Zusammenfassung Hintergrund Subjektive Krankheitsannahmen beinhalten Annahmen über Symptome, emotionale Reaktionen, Verlauf, Konsequenzen und Kontrollierbarkeit einer Erkrankung. Aktuelle Studien zeigen, dass subjektive Krankheitsannahmen mit der Krankheitsverarbeitung und dem psychischen Wohlbefinden assoziiert sind. Bisher gibt es kein Erhebungsinstrument zur Befragung von Kindern, sodass hier oftmals nur der Bericht der Eltern verfügbar ist. Ziel der Arbeit Das Ziel ist die Entwicklung und psychometrische Überprüfung eines Puppeninterviews zur altersgerechten Erfassung subjektiver Krankheitsannahmen für Kinder ab 4 Jahren. Beschreibung von Durchführungsempfehlungen mit Indikation und Kontraindikation. Methode Das Puppeninterview zur Erfassung subjektiver Krankheitsannahmen wurde auf Grundlage des „Illness Perception Questionnaire“ (IPQ-R) und des „Berkeley Puppet Interviews“ entwickelt und an zwei Stichproben (n = 11 und n = 64) überprüft. Ergebnisse Die Anwendbarkeit, Verständlichkeit und Nützlichkeit des Puppeninterviews wurde für die Akut- und Nachsorgephase gezeigt, wobei sich die Krankheitsannahmen je nach Krankheitsphase unterscheiden können. Es zeigten sich erwartungskonforme Interskalenkorrelationen im Puppeninterview (z. B. Chronizität – Konsequenzen für die Lebensführung: r = 0,690, p ≤ 0,05), hypothesenkonforme Ergebnisse zur Konstruktvalidität (z. B. Chronizität – internale Kontrolle r = −0,711, p ≤ 0,05) und zufriedenstellende interne Konsistenzen. Mitunter besprachen die Kinder mit den Puppen mögliche Bewältigungsstrategien, was zu einer Entlastung beitrug. Schlussfolgerung Die Einschätzungen der Eltern können zukünftig durch eine zuverlässige Erhebung von subjektiven Krankheitsannahmen bei Kindern ab 4 Jahren ergänzt werden, um medikamentöse und psychosoziale Interventionen gezielt anzupassen.
Abstract. Background: Despite the promising evidence for the effectiveness of school-based awareness programs in decreasing the rates of suicidal thoughts and suicide attempts in young people, no guidelines on the targets and methods of safe and effective awareness programs exist. Aims: This study intends to distill recommendations for school-based suicide awareness and prevention programs from experts. Method: A three-stage Delphi survey was administered to an expert panel between November 2018 and March 2019. A total of 214 items obtained from open-ended questions and the literature were rated in two rounds. Consensus and stability were used as assessment criteria. Results: The panel consisted of 19 participants in the first and 13 in the third stage. Recommended targets included the reduction of suicide attempts, the enhancement of help-seeking and peer support, as well as the promotion of mental health literacy and life skills. Program evaluation, facilitating access to healthcare, and long-term action plans across multiple levels were among the best strategies for the prevention of adverse effects. Limitations: The study is based on opinions of a rather small number of experts. Conclusion: The promotion of help-seeking and peer support as well as facilitating access to mental health-care utilities appear pivotal for the success of school-based awareness programs.
Background This study examines the role of illness perceptions and fear of progression (FoP) in paediatric cancer patients and their parents for patient’s health-related quality of life (HRQoL), controlling for sociodemographic and medical variables. 4–18-year-old patients in acute treatment or follow-up care and one parent were examined. Methods N = 46 patient-parent dyads in acute treatment and n = 84 dyads in follow-up care completed measures on illness perceptions (Illness-Perceptions-Questionnaire for 12–18-year-old patients and parents or as age-adapted puppet interview for 4–11-year-old patients) and FoP (Fear-of-Progression-Questionnaire for 7–18-year-old patients and parents). Patients also completed the KINDL-R to measure HRQoL. Hierarchical multiple regression analyses were calculated. Results In acute treatment, patient’s perceptions of symptoms and cyclicity of their illness explained variation in their HRQoL in addition to sociodemographic and medical variables. In follow-up care, patient’s FoP and parent’s perception of consequences explained additional variation in patient’s HRQoL. Overall, sociodemographic and medical variables explained less variation in HRQoL in follow-up care than in acute treatment. Conclusions Our results stress the importance of psychological factors for the well-being of paediatric cancer patients, particularly in follow-up care, where sociodemographic and medical variables play a lesser role. We recommend screening for illness perceptions and FoP during and after acute treatment to support patients and parents. Furthermore, standardized interventions focussed on changing maladaptive illness perceptions should be developed and evaluated. As parents’ perceptions, thoughts, and feelings may also play an important role for the well-being of the patients, interventions should be family-focussed and include parents. Trial registration The study has been pre-registered at the German Clinical Trials Register (registered 30/06/2020; DRKS00022034) and at the Open Science Framework (https://osf.io/3uwrx).
