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Individuals with autism spectrum disorder (ASD) often fail to attach context to their memories and are specifically impaired in processing social aspects of contextual information. The aim of the present study was to investigate the modulatory influence of social vs. non-social context on neural mechanisms during encoding in ASD. Using event-related fMRI, 13 boys with ASD and 13 typically developing boys comparable for age and IQ were investigated during encoding of neutral objects presented either with a social (faces) or a non-social (houses) context. A memory paradigm was then applied to identify brain activation patterns associated with encoding of subsequently recollected versus non-recollected objects. On the behavioural level, no significant between-group differences emerged. In particular, no differential effects of context on memory performance were observed. Neurally, however, context-specific group differences were observed in several brain regions. During encoding of subsequently recollected objects presented with a face, ASD subjects (compared to controls) showed reduced neural activation in the bilateral inferior frontal gyrus, bilateral middle frontal gyrus and right inferior parietal lobule. Neural activation in the right inferior frontal gyrus was positively correlated with memory performance in controls, but negatively in ASD individuals. During encoding of subsequently non-recollected objects presented in the non-social context, ASD subjects showed increased activation in the dorsal MPFC. Our findings suggest that in ASD subjects, fronto-parietal brain regions subserving memory formation and the association of contextual information are activated atypically when a social context is presented at encoding. The data add to findings from related research fields indicating that in ASD, socioemotional impairment extends into domains beyond social cognition. Increased activation in the dorsal MPFC in ASD individuals might reflect supervisory cognitive processes related to the suppression of a distracting non-social context., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Aim: Annually about 500,000 women worldwide are diagnosed with cervical cancer. For many patients, young age at the time of diagnosis and a good prognosis regarding the disease imply a long life with the side-effects and sequels of various treatment options. The present study investigated the extent to which different quality of life (QoL) domains in patients during and after treatment for cervical cancer are affected according to menopausal status, treatment status and treatment modality., Methods: QoL data from 346 cervical cancer patients from 14 countries who were included in a cervical cancer module validation study of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of life Group were analysed according to menopausal status, treatment status and treatment modality. QOL was assessed using the EORTC Quality of life Questionnaire (QLQ)-C30 and the QLQ-CX24 module. Statistical analyses were performed using descriptive statistics and analysis of covariance., Results: Active treatment had the strongest negative impact on 13 different QoL domains: physical, role, emotional, cognitive, social functioning, global health/QoL, fatigue, nausea and emesis, pain, appetite loss, constipation, symptom experience and sexual enjoyment. Irradiation alone ± other therapy was associated with most symptoms of diarrhoea. Age had the most negative impact on sexual activity and the strongest positive effect on sexual worry., Conclusion: Our results revealed that patients with cervical carcinoma had different side-effects with different impacts on QOL depending on the menopausal status and therapy modalities. Patients should be informed about the possibility that therapy may have a negative impact on QoL., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: The objective of this study was to assess the level of emotional distress and anxiety before one of the routine follow-up visits., Study Design: 210 patients with gynecological malignancies completed the Psychological Assessment Screening Scale and a survey questionnaire about their views of follow-up., Results: On the Psychological Assessment Screening Scale the majority of patients showed low levels of distress. The mean score on the physical condition scale was 4.7 (SD 2.7), on the sense of coherence scale 6.5 (SD 3.5), and on the emotional distress scale 7.7 (SD 3.9). The majority of patients (66%) reported low levels of anxiety and a high level of satisfaction with the follow-up regimen., Conclusions: Women undergoing routine follow-up after gynecological cancer treatment are satisfied with the current follow-up care. The psychological support patients receive due to regular clinic visits is highly valued., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Aims: To evaluate patient-reported outcomes and continence rates 5 years after the tension-free vaginal tape (TVT) operation and to compare these with subjective and objective cure rates., Methods: A total of 101 patients underwent clinical and urodynamic assessment and completed the Incontinence Outcome Questionnaire (IOQ) 5 years after the retropubic TVT operation. The IOQ results were compared with the subjective and objective cure rates., Results: At 5 years 85% of patients had a negative clinical stress test. Based on clinical stress test, stable cystometry to ≥300  ml and residual volume ≤100  ml, the physician assessment of cure was 80%. Patient-reported outcome showed improvement in incontinence symptoms in 86% of patients. Eighty-three percent of patients were satisfied with the results and 92% would recommend the operation to others. The results of the IOQ correlated more with patient-reported than with physician-assessed cure rates., Conclusion: Patient report high rates of satisfaction 5 years after the TVT operation., (Copyright © 2011 Wiley Periodicals, Inc.)

