Psychosocial Morbidity Research Articles

Review. The story of melanocyte: long way from bench to bedside

Skin is composed of major layers, a superficial epidermis and a deeper dermis. The color of skin is influenced by a number of pigments, including melanin. Melanin is produced by cells called melanocytes. Most skin disorders are relatively benign, but a few, including melanomas, can be fatal. A couple of the more noticeable disorders, namely albinism and vitiligo, affect the appearance of the skin and its accessory organs. Vitiligo is associated with significant psychosocial morbidity and profound effect on quality of life. Topical steroids, calcineurin inhibitors, phototherapy and surgery are most common treatments. However, there are many patients who do not respond to any of these modalities. The transplantation of cultured or non-cultured melanocyte is the most important treatment for hypopigmentory disorders. In this study, we are going to assess the history of melanocyte cultivation and evaluate the effectiveness of transplantation cultured cells. We examined the beginning process of isolation, characterization, and transplantation of epidermal cells. This review, summarize our current understanding of the cutaneous pigmentary system from the start of synthesis in the pigment cells, along with the response of repigmentation. During the production of melanin, melanosomes are transferred to neighboring keratinocyte in order to form perinuclear melanin caps. The objective of this review is to analyze the melanocytes transplantation in the last century up to now, and how epidermal cells can increase pigmentation in hypo-pigmented areas in skin disorders. Also, we focus on the story of the melanocyte back to 1950. In addition, prior systemic therapy was associated with a significant increase significant increase based on combined additional therapy, achieving desired results and improved outcomes. Despite the short study of a long way of melanocyte assessment and follow up patient's treatment, results of the all reports were confirmed the efficacy of the used method in the treatment of stable vitiligo who did not respond to the common algorithms of non-invasive treatments.

Parental decision regret among Australian parents after consenting to or refusing hypospadias repair for their son: Results of a survey with controls

Parental decision regret in hypospadias surgery is a recognised source of long-lasting psycho-social morbidity. High parental decision regret after their child's hypospadias repair is reported. The aim of this study is to report on decision regret in Australian parents, who accepted and declined surgery for their son and explore underlying factors for decision-making, satisfaction, and regret. An online anonymous survey was administered to three groups of parents: 1) parents who consented for hypospadias repair, 2) parents who declined repair and 3) a control group who requested circumcision for their child. Operations occurred between 2010 and 2020 in two paediatric hospitals in New South Wales, Australia. The survey included a validated decision regret assessment tool and additional questions to explore the possible basis of the opinions. One hundred and eighteen parents (invited - 381, completed - 116, response rate - 31%) participated in the survey. Decision regret was present in group 1 (n=89) - 55% (moderate-to-severe 15%), in group 2 (n=14) - 71% (moderate-to-severe 57%), and in the control group (n=15) - 15% (moderate-to-severe 8%) of parents. There was a significant difference in the median decision regret score between all three groups. Parents who chose hypospadias repair were mostly concerned about function. The prevalence of decision regret among Australian parents who consented for their son's hypospadias repair was lower compared with the mean decision regret reported in the literature to date (55% vs 65%). Decision regret and its severity were highest among parents who declined hypospadias repair. New strategies are needed to reduce decision regret in parents whether they elect for surgery or not.

“Who can I ring? Where can I go?” Living with advanced cancer whilst navigating the health system: a qualitative study

BackgroundPeople with advanced cancer often experience greater physical and psychosocial morbidity compared to those with early disease. Limited research has focused on their experiences within the Australian health system. The aim of this study was to explore the lived experiences of adults receiving care for advanced cancer.MethodsA qualitative design with a descriptive phenomenological approach was used to explore the lived experiences of people with advanced cancer following their diagnosis. Twenty-three people living with an advanced solid malignancy receiving care were referred by their oncologists to take part in an interview conducted at their home, the hospital, or over the phone.ResultsThree key themes emerged relating to participants’ experiences of living with advanced cancer: (1) living with a life-limiting diagnosis and uncertainty, (2) living with symptom burden and side effects, and (3) living within the health system, with two subthemes, the patient-clinician relationship, and care coordination. Participant relationships with their health professionals were particularly important and had a defining impact on whether patient experiences living with cancer were positive or negative.ConclusionPeople with advanced cancer experienced broad variation in their experiences navigating the health system, and their relationships with clinicians and other health professionals were important factors affecting their perceptions of their experiences. Attention to the coordination of care for people with advanced cancer is necessary to improve their experiences and improve symptom control and the management of their psychosocial burden.

