Cancer-related fatigue in adolescents and young adults: A systematic review of the literature.

Adolescents and young adults with cancer (AYA) represent a specific age cohort dealing with the disease in a stage of life characterized by development, upheavals, and establishment. The aim of this study was to point out the state of research on how AYA are affected by cancer-related fatigue (CRF). RESULTS: Twelve articles were included. CRF was found to be higher in AYA than in either of the comparison groups, healthy peers and older cancer patients. Most included studies did not measure CRF with multidimensional, fatigue-specific instruments. CONCLUSION: We found a gap in research concerning CRF in AYA. The existing findings suggest that CRF is a significant issue for AYA cancer patients. However, less is known about the prevalence, severity, and impact of CRF in AYA, and their treatment. This should be considered in future research, and risk and prevention factors should be ascertained. Multidimensional and fatigue-specific measuring tools should be used to do this.

[Effectively communicate active listening : Comparison of two concepts]. / Aktives Zuhören effektiv vermitteln : Zwei Konzepte im Vergleich.

Communication between physicians and patients has a great influence on patient adherence, patient satisfaction and the success of treatment. In this context, patient centered care and emotional support have a high positive impact; however, it is unclear how physicians can be motivated to communicate with patients in an appreciative and empathetic way. The implementation of such behavior requires a multitude of communicative skills. One of them is active listening, which is very important in two respects. On the one hand active listening provides the basis for several conversational contexts as a special communication technique and on the other hand active listening is presented in current textbooks in different ways: as an attitude or as a technique. In light of this, the question arises how active listening should be taught in order to be not only applicable in concrete conversations but also to lead to the highest possible level of patient satisfaction. The aim of this pilot study was to examine some variations in simulated doctor-patient conversations, which are the result of the different approaches to active listening. For this purpose three groups of first semester medical students were recruited, two of which were schooled in active listening in different ways (two groups of six students), i.e. attitude versus technique oriented. The third group (seven students) acted as the control group. In a pre-post design interviews with standardized simulation patients were conducted and subsequently evaluated. The analysis of these interviews was considered from the perspectives of participants and observers as well as the quantitative aspects. This study revealed some interesting tendencies despite its status as a pilot study: in general, the two interventional groups performed significantly better than the control group in which no relevant changes occurred. In a direct comparison, the group in which active listening was taught from an attitude approach achieved better results than the group in which the focus was on the technical aspects of active listening. In the group with active listening schooled as an attitude, the response to the feelings of the standardized simulation patients was significantly better from the perspectives of both participants and observers.

Which gynecological and obstetric patients want to attend psychosomatic services?

OBJECTIVE: The aim of this study is to explore the wish of gynecological and obstetric inpatients to attend psychosomatic services. Predictors influencing this wish are evaluated. METHOD: Three groups of patients participated in the study. The groups consisted of patients diagnosed with malignant gynecological diseases (n = 175), benign gynecological diseases (n = 302), and obstetric diseases (n = 238). The following domains were assessed in a cross-sectional design: symptoms of anxiety and depression (HADS), physical complaints (GBB-24), health-related quality of life (SF-12), and the wish to attend psychosomatic services. RESULTS: 34% of the participants indicated that they wanted to attend psychosomatic services during their stay in the hospital. The group of patients diagnosed with malignant gynecological diseases had the highest proportion of women who stated that wish (43%). Multiple logistic regression models showed that former psychotherapeutic experiences as well as low psychological quality of life predicted the wish to attend psychosomatic services in patients diagnosed with malignant gynecological or obstetric diseases. CONCLUSION: It was shown that a considerable proportion of patients wanted to attend psychosomatic care during their hospitalization. Contrary to physical and sociodemographic variables, psychological factors were significant predictors of the inpatient's wish to attend psychosomatic services. This suggests that the subjective estimation of impairments is a major predictor of the wish to attend psychosomatic care.

[Unemployment, job insecurity and the need for psychosocial support]. / Arbeitslosigkeitserfahrungen, Arbeitsplatzunsicherheit und der Bedarf an psychosozialer Versorgung.

BACKGROUND: For many concerned people unemployment leads to impairments of health, and above all, mental impairments. However, appropriate interventional measures are utilized by only few unemployed people. This study addresses the question, what need for professional psychosocial counselling exists depending on unemployment experience and job insecurity. METHODS: 387 young adults (54.4% female) with a mean age of 33.2 years were asked in 2006 in the context of the 20th wave of the Saxony Longitudinal Study (Sächsische Längsschnittstudie) about unemployment experience, perceived job insecurity and the subjective need for professional psychosocial counselling. Furthermore, the global psychological distress was assessed as an indicator for the objective need for psychosocial support. RESULTS: Over 70% of the participants have had experience with unemployment so far. On average women are unemployed for longer periods than men. Current unemployment [Odds Ratio 7.14; 95% confidence interval (CI) 3.28-15.54] proves to be, apart from the threat of loosing of one's job (Odds Ratio 5.26; 95% CI 3.34-8.28), the strongest predictor for mental burdens. However, the subjective need for psychosocial counselling is independent of these employment-related characteristics. 12.7% of the respondents claimed to have had a need for counselling in the last year. Significant predictors for professional counselling support are sex (Odds Ratio 2.08; 95% CI 1.23-3.55) and the mental burdens (Odds Ratio 2.84; 95% CI 1.50-5.38). CONCLUSION: Unemployment leads to objective mental burdens for the concerned people, but subjectively not to an increased need for psychosocial support. Therefore, it is necessary to communicate this health risk to the concerned in an appropriate way and to submit appropriate, low-threshold counselling offers.

