Superior outcome of women with stage I/II cutaneous melanoma: pooled analysis of four European Organisation for Research and Treatment of Cancer phase III trials.

PURPOSE: Several studies observed a female advantage in the prognosis of cutaneous melanoma, for which behavioral factors or an underlying biologic mechanism might be responsible. Using complete and reliable follow-up data from four phase III trials of the European Organisation for Research and Treatment of Cancer (EORTC) Melanoma Group, we explored the female advantage across multiple end points and in relation to other important prognostic indicators. PATIENTS AND METHODS: Patients diagnosed with localized melanoma were included in EORTC adjuvant treatment trials 18832, 18871, 18952, and 18961 and randomly assigned during the period of 1984 to 2005. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% CIs for women compared with men, adjusted for age, Breslow thickness, body site, ulceration, performed lymph node dissection, and treatment. RESULTS: A total of 2,672 patients with stage I/II melanoma were included. Women had a highly consistent and independent advantage in overall survival (adjusted HR, 0.70; 95% CI, 0.59 to 0.83), disease-specific survival (adjusted HR, 0.74; 95% CI, 0.62 to 0.88), time to lymph node metastasis (adjusted HR, 0.70; 95% CI, 0.51 to 0.96), and time to distant metastasis (adjusted HR, 0.69; 95% CI, 0.59 to 0.81). Subgroup analysis showed that the female advantage was consistent across all prognostic subgroups (with the possible exception of head and neck melanomas) and in pre- and postmenopausal age groups. CONCLUSION: Women have a consistent and independent relative advantage in all aspects of the progression of localized melanoma of approximately 30%, most likely caused by an underlying biologic sex difference.

A qualitative case study of the processes of peer education in a young adult tobacco control initiative, Leave the Pack Behind

Peer education involves peers offering credible and reliable information about sensitive life issues through the means of an informal peer group setting (Topping & Ehly, 1998). The purpose of this instrumental case study was to examine the processes of peer education through the exploration of two teams within a young adult tobacco control initiative, Leave the Pack Behind (LTPB). This qualitative case study examined two peer education teams over an eight-month period. Interviews, focus groups and observations were conducted with 12 participants across two peer education teams. Findings show the complexities of the processes of peer education including a connection between the stages of change and the changing role of the peer educator across stages of the empowerment process. Peer education teams and factors in the macro environment were also found to impact the process of peer education. This study provides a new definition for the process of peer education: peer education is a fluid process of knowledge exchange in which peer educators adopt different styles of facilitation as people move through stages of empowerment and change. This study contributes to the academic hterature upon the processes of peer education by providing a definition, a model and an overall understanding through an ecological and empowerment framework. The findings from this study suggest peer educators can be further trained to: use specific peer educational approaches that fit with student smoker's stage of change; better understand their position as a peer educator on the LTPB team; understand the reciprocal relationship between the macro environment and the peer education teams having an effect on one another.

Bringing Zombies Back to Life: An Autoethnographical Exploration of Alienation and Political Dis/Engagement in Emerging Adulthood Within Late-Stage Capitalism

In this thesis, by employing an autoethnographic methodology, I am exploring why certain understandings, or assemblages, of political engagement come to have greater meaning in my life and why other assemblages may be more hidden and thus fail to contribute substantially to the meaning of political in my life. Using immanent, Marxist and post-Marxist theories, as well as a zombie narrative, the study will contextualize the movement of assemblages in my life within late-stage capitalism which is juxtaposed with the zombie apocalypse. The placement and displacement of certain understandings of the political within my life will be theorized within the crisis of constituent power that is revealed in an immanent framework. Furthermore, the crisis of the constituent in late-stage capitalism creates new forms of radical alienation which will also be examined. By exploring my own struggles in becoming political I will theorize why political disengagement in emerging adulthood appears to be increasing, as well as possibilities for new forms of political engagement in a late-stage capitalist context.

