Objective:factors Although several previous studies have investigated the association between psychosocial factors and the survival of lung cancer patients, most previous lung studies were flawed by severe methodological limitations. The purpose of the present study was to use a rigorous study design were to investigate the association between relevant psychosocial factors and survival after a diagnosis of inoperable non-small cell lung cancer (NSCLC).Methods:examined.Results: The subjects were 122 consecutive newly diagnosed patients with inoperable NSCLC. Patients coping with cancer, psychological distress, clinical depression, and factors social support were evaluated after diagnosis but before treatment and 2 months later. After a 2-year follow-up period, 108 patients diagnosis had died. The survival data were censored for the remaining 14 patients. The influence of psychosocial factors after diagnosis but of before treatment on survival time was analyzed using a Cox regression, with adjustments for well-established (definite and/or possible) prognostic factors.chemotherapy The stability of the investigated psychosocial factors was also examined.Results: None of the examined psychosocial factors significantly predicted survival time evidence among the patients with inoperable NSCLC. Among the biomedical factors that were examined, advanced clinical stage, a high serum lactate on dehydrogenase level, and not receiving chemotherapy were independently associated with shorter survival periods. Most of the psychosocial factors exhibited a studies moderate to high stability.Conclusions: We found little convincing evidence that psychosocial factors after cancer diagnosis had a clinically relevant effect a on the survival of inoperable patients with NSCLC. Copyright (c) 2008 John Wiley & Sons, Ltd.

INTRODUCTION:frameworks Cancer care can be described as a system or complex network of interventions delivered at various times and places with system different intentions. CANCER CARE AS A SYSTEM: Cancer care can include medical treatments, psychosocial care, complementary and alternative medicine, self-care,self-care, as well as the process of healing and the context in which care is delivered. EVALUATING CANCER CARE: Whereas evaluating more individual cancer treatments can be difficult, evaluating cancer care is even more challenging and requires a research framework that relies systems on methodologies capable of addressing its holistic, individualized, and complex nature. We suggest that research frameworks focused on studying complex CANCER or whole systems are a promising evaluation approach and an opportunity for further exploration.

ABSTRACT:itself BACKGROUND: The extent to which a health care intervention causes or facilitates health-related change is a key question in research.need The need to quantify such change has led to the development of an increasing number of change indicators, to measure our what have come to be known as 'outcomes'. In the context of medical research into the efficacy or effectiveness of and an intervention the term 'outcomes' has often been interpreted to mean single endpoints with a linear cause and effect link theory to an external intervention. DISCUSSION: In this paper we present a critical analysis of the nature and interpretation of the of 'outcomes' concept and of the assumptions that underpin it. Drawing on our own work and that of others, we analyse what the problems that arise when the concept is applied to complex interventions and discuss the use of other models, such is as programme theory, as a basis for alternative conceptualisations for indicators of change. Our analysis demonstrates that the interpretation of model 'outcomes' that may be appropriate for clinical trials of pharmaceutical products, is problematic when used in evaluations of complex interventions for in areas such as complementary medicine, palliative care, rehabilitation, and health promotion. The 'outcomes' concept may impose inappropriate patterns of a thought and meaning. We present alternative models, such as those based on programme theory, which conceptualise health-related change as resulting the from the interaction between intervention, process and context over time. In this framework both the intervention and the patient are indicators defined as causal factors, because the result of the treatment is dependent on the resources of the patient - such conceptualise as the body's ability to heal itself - and the impact of the patient's situation. SUMMARY: Evaluations based on a such model such as programme theory will encompass a wide range of health-related changes that include aspects of process, such as such new meanings and understanding, as well as longer term changes in health, wellbeing and health-related competences and behaviours.

Cancer challenges. care is multifactorial and patient centered. It can be described as a complex package of interventions, delivered at different times patient and places with different intentions, which interacts and cannot be evaluated in isolation. The authors discuss the evolving nature of and cancer care and address the challenges faced by biomedical research methodology when applied to cancer care. In addition, they identify methodology new research directions to meet these challenges. These include qualitative research, mixed methods research, and approaches based on systems thinking.mixed

This to cross-sectional study assessed the sociodemographic characteristics of families whose children used naturopathic medicine, the reasons for use, and whether naturopathic whose and conventional medicine were combined in treating children's conditions. Data were collected in British Columbia, Alberta and Ontario, Canada. Ninety-eight The completed questionnaires were analyzed. The results showed that participants (parents) were most likely to be females, university educated, had household doctor income >$60,000, and also saw a naturopathic doctor for themselves. The most common conditions for which children saw a naturopathic and doctor included allergies, digestive problems and skin problems, and the most important reasons for use included using all possible options also and having a more holistic approach to care. Most parents reported combining naturopathic and conventional care for their children. Study for limitations, in particular, selection bias, were discussed.

