An epidemiologic study of breast cancer

A case-control study has been conducted in four areas of Canada in which 400 cases of breast cancer matched by age and marital status with neighborhood controls were administered medical and dietary questionnaires. The study is suggestive of an increased risk of breast cancer in post-menopausal women with younger age at menarche and an increased risk with delay of age at natural menopause. No protective effect of early age at first pregnancy was demonstrated in either pre- or post-menopausal women. An increased frequency of pregnancies of four months duration or less was found in cases compared to controls and a greater frequency in pre-menopausal cases compared to controls of a history of irregular menstrual periods. In pre-menopausal women no association has been found between increased height and weight as risk factors for breast cancer. For post-menopausal women, however, a weak association with increased height has been found, while a strong association with increased weight both at the time of menopause and the 12 months preceding diagnosis has ben confirmed.     

Perceptions of postmastectomy patients. Part I. The relationships between social support and network providers

With the increased incidence of breast cancer in the United States, emotional adjustment of postmastectomy patients is a growing concern. This study was designed to examine demographic and social network variables that relate to social support. Breast cancer patients (N = 613) who had a mastectomy within the past 24 months (means = 12 months) responded to the Norbeck Social Support Questionnaire (NSSQ). To supplement the quantitative data, interviews were conducted with 27 women. Results from the NSSQ indicated that women perceived greater emotional support (means = 4.25) than aid (means = 3.97) from their network providers. The average number of persons (both professional and lay) in the women's total network was 8.1, comprising 57% family members and 27% friends. Relationships with network providers were characterized as stable (5-year) and frequent (weekly). Social support increased with age, but the size of the network decreased. No significant difference existed between marital categories in emotional support or frequency of contact. Married or widowed women perceived similar amounts of aid, whereas single and divorced women indicated less. Divorced women reported significantly larger networks than the other three marital status categories. Persons with less education perceived greater emotional support than those with more education. Being married had a significant positive relationship to emotional support (p less than .001).     

Emotional intelligence in relation to nursing leadership: does it matter?

Aim  Discuss the importance of studying emotional intelligence (EI) of nursing leaders and the job satisfaction of nursing staff.
Background  The nursing shortage and issues with retention signifies the importance of assessing the influence nurse managers have on staff job satisfaction.
Evaluation  A review of the literature on the development of EI and the level of study involving nursing leadership was conducted to determine the need for further research in this area.
Key issues  Neurobehavioural research involving the limbic system has indicated that EI can be learned through educational programmes.
Conclusion  There is a need for further research in the area of EI of nurse managers in their role as leaders and the impact they have on the job satisfaction level of their nursing staff.
Implications for nursing management  The increasing nursing shortage and turnover rates signify the importance of research in the EI level of nursing leaders. Future research may include implementing educational programmes in the area of EI for nursing leaders resulting in a more positive work environment. Determining if EI influences nursing job satisfaction will provide a foundation for ongoing programme implementation to support and develop our nursing leaders.     

Whole-Genome Linkage and Association Scan in Primary,Nonsyndromic Vesicoureteric Reflux

