Body image and cancer-related lymphoedema: A systematic review.

OBJECTIVE: Cancer-related lymphoedema is a common side effect of cancer, affecting 24%-49% of people with cancer. Body image contributes to the well-being of individuals with this condition. This systematic review aimed to explore, for the first time, the state of the science concerning body image in cancer-related lymphoedema, including how body image is measured and variables associated with body image concerns. METHODS: Six databases were systematically searched for peer-reviewed articles describing empirical quantitative studies where body image was measured with a reliable and valid measurement tool in adults with cancer-related lymphoedema. RESULTS: Nine studies with 977 participants were included. The studies involved individuals who had experienced breast, head and neck, melanoma, and urogenital cancers and developed lymphoedema. There was considerable heterogeneity in body image measures used, precluding meta-analysis. The following variables were associated with increased body image concern: higher body integrity beliefs, experience of physical changes (e.g. pain) and differences in sensation and function, including changes in appearance related thoughts, feelings and emotions. Several studies described behavioural and psychological interventions which positively impacted body image outcomes in individuals with lymphoedema relating to specific cancers. CONCLUSION: Regular screening for body image concerns could encourage more positive body image awareness in individuals with cancer-related lymphoedema and lessen some of its associated negative consequences. Future longitudinal and individual differences research in this area is important to inform intervention development. There is also need for a more standardised approach to the study and measurement of body image in people with cancer-related lymphoedema.

Social support and childhood cancer survivors: A systematic review (2006-2022).

OBJECTIVE: Research has indicated that social support may play a protective role in the face of stress and help children and adolescents cope with the demands and challenges they face on a daily basis during their cancer journey. However, social support tends to reduce over time as survivors overcome their illness despite its ongoing importance even years after treatment has finished. The current review aimed to systematically examine existing evidence on social support in child and adolescent cancer survivors. METHODS: Five databases (PsychINFO, CINAHL, EMBASE, PubMed and Web of Science) were searched systematically to identify quantitative studies which explored social support from the perspective of child and adolescent cancer survivors aged 18 years or younger. RESULTS: A total of 10 studies met the eligibility criteria for inclusion. Findings from the review indicate that family and friends, particularly parents, are important sources of social support for survivors. Social support was positively related to posttraumatic growth, school re-entry and physical activity, and negatively related to psychological stress, depression, anxiety and stress. Furthermore, findings relating to gender, age and group differences were mixed. A number of methodological concerns were identified in the reviewed studies including small sample sizes, as well as a lack of consistency in the measurement of social support. CONCLUSIONS: Future studies of social support for child and adolescent cancer survivors need to address these shortcomings to help inform care and support interventions promoting social support in survivors.

Examining the Utility of Stress-, Motivation-, and Commitment-Based Perspectives of Athlete Burnout.

Burnout, characterized by exhaustion, reduced accomplishment, and devaluation, can have substantial negative implications for athletes. Notably, researchers continue to examine burnout from multiple perspectives, commonly focusing on stress-, motivation-, or commitment-related factors, with limited efforts to consider these perspectives together. In contrast, this study aimed to assess the utility of these multiple perspectives and the key predictors of burnout in the same athlete sample. Data on burnout, stress, motivation, motivational climate, and sport commitment were gathered from 370 Gaelic games athletes. Separate structural equation models incorporating stress, motivation, and commitment factors as predictors of burnout dimensions were assessed. All models showed adequate fit. However, differences in effect size suggest that stress is more strongly associated with exhaustion, while commitment and motivation showed a stronger relationship with reduced accomplishment and devaluation. Evidence of significant predictors across perspectives also supports an integrated approach and may inform integration efforts and targeted intervention strategies.

Unmet supportive care needs associated with quality of life for people with lung cancer: A systematic review of the evidence 2007-2020.