Post orthodontic effects of SARPE on sleep-disordered breathing in young adults as observed in a sleep laboratory

Introduction: L’expansion palatine du maxillaire a beaucoup d’effets positifs sur la respiration et la qualité du sommeil, mais peu d'études ont examiné ces données sur des adultes ayant dépassé l’âge permettant de bénéficier d'une expansion palatine conventionnelle. Le but de cette recherche est d’évaluer la stabilité de l’EPRAC (expansion palatine rapide assistée chirurgicalement) et son effet sur les troubles respiratoires après l’ablation des appareils orthodontiques. Méthodes: Neuf patients (Âge moyen 21, entre 16-39 ans) nécessitant une EPRAC ont passé des nuits dans un laboratoire de sommeil, et ce avant l’EPRAC, après l’EPRAC, et après l’ablation des appareils fixes. Les radiographies céphalométriques postéroantérieures ainsi que les modèles d’étude ont été pris pendant ces trois périodes de temps. Résultats: L’analyse des modèles d’étude a démontré une récidive significative au niveau des distances inter-molaires et inter-canines au niveau du maxillaire seulement. Les analyses céphalométriques ont démontré une récidive au niveau de la largeur maxillaire. Aucun changement important n'a été observé dans les stades de sommeil, mais une réduction importante dans l’index de ronflement a été notée. De plus, il y avait moins de changements entre les stades de sommeil. Conclusions: La récidive squelettique est minime et cliniquement non significative. Par contre, les changements dans les distances intermolaires et intercanines sont cliniquement importants. Il semble également qu'une EPRAC ait un effet positif sur la qualité de sommeil par la réduction de l’indice de ronflement ainsi que sur la diminution des changements entre les stades de sommeil.

Il était une fois l’ailleurs-- le stage de coopération internationale comme espace de développement du cosmopolitisme et de la conscientisation des jeunes Québécois

Chaque année, quelques milliers de jeunes Québécois découvrent la coopération internationale, par le biais de stages dans des pays dits « en développement ». Si les retombées de ces stages sur les populations partenaires du Sud sont connues et régulièrement évaluées, il existe en revanche peu d'études de suivi des stagiaires à leur retour au Québec. Quel impact cette expérience a-t-elle eu sur ces jeunes? Quelles étaient leurs motivations au départ? Et comment leur engagement vis-à-vis des problématiques de développement a-t-il évolué ou s’est-il même maintenu suite à leur séjour? Comment leur expérience a-t-elle façonné leurs projets professionnels et leurs perceptions de l’avenir? Ce mémoire a pour objet de dresser un portrait de l’impact d’un stage de coopération internationale sur les jeunes stagiaires de retour au Québec. Pour ce faire, notre recherche s’appuie sur des données quantitatives et qualitatives recueillies auprès d’anciens stagiaires de l’ONG Mer et Monde. Les données quantitatives ont été collectées à l’aide d’un sondage effectué auprès de 367 anciens stagiaires et un entretien de groupe a fourni les bases qualitatives de la recherche. Les résultats de l’analyse suggèrent que le stage a très certainement une forte influence sur l’engagement et le mode de vie des jeunes à leur retour au Québec. À la suite de l’expérience à l’étranger, l’identité des enquêtés est notamment affectée par rapport à six aspects : l’ouverture sur le monde, la conscience écologique, la conscience sociale, le développement personnel, le rapport à l’« Autre », et les représentations de l’« Ailleurs ». Il apparait que ce sont tout autant les habitudes de vie, que le regard que les stagiaires portent sur le monde, qui se sont trouvés affectés. Et la spécificité d’une telle expérience et les processus à l’œuvre nous permettent d’assimiler ce type de stage à une expérience de développement du cosmopolitisme et de la conscientisation des jeunes Québécois.