Treatment of Acquired Hypothalamic Obesity: Now and the Future.

The hypothalamus is the centre of neuroendocrine regulation of energy homeostasis and appetite. Maldevelopment of, or damage to, the key hypothalamic nuclei disrupts the coordinated balance between energy intake and expenditure leading, to rapid and excessive weight gain. Hypothalamic obesity is compounded by a disruption of the hypothalamic-pituitary axis, sleep disruption, visual compromise, and neurological and vascular sequalae. Amongst suprasellar tumors, craniopharyngioma is the most common cause of acquired hypothalamic obesity, either directly or following surgical or radiotherapeutic intervention. At present, therapy is limited to strategies to manage obesity but with a modest and variable impact. Current approaches include optimizing pituitary hormone replacement, calorie restriction, increased energy expenditure through physical activity, behavioral interventions, pharmacotherapy and bariatric surgery. Current pharmacotherapeutic approaches include stimulants that increase energy consumption, anti-diabetic agents, hypothalamic–pituitary substitution therapy, octreotide, and methionine aminopeptidase 2 (MetAP2) inhibitors. Some pharmacological studies of hypothalamic obesity report weight loss or stabilization but reported intervention periods are short, and others report no effect. The impact of bariatric surgery on weight loss in hypothalamic obesity again is variable. Novel or combined approaches to manage hypothalamic obesity are thus required to achieve credible and sustained weight loss. Identifying etiological factors contributing hypothalamic obesity may lead to multi-faceted interventions targeting hyperphagia, insulin resistance, decreased energy expenditure, sleep disturbance, hypopituitarism and psychosocial morbidity. Placebo-controlled trials using current single, or combination therapies are required to determine the impact of therapeutic agents. A well-defined approach to defining the location of hypothalamic damage may support the use of future targeted therapies. Intranasal oxytocin is currently being investigated as an anorexogenic agent. Novel agents including those targeting pro-opimelanocortin-C and AgRP/NPY expressing neurons and the MC4 receptor may result in better outcomes. This article discusses the current challenges in the management of hypothalamic obesity in children and young people and future therapeutic approaches to increasing weight loss and quality of life in these patients.

53. ENHANCED PSYCHOSOCIAL SUPPORT IS NEEDED FOR PLASTIC SURGERY PATIENTS: A STUDY OF EMOTIONAL AND SOCIAL INTERACTION MANAGEMENT IN BURN AND PLASTIC SURGERY PATIENTS

PURPOSE: Few studies have evaluated psychosocial morbidity after burns or reconstructive surgery. The NIH Patient-Reported Outcomes (PROMIS) questionnaires were designed to assess social interactions and emotional management with results available for the general population (GP). We used these questionnaires to evaluate psychosocial morbidity in burn and reconstructive patients. METHODS: Burn and reconstructive adult patients were surveyed during outpatient follow-up at an urban safety net hospital. Age, ethnicity, economic environment, employment, marital status, hospital length of stay (LOS), and number of surgeries were obtained from chart review. Burn and reconstructive patients were compared to each other and the GP for social interaction and emotional management. Analysis used t-tests and univariate regressions controlling for sociodemographic variables. RESULTS: 70 burn and 40 reconstructive patients completed surveys. Burn and reconstructive patients had equivalent emotional management to the GP. Reconstructive patients had impaired social interactions compared to burn patients and the GP (p < 0.05). Increasing age (p < 0.05) or partnership (marriage or domestic, p < 0.01) were associated with better social interactions for reconstructive patients. Surprisingly, ethnicity, economic environment, employment, LOS, and number of surgeries did not impact either social interactions or emotional management. CONCLUSION: Burn survivors receive more predictable psychosocial support via established programs, which may result in fewer psychosocial morbidities after hospitalization. Plastic surgery patients with this support through social networks or partnerships appear to function similarly well to the general population. We conclude, younger, single, reconstructive patients would benefit from structured psychosocial support to maintain mental wellbeing during recovery.

