Unraveling smoking ties: how tobacco use is embedded in couple interactions

The purpose of this research was to explore couple interactions related to tobacco use prior to pregnancy, as part of a larger grounded theory project focused on couple interactions related to tobacco use. Interviews with 28 women who quit or reduced smoking for pregnancy and their partners were conducted. Analysis of retrospective accounts of pre-index pregnancy interactions resulted in the identification of tobacco-related routines related to: (a) regulation of smoking; (b) practices related to the acquisition, use and handling of tobacco; (c) communication about tobacco use; and (d) responding to slips and lapses. Variations in the enactment of routines were captured in three tobacco-related interaction patterns: (a) disengaged; (b) conflictual; and (c) accommodating. Findings provide insights into the role tobacco plays in relationships and resistance to behavior change.     

Crossing the line: adolescents' experiences of controlling their tobacco use

Although adolescents are often curious about cigarettes and anxious to "try" smoking, they are unsure about what engaging in the act of smoking will mean. Most adolescents who experiment with smoking do not set out to become addicted to tobacco. Using a grounded theory approach, the authors examined the process youth undergo to regain control over their smoking. Accounts of early smoking experiences suggest that youth undergo a process to control tobacco use that includes (a) determining if smoking is a problem, (b) "crossing the line" of acceptable tobacco use, and (c) implementing strategies to regain control of smoking. The findings of this study lay the basis for the development of harm reduction approaches that facilitate youth's propensity to control their tobacco use.     

Case studies of power and control related to tobacco use during pregnancy.

OBJECTIVE: The objective was to identify and describe elements of power and control evident in couple tobacco-related interaction patterns during pregnancy. METHODS: Using a case study approach, elements of the Duluth Abuse Intervention Project Power and Control Wheel were used to examine women's experiences of tobacco reduction during pregnancy and post partum. Three cases were selected from a larger qualitative sample, using a maximum variation sampling approach. RESULTS: Although no direct evidence of partner abuse or violence accompanying partner efforts to influence women's smoking was described, most of the elements of power and control were present in the case study, and appeared to cause an emotional toll and a negative impact on women's ability to freely express their views about their own tobacco use. CONCLUSIONS: Elements of power and control, however subtle, are potentially important and unrecognized dimensions of women's tobacco reduction experiences. Additional care and attention should be taken in designing tobacco reduction interventions and policies directed at pregnant and post partum women and their partners to reduce the possibility that these interventions may contribute to the use of power and control.     

Tobacco use in intimate spaces: issues in the study of couple dynamics

Few guidelines exist for using qualitative research to examine couple dynamics in contexts complicated by strong social stigmas and wide-ranging patterns of interpersonal relationships. The purpose of this article is to describe the methodological and ethical issues that arose in an ongoing qualitative study focused on tobacco reduction in the context of couple relationships, and the strategies undertaken to deal with these challenges. The authors discuss their experiences with the following: recruitment in the context of social stigma and the potential for intracouple coercion, data collection and the implications of uncovering intimate dimensions of couples' lives, the impact of the research process on mothers' vulnerability, and the challenges of capturing shared, "dyad" experiences. These issues point to unique challenges in conducting qualitative research with couples and families and provide a useful base for similar studies.     

Does the proliferation fraction help identify mature B cell lymphomas with double‐ and triple‐hit translocations?

Mationg‐Kalaw E, Tan L H C, Tay K, Lim S T, Tang T, Lee Y Y L & Tan S Y
(2012) Histopathology
Does the proliferation fraction help identify mature B cell lymphomas with double‐ and triple‐hit translocations? Aims: The entity ‘B cell lymphoma, unclassifiable, with features intermediate between diffuse large B cell lymphoma (DLBCL) and Burkitt lymphoma (BL)’ refers to B cell neoplasms that share overlapping characteristics of BL and DLBCL. A subset of these ‘grey‐zone lymphomas’ possesses C‐MYC and IGH translocations but, in addition, contains additional rearrangements of BCL2 and/or BCL6 genes. The aim of this study was to investigate if the proliferation fraction by Ki67 immunostaining can be used to identify such double‐/triple‐hit lymphomas. Methods and results: We studied 492 cases of mature aggressive B cell neoplasms by histology, immunohistochemistry and interphase fluorescence in‐situ hybridization (FISH) using break‐apart probes against C‐MYC, BCL2, BCL6, IGH, MALT1, PAX5 and CCND1. Forty Burkitt lymphomas and 28 cases of MYC⁺ double‐/triple‐hit lymphomas were identified. Of the latter, 77% and 54% displayed proliferation fractions exceeding 75% and 90%, respectively. With a cut‐off of >75% by Ki67 immunostaining, the sensitivity and specificity for detection of MYC⁺ double/triple translocations was 0.77 and 0.36. Raising the proliferation fraction criterion to >90% improved the specificity to 0.62 at the expense of a low sensitivity of 0.54. Conclusions: Immunostaining for Ki67 is not a useful approach to prescreen B cell lymphomas for MYC⁺ double/triple translocations.     

Phenotypic and molecular dissection of metaplastic breast cancer and the prognostic implications

Metaplastic breast carcinoma (MBC) is relatively rare but accounts for a significant proportion of global breast cancer mortality. This group is extremely heterogeneous and by definition exhibits metaplastic change to squamous and/or mesenchymal elements, including spindle, squamous, chondroid, osseous, and rhabdomyoid features. Clinically, patients are more likely to present with large primary tumours (higher stage), distant metastases, and overall, have shorter 5-year survival compared to invasive carcinomas of no special type. The current World Health Organisation (WHO) diagnostic classification for this cancer type is based purely on morphology – the biological basis and clinical relevance of its seven sub-categories are currently unclear. By establishing the Asia-Pacific MBC (AP-MBC) Consortium, we amassed a large series of MBCs (n = 347) and analysed the mutation profile of a subset, expression of 14 breast cancer biomarkers, and clinicopathological correlates, contextualising our findings within the WHO guidelines. The most significant indicators of poor prognosis were large tumour size (T3; p = 0.004), loss of cytokeratin expression (lack of staining with pan-cytokeratin AE1/3 antibody; p = 0.007), EGFR overexpression (p = 0.01), and for ‘mixed’ MBC, the presence of more than three distinct morphological entities (p = 0.007). Conversely, fewer morphological components and EGFR negativity were favourable indicators. Exome sequencing of 30 cases confirmed enrichment of TP53 and PTEN mutations, and intriguingly, concurrent mutations of TP53, PTEN, and PIK3CA. Mutations in neurofibromatosis-1 (NF1) were also overrepresented [16.7% MBCs compared to ∼5% of breast cancers overall; enrichment p = 0.028; mutation significance p = 0.006 (OncodriveFM)], consistent with published case reports implicating germline NF1 mutations in MBC risk. Taken together, we propose a practically minor but clinically significant modification to the guidelines: all WHO_1 mixed-type tumours should have the number of morphologies present recorded, as a mechanism for refining prognosis, and that EGFR and pan-cytokeratin expression are important prognostic markers. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

Understanding the disaster experience of older adults by gender: the experience of survivors of the 2007 earthquake in Peru

We examine the experiences of older adult survivors of the August 2007 "Southern earthquake" in Peru within the cultural context of gender roles and family relationships. The data include 24 semistructured videotaped interviews conducted in Pisco in December 2007 with survivors of the earthquake aged 60-90. The responses, experiences, and adjustments of the older adult disaster survivors will be discussed in terms of their family and social support systems and gender roles. These older adults sustain their personal identities and deal with their health concerns in the aftermath of the earthquake in the context of these cultural systems of support.