Narrativising the facts: acting in screen and stage docudrama

This article presents findings and seeks to establish the theoretical markers that indicate the growing importance of fact-based drama in screen and theatre performance to the wider Anglophone culture. During the final decade of the twentieth century and the opening one of the twenty-first, television docudrama and documentary theatre have grown in visibility and importance in the UK, providing key responses to social, cultural and political change over the millennial period. Actors were the prime focus for the enquiry principally because so little research has been done into the special demands that fact-based performance makes on them. The main emphasis in actor training (in the UK at any rate) is, as it always has been, on preparation for fictional drama. Preparation in acting schools is also heavily geared towards stage performance. Our thesis was that performers called upon to play the roles of real people, in whatever medium, have added responsibilities both towards history and towards real individuals and their families. Actors must engage with ethical questions whether they like it or not, and we found them keenly aware of this. In the course of the research, we conducted 30 interviews with a selection of actors ranging from the experienced to the recently-trained. We also interviewed a few industry professionals and actor trainers. Once the interviews started it was clear that actors themselves made little or no distinction between how they set about their work for television and film. The essential disciplines for work in front of the camera, they told us, are the same whether the camera is electronic or photographic. Some adjustments become necessary, of course in the multi-camera TV studio. But much serious drama for the screen is made on film anyway. We found it was also the case that young actors now tend to get their first paid employment before a camera rather than on a stage. The screen-before-stage tendency, along with the fundamental re-shaping that has gone on in the British theatre since at least the early 1980s, had implications for actor training. We have also found that theatre work still tends to be most valued by actors. For all the actors we interviewed, theatre was what they liked doing best because it was there they could practice and develop their skills, there they could work most collectively towards performance, and there they could more directly experience audience feedback in the real time of the stage play. The current world of television has been especially constrained in regard to rehearsal time in comparison to theatre (and, to a lesser extent, film). This has also affected actors’ valuation of their work. Theatre is, and is not, the most important medium in which they find work. Theatre is most important spiritually and intellectually, because in theatre is collaborative, intensive, and involving; theatre is not as important in financial and career terms, because it is not as lucrative and not as visible to a large public as acting for the screen. Many actors took the view that, for all the industrial differences that do affect them and inevitably interest the academic, acting for the visible media of theatre, film and television involved fundamentally the same process with slightly different emphases.

Family literacy activities in the homes of successful young readers

This paper presents an account of the literacy activities engaged in by the parents of 29 children around the time that the children were about to start school at Key Stage 1. Fifteen of the children were reading fluently before they began school and the remaining fourteen were matched for age, sex, receptive vocabulary scores, preschool group attended and socio-economic family status, but not reading fluently. In order to ascertain that the fluent readers were not simply coming from homes where literacy activities were more in evidence, parents were asked to report on their own literacy activities. The data obtained indicated that there were no systematic differences in the activities of the two sets of parents. They also showed that there was a considerable amount of literacy activity evidence in the homes. It is argues that, whilst the home environment is highly instrumental in nurturing literacy development, it is not enough to account for precocious reading ability.

Who does not gain weight? Prevalence and predictors of weight maintenance in young women

OBJECTIVE: To investigate the prevalence and predictors of weight maintenance over time in a large sample of young Australian women.

DESIGN: This population study examined baseline and 4 y follow-up data from the cohort of young women participating in the Australian Longitudinal Study on Women's Health.

SUBJECTS: A total of 8726 young women aged 18-23 y at baseline.

MEASURES: Height, weight and body mass index (BMI); physical activity; time spent sitting; selected eating behaviours (eg dieting, disordered eating, takeaway food consumption); cigarette smoking, alcohol consumption; parity; and sociodemographic characteristics.

RESULTS: Only 44% of the women reported their BMI at follow-up to be within 5% of their baseline BMI (maintainers); 41% had gained weight and 15% had lost weight. Weight maintainers were more likely to be in managerial or professional occupations; to have never married; to be currently studying; and not to be mothers. Controlling for sociodemographic factors, weight maintainers were more likely to be in a healthy weight range at baseline, and to report that they spent less time sitting, and consumed less takeaway food, than women who gained weight.

CONCLUSIONS: Fewer than half the young women in this community sample maintained their weight over this 4 y period in their early twenties. Findings of widespread weight gain, particularly among those already overweight, suggest that early adulthood, which is a time of significant life changes for many women, may be an important time for implementing strategies to promote maintenance of healthy weight. Strategies which encourage decreased sitting time and less takeaway food consumption may be effective for encouraging weight maintenance at this life stage.

