Black sheep get the blues: A psychobiological model of social rejection and depression

Major life events involving social rejection are strongly associated with onset of depression. To account for this relation, we propose a psychobiological model in which rejection-related stressors elicit a distinct and integrated set of cognitive, emotional, and biological changes that may evoke depression. In this model, social rejection events activate brain regions involved in processing negative affect and rejection-related distress (e.g., anterior insula, dorsal anterior cingulate cortex). They also elicit negative self-referential cognitions (e.g., “I’m undesirable,” “Other people don’t like me”) and related self-conscious emotions (e.g., shame, humiliation). Downstream biological consequences include upregulation of the hypothalamic-pituitary-adrenal axis, sympathetic-adrenal-medullary axis, and inflammatory response. Pro-inflammatory cytokines play an important role in this process because they induce a constellation of depressotypic behaviors called sickness behaviors. Although these changes can be short-lived, sustained inflammation may occur via glucocorticoid resistance, catecholamines, sympathetic innervation of immune organs, and immune cell aging. This response also may be moderated by several factors, including prior life stress, prior depression, and genes implicated in stress reactivity.     

A systematic review of medical diagnosis of Ogilvie's syndrome in childbearing

Objectiveto review all published papers examining medical diagnosis of Ogilvie's syndrome and pregnancy with a view to assessing the implications of the diagnosis and the condition itself for childbearing women, midwives and medical practitioners.Designsystematic review.Search strategyMEDLINE, CINAHL, EMBASE, Web of Science and Cochrane databases were searched from 1950 to 2006 inclusive. Papers were read by two independent researchers and selected if they informed the link between Ogilvie's syndrome and childbearing or were concerned with other aspects of maternal mortality.Findings23 papers fulfilled the selection criteria and were of a suitable standard. Inconsistencies in relation to the diagnosis of Ogilvie's syndrome were noted, and an increase in maternal deaths from this condition was reported up to 2002.Key conclusionsthis paper highlights the strengths and weaknesses of medical diagnosis, as exemplified by Ogilvie's syndrome. The scientific basis of diagnoses such as Ogilvie's syndrome may deserve attention. This diagnosis has been shown to be unstable, both in temporal and aetiological terms. The midwifery and nursing reaction to the abrupt appearance of this condition is, at best, unfortunate. The attribution of blame to midwifery practices is deserving of a more robust response.Implications for practicethere may be clinical implications of the diagnosis of Ogilvie's syndrome for other aspects of maternity (including any nursing) care. A particularly significant area is the widely recognised increase in the caesarean rate with which Ogilvie's syndrome has been closely linked.     

Nursing shaping and influencing health and social care policy

Aim  This paper seeks to consider how nursing as a profession in the United Kingdom is developing its role in shaping and influencing policy using lessons learnt from a policy study tour undertaken in the United States of America and extensive experience as a senior nurse within the government, the health service and more recently within a Professional Organization.
Background  The nursing profession faces major changes in health and health care and nurses need to be visible in the public debate about future models of health and health care.
Methods  This paper critically reviews recent UK and USA literature and policy with relevance to nursing.
Results  Strategies that support nurses and nursing to influence policy are in place but more needs to be done to address all levels of nursing in order to find creative solutions that promote and increase the participation of nurses in the political process and health policy. There are lessons to be learnt in the UK from the US nursing experience. These need to be considered in the context of the UK and devolution.
Conclusions  Although much has been achieved in positioning nurses and nursing as an influencer in the arena of policy and political decision-making, there is a need for greater co-ordination of action to ensure that nursing is actively supported in influencing and shaping health and health care policy.
Implications for Nursing Management  All leaders and other stakeholders require to play their part in considering how the actions set out in this article can be taken forward and how gaps such as education, fellowship experience and media engagement can be addressed in the future.     

MicroRNAs as prognostic indicators and therapeutic targets: potential effect on breast cancer management.

The discovery of microRNAs (miRNA) as novel modulators of gene expression has resulted in a rapidly expanding repertoire of molecules in this family, as reflected in the concomitant expansion of scientific literature. MiRNAs are a category of naturally occurring RNA molecules that play important regulatory roles in plants and animals by targeting mRNAs for cleavage or translational repression. Characteristically, miRNAs are noncoding, single-stranded short (18-22 nucleotides) RNAs, features which possibly explain why they had not been intensively investigated until recently. Accumulating experimental evidence indicates that miRNAs play a pivotal role in many cellular functions via the regulation of gene expression. Furthermore, their dysregulation and/or mutation has been shown in carcinogenesis. We provide a brief review of miRNA biogenesis and discuss the technical challenges of modifying experimental techniques to facilitate the identification and characterization of these small RNAs. MiRNA function and their involvement in malignancy, particularly their putative role as oncogenes or tumor suppressors is also discussed, with a specific emphasis on breast cancer. Finally, we comment on the potential role of miRNAs in breast cancer management, particularly in improving current prognostic tools and achieving the goal of individualized cancer treatment.     

The Maastricht Treaty: setting a health care agenda for Europe

This paper is intended to promote awareness among the European cancer nursing community of recent developments in the European Union's views on health. The paper outlines the background leading to the Treaty on European Union (Maastricht Treaty). The main features of the Treaty are identified and Article 129 of the Treaty on the provisions for public health and prevention of disease is discussed. The implications of the Treaty for health care in general and cancer care in particular are addressed.     

Critical realism as emancipatory action: the case for realistic evaluation in practice development

Abstract  To provide rigour when preparing a research design, the researcher needs to carefully consider not only the methodology but also the philosophical intent of the study. This, however, is often absent from reported research and provides the reader with little evidence by which to judge the merits of the chosen methodology and its influence on the study. The purpose of this paper is to set out the case for critical realism as a framework to guide appropriate action in practice development and realistic evaluation for understanding the consequences of those actions.
It is evident that critical realism and critical social science share common ground. Emancipatory practice development (ePD) is based on the philosophy of critical social science and therefore by virtue is linked to the tenets of critical realism. Until now, the evaluation of ePD programme has been well served by 4th-generation evaluation. However, this paper outlines the need for a different approach to evaluation, one that is based on critical realism, that is concerned with emancipation, and that can be used in the ever-changing environment of clinical practice. Realistic evaluation not only links strongly to ePD programmes, but also serves as the basis for effective research questions that will test the outcomes of the research and inform the transferability of ePD mechanisms into differing contexts.     

Sick role and the cancer patient

This paper examines the concept of the sick role and its effect on the cancer patient. The hypothesis is put forward that lack of control and the creation of a feeling of helplessness can adversely affect the illness career of the cancer sufferer. Some of the various strategies used by cancer patients as ways of regaining a degree of control and overriding the paternalistic approach of the health care professions are examined and the importance of patient empowerment is emphasized.     

Qualified nurse and nursing auxiliary perceptions of their work environment in primary, team and functional nursing wards

The way in which nursing work is organized has major implications for the role of different staff grades. This paper describes how qualified nurses and nursing auxiliaries perceived their work in primary, team and functional nursing wards. The Work Environment Scale was distributed to 12 qualified nurses and 12 nursing auxiliaries within each organizational mode, and a response rate of 97% was achieved. While differences were found between organizational modes, there was no difference in work perceptions between qualified nurses and nursing auxiliaries within organizational mode. It is argued that this is due to cultures existing within organizational types which transcend staff grade.