An exploration of testicular cancer survivors' experience of ejaculatory dysfunction following retroperitoneal lymph node dissection-a sub-study of the PREPARE clinical trial.

PURPOSE: Ejaculatory dysfunction secondary to retrograde ejaculation or anejaculation is a complication of retroperitoneal lymph node dissection (RPLND) for survivors of testicular cancer. We explored survivors' experiences of ejaculatory dysfunction following RPLND. METHODS: In a sub-study of a single-arm phase 2 clinical trial (ACTRN12622000537752/12622000542796), participants reporting ejaculatory dysfunction ≥ 6 months following RPLND were invited to complete semi-structured interviews. Purposive sampling was used. Interviews continued until thematic saturation occurred, and codebook thematic analysis of interviews was performed. RESULTS: Of 58 individuals recruited to the trial, 33 (57%) reported ejaculatory dysfunction. Of these, 32 (97%) agreed to interview and 15 participated. Participants interviewed had median age 34 years (range 24-66), 12 (80%) in a long-term relationship with median time from surgery 36 months (range 11-112). Three overarching themes were identified. The first reflected the value of RPLND despite ejaculatory dysfunction. The second illuminated the impact(s) of ejaculatory dysfunction closely mapped to life stage, with flow-on impacts to fertility, sex, psychological wellbeing and communication. The third reflected information needs. Fertility was a substantial source of concern for some participants. Ejaculatory dysfunction had no effect on sex for some, whilst for others, sex was less pleasurable. Some reported benefits. Few reported ejaculatory dysfunction challenged masculinity, confidence, or self-esteem. CONCLUSIONS: Future research should examine interventions to reduce distress related to fertility, challenged masculinity and body image. IMPLICATIONS FOR CANCER SURVIVORS: Whilst most participants considered ejaculatory dysfunction to have little impact on their sexual function and relationships, some reported significant difficulties varying by life stage and relationship status.

Fear of cancer recurrence and psychological well-being in women with breast cancer: The role of causal cancer attributions and optimism.

This study aims to examine the association between cancer causal attributions, fear of cancer recurrence (FCR) and psychological well-being and the possible moderating effect of optimism among women with a previous diagnosis of breast cancer. Participants (N = 314) completed an online self-report assessment of causal attributions for their own breast cancer, FCR, psychological well-being and optimism. Simultaneous multiple regression analyses were conducted to explore the overall contribution of causal attributions to FCR and psychological well-being separately. Hierarchical multiple regression analyses were also utilised to examine the potential moderating influence of dispositional optimism on the relationship between causal attributions and FCR and psychological well-being. Causal attributions of environmental exposures, family history and stress were significantly associated with higher FCR. The attribution of stress was also significantly associated with lower psychological well-being. Optimism did not moderate the relationship between causal attributions and FCR or well-being. The observed relationships between causal attributions for breast cancer and FCR and psychological well-being suggest that the inclusion of causal attributions in screening for FCR is potentially important. Health professionals may need to provide greater psychological support to women who attribute their cancer to non-modifiable causes and consequently continue to experience distress.

Understanding maternal dietary choices during pregnancy: The role of social norms and mindful eating.

INTRODUCTION: Serious health complications associated with excessive weight have been documented for pregnant women and their babies during pregnancy, birth and beyond. Whilst research has focused on identifying particular foods that can be either detrimental or essential for the developing baby, pregnant women's food choices are likely determined by broader considerations. This study examined social influences as represented in reports of descriptive and injunctive social norms related to healthy eating during pregnancy, and individual differences in mindfulness while eating, as important potential correlates of pregnant women's self-reported diet. METHODS: Pregnant women (N = 139) completed a questionnaire that measured self-reported consumption of healthy and unhealthy foods, descriptive and injunctive norms related to healthy eating during pregnancy and the Mindful Eating Questionnaire (MEQ). Hierarchical multiple regressions were conducted to assess the extent to which norms and mindful eating accounted for variance in consumption of both foods. RESULTS: No significant associations were observed between perceived social norms related to diet during pregnancy and self-reported dietary behaviour. Mindful eating was found to play a role in pregnant women's eating behaviour, with the awareness subscale of the MEQ significantly associated with healthy eating and the emotional subscale associated with unhealthy eating. Age was also associated with consumption of unhealthy foods; younger pregnant women reported consuming more unhealthy snacks and fast food meals. CONCLUSIONS: The associations between mindful eating and dietary behaviour suggests that improving mindfulness related to food consumption before and during pregnancy may provide a strategy to address excessive gestational weight gain.

Familial risk for lifestyle-related chronic diseases: can family health history be used as a motivational tool to promote health behaviour in young adults?

