Fiona Schulte

Social competence in childhood brain tumor survivors: a comprehensive review.

PurposeTo review the literature investigating the social competence outcomes of child and adolescent survivors of brain tumors.MethodsTwenty articles published between 2000 and 2009 were accessed using PsycInfo and PubMed and reviewed for their findings related to three hypothesized levels of social competence (i.e., social adjustment, social performance, social skills).ResultsCurrent evidence indicates that childhood brain tumor survivors experience decreased social adjustment following treatment. Inconsistencies among studies continue to be an obstacle for advancing the field. The operationalization of social competence requires greater attention to facilitate comparability between studies (e.g., social adjustment, social performance, social skills). The effects of child, familial, and treatment factors and their relationships are still not well understood. There is a lack of theory driven research.ConclusionsMany childhood brain tumor survivors experience deficits in social competence at the level of social adjustment. These deficits worsen with time. Little is known about more rudimentary levels of social competence such as social skills or social performance. This information is needed to guide the development of social intervention programs.

Predictors of professional and personal satisfaction with a career in psychiatry.

Background: Many factors, including personal experience and personality traits, contribute to the emotional difficulties that psychiatrists experience in their professional work. The nature of the work itself also plays a significant role. Objective: To determine those personal and professional characteristics that predict satisfaction with the practice of psychiatry. Method: We mailed a questionnaire that included items pertaining to aspects of personal and professional life to the entire population of psychiatrists in Ontario (N = 1574). Results: Of the 1574, 52% (n = 802) responded. We conducted a series of regression analyses to determine factors related to career satisfaction or regret. A belief in the intrinsic value of psychiatry, a low perceived degree of emotional burden from patients, financial success, and satisfaction with psychotherapeutic work emerged consistently as significant predictors. A subsequent discriminant function analysis indicated that all 4 of these variables accurately predicted those psychiatrists with extreme satisfaction or dissatisfaction with work. Conclusions: These results reveal several variables associated with career satisfaction in the practice of psychiatry that might be useful to discuss with residents who are beginning their careers.

Evaluation of a Comprehensive Care Clinic Model for Children With Brain Tumor and Risk for Hypothalamic Obesity

The objectives of this study were to evaluate outcomes of a comprehensive care clinic (CCC) for children with hypothalamic obesity due to treatment for brain tumors by assessing weight parameters; health‐related quality of life (HRQoL); and perception of health status, disease burden, care satisfaction, and physical activity. Thirty‐nine patients (16 males) were reviewed. While attending the CCC the median %weight gain and percent ideal body weight (%IBW) of patients was lower (8.5%/year (range −3 to −14) and −4%/year (141.7–34), respectively) than the median %weight gain and %IBW (21.4% (15.8−32.0) and 19.9% (−18.7 to 149.2)) while treated in standard care. Rate of increase in %BMI slowed (4.5 kg/m2 %/year (−17.8 to 8.4) vs. 8.4 kg/m2 %/year (−3.1 to 28.1)) in patients attending the clinic compared to their before treatment in standard care. There was no change in blood pressure, fasting glucose, triglycerides or low‐density lipoprotein cholesterol, and a significant increase in high‐density lipoprotein cholesterol (1.09 ± 0.33 to 1.24 ± 0.04). After attending the CCC for a year, significant increases for child reported total HRQoL (63.7 ± 18.4–71.3 ± 13.3; P < 0.017), physical functioning (65.3 ± 15.9–69.5 ± 15.9; P < 0.045) and school functioning (61.1 ± 21.0–71.1 ± 16.5; P < 0.051) were found. Parents reported no significant change in HRQoL over the same period. Parents had significantly improved responses in areas of coordination of health care and understanding of their childs disease. Patients attending the CCC gained less weight while attending the clinic and exhibited improved HRQoL. Parents noticed improvements in various areas of their childs medical care.

Social problem solving and social performance after a group social skills intervention for childhood brain tumor survivors.

The aim of this study was to explore the ability of a group social skills intervention program for childhood brain tumor survivors to effect two steps of the social information processing model: social problem solving and social performance.

The feasibility and benefits of a 12-week yoga intervention for pediatric cancer out-patients.

Increasing rates of survival present a new set of psychosocial and physical challenges for children undergoing treatment for cancer. Physical activity (PA) has been shown to be a safe and effective strategy to mitigate the significant burden of cancer and its treatments, with yoga increasingly gaining recognition as a gentle alternative. The purpose of this study was to determine the feasibility and benefits of a 12‐week community‐based yoga intervention on health‐related quality of life (HRQL), select physical fitness outcomes and PA levels (PAL).

