Exercise for the management of cancer-related fatigue in lung cancer: a systematic review.

Cancer-related fatigue is a common, persistent and disabling side-effect of the cancer and its treatments. Exercise, once was contraindicated, is now the key non-pharmacological management for cancer-related fatigue. However, the role of exercise in lung cancer cohort is not clear. A computerised database search was undertaken using keyword search in the CENTRAL, PubMed, EMBASE, CINAHL, SPORTDiscus, AMED and Web of Science. Ten relevant articles were reviewed; the evidence on this cohort was found to be limited, warrants further research. However, the available evidence from other than lung cancer groups shows significant beneficial effects of exercises on cancer-related fatigue. Hence, exercises could possibly be used in the management of cancer-related fatigue in this cohort with due caution until more robust evidences are available.

General distress, hopelessness-suicidal ideation and worrying in adolescence: concurrent and predictive validity of a symptom-level bifactor model for clinical diagnoses.

BACKGROUND: Clinical disorders often share common symptoms and aetiological factors. Bifactor models acknowledge the role of an underlying general distress component and more specific sub-domains of psychopathology which specify the unique components of disorders over and above a general factor. METHODS: A bifactor model jointly calibrated data on subjective distress from The Mood and Feelings Questionnaire and the Revised Children's Manifest Anxiety Scale. The bifactor model encompassed a general distress factor, and specific factors for (a) hopelessness-suicidal ideation, (b) generalised worrying and (c) restlessness-fatigue at age 14 which were related to lifetime clinical diagnoses established by interviews at ages 14 (concurrent validity) and current diagnoses at 17 years (predictive validity) in a British population sample of 1159 adolescents. RESULTS: Diagnostic interviews confirmed the validity of a symptom-level bifactor model. The underlying general distress factor was a powerful but non-specific predictor of affective, anxiety and behaviour disorders. The specific factors for hopelessness-suicidal ideation and generalised worrying contributed to predictive specificity. Hopelessness-suicidal ideation predicted concurrent and future affective disorder; generalised worrying predicted concurrent and future anxiety, specifically concurrent generalised anxiety disorders. Generalised worrying was negatively associated with behaviour disorders. LIMITATIONS: The analyses of gender differences and the prediction of specific disorders was limited due to a low frequency of disorders other than depression. CONCLUSIONS: The bifactor model was able to differentiate concurrent and predict future clinical diagnoses. This can inform the development of targeted as well as non-specific interventions for prevention and treatment of different disorders.

Breakfast consumption and physical activity in British adolescents.

Studies show an inverse relationship between breakfast frequency and weight gain. This may reflect poor eating habits generally and associated low physical activity (PA) or direct impacts of breakfast on mechanisms leading to lethargy and reduced PA. The relationship between breakfast frequency and PA is inconclusive. We aimed to determine whether breakfast frequency is associated with PA levels in British adolescents independent of body composition and socio-economic status (SES). Habitual breakfast frequency (self-report questionnaire) was assessed in 877 adolescents (43% male, age 14·5 (SD 0·5) years old). PA was measured over 5 d (accelerometry, average counts/ min; cpm). Associations between daily PA and breakfast frequency were assessed using linear regression adjusted for body fat percentage and SES. Effect modification by sex and associations with PA during the morning (06.00-12.00 hours) were explored. For boys, there were no significant associations between breakfast frequency and PA. For girls, less frequent breakfast consumption was significantly associated with lower PA (cpm) during the morning (occasional v. frequent b - 6·1 (95% CI - 11·1, -1·1), P = 0·017) when adjusted for body fat percentage and SES. There were no associations between PA and breakfast consumption over the whole day; however, for girls, less frequent breakfast consumption may be associated with lower PA levels during the morning, suggesting that breakfast consumption should perhaps be taken into consideration when aiming to promote PA in adolescent girls.

Long-term outcome of offspring after maternal severe puerperal disorder.

OBJECTIVE: To study adult mental health in offspring of mothers who experienced severe puerperal disorder. METHOD: Mothers, followed up a mean of 23 years after puerperal disorder requiring hospitalization, were interviewed regarding adult psychiatric illness, childhood neurotic symptoms and conduct problems of 48 offspring of the index episode and 62 additional siblings. RESULTS: In these predominantly young adults the lifetime rate of ICD-10 adult psychiatric illness was 26%, and was higher in offspring of puerperal episodes (35% vs. 15%, P = 0.07). There were also high rates of childhood symptoms and problems. CONCLUSION: There are high lifetime rates of adult psychiatric illness in young adult offspring of mothers with puerperal disorder, which are likely to increase further with time, and warrant special attention.

