Physical and psychosocial functioning of adult survivors of allogeneic bone marrow transplantation.

While prospects for long-term survival following bone marrow transplantation (BMT) have increased, little is known about the quality of that survival. The present study was intended to document the physical and psychosocial functioning of survivors of allogeneic BMT as well as identify factors associated with variability in post-BMT functioning. Twenty-three patients who were living at home and were between 3 and 52 months post-BMT completed the Functional Living Index - Cancer and the Profile of Mood States. Results revealed that current functioning varied considerably across patients. The older a patient was at time of transplant, the poorer his current functioning was, particularly in the physical domain. Current functioning was not significantly associated with time since transplant, the diagnosis of acute or chronic graft-versus-host disease, or dose of total body irradiation given as part of BMT conditioning. Despite differences in functional status, however, only one patient indicated that he would not make the same choice again to undergo BMT. Information about the long-term functioning of BMT survivors is critical for the process of obtaining informed consent. Additionally, understanding of factors associated with variability in post-BMT functioning can increase the likelihood that patients will ultimately return to a normal, productive life.

Adolescent pregnancy and severe heart defect. A risky combination.

Current concern about adolescent pregnancy is based largely on its negative impact on the social, developmental, and economic prospects of the mother and her infant. The issues of adolescent pregnancy are more complex when the mother has a severe heart defect. Our case illustrates the problems that can arise in the pressure of associated medical problems. Although the patient's behavior contributed substantially to a tragic outcome, we believe that greater professional awareness and sensitivity regarding the needs of such adolescent patients might have produced a more favorable outcome.

Adolescent vicissitudes and medical judgement: a case study.

Professional concern about the widespread occurrence of adolescent pregnancy is based upon its negative impact on the social, developmental, and economic prospects of the mother and her infant. The usual presumption is that the pregnant adolescent is in good health but suffers from socioeconomic and cultural disadvantages, which the pregnancy will exacerbate. The problems of the pregnant adolescent are more complex when she also has a severe medical handicap. We draw upon such a case to illuminate the issues which arise when medical problems interact with the vicissitudes of adolescence. Although it is clear that the patient's own behavior contributed substantially to the tragic outcome of this case, we believe that greater professional anticipation of the contingencies of adolescent development might have produced a more favorable result.