Lesbians and HIV: clinical, research, and policy issues

Sources of risk for HIV infection in members of the lesbian community are surveyed, together with factors that adversely affect access to appropriate health care by women in general and lesbians in particular. Issues of clinical practice, research, and public policy are examined with a view to promoting more effective prevention and treatment strategies.     

Lesbians, gay men, and their families. Some therapeutic issues

Although a body of scientific data about working with parents and families of gays and lesbians has not yet developed, there is a growing body of literature of an anecdotal and personal nature that has been cited. These works provide therapists with background information and clients needing assistance with guided reading. Therapists working with families and friends of gay men can find the experience rewarding and the therapeutic interventions effective. Much of the work is common sense, listening with the "third" ear for those underlying issues separate from the son's gayness that may affect the person's attitudes, feelings, and responses. Maintaining a professional demeanor while conveying a sense of caring and concern for the individuals is a key issue. As gay people become more visible in society and as the number of individuals coming out increases, there will be a need for more therapists who can assist families with their own coming out process. This article provides some basic guidelines and, as individual therapists gain more experience in this area, it will be important that others report those experiences, sharing them with the rest of the therapist community.     

The value of home support for cancer patients: a study

The Community Oncology Project (COPE) was initiated to investigate home support from a trained oncology nurse at various stages of treatment. Patients who received home support during treatment responded better than those having visits after treatment had finished. The author discusses the patients' continuing need for home support and the issues of dependency that this raises.     

Family coping: issues and challenges for cancer nursing

BACKGROUND: Many factors influence diastolic function indexes obtained by monitoring left ventricular filling. Recent reports suggest that the study of myocardial wall velocity with Doppler tissue imaging (DTI) can give diastolic function parameters that are less affected by the same factors. An altered diastolic function has been demonstrated with invasive methods in patients with left ventricular hypertrophy (LVH). The aims of this study were 1) to compare a group of healthy subjects with a group of patients with LVH and presumably affected by diastolic dysfunction, to try to demonstrate if DTI could give new indexes to discriminate between the two groups; 2) to compare the indexes obtained with DTI against the ones given by Doppler study of left ventricular filling in the two populations. MATERIALS AND METHODS: Forty-two patients with LVH were compared to forty normal subjects. We studied the posterior wall velocity with pulsed DTI from parasternal view, measuring the early diastolic velocity (E'), the late diastolic velocity (A') and the E'/A' ratio. In addition, we estimated the usual ventricular filling parameters and the time interval between R wave of ECG and the peaks of E' and E waves. RESULTS: At left ventricular filling, patients with LVH showed an increase in A-wave peak velocity (mean 75.3 cm/s versus 66.4 cm/s; p < 0.05) and prolonged deceleration time (mean 216 ms versus 181 ms; p < 0.05), as compared to normal reference subjects. E-wave peak velocity and E/A ratio did not differ between the two groups. At DTI, patients with LVH had decreased early diastolic velocity (E') (mean 9 cm/s versus 12 cm/s; p < 0.05) and E'/A' ratio (mean 1.53 versus 1.91; p < 0.05) as compared to the control group. We observed an inverse correlation between E' wave and age in normal subjects. There was no correlation between the early diastolic myocardial velocity (E') and early inflow velocity (E) in both groups. A correlation was found between A and A' waves in normal subjects, but not in hypertrophic ones. The E'-wave peak always preceded the E-wave peak in all the subjects. CONCLUSION: Diastolic function indexes achieved by DTI can offer additional information that is independent of the data derived from left ventricular filling.     

Partners and fellow patients: two sources of emotional support for women with breast cancer

This study examined the helping process that occurred when 26 breast cancer patients (the disclosers) talked about their illness-related concerns with their partner and, in a separate conversation, with a fellow patient (the volunteer helpers). The conversations were rated by trained observers and by the disclosers in terms of several process and outcome variables. From the observers' perspective, the volunteer helpers were more helpful, empathic, and supportive, less critical, and used more self-disclosure than the partners. Disclosers did not differentiate between the two types of helper, and gave generally high ratings to both conversations. Strengths and weaknesses of each type of helper were identified. Findings are discussed in relation to the literature on formal and informal helping, and implications for training nonprofessional helpers are suggested.     