The objective of our study was to compare prospectively the QoL in long-term ovarian cancer survivors with short-term survivors and to explore discriminating variables between short-term and long-term survival. Thirty-three patients were included, 22 died within 5 years post diagnosis and 11 survived beyond 10 years. QoL data were collected pre-treatment (baseline), 1-year post diagnoses and for long-term survivors 10 years post-treatment using the EORTC QLQ-C30. At baseline, there was no difference in terms of FIGO stage, residual tumor and adjuvant chemotherapy. Significantly, more short-term survivors (96%) had intra operative ascites as compared to long-term survivors (55%) (p = 0.01). Before treatment, short-term survivors had clinically significantly lower QoL scores on the physical functioning (mean 75.45) and role functioning scale (mean 68.94) compared to long-term survivors (mean 68.94 and 84.85, respectively). They also reported higher levels of symptoms. One year post-diagnosis, QoL scores were comparable in most domains. Long-term survivors had a significantly better global QoL but more insomnia. Emotional functioning and global QoL/health status improved significantly from baseline to 1-year post-diagnosis and remained relatively stable at the 10-year follow-up. The presence of intra operative ascites and a supporting social network were identified as significant variables that discriminated between short-term and long-term survival. Compared to a reference sample, long-term survivors showed similar QoL scores but more dyspnoea. Although ovarian cancer patients do not belong to the most prevalent survivor populations, we found that long-term survivors have QoL scores similar to females without a history of cancer., (Copyright © 2010 UICC.)

Information is one of the main interventions given to cancer patients. Important research into information disclosure has been conducted and major advances have been made. We present the main theoretical models used to understand the information field and describe the current situation regarding the principal factors related to information: patients' needs, coping strategies, illness representations, cross-cultural differences, the role of the family, and strategies to enhance information giving, such as professional training and patient-targeted interventions. We highlight the need to assess patients' characteristics and desires through questionnaires and interviews and present the European Organisation for Research and Treatment of Cancer Quality of Life Group information questionnaire (EORTC QLQ-INFO 25). This instrument evaluates the level of information patients have received in different areas of their disease, treatment and care, and evaluates qualitative aspects. Finally, we describe the key areas of the information field and discuss how these areas could change in the future.

Introduction and Hypothesis: The purpose of this observational study was to examine the effect of periurethral injections with polyacrylamide hydrogel (PAHG) on quality of life (QoL) in selected patients with stress urinary incontinence (SUI)., Methods: Fifty-four women with comorbidities or other reasons precluding other surgery received PAHG for SUI. Patient-reported outcomes were assessed with the "Incontinence Outcome Questionnaire" (IOQ) 9 months postoperatively. The IOQ is a 27-item, condition-specific instrument that assesses patient-reported outcomes after incontinence surgery., Results: Forty-two women (78%) completed the questionnaire. Responses ranged from considerable (40%) and slight improvement (21%) to no change (29%) and worsening of symptoms (10%)., Conclusion: Periurethral injections with PAHG are likely to provide relief of symptoms and improvement in QoL.

Objective: A deficit in empathy has repeatedly been described as a central feature of autistic disorders. However, little is known about how adolescents with autism evaluate their own empathic abilities, and how their parents judge these skills. The present study assesses affective components of empathy via both self-report and parental report., Method: 18 boys with autism and 18 typically developing boys participated in the study. A German translation of the Bryant Index of Empathy was used for the self-assessment of empathy. Parents rated the empathic abilities of their sons using a German version of the Griffith Empathy Measure. Both questionnaires are comparable with regards to content and mainly tap into affective components of empathy., Results: Self-reports of empathy in adolescents with autism did not differ from controls. In contrast, parents of adolescents with autism judged their sons to be less empathic compared to parents of typically developing adolescents., Conclusions: The discrepancy between unimpaired self-reported empathy and parental report of impaired empathy in adolescents with autism might result from their difficulties in effectively conveying empathic feelings to other people. Alternatively, the results may be explained by impaired introspection on inner experiences in individuals with autism.

The present study aimed at identifying dysfunctions in brain networks that may underlie disturbed empathic behavior in autism spectrum disorders (ASD). During functional magnetic resonance imaging, subjects were asked to identify the emotional state observed in a facial stimulus (other-task) or to evaluate their own emotional response (self-task). Behaviorally, ASD subjects performed equally to the control group during the other-task, but showed less emotionally congruent responses in the self-task. Activations in brain regions related to theory of mind were observed in both groups. Activations of the medial prefrontal cortex (MPFC) were located in dorsal subregions in ASD subjects and in ventral areas in control subjects. During the self-task, ASD subjects activated an additional network of frontal and inferior temporal areas. Frontal areas previously associated with the human mirror system were activated in both tasks in control subjects, while ASD subjects recruited these areas during the self-task only. Activations in the ventral MPFC may provide the basis for one's "emotional bond" with other persons' emotions. Such atypical patterns of activation may underlie disturbed empathy in individuals with ASD. Subjects with ASD may use an atypical cognitive strategy to gain access to their own emotional state in response to other people's emotions.