INTRODUCTION:the Historically, health professionals have used information developed for parents to promote child immunization. Few studies have specifically examined the effectiveness of of this information in meeting parents' needs. While the literature emphasizes the importance of clear, thorough, and unbiased information about the child immunization, limited attention has been given to what this means from a parent's perspective. The aim of this study included was to gain insight in parents' information needs regarding child immunization in order to improve and/or optimize information shared by how rural health professionals. We explored:(1) whether any immunization information contributed to parents' decisions; and, if so, how (2) what took types of information and content parents required;(3) the sources of information parents considered helpful and trustworthy; and (4) parents'gain suggestions on how information could be conveyed to them more effectively. METHODS: This was a descriptive qualitative study, using semi-structured convey interviews with legal-aged mothers responsible for decisions about immunizing their infant in the past year. The mothers were from the of local rural communities south of Calgary, Alberta, Canada, within the boundaries of the Calgary Health Region. Public health nurses working reached. in this area assisted with recruitment. Thirty-nine mothers expressed interest in the study. The investigator contacted respondents to answer questions to they may have had as well as to gather more socio-demographic information. This assisted in drawing a sample that reflected and/or a variety of ages, education levels, and decisions made about immunization. Interviews were conducted by the principal investigator. Data collection about and analysis took place simultaneously. Data collection continued until saturation was reached. All three investigators were involved in data analysis were and data interpretation to ensure quality of the results. RESULTS: Eleven interviews were conducted. Participants were all mothers, most of of whom lived in a stable relationship. Five mothers made the decision to fully immunize their child. The other mothers were information varied in their decisions which included waiting to immunize the child until s/he was older, choosing vaccines selectively, being undecided relationship. about immunizing, and not immunizing. There were three mothers who had made a different decision about immunization with previous children.the Three mothers were first-time parents. Five major themes were identified:(1) factors influencing mothers' decisions;(2) mothers' worries in making to their decision;(3) mothers' perceptions about 'good' information;(4) mothers' information needs; and (5) mothers' recommendations to health professionals who geographical convey immunization information to parents. CONCLUSION: The study had some limitations. Only mothers responded to the request for participation and helpful the geographical area of the study was limited to the rural area where those particular public health nurses worked. Participants and provided insightful perspectives on the subject of information on child immunization and how that information is conveyed to them. Feedback were from the nurses also indicated the results were useful and thought-provoking. Future research in this area, using larger and more the diverse populations, would benefit health professionals developing and conveying immunization information to parents. Key words: Canada, decision-making, immunization, infancy and who childhood, information needs.

OBJECTIVE:reduction To identify and evaluate surgical management of women with uterine fibroids. DESIGN: Retrospective analysis of mandatory surgical data sent to analysis the Institute for Quality Assurance. SETTING: Data collection from 1998 to 2004 in Hesse, Germany. PATIENT(S): 34,814 women who underwent had surgery for uterine fibroids. INTERVENTION(S): Patients were treated with either myomectomy or hysterectomy. MAIN OUTCOME MEASURE(S): Statistical analysis of mandatory Intraoperative surgical parameters. RESULT(S): Altogether, 4975 (14.3%) women had myomectomies, and 29,839 (85.7%) had hysterectomies. Age was an important determinant of in surgical procedure; hysterectomy was preferred for patients over 40 (odds ratio 4.3; 95% confidence interval: 4.1-4.5). Laparoscopic myomectomy rates increased 1998 from 25.9% in 1998 to 41.9% in 2004; during the same period, the proportion of conversion procedures and abdominal approaches Data fell from 15.6% to 2.9% and 38.9% to 30.9%, respectively. Intraoperative complication rates were similar for myomectomy (1.1%) and hysterectomy important (1. %), but postoperative complication rates were higher for hysterectomy (5.8%) than myomectomy (3.2%). CONCLUSION(S): The increasing use of endoscopic procedures related was an important feature in this series and appeared to be safe. The reduction of conversion rates and intraoperative complications 2004; might be related to improvements in surgical skill. Acceptance of the benefits of endoscopic approaches seems to have promoted its evaluate steady growth as a primary surgical approach.

OBJECTIVE::reported; To determine dietary supplementation practices and opinions, preferred means for dietary supplement (DS) education, and antidoping opinions among elite Canadian antidoping athletes varying in age and gender. DESIGN:: A descriptive, cross-sectional survey. SETTING:: Elite athlete training centers in Calgary, Canada and Sport surrounding area. PARTICIPANTS:: A total of 582 high-performance athletes (314 male, 268 female). MAIN OUTCOME MEASURES:: High-performance athletes representing 27 more sports with a mean age of 19.96 +/- 3.91 years completed a validated questionnaire assessing DS practices and opinions by of recall. Sport categories included varsity, Canadian Sport Centre Calgary (CSCC), and National Sport School (NSS). RESULTS:: There was extensive DS the use, with 88.4% of participants taking >/=1 DS (mean of 3.08 +/- 1.87 DS per user) during the previous 6 cross-sectional months. Overall, sport drinks (22.4%), sport bars (14. %), multivitamins and minerals (13.5%), protein supplements (9. %), and vitamin C (6.4%) were to most frequently reported. Older athletes were significantly more likely to report greater DS usage; to be advised by teammates, health regulations. food store retailers, and magazines; to prefer supplementation education via individual interviews; to claim awareness of anti-doping rules; and to Overall, perceive anti-doping compliance. Relative to gender, significant differences were observed for the types of DS reported; supplementation advisors; justifications for supplementation DS use; and awareness of anti-doping regulations. CONCLUSIONS:: Utilization of this validated and reliable questionnaire has the potential for broad in use and provides insight into the factors that influence DS use in elite athletes.