Child maltreatment research: Federal support and policy issues.

The recent history of federal support for child maltreatment research paints a mixed picture of inadequate funding and uncertain administrative guidance against a backdrop of growing public concern about the prevalence of child abuse and neglect. This article describes some of the problems that have been identified in federal research funding, administration, and support of research initiatives and training concerning child abuse and neglect. Remedies for these difficulties are outlined, priorities for new research in this area are identified, and ways in which to rejuvenate the federal government's role in this area, in league with a concerted commitment to policy-relevant research by behavioral scientists, are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse issues in cancer patients. Part 1: Prevalence and diagnosis

Although rare, drug abuse problems present a complex set of physical and psychosocial issues that complicate cancer treatment and pain/ symptom management. Most oncologists are not be well versed in either the conceptual or practical issues related to addiction. As a result, they often struggle in their attempts to effectively treat patients who are or have been substance abusers, and they find it difficult to understand issues of addiction in patients with pain who have no history of substance abuse. In the first installment of a two-part series, the authors explore the epidemiology of substance abuse. An examination of the distinctions between abuse and dependence leads to definitions of these terms appropriate for the oncology setting. Guidelines for assessing aberrant drug-taking behavior are also offered. Part 2, which will appear in the next issue of ONCOLOGY, will discuss the clinical management of cancer patients with a history of substance abuse.     

Substance abuse issues in cancer patients. Part 2: Evaluation and treatment

The relationship between the therapeutic use of potentially abusable drugs for symptom control and the multifaceted nature of abuse and addiction is extremely complex. Research is only beginning to elucidate the nature of this relationship and its clinical implications. At present, practical management is based primarily on clinical experience and anecdotal observations. In part I of this two-part series (published last month), the authors explored the epidemiology of substance abuse in the cancer population, provided definitions of addiction and abuse appropriate for the oncology setting, and offered guidelines for the assessment of aberrant drug-taking behavior. In this second part, the authors provide recommendations for the evaluation and treatment of patients with cancer who have a history of substance abuse. Suggested therapeutic goals are outlined, and plans for inpatient and outpatient management and detailed.     

Professionally-led support groups for cancer patients: an intervention in search of a model

OBJECTIVE: The objective of this review was to evaluate the clinical and research literature on professionally-led support groups for cancer patients and to propose an approach that would address patients' needs from diagnosis through survivorship. METHOD: Computerized and manual searches, including Medline and Psychlit searches, were completed for reviews of the literature. Twelve research studies were identified that met our criteria for in-depth review. A clinical model emerged from discussions of an oncology study group based on theoretical formulations and clinical experience with oncology patients. RESULTS: We found that recent research suggests that professionally-led support groups are increasing in number and that participation in such groups seems to enhance patients' quality, and possibly even quantity, of survival. Despite this, little effort has been made to determine what type of group may be appropriate for which patients and when in their course of care. CONCLUSIONS: If psychosocial intervention, in the form of professionally-led support groups for cancer patients, is to be more effective, it should be guided by a model which takes into consideration the changing needs and concerns of patients over the course of illness and, in many cases, recovery. The authors present an outline delineating what such a model might entail.     

Cognitive therapy for depression: Conceptual issues and clinical efficacy.

Cognitive therapy has emerged as one of the most promising psychosocial interventions for the treatment of depression. It appears to be at least the equal of alternative interventions (including pharmacotherapy) with respect to acute treatment. In addition, there are indications that it may reduce risk of symptom return after treatment termination. Nonetheless, design limitations reduce the certainty with which such conclusions can be drawn. Furthermore, tests of its efficacy have largely been limited to nonbipolar outpatient (or subclinical) samples. At this time, cognitive therapy is best considered a promising, but as yet not adequately tested, intervention for the treatment of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cancer-related fatigue: clinical practice issues

The purpose of this paper is to review current nursing literature and practice in cancer-related fatigue and to provide a suggested plan of treatment. Cancer-related fatigue is one of the most common and challenging symptom-management problems. The successful treatment of fatigue depends on the clinician's understanding of the symptom's continuum within the cancer experience, its etiologies, assessment strategies, and research-based interventions. Clinical outcomes are measured by the patient's ability to balance energy expenditure and restoration. By applying this knowledge to clinical practice, oncology nurses can have a profound impact on the patient's quality of life.     

