Knowledge, satisfaction with information, decisional conflict and psychological morbidity amongst women diagnosed with ductal carcinoma in situ (DCIS)

Objective

To assess knowledge, satisfaction with information, decisional conflict and psychological morbidity amongst women diagnosed with ductal carcinoma in situ (DCIS) and to explore the factors associated with less knowledge and greater confusion about DCIS.

Methods

A cross-sectional survey of women diagnosed with DCIS in Australia (N = 144).

Results

This study found misunderstanding and confusion amongst women diagnosed with DCIS and a desire for more information about their breast disease. Approximately half of participants worried about their breast disease metastasizing; approximately half expressed high decisional conflict; 12% were anxious and 2% were depressed. Logistic regression analysis demonstrated that worry about dying from the breast disease was significantly associated with not knowing that DCIS could not metastasize (OR 3.9; 95% CI 1.03-14.25); and confusion about whether DCIS could metastasize was significantly associated with dissatisfaction with information (OR 12.5; 95% CI 3.8-40.2).

Conclusion

Good communication about how DCIS differs from invasive breast cancer is essential to alleviating the confusion and worry amongst women with DCIS.

Practice implications

Recommendations about how best to communicate a diagnosis of DCIS, including the uncertainties, are needed to guide health professionals to promote better understanding about DCIS and increase the well-being of women with DCIS.     

Gender differences in sagittal standing alignment before pubertal peak growth: the importance of subclassification and implications for spinopelvic loading

The aim of this study was to analyze gender differences in sagittal standing alignment at pre‐peak height velocity age thereby applying a scientifically sound and practically oriented classification scheme for overall standing balance. The study population consisted of healthy boys (n = 639) and girls (n = 557) before pubertal peak growth. During subjects' habitual standing, sagittal plane measures of the spine, pelvis and lower limbs were collected using a clinical screening protocol. With each subject classified as one of three postural types (neutral, sway‐back, or leaning‐forward), differences in sagittal plane alignment were analyzed between sexes. The results revealed clear differences between genders in each of the postural types. Within the neutral and sway‐back postural subgroups, boys presented more forward inclination of the trunk, more thoracic kyphosis and more pelvis backtilt compared with girls. Within the leaning‐forward category, girls displayed more forward trunk lean, less thoracic kyphosis and more pelvic anteversion. A state of lumbar segmental hyperextension appeared to exist in female leaning‐forward subjects. Our results reveal for the first time that sagittal standing alignment is different between prepubescent boys and girls when subjects are appropriately subclassified, and conversely represent a ‘wash‐out effect’ when pooled. When the classification system is applied, gender‐specificity in gravity line position is suggested, implying gender‐related differences in lever arms and thus load. Present findings may add to our understanding of gender‐specific biomechanical challenges posed by habitual posture, and may shed new light on sagittal standing alignment as a possible contributory factor in developmental spinal‐pelvic disorders.     

Medical device evaluation in the United Kingdom: past,present and future

The evaluation of medical devices in the UK has been through many changes since the early hospital equipment assessments in the 1960s. The range of medical devices evaluated has increased and the evaluation reports published have changed, but the evaluation programme continues to be a respected service for the NHS and social care. This review documents the history of the Device Evaluation Service, from its beginnings to the present day, and looks forward to its future. Following an independent strategic review and the Healthcare Industries Task Force (HITF) recommendations, the Device Evaluation Service is now entering a new and exciting developmental phase.     

Suicide trends and geographical variations in the United Kingdom, 1991-2004

Almost 6,000 people killed themselves in the UK in 2004. While suicide rates in the UK fell between 1991 and 2004 this decrease did not occur in all areas. Large disparities remain between suicide rates in the countries of the UK, and between regions and local areas. This article also presents inequalities in suicide rates by deprivation, and considers change over time, for men and women, and for different age groups.     

Medical device evaluation in the United Kingdom: past, present and future

The evaluation of medical devices in the UK has been through many changes since the early hospital equipment assessments in the 1960s. The range of medical devices evaluated has increased and the evaluation reports published have changed, but the evaluation programme continues to be a respected service for the NHS and social care. This review documents the history of the Device Evaluation Service, from its beginnings to the present day, and looks forward to its future. Following an independent strategic review and the Healthcare Industries Task Force (HITF) recommendations, the Device Evaluation Service is now entering a new and exciting developmental phase.     

Review of egg-related salmonellosis and reduction strategies in United States,Australia, United Kingdom and New Zealand

Globally, Salmonella enterica subsp. enterica is one of the most commonly reported causes of foodborne illness in humans. Contaminated food products of animal origin, particularly egg and egg products are frequently implicated in outbreaks of human salmonellosis. Salmonella enteritidis is frequently involved in egg and egg products-associated foodborne outbreaks in the USA and UK. However, in Australia and New Zealand, human infections caused by this serovar occur as a result of infection acquired while overseas travel, with Salmonella typhimurium being a predominant cause of local foodborne outbreaks. In this paper, an overview of Salmonella epidemiology on laying farms, egg-related Salmonella outbreaks in humans, and regulatory practises to control Salmonella across USA, UK, Australia and New Zealand is provided. Considering the estimated production of eggs in the USA, UK, Australia and New Zealand in 2015, the risk of foodborne illness in general is quite low for humans consuming eggs. Salmonella diagnostics, reporting and surveillance systems have improved over the years and will continue to improve in the years to come. However, given the number of different emerging Salmonella serovars a regular review of Salmonella control strategies from farm to fork is required.     

