Understanding Young Adult Cancer Survivors' Engagement with Cancer Storylines in Entertainment Media Narratives.

Purpose: Some young adult cancer survivors (YACS; ages 18-39) struggle to incorporate their cancer experiences into their identities. Using stories, or narratives, is a new approach that could help YACS to integrate cancer and their identity. These stories offer opportunities to experience perspectives outside of oneself, which can build validation and self-compassion. However, little is known about whether stories about cancer (i.e., the threat itself) are beneficial. Method: YACS completed an online survey about their engagement with cancer storylines in entertainment media narratives (e.g., books, movies, and television shows). They also described their reactions to encountering these storylines in entertainment media. Results: Participants (n = 108) were primarily White. Participants who sought cancer storylines reported a more positive impact of cancer on their sense of purpose and identity. Among YACS who had completed treatment, cancer storylines were sought after treatment more than during treatment. In addition, compared with their peers, participants who identified as Black reported greater cancer storyline seeking both during and after treatment. Nearly half of participants (n = 45, 47.4%) described reactions to cancer-related storylines as positive or mixed, primarily owing to feelings of inspiration or validation. Conclusion: Consuming cancer storylines can offer some benefits for YACS, especially among those finished with treatment and those who identify as Black. However, not all YACS responded positively, so future research should investigate which YACS could benefit most from cancer-related storylines. Nonetheless, entertainment media narratives represent a novel approach to supporting YACS' integration of cancer into their identity.

Reel reflections: the role of entertainment media narratives in coping among young adult cancer survivors.

INTRODUCTION: Young adult cancer survivors (YACS; ages 18-39) report a significant psychological burden. Entertainment media narratives (e.g., books, movies, shows that are produced for mass consumption) might be an effective tool for reducing this distress, although little is known about present use among YACS. METHOD: YACS completed a survey about their use of entertainment media narratives to cope with cancer using an adapted version of the Brief COPE. Additionally, YACS reported their use of entertainment media narratives to start conversations about their experience with others, and they described features of entertainment media narratives that they found helpful in coping. RESULTS: We recruited 108 YACS from three recruitment sites. Most participants were White (n = 65), female (n = 54), and recruited from Prolific (n = 56), an Internet-based, crowdsourced data collection platform. Participants were, on average, 30 years old and 45 months from the completion of their primary cancer treatment. YACS who used entertainment media to cope with cancer (n = 32; 29.6%) were significantly younger and significantly closer to the end of their primary treatment. Compared to nonusers, users of entertainment media narratives to cope were also more likely to identify as Black; identifying as Black was associated with a 2.05-factor increase in using narrative entertainment media to cope with cancer even when controlling for other demographic differences. Additionally, compared to their peers, Black YACS reported greater use of narratives to start cancer-related conversations. Emotional and inspirational storylines were the most helpful story features. DISCUSSION: Some YACS, especially Black YACS, use stories to cope with their cancer experience. YACS patients could find stories useful in exploring their cancer-related emotions, although the exact benefits are still unknown.

The effects of anaesthesia on the developing brain: a summary of the clinical evidence.

INTRODUCTION: There is data amassing in the literature regarding the potentially adverse effects of anaesthesia exposure on the developing human brain. The purpose of this article is to summarise current relevant data from clinical studies in this area. METHODS: Articles from journals written in English were searched for using PubMed, Ovid and Medline. Keywords used included: brain (newborn, infant, child and neonate), neurodegeneration, apoptosis, toxicity, neurocognitive impairment (developmental impairment and learning disorders) and anaesthesia (intravenous, inhalational and sedation). RESULTS: From the initial search, 23 articles were identified as potentially relevant, with publication dates spanning from 1978 to 2012.  Twelve studies were deemed irrelevant to the research questions. The results of neurocognitive assessment from eight of the remaining eleven studies had showed some differences in the performances of children exposed to anaesthesia. The control population in these studies was highly variable. The age at which the subjects were exposed to anaesthesia ranged from prenatal to 4 years in the majority of studies with one including children aged up to 12 years when exposed. DISCUSSION: Although there is clinical data suggesting a possible detrimental effect, the evidence is best considered preliminary and inconclusive at this stage. Many of the outcome measures were lacking in specificity and standardization in most cases. Parents should be counselled to not avoid necessary invasive procedures for fear of a currently ill-defined risk.  However, deferral of elective procedures beyond the first few years of life should be contemplated.

The effects of anaesthesia on the developing brain: a summary of the clinical evidence.

Introduction: There is data amassing in the literature regarding the potentially adverse effects of anaesthesia exposure on the developing human brain. The purpose of this article is to summarise current relevant data from clinical studies in this area. Methods: Articles from journals written in English were searched for using PubMed, Ovid and Medline. Keywords used included: brain (newborn, infant, child and neonate), neurodegeneration, apoptosis, toxicity, neurocognitive impairment (developmental impairment and learning disorders) and anaesthesia (intravenous, inhalational and sedation). Results: From the initial search, 23 articles were identified as potentially relevant, with publication dates spanning from 1978 to 2012.  Twelve studies were deemed irrelevant to the research questions. The results of neurocognitive assessment from eight of the remaining eleven studies had showed some differences in the performances of children exposed to anaesthesia. The control population in these studies was highly variable. The age at which the subjects were exposed to anaesthesia ranged from prenatal to 4 years in the majority of studies with one including children aged up to 12 years when exposed. Discussion: Although there is clinical data suggesting a possible detrimental effect, the evidence is best considered preliminary and inconclusive at this stage. Many of the outcome measures were lacking in specificity and standardization in most cases. Parents should be counselled to not avoid necessary invasive procedures for fear of a currently ill-defined risk.  However, deferral of elective procedures beyond the first few years of life should be contemplated.

