Patients treated for hematologic malignancies: affected sexuality and health-related quality of life.

BACKGROUND: Sexuality in relation to health-related quality of life (HRQoL) is studied mostly with younger patients as participants who have undergone bone marrow transplantation and concerns fertility and/or sexual function. However, patients with hematologic malignancies such as diffuse large B-cell lymphoma, chronic lymphocytic leukemia, or acute myeloid leukemia most often are above their fifties and are treated with chemotherapy or chemoimmunotherapy. OBJECTIVE: The aim was to examine how sexuality and HRQoL were affected in patients with hematologic malignancies at baseline compared with 1 month after chemotherapy or chemoimmunotherapy. METHODS: Data were collected twice with a longitudinal design using the Sexual Adjustment Questionnaire and the European Organization for Research and Treatment of Cancer Quality of Life questionnaire. RESULTS: Thirty-two patients responded. The importance of sexuality, sexual desire, and sexual ability decreased 1 month after treatment and distressing symptoms such as feelings of tiredness occurred more frequently compared with baseline. At the same time, improvement in global health status/quality of life as well as affected functions in HRQoL was reported. CONCLUSION: The findings are of significance for nurses in cancer care as these highlight that sexuality and HRQoL need to be considered also in older patients with hematologic malignancies when fertility issues are of less importance. IMPLICATION FOR PRACTICE: To meet these patients' needs regarding sexuality and HRQoL, the care must provide greater consistency and continuity. One way is to organize the care in a patient-centered way where patients continuously meet a nurse guided by the idea of holistic individual nursing care throughout the care trajectory.

Patient experiences of a theory-based lifestyle-focused group treatment in the prevention of cardiovascular diseases and type 2 diabetes.

BACKGROUND: Cardiovascular disease and type 2 diabetes are two of the most common public health diseases, and up to 80 % of the cases may be prevented by lifestyle modification. The physiological effects of lifestyle-focused treatment are relatively well studied, but how patients actually experience such treatments is still rather unclear. PURPOSE: The aim of this study was to explore how patients experience lifestyle-focused group treatment in primary and secondary prevention of cardiovascular disease and type 2 diabetes. METHOD: Qualitative interviews were conducted with 19 patients attending lifestyle-focused group treatment based on social cognitive theory at a behavioral medicine clinic in northern Sweden. The interviews were transcribed verbatim and analyzed according to Malterud's systematic text condensation. RESULTS: The study shows that patients participating in this kind of group-based lifestyle treatment went through a process of self-development which deepened their understanding of own responsibility for health and improved their skills in finding support in others. The process could be tracked through three different themes (the holistic view, personal responsibility, and group treatment) which together reflected the most essential parts of the informants' experience and showed the patient as an active decision maker struggling to adopt the principles of behavioral change. CONCLUSION: Lifestyle-focused group treatment, based on social cognitive theory, was shown to stimulate different components that strengthen patients' self-efficacy for long-term behavioral change.

Epidemiological research drives a paradigm shift in complementary feeding - the celiac disease story and lessons learnt.

Breast milk is the initial natural food for infants, but already during the second half year complementary feeding is essential. Epidemiological research, first on celiac disease and later on atopic diseases, has driven a paradigm shift with respect to most favorable age to introduce complementary feeding. Simplified, this implies a shift from later to earlier introduction, which is now taken into account in recommendations on infant feeding. Complementary feeding, including all foods, should not be initiated for any infant before 4 months of age, and not later than around 6 months, including infants with elevated disease risk (e.g. for celiac disease or atopic diseases). Motivating reasons could be that ongoing breastfeeding provides an 'immunological umbrella' and/ or a different age interval gives a 'window of opportunity' for developing oral tolerance towards gluten and other food antigens. This will for some infants be in conflict with recent WHO recommendations on exclusive breastfeeding for 6 months. Epidemiology has evolved over time and could, if increasingly used, contribute even more to innovations in pediatric nutrition and other phenomena related to population health.