Attributions of Cancer ‘Alarm’ Symptoms in a Community Sample

BackgroundAttribution of early cancer symptoms to a non-serious cause may lead to longer diagnostic intervals. We investigated attributions of potential cancer ‘alarm’ and non-alarm symptoms experienced in everyday life in a community sample of adults, without mention of a cancer context.MethodsA questionnaire was mailed to 4858 adults (≥50 years old, no cancer diagnosis) through primary care, asking about symptom experiences in the past 3 months. The word cancer was not mentioned. Target ''alarm'' symptoms, publicised by Cancer Research UK, were embedded in a longer symptom list. For each symptom experienced, respondents were asked for their attribution (‘what do you think caused it''), concern about seriousness (‘not at all’ to ‘extremely’), and help-seeking (‘did you contact a doctor about it’: Yes/No).ResultsThe response rate was 35% (n = 1724). Over half the respondents (915/1724; 53%) had experienced an ‘alarm’ symptom, and 20 (2%) cited cancer as a possible cause. Cancer attributions were highest for ‘unexplained lump’; 7% (6/87). Cancer attributions were lowest for ‘unexplained weight loss’ (0/47). A higher proportion (375/1638; 23%) were concerned their symptom might be ‘serious’, ranging from 12% (13/112) for change in a mole to 41% (100/247) for unexplained pain. Just over half had contacted their doctor about their symptom (59%), although this varied by symptom. Alarm symptoms were appraised as more serious than non-alarm symptoms, and were more likely to trigger help-seeking.ConclusionsConsistent with retrospective reports from cancer patients, ‘alarm’ symptoms experienced in daily life were rarely attributed to cancer. These results have implications for understanding how people appraise and act on symptoms that could be early warning signs of cancer.     

'Asking the Right Question'. A Comparison of Two Approaches to Gathering Data on 'Herbals' Use in Survey Based Studies

Background

Over the last decade academic interest in the prevalence and nature of herbal medicines use by pregnant women has increased significantly. Such data are usually collected by means of an administered questionnaire survey, however a key methodological limitation using this approach is the need to clearly define the scope of ‘herbals’ to be investigated. The majority of published studies in this area neither define ‘herbals’ nor provide a detailed checklist naming specific ‘herbals’ and CAM modalities, which limits inter-study comparison, generalisability and the potential for meta-analyses. The aim of this study was to compare the self-reported use of herbs, herbal medicines and herbal products using two different approaches implemented in succession.

Methods

Cross-sectional questionnaire surveys of women attending for their mid-trimester scan or attending the postnatal unit following live birth at the Royal Aberdeen Maternity Hospital, North-East Scotland. The questionnaire utilised two approaches to collect data on ‘herbals’ use, a single closed yes/no answer to the question “have you used herbs, herbal medicines and herbal products in the last three months”; and a request to tick which of a list of 40 ‘herbals’ they had used in the same time period.

Results

A total of 889 responses were obtained of which 4.3% (38) answered ‘yes’ to herbal use via the closed question. However, using the checklist 39% (350) of respondents reported the use of one or more specific ‘herbals’ (p<0.0001). The 312 respondents who reported ‘no’ to ‘herbals’ use via the closed question but “yes” via the checklist consumed a total of 20 different ‘herbals’ (median 1, interquartile range 1–2, range 1–6).

Conclusions

This study demonstrates that the use of a single closed question asking about the use of ‘herbals’, as frequently reported in published studies, may not yield valid data resulting in a gross underestimation of actual use.     

Male dance moves that catch a woman's eye

Male movements serve as courtship signals in many animal species, and may honestly reflect the genotypic and/or phenotypic quality of the individual. Attractive human dance moves, particularly those of males, have been reported to show associations with measures of physical strength, prenatal androgenization and symmetry. Here we use advanced three-dimensional motion-capture technology to identify possible biomechanical differences between women''s perceptions of ‘good’ and ‘bad’ male dancers. Nineteen males were recorded using the ‘Vicon’ motion-capture system while dancing to a basic rhythm; controlled stimuli in the form of avatars were then created in the form of 15 s video clips, and rated by 39 females for dance quality. Initial analyses showed that 11 movement variables were significantly positively correlated with perceived dance quality. Linear regression subsequently revealed that three movement measures were key predictors of dance quality; these were variability and amplitude of movements of the neck and trunk, and speed of movements of the right knee. In summary, we have identified specific movements within men''s dance that influence women''s perceptions of dancing ability. We suggest that such movements may form honest signals of male quality in terms of health, vigour or strength, though this remains to be confirmed.     