Isotretinoin as monotherapy for sebaceous hyperplasia.

Sebaceous hyperplasia is a common benign lesion composed of sebaceous glands. It is characterized as yellow or flesh-toned papules with central umbilication. The authors report the case of a 57-year-old Caucasian female with a longstanding history of sebaceous hyperplasia refractory to treatment on her face. Isotretionoin was used as an alternative therapy and was found to be effective.

Allopregnanolone treatment, both as a single injection or repetitively, delays demyelination and enhances survival of Niemann-Pick C mice.

Niemann-Pick C disease (NPC) is an irreversible neurodegenerative disorder without current treatment. It is thought to result from deficient intracellular cholesterol and/or ganglioside trafficking. We have investigated the effects of allopregnanolone treatments on survival, weight loss, motor function, magnetic resonance imaging (MRI), and neuropathology in the mouse model of NPC (Npc1(-/-) mice). We confirmed previous results showing that a single injection of 250 microg of allopregnanolone on postnatal day 7 significantly extended the life span of Npc1(-/-) mice. This caused a marked difference in the weight curves of the treated mice but no statistical difference in the Rota-Rod performance. T2-weighted MRI and diffusion tensor imaging (DTI) of treated mice showed values of signal intensity and fractional anisotropy closer to those of wild-type mice than those of untreated Npc1(-/-) mice. Neuropathology showed that day-7 treatment markedly suppressed astrocyte reaction and significantly reduced microglial activation. Furthermore, the steroid treatment also increased myelination in brains of Npc1(-/-) mice. Similar effects of allopregnanolone treatment were observed in Npc1(-/-), mdr1a(-/-) double-mutant mice, which have a deficient blood-brain barrier, resulting in increased steroid uptake. The effects on survival and weight loss of a single injection on day 7 followed by injections every 2 weeks were also evaluated in Npc1(-/-) mice, and the beneficial effects were found to be greater than with the single injection at day 7. We conclude that allopregnanolone treatment significantly ameliorates several symptoms of NPC in Npc1(-/-) mice, presumably by effects on myelination or neuronal connectivity.

The mediating role of optimism on post-radiation quality of life in nasopharyngeal carcinoma.

Nasopharyngeal carcinoma (NPC) is prevalent in southern China. In non-welfare countries, eating difficulties after radiotherapy may hinder NPC patients' short-term quality of life (QoL) especially regarding work and finance. This study explored the positive mediating role of optimism on the relationship between eating ability and QoL of Chinese NPC patients who received radiotherapy in Hong Kong. A sample of 211 newly referred patients were recruited and followed-up face-to-face or by telephone at four (post-radiation 1) (FU 1) and eight (post-radiation 2) (FU 2) months from baseline. QoL was measured by the FACT-G (Chinese). Optimism and eating ability were measured by two 11-point self-rated items. Mediating effects were tested with a series of multiple regression models. After adjustment for pre-radiation QoL, socioeconomic status and cancer stage, optimism significantly mediated the relationship between eating ability at FU 1 and overall QoL at FU 2, in particular physical and social/family well-being. This study is the first to underpin the mediating role of optimism on QoL of NPC patients. Faced with aversive side-effects of radiotherapy, facilitating positive thinking in Chinese NPC patients may accelerate their short-term post-radiation adjustment.

The development and evaluation of an integrated community-based, patient-centred learning activity at the University of Hong Kong.

OBJECTIVE: To develop and evaluate the Patient Care Project (PCP), an integrated patient-centred, community-based learning activity, implemented at the University of Hong Kong since 1992. DESIGN: The PCP, a required course in the first 2 preclinical years, is structured into four learning cycles over 9 months. Each cycle consists of a patient interview followed by a debriefing group tutorial. In-depth interviews with the same patient allow students to explore the impact of disease and patients' illness experience, as well as the contribution of the wider determinants of health to their condition. The debriefing tutorial frames empirical observations into theoretical models and its format reinforces habits of problem-based learning. The programme was evaluated using survey questionnaires completed by students, patients and tutors. PARTICIPANTS: 324 first- and second-year medical students. RESULTS: Students, participating patients and tutors all rated the PCP positively in end-of-course evaluations. Specifically, 68% of students commented that the PCP had met all or most of its stated objectives, while there was nearly unanimous agreement among patients that students demonstrated understanding and empathy in the visits and interviews. Tutor appraisal of student performance also indicated the attainment of all stated aims and objectives overall. CONCLUSIONS: The PCP is a valuable contribution to community-based learning and the promotion of the patient-centred clinical method.