Scalds and the hazards of hair braiding – The first UK series from a paediatric tertiary burns centre

IntroductionHair braiding is a popular method of hair styling thought to date as far back as 500BC. One of the techniques involves the use of hot water to ‘set the braids’ which carries the risk of significant scald injury. This study presents the first UK based case series of hair braiding associated scald burns referred to a paediatric tertiary burns centre. Our aim is to increase awareness of this novel mechanism of injury, highlight trends and develop targeted prevention strategies. MethodsRetrospective data collection of patients presenting to a regional paediatric burn centre with hair-braiding associated scald burns was collected over a 13 year period (2007–2020). Patient demographics, mechanism of injury, total body surface area (TBSA), location, depth and distribution were evaluated. The presence of additional family, quality, duration and delay of first aid were also collected. The need for admission and length of hospital stay and long-term outcomes were also appraised. ResultsFourteen patients with scald injuries secondary to hair braiding were identified. The mean age was 6.5 years (5–9) and all patients were female. The most prevalent ethnicity affected were patients with African heritage. The mean TBSA was 3% (1–7 %). First aid was performed in only 50% of cases, of which none was adequate. The distribution of burns was as follows: the back (43%), posterior nape of the neck (36%), posterior shoulder (14%), scalp and face (21.5%) chest (7%) and legs (7%).Nine patients required admission to hospital with the mean length of stay of 2.85 days (range 1–12). No patients required surgery. The mean time to healing was 14 days (range 9–26). Longterm complications included hypopigmentation and hypertrophic scarring requiring scar management strategies. DiscussionThis well recognized technique of hair styling carries significant risks of scald injury. Patients often require hospital admission, endure emotional distress and require time off school. Patients can develop significant hypopigmented and hypertrophic scarring at a young age leading to considerable psychosocial morbidity. We recommend spreading awareness of the dangers of hair braiding through education, safety device development, prevention campaigns and targeted outreach work to minimise the hazards of this hair styling technique.

A66 THE IMPACT OF A MULTIDISCIPLINARY ADOLESCENT AND YOUNG ADULT (AYA) INFLAMMATORY BOWEL DISEASE (IBD) ON CLINIC NO SHOW RATES

BackgroundTransitioning from pediatric to adult health care is associated with significant psychosocial and clinical morbidity. Adolescents not only transition their medical care, but also experience vast changes in the physical, social, and psychological spheres of their lives. The medical team must help navigate these changes to provide optimal care.IBD in adolescence is associated with increased hospitalizations and surgery. This is due to several factors, including medication non-adherence and a failure to attend medical appointments. There has been a greater focus on improving care for this unique population.McMaster Children’s Hospital has integrated the AYA IBD clinic for patients between the ages of 16 and 22. The goal is to transition patients using a developmentally appropriate framework to facilitate self-efficacy and help identify comorbid mental health conditions while building resilience.AimsTo explore the impact of the implementation of a dedicated transition clinic on attendance at medical visits for AYA patients with IBD.MethodsThe total numbers of patients booked in the AYA IBD Clinic was compared to an age matched subset of the patients in the adult McMaster Complex IBD (CIBD) Clinic. These visits were assessed based on whether the visit was: attended, cancelled, or no showed. Visits were then stratified between in-person and virtual visits. Unpaired t tests was performed to compare the AYA IBD clinic and the CIBD clinic. Findings were deemed significant based on p-values <0.05.ResultsThe percentages of patients that attended visits (in-person or virtually) was similar between both clinics at 86% versus 79% Year 1 (Y1) and 76% versus 81% Year 2 (Y2). The number of patients seen in the AYA clinic increased from Y1 (n=92) to Y2 (n=131). The CIBD clinic saw fewer patients between Y1 (n=202) and Y2 (n=79). There were a higher number of patients who cancelled or no showed in Y2 versus Y1 for the AYA virtual visits (13 versus 8) compared to the CIBD clinic (Y2,1 versus Y1,1).ConclusionsOur results highlight the challenges of transitioning adolescent patients with IBD. Our retrospective study was not powered to show significance. Given the increase in cancellation and no-show rates in Y2, the AYA clinic has incorporated a patient navigator to issue reminder phone calls and facilitate communication with patients between clinics. Future studies will re-assess how the presence of a patient navigator impacts attendance and cancellation rates. Future studies will also assess how the AYA clinic impacts transition readiness and self-efficacy, which is being measured through validated questionnaires in our clinic. Funding AgenciesGrants-In-Aid