The transition from pediatric to adult health care services for young adults with a disability : an ethical perspective

Young children with disabilities and their carers or parents tend to form a long-term dependent relationship with a paediatrician throughout childhood At some stage when the young person with a disability reaches early adulthood, the relationship is severed This paper draws upon recent research undertaken by the authors that describes the difficulties experienced by young people with disabilities as they go through the transition from paediatric care to adult mainstream health care services. The purpose of this article is to present the argument that the dependent, paternalistic relationship that tends to exist between young people with disabilities (and/or their carers) and paediatricians throughout childhood does not facilitate the successful negotiation of adult mainstream health care services, nor optimally promote the well-being of these young people with disabilities. It is proposed that the promotion of autonomy (or self-determination) via a well planned transition program will increase the likelihood that young adults with disabilities and/or their carers will be empowered to successfully negotiate the current mainstream health care system in Australia, and will enhance the well-being of young adults with disabilities.

Evidence-based strategies to promote physical activity among children, adolescents and young adults: review and update

This paper updates evidence reviewed in the first edition of Getting Australia Active on effective physical activity (PA) intervention strategies among children, adolescents and young adults. Intervention studies published between 1999 and September 2003 were identified using electronic databases and hand searching. A total of 28 discrete studies were identified (31 papers). Six of nine studies reported significant effects on child or youth PA in school settings. Those that incorporated whole-of-school approaches including curriculum, policy and environmental strategies appeared to be more effective than those that incorporated curriculum-only approaches. Five of 10 studies with children and two of five studies with adolescents reported increased PA or decreased sedentary behaviour in other settings. Interventions that included contact with families generally appeared to be most effective. One study with adolescents provided some evidence of the potential effectiveness of interventions based in primary care. Two of four papers reported modest short-term results among young adults, including increased PA stage of change or a higher likelihood of being adequately physically active, but none showed any evidence of sustained increases in PA. There is an urgent need for additional studies examining interventions aimed at young adults. Across the three life stages, future studies should include objective PA measures, longer-term follow-up, larger sample sizes, a specific focus on PA (rather than weight) and culturally-specific strategies that build evidence in Australian populations. Future studies should target high risk groups and a broad range of settings and strategies focusing on reducing sedentary behaviours as well as increasing PA.

Increasing central adiposity: the Nepean longitudinal study of young people aged 7-8 to 12-13y

BACKGROUND: Estimates of the prevalence of overweight and obesity in young people are typically based on body mass index (BMI). However, BMI may not indicate the level of central adiposity. Waist circumference has therefore been recommended to identify young people at risk of morbidity associated with central adiposity.

OBJECTIVE: To investigate (a) change in total and central adiposity between 7–8 and 12–13 y (b) agreement between classifying young people as overweight or obese based on total adiposity and central adiposity, and (c) risk factors associated with the development of total and central adiposity.

DESIGN: Anthropometric measurements were taken on 342 children in 1996/97 and 5 y later. Risk factors examined included birth weight, physical activity, TV viewing, pubertal status, parental adiposity, diet and socio-economic status.

RESULTS: Between 7–8 and 12–13 y indices of central adiposity increased more than total adiposity; waist circumference z-score increased by (means.d.) 0.740.92 and BMI z-score increased by 0.180.67. At 12–13 y there was moderate agreement between the two measures of adiposity (weighted kappa=0.64). However, waist circumference identified a greater number of young people as overweight or obese compared to BMI (41.2 vs 29.3%, P<0.001). Adiposity status at 7–8 y, maternal obesity, and pubertal stage were the strongest predictors of BMI status at 12–13 y. Risk factors associated with increased central adiposity were similar.

CONCLUSIONS: Overweight and obesity, as measured by waist circumference, is a bigger problem than is currently assessed by BMI. Targeting known risk factors for total adiposity may be an appropriate strategy for preventing increased central adiposity.

To stay or to go? 'At risk' young women speak about their influences and experiences in making decisions about post-compulsory schooling

Recent research indicates that young women who leave school early (ie at or before year 10) are the group most 'at risk' of becoming only marginally attached to the labour force or unemployed. Young women from low socio-economic backgrounds are more often those who 'choose' to leave schooling, often for complex reasons, some of which are only marginally connected to their schooling experiences. In order to better understand-and address-the needs of this cohort, it is necessary to examine the multi layered connections between students' lives in and out of school.

