Comparison of individuals opting for BRCA1/2 or HNPCC genetic susceptibility testing with regard to coping, illness perceptions, illness experiences, family system characteristics and hereditary cancer distress

OBJECTIVE: To study differences between individuals opting for genetic cancer susceptibility testing of a known familial BRCA1/2 and HNPCC related germline mutation. METHODS: Coping, illness perceptions, experiences with cancer in relatives and family system characteristics were assessed in 271 applicants for genetic testing before test result disclosure. Hereditary cancer distress, worry and cancer risk perception were assessed before, 1 week after, and 6 months after disclosure. RESULTS: Individuals from BRCA1/2 and HNPCC mutation families did not differ with regard to the number of experiences with cancer in relatives, grief symptoms, the course of cancer distress, worry and risk perception through time and most illness perceptions, coping responses and family characteristics. Individuals from BRCA1/2 families perceived hereditary cancer as more serious. They reported more frequently a passive coping style, cancer worry and a less open communication with their partner and children. CONCLUSION: Besides subtle differences, psychological mechanisms may be mainly identical in individuals opting for BRCA1/2 and HNPCC susceptibility testing. PRACTICE IMPLICATIONS: Based on our findings, using a similar counseling approach for individuals opting for BRCA1/2 or HNPCC genetic susceptibility testing is justified. In this approach, attention should be directed more to individual aspects than to the type of disorder.     

Exploring MEST: a new universal teaching strategy for school health services to promote positive mental health literacy and mental wellbeing among Norwegian adolescents

Background

Mental health among adolescents is an important public health challenge. School health services perform central public health functions in Norwegian municipalities, where school nurses are uniquely positioned to educate and promote mental health among adolescents. MEST (MEST is not an acronym; MEST is a short version of the Norwegian word for coping) is a newly developed universal working strategy for school health services that aims to promote positive mental health literacy (MHL) and mental wellbeing in the adolescent population. The aim of this study was to investigate the potential outcome mean differences in positive MHL and mental wellbeing between adolescents who participated and those who did not participate in MEST over a school year.

Methods

This study is based on cohort data collected from 357 adolescents (aged 15–21?years) in five Norwegian upper secondary schools at the beginning and end of the 2016/2017 school year. The data were analyzed by describing mean scores and estimating the average treatment effect (ATE) of MEST on positive MHL and mental wellbeing.

Results

Positive MHL increased significantly more among the MEST participants compared to the non-MEST participants (p?=?.02). No significant change in mental wellbeing was found between MEST and non-MEST participants (p?=?.98). Estimating the ATE of MEST on positive MHL, the MEST participants showed a significant 2.1% increase (p?=?.04) in the potential outcome mean of positive MHL compared to the nonparticipants. Estimating the ATE of MEST on mental wellbeing, the girls who attended MEST exhibited a significant 9.7% increase (p?=?.03) in the potential outcome mean of mental wellbeing compared with the girls who did not attend MEST, while no significant change (p?=?.99) was detected among boys or the entire sample of both genders combined (p?=?.12).

Conclusion

This study found a significant ATE of MEST on positive MHL and on mental wellbeing among girls. The results support further investments in studying MEST as a promising work strategy for school health services to promote adolescent mental health. This initial study of MEST may be used as a foundation for investing in future evaluations of MEST.

     

Effects of multidisciplinary pain treatment can be predicted without elaborate questionnaires

Purpose

Low back pain is one of the most common and expensive diseases of Western societies. Psychosocial factors such as low social status, depression, or work dissatisfaction are known to promote chronicity of low back pain. With a multidisciplinary approach, better outcomes can be achieved than with purely biomedical treatment. Optimal patient selection for multidisciplinary therapy reduces costs and labour. This study investigated whether elaborated questionnaires exceed simple items in predicting multimodal therapy success.

Methods

In this prospective longitudinal clinical study, 330 patients were followed up for six months after multidisciplinary therapy. We applied the patient questionnaire Heidelberg Short Early Risk Assessment Questionnaire for the Prediction of Chronicity in Low Back Pain (HKF-R10) that is approved and established for predicting chronicity in patients with acute low back pain to forecast the therapeutic outcome. Outcome criteria were QOL, pain reduction and back to work.

