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Phytosterols/phytostanols are bioactive compounds found in vegetable oils, nuts and seeds and added to a range of commercial food products. Consumption of phytosterols/phytostanols reduces levels of circulating LDL-cholesterol, a causative biomarker of CVD, and is linked to a reduced risk of some cancers. Individuals who consume phytosterols/phytostanols in their diet may do so for many years as part of a non-pharmacological route to lower cholesterol or as part of a healthy diet. However, the impact of long term or high intakes of dietary phytosterols/phytostanols has not been on whole-body epigenetic changes before. The aim of this systematic review was to identify all publications that have evaluated changes to epigenetic mechanisms (post-translation modification of histones, DNA methylation and miRNA expression) in response to phytosterols/phytostanols. A systematic search was performed that returned 226 records, of which eleven were eligible for full-text analysis. Multiple phytosterols were found to inhibit expression of histone deacetylase (HDAC) enzymes and were also predicted to directly bind and impair HDAC activity. Phytosterols were found to inhibit the expression and activity of DNA methyl transferase enzyme 1 and reverse cancer-associated gene silencing. Finally, phytosterols have been shown to regulate over 200 miRNA, although only five of these were reported in multiple publications. Five tissue types (breast, prostate, macrophage, aortic epithelia and lung) were represented across the studies, and although phytosterols/phytostanols alter the molecular mechanisms of epigenetic inheritance in these mammalian cells, studies exploring meiotic or transgenerational inheritance were not found.

The cost of cancer care is rising and represents a stressor that has significant and lasting effects on quality of life for many patients and caregivers. Adolescents and young adults (AYAs) with cancer are particularly vulnerable. Financial burden measures exist but have varying evidence for their validity and reliability. The goal of this systematic review is to summarize and evaluate measures of financial burden in cancer and describe their potential utility among AYAs and their caregivers. To this end, the authors searched PubMed, Embase, the Cochrane Library, CINAHL, and PsycINFO for concepts involving financial burden, cancer, and self-reported questionnaires and limited the results to the English language. They discarded meeting abstracts, editorials, letters, and case reports. The authors used standard screening and evaluation procedures for selecting and coding studies, including consensus-based standards for documenting measurement properties and study quality. In all, they screened 7250 abstracts and 720 full-text articles to identify relevant articles on financial burden. Eighty-six articles met the inclusion criteria. Data extraction revealed 64 unique measures for assessing financial burden across material, psychosocial, or behavioral domains. One measure was developed specifically for AYAs, and none were developed for their caregivers. The psychometric evidence and study qualities revealed mixed evidence of methodological rigor. In conclusion, several measures assess the financial burden of cancer. Measures were primarily designed and evaluated in adult patient populations with little focus on AYAs or caregivers despite their increased risk of financial burden. These findings highlight opportunities to adapt and test existing measures of financial burden for AYAs and their caregivers., (© 2021 American Cancer Society.)

Context: Among adolescents and young adults (AYAs), cancer and its treatment can disturb body image in distinct ways compared to younger or older individuals., Objective: Since AYA body image is not well understood, this study was designed to develop a conceptual framework for body image in AYAs with cancer., Methods: Concept elicitation interviews were conducted with 36 AYA patients [10 adolescents (15-17 years), 12 emerging adults (18-25 years), 14 young adults (26-39 years)] and health care providers (n = 36). The constant comparative method was used to analyze for themes and properties, with themes considered saturated if they were present and salient across participant sets., Results: Twenty themes emerged from participant data. Three themes illustrate a shared understanding of patients' experience of body image: (1) physical changes produce shifts in identity and experience of self; (2) precancer body image shapes how the AYA experiences cancer-related physical changes, and (3) changes to the body are upsetting. Nine themes were unique to patients while eight themes were unique to providers. Patient body image experiences were found to evolve over time, largely affected by concerns about how others view them. Providers appeared attuned to AYA patient body image but recognized that it is not systematically addressed with patients., Conclusion: More striking than differences between patient groups is the consistency of themes that emerged. The conceptual framework of body image developed from these data offers an important step toward addressing body image concerns for AYA patients., (© 2020 John Wiley & Sons Ltd.)

Purpose of Review: The purpose of this study is to review recent evidence for the role of the cytosolic fatty acid binding proteins (FABPs) as central regulators of whole-body metabolic control., Recent Findings: Dysregulated FABPs have been associated with a number of diseases, including obesity and nonalcoholic fatty liver disease (FABP1, FABP2, FABP4), cardiovascular risk (FABP3) and cancer (FABP5, FABP7). As underlying mechanisms become better understood, FABPs may represent novel biomarkers for therapeutic targets. In addition, the role of FABPs as important signalling molecules has also been highlighted in recent years; for example, FABP3 may act as a myokine, matching whole-body metabolism to muscular energy demands and FABP4 functions as an adipokine in regulating macrophage and adipocyte interactions during inflammation., Summary: In addition to their traditional role as fatty acid trafficking proteins, increasing evidence supports the role of FABPs as important controllers of global metabolism, with their dysregulation being linked to a host of metabolic diseases.