Primary vesicoureteric reflux accounts for approximately 10% of kidney failure requiring dialysis or transplantation, and sibling studies suggest a large genetic component. Here, we report a whole-genome linkage and association scan in primary, nonsyndromic vesicoureteric reflux and reflux nephropathy. We used linkage and family-based association approaches to analyze 320 white families (661 affected individuals, generally from families with two affected siblings) from two populations (United Kingdom and Slovenian). We found modest evidence of linkage but no clear overlap with previous studies. We tested for but did not detect association with six candidate genes (AGTR2, HNF1B, PAX2, RET, ROBO2, and UPK3A). Family-based analysis detected associations with one single-nucleotide polymorphism (SNP) in the UK families, with three SNPs in the Slovenian families, and with three SNPs in the combined families. A case-control analysis detected associations with three additional SNPs. The results of this study, which is the largest to date investigating the genetics of reflux, suggest that major loci may not exist for this common renal tract malformation within European populations.Vesicoureteric reflux (VUR) is abnormal movement of urine from the bladder retrogradely through the vesicoureteric junctions into the upper urinary tract. This is a study of primary VUR, i.e., VUR that is not secondary to bladder outflow obstruction caused by neurogenic damage or urethral valves or part of a multiorgan syndrome. VUR is usually a benign condition but can be associated with transient kidney damage, acute inflammation from ascending pyelonephritis, or permanent damage as a consequence of scarring after infection and/or congenital kidney defects histologically comprising renal hypoplasia (too few nephrons) and/or renal dysplasia (incomplete differentiation).^1–3 These renal defects are grouped under the term reflux nephropathy (RN). In the United Kingdom, RN accounts for 12% of the approximately 40,000 adults and 7% of the 768 children who require renal transplantation and/or life-long dialysis.⁴Traditionally, the diagnosis of VUR has been based on cystography with radiodense or radioisotopic materials to visualize retrograde passage of urine. Williams et al.³ reviewed 15 cystography studies in well children: The largest study reported no VUR in 722 children, whereas some of the smaller studies reported much higher percentages of affected individuals. The true prevalence of (primary) VUR in children remains uncertain: 1% is probably conservative, and 10 to 20% is possible.³ Screening studies of first-degree relatives of individuals with VUR identifies reflux in one third to one half of siblings^5,6 and 65% of offspring.⁷ Futhermore, there is a high concordance of primary VUR in identical twins,⁸ and families have been identified with multiple generations affected by primary VUR and RN.⁹ Collectively, these studies suggest that there is a substantial genetic component to VUR.The first genome-wide linkage analysis for VUR, based on seven kindreds,⁹ provided preliminary evidence for a locus on chromosome 1 and also for genetic heterogeneity. In this study, multipoint parametric and nonparametric linkage analysis was undertaken; however, one of the markers defining the interval on chromosome 1, GATA176C01, was subsequently found to be on chromosome 2 (Ensembl release 55, July 2009), so this localization should be treated with caution. Subsequent studies using similar kindreds^10–12 have supported the notion that the condition is genetically heterogeneous. In the largest linkage study of VUR before this report, Kelly et al.¹³ performed a linkage genome scan of 609 individuals (283 affected individuals in 129 families) and detected six to seven regions with suggestive evidence of linkage,¹⁴ one of which at chromosome 2q37 attained genome-wide significance when analyzed in a phenotypically derived subset of the data. The high incidence in offspring of affected individuals and the large number of pedigrees consistent with autosomal dominant inheritance, albeit with reduced penetrance, is in keeping with a dominant model; however, recently, a locus was identified on 12p11-q13 using a recessive model.¹⁵Here we report on linkage and association analysis in affected sibling pairs from two populations. We used the Affymetrix NspI array to generate genome-wide data, adding in haplotype-tagging single-nucleotide polymorphisms (SNPs) to obtain full coverage for six candidate genes: AGTR2, HNF1B, PAX2, RET, ROBO2, and UPK3A.¹⁶     

The long-term outcome of prenatally detected posterior urethral valves: a 10 to 23-year follow-up study

OBJECTIVE

To document the functional outcome of patients with prenatally detected posterior urethral valves (PUV) in the second decade of life, and to evaluate the possible impact of prenatal diagnosis on the long‐term outcome of this condition

PATIENTS AND METHODS

We analysed the functional outcome of 25 patients with prenatally detected PUV born between 1984 and 1996, whose mean (range) age at follow‐up was 17.7 (10–23) years. The findings were compared with those in 17 patients (mean age 16.1 years) who had presented clinically to our unit during the same period. The duration of follow‐up in both groups was ≥10 years. Late outcomes were also compared with published data for PUV. Outcome measures included; death, incidence of end‐stage renal failure (ESRF), age at transplantation and the most the recently available plasma creatinine level in untransplanted patients. We also examined any possible association between functional outcome and early predictors, including nadir plasma creatinine level at <1 year and vesico‐ureteric reflux (VUR).

