Role Functioning Research Articles

Generic vs. Disease-Specific Patient Reported Outcome (PRO) Instruments for Assessing HRQoL Burden Among Patients Diagnosed with Alopecia Areata: Evidence from TARGET-DERM AA

Introduction Alopecia areata (AA) is a chronic, autoimmune disease characterized by patchy hair loss. Compared to other disease areas, recent work has signaled a potential shortcoming, that generic quality of life (QOL) questionnaires are not sufficiently sensitive to the impact of AA disease severity. This cross-sectional analysis investigates the Short-Form 36, the dermatology life quality index (DLQI), and the Alopecia Areata Patient Priority Outcomes (AAPPO) for similar shortcomings. Methods Patients of all ages enrolled from December 2021 to June 2024 in TARGET-DERM AA (data collection on-going) in the United States and Canada were grouped by Severity of Alopecia Tool (SALT) score (1-20, 21-49, or 50-100). At enrollment, patients completed the AAPPO and DLQI questionnaire as well as the RAND MOS Short-Form 36. The SF-36 has 8 subdomain scores (vitality, physical function, bodily pain, general health, physical role function, emotional role function, social role function, mental health) along with the physical component summaries (PCS), mental component summaries (MCS), and the SF-6D utility index score. The Kruskal-Wallis test compared differences in mean scores across SALT subgroups defined by severity. Results Of the 141 AA patients, 61.7% were female; 95.0% adults, and 67.4% Non-Hispanic White. When comparing the SALT 1-20 and the >50 subgroups, significant differences in SF-36 derived mean scores were only observed in the PCS and the physical function score (p<0.05). None of the other scores (MCS, SF-6D, or other SF-36 subdomains) showed any differences. Mean DLQI scores were similar across subgroups (p>.05) Notably, the hair loss and activity limitation domains of the AAPPO demonstrated significant differences between the patient subgroups (p<.0001 and p<.05, respectively) Discussion In this real-world cohort, generic QoL instruments, namely the SF-36 and DLQI, did not capture differences in the underlying health-related QoL burden of AA patients with different AA severity. Such differences were clear when HRQoL was measured for AA patients with mild hair loss AAPPO.

Associations of physical activity and sedentary time with health-related quality of life in patients with localized renal cell cancer: a cross-sectional analysis within the ReLife study

Abstract Purpose This study examined the associations of device-measured moderate-to-vigorous physical activity (MVPA) and sedentary time as well as self-reported MVPA with health-related quality of life (HRQoL) in patients with localized renal cell cancer (RCC) in the recovery phase after surgery. Methods At 3 months post-surgery, 341 patients with stage I-III RCC participating in the ReLife study wore an ActivPAL3 device to determine MVPA and sedentary time. The SQUASH questionnaire was used for assessing self-reported MVPA, and the EORTC QLQ-C30 for assessing HRQoL (range 0–100). Multivariable linear regression models were used to examine the cross-sectional associations of MVPA and sedentary time with HRQoL. Results The highest (≥ 6.7 h/week) versus lowest (≤ 2.7 h/week) quartile of MVPA was associated with a better global health status (β, 10.2; 95% CI, 5.1, 15.3), summary score (β, 4.6; 95% CI, 1.1, 8.1), physical (β, 7.7; 95% CI, 3.8, 11.6), role (β, 12.4; 95% CI, 4.7, 20.2), and social functioning (β, 7.3; 95% CI, 0.2, 14.4), and lower fatigue (β, − 11.2; 95% CI, − 18.1, − 4.2). Results for self-reported MVPA were in the same direction but weaker. The lowest (≤ 8.8 h/day) versus highest (≥ 11.5 h/day) quartile of sedentary time was associated with better physical functioning (β, 4.6; 95% CI, 0.8, 8.5). Conclusions In patients with localized RCC, higher MVPA 3 months post-surgery was associated with better HRQoL outcomes including less fatigue whereas lower sedentary time was only associated with better physical functioning. This information can contribute to the development of physical activity guidelines and interventions to improve HRQoL.