Attitudes of German infertile couples towards preimplantation genetic diagnosis for different uses: a comparison to international studies.

BACKGROUND: In Germany, preimplantation genetic diagnosis (PGD) is currently not legal, but there is still a controversial debate about legalization. Studies about the attitudes of infertile couples towards PGD are rare. METHODS: A survey was conducted with 265 German infertile couples about knowledge, attitudes and prospective use of PGD. The influence of independent variables associated with approval of PGD is analysed by binary logistic regression. RESULTS: Sixty percent of respondents have heard about PGD. Eighty-seven percent support a general legalization of PGD in Germany for severe, early-onset genetic diseases. Seventy-four percent consider PGD morally acceptable. Sixty percent supported legalizing PGD for HLA-matching. But only a minority approved PGD to test for non-health-related traits. Respondents with a higher education level were the least supportive to all uses of PGD. CONCLUSIONS: Our results suggest that German infertile couples are as liberal towards PGD for health-related uses as in other western countries. They would legalize and use PGD to raise the rates to get pregnant and to avoid severe diseases of the offspring. Taking the opinions of German infertile couples into consideration could help redefine and reframe the public debate towards legalization of PGD and the moral status of the embryo in Germany.

Social sex selection and the balance of the sexes: empirical evidence from Germany, the UK, and the US.

Preconception sex selection for nonmedical reasons is one of the most controversial issues in bioethics today. The most powerful objection to social sex selection is based on the assumption that it may severely distort the natural sex ratio and lead to a socially disruptive imbalance of the sexes. Based on representative social surveys conducted in Germany, the United Kingdom, and the United States, this paper argues that the fear of an impending sex ratio distortion is unfounded. Given the predominant preference for a "gender balanced family," a widely available service for social sex selection is highly unlikely to upset the balance of the sexes in Western societies.

Psychological and physical factors influencing the health-related quality of life of patients of a department of gynecology in a university hospital.

The aim of our study was to assess the physical and mental quality of life of in-patients of a Gynecological University Hospital and the factors influencing the quality of life. 715 women, who were treated in hospital with non-malignant or malignant gynecological or obstetrical diseases, took part in the study. Besides demographical data and relevant medical parameters the quality of life (SF-12), anxiety and depression (HADS) as well as physical discomforts (GBB) were assessed. The physical quality of life of the study population was significantly lower than that of the normal population (p < 0.001). Patients with obstetric diseases in comparison with patients with malignant gynecological and other gynecological diseases had the lowest physical quality of life. Regarding the mental factor, patients with malignant gynecological diseases feel most impaired, followed by those with other gynecological and obstetrical conditions. The multivariate analysis of the quality of life showed that up to 60% of the variance could be explained. The lowest variance elucidation was found in obstetrical patients in whom the physical complaints elucidated only a small part of the variance. Our results show on the one hand the high impairment of mental and especially of physical quality of life in women who are in hospital with gynecological or obstetrical diseases. On the other hand they show the great significance of the quality of life as an outcome parameter. These findings should be considered in gynecological in-patient treatments by using integrated psychosomatic care.

Knowledge and attitudes towards preimplantation genetic diagnosis in Germany.

BACKGROUND: Preimplantation genetic diagnosis (PGD) is a technique which is often related to emotional debates because of its ethical and social implications. Worldwide there are different forms of legislation; Germany constitutes an interesting case because of the historical background concerning eugenics and dealing with handicapped persons at the time of national socialism. PGD is currently not legal but there are still polarized positions and legalization remains an issue. Studies about the attitudes of the general population towards PGD are rare. METHODS: Data were collected in a representative survey carried out in November 2003. Subjects were 2110 persons in Germany aged 18-50 years. RESULTS AND CONCLUSIONS: Respondents had little knowledge about PGD. There were incorrect assumptions about the diagnostic possibilities and a lack of basic genetic knowledge. A tendency towards a general acceptance of PGD for medical indications was found. Non-medical indications such as sex selection were generally not accepted. It could be observed that respondents who already had a notion about PGD overestimated the diagnostic possibilities and would eventually use PGD in the future more than respondents who had never heard about PGD before.

[Children--really why not... Results of a representative survey in East and West Germany]. / Kinder--warum eigentlich nicht.... Repräsentative Ergebnisse einer Studie im Osten und im Westen Deutschlands.

The topic "wish to get a child" is of interest in scientific research for several reasons. One reason is the dramatic drop in the birth rate ibn Eastern Germany following reunification between 1990-1995, one other reason is the declining birth rate as a constant fact in Germany as a whole. Resulting from this demographic phenomenon the question was to detect the determinants of wish to get a child and their positive or negative influences regarding the realization. To answer this question we developed an theoretical model which focussed the decision process. This model was tested in a representative survey in 1999. This article presents some first results of the study. The main finding was that the wish to get a child is very strongly influenced by emotional aspects.