Genetic testing for cancer predisposition: behavioral science issues

The discovery of major cancer susceptibility genes is likely to create strong pressures for clinical testing from biotechnology companies, insurance carriers, the medical community, and the public. However, before genetic testing for cancer predisposition is made widely available, we must identify the optimum strategies to enhance informed decision making, minimize adverse psychologic consequences, and promote adherence to recommended surveillance. This report provides an overview of behavioral research in these areas and, on the basis of this literature, presents suggestions for developing effective and ethical genetic testing protocols.     

Age-associated testosterone decline in men: clinical issues for psychiatry

OBJECTIVE: The author summarizes current knowledge about the diagnosis and treatment of testosterone decline in healthy aging men and the associated clinical issues for psychiatry. METHOD: A MEDLINE search was conducted in which the search terms "male climacteric," "male menopause," "andropause," "viropause," "low-testosterone syndrome," and "testosterone replacement therapy" were used. Literature published before 1966 was identified by reviewing the reference lists of later publications. RESULTS: Manifestations of testosterone deficiency have included depression, anxiety, irritability, insomnia, weakness, diminished libido, impotence, poor memory, reduced muscle and bone mass, and diminished sexual body hair. Although testosterone levels decline with age, there is great interindividual variability, and the connection between serum testosterone levels and clinical psychiatric signs and symptoms is not clear-cut, since other hormonal changes are implicated as well. Testosterone replacement therapy may offer hypogonadal men benefit, but long-term studies on its efficacy and safety are lacking. Comprehensive biopsychosocial assessment should be a routine part of the evaluation of complaints of low-testosterone syndrome in men. CONCLUSIONS: Testosterone decline/deficiency is not a state strictly analogous to female menopause and may exhibit considerable overlap with primary and other secondary psychiatric disorders.     

Fetal pulse oximetry during labor: issues and recommendations for clinical use

Sixteen final-year students and 14 nonstudents were recruited into a pilot study exploring the utility of the Merieux Multitest CMI in identifying stress-related immune impairment. The results of the investigation revealed that the examination group reported greater stress than the nonexamination group. The relationship between stress and immune impairment was explored using two widely held definitions of stress (i.e., stimulus and response). When stress was defined as the stimulus (i.e., examination versus nonexamination groups), reactions to the skin test were not significantly different. However, when stress was defined as the response (i.e., high stress versus low stress scores), the high-stress individuals were found to have poorer reactions to the skin test than the low-stress subjects. The results of the study highlight the need for greater precision in the definition of the term stress and, also, suggest that Multitest CMI can provide a rapid and reproducible means of assessing stress-related immune dysfunction.     

Group support for patients with metastatic cancer. A randomized outcome study

The effects of weekly supportive group meetings for women with metastatic carcinoma of the breast were systematically evaluated in a one-year, randomized, prospective outcome study. The groups focused on the problems of terminal illness, including improving relationships with family, friends, and physicians and living as fully as possible in the face of death. We hypothesized that this invention would lead to improved mood, coping strategies, and self-esteem among those in the treatment group. Eighty-six patients were tested at four-month intervals. The treatment group had significantly lower mood-disturbance scores on the Profile of Mood States scale, had fewer maladaptive coping responses, and were less phobic than the control group. This study provides objective evidence that a supportive group intervention for patients with metastatic cancer results in psychological benefit. Mechanisms underlying the effectiveness of this group intervention are explored.     

Battered women: Sex roles and clinical issues.

Examines how sex role biases contribute to the origins of spousal violence, compound its psychological effects, and interfere with effective treatment for battered women. Issues that commonly arise during psychotherapy with battered women and their batterers are discussed, such as self-esteem, denial, manipulation, body integration and sexuality, and familial relationships. Clinical impressions are supported with preliminary results of data collected from 400 battered women. Suggestions are made for implementing effective, nonsexist treatment programs with preventive, secondary, and tertiary strategies. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)