RESULTS

Three patients died (12%), two as neonates and one aged 3 years. Of five patients who had been shunted in utero, four died or developed early‐onset renal failure. In the 23 prenatally detected patients who survived the neonatal period, four (17%) had a renal transplant at a mean (range) age of 6.5 (3.0–12.0) years. Of 19 patients with prenatally detected PUV who had not been transplanted in the first 12 years of life, only one (5%) developed new‐onset ESRF at 10.0–23.4 years whilst 11 (58%) of these patients had normal creatinine values. In the untransplanted patients there was a statistically significant correlation between age and plasma creatinine level, but no correlation between late functional outcome and nadir creatinine in the first year of life, or bilateral VUR.

CONCLUSIONS

Prenatal diagnosis had little impact on mortality or ESRF in the first decade of life. This appears to be largely predetermined by renal dysplasia and the severity of intrauterine obstruction. However, the functional outcome of patients with prenatally detected PUV aged 10–23 years was considerably better than published long‐term data and the outcome of clinically presenting patients in our study. These findings suggest that the long‐term prognosis of PUV of intermediate severity might be improved by prenatal diagnosis.     

Anxiety in medical students: is preparation for full‐time clinical attachments more dependent upon differences in maturity or on educational programmes for undergraduate and graduate entry students?

INTRODUCTION: The transition to full-time clinical studies holds anxieties for most medical students. While graduate entry medical education has only recently begun in the UK, the parallel undergraduate and graduate entry MBBS courses taught at our school allowed us to study how 2 differently prepared groups perceived this vital time at a comparable stage in their training. METHOD: An anonymous questionnaire collected demographic data and graded anxiety in 13 statements relating to starting full-time clinical attachments. Two open questions allowed free text comment on the most positive and negative influences perceived during this time. Both a statistical analysis and a qualitative assessment were performed to compare the 2 groups of students. RESULTS: The 2 groups were similar with respect to gender but the graduate entry students were significantly older. The graduate entry students were significantly less anxious about most aspects of the transition period compared to the undergraduates. These course differences remained after adjusting for age and sex. When adjusted for course and age, male students expressed less anxiety. The main positive qualitative statements related to continual clinical and communication skills training in the graduate entry group. The main qualitative concerns in both groups related to 'fitting in' and perceived lack of factual knowledge. DISCUSSION: These data support the early introduction of clinical skills teaching, backed up by a fully integrated clinically relevant curriculum with continued assessment, in preparing students and reducing levels of anxiety before they start full-time clinical attachments. These course design differences appear to be more important than any differences in maturity between the 2 groups.     

EYE SYMPTOMS IN BRAIN TUMORS*

“An education isn't how much you have committed to memory, or even how much you know; it's being able to differentiate between what you know and what you don't.”     

Light delivery to tumour tissue through implanted optical fibres during photodynamic therapy

The maximum rate at which the light dose may be delivered during interstitial photodynamic therapy (PDT) has been measured for several types of delivery fibre. Measurements of light irradiance at the skin surface overlying subcutaneous experimental tumours were made during interstitial irradiation by 200m core diameter fibres whose output ends were either plane-cut or 5 mm long cylindrical diffusers. For plane-cut fibres, a rapid fall in light transmission, due to blood coagulation at the fibre tip, was observed at output powers greater than 229 mW and 104 mW in tumours with and without photosensitizer, respectively. Such a rapid fall was not observed with cylindrical diffusing fibres at output powers up to 1 W.In the clinical use of PDT the fibre output power is held constant at a level below which thermal effects may occur. In a second study, therefore, the irradiance at the skin surface was monitored for this treatment regime. A decrease in light transmission during treatment was observed. Plane-cut fibres showed a greater decrease than cylindrical diffusing fibres and for a given fibre type, non-photosensitized tumours showed a greater decrease than photosensitized tumours. For cylindrical diffusing fibres at output powers of 150 mW or less there was a 9% decrease in irradiance measured at the skin surface during the first 1000 s of treatment. The decrease was larger (30–40%) for fibre output powers in the range 200–300 mW.