Development and Evaluation of the Usefulness, Usability, and Feasibility of iNNOV Breast Cancer: Mixed Methods Study.

BackgroundDespite the efficacy of psychosocial interventions in minimizing psychosocial morbidity in breast cancer survivors (BCSs), intervention delivery across survivorship is limited by physical, organizational, and attitudinal barriers, which contribute to a mental health care treatment gap in cancer settings.ObjectiveThe aim of this study is to develop iNNOV Breast Cancer (iNNOVBC), a guided, internet-delivered, individually tailored, acceptance and commitment therapy–influenced cognitive behavioral intervention program aiming to treat mild to moderate anxiety and depression in BCSs as well as to improve fatigue, insomnia, sexual dysfunction, and health-related quality of life in this group. This study also aims to evaluate the usefulness, usability, and preliminary feasibility of iNNOVBC.MethodsiNNOVBC was developed using a user-centered design approach involving its primary and secondary end users, that is, BCSs (11/24, 46%) and mental health professionals (13/24, 54%). We used mixed methods, namely in-depth semistructured interviews, laboratory-based usability tests, short-term field trials, and surveys, to assess iNNOVBC’s usefulness, usability, and preliminary feasibility among these target users. Descriptive statistics were used to characterize the study sample, evaluate performance data, and assess survey responses. Qualitative data were recorded, transcribed verbatim, and thematically analyzed.ResultsOverall, participants considered iNNOVBC highly useful, with most participants reporting on the pertinence of its scope, the digital format, the relevant content, and the appropriate features. However, various usability issues were identified, and participants suggested that the program should be refined by simplifying navigation paths, using a more dynamic color scheme, including more icons and images, displaying information in different formats and versions, and developing smartphone and tablet versions. In addition, participants suggested that tables should be converted into plain textboxes and data visualization dashboards should be included to facilitate the tracking of progress. The possibility of using iNNOVBC in a flexible manner, tailoring it according to BCSs’ changing needs and along the cancer care continuum, was another suggestion that was identified.ConclusionsThe study results suggest that iNNOVBC is considered useful by both BCSs and mental health professionals, configuring a promising point-of-need solution to bridge the psychological supportive care gap experienced by BCSs across the survivorship trajectory. We believe that our results may be applicable to other similar programs. However, to fulfill their full supportive role, such programs should be comprehensive, highly usable, and tailorable and must adopt a flexible yet integrated structure capable of evolving in accordance with survivors’ changing needs and the cancer continuum.

Exercise Recommendation for People With Bone Metastases: Expert Consensus for Health Care Providers and Exercise Professionals.