The purpose of this interdisciplinary descriptive study was to examine the perceptions of nurses, school personnel, and parents about school reentry for children with cancer and to determine whether activities and services performed supported school reentry. The study also investigated parents' perception of the impact of cancer on their child's academic performance, cognitive ability, and school attendance. Results of the study showed that few activities and services were performed to facilitate children's school reentry by either nurses or school personnel. Parents reported no significant differences in their children's cognitive ability or academic performance. School attendance was significantly lower after diagnosis and therapy. Conclusions were that communication among nurses, school personnel, and parents was a major barrier to providing effective services to students and their parents. Nurses were unsure of how to help parents navigate the school bureaucracy, school personnel felt they needed more information, and parents felt that their children were not receiving all the school reentry services needed. Individuals in this study recommended that a liaison position be created to coordinate services.

As individuals assume more responsibility for their healthcare, nurses need to explore methods to support families' self-care practices. The purpose of this qualitative study was to: (a) determine what self-care and dependent-care operations children and parents perform to address self-care requisites, and (b) explore nursing interventions to promote operations. Orem's theory of self-care, theory of self-care deficit, and theory of nursing system were employed. Twenty-seven participants were interviewed about their cancer experiences. Results were that children and parents performed estimative, transitional, and productive operations to meet self-care requisites. Various nursing interventions that promoted these operations were identified. Recommendations were made for further interventions to support families.

It is essential to examine conflict between patients and health care professionals from the patient's perspective. The purposes of this study were to 1) identify sources of conflict, 2) determine nursing interventions that alleviate conflict, and 3) test a conceptual framework of sources of conflict. This phenomenological study focused on children with cancer and their parents' perceptions of conflicts with health care professionals as well as what they thought helped with such conflicts. Their reports of conflict were compared to C. W. Moore's circle of conflict conceptual framework. A purposive sample of 27 participants (9 children, 14 mothers, and 4 fathers) participated in the study. Study findings showed that conflict occurred between health care professionals and families originating from differences in expectations and desires regarding data, interests, structure, relationships, and values, consistent with C. W. Moore's conceptual framework. Nursing interventions reported by children and parents to be helpful in preventing or alleviating conflict were identified. C. W. Moore's framework may provide a valuable structure for assessing conflict and designing nursing interventions to alleviate conflict.

In this qualitative study the self-care practices of children with cancer and the dependent-care practices of their parents were examined. These practices were organized according to self-care requisites presented in Orem's theory of self-care. The intent of this examination was to determine the competency of participants, identify where self-care deficits occurred, and decide what nursing interventions were needed. A purposive sample of 9 children and 18 parents were interviewed to determine their experiences with cancer. Content analysis was conducted using a deductive approach to code and analyze the data according to Orem's universal, developmental, and health-deviation self-care requisites. NVivo qualitative analysis software was employed for data analysis. The findings of this study revealed that participants were competent agents, performing many practices in the areas of universal and developmental self-care requisites. Participants performed far fewer practices regarding health-deviation self-care requisites and interferences with development, however, indicating a need for supportive-educative nursing interventions in these areas. Future research should examine participants' operations and specific nursing interventions to support those operations.

The purpose of this phenomenological study was to examine parents' reactions to conflict with health care providers and the outcomes of the conflicts. This study builds on previous research that confirmed the occurrence and sources of conflict among these informants. Seventeen parents whose children had a diagnosis of cancer were interviewed in this study. A priori coding was used to identify the specific strategies for dealing with conflict proposed by Rubin and associates. Ginsburg's approach to narrative analysis was used to examine parent's stories. Findings were that parents used the strategies of problem solving, yielding, withdrawing, inaction, and contending identified by Rubin and associates in reaction to conflict with health care providers. Following episodes of contending, many parents in the study reframed the conflict and experienced transformations or turning points, resolving to become more effective advocates for their children. A few of these advocates proceeded to become community activist.

The purposes of this descriptive study were to examine the relationships between self-concept and (a) self-care, (b) dependent-care, and (c) basic conditioning factors for children with cancer, and to compare the self-concept of children on- and off-therapy. The theoretical framework was Orem's self-care deficit theory of nursing. The sample consisted of 74 children with cancer and their mothers. Results showed small but significant correlations between variables, providing some evidence that if children had higher self-concept scores they performed more self-care activities and received more dependent-care from their mothers. The self-concept scores of the on- and off-therapy groups were not significantly different. This study supports Orem's theory and reinforces the need to promote positive self-concept.

Purpose/objectives: To examine children's and their mothers' adjustment responses (self-care and anxiety) to cancer., Design: A descriptive multivariate study., Setting: Two metropolitan pediatric oncology clinics., Sample: A nonprobability sample of 74.9-18 year olds diagnosed with cancer and their mothers., Method: Children completed two questionnaires--the Children's Self-Care Performance Questionnaire and Children's State-Trait Anxiety Inventory. Mothers completed the Dependent Care Agent Performance Questionnaire, the State-Trait Anxiety Inventory, and a demographic data form., Findings: Multivariate analysis of variance indicated that children off therapy and their mothers had better adjustment responses than those on therapy. Basic conditioning factors significantly predicted children's self-care practices and state and trait anxiety as well as mothers' dependent-care and state anxiety. A significant canonical correlation surfaced between the set of children's adjustment responses and the set of mothers' adjustment responses., Conclusions: Children who have completed treatment for cancer and their mothers have better adjustment responses than those still receiving therapy. Basic conditioning factors predict adjustment responses, and a relationship exists between the adjustment responses of children and those of their mothers., Implications for Nursing Practice: Further research is needed to investigate children's self-care practices, determine mothers' dependent-care practices, and compare children with cancer to a normative sample. In clinical practice nurses must consider the profound effect of cancer on the mother and child the anxiety levels of children with cancer and their mothers, and the influence of these individuals on each other.