Transgender Women and the Sex Work Industry: Roots in Systemic,Institutional, and Interpersonal Discrimination

Because transgender people face discrimination on systemic, institutional, and interpersonal levels, the previous literature has supported that many transgender women view the sex work industry as their only viable career option. The current article reviews the literature on discrimination against transgender people, explores how discrimination influences their participation in sex work, and discusses how institutional discrimination against transgender women manifests within the criminal justice system. Furthermore, recommendations are provided for advocating for the rights of transgender people while promoting healthy behaviors and higher quality of life. Throughout the article, quotes from previous qualitative research are used to illustrate the experiences of transgender women through their own voices and perspectives.     

Gender,Ethnocultural, and Psychosocial Barriers to Diabetes Self-Management in Italian Women and Men With Type 2 Diabetes

Although several ethnic groups experience a greater burden of diabetes, this has not been examined in first-generation Italians, who compose one of the largest ethnocultural groups in Canada. In this cross-sectional study, the authors examined the relationship among gender and ethnocultural factors, family support, depressive symptomatology, and illness perceptions on diabetes self-management (DSM) in 50 Italian women and men with type 2 diabetes. The authors first conducted a focus group to explore cultural barriers. They then assessed gender, ethnocultural, and psychosocial barriers quantitatively by an interviewer-administered questionnaire, Compared with Italian men, Italian women reported significantly greater depressive symptomatology and perceived disease seriousness. Greater depressive symptomatology was significantly associated with perceived family sabotage and DSM barriers. In univariate analyses, shorter duration of diabetes and greater perceived treatment effectiveness significantly predicted better DSM. In conclusion, certain illness perceptions and culturally relevant gender-specific barriers should be addressed by health care providers to maximize DSM in this population.     

Histologic correlates of viral and bacterial infection of the placenta associated with severe morbidity and mortality in the newborn

The purpose of this study was to correlate the histologic features of the placenta with the in situ detection of viral or bacterial nucleic acids in cases of severe morbidity and mortality in the neonatal period. The criteria for the cases were either fetal or neonatal death (11 cases with autopsy material available in 8 cases) or idiopathic severe respiratory distress or central nervous system-related symptoms at birth (49 cases). Controls included 11 placentas from births with no morbidity and 6 placentas that were associated with severe neonatal morbidity of known etiology (trisomy, ruptured uterus, prolapsed cord). The 77 placental tissues were analyzed with a consensus bacterial probe and for a wide variety of viral infections. An infectious cause was found in 46/60 (76%) of cases; these were distributed as follows: enterovirus, 23 cases (22 were coxsackie virus); bacterial (consensus probe), 15 cases; cytomegalovirus (CMV), 4 cases; herpes simplex virus (HSV), 2 cases; parvovirus, 2 cases. The infectious agents localized primarily to Hofbauer cells and trophoblasts. In each of the 8 cases for which autopsy material was available, the same infectious agent that was detected in the placenta was also detected in the autopsy material (spleen, heart, central nervous system, or lungs). No infectious agent was detected in any of the 17 controls. Viral inclusions (only evident for DNA viruses) and stem vessel vasculitis were the 2 histologic findings that were associated with infectious disease in the placenta (P = 0.025). These data show that infection of the villi is highly associated with neonatal morbidity and mortality and that the histologic findings are, in most cases, nonspecific for infection.     

Stress and weight change in university students in the United Kingdom

Students in the US have been shown to gain weight during their first year at university. This study examined whether students in Britain have a similar weight change during their first year at university, and tested the hypothesis that stress plays a role. A cross-sectional survey was conducted to assess stress and perceived weight change. Two hundred and sixty eight students at University College London completed the questionnaire at the end of their first year of university. On average, students reported a significant weight increase (1.53 kg+/-2.70, p<0.001), although there was considerable variation, with 55% of the sample reporting weight gain, 12% weight loss, and 33% remaining stable. Logistic regression analyses demonstrated that stress was associated with greater risk of weight gain (OR, 1.27, 95% CI, 1.12 to 1.44, p=0.001) and weight loss (1.33, 1.10 to 1.61, p=0.003), but associations were stronger among women. The associations remained unchanged after adjustment for health behaviours. Our findings confirm a modest weight gain over the first year at university, which was associated with higher levels of perceived stress in women.     

Trends and geographical variations in alcohol-related deaths in the United Kingdom, 1991-2004

Alcohol-related deaths in the UK increased substantially between 1991 and 2004, from 4144 to 8221. Overall rates increased in all parts of the UK. There were, however, large differences in rates between countries and regions. This article presents these differences and also looks at patterns of alcohol-related mortality by deprivation within England and Wales. The article considers changes over time for males and females and for different age groups.