Exercise has been underutilized in people with advanced or incurable cancer despite the potential to improve physical function and reduce psychosocial morbidity, especially for people with bone metastases because of concerns over skeletal complications. The International Bone Metastases Exercise Working Group (IBMEWG) was formed to develop best practice recommendations for exercise programming for people with bone metastases on the basis of published research, clinical experience, and expert opinion. The IBMEWG undertook sequential steps to inform the recommendations: (1) modified Delphi survey, (2) systematic review, (3) cross-sectional survey to physicians and nurse practitioners, (4) in-person meeting of IBMEWG to review evidence from steps 1-3 to develop draft recommendations, and (5) stakeholder engagement. Recommendations emerged from the contributing evidence and IBMEWG discussion for pre-exercise screening, exercise testing, exercise prescription, and monitoring of exercise response. Identification of individuals who are potentially at higher risk of exercise-related skeletal complication is a complex interplay of these factors: (1) lesion-related, (2) cancer and cancer treatment-related, and (3) the person-related. Exercise assessment and prescription requires consideration of the location and presentation of bone lesion(s) and should be delivered by qualified exercise professionals with oncology education and exercise prescription experience. Emphasis on postural alignment, controlled movement, and proper technique is essential. Ultimately, the perceived risk of skeletal complications should be weighed against potential health benefits on the basis of consultation between the person, health care team, and exercise professionals. These recommendations provide an initial framework to improve the integration of exercise programming into clinical care for people with bone metastases.

Association between stuttering and psychosocial complications in Saudi Arabian individuals: A pilot study.

Stuttering is a multifaceted speech disorder that affects the interpersonal communication. It has a significant psychosocial impact on individuals who stutter and on their families. Stuttering is associated with substantial psychosocial morbidity, including social or generalized anxiety, stigmatization or discrimination, impaired self-image, and poor quality of life. Psychosocial morbidity, such as the one reported among stuttering individuals, may provoke suicidal ideation that varies with gender, age, geographic region, and psychosocial reality. The present research aimed to determine the association between stuttering and psychosocial complications in Saudi Arabian individuals. This study targeted a total of 107 male patients with stuttering. Only 59 of them fulfilled both inclusion and exclusion criteria. The researchers formulated a valid questionnaire to obtain quantifiable data for analysis. The questionnaire consisted of 76 questions spanning various domains. Following the data collection, a quantitative analysis was carried out. A total of 79.5% of the participants were adolescents or young adults between the ages of 16 and 26. Among them, 17.8% had a later onset of stuttering. The age of onset tended to be higher than 5 years, with over 80% of respondents reporting an age of onset in the last 5 years of their age. Among the participants, 57.6% reported a positive family history of stuttering. The present study reports that patients who stutter (PWS) are at a higher risk of developing negative thoughts leading to suicidal attempts due to social anxiety and depression. Therefore, future studies should be designed to establish the relationship between stuttering and suicidal thoughts in order to establish policies that may improve the quality of life of those who stutter.

Advances in Therapy for Atopic Dermatitis

ABSTRACT Atopic dermatitis (AD) is the most common chronic inflammatory skin condition in the world, characterized by epidermal barrier dysfunction, increased pathogen ingress, dysbiosis, and chronic inflammation. Patients with AD are at an increased risk of other comorbidities including skin infections, sleep disorders, and psychosocial morbidities that have significant impacts on quality of life and warrant more advanced therapeutics. A number of Th2 cytokines and the JAK-STAT pathway have been identified as playing critical roles in the pathogenesis of AD resulting in a rich pipeline of agents that target these factors. In this brief clinical review, we examine the evidence available for novel agents in Phase II and Phase III studies as potential treatments to broaden the therapeutic options, especially for patients with moderate-to-severe AD.

Prediction of ovarian hyperstimulation syndrome

OHSS is best defined as an iatrogenic condition caused by inflammatory mediators released by the hyperstimulated ovaries. OHSS is associated with significant physical and psychosocial morbidity and has been associated with maternal death. However, in most cases OHSS is self-limiting and requires supportive management and monitoring while awaiting resolution. Because OHSS is the most serious consequence of controlled ovarian stimulation, every attempt should be made to identify patients who are at highest risk. If the “at risk” women can be identified prior to or during treatment, targeted preventive measures can be applied.

