Sex talk and cancer: who is asking.

Estimates of sexual health problems after cancer treatment range from 40% to 100% across cancers, with almost half of cancer survivors reporting problems with sexual functioning. While many side effects of cancer treatment gradually resolve within the first year or two, many sexual health issues do not. These problems can remain severe and constant and can even become worse over time causing considerable distress. Although sexual health issues are common, they are not addressed often enough in cancer settings. There are a variety of barriers to addressing sexual health concerns. In this lecture, we discuss those challenges and offer some possible approaches nurses could use to improve sexual health care, including the BATHE and the PLISSIT models. Case examples highlighting the models are included.

Psychosocial trends in couples prior to commencement of in vitro fertilisation (IVF) treatment.

Facing infertility and undergoing fertility treatment can create emotional turmoil in couples' lives. It is essential for fertility therapy providers to assess the coping and communication strategies of couples before treatment in order to provide appropriate support. We performed a two time point (year 2003 & year 2009) cross-sectional study of patients attending our services to undergo in vitro fertilisation. All couples attending the Human Assisted Reproduction Ireland Unit, a tertiary referral academic centre at the Rotunda Hospital, were requested to complete a psychosocial questionnaire before commencing the treatment. The questions assessed couples' understanding of their own infertility, family background and support, relationship traits and stress levels prior to commencing fertility treatment. A total of 180 patients participated in the study. Our findings showed that within a 6-year time span, couples' attitudes have changed significantly. Compared to 6 years ago, couples now have a better understanding of infertility and are seeking treatment quicker. Interestingly, we showed higher stress levels nowadays with fewer couples following routine stress management. We also identified specific gender differences in that women have a more open attitude in discussing infertility and seeking more support from friends and family compared to men.

A welcome link for patients who are waiting.

In our present health-care system, wait-lists are unfortunately all too familiar. They create distress for both patients and health-care providers. Two nurses from the breast cancer site team of the Capital Health Queen Elizabeth II Cancer Care Program in Halifax, Nova Scotia, responded by developing a program that links breast cancer patients who have undergone surgery and are waiting for outpatient consultation with either a radiation or a medical oncology team. This "link" is by early intervention telephone contact with a nurse who cares for this patient population. Evaluation of the pilot program indicated high patient satisfaction. The authors outline the challenges in maintaining the program, even though it has had a positive impact on those awaiting health services.

Assessing the reliability and validity of the revised WCCNR stomatitis staging system for cancer therapy-induced stomatitis.

Before developing interventions for stomatitis, nurses require a simple, valid and reliable approach to staging severity. The eight-item WCCNR(R) was previously validated for chemotherapy-induced stomatitis. In this study, the validity and reliability of the WCCNR(R), a shorter three-item tool for staging stomatitis caused by chemotherapy, radiotherapy, or both, was assessed. Pairs of data collectors evaluated 207 patients from 10 Canadian cancer centres. The WCCNR(R) correlated well with the MacDibbs Mouth Assessment (r = 0.44, p = 0.0002 to r = 0.54, p < 0.0001), a standardized tool for staging radiotherapy-induced stomatitis. Agreement between data collectors at five sites was acceptable (kappa = 0.75); three additional sites were close to this target. Findings indicate that the WCCNR is a valid and reasonably reliable tool for staging stomatitis due to cancer therapy.

Dynamic changes in transcription factor complexes during erythroid differentiation revealed by quantitative proteomics.

During erythroid differentiation, beta-globin gene expression is regulated by the locus control region (LCR). The transcription factor NF-E2p18/MafK binds within this region and is essential for beta-globin expression in murine erythroleukemia (MEL) cells. Here we use the isotope-coded affinity tag (ICAT) technique of quantitative mass spectrometry to compare proteins interacting with NF-E2p18/MafK during differentiation. Our results define MafK as a 'dual-function' molecule that shifts from a repressive to an activating mode during erythroid differentiation. The exchange of MafK dimerization partner from Bach1 to NF-E2p45 is a key step in the switch from the repressed to the active state. This shift is associated with changes in the interaction of MafK with co-repressors and co-activators. Thus, our results suggest that in addition to its role as a cis-acting activator of beta-globin gene expression in differentiated erythroid cells, the LCR also promotes an active repression of beta-globin transcription in committed cells before terminal differentiation.

A complex chromatin landscape revealed by patterns of nuclease sensitivity and histone modification within the mouse beta-globin locus.

In order to create an extended map of chromatin features within a mammalian multigene locus, we have determined the extent of nuclease sensitivity and the pattern of histone modifications associated with the mouse beta-globin genes in adult erythroid tissue. We show that the nuclease-sensitive domain encompasses the beta-globin genes along with several flanking olfactory receptor genes that are inactive in erythroid cells. We describe enhancer-blocking or boundary elements on either side of the locus that are bound in vivo by the transcription factor CTCF, but we found that they do not coincide with transitions in nuclease sensitivity flanking the locus or with patterns of histone modifications within it. In addition, histone hyperacetylation and dimethylation of histone H3 K4 are not uniform features of the nuclease-sensitive mouse beta-globin domain but rather define distinct subdomains within it. Our results reveal a complex chromatin landscape for the active beta-globin locus and illustrate the complexity of broad structural changes that accompany gene activation.