Perception of breast cancer risk and surveillance behaviours of women with family history of breast cancer: a brief report on a Spanish cohort

Women with a family history of breast cancer (FHBC) are at increased risk for developing this disease. In this study, we have investigated the differences between two groups of women; those with family history of breast cancer (N=42) and women at population risk (N=42) in a Spanish cohort. Questionnaires assessed distress, perception of breast cancer risk, screening behaviours, coping skills, personality and quality of life. Neither group received genetic counselling before or after this study. Women with FHBC overestimated their risk of developing breast cancer. They report a subjective risk of developing breast cancer of 50%, with their actual risk, using the risk tables elaborated by Claus et al., being only 15% (p<0.05). Discriminant function analysis revealed the patients' information about breast cancer, worries about breast cancer, perception of risk based on family history, perception of lifetime risk of breast cancer and quality of life were the five variables that distinguished between both groups. Only 34% of women in the FHBC group performed monthly breast self-examination, 24% (10 subjects) had never attended previously for clinical breast examination and 45% (19 subjects) had never undergone a mammogram. This group of women had a significantly lower level of general satisfaction (p<0.05), an indicator of Quality of Life. The results support the need for developing psychological intervention for women with family history of breast cancer in order to increase adherence to surveillance behaviours, reduce distress, improve quality of life, and assure the earliest detection of breast cancer.     

AMPA Receptors are Coupled to the Nitric Oxide/Cyclic GMP Pathway in Cerebellar Astroglial Cells

In cultured rat cerebellar astroglia kainate induces cGMP formation with low potency (EC₅₀ 310 μM). In the presence of cyclothiazide, a blocker of α-amino-3-hydroxy-5-methyl-4-isoxazole propionate (AMPA) receptor desensitization, the effect of kainate was potentiated and glutamate and AMPA elicited large increases (>100-fold) in cGMP levels. The response to all three agonists was abolished by the nitric oxide synthase inhibitor N^G-nitro-L-arginine and required extracellular calcium. Uptake of Co²⁺ was induced by AMPA in a limited population of astroglial cells and this effect was potentiated by cyclothiazide. These results indicate that calcium-permeable AMPA receptors mediate stimulation of nitric oxide formation in cerebellar astroglia. This effect may be relevant for glutamate-dependent synaptic plasticity processes in the cerebellum.     

Facilitators and barriers to adoption of evidence-based perinatal care in Latin American hospitals: a qualitative study

Selective episiotomy and the active management of labor have been shown by numerous studies to benefit women's experience of labor as well as its outcomes. However, many Latin American public hospitals have not updated their clinical practices to reflect these findings. Limited access to new knowledge, limited time and physical resources and attitudes resistant to change are factors limiting the adoption of new practices in such hospitals. Interviews were conducted with three department heads, and focus groups were conducted with 31 physicians and midwives working in 10 public hospitals in Argentina and Uruguay. All were asked about facilitators and barriers to making changes in clinical practice. In addition, three focus groups were conducted with 16 pregnant women served by public hospitals. Responses were grouped according to stages of change in incorporating new evidence into practice. Numerous facilitators and barriers were identified by participants, as well as potential strategies for promoting change that could be incorporated into interventions. Barriers included limited access to information, negative attitudes toward changes in practice, lack of skills in performing new practices, lack of medical resources and explicit guidelines and a perceived need to practice defensive medicine. Changing long-standing clinical practice is difficult. Interventions must be adapted to translate evidence-based approaches to new cultures and contexts. Improving information access, use of role models, skill development and improved resources and support may be effective ways to overcome barriers to change in Latin American obstetric care.     

Assessment of the psychometric properties of the Detection of Emotional Distress Scale in cancer patients

Objective

To evaluate and alleviate the emotional distress suffered by advanced cancer patients, simple screening methods that can be easily used by health staff and easily understood by patients are required. The objective of this multicenter study was to analyze the psychometric properties and clinical utility of the Detection of Emotional Distress (DED) scale in advanced cancer patients attending a palliative care unit.

Methods

The DED scale was administered to 105 advanced cancer patients attended in five palliative care units in Catalonia (Spain).

Results

A total of 58.3% of the patients had moderate to severe emotional distress, a result similar to those of other scales such as the emotional thermometer. Statistical analysis of ROC curves suggested that the cutoff for the detection of emotional distress by the DED scale was equivalent to a score of ≥ 9 points, with a sensitivity and specificity above 75%.

Conclusions

The DED scale is useful and easy to use in the identification of emotional distress in advanced cancer patients attended in palliative care units. This scale could also be applied in other patients and health care fields, such as patients with chronic diseases, home care, and primary care.     

Prevalence and clinical correlates of disinhibition in dementia.