Cognitive-Behavioural Social Skills Training: Mediation of Treatment Outcomes in a Randomized Controlled Trial for Youth at Risk of Psychosis: L'entraînement aux compétences sociales cognitivo-comportementales : variables médiatrices des résultats thérapeutiques dans le cadre d'un essai clinique randomisé pour les jeunes présentant un risque de psychose.

Currently, there are no effective treatments for functional outcomes (i.e., role and social) and negative symptoms for youth at clinical high-risk (CHR) for psychosis. Investigations into possible mechanisms that may contribute to the improvement of functioning and negative symptoms are needed in CHR research to help inform psychosocial treatments. The present study examined whether functioning and negative symptoms were mediated by asocial beliefs, defeatist beliefs, self-efficacy, maladaptive schemas, anxiety, depression, social cognition, or attenuated psychotic symptoms (APS) in a large clinical trial. CHR participants (n = 203; 104 females; 99 males) were recruited as part of a three-site randomized control trial comparing group cognitive-behavioural social skills training (CBSST) versus a supportive therapy group. Mediation analyses were conducted to test the relationships between treatment group, mediators (asocial beliefs, defeatist beliefs, self-efficacy, maladaptive schemas, anxiety, depression, social cognition, and APS), and outcome (social and role functioning, and negative symptoms). The mediation analyses employed conditional process path analysis via ordinary least squares regression. At the end of treatment, but not 12-month follow-up, more severe APS were found to mediate the impact of treatment on negative symptoms, and social and role functioning. The greater the severity of APS, the less likely that CBSST would result in improvement in negative symptoms and social and role functioning. Many of the other variables showed significant associations with social (less for role) functioning and negative symptoms but did not mediate the effect of treatment on these outcomes at the end of treatment or 12-month follow-up. There were no significant mediators except for APS at the end of treatment. Since more severe APS may result in participants being unable to fully participate in therapy and thus limit their gains, clinical implications may include offering some individual therapy to prepare these young people to benefit from the group treatment.

The Geometry and Dynamics of Meaning.

An enigma for human languages is that children learn to understand words in their mother tongue extremely fast. The cognitive sciences have not been able to fully understand the mechanisms behind this highly efficient learning process. In order to provide at least a partial answer to this problem, I have developed a cognitive model of the semantics of natural language in terms of conceptual spaces. I present a background to conceptual spaces and provide a brief summary of their main features, in particular how it handles learning of concepts. I then apply the model to give a geometric account of the semantics of different word classes. In particular, I propose a "single-domain hypotheses" for the semantics of all word classes except nouns. These hypotheses provide a partial answer to the enigma of how words are learned. Next, a dynamic cognitive model of events is introduced that replaces and extends the function of thematic roles. I apply it to analyze the meanings of different kinds of verbs. I argue that the model also explains some aspects of syntactic structure. In particular, I propose that a sentence typically refers to an event. Some further applications of conceptual spaces are briefly presented.

Attention Deficit Hyperactivity Disorder among Youth at Clinical High Risk of Psychosis

Abstract Background Attention Deficit Hyperactivity Disorder (ADHD) affects a significant proportion of the population and is associated with numerous adverse outcomes including lower educational attainment, occupational challenges, increased substance use, and various mental health issues including psychosis. This study examined the demographic, clinical, cognitive, social cognitive and functional differences between youth at clinical high-risk (CHR) for psychosis with and without co-morbid ADHD. Method Data was drawn from the North American Prodrome Longitudinal Studies (NAPLS2 and NAPLS3), which included 764 and 710 CHR individuals, respectively. After applying exclusion criteria, the sample consisted of 271 CHR participants with ADHD and 1118 without ADHD. All data was examined cross-sectionally. Results Compared to the non-ADHD group, the ADHD group was younger, had more difficulties with role functioning, premorbid functioning, social cognition, were more likely to have a co-morbid learning disorder and reported less depression symptoms. There were no significant differences between the groups on positive or negative psychotic symptoms, transition rates, adverse events, or other co-morbid disorders including substance use and depression. Discussion Co-morbid ADHD is likely not a significant predictor of transition to psychosis among CHR youth, however those CHR with ADHD may experience symptoms at a younger age than those without and present with a distinct clinical profile.