Aim: The EORTC Quality of Life (QOL) Group has developed an instrument to evaluate the information received by cancer patients. This study assessed the psychometric characteristics of the EORTC INFO module in a large international/multi-cultural sample of cancer patients., Methods: The provisional 26-item information module (EORTC INFO26) was administered with the EORTC QLQ-C30 and the information scales of the inpatient satisfaction module EORTC IN-PATSAT32 on two occasions during the patients' treatment and follow-up period. Questionnaire-hypothesised scale structure, reliability, validity and responsiveness to changes were evaluated through standard psychometric analyses. Patient acceptability was assessed with a debriefing questionnaire., Results: The study comprised 509 patients from 8 countries (7 European countries and Taiwan) with different cancers and disease stages. Multi-trait scaling analysis led to the deletion of one item but confirmed the hypothesised 4 multi-item scales (information about disease, medical tests, treatment and other services) and eight single items. Internal consistency for all scales was good (α>0.70), as was test-retest reliability (intraclass correlations>0.70). All items can be combined to generate a single score (α>0.90). Convergent validity was supported by significant correlations with related areas of IN-PATSAT32 (r>0.40). Low correlations with EORTC QLQ-C30 scales confirmed divergent validity (r<0.30) The EORTC INFO-25 module discriminated among groups based on gender, age, education, levels of anxiety and depression, information wishes and satisfaction. Only one scale captured changes over time., Conclusions: The EORTC QLQ-INFO 25 is a reliable and valid self-reported instrument. The module can be used in cross-cultural observational and intervention studies., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Although empathy is rooted early in life, the ability to understand and share the emotions of others continues to develop after childhood. Here, we aimed at exploring developmental changes in the neural mechanisms underlying empathy from childhood to early adulthood. Using functional magnetic resonance imaging, 47 healthy male subjects aged 8-27 years were investigated during an explicit empathy task. Emotional faces were presented and participants were either asked to infer the emotional state from the face (other-task) or to judge their own emotional response to the face (self-task). A perceptual decision on the width of faces was used as a control condition. Age-related activity increases were observed in the fusiform gyrus and inferior frontal gyrus, depending on whether subjects attributed emotions to self or other. During the self-task, activity in the right precuneus and right intraparietal sulcus decreased as a function of age. No age-related differences were observed in behavioral performance measures. Increased activity in the fusiform gyrus and in the frontal component of the human mirror neuron system with increasing age may be explained by greater experience and expertise accumulated during socio-emotional interactions. Greater recruitment of right parietal structures in younger as compared to older subjects might reflect developmental differences in the cognitive strategies to infer one's own emotional response. This study is the first to show developmental changes in the neural mechanisms supporting empathy. Our findings may have important implications for the development of novel therapeutic interventions in clinical conditions characterized by empathy deficits, such as autism spectrum disorder.

A deficit in empathy has been repeatedly described in individuals with autism spectrum disorder (ASD) and also, albeit less markedly, in their unaffected relatives. Here, we aimed to investigate the neural mechanisms of empathy in ASD, and to explore familial contributions to empathy correlates. Using functional magnetic resonance imaging, 15 boys with ASD, 11 fathers of adolescents with ASD, and two control groups comparable for age and IQ (n=15 typically developing boys and their fathers (n=9)) were investigated during an empathy task. Emotional faces were presented and participants were either asked to infer the emotional state from the face (other-task) or to judge their own emotional response to the face (self-task). When attributing emotions to self and other, the ASD group showed diminished fusiform gyrus activation compared to controls. Neural activity in the fusiform gyrus was inversely related to social deficits in ASD subjects. Moreover, when ASD subjects inferred their own emotional response to faces, they showed less congruent reactions and inferior frontal gyrus activity was decreased. Although fathers of ASD children scored higher on a self-rating scale for autistic symptoms compared to control fathers, their task performance was unimpaired. However, neurally, fathers of affected children also showed reduced fusiform gyrus activation when inferring others' emotions. Shared abnormalities in fusiform gyrus activation in affected adolescents and first-degree relatives suggest that this dysfunction constitutes a fundamental deviation in ASD. Moreover, the findings provide evidence that both aberrant neural face and mirroring mechanisms are implicated in empathy impairments in ASD.

Health problems can develop during a pregnancy, turning it into a high risk. The aim of this study was to explore the influence of hypertensive disorders, gestational diabetes, and preterm birth as risk factors for health-related quality of life (HRQL) and depressive symptoms during late pregnancy and postpartum. A prospective, longitudinal study was performed with three assessments. Ninety women were recruited in the study including 29 controls. HRQL was measured using the WHO-QOL-BREF questionnaire. Depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS). Statistical analyses were performed using ANOVA and the chi-square test to explore HRQL and depressive symptoms between three pregnancy risk groups and controls. Women of the preterm group had statistically significant higher depression scores and lower HRQL scores on the physical domain during pregnancy than those without complications. Women with hypertensive disorders showed the second most depressive symptoms. Physical and global HRQL improved and depressive symptoms decreased significantly from late pregnancy and early postpartum period to late postpartum. Pregnant specific health problems, especially the risk for preterm delivery is associated with more depressive symptoms and decreased HRQL in pregnancy. Guidance and communication for these women is important. The counseling should be multi professional to reduce childbirth burdens.