INTRODUCTION: The aim of this review was to systematically examine the evidence on the relationship between quality of life (QoL) and unmet supportive care needs in patients with lung cancer. METHODS: Six databases were searched for studies published since 2007. Studies were included if they measured QoL using a standardised tool and examined its association with unmet supportive care needs in lung cancer patients. RESULTS: Six studies involving 562 patients were included. Nearly two thirds of the patients had been diagnosed with advanced cancer (Stage III or IV), and the majority had been diagnosed for less than 2 years. There was a negative association between QoL and unmet needs using two different measures (Supportive Care Needs Survey[SCNS] and Cancer Survivors Unmet Needs Survey [CaSUN]). In two studies, the relationship was limited to physical and/or psychological domains. CONCLUSIONS: Unmet supportive care needs are associated with poorer QoL for people with lung cancer: The findings suggest that unmet physical and psychological needs may have the most impact on QoL and reflect the high symptom burden and psychological distress associated with lung cancer. Further work is needed to examine these relationships to identify the services and interventions that address the range of care needs across the disease trajectory.

Is a pandemic as good as a rest? Comparing athlete burnout and stress before and after the suspension of organised team sport due to Covid-19 restrictions, and investigating the impact of athletes' responses to this period.

The COVID-19 pandemic resulted in social-distancing measures and the suspension of organised sport globally, and has been shown to have negatively impacted mental health. However, athletes may have experienced reprieve from sport demands, which have previously been linked with maladaptive responses such as burnout and stress. The aims of this study were (1) compare levels of burnout and stress reported by Gaelic games athletes pre- and post-COVID-19 suspension period, (2) explore how athletes utilised and perceived this period and the return to sport, and (3) examine the implications of this for burnout. Participants completed an online questionnaire, which included the athlete burnout questionnaire, perceived stress scale, sport emotion questionnaire, demographic questions, weekly training hours, and other hours for sport (e.g. travel) before Covid-19 (BC-19) and after the Covid-19-induced suspension (AC-19_S). Questions relating to how athletes utilised (e.g. training focus) and perceived (positive/negative impact) the period were included AC-19 S. Data was compared across time-points and we explored predictors of burnout AC-19_S. Ninety-two athletes completed the questionnaire at both time-points. No significant differences in burnout or stress were identified, suggesting the suspension period did not significantly impact these variables. Burnout BC-19, stress AC-19_S, unpleasant emotions about returning to sport and using the period to rest/recover positively predicted burnout AC-19_S. Reduction in other hours across time-points and pleasant emotions about returning predicted lower burnout. Results suggest an athletes' response to a suspension period and subsequent return to sport can impact feelings of burnout, and may have implications for future unanticipated change events.

Siblings' Perspectives of the Impact of Child Sexual Abuse Disclosure on Sibling and Family Relationships.

Child sexual abuse (CSA) may have significant consequences for siblings; however, limited research has been conducted on the impact of the abuse on sibling and family relationships following the disclosure of CSA. This study sought to investigate sibling responses to disclosures of CSA among a group of adult siblings in Ireland, and the impact on sibling and family relationships through an online survey. A thematic analysis was conducted on a sub-set of participants who responded to open-ended questions (n = 45). Three main themes were identified as follows: (a) intense emotional reactions, (b) relationship support and strain, and (c) managing family dynamics. CSA disclosure may have a substantial impact on sibling and family relationships. Supporting siblings in the aftermath of CSA disclosure is essential, both for the well-being of the individual who was sexually abused and for the wider family.

El abuso sexual infantil puede tener consecuencias importantes para los hermanos, sin embargo, se han realizado pocas investigaciones sobre el efecto del abuso en las relaciones familiares y fraternales después de la revelación de abuso infantil. El presente estudio tuvo como finalidad investigar las respuestas de los hermanos a las revelaciones de abuso sexual infantil entre un grupo de hermanos adultos en Irlanda, y el efecto en las relaciones familiares y fraternales mediante una encuesta en línea. Se realizó un análisis temático en un subconjunto de participantes que respondieron preguntas de interpretación abierta (n=45). Se identificaron tres temas principales: (a) reacciones emocionales intensas, (b) apoyo y tensión en la relación, y (c) manejo de la dinámica familiar. La revelación del abuso sexual infantil puede tener un efecto considerable en las relaciones fraternales y familiares. Es fundamental apoyar a los hermanos después de la revelación de abuso sexual infantil, tanto por el bienestar de la persona que fue abusada sexualmente como para el resto de la familia.

An investigation into the relationship between social support, stress, and psychological well-being in farmers.

