Sexual dimorphism in cancer.

The incidence of many types of cancer arising in organs with non-reproductive functions is significantly higher in male populations than in female populations, with associated differences in survival. Occupational and/or behavioural factors are well-known underlying determinants. However, cellular and molecular differences between the two sexes are also likely to be important. In this Opinion article, we focus on the complex interplay that sex hormones and sex chromosomes can have in intrinsic control of cancer-initiating cell populations, the tumour microenvironment and systemic determinants of cancer development, such as the immune system and metabolism. A better appreciation of these differences between the two sexes could be of substantial value for cancer prevention as well as treatment.

Coneixements, actituds i percepció versus la infecció per Virus del Papil·loma Humà en els professionals d'infermeria : tendències en salut pública

Actualment, s’evidencia una dificultat en el seguiment estricte de les infeccions de transmissió sexual (ITS). A nivell mundial, aquestes causen un problema de Salut Pública (SP) en termes de morbiditat i mortalitat per complicacions i seqüeles que es poden originar si no es diagnostiquen i no es tracten adequadament. Entre les ITS més comunes trobem la provocada pel Virus del Papil·loma Humà (VPH), la principal causant del càncer de cèrvix, entre altres complicacions La família de VPH compta amb més de 150 tipus virals. El coneixement de la situació epidemiològica de la infecció per VPH es veu dificultada per varis aspectes: el caràcter asimptomàtic; l’estigma social; les dificultats diagnòstiques; la falta de homogeneïtat dels sistemes de vigilància amb la infradeclaració de casos. Ens trobem en una inversemblança constant. Les intervencions des de SP, ja sigui a nivell nacional com regional, sónpròpiament enfocades a la prevenció de la malaltia. Paral·lelament, la incidència de les ITS continua amb una tendència ascendent, cosa que provoca una inquietant preocupació. Partint de la problemàtica exposada, el present estudi pretén identificar elsconeixements que tenen els professionals d’infermeria de l’atenció primària en relació a la infecció de transmissió sexual pel virus del papil·loma humà i quina és la seva percepció i actitud sobre l’atenció a l’usuari. Es tractarà d’un estudi multicèntric amb disseny descriptiu transversal. La instrumentació es farà mitjançant una enquesta totalment anònima sobre una mostra aproximada de 115 professionals d’infermeria que durant l’any 2013 que treballen a les àrees bàsiques de salut (ABS) de l’Institut Català de la Salut (ICS) del Gironès. Aquest estudi vol fer visible la necessitat d’incrementar la formació dels professionals d’infermeria en relació a la infecció VPH i el requeriment d’un consell addicional que promogui la salut encaminat a empoderar a la comunitat mitjançant educació per a la salut

A qualitative analysis of immigrant population health practices in the Girona Healthcare Region

The research we present here forms part of a two-phase project - one quantitative and the other qualitative - assessing the use of primary health care services. This paper presents the qualitative phase of said research, which is aimed at ascertaining the needs, beliefs, barriers to access and health practices of the immigrant population in comparison with the native population, as well as the perceptions of healthcare professionals. Moroccan and sub-Saharan were the immigrants to who the qualitative phase was specifically addressed. The aims of this paper are as follows: to analyse any possible implications of family organisation in the health practices of the immigrant population; to ascertain social practices relating to illness; to understand the significances of sexual and reproductive health practices; and to ascertain the ideas and perceptions of immigrants, local people and professionals regarding health and the health system. Methods: qualitative research based on discursive analysis. Data gathering techniques consisted of discussion groups with health system users and semi-structured individual interviews with healthcare professionals. The sample was taken from the Basic Healthcare Areas of Salt and Banyoles (belonging to the Girona Healthcare Region), the discussion groups being comprised of (a) 6 immigrant Moroccan women, (b) 7 immigrant sub-Saharan African women and (c) 6 immigrant and native population men (2 native men, 2 Moroccan men and 2 sub-Saharan men); and the semi-structured interviews being conducted with the following healthcare professionals: (a) 3 gynaecologists, (b) 3 nurses and 1 administrative staff. Results: use of the healthcare system is linked to the perception of not being well, knowledge of the healthcare system, length of time resident in Spain and interiorization of traditional Western medicine as a cure mechanism. The divergences found among the groups of immigrants, local people and healthcare professionals with regard to healthcare education, use of the healthcare service, sexual and reproductive healthcare and reticence with regard to being attended by healthcare personnel of the opposite sex demonstrate a need to work with the immigrant population as a heterogeneous group. Conclusions: the results we have obtained support the idea that feeling unwell is a psycho-social process, as it takes place within a specific socio-cultural situation and spans a range of beliefs, perceptions and ideas regarding symptomology and how to treat it

Sexual dimorphism of sonic apparatus and extreme intersexual variation of sounds in Ophidion rochei (Ophidiidae): first evidence of a tight relationship between morphology and sound characteristics in Ophidiidae

