Adolescent's stress responses and psychological functioning when a parent has early breast cancer.

OBJECTIVE: To identify factors associated with psychological functioning in adolescent children of early-stage breast cancer patients. METHOD: Adolescents' self-reported psychological functioning using the Child Behaviour Checklist (YSR), Mental Health subscale of the Child Health Questionnaire (CHQ-MH) and Child Impact of Events (C-IES) scale. The Family Assessment Device (FAD) and the Family Environment Scale (FES cohesion subscale) assessed family functioning. Maternal depression was assessed on the Beck Depression Inventory (BDI) and quality of life using the SF8. Using a cross-sectional within-groups design, assessments were obtained for 56 adolescents of 11-17 years . RESULTS: High rates of stress were found (C-IES) in 33% males and 45% females. Thirty percent of adolescents reported psychological problems (YSR) (28% males and 32% females) when compared with published norms. Poor family functioning was linked with YSR internalising and externalising problems; poor family cohesion with higher externalising and total YSR psychological problems. Maternal depression was linked with adolescent-reported internalising problems. CONCLUSIONS: When mothers have breast cancer, a substantial minority of their adolescent children have psychological and stress response-related problems linked with poor family functioning. These results argue in favour of a family-oriented approach to psychological support of breast cancer patients.

Factors associated with emotional and behavioural problems among school age children of breast cancer patients.

To identify factors linked with emotional and behavioural problems in school age (6- to 17-year-old) children of women with breast cancer. Reports of children's emotional and behavioural problems were obtained from patient mothers, their healthy partners, the children's teacher and adolescents using the Child Behaviour Checklist and Mental Health subscale of the Child Health Questionnaire. Parents reported on their own level of depression and, for patients only, their quality of life. Family functioning was assessed using the Family Assessment Device and Cohesion subscale of the Family Environment Scale. Using a cross-sectional within groups design, assessments were obtained (N=107 families) where the patients were 3-36 months postdiagnosis. Risk of problems in children were linked with low levels of family cohesion, low affective responsiveness and parental over-involvement as reported by both child and mother. Adolescents reported family communication issues, which were associated with externalising behaviour problems. Maternal depression was related to child internalising problems, particularly in girls. Whether the mother was currently on or off chemotherapy was not associated with child problems nor was time since cancer diagnosis. These findings held across child age. Where mothers have early stage breast cancer, a substantial minority of their school-aged children have emotional and behavioural problems. Such cases are characterised by the existence of maternal depression and poor family communication, rather than by the mother's treatment status or time since diagnosis. Targeted treatments, which focus on maternal depression and family communication may benefit the children and, through improved relationships, enhance the patients' quality of life.

The altered baroreceptor response to nitroglycerin in congestive heart failure.

The use of nitroglycerin as a vasodilator in the treatment of congestive heart failure has demonstrated that the hemodynamic response is related to the degree of left ventricular dysfunction. Little emphasis has been placed on the mechanisms responsible for the variability in heart rate response to nitroglycerin. To study this problem, 33 patients with a variety of chronic cardiac disorders were given 0.4 mg of nitroglycerin sublingually. An increase in heart rate of less than 3 beats/min to sublingual nitroglycerin allowed a clear identification of a group of patients who had a left ventricular end-diastolic pressure greater than 18 mmHg or pulmonary artery mean pressure greater than 22 mmHg, and who had improvement in hemodynamic parameters following nitroglycerin. This alteration in baroreceptor sensitivity appears to be related to the level of left ventricular filling pressure, and can be used as a simple bedside means of identifying a group of patients who benefit the most from the vasodilator action of nitroglycerin.

Effects of isometric exercise on the end-diastolic pressure, volumes, and function of the left ventricle in man.

Changes induced in left ventricular (LV) hemodynamics by isometric exercise were analyzed in 43 patients: 30 with coronary heart disease (CAD), four with noncoronary heart disease, nine normal. Volumes were angiographically determined and correlated with left ventricular end-diastolic pressure (LVEDP) both at rest and during the fifth minute of 30% sustained handgrip (HNG). All normals and eight with CAD improved LV function during HNG. LVEDP decreased or remained constant, end-diastolic volume (EDV) decreased, end-systolic volume (ESV) decreased, as ejection fraction (EF) remained constant. None of these eight CAD cases altered their regional LV contraction pattern during HNG. Twenty-five patients, 21 CAD and four nonCAD, showed diminished LV function during HNG. LVEDP increased, EDV decreased, ESV increased, as EF declined. In these 21 CAD patients, at least one major coronary vessel was narrowed 70% or more and, with but two exceptions, was not supported by adequate collaterals. In 18, new asynergic zones developed in previously normally contracting areas or pre-existing asynergic zones extended during HNG.