Although the coexistence of attention-deficit/hyperactivity disorder (ADHD) and tic disorder (TD) is common, the nature of association is yet not fully understood. Thus, the aim of the present study was to explore attentional dysfunction in children with pure ADHD compared to children with comorbid ADHD + TD. Three groups of 20 children each, aged 8-15 years with either ADHD, ADHD + chronic tic disorder or Tourette syndrome (ADHD + TD) and a healthy control group were compared in their performance on three computerized attention tasks. Tasks of sustained attention, selective attention and interference control were employed. In addition, parental ratings of ADHD symptom severity and behaviour problems were obtained. Both clinical groups were rated as equally inattentive, however, externalising symptoms were more severe in the ADHD group. Objective measures of attentional performance revealed differences between the groups: whereas the ADHD group was markedly impaired in sustaining attention and selective attention/inhibitory control, the ADHD + TD group only showed marginal deficits in selective attention/inhibitory control. Possible explanations for the superior performance of the comorbid group are discussed: In particular, the results may indicate that in some patients, the tic disorder produces behavioural symptoms of ADHD, but not the broad neurocognitive deficits that usually are associated with ADHD. Alternatively, compensatory neural mechanisms of TD patients may result in a better neuropsychological performance of comorbid patients relative to patients suffering from pure ADHD.

Purpose: We analyze the impact of adolescent pregnancy in terms of social, familial, and educational changes during the subsequent years., Methods: Study participants included all adolescents delivering at an age of 17 years or less within a time frame of 5 years. A telephone interview was performed by using 16 self-developed questions as well as a well-recognized questionnaire on Life Satisfaction (FLZ(M)-A). Out of these 186 adolescents, 131 (70%) adolescents were available for the study. The adolescents were split in two study subsamples: 0-2.5 years after delivery and 2.5-5 years after delivery., Results: We found significant differences concerning relationship/partner, education/educational level, employment status, means of subsistence, person in a position of trust, close friends and current contraceptive use. Apart from the domain "leisure time/hobbies" study participants were more satisfied compared with a population reference group of the same age., Conclusion: Our study did not support the common assumption that adolescent pregnancy may be a disadvantage for young women. In our study a considerable number does achieve a higher level of education. Furthermore we have shown that adolescents are more satisfied in certain areas of life compared with a population reference group.

The aim of this study is to develop and psychometrically test a questionnaire (Incontinence Outcome Questionnaire, IOQ) for assessing quality of life (QOL) after surgery for stress urinary incontinence that can be used as a single measurement after the intervention. A total of 171 patients who underwent the tension-free vaginal tape (TVT/TVT-O) operation for stress urinary incontinence completed the King s Health Questionnaire (KHQ), the Short Form-12 (SF-12) and the IOQ. The internal consistency, internal and external validity and responsiveness of the IOQ were tested. The IOQ-QOL subscale showed good internal consistency (Cronbach's alpha=0.83) and significant correlations with the KHQ and the SF-12 scales (r=0.30-0.56). Partial correlations with objective parameters showed a significant relation for the IOQ-QOL subscale with objective continence/incontinence. The results of our study suggest that the IOQ is a valid and reliable instrument for assessing QOL after incontinence surgery and can be used if baseline or pre-operative data are unavailable.

Information disclosure is a key factor in the support for cancer patients. The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group has developed a questionnaire to evaluate the level of information received by cancer patients at different stages of their disease and treatment: the EORTC QLQ-INFO26. It can be used in clinical practice and research, including clinical trials. The questionnaire was developed following EORTC Quality of Life Group guidelines. The paper presents the data on 133 patients from eight countries. The resulting EORTC QLQ-INFO26 questionnaire includes four sub-scales on information regarding their cancer, medical tests, treatment and other services and several single items., (Copyright 2006 John Wiley & Sons, Ltd.)

Background: The purpose of the study was to evaluate first-line platinum/paclitaxel (Taxol) under phase III trial conditions in ovarian cancer (OC) patients aged >or=70 years., Patients and Methods: Phase III results of 779 patients with OC International Federation of Gynecology and Obstetrics (FIGO) stage IIB/IV treated with cisplatin/paclitaxel versus carboplatin/paclitaxel were retrospectively analyzed according to feasibility, toxicity (National Cancer Institute Common Toxicity Criteria) and quality of life (QoL) [European Organization for Research and Treatment of Cancer QoL questionnaire (EORTC QLQ-C30)] in patients aged <70 or >or=70 years., Results: One hundred and three (13%) patients were aged >or=70 years. Patient characteristics (<70 versus >or=70 years) showed significant differences with regard to Eastern Cooperative Oncology Group performance status, residual disease and constitutional factors but not to FIGO stage, histology or grading. Elderly patients received 98%, 100% and 96% of the recommended paclitaxel, carboplatin and cisplatin dose, respectively, per cycle. Early discontinuation was more frequent in elderly, although QoL, nonhematological and hematological toxicity were comparable between elderly and younger patients, except for febrile neutropenia (5% versus <1%, P = 0.005). There were no significant differences with regard to cycle delays, dose reductions or the use of granulocyte colony-stimulating factor and antibiotics., Conclusion: Platinum/paclitaxel appeared to be feasible and tolerable in elderly patients under clinical trial conditions, but there seems to be a different investigators' estimation of toxicity and less intention to maintain trial treatment in elderly.