This study investigated the stress-buffering effect of social support on psychological well-being and impact of demographic factors on stress in a sample of farmers. One-hundred and ninety-six farmers completed an online questionnaire including measures of social support, stress, psychological well-being, and demographics. Overall, after controlling for stress, increased social support was associated with higher psychological well-being. Family support had a significant relationship with financial and farm-related factors of stress but not with psychological well-being, while friend and significant other support had a much greater impact on psychological well-being than family support. Membership of a farming organisation was found to be protective against social stress while working on one type of farm only (e.g., dairy) was protective against financial stress. The findings highlight the potential utility of the stress-buffering model in understanding stress among farmers. Future interventions which facilitate social support, reduce stress, and boost psychological well-being among farmers are needed.

"Dying With Dignity": A Qualitative Study With Caregivers on the Care of Individuals With Terminal Cancer.

This study aimed to examine family members' attitudes and perceptions regarding their choice of care in the event of terminal illness, based on their experience in a caregiver's role, while a loved one was terminally ill. All participants (N = 10) had cared for an immediate family member with terminal cancer. Snowball sampling was used. Qualitative data were collected through in-depth, semi-structured interviews. The data were transcribed verbatim and analyzed using thematic analysis. Five themes were identified from the data. These included two themes relating to participants' experience of care, two themes in relation to participants' attitudes toward the type of care they experienced and a final theme related to the role of religion and spirituality in dealing with loss. The findings of this study support the integration of multidisciplinary healthcare teams and the introduction of holistic care as early as possible within hospitals for individuals with terminal cancer, using the biopsychosocial-spiritual model.

Value-Related Neuronal Responses in the Human Amygdala during Observational Learning.

The amygdala plays an important role in many aspects of social cognition and reward learning. Here, we aimed to determine whether human amygdala neurons are involved in the computations necessary to implement learning through observation. We performed single-neuron recordings from the amygdalae of human neurosurgical patients (male and female) while they learned about the value of stimuli through observing the outcomes experienced by another agent interacting with those stimuli. We used a detailed computational modeling approach to describe patients' behavior in the task. We found a significant proportion of amygdala neurons whose activity correlated with both expected rewards for oneself and others, and in tracking outcome values received by oneself or other agents. Additionally, a population decoding analysis suggests the presence of information for both observed and experiential outcomes in the amygdala. Encoding and decoding analyses suggested observational value coding in amygdala neurons occurred in a different subset of neurons than experiential value coding. Collectively, these findings support a key role for the human amygdala in the computations underlying the capacity for learning through observation.SIGNIFICANCE STATEMENT Single-neuron studies of the human brain provide a unique window into the computational mechanisms of cognition. In this study, epilepsy patients implanted intracranially with hybrid depth electrodes performed an observational learning (OL) task. We measured single-neuron activity in the amygdala and found a representation for observational rewards as well as observational expected reward values. Additionally, distinct subsets of amygdala neurons represented self-experienced and observational values. This study provides a rare glimpse into the role of human amygdala neurons in social cognition.

Variables associated with distress amongst informal caregivers of people with lung cancer: A systematic review of the literature.

OBJECTIVE: Informal caregivers of people with lung cancer often experience a substantial care burden and associated negative consequences due to the often-contracted course of the disease. The objective of this review was to systematically examine the evidence on the factors associated with lung cancer caregiver distress. METHODS: Five databases (MEDLINE, CINAHL, EMBASE, PsychINFO and Web of Science) were searched for studies investigating factors associated with distress amongst caregivers of people with lung cancer. Empirical studies published up to July 2020 were included if they measured distress using a valid and reliable measure and examined its association with at least one other factor, with a sample of 50 or more caregivers. RESULTS: Thirty publications describing 27 studies (16 cross-sectional; 6 prospective; 8 intervention) involving 3744 caregivers (primarily spouse or adult child) were included. A narrative synthesis of the findings is presented due to heterogeneity in study design, variables measured and analyses conducted. Patient variables associated with greater distress included: stage of cancer and quality of spousal relationship. Caregiver variables associated with higher distress included: social support, coping strategies and self-efficacy. CONCLUSIONS: Several variables were associated with distress amongst lung cancer caregivers. Understanding these variables could inform the development of interventions that will enable caregivers to care effectively while maintaining their own well-being. Screening for distress among caregivers may identify those caregivers who would benefit from early intervention.