Norwegian and Swedish value sets for the EORTC QLU-C10D utility instrument.

This study aimed to develop utility weights for the European Organization for Research and Treatment of Cancer (EORTC) QLU-C10D, a cancer-specific utility instrument, tailored to the Norwegian and Swedish populations. The utility weights are intended for use in the specific welfare contexts of Norway and Sweden to support more precise healthcare decision-making in cancer treatment and care. This cross-sectional study included 1019 Norwegian and 1048 Swedish participants representative in age and gender of the two general populations. Participants completed a discrete choice experiment involving 960 choice sets, each consisting of two EORTC QLU-C10D health states described by the instrument's domains and the duration of each state. Utility weights were calculated using generalized estimation equation models, and non-monotonic levels were merged to ensure consistent valuation. In the Norwegian participants, the largest utility decrements were seen for the domain of physical functioning (decrement of -0.263 for highest level "very much"), followed by pain (decrement -0.205 for level "very much") and role functioning (-0.139). Among the cancer-specific domains, nausea had the largest utility decrement (-0.124). In the Swedish participants, the largest utility decrements were also observed for physical functioning (-0.207 for the response "very much"), followed by pain (-0.139), role functioning (-0.133), and nausea (-0.119). Emotional functioning also exhibited a sizable utility decrement (-0.115). This study provides the first set of utility weights for the EORTC QLU-C10D specific to Norway and Sweden, reflecting the unique health preferences of these populations. The generated utility decrements can inform cost-utility analyses and optimize resource allocation in cancer care within the Norwegian and Swedish healthcare systems.

Health Related Quality of Life (HRQoL) Following APER: Early Effects on Ano Rectal Cancer Patients

Background: Colorectal cancer is the third most common cancer worldwide, accounting for approximately 10% of all cancer cases and is the second leading cause of cancer-related deaths worldwide. Treatment of rectal cancer had been primarily focused on oncologic outcome, with detailed assessment of survival and local recurrence. Less attention has been given to functional outcome and quality of life (QoL). Methodology: This prospective study was conducted in the Department of Surgical Oncology, National Cancer Research Institute & Hospital, Dhaka from July, 2019 – March, 2021. Total 33 patients who fulfilled the inclusion and exclusion criteria were included in this study by purposive sampling. The scoring formulas supplied by EORTC was used for both the questionnaires (QLQ-C30 and QLQ-CR29) and in accordance to the scoring manual, the questionnaire items were grouped into scales in the categories – global health status QOL, functional scales and symptoms scales and then compiled. The p value was set as significant if p<0.05. Results: Mean age of the patient was 45.1±13.9 years. Physical function, role function, emotional function, cognitive function, social function and global health status were significantly (p=0.001) decreased after treatment group than before treatment group. Fatigue, nausea and vomiting, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea and financial difficulties were significantly increased after treatment group than before treatment group. Conclusion: Surgical oncologist can improve the quality of life of patients by saving the neurovascular structures while performing anterior/posterior/lateral dissection of rectum. Multidisciplinary approach including “Tumour Board” as well as performing sphincter saving procedures (AR) rather than APER could drastically improve the quality of life of cancer patients. Preoperative counselling, taking time to explain and understand patients’ concern results in decreased stress and improve ......

