"Don't Try to Cover the Sky with Your Hands": Parents' Experiences with Prognosis Communication About Their Children with Advanced Cancer.

BACKGROUND: Physicians worry that disclosure of prognostic information can be distressing and deprive families of hope. Retrospective studies have shown that prognostic disclosure does not abrogate hope, but prospective data are lacking. OBJECTIVE: The study objective was to prospectively evaluate responses to prognosis communication among parents of children with advanced cancer. DESIGN: For this qualitative study we audiotaped conversations between clinicians and parents of children with newly relapsed or refractory cancer, and then interviewed parents about experiences with prognosis communication. Parents were asked to reflect on physician statements about prognosis. SETTING/SUBJECTS: Subjects were 32 pairs of parents and clinicians of children with relapsed or refractory cancer treated at Dana-Farber/Boston Children's Center for Cancer and Blood Disorders, Boston, Massachusetts. RESULTS: Prognosis was discussed in 28/32 conversations (88%). Although most parents (N = 22, 69%) found prognostic information upsetting, most also valued honest communication about prognosis (N = 22, 69%.) Parents noted that frank disclosure fostered hope by relieving uncertainty and allowing them to make the best possible decisions for their children. Excessive optimism or a lack of information, in contrast, was sometimes experienced as a threat to hope and the parent-clinician relationship. A minority of parents were upset by clinician communication about prognosis (N = 4, 12%), but most did not consider the clinician responsible for their distress. Rather, parents attributed distress to the difficult situation. CONCLUSIONS: Many parents consider prognosis communication to be both difficult and necessary. While upsetting, prognostic information engenders hope by helping parents feel prepared to do their best for their children in the difficult days to come.

Parental hope for children with advanced cancer.

BACKGROUND: Previous work suggests that parents of children with cancer can remain hopeful despite receiving prognostic information, but we know little about what hope means to such parents, or the extent to which parents can feel hopeful even while facing the child's impending death. METHODS: We audiotaped conversations between clinicians and parents of 32 children with relapsed or refractory cancer, and then interviewed parents about their hopes and expectations for their child. RESULTS: Parent statements about prognosis in interviews mirrored those made by clinicians during discussions about the child's diagnosis with refractory or relapsed cancer. Clinicians used language referring to hope during these conversations but did not ask parents directly about their hopes. Parents expressed a range of hopes for their children, from hopes related to cure or treatment response, to quality of life, normalcy, and love and relationships for the child. For most parents, expectations about prognosis were not aligned with their hopes for the child; for example, many parents hoped for a cure and also reported that they did not believe cure was possible. Many parents were able to acknowledge this incongruence. CONCLUSIONS: Parents accurately conveyed the reality of their child's serious condition in the setting of advanced cancer, and yet maintained hope. Hopes were not limited to hope for cure/treatment response. Clinicians should be encouraged to engage in direct conversations about hope with parents as a means to elicit realistic hopes that can help to focus the most meaningful plans for the child and family.

The frequency of company-sponsored alcohol brand-related sites on Facebook™-2012.

BACKGROUND: This research provides an estimate of the frequency of company-sponsored alcohol brand-related sites on Facebook™. OBJECTIVES: We conducted a systematic overview of the extent of alcohol brand-related sites on Facebook™ in 2012. METHODS: We conducted a 2012 Facebook™ search for sites specifically related to 898 alcohol brands across 16 different alcoholic beverage types. Descriptive statistics were produced using Microsoft SQL Server. RESULTS: We identified 1,017 company-sponsored alcohol-brand related sites on Facebook™. CONCLUSIONS: Our study advances previous literature by providing a systematic overview of the extent of alcohol brand sites on Facebook™.

The Framingham Heart Study clock drawing performance: normative data from the offspring cohort.

