践提供参考。方法: 检索PubMed（http:∥www.ncbi.nlm.nih.gov/pubmed/）、美国临床肿瘤学会年会摘要集（http:∥www.asco.org/）与ClinicalTrials.gov（http:∥www.clinicaltrials.gov）以获取涉及靶向药物（单药或多种靶向药物联合治疗）用于儿童及青少年患者,并有皮肤不良反应报告的临床试验。对入选研究进行质量评价（非随机对照试验用MINORS量表,随机对照试验用Cochrane偏倚风险评价工具）,并提取资料。以各类皮肤不良反应（皮疹、皮肤干燥、瘙痒与黏膜炎）发生率为结局指标进行Meta分析。结果: 共纳入24项研究,涉及960名患者。研究疾病涉及多种实体瘤与白血病。共涉及14种不同的靶向抗肿瘤药。绝大多数研究为高质量研究。Meta分析结果显示,皮疹的合并事件率及其95%置信区间（CI）为0.19[0.12～0.28],皮肤干燥为0.24[0.06～0.51],瘙痒为0.12[0.04～0.24]以及黏膜炎为0.21[0.07～0.39]。发表偏倚分析提示皮疹之结局指标的报道可能存在发表偏倚（Egger’s P=0.007）。结论:靶向抗肿瘤药应用于儿童或青少年人群可引起部分患者出现皮疹、皮肤干燥等不良反应。这些不良反应影响生活质量并可能导致残疾,临床应用时需予重视。     

Impact of a sports project centered on scuba diving for adolescents with type 1 diabetes mellitus: New guidelines for adolescent recreational diving,a modification of the French regulations

Background

Recreational scuba diving has been authorized for type 1 diabetics over 18 years old – the age of majority in France – since 2004, but it remained forbidden for younger diabetics by the French underwater federation (FFESSM). Here, we present a study to evaluate:– the conditions under which diving could be authorized for 14- to 18 year olds with type 1 diabetes;– the value of continuous glucose monitoring (CGM) while diving. A secondary objective was to monitor the impact of diving on the teenagers’ quality of life.

Sleep and stress in adolescents: the roles of pre-sleep arousal and coping during school and vacation

Study objectivesThis study explored the relationship between stress and actigraphy-measured and self-reported sleep in adolescents during periods of restricted (school) and unrestricted (vacation) sleep opportunities. We further examined whether (1) cognitive pre-sleep arousal (PSA) mediated the relationship between stress and sleep onset latency (SOL), and (2) coping moderated the effect of stress on PSA.MethodsParticipants were 146 (77 females) adolescents (M = 16.2, SD = 1.0) recruited from the community. Actigraphy assessed daily sleep over the last week of a school-term and the following two-week vacation. The following self-report measures were administered during both school and vacation: the Pittsburgh Sleep Quality Index, Inventory of High-School Students Recent Life Experiences (stress), Pre-Sleep Arousal Scale, and the Brief COPE (coping).ResultsPath analyses showed that during both school and vacation, higher cognitive PSA mediated the relationship between higher stress and longer self-report SOL (p < 0.01). During vacation, higher PSA also mediated the relationship between higher stress and longer actigraphy SOL (p < 0.05). During vacation (but not school), problem-focused coping moderated the mediating effects of PSA (p < 0.05), such that more frequent use of coping was associated with weaker association between stress and cognitive PSA, and shorter actigraphy and self-report SOL.ConclusionsCognitive PSA and coping may be two modifiable factors influencing how stress affects adolescents' sleep onset. Interventions that reduce cognitive arousal at bedtime may therefore shorten adolescents’ sleep onset during both school and vacation. Further, the use of problem-focused coping strategies might be protective against the effects of stress on sleep onset, especially during vacation periods.Statement of significanceThis paper expands the understanding of the stress-sleep association in adolescents by examining the mediating role of cognitive pre-sleep arousal and the moderating effects of coping. By examining these associations during both school and vacation periods, findings are likely to be applicable to both restricted and relatively unconstrained sleep conditions. Practically, our findings suggest that interventions directed towards the reduction of cognitive pre-sleep arousal may improve adolescents' sleep onset latency. Additionally, fostering healthy coping, especially problem-focused coping strategies such as problem solving, may mitigate the effects of stress on adolescents' sleep.