Impact of perioperative high-protein nutritional support on the quality of life of patients with primary lung cancer: a Russian prospective multicenter comparative study (NUTRILUNC study)

BACKGROUND: Individuals over the age of 70 comprise over half of operable patients with stage 0–IIIA lung cancer. In the early postoperative period of this cohort, pain, fatigue, insomnia, and/or mood disturbances are the four most common symptoms, which can significantly diminish quality of life and functional status. Perioperative nutritional support in such patients, which enhances exercise tolerance, can have a positive impact on their quality of life and socialization. AIM: To assess the effect of perioperative nutritional support using high-protein oral nutrition supplements on the general health and quality of life of non-small cell lung cancer patients during the postoperative period. MATERIALS AND METHODS: Patients with primary non-small cell lung cancer (n=112, 69 males), aged 57.2±8.2, who were awaiting lung surgery and at risk of malnutrition (Nutritional Risk Screening Assessment 2002 score ≥3) were randomly assigned into two groups. Oral nutritional support (Nutridrink Compact Protein, Nutricia LLC) was administered to the study group (n=55) at a rate of 250 ml/d (36 g of protein, 612 kcal) for 14 days prior to and 14 days following the surgery, in addition to the standard diet. Control group patients (n=57) were provided a standard diet. The quality of life was assessed using the Quality of Life Questionnaire Core-30. Results are presented as mean ± standard deviation. Differences were considered significant at p ≤0.05. RESULTS: Throughout the entire observation period, the study group exhibited superior growth indicators in terms of general health status, physical, and role functioning than the control group (p 0.05). The study group patients exhibited a propensity toward improved emotional functioning, and by the end of the study, weakness and insomnia were less pronounced (p 0.05). Other indicators did not exhibit any significant variations. CONCLUSION: Нigh-protein perioperative oral nutrition supplements exert a positive impact on the quality of life of non-small cell lung cancer patients.

A prospective mixed‐methods pilot study of a novel group structured education programme for adults with cystic fibrosis diabetes

AbstractBackground: Cystic fibrosis diabetes (CFD) is associated with increased morbidity and mortality in adults with cystic fibrosis (CF). In addition, poor glycaemic control can result in microvascular complications. Group educational programmes for people with type 1 and 2 diabetes have been shown to improve diabetes outcomes. The national guidelines recommend that people with CFD should receive education regarding diabetes; however, specific CFD group education programmes have not been evaluated.Aims: This study aimed to test whether this novel diabetes contents and intervention for CFD based on the Beta Cell Education Resources for Training in Insulin and Eating (BERTIE) type 1 diabetes education programme was beneficial for adults with CFD. The adapted course, Improved Diabetes Education in Adults with Cystic Fibrosis (IDEA‐CF ), incorporated CFD‐specific topics and was delivered virtually via videoconference group sessions to facilitate peer learning and support without the risk of cross‐infection. A pilot study was conducted utilising this novel IDEA‐CF virtual structured program to ensure that the intervention met the patients’ educational needs.Methods: This randomised controlled multimethods pilot study recruited adults with CFD taking insulin therapy and cared for by a large regional CF centre. After providing written informed consent, the participants completed all the study forms and questionnaires before randomisation. Randomisation was performed using a computerised randomisation system that allocated adults with CFD into the intervention group (IDEA‐CF) or routine care group for the 12‐week study period. Participants who were randomised into the routine group continued to receive one‐on‐one education as before. Using the CF quality‐of‐life (QoL) questionnaire (revised Cystic Fibrosis Questionnaire [CFQ‐R]), outcomes were measured at baseline and 12‐week visits in both groups. The participants in the intervention group were asked to take part in a semistructured qualitative interview after the completion of the intervention, which was performed by a CF psychologist.Results: A total of 20 participants were recruited, with 18 completing the intervention and study follow‐up visits. In the CFQ‐R domains, physical functioning, emotional functioning, eating, role functioning and respiratory symptoms were significantly improved in the intervention group compared with the routine care group. The IDEA‐CF Knowledge Assessing Questionnaire (IDEA‐CF KAQ) scores in the intervention group improved compared with the IDEA‐CF KAQ scores in the control group, suggesting that education improves knowledge and understanding. The IDEA‐CF structured virtual group education group was well received, with participants valuing the educational content and the ability to interact with each other and to learn from their peers’ experiences constructively.Conclusions: Our study demonstrated that the IDEA‐CF education programme improved health‐related QoL and diabetes knowledge, as evidenced by the results of the IDEA‐CF KAQ. The participants valued the educational contents of the programme and reported a positive experience interacting with their peers.