UNLABELLED: BACKGROUND/STUDY CONTEXT: Although the Clock Drawing Test (CDT) is a popular tool used to assess cognitive function, limited normative data on CDT performance exist. The objective of the current study was to provide normative data on an expanded version of previous CDT scoring protocols from a large community-based sample of middle to older adults (aged 43 to 91) from the Framingham Heart Study. METHODS: The CDT was administered to 1476 Framingham Heart Study Offspring Cohort participants using a scoring protocol that assigned error scores to drawn features. Total error scores were computed, as well as for subscales pertaining to outline, numeral placement, time-setting, center, and "other." RESULTS: Higher levels of education were significantly associated with fewer errors for time-setting (Command: p < .001; Copy: p = .003), numerals (Command: p < .001), and "other" (Command: p < .001) subscales. Older age was significantly associated with more errors for time-setting (Command: p < .001; Copy: p = .003), numerals (Command: p < .001), and "other" (Command: p < .001) subscales. Significant differences were also found between education groups on the Command condition for all but the oldest age group (75+). CONCLUSION: Results provide normative data on CDT performance within a community-based cohort. Errors appear to be more prevalent in older compared with younger individuals, and may be less prevalent in individuals who completed at least some college compared with those who did not. Future studies are needed to determine whether this expanded scoring system allows detection of preclinical symptoms of future risk for dementia.

Alcohol advertising at Boston subway stations: an assessment of exposure by race and socioeconomic status.

OBJECTIVES: We investigated the frequency of alcohol ads at all 113 subway and streetcar stations in Boston and the patterns of community exposure stratified by race, socioeconomic status, and age. METHODS: We assessed the extent of alcohol advertising at each station in May 2009. We measured gross impressions and gross rating points (GRPs) for the entire Greater Boston population and for Boston public school student commuters. We compared the frequency of alcohol advertising between neighborhoods with differing demographics. RESULTS: For the Greater Boston population, alcohol advertising at subway stations generated 109 GRPs on a typical day. For Boston public school students in grades 5 to 12, alcohol advertising at stations generated 134 GRPs. Advertising at stations in low-poverty neighborhoods generated 14.1 GRPs and at stations in high-poverty areas, 63.6 GRPs. CONCLUSIONS: Alcohol ads reach the equivalent of every adult in the Greater Boston region and the equivalent of every 5th- to 12th-grade public school student each day. More alcohol ads were displayed in stations in neighborhoods with high poverty rates than in stations in neighborhoods with low poverty rates.

Alcohol advertising on Boston's Massachusetts Bay Transportation Authority transit system: an assessment of youths' and adults' exposure.

OBJECTIVES: We investigated the frequency with which alcohol advertisements appeared on Massachusetts Bay Transportation Authority (MBTA) transit lines in Boston, MA, and we calculated adult and youths' exposure to the ads. METHODS: We measured the nature and extent of alcohol advertisements on 4 Boston transit lines on 2 separate weekdays 1 month apart in June and July of 2008. We calculated weekday ad exposure for all passengers (all ages) and for Boston Public School student passengers (aged 11-18 years). RESULTS: Alcohol ads were viewed an estimated 1,212,960 times across all Boston-area transit passengers during an average weekday, reaching the equivalent of 42.7% of that population. Alcohol ads were viewed an estimated 18,269 times by Boston Public School student transit passengers during an average weekday, reaching the equivalent of 54.1% of that population. CONCLUSIONS: Advertisers reached the equivalent of half of all Boston Public School transit passengers aged 11 to 18 years and the equivalent of nearly half of all transit passengers in the Boston area with an alcohol advertisement each day. Because of the high exposure of underage youths to alcohol advertisements, we recommend that the MBTA prohibit alcohol advertising on the Boston transit system.

Cultural definitions of elder maltreatment in Portugal.

A small convenience sample of 34 participants (17 males, 17 females) from the Portuguese islands of the Azores and Madeira were asked to provide examples of how extreme, moderate, and mild maltreatment towards an elder would be defined in their culture and society. Neglect, especially psychological neglect, physical maltreatment, and psychological maltreatment were the most frequently reported types of maltreatment. References to neglect and physical maltreatment appeared most often as examples of extreme maltreatment. In general, men were somewhat more likely than women to provide examples of physical aggression in their examples of maltreatment. As examples of extreme maltreatment, females provided significantly more examples of abandonment than males. Although interpretations of the findings must be cautious because of the small sample size and limited statistical power, the study illustrates a procedure for assessing constructs of elder mistreatment in a way that attends to respondents' own constructions of the phenomenon.