Many Ophidiidae are active in dark environments and display complex sonic apparatus morphologies. However, sound recordings are scarce and little is known about acoustic communication in this family. This paper focuses on Ophidion rochei which is known to display an important sexual dimorphism in swimbladder and anterior skeleton. The aims of this study were to compare the sound producing morphology, and the resulting sounds in juveniles, females and males of O. rochei.Results: Males, females, and juveniles possessed different morphotypes. Females and juveniles contrasted with males because they possessed dramatic differences in morphology of their sonic muscles, swimbladder, supraoccipital crest, and first vertebrae and associated ribs. Further, they lacked the ‘rocker bone’ typically found in males. Sounds from each morphotype were highly divergent. Males generally produced non harmonic, multiple-pulsed sounds that lasted for several seconds (3.5 ± 1.3 s) with a pulse period of ca. 100 ms. Juvenile and female sounds were recorded for the first time in ophidiids. Female sounds were harmonic, had shorter pulse period (±3.7 ms), and never exceeded a few dozen milliseconds (18 ± 11 ms). Moreover, unlike male sounds, female sounds did not have alternating long and short pulse periods. Juvenile sounds were weaker but appear to be similar to female sounds.Conclusions: Although it is not possible to distinguish externally male from female in O. rochei, they show a sonic apparatus and sounds that are dramatically different. This difference is likely due to their nocturnal habits that may have favored the evolution of internal secondary sexual characters that help to distinguish males from females and that could facilitate mate choice by females. Moreover, the comparison of different morphotypes in this study shows that these morphological differences result from a peramorphosis that takes place during the development of the gonads

Supporting older people’s independent living at home through social and health care collaboration

Tässä tutkimuksessa tarkasteltiin ikäihmisten kotona asumista sosiaali- ja terveydenhuollon yhteistyön näkökulmasta. Tutkimuksen tarkoituksena oli lisätä ymmärrystä iäkkäiden kotihoidon asiakkaiden voimavaroista arjesta selviytymisen näkökulmasta, ja tutkia miten asiakkaiden hoito sosiaali- ja terveydenhuollon yhteistyönä toteutuu. Tutkimus oli poikkileikkaustutkimus, jossa sovellettiin kuvailevaa ja vertailevaa tutkimusasetelmaa. Tutkimusaineisto kerättiin yhden länsisuomalaisen kunnan kotihoidon asiakkailta (≥65 v.) ja heitä hoitavilta ammattihenkilöiltä. Kotihoidon 21 iäkästä asiakasta kuvasivat omia voimavarojaan arjesta selviytymisen näkökulmasta sekä kokemuksiaan hoidon toteutumisesta ammattihenkilöiden yhteistyönä. Aineisto kerättiin avoimella haastattelulla ja analysoitiin sisällön analyysillä. Lisäksi 25 kotihoidon ammattihenkilöä: 13 kotipalvelun työntekijää, 11 kotisairaanhoitajaa ja lääkäri kuvasivat kokemuksiaan iäkkään asiakkaan hoidon toteutumisesta ammattihenkilöiden yhteistyönä. Aineisto kerättiin fokusryhmähaastattelulla ja analysoitiin sisällön analyysillä. Näiden tulosten sekä aikaisemman kirjallisuuden perusteella laadittiin strukturoitu kyselylomake, jolla analysoitiin ja vertailtiin asiakkaiden ja ammattihenkilöiden näkemyksiä siitä, miten asiakkaiden hoito sosiaali- ja terveydenhuollon yhteistyönä toteutui. Esitestausten jälkeen kyselylomake lähetettiin 200 kotihoidon asiakkaalle ja 570 heitä hoitavalle kotihoidon työntekijälle: 485 kotipalvelun työntekijälle, 81 kotisairaanhoitajalle ja 4 lääkärille. Kyselyyn vastasi 120 asiakasta (60 %) ja 370 ammattihenkilöä (65 %). Ryhmien välisten erojen tarkastelussa käytettiin ristiintaulukointia, Pearsonin khin neliötestiä ja Fisherin tarkan todennäköisyyden testiä. Iäkkäiden asiakkaiden kuvauksissa voimavarat muodostuivat elämänhallinnan tunteesta ja toimintatahdon säilymisestä. Asiakkaat ammensivat arkeen voimaa harrastuksista ja sosiaalisesta verkostosta, mutta ulkopuolisten asettamat elämisen ehdot, terveydentilan heikkeneminen sekä yksinäisyys asettivat ikäihmisen ja hänen voimavaransa suurten haasteiden eteen. Tulokset osoittivat, että ammattihenkilöiden toiminta oli osittain ristiriidassa ikäihmisten omien odotusten kanssa, eikä se kaikilta osin tukenut asiakkaiden omia voimavaroja. Ammattihenkilöt tekivät hoitoon liittyviä päätöksiä ja toimintoja asiakkaiden puolesta, vaikka asiakkaille itselleen oli tärkeää elämänhallinnan tunne ja toimintatahdon säilyminen. Asiakkaiden voimavarojen tukemista moniammatillisena yhteistyönä vaikeuttivat ammattihenkilöiden vaikeus tunnistaa asiakkaiden omia voimavaroja sekä niitä uhkaavia tekijöitä, tiedon kulun ongelmat, tavoitteeton ja epäyhtenäinen tapa toimia sekä ammattihenkilöiden vastakkain asettuvat näkemyserot ja toimintatavat. Asiakkaiden ja ammattihenkilöiden näkemykset toteutetusta hoidosta erosivat toisistaan tilastollisesti merkitsevästi (p<0.05). Asiakkaat arvioivat sekä itsenäiseen toimintaan tukemisen että fyysisen, psyykkisen ja sosiaalisen tuen toteutuneen työntekijöitä huonommin. Yhteistyön kehittämishaasteita kotihoidossa ovat asiakkaan oman elämänsä asiantuntijuuden vahvistaminen, toimintakulttuurin muuttaminen asiakaslähtöiseksi tavoitteelliseksi toiminnaksi, ammattihenkilöiden roolien ja vastuun selkiyttäminen sekä tiedon kulun menetelmien kehittäminen. Tutkimus vahvistaa gerontologisen hoitotieteen tietoperustaa ja tuottaa uutta tietoa, jota voidaan soveltaa sosiaali- ja terveysalan koulutuksessa ja johtamisessa