Minimal Clinically Important Differences in the Cancer Quality of Life Questionnaires in Patients with Head and Neck Cancer

Purpose: The purpose of this study is to determine the magnitude of change that is clinically meaningful in the EORTC QLQ-C30 and EORTC QLQ-HN35 instruments in head and neck cancer patients. Methods: Two hundred and twenty-two patients completed the EORTC QLQ-C30 and EORTC QLQ-HN35 at baseline and follow-up one to two months later. Minimal clinically important differences (MCIDs) were calculated through anchor- and distribution-based methods for improvement and deterioration. Karnofsky Performance status (KPS) was used as the anchor to determine meaningful change. Results: In the group of patients who deteriorated, more scales and symptoms demonstrated statistically significant meaningful change. EORTC QLQ-C30 meaningful change values for deterioration with KPS anchor ranged from 7.2 (physical functioning) to 16.7 units (Global Health Status), and for improvement ranged from 10.0 (role functioning) to 16.7 units (Global Health Status). Conclusions: We report—for the first time, to the best of our knowledge—MCID for EORTC QLQ-C30 and QLQ-HN35 in head and neck cancer patients. Knowledge of meaningful change in these questionnaires allows physicians to assess patient change over time, along with evaluating the impact of treatment on quality of life.

Analysis of the Status Quo and Influencing Factors of Advanced Lung Cancer Patients’ Quality of Life

Objective: To investigate the quality of life and related influencing factors of patients with advanced lung cancer. Methods: A cross-sectional survey was conducted on 51 patients with advanced lung cancer who were hospitalized in the Department of Oncology from January 2023 to December 2023, and the influencing factors of patients’ quality of life were analyzed. Results: Among the five functional scales (physical, role, cognitive, emotional, and social functioning) of the QLQ-C30 scale, the social and emotional function scores were the lowest, respectively 16.7 (IQR: 0, 33.3) points, and 16.7 (IQR: 8.3, 25), and among the three symptom scales (fatigue, pain, nausea and vomiting), the fatigue symptom score was the highest: 77.7 (IQR: 66.7, 88.9) points. The results of Spearman correlation analysis showed that the anxiety score of patients with advanced lung cancer was positively correlated with depression score (P < 0.01), while the quality of life of patients with advanced lung cancer was not correlated with anxiety and depression score (P > 0.1). The self-care ability, the nature of the disease, and whether the patient was treated for chemotherapy were the independent influencing factors of the patient’s quality of life, and the difference was statistically significant (P < 0.001). Conclusion: Patients with advanced lung cancer have different degrees of anxiety and depression, and their quality of life is affected by many factors, which are mainly related to the patient’s self-care ability, the nature of the disease, and whether they received chemotherapy.

Quality of Life and Symptoms of Hospitalized Hematological Cancer Patients

Patients with hematological malignancies undergo intensive treatment and prolonged hospitalization, thus having a variety of physical and psychosocial symptoms and worse quality of life (QOL). This study aimed to assess the QOL and investigate the symptoms of hospitalized hematological cancer patients. A cross-sectional study was conducted in the hematology clinics and day units of two general hospitals of Heraklion, Crete. Adult patients with hematological malignancy and an adequate understanding of the Greek language participated. A demographic questionnaire, the European Organization for Research and Treatment for Cancer quality assessment questionnaire (EORTC QLQ-C30), and the MD Anderson Symptom Inventory (MDASI) were used. The sample consisted of 120 patients—42.5% were women, with a mean age of 65.6 years. The mean time from diagnosis was 33 months. The global health status of QoL had an average value of 47.1. The highest levels of QOL were found in the subscale of cognitive function (72.8) and the lowest in the role function (46.1). For the EORTC QLQ-C30 symptoms scale, the lowest score was found in nausea-vomiting (11.0) and the highest in fatigue (59.1). In the MDASI, in part I (core symptoms), higher levels but also medium intensities were reported at fatigue (78.3%, mean 3.5), drowsiness (65.0, mean 3.3), and distress (65.8%, mean 2.8). In part II, enjoyment of life (85.8%, mean 5.1) had the highest, and relation with other people (67.5%, mean 3.7) had the lowest scores. The increase in the severity of the core symptoms (part I) was related to females (rho = 0.193, p <0.05) and comorbidities (rho = 0.220, p < 0.05). It was also associated with a significant decrease in all functional domains and increased fatigue (rho = 0.571, p < 0.05) in the EORTC QLQ-C30 questionnaire. The increased global health status was related to males (rho = −0.185, p < 0.05) and physical functioning with younger age (rho = −0.331, p < 0.05), higher education (rho = 0.239, p < 0.05), fewer months from diagnosis (rho = −0.199, p < 0.05), and low comorbidity (rho = −0.209, p < 0.05). Finally, multiple linear regression analysis revealed that the total average symptom score of the MDASI was the most significant factor influencing the global health status of the EORTC QLQ-C30 (β = −4.91, p < 0.001). The increased global health status of the EORTC QLQ C30 was not significantly related (p > 0.05) to the social characteristics of the patients, such as education or employment, which requires further validation. The QoL of hematological cancer patients significantly decreases during treatments due to a considerable number of symptoms that must be taken into consideration for high-quality, individualized care.