Investigating the impact of self-management behaviours on quality of life and fear of recurrence in head and neck cancer survivors: A population-based survey.

OBJECTIVES: Emerging cancer-survivorship research suggests that self-management can lead to improved outcomes. However, research examining the impact of self-management behaviours on quality of life (QoL) and fear of recurrence (FoR) in cancer survivors is lacking. This study investigated the relationship between self-management behaviours and QoL and FoR following treatment for head and neck cancer (HNC). METHODS: Postal surveys were sent to 734 eligible HNC survivors (ICD10 C01-C14; C32) in the Republic of Ireland who were 12- to 60-months post diagnosis. QoL and FoR were measured using the Functional Assessment of Cancer Therapy (FACT-G and Head and Neck Cancer Subscale) measure and Fear of Relapse/Recurrence Scale, respectively. Seven self-management behaviours were measured using the Health Education Impact Questionnaire. RESULTS: Three hundred and ninety-five HNC survivors completed surveys (50.3% response rate). After controlling for sociodemographic and clinical characteristics, self-management behaviours accounted for 20% to 39.4% of the variance in QoL and FoR. Higher scores on positive and active engagement in life, constructive attitudes and approaches, and skill and technique acquisition were significantly associated with higher global QoL and lower FoR, whilst higher scores on positive and active engagement in life and constructive attitudes and approaches only were significantly associated with higher HNC-specific QoL. Additionally, lower scores on self-monitoring and insight were significantly associated with higher HNC-specific and global QoL and lower FoR. CONCLUSIONS: The findings highlight the potential utility of self-management interventions promoting active problem solving, positive self-talk, and skill acquisition amongst cancer survivors. However, increased self-monitoring may relate to negative outcomes in HNC, a finding that warrants further investigation.

Testosterone causes both prosocial and antisocial status-enhancing behaviors in human males.

Although popular discussion of testosterone's influence on males often centers on aggression and antisocial behavior, contemporary theorists have proposed that it instead enhances behaviors involved in obtaining and maintaining a high social status. Two central distinguishing but untested predictions of this theory are that testosterone selectively increases status-relevant aggressive behaviors, such as responses to provocation, but that it also promotes nonaggressive behaviors, such as generosity toward others, when they are appropriate for increasing status. Here, we tested these hypotheses in healthy young males by injecting testosterone enanthate or a placebo in a double-blind, between-subjects, randomized design (n = 40). Participants played a version of the Ultimatum Game that was modified so that, having accepted or rejected an offer from the proposer, participants then had the opportunity to punish or reward the proposer at a proportionate cost to themselves. We found that participants treated with testosterone were more likely to punish the proposer and that higher testosterone levels were specifically associated with increased punishment of proposers who made unfair offers, indicating that testosterone indeed potentiates aggressive responses to provocation. Furthermore, when participants administered testosterone received large offers, they were more likely to reward the proposer and also chose rewards of greater magnitude. This increased generosity in the absence of provocation indicates that testosterone can also cause prosocial behaviors that are appropriate for increasing status. These findings are inconsistent with a simple relationship between testosterone and aggression and provide causal evidence for a more complex role for testosterone in driving status-enhancing behaviors in males.

Chemical Sensors Generated on Wafer-Scale Epitaxial Graphene for Application to Front-Line Drug Detection.

Generation of large areas of graphene possessing high quality and uniformity will be a critical factor if graphene-based devices/sensors are to be commercialized. In this work, epitaxial graphene on a 2" SiC wafer was used to fabricate sensors for the detection of illicit drugs (amphetamine or cocaine). The main target application is on-site forensic detection where there is a high demand for reliable and cost-efficient tools. The sensors were designed and processed with specially configured metal electrodes on the graphene surface by utilizing a series of anchors where the metal contacts are directly connected on the SiC substrate. This has been shown to improve adhesion of the electrodes and decrease the contact resistance. A microfluidic system was constructed to pump solutions over the defined graphene surface that could then act as a sensor area and react with the target drugs. Several prototypic systems were tested where non-covalent interactions were used to localize the sensing components (antibodies) within the measurement cell. The serendipitous discovery of a wavelength-dependent photoactivity for amphetamine and a range of its chemical analogs, however, limited the general application of these prototypic systems. The experimental results reveal that the drug molecules interact with the graphene in a molecule dependent manner based upon a balance of π -stacking interaction of the phenyl ring with graphene (p-doping) and the donation of the amine nitrogens lone pair electrons into the π - π *-system of graphene (n-doping).