Classification, comorbidity, heredity, and risk factors of female sexual dysfunctions

Female sexual dysfunctions, including desire, arousal, orgasm and pain problems, have been shown to be highly prevalent among women around the world. The etiology of these dysfunctions is unclear but associations with health, age, psychological problems, and relationship factors have been identified. Genetic effects explain individual variation in orgasm function to some extent but until now quantitative behavior genetic analyses have not been applied to other sexual functions. In addition, behavior genetics can be applied to exploring the cause of any observed comorbidity between the dysfunctions. Discovering more about the etiology of the dysfunctions may further improve the classification systems which are currently under intense debate. The aims of the present thesis were to evaluate the psychometric properties of a Finnish-language version of a commonly used questionnaire for measuring female sexual function, the Female Sexual Function Index (FSFI), in order to investigate prevalence, comorbidity, and classification, and to explore the balance of genetic and environmental factors in the etiology as well as the associations of a number of biopsychosocial factors with female sexual functions. Female sexual functions were studied through survey methods in a population based sample of Finnish twins and their female siblings. There were two waves of data collection. The first data collection targeted 5,000 female twins aged 33–43 years and the second 7,680 female twins aged 18–33 and their over 18–year-old female siblings (n = 3,983). There was no overlap between the data collections. The combined overall response rate for both data collections was 53% (n = 8,868), with a better response rate in the second (57%) compared to the first (45%). In order to measure female sexual function, the FSFI was used. It includes 19 items which measure female sexual function during the previous four weeks in six subdomains; desire, subjective arousal, lubrication, orgasm, sexual satisfaction, and pain. In line with earlier research in clinical populations, a six factor solution of the Finnish-language version of the FSFI received supported. The internal consistencies of the scales were good to excellent. Some questions about how to avoid overestimating the prevalence of extreme dysfunctions due to women being allocated the score of zero if they had had no sexual activity during the preceding four weeks were raised. The prevalence of female sexual dysfunctions per se ranged from 11% for lubrication dysfunction to 55% for desire dysfunction. The prevalence rates for sexual dysfunction with concomitant sexual distress, in other words, sexual disorders were notably lower ranging from 7% for lubrication disorder to 23% for desire disorder. The comorbidity between the dysfunctions was substantial most notably between arousal and lubrication dysfunction even if these two dysfunctions showed distinct patterns of associations with the other dysfunctions. Genetic influences on individual variation in the six subdomains of FSFI were modest but significant ranging from 3–11% for additive genetic effects and 5–18% for nonadditive genetic effects. The rest of the variation in sexual functions was explained by nonshared environmental influences. A correlated factor model, including additive and nonadditive genetic effects and nonshared environmental effects had the best fit. All in all, every correlation between the genetic factors was significant except between lubrication and pain. All correlations between the nonshared environment factors were significant showing that there is a substantial overlap in genetic and nonshared environmental influences between the dysfunctions. In general, psychological problems, poor satisfaction with the relationship, sexual distress, and poor partner compatibility were associated with more sexual dysfunctions. Age was confounded with relationship length but had over and above relationship length a negative effect on desire and sexual satisfaction and a positive effect on orgasm and pain functions. Alcohol consumption in general was associated with better desire, arousal, lubrication, and orgasm function. Women pregnant with their first child had fewer pain problems than nulliparous nonpregnant women. Multiparous pregnant women had more orgasm problems compared to multiparous nonpregnant women. Having children was associated with less orgasm and pain problems. The conclusions were that desire, subjective arousal, lubrication, orgasm, sexual satisfaction, and pain are separate entities that have distinct associations with a number of different biopsychosocial factors. However, there is also considerable comorbidity between the dysfunctions which are explained by overlap in additive genetic, nonadditive genetic and nonshared environmental influences. Sexual dysfunctions are highly prevalent and are not always associated with sexual distress and this relationship might be moderated by a good relationship and compatibility with partner. Regarding classification, the results supports separate diagnoses for subjective arousal and genital arousal as well as the inclusion of pain under sexual dysfunctions.