Change in Quality of Life in Patients with Advanced Rectal Cancer Between 2010 and 2022.

Advanced rectal cancer is one of the most common cancers worldwide and has a significant impact on public health. Because favorable and long-term survival has been achieved with multimodal therapy, patient quality of life is very important. The intention of this study was to assess patients' quality of life using various functioning and symptom scores from the years 2010 to 2022 and to examine changes over time. Data on health-related quality of life were collected from rectal cancer patients treated at the University Hospital Erlangen in Germany over a period of 13 years. The EORTC QLQ-C30 questionnaire and the rectal cancer-specific module QLQ-CR38 were completed in this study by a total of 516 patients. The questionnaires were collected before, during and at annual follow-up visits after treatment. Statistical significance was defined as p-values < 0.05 as well as a difference of 10 or more percentage points. The deterioration in scores is most pronounced immediately after radiochemotherapy, especially for pain (+19.8 pp), fatigue (+16.1 pp) and diarrhoea (+24.8 pp). One year after the end of therapy, most of the values are again comparable to or better than those of the German general population and only role functioning (-19.8 pp), social functioning (-24.6 pp), diarrhoea (-21.6 pp) and financial difficulties (-16.3 pp) are considerably worse. Some baselines deteriorate clearly over time from 2010 to 2022; these are role functioning (-23.9 pp), social functioning (-17.3 pp), body image (-15.2 pp), fatigue (+13.8 pp) and nausea and vomiting (+10.5 pp). An improvement in therapy in terms of a reduction in side effects and, thus, an improvement in quality of life over time could not be proven. The deterioration in individual scores over time does not appear to be a problem specific to rectal cancer patients, but rather, is associated with social developments or systemic healthcare factors in German society that are not directly related to oncological diseases.

Feasibility, acceptability, and preliminary efficacy of a self-directed online psychosocial intervention for women with metastatic breast cancer: Finding My Way-Advanced

PurposeFew digital interventions target patients with advanced cancer. Hence, we feasibility-tested Finding My Way-Advanced (FMW-A), a self-guided program for women with metastatic breast cancer.MethodsA single-site randomised controlled pilot trial was conducted. Participants were recruited through clinicians, professional networks, and social media and randomised to intervention or usual-care control. Participants were randomly allocated to either the intervention (FMW-A; a 6-week, 6-module CBT-based online self-directed psychosocial program for women with MBC + usual care resources) or control (usual care resources: BCNA’s Hope and Hurdles kit). Feasibility outcomes included rates of recruitment, uptake, engagement, and attrition. Distress, QOL, and unmet needs were evaluated for signals of efficacy, and qualitative feedback was collected to assess acceptability.ResultsDue to COVID-19 and funding constraints, the target recruitment of 40 was not reached (n = 60 approached; n = 55 eligible; n = 35 consented). Uptake was high (n = 35/55; 63.6%), engagement modest (median 3/6 modules per user), and attrition acceptable (66% completed post-treatment). Efficacy signals were mixed: compared to controls, FMW-A participants experienced small improvements in fear of progression (d = 0.21) and global QOL (d = 0.22) and demonstrated a trend towards improvements in cancer-specific distress (d = 0.13) and role functioning (d = 0.18). However, FMW-A participants experienced small-to-moderate deteriorations in general distress (d = 0.23), mental QOL (d = 0.51), and social functioning (d = 0.27), whereas controls improved. Qualitatively, participants (n = 4) were satisfied with the program, perceived it as appropriate, but noted some sections could evoke transient distress.ConclusionThe study demonstrated feasibility (high uptake and acceptable retention) and generated realistic recruitment estimates. While FMW-A appears promising for targeting cancer-specific distress and fear of progression, the mixed findings in quality of life and general distress warrant further revisions and testing.