Objective Recent evidence suggests that illness perceptions in paediatric patients and their parents may differ, with parents holding more negative views compared to their children. Little is known about illness perceptions of very young patients and their parents. This study investigates illness perceptions in paediatric cancer patients aged 4–18 years and their parents in acute treatment or follow‐up care, distinguishing patients by age (4–11, 12–18) and stage of medical treatment. Methods N = 45 patient–parent dyads in acute treatment and n = 95 dyads in follow‐up care were examined. Parents and older children aged 12–18 years completed the Illness Perception Questionnaire—Revised (IPQ‐R) and younger children aged 4–11 years were examined using an age‐adapted hand puppet interview containing the IPQ‐R questions. Difference scores of illness perceptions (symptoms, timeline‐acute/chronic, timeline‐cyclical, personal control, illness coherence, consequences, emotional representations) between children and parents were tested for significance using Wilcoxon signed‐rank tests. Results Overall, parents perceived more symptoms associated with their child's illness/treatment than the children themselves. In acute treatment, younger children indicated more negative and older children more positive views regarding chronicity than parents. Younger children held less negative views on consequences, and all children reported less negative emotional representations than parents. In follow‐up care, all children held less negative views on consequences and emotional representations. Older children reported less negative views on chronicity, cyclicity and illness coherence. Conclusion Differences in illness perceptions of paediatric patients and their parents should be considered during and after treatment/medication and psychosocial care to support illness coping in person‐ and family‐centred interventions.
Die pathohistologische Beurteilung von endoskopisch entnommenen Gewebeproben geh?rt in der Gastroenterologie zur Routinediagnostik. Die Schnittpr?parate, anhand derer der Pathologe die Diagnose stellt, werden im histologischen Labor angefertigt. Die unterschiedlichen Bearbeitungsschritte, die hierf?r notwendig sind, werden unter dem Begriff Histotechnik zusammengefasst.
A case of precursor B-cell lymphoma of unusual location in the mandible is presented. Clinical features as well as technical examinations led to the misdiagnosis of chronic osteomyelitis. Only immunohistological examination of intraoperatively taken biopsies was able to reveal the true diagnosis. High-dose chemotherapy was started and full remission could be achieved.
Hintergrund. Krebserkrankungen bei Kindern sind mit einem erhöhten Risiko für psychosoziale Belastungen assoziiert. Zur quantitativen und qualitativen Bedarfseinschätzung nach psychosozialer Nachsorge liegen bisher keine Instrumente vor. Mit dem NPO-11 wurde nun ein ökonomisches Screening entwickelt. Patienten und Methoden. Elf dichotome Items erfassen die Bereiche Progredienzangst, Traurigkeit, Antrieblosigkeit, Selbstwertprobleme, Schul- und Ausbildungsprobleme, somatische Beschwerden, emotionaler Rückzug, soziale Desintegration, Pseudoreife, Eltern-Kind-Konflikte sowie Elternpaar-Konflikte entweder im Selbst- oder Elternbericht. Zur psychometrischen Überprüfung wurde der NPO-11 an N=101 Eltern-Kind-Dyaden getestet.Ergebnisse. Selbst- und Elternberichtversion zeigten eine gute Ausfüllgüte mit Zustimmungsraten ohne Boden- oder Deckeneffekte. Die Interrater-Reliabilität der 11 Items war ausreichend bis moderat. Faktorenanalytisch konnte die Gültigkeit eines Gesamtwerts nachgewiesen werden. Dieser zeigte für Selbst- und Elternbericht eine ausreichende bzw. gute interne Konsistenz sowie hohe Validität durch Korrelationen mit gesundheitsbezogener Lebensqualität.Schlussfolgerung. Mit dem NPO-11 wurde ein reliables und valides Screening zur Einschätzung des psychosozialen Nachsorgebedarfs in der pädiatrischen Onkologie entwickelt. Bei dem Übergang von stationärer zu ambulanter Behandlung kann eingeschätzt werden, welches Ausmaß an psychosozialen Interventionen notwendig ist und auf welche Themenfelder diese Angebote ausgerichtet sein sollten.
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