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Aghaei A, Herran K, Fanaei SA, Khalili M, Jayadev P. Lived experiences of neurofibromatosis type 1 patients: Social life, stigma, and intervention strategies. J Health Psychol 2024; 29:811-824. [PMID: 37933158 DOI: 10.1177/13591053231208619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
Neurofibromatosis type 1 (NF1) is a neurogenetic disorder associated with visual-spatial problems, executive dysfunction, and language deficits, making patients experience social isolation, stigma, anxiety, and depression. Here, we explored NF1 patients' lived experiences by conducting semi-structured, in-depth interviews with 21 NF1 patients and 16 care providers. The thematic analysis uncovered dimensions of NF1 patients' social lives at different ecological levels, including their relationships with family, friends, teachers, coworkers, providers, and society. Positive dimensions of NF1 patients' social life (e.g. familial support and sacrifice, responsibility, and self-sufficiency, supportive friends, and professors) counter negative dimensions (e.g. the vulnerability in sexual relationships, social interactions, discriminatory professors, misconceptions about abilities, appearance bias, internalized and social stigma, violence, and low self-esteem). Adaptive strategies used or suggested by NF1 patients at personal (e.g. supportive network, positive reframing, acceptance of their bodies) and social levels (e.g. psychological support, group therapy, public awareness, and governmental support) were identified.
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Psychosocial implications of rare genetic skin diseases affecting appearance on daily life experiences, emotional state, self-perception and quality of life in adults: a systematic review. Orphanet J Rare Dis 2023; 18:39. [PMID: 36823650 PMCID: PMC9951542 DOI: 10.1186/s13023-023-02629-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Since the beginning of human genetic research, there are very few publications sharing insights of the negative impact of rare genetic skin diseases (RGSD) on patients' experiences. This systematic review assessed the psychosocial implications of these conditions in terms of daily life experiences, emotional state, self-perception, and Quality of Life (QoL). METHODOLOGY A systematic review was carried out on albinism, neurofibromatosis type 1 (NF1), birthmarks and inherited ichthyosis. The PubMed, Scopus, PsycArticle, PsychInfo, Psychology and Behavioral Sciences Collection, and SOCindex databases were queried. Inclusion criteria were adult patients with one of these RGSDs. Simple descriptive statistics and qualitative content analysis were conducted to summarize the main results reported by the authors. RESULTS Of the 9987 articles retrieved, 48 articles were included: albinism (16), NF1 (16), inherited ichthyosis (10), birthmarks (6). The majority of the studies on albinism were conducted in Africa. Twenty-seven studies quantitatively assessed diverse psychological parameters: 13 showed a significant impact of the disease on QoL, five on emotional state, two on self-representation and two others on psychiatric comorbidities. Disease severity and visibility were good predictors of QoL (except for albinism). Body image and appearance concerns were also associated with QoL and emotional state. The 19 qualitative studies highlighted recurring themes across each of these diseases: discrimination and stigma during childhood and adolescence, discomfort in social interactions, guilt of transmission, the importance of social support from family and friends, altered daily life functioning, altered romantic and sex life, limited academic and professional aspirations, lack of interest and support from the medical field, and the unpredictability of the evolution of the disease. The only two mixed-method studies in this review were unable to contribute to any inferential analyses but could corroborate some of the qualitative findings. CONCLUSION These results showed that RGSDs have a significant impact on different aspects of patients' lives. This review has demonstrated that there is a real need for support systems for patients with these diseases. Such systems should be developed to provide them with necessary information and to guide them through an appropriate care pathway.
