Axillary lymph node dissection (ALND) as part of surgical treatment for patients with breast cancer is associated with significant morbidity. Sentinel lymph node biopsy (SLNB) is a newly developed ...method of staging the axilla and has the potential to avoid an ALND in lymph node-negative patients, thereby minimizing morbidity. The aim of this study was to investigate physical and psychological morbidity after SLNB in the treatment of early breast cancer in a randomized controlled trial.
Between November 1999 and February 2003, 298 patients with early breast cancer (tumors 3 cm or less on ultrasound examination) who were clinically node negative were randomly allocated to undergo ALND (control group) or SLNB followed by ALND if subsequently found to be lymph node positive (study group). A detailed assessment of physical and psychological morbidity was performed during a 1-year period postoperatively.
A significant reduction in postoperative arm swelling, rate of seroma formation, numbness, loss of sensitivity to light touch and pinprick was observed in the study group. Although shoulder mobility was less impaired on average in the study group, this was significant only for abduction at 1 month and flexion at 3 months. Scores reflecting quality of life and psychological morbidity were significantly better in the study group in the immediate postoperative period, with fewer long-term differences.
SLNB in patients undergoing surgery for breast cancer results in a significant reduction in physical and psychological morbidity.
The loss of Sir John Franklin’s Arctic expedition has provoked speculation about the cause of the fatal outcome from the expedition’s departure in 1845 to the present day. This study describes how ...The Lancet, first published in 1823 and now one of the world’s leading medical journals, drew conclusions at the time of the expedition’s loss, which closely parallel those of today’s most recent research. The journal took evidence from Arctic medical and naval experts to conclude in 1859 that the Admiralty’s misdirected searches committed the crews to ice-bound entrapment, which had fatal nutritional consequences. The Lancet’s prescience has been supported by recent research showing that the unique physical circumstances faced by the expedition had nutritional effects related to vitamin deficiencies, which explain mortality over the third winter and the eventual total loss. It is significant that, although published 160 years apart and with vitamins unknown in the Victorian era, both studies took robust evidence-based approaches to draw similar conclusions.
It has previously been hypothesized that lower socio-economic status can accelerate biological ageing, and predispose to early onset of disease. This study investigated the association of ...socio-economic and lifestyle factors, as well as traditional and novel risk factors, with biological-ageing, as measured by telomere length, in a Glasgow based cohort that included individuals with extreme socio-economic differences.
A total of 382 blood samples from the pSoBid study were available for telomere analysis. For each participant, data was available for socio-economic status factors, biochemical parameters and dietary intake. Statistical analyses were undertaken to investigate the association between telomere lengths and these aforementioned parameters.
The rate of age-related telomere attrition was significantly associated with low relative income, housing tenure and poor diet. Notably, telomere length was positively associated with LDL and total cholesterol levels, but inversely correlated to circulating IL-6.
These data suggest lower socio-economic status and poor diet are relevant to accelerated biological ageing. They also suggest potential associations between elevated circulating IL-6, a measure known to predict cardiovascular disease and diabetes with biological ageing. These observations require further study to tease out potential mechanistic links.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Socioeconomic gradients in health persist despite public health campaigns and improvements in healthcare. The Psychosocial and Biological Determinants of Ill-health (pSoBid) study was designed to ...uncover novel biomarkers of chronic disease that may help explain pathways between socioeconomic adversity and poorer physical and mental health.
We examined links between indicators of early life adversity, possible intermediary phenotypes, and markers of ill health in adult subjects (n = 666) recruited from affluent and deprived areas. Classical and novel risk factors for chronic disease (lung function and atherosclerosis) and for cognitive performance were assessed, and associations sought with early life variables including conditions in the parental home, family size and leg length.
Associations were observed between father's occupation, childhood home status (owner-occupier; overcrowding) and biomarkers of chronic inflammation and endothelial activation in adults (C reactive protein, interleukin 6, intercellular adhesion molecule; P < 0.0001) but not number of siblings and leg length. Lung function (forced expiratory volume in 1 second) and cognition (Choice Reaction Time, the Stroop test, Auditory Verbal Learning Test) were likewise related to early life conditions (P < 0.001). In multivariate models inclusion of inflammatory variables reduced the impact and independence of early life conditions on lung function and measures of cognitive ability. Including variables of adult socioeconomic status attenuated the early life associations with disease biomarkers.