Late effects of cancer at a young age: Registry-based studies of the health of cancer patients and their off-spring

Modern cancer therapy has resulted in increased survival among patients diagnosed with cancer at a young age. These improvements have led to the investigation of late morbidity and mortality associated with cancer and its treatments. The aim of this study was to evaluate late effects of cancer treated at a young age on the health of patients and their offspring. Utilising the nationwide population-based registries in Finland, we evaluated the risk of hypothyroidism and the probability of parenthood in cancer survivors as well as preterm birth, neonatal outcomes, and the risk of cancer among offspring of patients. The survivor cohort, identified from the Finnish Cancer Registry, consisted of 25,784 cancer patients diag-nosed between ages 0 and 34 in 1953–2004. By linkage to the population register, siblings of these patients were identified for comparison. The prevalence of hypothyroidism was higher among former childhood cancer (aged 0–16) patients than in the general population. The probability of parenthood following early onset cancer was overall significantly reduced compared to siblings. Offspring of female cancer survivors were at an increased risk of preterm birth, this risk being highest among patients diagnosed in childhood and early adulthood (aged 20–34 years). The offspring were not, however, at a significantly increased risk of neonatal death or stillbirth, though they were more likely to need monitoring or intensive care in the neonatal period. The risk of sporadic cancer among offspring of male and female cancer survivors was not elevated in comparison to the general population. The study showed that former cancer patients are at risk of certain adverse endocrine and reproductive health outcomes and should be followed for timely intervention. The offspring of cancer survivors do not appear to be at risk for adverse health outcomes.

Venäläistä rulettia – Nuorten perhesuunnittelun esteet ja tarpeet Pietarissa ja Riiassa

