The Saint Siluan warning signs of cancer in children: impact of education in rural South Africa

Two thirds of children with cancer never reach a specialist centre for treatment in South Africa. The majority of those who present have advanced disease. A campaign was undertaken to educate the public and the primary health workers on the Saint Siluan early warning signs of cancer in children. There was a statistically significant increase in the number of new patients referred in the 6 years following the campaign (P = 0.001), but did not succeed in achieving the referral of patients at earlier stages of disease. This list of the warning signs appears to be useful in promoting awareness of cancer.     

Oncology healthcare professionals’ knowledge,attitudes, and practices regarding young carers

ObjectiveIncreasing numbers of youths are facing a relative’s cancer. In this context, some are required to provide significant support and are called young carers (YCs). However, little is known about how these youth are viewed and supported by health professionals. The aim of this study was to investigate the knowledge, attitudes, and practices of oncology healthcare professionals regarding YCs.MethodsThirty-one oncology professionals working in France (adult and pediatric departments and homecare services) participated in semi-structured interviews.ResultsThe results indicated that almost all professionals had already met a YC and could identify several situations in their professional context. Their knowledge of YCs appeared to influence their attitudes and practices. They perceived this situation in a rather superficial way when their discourse and ideas were explored in-depth. They mentioned some ideas for improving support for YCs, but also many barriers.ConclusionThe results highlight a moderate level of awareness. Thus, it is necessary to enhance providers’ awareness and knowledge of YCs.Practice implicationsAwareness campaigns and training programs need to be developed for oncology healthcare professionals to help them better identify, understand, and support YCs and their families. This type of action would positively impact patient care.     

Effects of health education on HIV/AIDS related knowledge among first year university students in China

BackgroundThe number of new HIV infections has increased and implementation of school-based health education programs on AIDS have been advocated for a long time.ObjectiveThis study aimed to explore the effectiveness of an intervention of HIV/AIDS on the knowledge of HIV/AIDS prevention and control among first year university students.MethodsAn awareness questionnaire was adopted to assess awareness and knowledge of HIV/AIDS pre- and post-health education among first year university students in Qinghai, China. Independent sample t-test, chi-square test, and multiple logistic regression analyses were used.ResultsA total of 2,165 and 2,062 first year university students were respectively recruited pre- and post- HIV/AIDS health education. The awareness rate increased significantly after the health education intervention (from 48.59%, 95%CI: 46.47%–50.72% to 76.24%, 95%CI: 74.35%–78.06%). Students from Hui and Tibetan ethnicities, and those holding prejudices against AIDS patients were less knowledgeable than their counterparts regarding HIV/AIDS related knowledge, whereas urban-dwellers and those with higher paternal education were positively associated with awareness of HIV/AIDS related knowledge (p <0.05).ConclusionHIV/AIDS awareness among first year university students improved greatly after receiving an education intervention, which underscores its utility as part of the approaches of HIV/AIDS control and prevention.     

Treatment needs and diagnosis awareness in primary care patients with chronic kidney disease

Background

GPs in England are required to keep a register of patients with chronic kidney disease (CKD). National Institute for Health and Clinical Excellence (NICE) guidelines recommend regular follow-up, but patients are perceived to be low risk and not requiring active management.

Aim

To assess treatment needs of CKD stage 3 patients in primary care, as well as their awareness of CKD.

Design and setting

A cross-sectional analysis from a longitudinal prospective study in 32 general practices.

Method

A total of 1741 participants underwent clinical assessment including urine and blood tests. Participants were asked about awareness of their CKD. Results were reviewed and a letter recommending treatment in line with NICE guidelines was sent to their GP.

Results

The mean age of participants was 73 ± 9 years; 60% (n = 1052) were female and diabetes was present in 17%; 67% of participants required further intervention. Most required improved control of hypertension (n = 1576; 33.1% of cohort). Other recommendations included advice to investigate anaemia (n = 1142; 8.2%) or stop nephrotoxic drugs (n = 1120; 7.5%). Less than 6% of participants met NICE criteria for referral to nephrology services and 41% were unaware of their CKD diagnosis. Multivariable analysis identified subjects with formal educational qualifications, age <75 years, estimated glomerular filtration rate (eGFR) 30–44 ml/min/1.73 m², and significant albuminuria as more likely to be aware of their diagnosis.

Conclusion

The study data show that the majority of patients required at least one intervention to improve the management of their CKD. Most interventions could be delivered in primary care and only a minority required nephrology referral. Many patients were unaware of their CKD diagnosis, and efforts should be made to improve this to facilitate involvement in their care.     

Emotion Coming of Age

Viewing emotion regulation as a process that occurs during the generation of emotion and with the aim of self-maintenance rather than self-control is emphasized. In a self-maintenance view, the cognitive system is seen as receiving information from the emotion system as well as influencing it, and self-maintenance is seen as occurring (largely below conscious awareness) by means of dynamic processes that involve both self- and other regulation. It is suggested that the field has yet to pay adequate attention to implicit and relational processes of regulation. An issue of major clinical significance is the importance of generating theory and research to help understand to what extent automatic emotion processes can be changed through deliberate conscious cognitive processes of self-control and to what extent they can only be changed through more implicit processes based on new emotional and/or relational experiences .     

