The Survivor Health and Resilience Education (SHARE) Program: Development and Evaluation of a Health Behavior Intervention for Adolescent Survivors of Childhood Cancer

Few evidence-based health behavior interventions for adolescent survivors of childhood cancer currently exist. These interventions are necessary to address a range of lifestyle and behavioral factors (e.g., diet and physical activity, tobacco and alcohol use, excessive sun exposure) that may place survivors at increased risk for secondary cancers other chronic diseases. To address this need, the development and evaluation of a health promotion and disease prevention program for childhood cancer survivors is described, with an emphasis on the steps leading up to conducting a randomized controlled trial to test its efficacy. Data gathered from trial participants suggest the preliminary evaluation of the intervention is favorable. Trends and future directions in behavioral intervention research with childhood cancer survivors are discussed, along with the role of behavioral research in health promotion and disease prevention.     

国际麻醉药品的医疗消耗趋势

本文通过明晰的表格形式列出国际上不同国家历年麻醉药品的医疗消耗量,比较了发达国家与发展中国家的具体数据,并通过各国吗啡人均消耗量来揭示我国目前贯彻“癌症三阶梯止痛方案”与国际发达国家的差距。旨在强调对麻醉药品的管理,一方面要严格控制以免滥用造成危害,另一方面还要保证足够的医疗消耗。     

生育获得脐血行干细胞移植治疗重大遗传性疾病的风险和对策

通过生育获得脐带血行干细胞移植是治疗重大疾病的一条可行之路,但在治疗遗传性疾病时,当事家庭、检测机构和医疗机构三方都存在着极大的风险,特别是当事家庭很有可能要承受精神和经济上的更大打击,而且客观上造成患病或者携带者人群的进一步扩大,成为一个不可忽视的社会问题。有必要进行充分的伦理思考后提出尽可能周全的办法,以降低各方面的风险。     

干细胞移植治疗视网膜疾病的启示

干细胞是指具有自我更新、高度增殖和多向分化潜能的细胞群体,通过胚胎干细胞及视网膜干细胞、骨髓间充质细胞等成体干细胞移植治疗眼底病是近年来研究的热点,并取得了重要进展,为视网膜疾病的治疗开辟了新的途径,但同时也面临着技术的探讨及哲学的思考。本文就干细胞移植治疗视网膜疾病这一问题进行相关哲学思考。     

Survivin与子宫内膜癌的基因治疗的思考

子宫内膜癌是妇科常见的恶性肿瘤,发病机制不很清楚,早期诊断及治疗可改善预后,而目前的手术治疗方式损伤较大。Survivin是近年发现的新凋亡抑制基因,在多数恶性肿瘤组织中表达丰富,而在正常成人组织中不表达,这种表达特异性使其成为肿瘤诊断和基因治疗的新靶点。本文着重思考以Survivin为靶点的基因治疗方法在子宫内膜癌中的应用。     

脐血干细胞移植治疗肌萎缩侧索硬化伦理问题的思考

肌萎缩侧索硬化症是神经系统一种致死性疾病,目前尚无有效治疗方法,脐血干细胞移植为其生存带来了希望。详细论述了脐血、干细胞与伦理学,肌萎缩侧索硬化与生命伦理学的关系,以及如何在肌萎缩侧索硬化治疗中体现生命伦理学的核心精神。面对脆弱的生命,医务人员、伦理学者和管理部门应该如何为此类疾病患者生命和健康作出应尽的职责。     

Successful Use of Peer Educators for Sharing Genetic Information

This study examined the impact of a genetics education module provided by Reach to Recovery peer volunteers. Participants included 113 women with confirmed breast cancer diagnoses. Eighty-eight of these women (78%) completed a baseline survey, participated in a peer-led intervention, and completed a follow-up survey. Approximately half of the women received an education module that included a genetic component, while the other half did not. Results indicated that women who received the genetics module had greater increases in genetics knowledge than the group that did not receive the module. However, follow-up interest in genetic testing was not significantly different between the two groups. Results indicate that a peer-led genetics module can increase knowledge about genetics. However, it does not appear to have a differential effect on genetic testing interest.     

Clinical Characterization and Risk Profile of Individuals Seeking Genetic Counseling for Hereditary Breast Cancer in Brazil

Hereditary breast cancer (HBC) accounts for 5–10% of breast cancer cases and it significantly increases the lifetime risk of cancer. Our objective was to evaluate the sociodemographic variables, family history of cancer, breast cancer (BC) screening practices and the risk profile of cancer affected or asymptomatic at-risk women that undergo genetic counseling for hereditary breast cancer in public Brazilian cancer genetics services. Estimated lifetime risk of BC was calculated for asymptomatic women using the Gail and Claus models. The majority of women showed a moderate lifetime risk of developing BC, with an average risk of 19.7% and 19.9% by the Gail and Claus models, respectively. The average prior probability of carrying a BRCA1/2 gene mutation was 16.7% and overall only 32% fulfilled criteria for a hereditary breast cancer syndrome as assessed by family history. We conclude that a significant number of individuals at high-risk for HBC syndromes may not have access to the benefits of cancer genetic counseling in these centers. Contributing factors may include insufficient training of healthcare professionals, disinformation of cancer patients; difficult access to genetic testing and/or resistance in seeking such services. The identification and understanding of these barriers is essential to develop specific strategies to effectively achieve cancer risk reduction in this and other countries were clinical cancer genetics is not yet fully established.     

Using Adult Learning Theory Concepts to Address Barriers to Cancer Genetic Risk Assessment in the African American Community

Utilization of cancer genetic risk assessment can be profoundly influenced by an individuals’ knowledge of risk assessment, attitudes regarding illness and healthcare, and affective reactions derived from social norms. Race and ethnicity play a powerful role in the development of an individual's attitudes and should be considered when attempting to understand a person's openness to cancer genetic risk assessment (Lannin et al., 1998). Until recently, however, cancer screening and prevention programs have been primarily based on data from studies conducted with the Caucasian population, yielding data that are not fully applicable to the African American community. In the last several years, research findings regarding African American's knowledge, attitudes, and feelings about genetic counseling and testing have grown (Matthews et al., 2000; Singer et al., 2004; Thompson et al., 2003). However, to the authors’ knowledge, these data have yet to be presented in a manner that both summarizes the barriers that African Americans have reported regarding cancer genetic risk assessment, while at the same time suggesting methods individual genetic counselors can utilize during community presentations to help address these barriers. This article will first summarize previous empirical findings regarding African Americans’ knowledge, attitudes, and feelings about cancer genetic risk assessment. The article will then apply adult learning theory to those findings to provide genetic counselors with practical, theory based techniques to apply toward community based educational programs with African American groups.     

Breast Cancer as Trauma: Posttraumatic Stress and Posttraumatic Growth

Diagnosis and treatment of cancer has been associated with both posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG). This cross-sectional study sought to assess the frequency, common predictors, and interrelationships of PTSD symptoms and PTG in breast cancer survivors (n = 65). In this sample, symptoms of PTSD and reports of PTG were common and were not significantly related to one another. Greater social constraints on talking about breast cancer and perception of cancer as a traumatic stressor were associated with greater PTSD symptomatology. Younger age and perception of cancer as a traumatic stressor were associated with greater PTG. Findings suggest the central role of subjective appraisal in adjustment to cancer. Psychosocial interventions should be sensitive to the potential for PTG, both in treatment design and in assessment of outcomes.