Results

With regard to outcome criteria, the HKF-R10 was unable to anticipate therapeutic success, but education level, depression, best pain condition, and helplessness predicted therapy success with an 80 % probability for QOL improvement.

Conclusions

It is not necessary to confront patients with an extensive and complicated questionnaire to predict the outcome of multidisciplinary therapy. In fact, assessing a few specific items allows better and easier prognosis estimation.     

Do educational meetings and group detailing change adherence to drug formularies in hospitals? A cluster randomized controlled trial

Purpose

The aim of this study was to examine whether educational meetings and group detailing could increase the use of drugs from the ward lists or the drug formulary in hospitals.

Methods

Twelve medical wards from two hospitals were randomized into three groups: control, basic and extended intervention. All wards had a ward list review before interventions. Moreover, the basic intervention consisted of an educational meeting, and the extended intervention included two group detailing sessions. The proportion of drugs used from the ward list or hospital drug formulary (HDF) was the primary outcome. Data (defined daily doses [DDDs], numbers and cost [Euros]) on drugs sold to the wards were retrieved from the two hospitals from 1 July 2011 to 31 August 2012. Baseline data: from July to September 2011, and follow-up data: from June to August 2012.

Results

The proportion of formulary drugs used increased for the extended intervention group (0.04, range ?0.02 to 0.09) and basic intervention group (0.03, range ?0.03 to 0.09) in comparison with a decrease in the control group (?0.01, range ?0.03 to ?0.02). The interventions did not significantly change odds for selecting drugs from the formulary in comparison with the control group (basic intervention: OR 1.09 [95 % CI 0.81 to 1.46]; extended intervention: OR 1.00 [95 % CI 0.75 to 1.35]).

Conclusions

In this study, educational meetings and group detailing do not significantly improve adherence to ward lists or HDF. The adherence to the formularies at baseline was relatively high, which may explain why the interventions did not have a significant effect.     

Recognition of a subregion of human proinsulin by class I-restricted T cells in type 1 diabetic patients

Proinsulin is a key autoantigen in type 1 diabetes. Evidence in the mouse has underscored the importance of the insulin B chain region in autoimmunity to pancreatic beta cells. In man, a majority of proteasome cleavage sites are predicted by proteasome cleavage algorithms within this region. To study CD8+ T cell responses to the insulin B chain and adjacent C peptide, we selected 8- to 11-mer peptides according to proteasome cleavage patterns obtained by digestion of two peptides covering proinsulin residues 28 to 64. We studied their binding to purified HLA class I molecules and their recognition by T cells from diabetic patients. Peripheral blood mononuclear cells from 17 of 19 recent-onset and 12 of 13 long-standing type 1 diabetic patients produced IFN-gamma in response to proinsulin peptides as shown by using an ELISPOT assay. In most patients, the response was against several class I-restricted peptides. Nine peptides were recognized within the proinsulin region covering residues 34 to 61. Four yielded a high frequency of recognition in HLA-A1 and -B8 patients. Three peptides located in the proinsulin region 41-51 were shown to bind several HLA molecules and to be recognized in a high percentage of diabetic patients.     

Long‐term effects of a preoperative smoking cessation programme

Introduction: Preoperative smoking intervention programmes reduce post‐operative complications in smokers. Little is known about the long‐term effect upon smoking cessation. Aim: To discover long‐term quit rates and the reasons behind successful cessation. Materials and Methods: 101 one of 120 smokers, randomised to smoking intervention or no intervention before hip and knee surgery, completed questionnaires concerning smoking after 1 year. We selected representative men and women for focus group interviews. Results: Significantly more patients from the intervention group abstained from smoking for 1 year post‐operatively [13 in 60 patients (22%) vs 2 in 60 (3%), P < 0.01]. Sex (male), low nicotine dependency, non‐smoking spouse and preoperative smoking intervention were related to smoking cessation. All patients gave the same reasons for smoking cessation: improved health and saving money. Follow‐up for 5 years showed 17% of the controls and 8% in the intervention group (P = 0.42) had died. Conclusion: The intervention group had a significantly higher quit rate 1 year after a preoperative smoking cessation programme. Please cite this paper as: Villebro NM, Pedersen T, Møller AM and Tønnesen H. Long‐term effects of a preoperative smoking cessation programme. The Clinical Respiratory Journal 2008; 2: 175–182.     