Latviassa ja Venäjällä heikko demografinen tilanne on lisännyt keskustelua seksuaali- ja kansalaisoikeuksista sekä valtion merkityksestä niiden toteuttamisessa. Väestöpolitiikassa näkyy yhteiskunnallinen tilanne sekä sen kyky ja mahdollisuudet huomioida nuorten perhesuunnitteluun liittyviä tarpeita. Huomion kohteena on myös palvelujärjestelmä ja siinä toteutuva yksilöllinen taso. Tutkin perhesuunnittelua kokonaisvaltaisesti, mikä ilmenee erilaisten polkuriippuvuuksien tarkasteluina. Mielenkiintoiseksi kohteen tekee entisten sosialististen valtioiden erityislaatuisen murroksen läpikäyminen. Perhesuunnittelu on osa seksuaali- ja ihmisoikeuksia. Siihen kuuluu seksuaaliterveydestä tiedottaminen ja ohjaus sekä siihen liittyvät toimenpiteet. Perhesuunnittelu sisältää niin sosiaaliset, kasvatukselliset kuin lääketieteellisetkin näkökulmat. Siihen liitetään myös moraalisia ja taloudellisia näkemyksiä, sekä politiikkaa ja henkilökohtaisuutta. Tutkimustehtäväni on nuorten perhesuunnittelun esteet ja tarpeet Riiassa ja Pietarissa. Sovellan metodologisena lähestymistapana sosiaalihistoriallista ja etnografista tutkimusotetta, jolloin perinteen vaikutusten, kulttuuristen rakenteiden ja yksilöllisten toimintatapojen ymmärtäminen mahdollistuu. Aineisto koostuu viranomaishaastatteluista sosialismin kaudella toteutuneesta sekä nykyisestä perhesuunnittelusta ja nuorten haastatteluista Pietarissa ja Riiassa. Perehdyn myös lisääntymisterveyteen liittyviin sanomalehtiartikkeleihin sekä Latviassa että Venäjällä. Lisäksi havainnoin seksuaalineuvontatilanteita Pietarissa. Sekä sosialismin aikana että nykyään painottuvat väestönkasvun odotukset, joita tuetaan sukupuoli- ja moraalikasvatuksen avulla. Perhesuunnittelun esteiden analyysin tuloksissa on nähtävissä sosiaalisten olosuhteiden ja rakenteiden merkitys. Jälkisosialistisesta riskiyhteiskunnasta puuttuvat yhteiskuntaan integroitumisen mahdollistavat instituutiot. Tämä ilmenee yhteiskunnallisena vastuuttomuutena. Universaalit palvelut ovat suurelta osin peräisin sosialismin ajalta. Kaupalliset yritykset tekevät lähinnä teknisiä, yksittäisiä ehkäisyvälineisiin liittyviä interventioita nuorten elämään. Teini-ikäiset jätetään oman harkintansa varaan. Latviassa perhesuunnitteluun liittyvä ennalta ehkäisevä toiminta on huomioitu uudessa lisääntymisterveyslaissa, mutta sen heikko toteutus tuo sen lähelle neuvostoaikaista kulttuurikonventiota, jossa määrällisillä suoritteilla ja sekundaaripreventiolla on arvoa. Venäjällä voimavarat kohdentuvat jälkihuollon palveluihin. Foucaultin valta-analyysi kertoo strategiasta, jossa ihminen sisäistää vallankäytön osaksi omaa ajatteluaan ja toimintaansa. Tässä näkökulmassa yksilöllinen, yhteiskunnallinen ja historiallinen ulottuvuus limittyvät toisiinsa. Vallan muodot ovat yhteiskunnan rakenteissa. Väestöpolitiikan avulla tuotetaan tietoa ja muovataan hallitsemisen kohteita. Osa haastatelluista nuorista omaksui yhteiskunnan passiivisuuden osaksi omaa toimintaansa. He eivät tiedostaneet palvelujärjestelmän puutteita eivätkä kyseenalaistaneet sen oikeutusta. Myös lehtiartikkelit ja viranomaishaastattelut tukivat osittain seksuaalikasvatuksen sivuuttamista. Silloin hyväksyttävänä totuutena pidettiin väestöpolitiikkaa, jossa on annettu tilaa populistisille suuntauksille. Sekä Latviassa että Venäjällä ilmaistiin tavoitteita väestön kasvusta. Kansainvälisten seksuaalioikeuksien maihinnousu ei ole poistanut ääri uskonnollisten ja osittain kansalaisjärjestöjen puitteissa tapahtuvaa perhesuunnittelun vastustusta. Näissä suuntauksissa vaikutetaan ihmisten moraaliin ja vastustetaan yhteiskunnan interventioita kieltämällä seksuaalikasvatus. Sosialismin aikana sosiaali- ja terveydenhuoltoa toteutettiin totalitaristisessa, suljetussa yhteiskunnassa tiukasti rajatuilla voimavaroilla. Tuolta ajalta peräisin oleva viranomaisten yleinen medikalisoitunut ja tekninen lähestymistapa estää osittain nuoren valtaistumista. Vieläkin heikko tiedottaminen ja puutteellinen koulutus vaikuttavat ammattilaisten keskuudessa. Yksi haitallisista perhesuunnitteluun kuuluvista uskomuksista oli hormonaalisen ehkäisyn aiheuttamat ongelmat. Lisäksi pelättiin heikkotasoisesti tehtyjen aborttien aiheuttavan hedelmättömyyttä. Uskomukset ovat eläneet vieläkin, kun osa asiantuntijoista kannusti ensimmäisen raskauden päättymistä synnytykseen. Näillä käsityksillä on ollut taipumus siirtyä sukupolvelta toiselle myös kansalaisten keskuudessa. Sukuyhteisöjen ja verkostojen oleellinen merkitys teini-ikäisen arjessa ja selviytymisessä painotti perinteistä sosialisaatiota. Uskomusten lisäksi nuorten heikko taloudellinen tilanne on ohjannut heitä ehkäisyssä luonnonmenetelmien käyttöön. Neuvostoaikainen seksuaalikielteisyyden perinne on vaikuttanut myös sukupolvien kyvyttömyyteen keskustella aiheesta. Yleisen ennaltaehkäisevän neuvonnan puuttuminen on suunnannut suurta osaa nuoria mallioppimiseen, jossa esimerkit ovat nousseet satunnaisista löydöistä. Toisaalta työntekijöiden neuvokkuus ja aloitteellisuus erilaisissa ohjaamistilanteissa, toimintatavoissa ja instituutioiden perustamisissa kuvaavat eettistä vastuunottoa ja paneutumista nuorten perhesuunnittelun toteutumiseen sekä sen mahdollisuuksiin. Perhesuunnitteluun liittyvän tiedonsaannin parantamiseksi viranomaiset ovat aloittaneet nuorten vertaisryhmiä. Lisäksi yhtenä uutena virallisena lähestymistapana oli neuvostoaikana kielletty psykoterapeuttisen suuntauksen avoin käyttöönotto. Myös nuorille suunnattuja palveluja niin lainsäädännön kuin instituutioiden tasolla on saatu aikaan. Nämä myönteiset tapaukset jäivät kuitenkin yksittäisiksi, osittain joidenkin työntekijöiden omakohtaisen sitoutumisen varaan toimiviksi. Tutkimuksessa nousee esiin yhteiskunnan vastuu erityisesti haavoittuvien ryhmien kohdalla. Nuoret ovat tiedoiltaan ja kokemuksiltaan heikossa asemassa. Sosiaalipoliittisesta näkökulmasta julkisilla ja ennaltaehkäisevillä palveluilla on keskeinen merkitys etenkin niiden kohdalla, jotka tarvitsevat runsaasti palveluja. Usein tähän ryhmään kuuluvat ovat passiivisia tiedon hakijoita. Tutkimus tuo esille perhesuunnittelun palvelujärjestelmään ja sen kohderyhmään kuuluvan moniulotteisuuden, jossa toisiinsa nivoutuvat kulttuuriset myytit, uskomukset, tabut, toimintatavat ja tietämys. Näiden polkujen avaaminen tässä tutkimuksessa edistää perhesuunnittelun esteiden tunnistamista ja niihin soveltuvien ratkaisukeinojen löytymistä.