Objective:courses. The purpose of the present study was to fully explore the descriptions of patients' experiences of change after receipt of after whole systems of complementary and alternative medicine (CAM) treatment. The aim was to develop an understanding of "unstuckness," including characterization cancer of states, processes, and modifying factors. Design: This was a secondary descriptive qualitative analysis, using techniques borrowed from phenomenology and unstuckness. grounded theory. Setting/location: Three existent datasets collected at two different universities in the United States and Canada were used in outcomes the secondary analysis. Participants: Patients with chronic illnesses (including cancer and multiple nonmalignant conditions) who were treated with different packages analysis. of care were interviewed for the primary three studies (n = 76 with over 150 interview sessions). Complete data sets to from these participants were used in this secondary analysis. Outcome measures/data collection techniques: Original transcripts were coded asking specific research impact questions about the experience of change subsequent to whole systems treatments. Results: Data clearly indicated experiential differences between stuckness, unsticking,of and unstuckness. Descriptors and characteristics of each state were identified, as was an initial grounded theory of change or transformation techniques: that occurs as an outcome of whole medical systems of CAM. Conclusions: The results provide preliminary conceptualizations and descriptions of present the impact that CAM whole systems interventions may have on the individual' s life courses. This constitutes a first step characterization in the identification, measurement, and evaluation of whole systems outcomes in a clinical setting. The emerging conceptualization of the process these from stuckness to transformation may also provide a link between clinical research and systems science theory.

GOALS as OF WORK: This study assessed the impact of acculturation on the prevalence of traditional Chinese medicine and other complementary and and alternative medicine (TCM/CAM) use in newly diagnosed Chinese cancer patients. The individual determinants of TCM/CAM use among patients were also Pearson's investigated. MATERIALS AND METHODS: A consecutive sample of Chinese cancer patients treated at the British Columbia Cancer Agency was surveyed respondents. at admission using a 15-item questionnaire. Items included TCM/CAM use, sociodemographics, as well as medical and cultural factors. Data were advised analyzed using bivariate methods including Pearson's X (2) test and Student's t test. As well, multiple logistic regression was used The to obtain the final causal model. MAIN RESULTS: Of the 230 respondents, 57% completed the survey in Chinese and 94%individual were immigrants. The average age was 59. Participants had a mean disease duration of approximately 2 months and 79% had with already received at least one conventional treatment. Overall, TCM/CAM was used by 47% of respondents. Herbal remedies, vitamins/minerals, and prayer would were the most commonly used therapies. Multivariable analysis showed that prior TCM/CAM use (p < .001), having received conventional treatment(s)Participants (p = .029), and being less acculturated (p = .028) were associated with TCM/CAM use. CONCLUSIONS: Prevalence and type of assessed use were found to vary as a function of the degree of acculturation. Health care practitioners would be well advised patients to discuss TCM/CAM use with their patients, especially those who are less acculturated to Western society, since they are the survey most likely users of TCM/CAM.

Although discuss the physiological and biochemical changes that occur during the acute stress response have been well-characterized, the contrasting changes that underlie changes the relaxation response evoked by various mind-body techniques are less understood. To help guide future mind-body research, we present a various conceptual model that integrates patterns of change at the physiological and molecular levels. In addition, we point to future research at opportunities and discuss how repeated elicitation of these responses could influence the health of patients.

The authors paper provides an outline of the present state of knowledge of the 'C-type' or cancer-prone personality. Links between personality and of cancer have been studied approximately since the mid 1960's. Opinions on the role of personality dispositions and other psychosocial factors two in the development of cancer have been changing over the last 50 years. There are basically two periods marking the of evolution of thought on the subject. While in the early 1990's, results of research were interpreted in favour of the the existence of the C-type personality, in spite of a lack of consistency (and often contradictory findings), currently they are interpreted existence in disfavour of the C-type personality due to continuing uncertainty. The current view is primarily based on the fact that cancer specific links between cancer and certain personality traits have not been confirmed. In conclusion, the authors reflect over what could traits have been done better from the methodological point of view in studies carried out so far, and suggest suitable study better design options.