Role function in postmenopausal women during aromatase inhibitor therapy for breast cancer.

Few studies have examined aromatase inhibitor therapy relating to role function in breast cancer survivors of working age. Our study sought to identify how pre-therapy sociodemographic and health/treatment-related characteristics, as well as patient-reported symptoms measured every six-months, influence role function during 18months of AI therapy for early-stage breast cancer. We performed a secondary analysis of longitudinal study data using linear mixed-effects modeling to examine role physical (RP) and role emotional (RE) functioning measured with the Medical Outcome Study Short Form 36 v2. The sample of postmenopausal women (N = 351) consisted of three cohorts: chemotherapy followed by anastrozole (CFAI), anastrozole only (AI only), and non-cancer controls. Our choice of variables and interpretation of findings was theoretically based on the Cancer Survivorship and Work Model. Stepwise backward deletion determined which predictors to include in the final model, accounting for treatment group. Both treatment groups were associated with greater limitations in RP functioning than controls. CFAI had twice the impact on RP compared to AI only. While the RP model displayed significant predictors across sociodemographic, health/treatment, and symptom characteristics, only symptoms were associated with greater limitations in RE functioning. Findings were significant at p < .05. Transitioning from acute to extended survivorship is a critical juncture in which multiple factors place breast cancer survivors at risk of diminished role function. Early interventions to address role function limitations during systemic treatment may lead to better work outcomes and improve the quality of long-term survivorship.

Discipline

With Discipline, we focus on techniques and mechanisms that advance corporeal, attitudinal, and behavioural docility and thereby contribute to contemporary processes of social differentiation and exclusion. Exploring the intersection of migration policy and welfare governance, we discuss disciplinary measures deployed at the intersection of welfare and migration regimes with the aim of understanding how internal border and welfare controls discipline poor non-citizens by criminalising certain kinds of behaviour. Drawing on concepts including micro-violence and micro-aggression, this keyword looks at bureaucratic practices, their justifications and their consequences for non-citizens, before moving on to theorise how such practices have come to permeate the wider society. Disciplinary systems of welfare governance depend on the threat of punishment: individuals are prompted to discipline themselves because they could become the object of disciplinary power at any moment. Such disciplinary techniques are efficient, productive, and subtle, and can result in the increasingly ‘automatic’ internalisation by non-citizens of certain kinds of behaviour.

Suspicion and surveillance

In this article we focus on contemporary processes of social differentiation and exclusion at the intersection of migration policy and welfare governance. The keyword pair looks at bureaucratic practices, their justifications, and their consequences for non-citizen subjects’ paths and moves on to theorise about the permeation of these practices into society. We discuss the effects of the suspicion-surveillance nexus on the observed body and mind and how they operate in support of increasingly intrusive practices. Rather than debating the legality of such practices and the inequalities and power relations they imply, we focus on the possibilities of control as discourses become technologised.