The relationship between binge eating disorder and non-purging bulimia nervosa

Aims.To further investigate the differentiation between non-purging bulimia nervosa (BN-NP) and binge eating disorder (BED), particularly as concerns weight-shape overconcern affecting self-esteem, a core belief to both anorexia and bulimia nervosa. Methods.Twenty-five female subjects with BN-NP and 25 female subjects with BED, consecutively referred to the Eating Disorder Unit of the DPPhNB, were administered the BEDCI, the EDI-2 and the BUT. Results.BED patients had a higher BMI (35.5 vs. 23.8 kg/m2, p<0.0001 and were slightly older than BN-NP ones. Weight-shape concerns as one of the main/the most important things influencing self-esteem were reported by 68% of BN-NP patients and 62.5% of BED ones. Age at onset of binge-eating, weight-cycling, overall impairment due to the eating behavior, sexual harassment, depressive and substance abuse comorbidity were equally represented in the two groups of patients. BN-NP patients scored higher than BED ones as regards EDI drive for thinness (p<0.05) and BUT weight phobia (p<0.05), with these scores significantly related to differences in BMI (p<0.0005 and p=0.012). Weight-shape overconcern influencing self-esteem was predictive of an earlier onset of binge-eating (p<0.05) and higher scores at the BUT weight phobia, and body image concerns (p<0.05). Conclusions.Differences between BED and BN-NP seem to be more of degree than type and there seems little value in the separation between BED and BN-NP based on weight-shape concerns that substantially impair self-esteem. This construct seems core to both disorders and plays a substantial role in triggering and maintaining the binge-eating cycle.

Quality of Life and Anxiety in Adolescents with Differentiated Thyroid Cancer

CONTEXT Adolescents with differentiated thyroid cancer (DTC) require lifelong monitoring with a high possibility of reoperation or radioactive iodine. Although adult DTC survivors have similar or slightly worse quality of life (QOL), this has not been evaluated in the pediatric population. OBJECTIVE Our objective was to compare QOL and anxiety in adolescents with DTC to patients with acquired autoimmune hypothyroidism. DESIGN, SETTING, AND PATIENTS In this cross-sectional pilot study, three validated questionnaires were administered to 16 adolescents with DTC and 16 controls for assessment of QOL and anxiety levels. These included teen and parent PedsQL, Multidimensional Anxiety Scale for Children, and Coddington Life Events Scales for Adolescents. The contribution of age, time since diagnosis, and biochemical variables were compared with the outcome measures. RESULTS There were 16 DTC patients (seven males); 13 had papillary carcinoma, one had follicular carcinoma, and two had mixed type. At diagnosis, five DTC patients had lymph node involvement and two had lung metastases, although at time of assessment, only one DTC patient had lymph node involvement. DTC patients were older than control subjects (P=0.004) and had lower TSH levels than control subjects at time of assessment (P=0.013). QOL and anxiety levels did not differ between DTC patients compared with control subjects and with previously reported scores in a healthy cohort. QOL and anxiety level parameters were not influenced by age, time since diagnosis, or free T4 levels measured at the time of assessment. CONCLUSIONS Adolescents with DTC have similar QOL and anxiety levels compared with autoimmune hypothyroidism patients and with a healthy normative population.

Quality of Life in Survivors of Pediatric Cancer and Their Siblings: The Consensus Between Parent-Proxy and Self-Reports

To examine the discrepancy between survivor–parent and sibling–parent reports of health‐related quality of life (HRQL) and the level of agreement (i.e., correlation) between child reports (i.e., survivor and sibling) and parent‐proxy reports of HRQL.

Reasons for Non-Completion of Health Related Quality of Life Evaluations in Pediatric Acute Myeloid Leukemia: A Report from the Children's Oncology Group

Background Health related quality of life (HRQL) assessments during therapy for pediatric cancer are important. The objective of this study was to describe reasons for failure to provide HRQL assessments during a pediatric acute myeloid leukemia (AML) clinical trial. Methods We focused on HRQL assessments embedded in a multicenter pediatric AML clinical trial. The PedsQL 4.0 Generic Core Scales, PedsQL 3.0 Acute Cancer Module, PedsQL Multidimensional Fatigue Scale, and Pediatric Inventory for Parents were obtained from parent/guardian respondents at a maximum of six time points. Children provided self-report optionally. A central study coordinator contacted sites with delinquent HRQL data. Reasons for failure to submit the HRQL assessments were evaluated by three pediatric oncologists and themes were generated using thematic analysis. Results There were 906 completed and 1091 potential assessments included in this analysis (83%). The median age of included children was 12.9 years (range 2.0 to 18.9). The five themes for non-completion were: patient too ill; passive or active refusal by respondent; developmental delay; logistical challenges; and poor knowledge of study processes from both the respondent and institutional perspective. Conclusions We identified reasons for non-completion of HRQL assessments during active therapy. This information will facilitate recommendations to improve study processes and future HRQL study designs to maximize response rates.

A Randomized Control Intervention Trial to Improve Social Skills and Quality of Life in Pediatric Brain Tumor Survivors.

To determine if a group social skills intervention program improves social competence and quality of life (QOL) in pediatric brain tumor survivors (PBTS).