Objective: The purpose of this study was to evaluate changes in condition-specific and generic quality of life (QOL) and continence rates 1 year after the tension-free vaginal tape (TVT) operation for stress urinary incontinence., Study Design: A total of 99 patients undergoing the TVT operation underwent clinical and urodynamic assessment and completed the German language King's Health Questionnaire (KHQ) and the Short Form 36 (SF-36) before and 3 and 12 months after surgery. Overall, 72 TVTs were performed as isolated procedure and 27 in combination with other operations. Data were analyzed with the Chi-square test, analyses of variance, and the Tukey test., Results: Overall, the objective continence rate was 80% at 1 year and did not differ significantly between patients with or without concomitant surgery. Significant and clinically relevant (>10 points) improvements were seen in all domains of the KHQ except General Health perception. The SF-36 showed statistically significant but not clinically significant improvement., Conclusion: The TVT operation is associated with improved condition-specific QOL in women with stress urinary incontinence. The condition-specific KHQ is more appropriate than the generic SF-36 for evaluating treatment results in women treated for incontinence.

This study examined adults' affective and facial reactions to tastes which differ in quality and valence, and the impact of sadness and joy on these reactions. Thirty-six male and female subjects participated voluntarily. Subjects each tasted 6 ml of a sweet chocolate drink, a bitter quinine solution (0.0015 M) and a bitter-sweet soft drink. Following a baseline period, either joy or sadness was induced using film clips before the same taste stimuli were presented for a second time. Subjects rated the drinks' pleasantness and intensity of taste immediately after each stimulus presentation. Facial reactions were videotaped and analysed using the Facial Action Coding System (FACS [P. Ekman, W.V. Friesen, Facial Action Coding System: Manual. Palo Alto, CA: Consulting Psychologists Press; 1978., P. Ekman, W. Friesen, J. Hager, Facial Action Coding System. Salt Lake City, Utah: Research Nexus; 2002.]). The results strongly indicated that the tastes produced specific facial reactions that bear strong similarities to the facial reactivity patterns found in human newborns. The data also suggest that some adults' facial reactions serve additional communicative functions. Emotions modulated taste ratings, but not facial reactions to tastes. In particular, ratings of the sweet stimulus were modulated in congruence with emotion quality, such that joy increased and sadness decreased the pleasantness and sweetness of the sweet stimulus. No emotion-congruent modulation was found for the pleasantness and intensity ratings of the bitter or the bitter-sweet stimulus. This 'robustness' of bitter taste ratings may reflect a biologically meaningful mechanism.

Over the last decade, health related quality of life (HRQOL) investigations have become an increasingly important part of many cancer clinical trial research programs. This paper presents a review of all HRQOL studies published by the European Organisation for Research and Treatment of Cancer (EORTC), one of the largest clinical trials organisations in Europe. The findings highlight 24 clinical trials that have been published to date, enrolling over 9000 patients. HRQOL is fully integrated into EORTC phase III trials. In many trials, HRQOL provides a valuable source of additional information useful to both clinician and patient when making treatment decisions. Furthermore, several trials have found that the combined use of clinical information along with HRQOL data has led to the development of new standards of care in several different cancer sites. With more than 40 ongoing HRQOL studies in the EORTC, we expect HRQOL to play an even greater role over the coming decade in helping establish the optimal treatment and care approach for cancer patients.

Aims: The purpose of this study was to evaluate the psychometric properties of and validate the German-language version of the King's Health Questionnaire (KHQ) in women with stress urinary incontinence (SUI)., Methods: A total of 145 women treated for stress incontinence with surgery or physiotherapy completed the the KHQ and the SF-36 before and after treatment. Psychometric analyses of the quality of life (QoL) instruments determined the reliability (Cronbach's alpha), internal and external validity, and responsiveness of the KHQ subscales., Results: The KHQ showed good internal consistency, content validity, and criterion validity as measured by correlation with scores on the SF-36. Cronbach's alpha coefficient ranged from 0.76 to 0.86, indicating a high internal consistency of the subscales. Concerning criterion validity, correlations between the KHQ subscales and the SF-36 were low to moderate. The highest correlation was found between the general health perception subscales of both questionnaires., Conclusions: The results indicate good psychometric properties for the German-language KHQ.

