Risk,anxiety and defensive action: general practitioner's referral decisions for women presenting with breast problems

Women visiting their general practitioners with breast problems are a common occurrence in the United Kingdom (UK). General practitioners can expect to see around 30 new presentations per 1000 women each year. Although routine, this aspect of their work is characterized by a considerable degree of uncertainty. Differential diagnosis is difficult and the most important problem facing the general practitioner is how to distinguish between symptoms that require immediate referral and those which can be managed in primary care. If they refer women inappropriately, specialist services will be overloaded resulting in delay in treatment for those who may have breast cancer. The paper draws on data from a study of a systematic sample of 85 women newly referred to four main specialist breast clinics and their referring general practitioners. In-depth, semi-structured interviews were conducted with the referring general practitioners. Examination of respondents' discourses revealed that in providing justification for their referral behaviour they invoked a number of arguments that served to present their referral decisions as ‘apparently’ logical and defensible. They achieved this by locating the source of risk with the ‘disease’ (breast cancer) on the one hand and the ‘litigious woman’ on the other. These became the sites of risk rather than the objective nature of individual patient's signs, symptoms and personal characteristics. Two broad defensive stances emerged in their discourses: (1) women were ‘at risk’ from a malevolent disease, the vagaries of clinical judgement and anxiety; (2) doctors were ‘at risk’ with their clinical and professional autonomy threatened by women who, in the context of breast cancer, become litigious. This has important implications for those wishing to modify general practitioners behaviour to reduce inappropriate referrals.     

Binding thermodynamic characterization of human P2X1 and P2X3 purinergic receptors

The present study was designed to perform binding and thermodynamic characterization of human P2X1 and P2X3 purinergic receptors expressed in HEK 293 cells. The thermodynamic parameters DeltaG degrees , DeltaH degrees and DeltaS degrees (standard free energy, enthalpy and entropy) of the binding equilibrium of well-known purinergic agonists and antagonists at P2X1 and P2X3 receptors were determined. Saturation binding experiments, performed in the temperature range 4-30 degrees C by using the high affinity purinergic agonist [3H]alphabetameATP, revealed a single class of binding sites with an affinity value in the nanomolar range in both cell lines examined. The affinity changed with the temperature whereas receptor density was essentially independent of it. van't Hoff plots of the purinergic receptors were linear in the range 4-30 degrees C for agonists and antagonists. The thermodynamic parameters of the P2X1 or P2X3 purinergic receptors were in the ranges -31 kJ mol(-1) < or =DeltaH degrees < or =-19 kJ mol(-1) and 17 J K(-1) mol(-1)< or =DeltaS degrees < or =51 J K(-1)mol(-1) or -26 kJ mol(-1)< or =DeltaH degrees < or =36 kJ mol(-1) and 59< or =DeltaS degrees < or =249 JK(-1) mol(-1), respectively. The results of these parameters showed that P2X1 receptors are not thermodynamically discriminated and that the binding of agonists and antagonists was both enthalpy and entropy-driven. P2X3 receptors were thermodynamically discriminated and purinergic agonist binding was enthalpy and entropy-driven while antagonist binding was totally entropy-driven. The analysis of such thermodynamic data makes it possible to obtain additional information on the nature of the forces driving the purinergic binding interaction. These data could be interesting in drug discovery programs aimed at development of novel and potent P2X1 and P2X3 purinergic ligands.     

WAY-163909 [(7bR, 10aR)-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta-[b][1,4]diazepino[6,7,1hi]indole], a novel 5-hydroxytryptamine 2C receptor-selective agonist with anorectic activity