OBJECTIVE AND METHODS: The phenomenology, main clinical correlates, and long-term evolution of disinhibition in dementia are not well known. To examine this issue, we studied a consecutive series of 272 patients with probable Alzheimer disease using a comprehensive psychiatric and neuropsychological evaluation that included the Disinhibition Scale. A subset of patients was reexamined with the same instruments between 1 and 4 years after the initial evaluation. RESULTS: A factor analysis of the Disinhibition Scale demonstrated 4 factors: (1) abnormal motor behavior, (2) hypomania, (3) loss of insight and egocentrism, and (4) poor self-care. Disinhibition was significantly associated with major and dysthymic depression, more severe negative symptoms, and loss of awareness. Most patients with disinhibition at the initial evaluation still showed disinhibition at follow-up, whereas 23% of patients without disinhibition at the initial evaluation developed disinhibition at follow-up. CONCLUSIONS: Disinhibition is a frequent and long-lasting problem in dementia. Our study demonstrates that the construct of disinhibition consists of 4 independent subsyndromes, each of which may have specific underlying mechanisms.     

Multiple telencephalic and extratelencephalic embryonic domains contribute neurons to the medial extended amygdala

Dysfunctions in emotional control and social behavior are behind human neuropsychiatric disorders, some of which are associated with an alteration of amygdalar development. The medial extended amygdala is a key telencephalic center for control of social behavior, but very little is known about its development. We used in vitro migration assays for analyzing the origin of the neurons of the medial extended amygdala in mouse embryos (E13.5-E16.5). We compared the migration assays with immunofluorescence/immunohistochemistry for calbindin and radial glial fibers and with mRNA expression of several genetic markers of distinct forebrain subdivisions. We provide experimental evidence for multiple embryonic origins of the principal neurons of the medial extended amygdala. In particular, we provide novel evidence indicating that a major part of the neurons derives from a caudoventral pallidal subdivision (previously called or included as part of the anterior peduncular area), forming a cell corridor with similar molecular features (expression of Lhx6 and calbindin), connectivity, and function, which relates to reproductive behavior. We also provide novel experimental evidence indicating that the ventral pallium produces some neurons for the medial amygdala, which correlates with data from Lhx9 expression. Our results also confirm that some neurons of the medial extended amygdala originate in the preoptic area (our results indicate that these cells specifically originate in its commissural subdivision) and the supraoptoparaventricular domain of the hypothalamus. Our study helps to set up the foundations for a better understanding of medial amygdalar control of behavior in normal and abnormal conditions.     

Primary tumors of the posterior pituitary: A systematic review

In 2017, the World Health Organization established that pituicytoma, granular cell tumor (GCT), spindle cell oncocytoma (SCO) and sellar ependymomas (SE) are posterior pituitary tumors (PPT). They probably arise from the pituicytes and may constitute a unique histopathological entity. We carried out a systematic review using PubMed’s database. A total of 266 patients with pathological diagnosis of PPT (135 pituicytomas, 69 GCT, 47 SCO, 8 SE and 7 mixed histology tumors) were analyzed. Gender distribution was identical and median age at diagnosis was 48?±?21.8 years. Main presentation symptoms were visual disorders (n?=?142; 58.1%), headache (n?=?99; 40.5%), hypopituitarism (n?=?84; 34.4%), hypercortisolism (n?=?10; 4.1%), polyuriapolydipsia (n?=?6; 2.4%) and acromegaly features (n?=?5; 2.0%). On MRI, 122 (47.6%) patients showed sellar with suprasellar extension masses, 67 (23.1%) were suprasellar and 63 (24.6%) exclusively sellar. Median tumor size was 22.0?±?14.2 mm. Two hundred sixty four patients underwent surgery, transphenoidal access was selected in 132 (64.4%) and craniotomy in 58 (28.3%). Complications were hypopituitarism (n?=?70; 42.1%), diabetes insipidus (n?=?55; 33.1%) and hemorrhage (n?=?50; 30.1%). Tumor persisted in 93 patients (45.6%) and recurred in 13 (6.4%). Regarding comparison between main types of PPT, SCO patients were diagnosed later (60.0 vs 47.0 vs 47.0 years, p?=?0.023), the tumor was larger 25.0 mm [10.8] vs 20.0 mm [14.2] vs 2.0 mm [15.0] and they were frequently sellar with suprasellar extension tumors (71.7% vs 46.2% vs 32.8%, p?=?0.003) compared to pituicytoma and GCT. In conclusion, PPT are rare tumors and have been misdiagnosed mainly as non-functioning pituitary adenomas. Different types of PPT share similar epidemiology, clinical manifestations and surgical outcomes. Surgery is the only curative option but complications and subtotal resection are common.