This study defines the psychometric properties of the European Organisation for Research and Treatment of Cancer (EORTC) quality of life (QOL) questionnaire designed to measure the QOL of patients with ovarian cancer. The ovarian cancer module (EORTC QLQ-OV28) was developed to supplement the EORTC QLQ-C30. The core questionnaire and the QLQ-OV28 were prospectively administered to 368 ovarian cancer patients after they had been treated with radical or debulking surgery followed by chemotherapy. The QLQ-OV28 module assesses abdominal/gastrointestinal symptoms, peripheral neuropathy, other chemotherapy side-effects, hormonal/menopausal symptoms, body image, attitude to disease/treatment and sexual functioning. Questionnaires were well accepted by patients, baseline compliance rates were 86%, 72% provided a second assessment, less than 3% of the items had missing data. Multi-trait scaling analyses confirmed the hypothesised scales. All hypothesised scales exhibited good psychometric properties. These results support the clinical and psychometric validity of the EORTC QLQ-OV28 module as a supplement to the EORTC QLQ-C30.

Objective: The aims of this study were to compare the quality of life (QOL) of women with different cancer sites; to identify predictors of QOL; and to examine the agreement between patient self-reported QOL and QOL ratings provided by clinicians and significant others., Methods: A prospective study was conducted including 248 patients with gynecologic and breast cancer. QOL data were collected at six time points before, during, and after treatment, using the EORTC QLQ-C30 and the Spitzer QL index (QL-I)., Results: Baseline assessments showed comparable QOL scores among patients with different gynecologic malignancies and breast cancer. During active treatment breast cancer patients had significantly higher mean scores in physical functioning compared to women with gynecologic cancers and higher scores in role functioning compared to patients with cervical cancer. After completion of treatment there were no statistically significant differences in QOL among the groups. For all women, global QOL and emotional functioning were mostly affected during and after treatment. Regression analysis showed that patients' global QOL was significantly predicted by severity of surgery (t = 3.903, P < 0.01) and pretreatment performance status (t = 3.116, P = <0.01). Comorbidity, family support, number of treatments, age, and stage of disease were not predictive. The comparison of patient self-rated QOL and observer-rated QOL showed that the QL-I mean scores of health providers and relatives were generally in close agreement with those of patients. Intraclass correlations were moderate to high during active treatment and excellent after completion of treatment., Conclusion: In female cancer patients, global QOL and emotional functioning are mostly affected during the course of disease, independent of their diagnosis. Significant others and health professionals are able to provide useful information on QOL of patients recovering from cancer.

The aim of this study was to investigate the impact of vaginal and abdominal hysterectomy on women's sexual behavior, sexual dysfunction, body image and satisfaction with surgery. A prospective study was conducted on 90 women to evaluate the outcomes of hysterectomy. Data were collected prior to surgery, three months and two years after surgery, using self-report questionnaires. The results showed significant differences in women's sexual behavior and sexual dysfunction before and after hysterectomy, independent of the surgical procedure performed. Women in both groups reported improvements in sexual desire, sexual activity and sexual intercourse three months and two years after surgery. Sexual dysfunction such as dyspareunia, vaginismus, lack of orgasm and loss of sexual interest diminished significantly after surgery. Regression analyses revealed that postmenopausal status, severity of gynecological complaints and frequency of sexual intercourse were the most important factors for improved sexual outcomes. Women in the abdominal group were dissatisfied with their body image because of the abdominal scar, experienced more pain and had a longer period of recovery from surgery compared to women in the vaginal group. According to the results, sexual behavior alone is not an important factor in choosing vaginal or abdominal hysterectomy. However, sexual behavior was important in both groups when evaluating outcomes after hysterectomy.

Understanding quality of life has become an increasingly important issue in the treatment and clinical care of patients with gynecological cancer. The short- and long-term side-effects of treatment may also impact on a woman's self worth and sexuality. In our review we address the key issues related to the treatment and management of patients with gynecological cancer. We focus on the methodology issues and limitations in the design of studies and propose our view of how to approach and enhance better quality trials in the future.

A questionnaire was developed, according to the European Organization for Research and Treatment of Cancer (EORTC) published guidelines, to supplement the EORTC quality of life questionnaire-core 30 (QLQ-C30) to assess the quality of life (QL) of women with ovarian cancer treated in clinical trials. The provisional 28-item module, OV28, assesses abdominal symptoms; peripheral neuropathy; other chemotherapy side-effects; hormonal symptoms; body image; attitude to disease and treatment; and sexual functioning. The first 24 items of the module (excluding sexual functioning) were included in a UK multicentre trial (SCOTROC). The trial data were used for preliminary scaling analysis. Two problematic items were identified. When these were treated as single items along with the 'other chemotherapy side-effects' the instrument showed excellent scale properties. Mean scale scores discriminated between trial patients pre- and on chemotherapy. This is a promising tool for assessing the QL of women with ovarian cancer. The EORTC international field study (Protocol 15982) to assess more fully the psychometric properties of the OV28 is well underway.