Health Related Quality of Life after Childhood Cancer - A Finnish Nationwide survey

The purpose of this Finnish epidemiological nationwide cross-sectional study was to evaluate the Health Related Quality of Life (HRQL) of young people that have survived childhood cancer at least four years after cancer diagnosis. The study aims were (1) to increase knowledge and understanding about the relationship between childhood cancer and its treatment and HRQL of childhood cancer survivors and (2) to identify survivors who need and could benefit from ongoing long-term follow-up, as well as (3) to identify what kind of aftercare the childhood cancer survivors will possibly need. HRQL and fatigue of currently still young survivors of extracranial childhood malignancies were evaluated with self-reports and parent proxy reports. HRQL was measured with age-appropriate generic instruments: PedsQL™, SF-36, 15D, 16D and 17D. Fatigue for children and adolescents aged below 18 years was measured with the PedsQL™ Multidimensional Fatigue Scale Finnish version. PedsQL™ parent-proxy and the PedsQL™ Multidimensional Fatigue Scale Parentproxy instruments were used to assess the perception of the parents on HRQL and fatigue of their children and adolescents. Postal-survey questionnaires were mailed to 852 childhood cancer survivors aged 11-27 years and their randomly selected gender-, age and living-place matched controls, as well as under 18-year-old children´s parents. A total of 474 survivors, 595 controls, 209 survivor’s parent and 253 control’s parent replied. The mean age of survivors at the time of the study was 18.4 years. The mean length of survival was 12.3 years, and the mean age at diagnosis 5.5 years. The most of the Finnish childhood cancer survivors evaluated that their HRQL as good. Survivors rated their HRQL equal or higher than their controls. The only dimension where the survivors scored poorer than the controls was the 15D mobility dimension. Survivors of childhood cancer did not suffer from significant fatigue. There were subgroups of childhood cancer survivors who had poorer level of HRQL, and suffered from fatigue more than the reference group. The demographic factors that associated with poorer HRQL were female gender, greater weight, living alone, need of remedial education, an additional non-cancer diagnosis, survivors with siblings, and self-reported unhappiness. Disease-related factors that associated with poorer HRQL were higher age at the time of diagnosis, the diagnosis of Wilms tumor, neuroblastoma, or osteosarcoma, and treatment with stem cell transplantation. The factors associated with more fatigue in survivors were male gender, older age at evaluation, the need of remedial education at school, lower overall average grade in the latest school marks report, length of survival more than 10 years, lower HRQL-scores, and a sarcoma diagnosis. However, all the used demographic and disease related factors explained only about one third of the variation in the HRQL scores. In open questions, the survivors were most worried about their physical health, but were also worried about their mental health, cancer inheritance, late-effects, and fertility and relapse issues. It seems that there are subgroups of survivors who need and could benefit from ongoing long-term follow-up. In the future, the survivors of childhood cancer need more information about their physical and mental health, as well as on their cancer inheritance, possible late-effects including fertility issues, and on the risk of relapse.