This paper reports on the initial stage of a three year ARC-funded study, 'Young women negotiating from the margins of education and work.' In interviews and focus groups, young women identified as 'at risk' of leaving school early speak about the factors that have influenced their decisions. We examine the data with specific reference to the question: what type of social capital do these young women deploy in making their choices? Recent research (Croninger & Lee, 2001) suggest that teachers' support and guidance are a form of social capital that can make a difference, particularly in regards to students from lower socio-economic backgrounds. We discuss the young women's and teachers' interview data in light of recent debates about social capital and education.

Psychosocial factors and survival of young women with breast cancer: a population-based prospective cohort study

Purpose: Most women with early-stage breast cancer believe that psychosocial factors are an important influence over whether their cancer will recur. Studies of the issue have produced conflicting results.

Patients and Methods: A population-based sample of 708 Australian women diagnosed before age 60 years with nonmetastatic breast cancer was observed for a median of 8.2 years. Depression and anxiety, coping style, and social support were assessed at a median of 11 months after diagnosis. Hazard ratios for distant disease-free survival (DDFS) and overall survival (OS) associated with psychosocial factors were estimated separately using Cox proportional hazards survival models, with and without adjustment for known prognostic factors.

Results: Distant recurrence occurred in 209 (33%) of 638 assessable patients, and 170 (24%) of 708 patients died during the follow-up period. There were no statistically significant associations between any of the measured psychosocial factors and DDFS or OS from the adjusted analyses. From unadjusted analyses, associations between greater anxious preoccupation and poorer DDFS and OS were observed (P = .02). These associations were no longer evident after adjustment for established prognostic factors; greater anxious preoccupation was associated with younger age at diagnosis (P = .03), higher tumor grade (P = .02), and greater number of involved axillary nodes (P = .008).

Conclusion: The findings do not support the measured psychosocial factors being an important influence on breast cancer outcomes. Interventions for adverse psychosocial factors are warranted to improve quality of life but should not be expected to improve survival.

Basic symptoms in young people at ultra high-risk of psychosis

Basic Symptoms are cognitive and emotional disturbances characteristic of the early stage of psychosis. This study established the utility of an instrument to identify Basic Symptoms amongst young people at high-risk for developing psychosis, thereby facilitating the pathway to treatment for these individuals. The portfolio focuses on how having an unwell parent contributes to and influences the development of psychopathology in offspring. The four clinical case studies are presented in detail, and the intervention strategies for each individual are evaluated.

Learning between schools and hospitals – young people and a curriculum of (dis)connection

As noted in other papers in this volume, a group of health and education researchers and practitioners came together to further develop their understanding of the situation of young people, who were clients of The Royal Children's Hospital Education Institute in 2007 in Melbourne, Australia. The resultant research project, funded by the Australian Research Council Linkage Grant, aimed to understand young people's perspectives on who they are and what matters to them in relation to education connectedness, identity, social relationships, and experiences with professionals. The project team was aware of the persisting patterns of relationships between the hospital, schools, young people, and their families. They were also cognizant of the heavy emphasis in the research and professional literature on evidence from relevant family adults and from health and education professionals. The intention of this project was to put the young people at the centre a study with the stories they told through word and image. Identity issues and school connections framed the analytical work. Thirty-one adolescents dealing with chronic illness participated in this longitudinal qualitative study for a 3-year period of their lives. Given the apparently active role of teachers and health professionals in the lives of these young people, the researchers wanted to include the various relevant adults to see what coherence or lack of coherence existed in the categories, emphases, and values they expressed compared with those of the young people. The researchers have had to determinedly keep their focus on the data from the young people and not be seduced by the familiar and readily accessible data from these professionals. Nonetheless, this data set does provide a ‘curriculum conversation’, which is profitably read behind the stories of the young people and in the foreground of new pathways of curriculum construction. It is this data which informs the work reported in this paper and which has led the researchers to resist the rhetoric of currently held story lines in this field, to see beyond the present hierarchies of power over relevant ‘knowledges’, to maintain a dual focus with the young people at centre stage and the professionals as ‘walk ons /extras’ and to argue for a ‘curriculum of connection’ between young people and the relevant education and health professionals. These issues are readily engaged in arguments for change through the interweaving of larger discourses of inclusivity, curriculum, and policy. This paper works those intersections in the everyday positionings of professionals and young people.