Cardiovascular responses to a laboratory stressor in women: Assessing the role of body awareness

Body awareness (BA) is characterised by a general tendency towards awareness and recognition of normal, non-emotive bodily processes and physical sensations. BA considers one's sensitivity towards and belief in how well they can sense, predict, and describe their bodily functions and sensations. This study investigated the role of BA in haemodynamic and anxiety responses to a laboratory stressor. Women (n?=?40) completed assessments of BA and state/trait anxiety. Women with low BA displayed higher blood pressure (BP) and heart rate (HR) reactivity in response to the stressor than women with high BA. Delayed HR recovery poststressor was observed in women with low BA. BA was a significant predictor of haemodynamic reactivity over and above trait anxiety. BA effects on state anxiety were not observed. Thus, greater BA is associated with less haemodynamic stress reactivity in women lending further support for the development of BA interventions aimed at stress reduction.     

Factors affecting body awareness in older adults with chronic musculoskeletal pain

IntroductionChronic musculoskeletal pain (CMP) and cognitive impairment (CI) may reduce body awareness in older adults. The first aim of this study was to determine the impact of CMP and CI on body awareness in older adults. The second was to search for the factors most affecting body awareness using logistic regression analysis.Material and methodsTwo hundred and 65 older adults (males: 138 and females: 127) aged 65 and over (mean age; 72.27 ±6.42 years) living in their own homes were included. We used the following evaluation methods: CMP intensity (Visual Analog Scale – VAS), cognitive status (Hodkinson’s Abbreviated Mental Test – HAMT), and body awareness (Body Awareness Questionnaire – BAQ). Logistic regression analysis was used to determine the factor most affecting the BAQ score.ResultsEighty-five point two percent of participants (n = 265) reported CMP (lower extremity pain: 74.6%; spinal pain: 66.6%; upper extremities pain: 44.4%). CMP intensity was higher in lower extremities (mean VAS: 5.73 ±1.86 cm). Gender differences in terms of CMP were found in favor of males (p = 0.0001). Mean HAMT score was 8.16±1.65. Gender difference in favor of males was significant (p = 0.0001). Mean BAQ score was 77.61±20.90; there was no significant difference between the gender (p = 0.142). There was a significant moderate positive correlation between body awareness and cognitive status (r = 0.382, p = 0.0001). However, a weak negative correlation was found between body awareness and pain intensity (r = –0.234, p = 0.0001). Regression analysis showed that living environment (rural area), low education level, low cognition level and increased CMP intensity significantly predicted body awareness.ConclusionsThe results obtained from this study indicate that cognitive impairment and pain should be reduced by improving body awareness among older adults. That is why health professionals should evaluate all related factors affecting body awareness before planning the most suitable rehabilitation program.     

脑血管病危险因素在神经内科门诊患者中的知晓率调查分析

目的了解神经内科门诊缺血性脑血管疾病患者对导致脑血管病的主要危险因素的知晓情况,为脑卒中筛查工作提供依据。方法2013年2～7月,对1389例神经内科患者进行问卷调查,测量身高、体重、腰围、臀围、血压,同时测定空腹血脂、空腹血糖。并进行脑血管意外危险因素知晓率的流行病学调查。结果l389例神经内科门诊患者中,高血压病患病率55．6％,知晓率32．6％;糖尿病患病率46．2％,知晓率22．8％;高脂血症患病率82．6％,知晓率43．5％;肥胖患病率57．5％,知晓率33．0％;冠心病患病率67．1％,知晓率32．7％。其中35~44岁年龄（青壮年）组患者对患高血压病、糖尿病、高脂血症、肥胖和冠心病的知晓率更低,分别为8．7％、0、15．4％、9．4％、3．6％,与其他年龄组比较,差异有统计学意义。结论各年龄组患者的高血压病、糖尿病、冠心病、高血脂、肥胖的患病率均较高;对脑血管病的主要危险因素知晓率均较低;以35～44岁组的知晓率最低。对35～44岁组患者加强血脂、血压、血糖筛查,提高知晓率,对降低脑卒中的发病率具有重要意义。     

Incidence of accidental awareness during general anaesthesia in obstetrics: a multicentre,prospective cohort study

General anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115 consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in England were recruited to the study. Patients received three repetitions of standardised questioning over 30 days, with responses indicating memories during general anaesthesia that were verified using interviews and record interrogation. A total of 12 patients had certain/probable or possible awareness, an incidence of 1 in 256 (95%CI 149–500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 122–417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%) patients, paralysis by five (41.7%) and paralysis with pain by two (16.7%). Accidental awareness occurred during induction and emergence in nine (75%) of the patients who reported awareness. Factors associated with accidental awareness during general anaesthesia were: high BMI (25–30 kg.m^-2); low BMI (<18.5 kg.m^-2); out-of-hours surgery; and use of ketamine or thiopental for induction. Standardised psychological impact scores at 30 days were significantly higher in awareness patients (median (IQR [range]) 15 (2.7–52.0 [2–56]) than in patients without awareness 3 (1–9 [0–64]), p = 0.010. Four patients had a provisional diagnosis of post-traumatic stress disorder. We conclude that direct postoperative questioning reveals high rates of accidental awareness during general anaesthesia for obstetric surgery, which has implications for anaesthetic practice, consent and follow-up.