Clinico-epidemiological profile of patients with sexually transmitted infections at a tertiary care centre

Background: Sexually Transmitted Infections (STIs) are one of the most disastrous events of human health causing huge psychosocial and economic morbidity in young and sexually active adults. Population explosion, migration from rural to urban areas, commercial sex and lack of awareness has all led to enormous spread of STIs in the community. Their epidemiological profile varies from country to country and from one region to another within a country. This study highlights the pattern of STIs in patients as seen at our hospital for a period of 2 years. Aim: To study the clinico-epidemiological profile of the patients with Sexually Transmitted Infections. Methods and Material: This study was conducted at Dept. of Dermatology, Venereology and Leprosy at PDU Govt. Medical College and Hospital, Rajkot, Gujarat. This included 300 consecutive symptomatic STI patients presenting to the clinic between November-2013 to October-2015. Diseases were diagnosed on the basis of detailed history, clinical examination and relevant investigations. Results: Most common age group affected was 21-30 years (39%). Incidence of STI was high among Males (75.33%). Married persons were more commonly affected (55.33%) as compared to unmarried. Herpes Genitalis (42.33%) was the most common STI followed by Genital warts (27.33%), Genital Molluscum Contagiosum (16.67%). The overall sero-prevalence of HIV among the STI patients was-19% and Herpes Genitalis was most commonly associated with sero-positivity.Conclusion: Study concluded that bacterial STIs are having declining trend and viral STIs are having upward trend. The persistent and recurrent nature of viral infections is responsible for their increasing trend in the current STI scenario.

Medical and psychosocial health status of adolescent school going girls

Aim: To evaluate medical and psychosocial health status of adolescent school going girls. Material and Methods: The present cross-sectional study was conducted in the Christian Medical College, Ludhiana from February 2017 to January 2019. The study group was consisted of 1000 adolescent girls of school aged 10-19 yrs in rural Ludhiana. Children were screened for any of adolescent morbidity based on questionnaire. The patients were interviewed that requests for the demographic, socioeconomic status, medical history and previous history of taking any medications and supplements. Girl’s socioeconomic status were classified according to Kuppuswamy scale. For skin related disease dermatologist was considered. Dental caries, dental staining and brushing habits were recorded based upon the examination. Informed pertaining to psychosocial morbidities were recorded i.e. depression, anxiety, stuttering and psychosomatic symptoms. Results: 37.1% girls belong to 10-14yr age group, likewise 25.5% to 15-17yrs and 37.4% to 18-19yr age group. Majority of girls (99.6%) attained menarche after 12yrs of age and dysmenorrhea (12.8%) was reported to be the most common menstrual problem among girls; majority of girls were using sanitary pads for menstrual hygiene purpose. In hearing assessment about 1.7% of girls were found in having hearing difficulty. 35.1% of girls were suffering from dental caries; dental staining was present in 15.8% of girls. Acne was the commonest skin problem (13%).5.2% of girls were found to be in depressed mood, 1.2% of total girls were anxious and stuttering was reported in 0.9% of total girls. Conclusion: To achieve wholesome adolescent health, we need to have a multidimensional approach covering all the adolescent health problems with special emphasis on mental health, behaviour change communication towards healthy lifestyle and positive social environment to acquire life skills.

Soft tissue reconstruction of the lower extremity in the pediatric population

Lower extremity defects are a source of significant functional and psychosocial morbidity for pediatric patients and require complex reconstructions to restore form and function. The advent of microsurgical reconstruction along with advances in wound care techniques and technologies have empowered reconstructive surgeons to perform limb salvage surgery in patients that would traditionally require amputation; however, the indications for performing reconstructive surgery for complicated cases are not ironclad. While this is the case, applying the principles of lower extremity reconstruction in adults to the pediatric population is often sufficient to achieve a satisfactory outcome. This overview discusses the evaluation and management of soft tissue defects of the leg in pediatric patients.