The European Organization for Research and Treatment of Cancer (EORTC) has taken a leading role in the development of the methodology of quality of life (QL) measurement. In the EORTC Quality of Life Study Group (QLSG) valid instruments to assess QL in a general manner and disease-specific modules have been developed to be used in oncological clinical trials. Statistical and methodological aspects of QL research are discussed. The application of QL assessments in clinical trials represents a subsequent challenge. To improve the practice of QL assessment in clinical trials an 'EORTC model' has been developed. This model requires the collaboration of liaison persons, the EORTC Cooperative Tumour Groups and the EORTC Data Centre Quality of Life Unit (QL Unit). Cooperation between these parties, protocol development and advantages and concerns of the model are mentioned in this paper. Finally, suggestions for improvement are proposed.

The objective of this prospective study was to compare outcomes concerning psychological and physical functioning of patients with various gynecological malignancies. A sample of 119 newly diagnosed cancer patients completed two questionnaires evaluating psychological well-being and functioning in daily living. Outcome measures were obtained at three time points: before surgery, 3 months after surgery, and 1 year after surgery. The results showed that the psychological well-being improved significantly from the first to the third time point for the sample as a whole. After surgery, patients with ovarian and cervical cancer showed slightly lower scores than patients with endometrial cancer. The level of functioning in daily living declined 3 months after surgery for all except endometrial cancer patients, but increased significantly at the 1 year follow-up. At all three time points the mean differences for psychological well-being and functioning in daily living were not statistically significant among subgroups. Physical and psychological well-being of the patients treated for gynecological malignancies is affected independently of age, cancer site and stage of disease. However, throughout the observational period the psychological well-being scores were lower than those of patients with other chronic illnesses or healthy subjects. Therefore, we conclude that psychological interventions for patients facing gynecological cancer treatment should be provided as an integral component of cancer management.

Pelvic pain is one of the most frequent disorders in gynecological practice often without clinical evidence. There are many underlying factors which contribute to this disorder, psychological as well as somatic. In the Department of Obstetrics and Gynecology at the University Hospital Graz, the diagnosis of chronic pelvic pain patients includes a medical as well as a psychological evaluation. According to the international diagnostic manuals pelvic pain is classified as a somatoform disorder. Our clinical experience shows that the majority of women with pelvic pain have a diagnosis of a somatoform pain disorder, which requires psychological interventions rather than medical. However, these patients usually undergo a variety of medical therapies, often without longterm success. These medically oriented treatments increase the patients' belief that the pain is of physical origin and not psychological, which is one of the greatest obstacles of psychological treatment. Chronic pelvic pain is a complex syndrome where medical and psychological diagnostic evaluation is essential. Psychological interventions can be performed at an earlier stage, in order to prevent the pain from becoming a chronic problem. The presence of psychologists within the Gynecology Department may help to establish a multidisciplinary treatment for these patients.

Objective: Little research has evaluated maternal experience with fetal pulse oximetry for fetal surveillance. The purpose of this study was to compare maternal perceptions of labor with intrapartal cardiotocography with or without fetal pulse oximetry in a research setting., Methods: One hundred women with vaginal, vertex deliveries and uncomplicated fetal outcomes were enrolled. The study group was a subset of 50 mothers who had participated in a pulse oximetry trial. The control group of 50 mothers was monitored by cardiotocography only. Both groups were matched for age, parity, weeks of gestation, epidural anesthesia use, and duration of labor. A global measure of maternal perception of labor was established by experience with labor, general attitude toward monitoring devices, satisfaction with monitoring, nursing and medical care, and anxiety, each of which was evaluated separately. The mothers in the study group were also interviewed about aspects related to the fetal pulse oximetry research setting, such as information, movement restriction, discomfort, care, privacy, and safety. The questionnaires were based on a standardized rating scale model, and the interviews were conducted two to four days after delivery. The results were analyzed by chi-squared, paired t test, and ANOVA., Results: No significant differences were observed between the study and control participants in any parameter concerning the maternal perception of labor. Mothers' experiences with pulse oximetry as assessed by interview was overwhelmingly positive., Conclusions: Fetal monitoring by pulse oximetry in a research setting did not affect maternal perceptions of labor. Mothers' experiences with pulse oximetry were highly positive, suggesting that research in fetal pulse oximetry need not compromise maternal perceptions of labor.

This study examined gender differences in 162 female and 65 male patients with cancer referred to home care. Data were collected before hospital discharge using the Multidimensional Functional Assessment Questionnaire, the Karnofsky Performance Status, and the Quality of Life-Cancer Scale. Controlling for age and stage of disease, the results showed that men reported significantly more cancer-related impairments, more limitations in activity of daily living, and poorer social resources than women. No gender differences were found in quality of life, perceived emotional health, perceived physical health, performance status, and comorbidity. Significant predictors of self-care activities were: for women perceived physical health, Karnofsky Performance Status, and stage of disease (58% variance explained); for men Karnofsky Performance Status and medication taken (67% variance explained). Gender differences should be considered in discharge planning to provide appropriate home care services for male and female patients with cancer.