Tradução para português, adaptação cultural e validação do Female Sexual Function Index

OBJETIVO: traduzir para o português, adaptar culturalmente e validar o questionário Female Sexual Function Index (FSFI). MÉTODOS: dois tradutores brasileiros, cientes dos objetivos desta pesquisa, preparam duas versões do FSFI para o português, as quais foram retro-traduzidas por outros dois tradutores ingleses. As diferenças foram harmonizadas e pré-testadas em um estudo piloto. As versões finais do FSFI e de outro questionário, o Short-Form Health Survey, já vertido e publicado em português, foram simultaneamente administradas a cem pacientes. Foram testadas as propriedades psicométricas do FSFI, como confiabilidade (consistência interna e teste-reteste) e validades de construto. O reteste foi realizado após quatro semanas, a partir da primeira entrevista. RESULTADOS: o processo de adaptação cultural não alterou a versão em português do FSFI comparado ao original. O alfa de Cronbach padronizado do questionário foi 0,96; avaliado por domínios, variou de 0,31 a 0,97. Como medida de confiabilidade teste-reteste, foi aplicado o coeficiente de correlação intra-classes, que foi considerado forte e idêntico (1,0). O coeficiente de correlação de Pearson entre o FSFI e o Short-Form Health Survey foi positivo, mas fraco na maioria dos domínios afins, variando de 0,017 a 0,036. CONCLUSÕES: a versão do FSFI foi traduzida para o português e adaptada culturalmente e é válida para avaliação da resposta sexual das mulheres brasileiras.

Foot Health In Older People - Development of a preventive, evaluative instrument for nurses

Foot health is a part of overall health in every age group and its importance increases during ageing. Health care professionals are in a vital position for preventing foot health problems, and identifying and caring them in older people. Despite the rather high number of studies conducted in the field of foot health in older people, reliable and valid nurse-administered foot health assessment instruments seem to be lacking. By identifying foot health in older people, it is possible to develop nursing interventions to enhance safe, independent living at home. The purpose of this three-phase study was to develop an instrument to assess the level of foot health in older people and evaluate foot care practices from the perspective of older people themselves and nurses in home care. The ultimate goal is to prevent foot health problems by increasing the attention paid to older people’s feet and recognizing those foot health problems which need further care; thus not focus on different foot health problems. The study was conducted in different phases and contexts. In phase 1, a descriptive design with a literature review from the Medline (R) and CINAHL databases to explore foot health in older people and nurses’ role in foot health care and pre-post design intervention study in nursing home with nursing staff (n=16) and older residents (n=43) were conducted. In phase 2, a descriptive and explorative study design was employed to develop an instrument for assessing foot health in older people (N=651, n=309, response rate 47%) and explore the psychometrics of the instrument. The data were collected from sheltered housing and home care settings. Finally, in phase 3, descriptive and explorative as well as cross-sectional correlational survey designs were used to assess foot health and evaluate the foot self-care activities of older people (N=651, n=309, response rate 47%) and to describe foot care knowledge and caring activities of nurses (N=651, n=322, response rate 50%) in home care in Finland. To achieve this, the Foot Health Assessment Instrument (FHAI) developed in phase 2 was used; at the same time, this large sample also was used for the psychometric evaluation of the FHAI. The data analysis methods used in this study were content analysis, descriptive and inferential statistics including factor and multivariate analysis. Many long-term diseases can manifest in feet. Therefore, the FHAI, developed in this study consisted of items relating to skin and nail health, foot structure and foot pain. The FHAI demonstrated acceptable preliminary psychometric properties. A great deal of different foot health problems in older people were found of which edema, dry skin, thickened and discoloured toenails and hallux valgus were the most prevalent foot health problems. Moreover, many older people had difficulties in performing foot self-care. Nurses’ knowledge of foot care was insufficient and revealed a need for more information and continuing education in matters relating to foot care in older people. Instead, nurses’ foot care activities were mainly adequate, though the findings indicate the need for updating foot care activities to correspond with the evidence found in the field of foot care. Practical implications are presented for nursing practice, education and administration. In future, research should focus on developing interventions for older people and nurses to promote foot health in older people and to prevent foot health problems, as well as for further development of the FHAI.

Pain symptoms and sleep problems among school-aged children. Long-term prevalence changes, and pain symptoms as predictors of later mental health

Children’s pain symptoms and sleep problems are among the most common health complaints. They distract children from activities, decrease the quality of life, contribute to a significant economic burden, and have shown continuity into adulthood. The main aims of this thesis were to investigate long-term changes in the prevalence of pain symptoms and sleep problems among Finnish school-aged children, and the later mental health of those who in childhood experience pain. Prevalence, co-occurrence, and associated psychosocial factors of pain symptoms and sleep problems were also assessed. In study I, prevalence changes in eight-year-old children’s pain symptoms and sleep problems were investigated in three cross-sectional population-based samples (years 1989: n=1038, 1999: n=1035, and 2005: n=1030). In study II, cross-sectional associations between pain symptoms, sleep problems, and psychosocial factors were assessed among 13-18-year-old adolescents (n=2476). In studies III and IV, associations between pain symptoms at age eight (n=6017), and register-based data on antidepressant use and severe suicidality by age 24, were examined in a nationwide birth cohort. Pain symptoms and sleep problems were common and often co-occurred. A considerable number of children’s pain symptoms remained unrecognized by the parents. The prevalence of pain symptoms, sleep problems, and multiple concurrent symptoms approximately doubled from 1989 to 2005. Psychiatric difficulties or demographic factors did not explain the increase. Psychosocial factors that were associated with pain, sleep problems, and a higher number of symptoms, were female sex, psychological difficulties, emotional symptoms, smoking, victimization, and feeling not cared about by teachers. In longitudinal analyses, the child’s own report of headache, and to a smaller degree the parental report of the child’s abdominal pain predicted later antidepressant use. Parental report of the child’s abdominal pain predicted severe suicidality among males. If one of the symptoms is present, health care professionals should inquire about other symptoms as well. Questions should be directed to the children, not only to their parents. Inquiring about psychiatric difficulties, substance use, victimization, and relations with teachers should be included as a part of the assessment. Further studies are needed to clarify the reasons that underlie the increased prevalence rates, and the factors that may increase or decrease the risk for later mental health problems among pain-suffering children.