ATTENTION DEFICIT HYPERACTIVITY DISORDER SYMPTOMS IN ADULTS WITH ESSENTIAL TREMOR

Background: Essential tremor is the most common movement disorder. İn this disease, which is characterized by tremor that increases with action and passes at rest, different accompanying symptoms can also be seen. Objective: The purpose of this study was to investigate attention deficit hyperactivity symptoms in adults with ET. Methods: Fifty six essential tremor patients and 56 controls were included in the study. Patients were recruited from outpatient clinic at Kirikkale University Medicine Faculty. An informed consent form was signed by each patient after detailed information. Institutional ethics committee approval was obtained. Patients’ characteristics such as education level, gender, age and disease duration were recorded. Symptoms of ADHD in patients and controls were determined by using the Adult Report Deficit / Hyperactivity Disorder Self Report Scale. Short Form-36 and Hospital Anxiety and Depression Scale were also performed. Essential tremor severity was determined by using the Whiget essential tremor scale. Results: Essential tremor patients had significantly higher rate of Adult Attention Disorder Self-Report Scale Deficit/Hyperactivity scores compared to controls. Scores of Adult Attention Deficit/Hyperactivity Disorder Self-Report Scale were associated with depression and anxiety scores and physical and mental component scores of Short Form-36 in bivariate analyses. There was a positive correlation between tremor severity and ASRS scores( ASRS A scores= 17,3±5,5, p=0,032, ASRS B scores= 27,7±6,7,p=0,043, ASRS T scores= 45±12,2, p=0,017) however there was no significant statistical relationship between the duration of disease and ASRS scores. Conclusion: This study showed that ADHD symptoms can be observed in adult essential tremor patients and this may be associated with increased psychosocial morbidity and lowered quality of life in ET patients.

Cancer in the Adolescent and Young Adults (AYA) and Children: A Comprehensive Analysis of the Epidemiology and Psychosocial Morbidity in the Indian Population.

Bhupesh GuleriaAims Adolescent and young adults (AYAs), children with cancer, and their guardians have unique psychosocial morbidities adversely effecting quality of life (QOL). This is measurable using patented tools. We analyzed epidemiological and clinicopathological patterns of solid organ cancers in this subgroup. We also assessed psychosocial morbidity and changes in QOL faced by them. Methods All patients aged 2 to 39 years, newly diagnosed with cancer from April 2017 to March 2019 were included. Clinical history, diagnosis, staging, treatment, outcomes, and follow-up were recorded. The National Comprehensive Cancer Network (NCCN) distress thermometer and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C-30) were used to assess psychosocial morbidity of AYAs, children ≥ 12 years, and parents of children < 12 years. Pediatric Quality of Life Inventory (Peds QL) version 3.0 was used for children < 12 years. Data was analyzed using descriptive statistics. Results A total of 571 patients (512 AYAs, 59 children) were enrolled. Median age was 30 years with male predominance (58.1%). Most cases (98.6%) were absent from school or work. Carcinoma breast was the most common in females (29.3%) and non-Hodgkin lymphoma in males (12.6%). 91.06% had overall NCCN distress score ≥ 4. Also, 73.81 and 79.49% had “quite a bit” or “very much” responses on functional and symptom scales, respectively, in EORTC QLQ C-30 questionnaire. Peds QL version 3.0 revealed total score ranging from 276 to 523 for each patient. Conclusion AYAs and children with cancer are extremely vulnerable to psychological stress and morbidity. Use of well-established tools help in assessing their mental status and timely psychiatric referral can be initiated.

A case of lichen planopilaris associated with lichen planus following Blaschko lines successfully treated with topical corticosteroid

Lichen planopilaris (LPP) is characterized by erythematous, keratotic follicular papules and cicatricial alopecia. LPP, the most common cause of cicatricial alopecia, is usually seen in women and causes significant psychosocial morbidity. We describe here a 42-year-old woman with a 6-month history of hair loss accompanied by itching on the scalp. Dermatological examination revealed patchy cicatricial alopecia in the vertex and band-like purple flat patches and plaques following the Blaschko lines on the right half of the body, together with post-inflammatory hyperpigmentation. Histopathological examination of the scalp biopsy was consistent with LPP, while thigh biopsy was consistent with lichen planus. With the histopathological and clinical evidence, our patient was evaluated as LPP associated with LP and successfully treated with topical corticosteroid. A few LPP and LP cases following the Blaschko lines have previously been reported separately. However, LPP, together with LP following Blaschko lines, have not been reported in the same patient.