Combination of standard cytotoxic agents with polyamine analogues in the treatment of breast cancer cell lines.

Polyamines are essential for cell growth and differentiation. Structural polyamine analogues have been shown to have antitumor activity in experimental models including breast cancer. The ability of polyamine analogues to alter activity of cytotoxic chemotherapeutic agents in breast cancer models has not been evaluated. This study evaluates the ability of two polyamine analogues, N1-ethyl-N11-[(cyclopropyl)methyl]-4,8-diazaundecane (CPENSpm) and N1-ethyl-N11-[(cycloheptyl)methyl]-4,8-diazaundecane (CHENSpm) to synergize with cytotoxics in five human breast cancer cell lines. Antagonism, additivity, or synergy of the combinations was determined using the median effect/combination index model. The chemotherapeutic agents chosen, cis-diaminechloroplatinum(II), doxorubicin, 5-fluorouracil, fluorodeoxyuridine, 4-hydroperoxycyclophosphamide, paclitaxel, docetaxel, and vinorelbine, all have antitumor activity in breast cancer and represent a spectrum of mechanisms. Three treatment schedules of polyamine analogue and cytotoxic were tested in MCF-7 and MDA-MB-468 lines, demonstrating a schedule-dependence of synergistic growth inhibition. Cytotoxic agent alone for 24 h followed by polyamine analogue alone for 96 h resulted in the most synergistic combinations and the greatest synergy. This schedule was then tested in three additional breast cancer lines, and several synergistic combinations were again identified. Two cytotoxics, vinorelbine and the fluoropyrimidines, showed the most promise in combination with the polyamine analogues. They were able to synergize with one or both polyamine analogues in most of the breast cancer cell lines. CPENSpm was also able to synergize with virtually all of the cytotoxics in the estrogen receptor alpha-positive MCF-7 and T-47D lines. These preclinical data demonstrate a treatment schedule and combinations of polyamine analogues and cytotoxics that will be important to study mechanistically and clinically for breast cancer.

Incidental detection of preclinical renal tumors with electron beam computed tomography: report of 26 consecutive operated patients.

PURPOSE: The purpose of this work was to describe the positive predictive value of electron beam CT (EBCT) for diagnosis of solid renal tumors. METHOD: Among 11,932 consecutive patients undergoing screening EBCT, 27 cases met EBCT criteria for solid renal tumors. Twenty-six of 27 patients underwent surgery. RESULTS: Surgical pathology identified 25 solid renal tumors and 1 adrenal hemorrhage with thrombus. Twenty tumors were classified as T1N0M0, one was T2N0M0, and one was T3aN0M0. All tumor patients are clinically well at 1-41 months (mean 17 months) postoperatively. None of the patients had clinical signs or symptoms characteristic of renal malignancy. CONCLUSION: EBCT is an effective tool for detection of solid renal tumors in a healthy outpatient population (positive predictive value 0.96). The detection rate is low [0.2% (26/11,932) at our facility] in patients undergoing EBCT for other indications. The cost-effectiveness and sensitivity of this technique for solid renal tumor detection among various populations remain to be determined.

Long-term outcome of severe puerperal psychiatric illness: a 23 year follow-up study.

BACKGROUND: Although there have been many follow-up studies of severe puerperal psychiatric illness, few have been very long-term. METHODS: Sixty-four subjects from 85 (75.3%) in an unselected sample of women admitted to a psychiatric hospital within 6 months of childbirth were successfully followed up a mean of 23 years (range 17-28) later. Most subjects were interviewed in detail, with further information obtained from general practice and hospital records. Data included subsequent illnesses and diagnoses, subsequent childbirth, longitudinal social function, current symptoms and social function. RESULTS: Seventy-five per cent of subjects had further psychiatric illnesses, most of them unrelated to childbirth, and 37% had at least three subsequent episodes. The risk of puerperal psychiatric illness was 29% in subsequent pregnancies. At outcome interview the majority of subjects were well, with satisfactory social adjustment. Diagnoses in subsequent psychiatric illnesses showed considerable consistency with index diagnoses, with some shift to bipolar disorder. Further illnesses were less likely to occur where the index illness occurred with first child, onset was within 1 month of delivery, and where the index diagnosis was unipolar depression. CONCLUSIONS: There is a high risk of subsequent non-puerperal recurrences following severe puerperal psychotic illness, showing considerable diagnostic consistency with the index episode, but with good functional outcome. Puerperal illnesses showed strong continuities with non-puerperal illnesses in these women.