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Mavragani A, Feragen KJB, Pripp AH, Nordgreen T, Williamson H, Kling J. Predictors of Adolescents' Response to a Web-Based Intervention to Improve Psychosocial Adjustment to Having an Appearance-Affecting Condition (Young Person's Face IT): Prospective Study. JMIR Form Res 2023; 7:e35669. [PMID: 36652281 PMCID: PMC9892986 DOI: 10.2196/35669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Adolescents with a condition affecting their appearance that results in a visible difference can be at risk of psychosocial distress and impaired adjustment. Evidence for the effectiveness of existing interventions in improving psychosocial outcomes is limited, and relevant treatment can be difficult to access. Young Person's Face IT (YPF), a self-guided web-based intervention, has demonstrated potential in reducing social anxiety in adolescents with a visible difference. However, more knowledge is needed about the variables that contribute to variations in intervention effects to identify those who may benefit most from YPF. OBJECTIVE This study aimed to investigate demographic, psychosocial, and intervention-related variables as predictors of overall intervention effects after adolescents' use of YPF. METHODS We used longitudinal data collected as part of a larger, ongoing mixed methods project and randomized controlled trial (ClinicalTrials.gov NCT03165331) investigating the effectiveness of the Norwegian version of YPF. Participants were 71 adolescents (mean age 13.98, SD 1.74 years; range 11-18 years; 43/71, 61% girls) with a wide range of visible differences. The adolescents completed primary (body esteem and social anxiety symptoms) and secondary (perceived stigmatization, life disengagement, and self-rated health satisfaction) outcome measures at baseline and postintervention measurement. The predictor variables were demographic (age and gender), psychosocial (frequency of teasing experiences related to aspects of the body and appearance as well as depressive and anxiety symptoms), and intervention-related (time spent on YPF) variables. RESULTS Two-thirds (47/71, 66%) of the adolescents completed all YPF sessions and spent an average of 265 (SD 125) minutes on the intervention. Backward multiple regression analyses with a 2-tailed P-value threshold of .20 revealed that several variables were retained in the final models and predicted postintervention outcome changes. Body esteem was predicted by age (P=.14) and frequency of teasing experiences (P=.09). Social anxiety symptoms were predicted by gender (P=.12), frequency of teasing experiences (P=.03), depressive and anxiety symptoms (P=.08), and time spent on YPF (P=.06). Perceived stigmatization was predicted by age (P=.09), gender (P=.09), frequency of teasing experiences (P=.19), and depressive and anxiety symptoms (P=.06). Life disengagement was predicted by gender (P=.03), depressive and anxiety symptoms (P=.001), and time spent on YPF (P=.14). Self-rated health satisfaction was predicted by age (P=.008). However, the results were limited by relatively low explained postintervention variance, ranging from 1.6% to 24.1%. CONCLUSIONS This study suggests that adolescent boys, adolescents who experience higher levels of psychosocial distress related to their visible difference, and adolescents who spend sufficient time on YPF may obtain better overall intervention effects.
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Affiliation(s)
| | | | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Johanna Kling
- Centre for Rare Disorders, Rikshospitalet, Oslo University Hospital, Oslo, Norway
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4
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Struemph KL, Watts ATM, Wolters PL, Tamula MA, Baldwin A, Widemann B, Martin S. Adolescents and young adults with neurofibromatosis type 1: A descriptive study of adaptive functioning. Am J Med Genet A 2021; 188:488-497. [PMID: 34731530 DOI: 10.1002/ajmg.a.62544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/09/2021] [Accepted: 09/25/2021] [Indexed: 11/10/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a genetic syndrome affecting about 1 in 3500 individuals; many of those affected have plexiform neurofibroma (pNF) tumors and associated symptoms and complications. Furthermore, learning and attention problems, as well as deficits in adaptive functioning, are common, often beginning in early childhood. This study aimed to describe adaptive functioning and to examine relationships between adaptive functioning and cognitive and academic variables and level of independence among adolescents and young adults (AYA) with NF1 and pNF tumors. Fifty-five AYA aged 16-31 years participated in a series of neuropsychological evaluations while parents completed the Vineland Adaptive Behavior Scales (VABS-II) as part of a larger natural history study. Over one-third (35%) of AYA were neither in school nor employed. Mean VABS-II daily living and socialization scores were low average while mean Verbal and Performance IQ scores were average. VABS-II scores were positively correlated with processing speed, executive functioning, and working memory scores. Verbal IQ was the only significant predictor of work/school status. Identification of the correlates and predictors of adaptive functioning and life achievement can help guide healthcare providers with the early identification of risk factors and possible areas for intervention.