“Ask” or “Inquire”: operationalizing speech formality in psychosis and its risk states using etymology

Many individuals with psychotic symptoms have less complex language than healthy individuals. Word etymology is a lexical feature that has not yet been studied in clinical populations, but among healthy individuals, words of Old French origin are chosen over Germanic-origin words to convey formality (e.g. “inquire” vs. “ask”). Differences in language complexity among individuals with psychotic symptoms may relate to differences in etymological content in speech. Here, we determined the proportion of Germanic-origin word use and Old-French-origin word use in a large cohort of individuals with recent-onset psychosis or at clinically high risk for psychosis, hypothesizing that individuals with recent onset psychosis would have increased use of Germanic-origin words and decreased use of Old-French-origin words. This hypothesis was borne out, even after adjusting for sex, age, recruitment site, education, racial identity, and for a subset, IQ. Etymology proportions were associated with role but not social functioning in individuals with psychotic symptoms, consistent with the premise that they reflect speech formality. Understanding speech differences in the psychosis spectrum through the lens of etymology may lead to new interventions to improve role functioning.

Effects of Virtual Reality Therapy for Patients With Breast Cancer During Chemotherapy: Randomized Controlled Trial.

Patients with breast cancer endure high levels of psychological and physical pain. Virtual reality (VR) may be an acceptable, safe intervention to alleviate the negative emotions and pain of patients with cancer. We aimed to test the long-term effects of VR on psychological distress and quality of life (QOL) with traditional care in Chinese patients with breast cancer. We also explored the intervention mechanism and the acceptability of VR. A total of 327 eligible participants were randomly assigned to a VR intervention group or a control group. The Distress Thermometer, QLQ-C30 (Quality of Life Questionnaire version 3.0), and Virtual Reality Symptom Questionnaire were assessed at baseline, postintervention (3 mo), and follow-up (6 mo). Analysis followed the intention-to-treat (ITT) principle. The generalized estimating equations model was used to analyze the longitudinal data, and the PROCESS macro was used to analyze the mediating effect. Compared with the control group, patients with breast cancer in the VR group had lower distress scores (P=.007), and higher health-related QOL scores (physical, role, emotional, cognitive, and social functioning) after 6 months (P<.05). Psychological distress had mediating effects on the longitudinal association between VR and the health-related QOL (indirect effect=4.572-6.672, all P<.05). VR intervention technology may help reduce distress and improve QOL for patients with breast cancer over time. By incorporating a mediating analysis, we showed that the QOL benefits of VR intervention was manifested through positive effects on psychological distress risk factors.

Evaluation of Lifestyle for Women with Breast Cancer

Introduction: Breast cancer is a significant global health concern, affecting millions of women worldwide. While advancements in diagnosis and treatment have improved survival rates, the impact of this disease extends beyond physical health. It also significantly influences a woman's lifestyle and overall well-being. Objectives: The current study intends to analyze the lifestyle of breast cancer patients who are receiving therapy or are being followed up at the Oncology Teaching Hospital in Medical City, Baghdad, Iraq. Method: The present study uses a descriptive design with an application of an evaluation approach. A convenience sample of 100 women with breast cancer was selected from the Teaching Oncology Hospital at the Medical City in Baghdad City, Iraq. The study's objectives are served by a questionnaire. Physical, role, emotional, cognitive, and social functioning are its five functional domains. These domains are evaluated as low, moderate and high. Each study participant received a questionnaire explaining how to complete it, along with a form requesting their approval to remain anonymous. They also had the opportunity to leave the study at any time without being provided an explanation. A panel of (10) experts determines the questionnaire's content validity, and its internal consistency reliability is calculated via the split-half method with a Cronbach’s alpha correlation coefficient of (r=0.92). Data are collected using the study questionnaire, and they are then analyzed via a descriptive statistical data analysis approach on the basis of frequency and percentage. Results: The study revealed that the majority of these women experienced sleep issues, but most of them experienced problems with body weight gain (70%), social and community activity (70%), sexuality (60%), stress (60%), diet (56%), physical activity (50%) and smoking (45%), and some of them took birth control pills and used hormone replacement therapy (43%). Conclusion: This study revealed that women with breast cancer have experienced a variety of lifestyle domain-associated problems. These problems are clearly manifested in the results of this study.