Barriers to active self-management following treatment for head and neck cancer: Survivors' perspectives.

OBJECTIVE: Active self-management practices may help head and neck cancer (HNC) survivors to deal with challenges to their physical, functional, social, and psychological well-being presented by HNC and its treatment. This study investigates the factors perceived by HNC survivors to act as barriers to their active self-management following primary treatment. METHODS: In this qualitative study, 27 HNC survivors identified through 4 designated cancer centres in Ireland participated in face-to-face semistructured interviews. Interviews were audio-recorded, transcribed, and analysed using thematic analysis. RESULTS: Four themes (and associated subthemes) describing barriers to survivors' active self-management were identified: emotional barriers (eg, fear of recurrence), symptom-related barriers (eg, loss of taste), structural barriers (eg, access to appropriate health services), and self-evaluative barriers (eg, interpersonal self-evaluative concerns). CONCLUSIONS: This is the first study to describe HNC survivors' views about barriers to their active self-management after treatment. The findings have important implications for self-management research and intervention development concerning HNC survivorship.

Psychological variables associated with quality of life following primary treatment for head and neck cancer: a systematic review of the literature from 2004 to 2015.

OBJECTIVE: There has been a recent proliferation of research on quality of life (QoL) in head and neck cancer (HNC). The objective of this review was to systematically examine the evidence on psychological factors associated with QoL outcomes for HNC survivors in the post-treatment period published during 2004-2015. METHODS: Five databases were searched for studies investigating psychological factors associated with QoL in HNC survivors. Empirical studies published between January 2004 and June 2015 were included if they measured QoL as an outcome following treatment using a reliable and valid measure, examined its association with at least one psychological factor and included at least 50 HNC survivors. RESULTS: Twenty-four publications describing 19 studies (9 cross-sectional, 10 prospective) involving 2,263 HNC survivors were included. There was considerable heterogeneity in study design and diversity in measurement and analysis. Distress-related variables (depression, anxiety, distress) were most frequently investigated, and mostly reported negative associations with QoL outcomes. Associations were also observed between other psychological factors (e.g., coping, neuroticism and fear of recurrence) and QoL. CONCLUSIONS: Several psychological factors predict QoL among HNC survivors who have completed treatment. Routine screening and early interventions that target distress could improve HNC survivors' QoL following treatment. Longitudinal and population-based studies incorporating more systematic and standardised measurement approaches are needed to better understand relationships between psychological factors and QoL and to inform the development of intervention and supportive care strategies.Copyright © 2016 John Wiley & Sons, Ltd.

Self-management strategies used by head and neck cancer survivors following completion of primary treatment: A directed content analysis.

OBJECTIVE: Head and neck cancer (HNC) survivors encounter unique challenges following treatment. This study aimed to identify self-management strategies that HNC survivors use to overcome these posttreatment challenges. METHODS: Twenty-seven individuals from 4 designated cancer centres in Ireland were interviewed about self-management strategies that helped them overcome challenges following HNC treatment. Interviews were audio-recorded, transcribed, and analysed using directed content analysis. RESULTS: Twenty self-management strategy types (encompassing 77 specific strategies) were identified. The most frequently used self-management strategy types were self-sustaining (used by 26 survivors), self-motivating (n = 25), and proactive problem solving (n = 25). The most frequently used specific strategies were adaptive approaches to ongoing physical consequences of HNC and its treatment (n = 24), customising dietary practices (n = 24), and maintaining a positive outlook (n = 22). CONCLUSIONS: The study identified strategies that helped HNC survivors to self-manage posttreatment challenges. This information could inform the design/development of self-management interventions tailored towards HNC survivors.

