Deconstructing noncompliance: parental experiences of children's challenging behaviours in a clinical sample.

PURPOSE: This study explored the phenomenon of children's nonconforming behaviours from the perspective of parents who sought clinical services for children's severe noncompliance. METHOD: Mothers from 25 families who accessed clinical services were interviewed about their relationship with their children aged 8-13 and their experiences of their children's challenging behaviours. RESULTS: Mothers distinguished two different types of challenging behaviour: normative resistance and extreme aggression. Mothers described normative resistance as an expected part of children's developing autonomy and treated resistance with behavioural management strategies. Mothers also described occasions when children displayed emotionally dis-regulated extreme aggression, which were consistent with clinical descriptions of children's difficult to manage behaviour. CONCLUSION: Contrary to clinical recommendations mothers used relational strategies to reconnect children with their agency. The distinction between two different child behaviours, and strategies for each challenging behaviours have theoretical and practical implications.

Cancer-Related Fatigue in Adolescents and Young Adults After Cancer Treatment: Persistent and Poorly Managed.

Cancer-related fatigue is the most prevalent and distressing symptom experienced by adolescents and young adults (AYAs). An electronic survey was undertaken to ascertain current fatigue management and perceptions of its effectiveness. Eighty-five percent of responders (68/80) experienced fatigue, and it was worse more than 1 year after cancer treatment ended, compared to <1 year (p = 0.007). Forty-one percent received no fatigue management. Although advice to exercise was the most frequent intervention, the greatest impact of fatigue was on the ability to exercise and most did not find exercise advice helpful. Early intervention is warranted, supporting AYAs to persevere with increasing activity.

Prostatic relapse of an undifferentiated teratoma 24 years after orchidectomy.

BACKGROUND: Non-seminomatous germ cell tumours make up about 40 % of all germ cell tumours, which in turn are the most common tumours in men aged 15-44 years. Low risk stage I non-seminomatous germ cell tumours, which are confined to the testes, are commonly treated by orchiectomy and surveillance. Up to 20 % of patients with this diagnosis relapse, usually within 1-2 years of follow up, but very rarely after more than 5 years. The most common sites of relapse are the retroperitoneal lymph nodes, the mediastinum, and the lungs. We describe a case of relapse in the prostate over 20 years after initial diagnosis, which has not been described in the literature so far. CASE PRESENTATION: This report presents a 49-year-old white British man with relapsed testicular non-seminomatous germ cell tumour 22 years after initial treatment with orchidectomy only. He relapsed with a prostatic mass, haematospermia and back pain. His prostate specific antigen levels were within normal range. Alpha feto-protein and lactate dehydrogenase levels were elevated, and his human chorionic gonadotrophin levels were normal. A biopsy confirmed undifferentiated malignant tumour, shown immunohistochemically to be a yolk sac tumour. The patient was initially treated with bleomycin, etoposide and cisplatin chemotherapy, but developed bleomycin-related pulmonary side effects after two cycles. His treatment was changed and he completed four cycles of chemotherapy by receiving two cycles of etoposide, ifosfamide, and cisplatin. Post treatment blood tumour markers were normal, but a follow up computed tomography showed a mass in the base of the prostate, the trigone and the left distal ureter which was surgically resected. The histology from the surgical resection was of necrotic tissue. The patient is now in follow up at 3 years after treatment with no evidence of residual disease on computed tomography. His Alpha feto-protein, beta human chorionic gonadotrophin and lactate dehydrogenase levels are normal. CONCLUSIONS: Very late relapse in stage I non-seminomatous germ cell tumours is extremely rare and the prostate is a highly unusual site of relapsed disease. For diagnosis of late relapse, this case confirms the value of serum biomarkers in germ cell tumours, in particular non-seminomatous germ cell tumours.

Mothers' use of blogs while engaged in family-based treatment for a child's eating disorder.

INTRODUCTION: We explore parents' use of blogs while engaged in family-based treatment (FBT), a form of treatment in which parents engage as the primary givers of care for a child's eating disorder. We sought to bring together emergent literature on the value of blogging for social support with a body of literature on caregiving for a child with an eating disorder and to understand how parents use blogs while engaged in FBT. METHOD: We conducted a thematic analysis of 138 blog entries written by 5 mothers. RESULTS: Two main themes emerged: the importance of support and shifts in parenting. Blogs detailed how parents actively seek to meet their needs during a difficult time using online interactions to bolster sources of support that exist offline. This intensive form of treatment also provoked shifts in parenting, which parents described on their blogs. Parents' blogs were rich with descriptions of their use of mutually reinforcing on- and offline support. DISCUSSION: The unique context of the blogs allowed for access to data that were not generated for the purpose of research. Results add to the growing body of literature about parents' caregiving experiences and use of blogs for social support, and they offer implications for using online spaces as adjunct support for families. (PsycINFO Database Record

Malignant germ cell tumours in the elderly: a histopathological review of 50 cases in men aged 60 years or over.

Malignant testicular germ cell tumours in the elderly are extremely rare with anecdotal accounts of their aggressive behaviour. Fifty cases of germ cell tumour, diagnosed at the age of 60 years or above, were pathologically reviewed. The oldest patient was 86 years of age, with 78% of cases presenting in men in their 60s. Forty-one (82%) of the tumours were seminomas with only nine cases (18%) of mixed or non-seminomatous germ cell tumour. However, all non-seminomatous types of tumour were represented in the series. The macroscopic tumour size was significantly larger (median=6 cm, range=2-11 cm) than comparable series in younger men. They were also of higher stage with more frequent vascular invasion and rete testis invasion than is typically seen in a younger population. The tumours were less associated with intratubular germ cell neoplasia than in younger men as it was present in only 47% of assessable cases. We conclude that germ cell tumours, in man aged 60 years or above, present at a later stage than in younger men, and although most are seminomas, non-seminomatous tumours may occur with a wide spectrum of morphology.