Prevalence and risk factors for HBV, HCV and HDV infections among injecting drug users from Rio de Janeiro, Brazil

Viral hepatitis constitutes a major health issue, with high prevalence among injecting drug users (IDUs). The present study assessed the prevalence and risk determinants for hepatitis B, C and D viruses (HBV, HCV and HDV) infections among 102 IDUs from Rio de Janeiro, Brazil. Serological markers and HCV-RNA were detected by enzyme immunoassay and nested PCR, respectively. HCV genotyping was determined by restriction fragment length polymorphism analysis (RFLP). HBsAg, anti-HBc and anti-HBs were found in 7.8, 55.8 and 24.7% of IDUs, respectively. In the final logistic regression, HBV infection was independently associated with male homosexual intercourse within the last 5 years (odds ratio (OR) 3.1; 95% confidence interval (CI) 1.1-8.8). No subject presented anti-delta (anti-HD). Anti-HCV was detected in 69.6% of subjects, and was found to be independently associated with needle sharing in the last 6 months (OR 3.4; 95% CI 1.3-9.2) and with longer duration of iv drug use (OR 3.1; 95% CI 1.1-8.7). These data demonstrate that this population is at high risk for both HBV and HCV infection. Among IDUs from Rio de Janeiro, unprotected sexual intercourse seems to be more closely associated with HBV infection, whereas HCV is positively correlated with high risk injecting behavior. Comprehensive public health interventions targeting this population and their sexual partners must be encouraged.

Female novelty and the courtship behavior of male guinea pigs (Cavia porcellus)

In several rodent species, an increase or recovery of sexual behavior can be observed when sexually satiated males are placed in contact with a novel mate. In order to assess the influence of female novelty on the courtship behavior of guinea pigs (Cavia porcellus), four adult males were observed during four daily 15-min sessions while interacting with the same pregnant female (same-female sessions). A new female was presented during the fifth session (switched-female session). The duration of behavioral categories was obtained from videotape records using an observational software. From the first to the second session, all males decreased the time allocated to investigating (sniffing and licking), following, and mounting the female, and that response did not recover by the end of the same-female sessions. No similar decreasing tendencies were detected in the circling or rumba categories. A marked increase of investigating occurred in all males from the last same-female session (8.1, 11.9, 15.1 and 17.3 percent session time) to the switched-female one (16.4, 18.4, 37.1 and 28.9 percent session time, respectively). Increases in following and circling were recorded in three of four males, and full-blown recovery of mounting in one male. No consistent changes in the females' responses to males (following or attacking) were observed throughout testing. These results are consistent with the hypothesis that guinea pig males recognize individual females and that courtship responses may suffer a habituation/recovery process controlled by mate novelty.

The modest but growing Brazilian presence in psychiatric, psychobiological and mental health research: assessment of the 1998-2002 period

The objective of the present survey was to assess the Brazilian scientific production in psychiatry, psychobiology, and mental health during the 1998-2002 period. The universities' graduate programs concentrate the vast majority of the scientific production in Brazil. We assessed the annual reports from the graduate programs to the Brazilian Ministry of Education concerning master's and doctoral theses and the articles published in journals indexed by the Institute of Scientific Information (ISI). There are nine Master's and Doctoral graduate programs dedicated to research in psychiatry, neuropsychiatry, psychobiology, and mental health in the country, seven being located in southern states. During the 5-year period, from 1998 to 2002, 186 students received their doctorate degree (37/year). The programs published 637 articles in journals indexed by ISI, the majority of them in journals with an impact factor higher than 2. The research advisors' productivity varied among graduate programs, ranging from 0.6 to 2.0 articles per year in ISI-indexed journals. Despite the substantial barriers faced by the Brazilian scientific community (mainly financial and writing difficulties), Brazil's scientific mental health production is on the rise. The number of articles published in ISI-indexed journals has doubled without a significant increase in the number of graduate theses, suggesting that there was an improvement in both the quality of the scientific production and the productivity of the graduate programs. Based on these data, it is reasonable to predict a tendency to an increase in production over the next few years.