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Affiliation(s)
- Kari L Struemph
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Adreanna T M Watts
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Pamela L Wolters
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Mary Anne Tamula
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Andrea Baldwin
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Brigitte Widemann
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
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Jensen SE, Patel ZS, Listernick R, Charrow J, Lai JS. Lifespan Development: Symptoms Experienced by Individuals with Neurofibromatosis Type 1 Associated Plexiform Neurofibromas from Childhood into Adulthood. J Clin Psychol Med Settings 2018; 26:259-270. [PMID: 30298332 DOI: 10.1007/s10880-018-9584-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This secondary data analysis qualitatively identified salient concerns reported by individuals with Neurofibromatosis Type 1 (NF1)-associated plexiform neurofibromas (pNFs) at different stages of development. Past literature has focused on overall symptomatology, but has not examined nuances in how these symptoms are experienced across developmental phases. Therefore, we aimed to identify commonalities and differences in symptom experiences across age groups to better assist individuals to adjust to symptoms across the lifespan. Thirty-one children, adolescents, and adults (age ≥ 5 years old) and 15 parents participated in semi-structured interviews. Analyses focused on the following symptom categories: pain, social functioning, physical function impact, and stigma. Aspects of pain endorsed by all age groups included localized brief pain on contact with pNF and abnormal sensations; however, only adolescents and adults reported chronic pain and change in pain over time. Social functioning themes of limited activity participation, role limitations, and relationship impact were endorsed by all age groups, but differences emerged across age groups in the types of activity and role limitations, the type of relationship impact, and family planning concerns. All age groups described difficulty with mobility, but only parents reported problems with coordination and physical developmental milestones. While all age groups reported external stigma, internalized stigma was predominately endorsed by adults. While individuals in all age groups described pNF concerns related to pain, social function, physical function, and stigma, specific aspects of these symptoms differed across the developmental continuum. These findings can help assist individuals with pNF better transition to the next developmental phases.
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Affiliation(s)
- Sally E Jensen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zabin S Patel
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert Listernick
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Division of Academic General Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joel Charrow
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Division of Genetics, Birth Defects and Metabolism, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jin-Shei Lai
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. .,Department of Medical Social Sciences and Pediatrics, Feinberg School of Medicine at Northwestern University, 633 N. St. Clair, 19th Floor, Chicago, IL, 60611, USA.
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6
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Rietman AB, van Helden H, Both PH, Taal W, Legerstee JS, van Staa A, Moll HA, Oostenbrink R, van Eeghen AM. Worries and needs of adults and parents of adults with neurofibromatosis type 1. Am J Med Genet A 2018; 176:1150-1160. [PMID: 29681082 PMCID: PMC5947156 DOI: 10.1002/ajmg.a.38680] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 02/06/2018] [Accepted: 02/22/2018] [Indexed: 12/22/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a neurocutaneous disorder associated with lifelong tumor growth propensity and neurocognitive impairments. Although follow-up of adults with NF1 often focuses on tumor growth, follow-up of cognitive or social problems and other NF1-related comorbidity is often not a part of standardized care. In order to provide optimal care services for these patients, we explored the care needs of adults with NF1. A qualitative study was performed using semi-structured group interviews, exploring worries and care needs in medical, psychological, and socioeconomic domains, also focusing on the transition from pediatric to adult care. Four focus groups were conducted, including young adult patients, patients over age 30, and parents of young adult patients. In total, 30 patients and 12 parents participated. Data were transcribed verbatim and analyzed by computerized thematic analysis. Themes were organized using the World Health Organization International classification of functioning, disability, and health (ICF). Results indicated many and diverse worries and care needs both during the transitional period and in adulthood in medical, mental health, and socioeconomic domains. Worries could be categorized into 13 themes. Parents reported high stress levels and difficulties with their parental role. Participants expressed the need for more information, access to NF1 experts, daily living support, care for mental health and socioeconomic participation, and closer communication between health-care providers. In conclusion, worries and needs of patients and parents underline the importance of multidisciplinary follow-up and continuity of care during and after the transitional period. Additionally, parental stress requires more attention from care providers.
