Genetic testing for alpha1-antitrypsin deficiency.

PURPOSE: The Alpha Coded Testing Study investigated the risks, benefits, and psychological impact of home genetic testing for alpha1-antitrypsin deficiency. METHODS: In the study, 996 adult individuals requested and returned a home-administered, confidential, fingerstick blood test. RESULTS: Individuals highly rated the benefits of establishing a diagnosis (82%), helping family members (86%), and anticipating peace of mind (79%). 78% of 239 current smokers reported a high likelihood of smoking cessation if diagnosed with AATD. After testing, more than 60% indicated that they would share the results with family and physicians but < 30% would share results with insurance companies. CONCLUSIONS: Confidential home testing for genetic disorders requires a comprehensive program of participant support.     

The use and acceptability of a one-on-one peer support program for Australian women with early breast cancer

A population-based survey of Australian women diagnosed with early breast cancer examined the uptake and acceptability of a peer support program, the Breast Cancer Support Service (BCSS). We examined the characteristics and perceptions of women who did and did not use the BCSS. More than one-third (36%) had used the BCSS, most of whom first heard of it from hospital staff (36%) or clinicians (16%). Women perceived meeting someone else with similar experiences (53%) as the most beneficial aspect of the program and 89% said they would definitely recommend it to others. The findings suggest that uptake is related to provision of information about the BCSS. Peer support programs appear to be acceptable to both women who do and do not use the BCSS. To ensure that women can choose whether to participate in peer support programs requires strategies that encourage health professionals to provide comprehensive supportive care information.     

Is breast cancer care in accord with clinical practice guidelines: a consumer audit

OBJECTIVES: To assess whether information, support and other psychosocial care for women with early breast cancer in Australia is in accord with published Australian clinical practice guidelines. DESIGN: An interview survey of a population-based sample of women with early breast cancer. SETTING: The whole of Australia. PARTICIPANTS: Women diagnosed with early breast cancer 6-12 months before the survey were identified through the population-based cancer registries. An initial sample of 1184 women was drawn from the cancer registries; the doctors of 104 women did not agree to any participation and a further 212 women were excluded as ineligible. A randomly selected sample of 832 of the 868 women who were eligible to participate were invited to participate in the study and 544 (76%) of the 716 who could be contacted completed a full interview. MAIN OUTCOME MEASURES: A telephone interview covering 12 aspects of care recommended in the published guidelines. Results: Most women received care in accord with the following recommendations: diagnosis given by a senior doctor (95%), face to face (86%) and in an open manner (90%). Fewer women received recommended care in relation to: involvement in decision making (73%), information about clinical trials (13%); receiving breast reconstruction following mastectomy (8%), evidence-based consumer guides (62%) and adequate support for families (65%). CONCLUSIONS: The extent to which the provision of information, support and psychosocial care is in accord with recommendations can be audited effectively by a survey of women who have received treatment. Some 80% or more of women received care in accord with half of the 12 target guidelines; however, further programmes are required to improve access to information and participation in clinical trials and to better understand participation in decision making.     

Development of a more efficient algorithm for identifying false-positive reactivity results in a dengue virus immunoglobulin M screening assay

Of 2,692 sera screened for dengue virus immunoglobulin M by using a μ-capture enzyme-linked immunosorbent assay (ELISA), 954 had equivocal (index from 0.90 to 1.10) or positive (index of >1.10) results and were retested using a background subtraction (BS) ELISA that identifies screen false positives. No false positives were found among 427 sera with screen ELISA indices of >6.00; thus, retesting this specimen subset by BS ELISA is unnecessary.     