ISSUE ADDRESSED: Risk for colorectal cancer, breast cancer, heart disease and diabetes has both a familial and a lifestyle component. This quasi-experimental study aimed to determine whether a Family Health History (FHH) assessment and the subsequent provision of risk information would increase young adults' (17-29 years) intentions to modify health behaviours associated with the risk of these chronic diseases (i.e. alcohol consumption, fruit and vegetable intake and physical activity) and to talk to their family about their risk. METHODS: After baseline measures of current and intended health-related behaviours, participants (n = 116) were randomly allocated to either a FHH assessment or control information. Based on the FHH provided, participants in the FHH condition were then classified as 'above-average risk' or 'average risk'. One week later, participants were provided with tailored health information and completed follow-up measures of intended health-related behaviours and perceived vulnerability. RESULTS: Participants classified as 'above-average risk' had increased perceptions of vulnerability to a chronic disease. Despite this, no group differences were found in intentions to change physical activity or fruit and vegetable consumption. Participants with above-average risk reported greater intentions to decrease the frequency of their alcohol consumption than average risk/control participants. In addition, completing a FHH assessment promoted intended communication with family members about chronic disease risk. CONCLUSIONS: FHH assessments may have the greatest value within the family context. SO WHAT? Future research could examine the impact of providing FHH information to different family members as a health promotion strategy.

Sun-related behaviours among young Australians with Asian ethnic background: differences according to sociocultural norms and skin tone perceptions.

Deliberate tanning, poor sun protection and sun exposure increase an individual's risk for skin cancer. Recent evidence suggests that individuals of Asian heritage have lower incidence of skin cancer than Caucasians but that their post-diagnosis outcomes are often worse. In Western cultures tanning behaviours are often motivated by a desire for 'attractive' tanned skin. Conversely, a light complexion is desired in a number of Asian cultures and may consequently serve to protect this group from excessive and risky sun exposure behaviours. This possibility is yet to be tested, with little known about the sun-related behaviours of Asian people residing in Australia. The present study involves 140 South Australian young adults who report having Asian heritage. Results show that the majority of female participants, and significantly fewer males, reported participating in deliberate outdoor tanning behaviour. Perceptions of family, peer and media tanning norms influenced behaviour, with peer norms being the strongest predictor. The desire for a lighter skin tone was associated with increased sun-protective behaviour and a lower number of previous severe sunburns. As a significant proportion of participants engaged in deliberate tanning behaviour, it is recommended that future research continue to explore factors associated with tanning, including an explicit measure of culture.

Corpus callosum morphology in children and adolescents with attention deficit hyperactivity disorder: a meta-analytic review.

Several studies have examined corpus callosum (CC) morphology in children and adolescents with attention deficit hyperactivity disorder (ADHD). A meta-analysis of atypical brain morphology in children and adolescents with ADHD by Valera, Faraone, Murray, and Seidman (2006) reported a reduction in the splenium of the CC in this group compared with healthy controls. This meta-analysis undertook a more detailed examination of callosal morphology by also considering comorbid conditions and gender differences. The data from 13 studies were analyzed. Consistent with Valera et al. (2006), the splenium was smaller in children and adolescents with ADHD than in healthy controls. However, this result appears to be the result of a smaller splenium in females with ADHD. In addition, boys exhibited a smaller rostral body. There were no significant differences in CC measurements of studies that included ADHD samples with comorbid conditions. However, comorbidities were not consistently reported, making it difficult to accurately evaluate the impact of comorbidity on CC size. Additional research is needed to investigate whether gender differences reflect different ADHD subtypes. In addition, it is not known if these CC differences persist into adulthood.

Neuropsychological deficits in frontotemporal dementia and Alzheimer's disease: a meta-analytic review.

We sought to identify the cognitive tests that best discriminate between Alzheimer's disease (AD) and frontotemporal dementia (FTD). A comprehensive search of all studies examining the cognitive performance of persons diagnosed with AD and FTD, published between 1980 and 2006, was conducted. Ninety-four studies were identified, comprising 2936 AD participants and 1748 FTD participants. Weighted Cohen's d effect sizes, percentage overlap statistics, confidence intervals and fail-safe Ns were calculated for each cognitive test that was used by two or more studies. The most discriminating cognitive tests were measures of orientation, memory, language, visuomotor function and general cognitive ability. Although there were large and significant differences between groups on these measures, there was substantial overlap in the scores of the AD and FTD groups. Age, education, years since diagnosis and diagnostic criteria did not significantly contribute to the group differences. Given the large overlap in the test performance of persons diagnosed with AD and FTD, cognitive tests should be used cautiously and in conjunction with a medical history, behavioural observations, imaging and information from relatives when making differential diagnoses.