The holistic assessment of the patient in pain.

Holistic pain assessment involves the recognition of pain, an understanding of the context in which it is experienced and knowledge of the resources available to deal with it. Psychosocial and functional approaches to assessment are key to helping the patient cope with pain.

Identification of seven Treponema species in health- and disease-associated dental plaque by nested PCR.

Species-specific nested PCR was used to detect Treponema amylovorum, Treponema denticola, Treponema maltophilum, Treponema medium, Treponema pectinovorum, Treponema socranskii, and Treponema vincentii in dental plaque. Subjects with periodontitis harbored all species, but T. pectinovorum and T. vincentii were not found in plaque from disease-free subjects.

An exploration of the value of specialist neurosurgical nurses.

The differences in the knowledge and skills of 75 nurses working in a variety of practice settings were examined using a case study vignette of a neurosurgical patient developed by researchers. The case study tested nursing care throughout a patient's hospital experience, including admission, presurgery, postsurgery and discharge preparation. The findings showed that nurses who had specialised in neurosurgery scored markedly higher, in all aspects of practice knowledge, than expert nurses in other specialties and general nurses. Patients undergoing neurosurgery are safer if they have nurses who are experienced, skilled and knowledgeable to care for them.

Primary prevention of eating disorders: might it do more harm than good?

OBJECTIVE: The aim of this pilot study was to evaluate a new school-based eating disorder prevention program designed to reduce dietary restraint. METHOD: Forty-six school-girls, aged 13-14 years, took part. The intervention consisted of eight weekly sessions of 45 min duration. A battery of self-report questionnaires was administered before and after the intervention and 6 months later. RESULTS: Unlike previous prevention studies, there was not only an increase in knowledge at postintervention but there was also a decrease in target behavior and attitudes. However, these effects were short-lived since they had disappeared 6 months later: indeed, at 6-month follow-up there was an increase in dietary restraint compared with baseline. DISCUSSION: These findings suggest that the intervention had been counterproductive since it led to an increase in dietary restraint. They imply that school-based prevention programs may do more harm than good.

Using research for practice: a UK experience of the BARRIERS Scale.

It is generally recognized that the majority of health care has been largely based upon opinion rather than research evidence of clinical effectiveness. Attempts to rectify this have been initiated by increasing emphasis on the dissemination of findings. For example, in the UK this had been supported via the Cochran Collaboration and the Centre for Dissemination and Reviews. Dissemination does not, however, guarantee implementation. The complex nature of research utilization has been studied and obstacles identified that can influence the uptake of research by practising nurses. Sandra Funk and colleagues developed the BARRIERS Scale using this research and literature on research utilization. The scale may be helpful for identifying and measuring the barriers to research utilization perceived by nurses working within the UK and has formed the basis of the present study. A convenience sample of 316 comprising a broad spectrum of nurses working in the UK provided the data. Comparison is made with North American nurses from the studies used in the scale's development. The results suggest there ware items which are consistently perceived as either strong or negligible barriers by both groups of nurses. Differences, however, did emerge between nurses from the UK and North America on several items. These included the confidence in evaluating research and the perception of the nurse's authority to change patient procedures. Psychometric evaluation was also done. These findings are presented and discussed.

Serum thrombopoietin levels in patients with aplastic anaemia.

Endogenous serum thrombopoietin (TPO) levels were measured in 31 patients with aplastic anaemia (AA) using an enzyme immunoassay with a sensitivity of 20 pg/ ml. The median platelet count for all AA patients was 30 +/- 29 x 10(9)/l (range 5-102) compared with a median of 284 +/- 59 x 10(9)/l (range 148-538) for normal controls. Serum TPO levels were significantly elevated in all patients compared with normals (1706 +/- 1114.2, range 375-5000 v 78 +/- 54, range 16.5-312.9, P < 0.0001). There was no correlation between serum TPO levels and the degree of thrombocytopenia in AA patients, but TPO levels were significantly higher in patients who were platelet transfusion dependent than in patients who were transfusion independent (P < 0.01). There was a trend for higher TPO levels in patients with severe AA compared with non-severe AA patients. Clinical trials of TPO and a related truncated, pegylated molecule, megakaryocyte growth and development factor (PEG-rHuMGDF), are awaited to determine whether treatment with these drugs will result in increased platelet counts in patients with AA.