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Affiliation(s)
- Andre B. Rietman
- ENCORE Expertise Center for Neurodevelopmental DisordersErasmus Medical CenterRotterdamThe Netherlands
- Department of Child and Adolescent Psychiatry/PsychologyErasmus Medical Center‐Sophia Children's HospitalRotterdamThe Netherlands
| | - Hanneke van Helden
- ENCORE Expertise Center for Neurodevelopmental DisordersErasmus Medical CenterRotterdamThe Netherlands
- Intellectual Disability Medicine, Department of General PracticeErasmus Medical CenterRotterdamThe Netherlands
| | - Pauline H. Both
- ENCORE Expertise Center for Neurodevelopmental DisordersErasmus Medical CenterRotterdamThe Netherlands
- Intellectual Disability Medicine, Department of General PracticeErasmus Medical CenterRotterdamThe Netherlands
| | - Walter Taal
- ENCORE Expertise Center for Neurodevelopmental DisordersErasmus Medical CenterRotterdamThe Netherlands
- Department of Neuro‐Oncology/NeurologyErasmus Medical Center‐Cancer InstituteRotterdamThe Netherlands
| | - Jeroen S. Legerstee
- ENCORE Expertise Center for Neurodevelopmental DisordersErasmus Medical CenterRotterdamThe Netherlands
- Department of Child and Adolescent Psychiatry/PsychologyErasmus Medical Center‐Sophia Children's HospitalRotterdamThe Netherlands
| | - AnneLoes van Staa
- Research Center Innovations in CareRotterdam University of Applied SciencesRotterdamThe Netherlands
| | - Henriette A. Moll
- ENCORE Expertise Center for Neurodevelopmental DisordersErasmus Medical CenterRotterdamThe Netherlands
- Department of General PediatricsErasmus Medical Center‐Sophia Children's HospitalRotterdamThe Netherlands
| | - Rianne Oostenbrink
- ENCORE Expertise Center for Neurodevelopmental DisordersErasmus Medical CenterRotterdamThe Netherlands
- Department of General PediatricsErasmus Medical Center‐Sophia Children's HospitalRotterdamThe Netherlands
| | - Agnies M. van Eeghen
- ENCORE Expertise Center for Neurodevelopmental DisordersErasmus Medical CenterRotterdamThe Netherlands
- Intellectual Disability Medicine, Department of General PracticeErasmus Medical CenterRotterdamThe Netherlands
- Department of General PediatricsErasmus Medical Center‐Sophia Children's HospitalRotterdamThe Netherlands
- De Hartekamp GroepCare and Service Center for People with Intellectual DisabilitiesHaarlemThe Netherlands
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Draucker CB, Nutakki K, Varni JW, Swigonski NL. The health-related quality of life of children, adolescents, and young adults with neurofibromatosis type 1 and their families: Analysis of narratives. J SPEC PEDIATR NURS 2017; 22. [PMID: 28198162 DOI: 10.1111/jspn.12174] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/29/2016] [Accepted: 01/15/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Provide an in-depth description of the health-related quality of life (HRQoL) in youth diagnosed with neurofibromatosis type 1 (NF1) and their families. DESIGN AND METHODS Data were drawn from qualitative interviews conducted for a larger study aimed at developing the Pediatric Quality of Life Inventory™ (PedsQL™) NF1 module. RESULTS Youth with NF1 and their families experience a wide range of concerns related to HRQoL due to the varied symptom expression and uncertain trajectory of the disorder. PRACTICE IMPLICATIONS Pediatric nurses should routinely assess for HRQoL in this population and develop strategies tailored to those concerns that require intervention.