Aortic valve stenosis: fatal natural history despite normal left ventricular function and low invasive peak-to-peak pressure gradients

For many years, the severity of valvular aortic stenosis (AS) was evaluated mainly on the basis of cardiac catheterization. In many centers, the handy peak-to-peak transvalvular pressure difference or 'peak-to-peak gradient' in relation to left ventricular function was used as a crucial feature in taking a decision regarding valve substitution. In a prospective study during the period 1994-1997, 150 consecutive patients with AS were examined systematically using cardiac catherization as well as transthoracic (TTE) and transesophageal echocardiography. The study was performed in order to compare the diagnostic accuracy and reproducibility of the three modalities with the purpose of improving our evaluation strategy. We found that the three methods were able to determine the aortic valve area with similar accuracy and reproducibility. The data thus support earlier papers and the currently recommended strategy of managing most patients on the basis of TTE since this approach is more rapid and gentle to the patients. In accordance with the past policy of our department, however, considerable weight was put on the invasive data during the study period. Thus, 12 patients with invasive peak-to-peak gradient <50 mm Hg and no severe depression of left ventricular function were not offered valve replacement, despite symptoms and significant valve area reductions. At 2.5 years of follow-up, 6 had died, 3 of severe heart failure, 2 while awaiting scheduled valve replacement, and 1 during aortocoronary bypass surgery. Another 3 patients later experienced further symptom progression and underwent successful aortic valve replacement. In the remaining 3 patients, all free from coronary stenoses and other valvular heart disease than AS, heart failure symptoms had worsened considerably during continued medical therapy. In conclusion, we do not recommend consideration of the peak-to-peak gradient in the process of deciding whether or not AS patients should receive valve replacement. A low peak-to-peak gradient does not exclude severe AS, even in the presence of preserved left ventricular function.     

A Prospective,Randomized Study: Switch Off the Sacral Nerve Stimulator During the Night?

Purpose Sacral nerve stimulation is an effective treatment for fecal incontinence. Some have recommended to “switch off” the pacemaker during the night to extend the lifetime of the expensive pacemaker. This study was designed to investigate whether a nightly “switch off” affects the clinical results of sacral nerve stimulation. Methods Twenty patients successfully treated with sacral nerve stimulation (19 females; median age, 59 (range, 36–72) years) were randomized to: Group A, pacemaker continuously “on” for three weeks followed by three weeks with the pacemaker “off” during the night, or Group B, opposite order. Daily bowel-habit diary, Wexner, and St. Mark’s incontinence scores were obtained. Results One failed to return the daily bowel-habit diary, leaving 19 participating patients. Median Wexner incontinence score increased from 6 (range, 2–14) to 7 (range, 3–16) during the “off” period (P = 0.04), whereas St. Mark’s incontinence score increased from 10 (range, 3–16) to 11 (range, 3–18; P = 0.03). Median number of days with soiling per three weeks increased from 0 (range, 0–12) to 1 (range, 0–15) during the “off” period (P = 0.008). Seven of 19 had more days with soiling during the “off” period. Defecation frequency per three weeks increased from 26 (range, 11–71) to 34 (range, 9–70) during the “off” period (P = 0.19). Only four continued with a nightly “switch off” after the study. Conclusions It could be considered to recommend compliant patients to “switch off” the pacemaker during the night to extend the lifetime of the pacemaker. One-third experienced increased soiling, and they should turn the pacemaker on all day and night. Among the remaining, only a minor proportion will be motivated for turning the pacemaker off. Read at the meeting of the European Society of Coloproctology, Malta, September 26 to 29, 2007.