The pharmacological profile of WAY-163909 [(7bR, 10aR)-1,2,3,4,8,9,10,10a-octahydro-7bH-cyclopenta-[b][1,4]diazepino[6,7,1hi]indole], a novel 5-hydroxytryptamine (HT)(2C) (serotonin) receptor-selective agonist is presented. WAY-163909 displaced [(125)I]2,5-dimethoxy-4-iodoamphetamine binding from human 5-HT(2C) receptor sites, in Chinese hamster ovary (CHO) cell membranes, with a K(i) value of 10.5 +/- 1.1 nM. Binding affinities determined for the human 5-HT(2A) and 5-HT(2B) receptor subtypes were 212 and 485 nM, respectively. In functional studies, WAY-163909 stimulated the mobilization of intracellular calcium in CHO cells stably expressing the human 5-HT(2C) receptor with an EC(50) value of 8 nM, and E(max) relative to 5-HT of 90%. WAY-163909 failed to stimulate calcium mobilization in cells expressing the human 5-HT(2A) receptor subtype (EC(50) > 10muM) and was a 5-HT(2B) receptor partial agonist (EC(50) 185 nM, E(max) 40%). WAY-163909 exhibited negligible affinity (<50% inhibition at 1 muM) for other receptor sites examined, including human 5-HT(1A), D2, and D3 receptors, and the 5-HT transporter binding site in rat cortical membranes. WAY-163909 exhibited weak affinity for the human D4 (245 nM) and 5-HT(7) (343 nM) receptor subtypes and the alpha1 binding site in rat cortical membranes (665 nM). WAY-163909 produced a dose-dependent reduction in food intake in normal Sprague-Dawley rats (ED(50) = 2.93 mg/kg), an effect blocked by a 5-HT(2C) receptor antagonist but not by a 5-HT(2A) or 5-HT(2B) receptor antagonist. In addition, WAY-163909 decreased food intake in obese Zucker rats and diet-induced obese mice with ED(50) values of 1.4 and 5.19 mg/kg i.p., respectively, consistent with the potential utility of 5-HT(2C) receptor agonists as anti-obesity agents.     

Longitudinal assessment of vibrations during manual and power wheelchair driving over select sidewalk surfaces

Wheelchair users rely on their wheelchairs for mobility for extended periods of time every day. According to the International Standards Organization 2631-1 standard on human vibration, individuals in a seated position when exposed to whole-body vibrations (WBV) are at risk of injury. This study evaluated vibration exposure during manual and power wheelchair driving over nine sidewalk surfaces and differences in vibration exposure over 3 years. Ten nondisabled subjects were asked to drive a manual wheelchair at 1 m/s and a power wheelchair at 1 m/s and 2 m/s over nine sidewalk surfaces while WBV were measured at the seat and footrest of the wheelchair. At 1 m/s, significant differences existed between surfaces and years at both the seat and the footrest for the manual and power wheelchair users. At 2 m/s, significant differences existed between surfaces and years at the seat and the footrest for power wheelchair users. Our results show that both manual and power wheelchair users may be at risk for secondary injuries from WBV when traveling over certain surfaces.     

A preliminary investigation of affective interaction in chronic pain couples

The objective of this preliminary study was to examine the extent to which affective marital interaction related to depressive symptoms in persons with chronic pain and their spouses and to pain severity in persons with pain. Couples from the community completed self-report surveys and engaged in a videotaped conversation on a topic of mutual disagreement that was coded for three affect types (i.e., anger/contempt, sadness, humor). Humor was positively related to marital satisfaction in both partners. Spouse anger/contempt and sadness were positively related to depressive symptoms in spouses. Several significant interaction effects between couple pain status (i.e., whether one or both partners reported pain) and affect also emerged. Specifically, sadness in the participant designated as the person with pain was associated with greater depressive symptoms and pain severity when only he or she reported pain whereas sadness was related to fewer depressive symptoms and less pain severity when both partners reported pain. The relationships between spouse anger and spouse depressive symptoms and between spouse humor and pain severity in the person with pain were also moderated by couple pain status. These exploratory findings can be interpreted in light of emotion regulation and pain empathy theories. For example, partners who have not experienced pain themselves may fail to empathize with persons in pain, thus preventing effective emotion regulation. When both spouses report chronic pain, expressions of negative affect may instead promote emotion regulation because the affect is experienced with a spouse who may be more empathetic.