The Relationship between Sleep-Wake Cycle and Cognitive Functioning in Young People with Affective Disorders

Although early-stage affective disorders are associated with both cognitive dysfunction and sleep-wake disruptions, relationships between these factors have not been specifically examined in young adults. Sleep and circadian rhythm disturbances in those with affective disorders are considerably heterogeneous, and may not relate to cognitive dysfunction in a simple linear fashion. This study aimed to characterise profiles of sleep and circadian disturbance in young people with affective disorders and examine associations between these profiles and cognitive performance. Actigraphy monitoring was completed in 152 young people (16–30 years; 66% female) with primary diagnoses of affective disorders, and 69 healthy controls (18–30 years; 57% female). Patients also underwent detailed neuropsychological assessment. Actigraphy data were processed to estimate both sleep and circadian parameters. Overall neuropsychological performance in patients was poor on tasks relating to mental flexibility and visual memory. Two hierarchical cluster analyses identified three distinct patient groups based on sleep variables and three based on circadian variables. Sleep clusters included a ‘long sleep’ cluster, a ‘disrupted sleep’ cluster, and a ‘delayed and disrupted sleep’ cluster. Circadian clusters included a ‘strong circadian’ cluster, a ‘weak circadian’ cluster, and a ‘delayed circadian’ cluster. Medication use differed between clusters. The ‘long sleep’ cluster displayed significantly worse visual memory performance compared to the ‘disrupted sleep’ cluster. No other cognitive functions differed between clusters. These results highlight the heterogeneity of sleep and circadian profiles in young people with affective disorders, and provide preliminary evidence in support of a relationship between sleep and visual memory, which may be mediated by use of antipsychotic medication. These findings have implications for the personalisation of treatments and improvement of functioning in young adults early in the course of affective illness.     

Unhealthy Days and Quality of Life in Irish Patients with Diabetes

Objectives

To study the determinants of health-related quality of life (HRQoL) in Irish patients with diabetes using the Centres for Disease Controls'' (CDC''s) ‘Unhealthy Days’ summary measure and to assesses the agreement between this generic HRQoL measure and the disease-specific Audit of Diabetes Dependant Quality of Life (ADDQoL) measure.

Research Design and Methods

Data were analysed from the Diabetes Quality of Life Study, a cross-sectional study of 1,456 people with diabetes in Ireland (71% response rate). Unhealthy days were assessed using the CDC''s ‘Unhealthy days’ summary measure. Quality of life (QoL) was also assessed using the ADDQoL measure. Analyses were conducted primarily using logistic regression. The agreement between the two QoL instruments was measured using the kappa co-efficient.

Results

Participants reported a median of 2 unhealthy days per month. In multivariate analyses, female gender (P = 0.001), insulin use (P = 0.030), diabetes complications (P = <0.001) were significantly associated with more unhealthy days. Older patients had fewer unhealthy days per month (P = 0.003). Agreement between the two measures of QoL (unhealthy days measure and ADDQoL) was poor, Kappa = 0.234

Conclusions

The findings highlight the determinants of HRQoL in patients with diabetes using a generic HRQoL summary measure. The ‘Unhealthy Days’ and the ADDQoL have poor agreement, therefore the ‘Unhealthy Days’ summary measure may be assessing a different construct. Nonetheless, this study demonstrates that the generic ‘Unhealthy Days’ summary measure can be used to detect determinants of HRQoL in patients with diabetes.     

Coverage and Quality of Antenatal Care Provided at Primary Health Care Facilities in the ‘Punjab’ Province of ‘Pakistan’

Background

Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In ‘Pakistan’ antenatal services to rural population are being provided through a network of primary health care facilities designated as ''Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to ‘Divisions’ and ‘Districts’. By population ‘Punjab’ is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in ‘Punjab’ province of ‘Pakistan’.

Methods

Quantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers.

Results

The overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage.

Conclusion

The coverage and quality of the antenatal care services in ‘Punjab’ are extremely compromised. Only half of the expected pregnancies are enrolled and out of those 1/3 drop out in follow-up visits.     

Power through ‘Us’: Leaders’ Use of We-Referencing Language Predicts Election Victory

Leaders have been observed to use distinct rhetorical strategies, but it is unclear to what extent such strategies are effective. To address this issue we analyzed the official election campaign speeches of successful and unsuccessful Prime Ministerial candidates in all 43 Australian Federal elections since independence from Britain in 1901 and measured candidates'' use of personal (‘I’, ‘me’) and collective pronouns (‘we’, ‘us’). Victors used more collective pronouns than their unsuccessful opponents in 80% of all elections. Across all elections, victors made 61% more references to ‘we’ and ‘us’ and used these once every 79 words (vs. every 136 words for losers). Extending social identity theorizing, this research suggests that electoral endorsement is associated with leaders'' capacity to engage with, and speak on behalf of, a collective identity that is shared with followers whose support and energies they seek to mobilize.     