In a randomized clinical trial, the efficacy of three interventions, designed to increase patient knowledge of cancer screening and satisfaction with preventive health care, were evaluated: verbal information; graphically supported information; information provided using video colposcopy; no standardized information (control condition). A sample of 147 healthy women were randomly assigned to the intervention group (IG) or the control group (CG). Pre- and post-test measures were obtained using a semi-structured interview, the State-Trait Anxiety Inventory and the Patient Satisfaction Tool. At pre-test, women had a low level of knowledge which increased significantly at post-test. The knowledge scores were slightly higher in women who received information supported by graphic or video colposcopy than in women who received standardized information without teaching aids. Compared to the CG, women in the IGs scored significantly higher on questions related to cervical cancer prevention. The level of satisfaction was significantly higher in women receiving video-supported information and graphic-supported information compared to women receiving information without teaching aids. The results indicated that visual teaching aids were effective: video colposcopy in increasing patient satisfaction with preventive health care; and graphic representation in improving knowledge regarding cancer screening. The combination of both should routinely accompany cervical cancer screening.

The purpose of this study was to examine the relationship between self-care responses and variables concerning health status, disease and treatment, socioeconomic resources, demographic characteristics, and health beliefs in a heterogeneous sample of 227 cancer patients referred to home care. Data were collected prior to discharge from the hospital using the OARS Functional Assessment Questionnaire, the Karnofsky Performance Status, the Multidimensional Health Locus of Control Scale, and the Preference for Participation in Care Tool. The results indicated that the variables related to health status, disease and treatment were highly correlated with self-care behavior (SCB), and to a lower extent to self-care preference (SCP). Karnofsky performance status, cancer-related impairments, perceived physical health, and stage of disease were identified as significant predictors of SCB explaining 57% of the variance. Age, gender, education, live-in resources, and perceived mental health were dominant predictors of SCP explaining only 17% of the variance. Further research endeavors should investigate other models that might prove to be better predictors of SCP.

This study deals with psychological aspects of coping observed in gynecological cancer patients--on the one hand with behavioral, emotional and cognitive reactions to the disease and on the other hand with the efficiency value of these mechanisms in handling the disease. As one important aspect, the attitude towards control of the disease should be correlated with the coping process. Accordingly, the results demonstrate a correlation between high self-responsibility and positive appraisal of the disease: Women who believe they are in control of the disease try harder to fight the disease and interpret their own situation more positively than women with a fatalistic attitude and this enables them to make more sense of the disease; they experience more positive changes in their own lifestyle due to the disease. Furthermore, women who ascribe responsibility for the course of the disease to other interpret their situation in a more positive light. They actively search for social support and obviously experience this trust in the power of other people as a helpful measure. A fatalistic attitude to the disease is combined with rumination and social withdrawal.

The subjective reactions and the mental state of 50 patients with a diagnosis CIN I, II and III were studied. The data were gathered after gynaecological follow-up examinations in semistructured interviews and with a list of complaints (B-L) according to Zerssen (1975). Patients with CIN I or II were examined and interviewed 3 months after diagnosis, patients with persistent CIN I or II were studied after 6 months, and patients with CIN III before conization. Patients with CIN reacted to the diagnosis in a similar manner to patients confronted with the diagnosis of cancer. Effective coping with the disease depended on adequate medical information being received by the women. The patients who were satisfied with the medical information had a more positive approach to the course of the disease and found it less life-threatening than those patients who were dissatisfied with the information received. The results of this study indicate that subjective experience of the disease is largely independent of its objective severity.

Seventy-two patients with cervical cancer (n = 24), ovarian cancer (n = 24), or no disease (n = 24) were questioned about sexual activity and personal relationships. The interviews were conducted in a semistandardized fashion according to the Tübingen Sexual Therapy Scale. Patients with invasive cervical cancer did not have a larger number of sexual partners, an earlier age of first intercourse, greater sexual activity or less stable relationships than patients with ovarian cancer of healthy women. There was no statistical difference among the groups with regard to the relationships. However, patients with cervical cancer reported greater degrees of satisfaction with both sexuality and relationships.

Case report on a repressed pregnancy in a 19 year old women. Her short biography is demonstrated. For explaining this phenomenon theoretical models of defense behaviour from the perspective of psychoanalysis and information psychology had been described. These considerations are discussed connected with the case report.

In the present survey the psychic and physical mastering of abortion is considered to be a subject of the research of a "critical life-event". Special interest was devoted to the consequences of the process of mastering before and after abortion on the mental and physical condition of the examined human females (n = 39). The diagnosis showed that especially before abortion in a time of a serious state of inner conflict, interference concerning the physical condition and psyche of women arise, while actually after abortion the mood is more euphoric. The inconvenience increased in dependence on experience of social welfare and support. Three months after abortion specific complaints such as pains in the lower abdomen, bleeding and sudden urge to cry occur. The administration of contraception after abortion is becoming significantly safer.