Modifiable risk factors for neurocognitive and psychosocial problems after Hodgkin lymphoma

AbstractLong-term survivors of childhood Hodgkin lymphoma (HL) experience a high burden of chronic health morbidities. Correlates of neurocognitive and psychosocial morbidity have not been well established. A total of 1760 survivors of HL (mean ± SD age, 37.5 ± 6.0 years; time since diagnosis, 23.6 ± 4.7 years; 52.1% female) and 3180 siblings (mean age, 33.2 ± 8.5 years; 54.5% female) completed cross-sectional surveys assessing neurocognitive function, emotional distress, quality of life, social attainment, smoking, and physical activity. Treatment exposures were abstracted from medical records. Chronic health conditions were graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events version 4.3 (1 = mild, 2 = moderate, 3 = severe/disabling, and 4 = life-threatening). Multivariable analyses, adjusted for age, sex, and race, estimated relative risk (RR) of impairment in survivors vs siblings and, among survivors, risk of impairment associated with demographic, clinical, treatment, and grade 2 or higher chronic health conditions. Compared with siblings, survivors had significantly higher risk (all, P < .05) of neurocognitive impairment (eg, memory, 8.1% vs 5.7%), anxiety (7.0% vs 5.4%), depression (9.1% vs 7%), unemployment (9.6% vs 4.4%), and impaired physical/mental quality of life (eg, physical function, 11.2% vs 3.0%). Smoking was associated with a higher risk of impairment in task efficiency (RR, 1.56; 95% confidence interval [CI], 1.02-2.39), emotional regulation (RR, 1.84; 95% CI, 1.35-2.49), anxiety (RR, 2.43; 95% CI, 1.51-3.93), and depression (RR, 2.73; 95% CI, 1.85-4.04). Meeting the exercise guidelines of the Centers for Disease Control and Prevention was associated with a lower risk of impairment in task efficiency (RR, 0.70; 95% CI, 0.52-0.95), organization (RR, 0.60; 95% CI, 0.45-0.80), depression (RR, 0.66; 95% CI, 0.48-0.92), and multiple quality of life domains. Cardiovascular and neurologic conditions were associated with impairment in nearly all domains. Survivors of HL are at elevated risk for neurocognitive and psychosocial impairment, and risk is associated with modifiable factors that provide targets for interventions to improve long-term functional outcomes.

Sharing psychosocial risk screening information with pediatric oncology healthcare providers: Service utilization and related factors.

Psychosocial morbidity in pediatric oncology patients and their caregivers is widely recognized. Although routine systematic psychosocial screening has been proposed as a standard of care, screening is still limited. The present study assessed whether supplying the patient's treating team of healthcare providers with psychosocial risk screening information near diagnosis would increase the rate of documented psychosocial contacts, particularly for patients/families with elevated risk. The effect of demographic and clinical factors was also examined. Ninety-three families with a child/youth newly diagnosed with cancer participated. Families were randomly assigned to a care as usual control group (n=44) or an intervention group (n=49) where the treating team was provided with a summary of family psychosocial risk, measured by the Psychosocial Assessment Tool (PAT). The PAT was completed by the primary caregiver, who also provided demographic information. The number of psychosocial intervention contacts documented in the medical charts was examined. The rate of psychosocial intervention did not significantly differ between the groups (P>0.05). The intensity of the child's cancer treatment was found to be the only significant predictor of the number of documented psychosocial intervention contacts (β=0.396, P<0.001). Clinical factors appear to be more predictive of the rate of psychosocial intervention provided to pediatric oncology patients and their families than informing the treating team of family psychosocial risk. Additional research is required to address the gap between psychosocial risk screening, psychosocial intervention, and family outcomes.