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Affiliation(s)
- Claire Burke Draucker
- Angela Barron McBride Professor of Psychiatric Mental Health Nursing, Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Kavitha Nutakki
- Research Associate, Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James W Varni
- Professor Emeritus, Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, Texas, USA
| | - Nancy L Swigonski
- Professor, Department of Pediatrics; Professor, Fairbanks School of Public Health; Affiliate Scientist, Regenstrief Institute, Inc.; Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana, USA
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8
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Knowledge and Self-Esteem of Individuals with Neurofibromatosis Type 1 (NF1). J Genet Couns 2016; 26:620-627. [DOI: 10.1007/s10897-016-0036-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/12/2016] [Indexed: 11/25/2022]
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9
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The Role of Appearance in Adolescents’ Experiences of Neurofibromatosis Type 1: A Survey of Young People and Parents. J Genet Couns 2016; 25:1054-62. [DOI: 10.1007/s10897-016-9944-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 02/17/2016] [Indexed: 11/25/2022]
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10
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Barke J, Coad J, Harcourt D. Parents' experiences of caring for a young person with neurofibromatosis type 1 (NF1): a qualitative study. J Community Genet 2016; 7:33-9. [PMID: 26201467 PMCID: PMC4715819 DOI: 10.1007/s12687-015-0247-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/14/2015] [Indexed: 11/27/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is a variable and unpredictable genetic condition that can lead to changes to an individual's appearance. Research has started to explore children's and young people's experiences of living with the condition; however, there is a lack of research with parents. This exploratory qualitative study set out to examine parents' experiences of caring for a young person with NF1. Seven parents took part in semi structured interviews which were subjected to a thematic analysis. Three key themes were identified which related to managing the uncertainty of the condition, the impact of an altered appearance, and others' awareness and understanding of NF1. Parents felt that understanding NF1 themselves in order to support their child was beneficial whilst a perceived lack of understanding by others was cited as a significant challenge. Parents require trustworthy information and also more widely call for greater understanding and awareness of the condition.
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Affiliation(s)
- Jenny Barke
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK.
| | - Jane Coad
- Nursing, Midwifery and Healthcare Practice, Coventry University, Priory Street, Coventry, CV1 5FB, UK
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
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Crawford HA, Barton B, Wilson MJ, Berman Y, McKelvey-Martin VJ, Morrison PJ, North KN. The Impact of Neurofibromatosis Type 1 on the Health and Wellbeing of Australian Adults. J Genet Couns 2015; 24:931-44. [DOI: 10.1007/s10897-015-9829-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
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12
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Castrillón N, Blanco I. Conviviendo con la Neurofibromatosis tipo 1: Revisión de la literatura. PSICOONCOLOGIA 1970. [DOI: 10.5209/psic.59173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo: En este estudio se realiza una revisión de la literatura sobre el impacto psicológico y emocional que conlleva la Neurofibromatosis tipo 1 (NF1) en los pacientes adultos. Método: Se realizó una revisión bibliográfica en PubMed (Medline) entre enero del 2007 y abril del 2017 de artículos publicados en el idioma inglés. Se encontraron un total de 75 artículos de los cuales se seleccionaron 23 con base en los criterios de inclusión y exclusión definidos para esta revisión. Resultados: Prácticamente todos los estudios vienen a concluir que los cambios y/o desfiguración en la imagen corporal o apariencia física, la visibilidad, el dolor y la gravedad de la enfermedad son el eje central sobre el cual gira el deterioro en la calidad de vida de las personas con NF1, debido a las dificultades que tienen los enfermos para adaptarse a los cambios físicos y para hacer frente a los problemas de ansiedad y el estrés psicológico que genera la carga de la enfermedad. Conclusiones: Conocer el impacto psicológico y emocional que tiene la NF1 permitirá desarrollar e implementar intervenciones psicoterapéuticas y psicosociales específicas para este grupo de población con el objetivo de facilitarles que puedan afrontar las consecuencias y los retos que trae asociada la enfermedad.
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