What aspects of autism predispose to talent?

In this paper, we explore the question, why are striking special skills so much more common in autism spectrum conditions (ASC) than in other groups? Current cognitive accounts of ASC are briefly reviewed in relation to special skills. Difficulties in ‘theory of mind’ may contribute to originality in ASC, since individuals who do not automatically ‘read other minds’ may be better able to think outside prevailing fashions and popular theories. However, originality alone does not confer talent. Executive dysfunction has been suggested as the ‘releasing’ mechanism for special skills in ASC, but other groups with executive difficulties do not show raised incidence of talents. Detail-focused processing bias (‘weak coherence’, ‘enhanced perceptual functioning’) appears to be the most promising predisposing characteristic, or ‘starting engine’, for talent development. In support of this notion, we summarize data from a population-based twin study in which parents reported on their 8-year-olds'' talents and their ASC-like traits. Across the whole sample, ASC-like traits, and specifically ‘restricted and repetitive behaviours and interests’ related to detail focus, were more pronounced in children reported to have talents outstripping older children. We suggest that detail-focused cognitive style predisposes to talent in savant domains in, and beyond, autism spectrum disorders.     

Mating tactics determine patterns of condition dependence in a dimorphic horned beetle

The persistence of genetic variability in performance traits such as strength is surprising given the directional selection that such traits experience, which should cause the fixation of the best genetic variants. One possible explanation is ‘genic capture’ which is usually considered as a candidate mechanism for the maintenance of high genetic variability in sexual signalling traits. This states that if a trait is ‘condition dependent’, with expression being strongly influenced by the bearer''s overall viability, then genetic variability can be maintained via mutation-selection balance. Using a species of dimorphic beetle with males that gain matings either by fighting or by ‘sneaking’, we tested the prediction of strong condition dependence for strength, walking speed and testes mass. Strength was strongly condition dependent only in those beetles that fight for access to females. Walking speed, with less of an obvious selective advantage, showed no condition dependence, and testes mass was more condition dependent in sneaks, which engage in higher levels of sperm competition. Within a species, therefore, condition dependent expression varies between morphs, and corresponds to the specific selection pressures experienced by that morph. These results support genic capture as a general explanation for the maintenance of genetic variability in traits under directional selection.     

Child Allergic Symptoms and Well-Being at School: Findings from ALSPAC,a UK Cohort Study

Background

Eczema and asthma are common conditions in childhood that can influence children’s mental health. Despite this, little is known about how these conditions affect the well-being of children in school. This study examines whether symptoms of eczema or asthma are associated with poorer social and mental well-being in school as reported by children and their teachers at age 8 years.

Methods

Participants were from the Avon Longitudinal Study of Parents and Children. Measures of child well-being in school were child-reported (n = 6626) and teacher reported (n = 4366): children reported on their enjoyment of school and relationships with peers via a self-complete questionnaire; teachers reported child mental well-being using the Strengths and Difficulties Questionnaire [binary outcomes were high ‘internalizing’ (anxious/depressive) and ‘externalizing’ (oppositional/hyperactive) problems (high was >90th percentile)]. Child rash and wheeze status were maternally reported and symptoms categorised as: ‘none’; ‘early onset transient’ (infancy/preschool only); ‘persistent’ (infancy/preschool and at school age); and ‘late onset’ (school age only).

Results

Children with persistent (OR 1.29, 95% CI 1.02 to 1.63) and late onset (OR 1.48, 95% CI 1.02 to 2.14) rash were more likely to report being bullied, and children with persistent wheeze to feel left out (OR 1.42, 95% CI 1.10 to 1.84). Late onset rash was associated with high teacher-reported internalising behaviours (OR 1.61, 95% CI 1.02 to 2.54), and persistent rash with high externalising behaviours (OR 1.37, 95% CI 1.02 to 1.84). Child sleep and maternal mental health explained some of the associations with teacher-reported mental well-being.

Conclusion

Symptoms of eczema or asthma can adversely affect a child’s social and mental well-being at primary school. This suggests interventions, such as additional support or education of peers, should begin at early stages in schooling.     