The involvement of model-based but not model-free learning signals during observational reward learning in the absence of choice.

A major open question is whether computational strategies thought to be used during experiential learning, specifically model-based and model-free reinforcement learning, also support observational learning. Furthermore, the question of how observational learning occurs when observers must learn about the value of options from observing outcomes in the absence of choice has not been addressed. In the present study we used a multi-armed bandit task that encouraged human participants to employ both experiential and observational learning while they underwent functional magnetic resonance imaging (fMRI). We found evidence for the presence of model-based learning signals during both observational and experiential learning in the intraparietal sulcus. However, unlike during experiential learning, model-free learning signals in the ventral striatum were not detectable during this form of observational learning. These results provide insight into the flexibility of the model-based learning system, implicating this system in learning during observation as well as from direct experience, and further suggest that the model-free reinforcement learning system may be less flexible with regard to its involvement in observational learning.

Anterior insula activity reflects the effects of intentionality on the anticipation of aversive stimulation.

If someone causes you harm, your affective reaction to that person might be profoundly influenced by your inferences about the intentionality of their actions. In the present study, we aimed to understand how affective responses to a biologically salient aversive outcome administered by others are modulated by the extent to which a given individual is judged to have deliberately or inadvertently delivered the outcome. Using fMRI, we examined how neural responses to anticipation and receipt of an aversive stimulus are modulated by this fundamental social judgment. We found that affective evaluations about an individual whose actions led to either noxious or neutral consequences for the subject did indeed depend on the perceived intentions of that individual. At the neural level, activity in the anterior insula correlated with the interaction between perceived intentionality and anticipated outcome valence, suggesting that this region reflects the influence of mental state attribution on aversive expectations.

Differentiating neural systems mediating the acquisition vs. expression of goal-directed and habitual behavioral control.

Considerable behavioral data indicate that operant actions can become habitual, as demonstrated by insensitivity to changes in the action-outcome contingency and in subjective outcome values. Notably, although several studies have investigated the neural substrates of habits, none has clearly differentiated the areas of the human brain that support habit formation from those that implement habitual control. We scanned participants with functional magnetic resonance imaging as they learned and performed an operant task in which the conditional structure of the environment encouraged either goal-directed encoding of the consequences of actions, or a habit-like mapping of actions to antecedent cues. Participants were also scanned during a subsequent assessment of insensitivity to outcome devaluation. We identified dissociable roles of the cerebellum and ventral striatum, across learning and test performance, in behavioral insensitivity to outcome devaluation. We also showed that the inferior parietal lobule (an area previously implicated in several aspects of goal-directed action selection, including the attribution of intent and awareness of agency) predicted sensitivity to outcome devaluation. Finally, we revealed a potential functional homology between the human subgenual cortex and rodent infralimbic cortex in the implementation of habitual control. In summary, our findings suggested a broad systems division, at the cortical and subcortical levels, between brain areas mediating the encoding and expression of action-outcome and stimulus-response associations.

The role of the posterior temporal and medial prefrontal cortices in mediating learning from romantic interest and rejection.

Romantic interest or rejection can be powerful incentives not merely for their emotional impact, but for their potential to transform, in a single interaction, what we think we know about another person--or ourselves. Little is known, though, about how the brain computes expectations for, and learns from, real-world romantic signals. In a novel "speed-dating" paradigm, we had participants meet potential romantic partners in a series of 5-min "dates," and decide whether they would be interested in seeing each partner again. Afterward, participants were scanned with functional magnetic resonance imaging while they were told, for the first time, whether that partner was interested in them or rejected them. Expressions of interest and rejection activated regions previously associated with "mentalizing," including the posterior superior temporal sulcus (pSTS) and rostromedial prefrontal cortex (RMPFC); while pSTS responded to differences from the participant's own decision, RMPFC responded to prediction errors from a reinforcement-learning model of personal desirability. Responses in affective regions were also highly sensitive to participants' expectations. Far from being inscrutable, then, responses to romantic expressions seem to involve a quantitative learning process, rooted in distinct sources of expectations, and encoded in neural networks that process both affective value and social beliefs.