Neutrophils contribute to development of a protective immune response during onset of infection with Leishmania donovani

Neutrophils are key components of the inflammatory response and as such contribute to the killing of microorganisms. In addition, recent evidence suggests their involvement in the development of the immune response. The role of neutrophils during the first weeks post-infection with Leishmania donovani was investigated in this study. When L. donovani-infected mice were selectively depleted of neutrophils with the NIMP-R14 monoclonal antibody, a significant increase in parasite numbers was observed in the spleen and bone marrow and to a lesser extent in the liver. Increased susceptibility was associated with enhanced splenomegally, a delay in the maturation of hepatic granulomas, and a decrease in inducible nitric oxide synthase expression within granulomas. In the spleen, neutrophil depletion was associated with a significant increase in interleukin 4 (IL-4) and IL-10 levels and reduced gamma interferon secretion by CD4⁺ and CD8⁺ T cells. Increased production of serum IL-4 and IL-10 and higher levels of Leishmania-specific immunoglobulin G1 (IgG1) versus IgG2a revealed the preferential induction of Th2 responses in neutrophil-depleted mice. Altogether, these data suggest a critical role for neutrophils in the early protective response against L. donovani, both as effector cells involved in the killing of the parasites and as significant players influencing the development of a protective Th1 immune response.     

Psychiatric and psychological factors in patient decision making concerning antidepressant use

The observation that the use of antidepressants has strongly increased during the past decade implies that on a micro level doctors and patients more often decide that antidepressants are the appropriate treatment. Therefore, it is important to increase insight into patients' decision making regarding the use of antidepressants. The decision making model used in the present study was based on A. Bandura's (1986) social cognitive theory. Two cohorts of patients were recruited and followed for 9 months. Among patients who use antidepressants (N = 166), the stronger pros and weaker cons of discontinuation and self-efficacy predicted more proximal goal intentions. Goal intentions predicted discontinuation after 9 months. Among patients who had used antidepressants in the past (N = 73), stronger pros of discontinuation and the weaker perceived functions of antidepressants predicted a more positive evaluation of their present state, compared with when they still used antidepressants. These temporal comparisons, in turn, predicted renewed use of antidepressants after 9 months. The results provide a framework for supporting and influencing decision making with regard to the use of antidepressants.     

Are lapsed donors willing to resume blood donation,and what determines their motivation to do so?

BACKGROUND: This study investigated the possibility of rerecruiting lapsed blood donors. Reasons for donation cessation, motivation to restart donation, and modifiable components of donation motivation were examined. We distinguished between lapsed donors who had passively withdrawn by merely not responding to donation invitations and donors who had contacted the blood bank to actively withdraw. STUDY DESIGN AND METHODS: A cross‐sectional survey was sent to 400 actively lapsed donors and to 400 passively lapsed donors, measuring intention to restart donation and psychological correlates of restart intention. The data were analyzed using multiple regression analyses. RESULTS: The response rate among actively lapsed donors was higher than among passively lapsed donors (37% vs. 25%). Actively lapsed donors typically ceased donating because of physical reactions, while passively lapsed donors quit because of a busy lifestyle. Nonetheless, 51% of actively lapsed responders and 80% of passively lapsed responders were willing to restart donations. Multiple regression analysis showed that, for passively lapsed donors, cognitive attitude was the strongest correlate of intention to donate in the future (β = 0.605, p < 0.001), with affective attitude (β = 0.239, p < 0.05) and self‐efficacy (β = 0.266, p < 0.001) explaining useful proportions of the variance as well. For actively lapsed donors, cognitive attitude was also the strongest correlate of intention (β = 0.601, p < 0.001), with affective attitude (β = 0.345, p < 0.001) and moral norm (β = ?0.118, p < 0.05) explaining smaller proportions of the variance. CONCLUSION: The majority of lapsed donors indicated a moderate to high intention to restart donations. Interventions focusing on boosting cognitive and affective attitudes and self‐efficacy could further raise such intentions.     

An evidence-based approach to COPD: part 1

OVERVIEW: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States, affecting as many as 24 million Americans and resulting in 1.5 million ED visits, 700,000 hospital admissions, and 124,000 deaths annually. This article, the first in a two-part series on COPD, outlines current guidelines and other evidence-based recommendations on diagnosing and managing stable COPD in the outpatient setting. Part 2 will appear in a future issue of AJN and will focus on managing acute exacerbations of COPD.