Maternal ethnicity and birthweight among blacks.

This paper examines the association of ethnicity and birthweight, adjusted for other maternal and infant characteristics, among black women who gave birth in Massachusetts from 1987 through 1989. Data are drawn from the standard certificate of live birth, which includes questions on race and ethnicity/ancestry as well as birthweight; maternal sociodemographic and biological characteristics; access to prenatal care; and infant characteristics. The study cohort consists of 18,571 black infants and a comparison group of 206,358 non-Hispanic white infants. Infants whose mothers reported their race as black were further categorized into six ethnic groups: American, Haitian, West Indian, Cape Verdean, Hispanic, and other black. In addition to descriptive analyses, we used multiple linear regression to measure the association between ethnicity, other characteristics, and birthweight; and we used multiple logistic regression to measure the odds ratio of low birthweight (ranging from 500 g to 2499 g) for the six black ethnic groups, adjusted for other characteristics. Results indicate that Americans have lower mean birthweight and generally higher levels of risk than other black ethnic groups. Compared to the reference group of non-Hispanic whites, Americans (OR = 1.49), other blacks (OR = 1.41), and West Indians (OR = 1.37) have significantly elevated relative risks of low birthweight.

Frequent and difficult problems perceived by nurses caring for the dying in community, hospice and acute care settings.

A total of 167 practising nurses from three practice settings--community, hospice and acute care--were asked to identify the five most common problems encountered when caring for the dying and the five most difficult problems to manage. Nine main categories of problems were elicited, including physical, work-related, nurse-related, death-related and spiritual problems. Key categories have been selected for discussion in this paper. Specific differences in the responses obtained from the three practice settings may be related to differences in the ethos of care of the dying patient in each area, particularly between hospice/community care and acute care. The findings of the survey will serve as a basis for planning initiatives in education and research in palliative care nursing.

Effect of actor depression on observer attributions: existence and impact of negative attributions toward the depressed.

This experiment examined whether others explain the successes and failures of depressed versus nondepressed people differently and how these attributions are related to affective and behavioral reactions to a request for psychological help. Ss reported attributions about the success and failure experiences of hypothetical depressed and nondepressed people. Ss also responded to a hypothetical request for psychological help by indicating their attributions, affective reactions, willingness to help, and desire for future social contact. As hypothesized, Ss displayed more negative attributions toward depressed people. Replicating prior research, Ss responded to the depressive's request for help with mixed emotional and behavioral reactions. Path analyses revealed that attributions influenced affective reactions, which influenced willingness to help; but a more complex pattern emerged from the analysis of desire for future social contact. Results are discussed in terms of the interpersonal impact and possible causes of negative attributions about the experiences of depressed people.

Rorschach structure of a hospitalized sample of Vietnam veterans with PTSD.

Rorschach structural summary data are presented for a group of 41 posttraumatic stress disorder (PTSD) patients who were being treated in a specialized inpatient PTSD treatment program. Results suggest that patients suffering from PTSD exhibit impaired reality-testing abilities and tend to utilize ineffective coping strategies. The group's structural summary factors are presented as incipient normative data for the Exner Comprehensive System on patients with PTSD. Implications that these protocols suggest a more severe and pervasive level of psychopathology than would be expected from theoretical descriptions of the disorder are discussed.

Psychometric evaluation of the Geriatric Depression Scale and the Zung Self-Rating Depression Scale using an elderly community sample.

In this study the psychometric properties of the Geriatric Depression Scale (GDS) and the Zung Self-Rating Depression Scale (SDS) were evaluated and compared, using a relatively large elderly community sample. The GDS generally performed well, replicating earlier findings from a different population. Also, as hypothesized, the SDS, which has a multiple-choice format, had a higher non-completion rate than the GDS, which has a true-false format. Finally, no significant differences between the responses of young-old and old-old subjects were observed.