Adverse levels of biomarkers of ill health in adults appear to be influenced by father's occupation and childhood home conditions. Chronic inflammation and endothelial activation may in part act as intermediary phenotypes in this complex relationship. Reducing the 'health divide' requires that these life course determinants are taken into account.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Objective To assess the utility of Leventhal's Self-Regulatory Model (SRM) to predict self-care behavior with regard to dietary, medication, and fluid regimes in end-stage renal disease ...(ESRD) patients. Methods In a prospective study, ESRD patients treated via hospital-based haemodialysis ( N =73) were screened for cognitive deficits and completed questionnaires that enquired about illness perceptions, coping strategies, knowledge of kidney disease, and psychological distress at Time 1. Physiological proxy measures of self-care behaviors regarding diet (serum potassium levels), fluid intake (mean and standard deviation of interdialytic weight gain), and medication (serum phosphate levels) regimes were collected 3 weeks later at Time 2. Results Illness representations (emotional and timeline perceptions) predicted self-care behaviors with regard to diet and medication. Emotion-focused coping strategies predicted higher levels of variation in adherence to fluid restrictions. Younger males were less likely to adhere to the fluid restrictions. Conclusions The SRM has predictive utility. Psychological interventions should focus on alleviating disease-specific distress and challenging erroneous timeline perceptions in order to increase adherence to dietary and medication regimes in ESRD patients. A more specific measure of coping for ESRD is required to clarify the role of coping strategies in this population. Younger, male patients should be targeted for extra support with fluid restrictions.
Associations between socio-economic status (SES), personality and inflammation were examined to determine whether low SES subjects scoring high on neuroticism or hostility might suffer relatively ...higher levels of inflammation than affluent subjects.
In a cross-sectional design, 666 subjects were recruited from areas of high (most deprived - "MD") and low (least deprived - "LD") deprivation. IL-6, ICAM-1, CRP and fibrinogen were measured along with demographic and health-behaviour variables, and personality traits of neuroticism, extraversion and psychoticism (hostility). Regression models assessed the prediction of inflammation as a function of personality, deprivation and their interaction.
Levels of CRP and IL-6 were an increasing function of neuroticism and extraversion only in LD subjects opposite trends were seen in MD subjects. The result was ascribed parsimoniously to an inflammatory ceiling effect or, more speculatively, to SES-related health-behaviour differences. Psychoticism was strongly associated with ICAM-1 in both MD and LD subjects.
The association between neuroticism, CRP and IL-6 may be reduced in MD subjects confirming speculation that the association differs across population sub-groups. The association between psychoticism and ICAM-1 supports evidence that hostility has adverse effects upon the endothelium, with consequences for cardiovascular health. Health interventions may be more effective by accounting for personality-related effects upon biological processes.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The primary objective was to conduct a detailed analysis of individual variation in psychological morbidity in the year following surgery for breast cancer. The salience of the patients' “illness ...perceptions” to morbidity was examined as a secondary objective.
Psychological morbidity was assessed with the General Health Questionnaire (GHQ-28) in a prospective study of 371 women having surgery for primary breast cancer. Patients also completed the Illness Perception Questionnaire (IPQ), Mental Adjustment to Cancer Scale (MAC) and the Eysenck Personality Scales (EPS). Assessments were made postoperatively and at 3, 6 and 12 months after surgery.
Whilst descriptive statistics indicated a general reduction in mean distress over the 12-month follow-up, close analysis showed that a quarter of all patients maintained clinically significant levels of distress throughout the period. Patients with chronically elevated distress were characterised by higher levels of neuroticism, greater symptom awareness, more pain and poorer self-rated general health. In the regression analysis, psychological morbidity across the 1-year follow-up was predicted principally by the immediate postoperative state of distress, IPQ symptom awareness and the perceived time line of the illness, general health and, to a more minor extent, by neuroticism.
There is marked individual variation in psychological morbidity in the year following breast cancer surgery, which is reliably predicted by the patient's immediate postoperative state of distress, her perception of the impact of the symptoms and the time line of the disease. Subgroups of patients with chronically high distress are characterised by factors including personality and negative perceptions and beliefs about their illness.
Objective
Objective measure of scarring and three-dimensional (3D) facial asymmetry after surgical correction of unilateral cleft lip (UCL) and unilateral cleft lip (UCLP). It was hypothesized that ...the degree of scarring or asymmetry would be correlated with poorer psychological function.
Design
In a cross-sectional design, children underwent 3D imaging of the face and completed standardized assessments of self-esteem, depression, and state and trait anxiety. Parents rated children's adjustment with a standard scale.
Setting
Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences.
Patients
Fifty-one children aged 10 years with UCLP and 43 with UCL were recruited from the cohort treated with the surgical protocol of the CLEFTSIS managed clinical network in Scotland.
Methods
Objective assessment to determine the luminance and redness of the scar and facial asymmetry. Depression, anxiety, and a self-esteem assessment battery were used for the psychological analysis.
Results
Cleft cases showed superior psychological adjustment when compared with normative data. Prevalence of depression matched the population norm. The visibility of the scar (luminance ratio) was significantly correlated with lower self-esteem and higher trait anxiety in UCLP children (P = .004). Similar but nonsignificant trends were seen in the UCL group. Parental ratings of poorer adjustment also correlated with greater luminance of the scar.
Conclusions
The objectively defined degree of postoperative cleft scarring was associated with subclinical symptoms of anxiety, depression, and low self-esteem.
Previous research shows a low success rate for lean implementations. Few studies have considered the role that organisational culture plays in lean implementations and specifically the interaction ...effects of Organisational Culture and Lean Management on Operating Performance. This research examines empirically the role that Organisational Culture (OC) plays in the relationship between Lean Practices (LPs) and Operational Performance (OP) using a survey of 295 UK manufacturers. Cultural dimensions are shown to fully mediate the impact of lean management practices on Operational Performance. The findings indicate that LPs are positively associated with organisational cultures that are procedurally focused, employee oriented, structurally open, socially loose, rule driven (norm) and market oriented. In contrast, LPs are negatively associated with results-oriented and pragmatic cultures, which also carried over to the impact on operating performance. The results highlight that a procedural focus is important for lean practice integration. Moreover, LPs are shown to be positively associated with the softer dimensions of culture (i.e. employee orientation and open communication), which appear to aid initial lean integration. However, only external market orientation is associated with improved operating performance. Overall, the findings provide new insights into the contextual factors associated with successful Lean implementations.
•Cognitive archaeology; estimating mental effects of heavy metals in human remains.•Blood lead not linked to cognitive deficit in officer of 1845 Franklin expedition.•Further evidence to question ...role of lead in loss of the 1845 Franklin expedition.
Lead poisoning has been implicated in the loss in the Arctic of all 129 officers and men of the British Royal Naval “Franklin expedition” of 1845. In a unique study, D’Ortenzio et al. (2018) estimated blood-lead concentrations of an officer of the expedition over the three months prior to his death which is thought to have occurred before the desertion of the expedition’s ships. The present study applies regression coefficients which quantify the relationship between blood lead and neuropsychological function to the data of D’Ortenzio et al. to estimate whether the officer’s lead exposure would have impaired his cognitive performance in the critical period prior to the desertion. It is shown that the blood-lead concentrations would have been associated with only small deficits in higher-order cognitive processes including attention, visual scanning, memory and decision-making which would not have been of functional significance. Greater deficits were associated with psychomotor functions involving eye-hand co-ordination and fine motor control which, although not defined formally as “impairment”, might have affected accuracy when using firearms or operating instruments relevant to the scientific objectives of the expedition. The study also reviews evidence that the levels of lead in the Franklin crew, while high relative to today, were typical of those of the lead-exposed Victorian population from which they were recruited. The results contribute to evidence that lead exposure did not play a significant role in the loss of the Franklin expedition.
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