Distributed Patterns of Event-Related Potentials Predict Subsequent Ratings of Abstract Stimulus Attributes

Exposure to pleasant and rewarding visual stimuli can bias people''s choices towards either immediate or delayed gratification. We hypothesised that this phenomenon might be based on carry-over effects from a fast, unconscious assessment of the abstract ‘time reference’ of a stimuli, i.e. how the stimulus relates to one''s personal understanding and connotation of time. Here we investigated whether participants'' post-experiment ratings of task-irrelevant, positive background visual stimuli for the dimensions ‘arousal’ (used as a control condition) and ‘time reference’ were related to differences in single-channel event-related potentials (ERPs) and whether they could be predicted from spatio-temporal patterns of ERPs. Participants performed a demanding foreground choice-reaction task while on each trial one task-irrelevant image (depicting objects, people and scenes) was presented in the background. Conventional ERP analyses as well as multivariate support vector regression (SVR) analyses were conducted to predict participants'' subsequent ratings. We found that only SVR allowed both ‘arousal’ and ‘time reference’ ratings to be predicted during the first 200 ms post-stimulus. This demonstrates an early, automatic semantic stimulus analysis, which might be related to the high relevance of ‘time reference’ to everyday decision-making and preference formation.     

Never Say No … How the Brain Interprets the Pregnant Pause in Conversation

In conversation, negative responses to invitations, requests, offers, and the like are more likely to occur with a delay–conversation analysts talk of them as dispreferred. Here we examine the contrastive cognitive load ‘yes’ and ‘no’ responses make, either when relatively fast (300 ms after question offset) or delayed (1000 ms). Participants heard short dialogues contrasting in speed and valence of response while having their EEG recorded. We found that a fast ‘no’ evokes an N400-effect relative to a fast ‘yes’; however, this contrast disappeared in the delayed responses. ''No'' responses, however, elicited a late frontal positivity both if they were fast and if they were delayed. We interpret these results as follows: a fast ‘no’ evoked an N400 because an immediate response is expected to be positive–this effect disappears as the response time lengthens because now in ordinary conversation the probability of a ‘no’ has increased. However, regardless of the latency of response, a ‘no’ response is associated with a late positivity, since a negative response is always dispreferred. Together these results show that negative responses to social actions exact a higher cognitive load, but especially when least expected, in immediate response.     

Placebo Use in the United Kingdom: Results from a National Survey of Primary Care Practitioners

Objectives

Surveys in various countries suggest 17% to 80% of doctors prescribe ‘placebos’ in routine practice, but prevalence of placebo use in UK primary care is unknown.

Methods

We administered a web-based questionnaire to a representative sample of UK general practitioners. Following surveys conducted in other countries we divided placebos into ‘pure’ and ‘impure’. ‘Impure’ placebos are interventions with clear efficacy for certain conditions but are prescribed for ailments where their efficacy is unknown, such as antibiotics for suspected viral infections. ‘Pure’ placebos are interventions such as sugar pills or saline injections without direct pharmacologically active ingredients for the condition being treated. We initiated the survey in April 2012. Two reminders were sent and electronic data collection closed after 4 weeks.

Results

We surveyed 1715 general practitioners and 783 (46%) completed our questionnaire. Our respondents were similar to those of all registered UK doctors suggesting our results are generalizable. 12% (95% CI 10 to 15) of respondents used pure placebos while 97% (95% CI 96 to 98) used impure placebos at least once in their career. 1% of respondents used pure placebos, and 77% (95% CI 74 to 79) used impure placebos at least once per week. Most (66% for pure, 84% for impure) respondents stated placebos were ethical in some circumstances.

Conclusion and implications

Placebo use is common in primary care but questions remain about their benefits, harms, costs, and whether they can be delivered ethically. Further research is required to investigate ethically acceptable and cost-effective placebo interventions.     

Species Adaptive Strategies and Leaf Economic Relationships across Serpentine and Non-Serpentine Habitats on Lesbos,Eastern Mediterranean

Shifts in species'' traits across contrasting environments have the potential to influence ecosystem functioning. Plant communities on unusually harsh soils may have unique responses to environmental change, through the mediating role of functional plant traits. We conducted a field study comparing eight functional leaf traits of seventeen common species located on both serpentine and non-serpentine environments on Lesbos Island, in the eastern Mediterranean. We focused on species'' adaptive strategies across the two contrasting environments and investigated the effect of trait variation on the robustness of core ‘leaf economic’ relationships across local environmental variability. Our results showed that the same species followed a conservative strategy on serpentine substrates and an exploitative strategy on non-serpentine ones, consistent with the leaf economic spectrum predictions. Although considerable species-specific trait variability emerged, the single-trait responses across contrasting environments were generally consistent. However, multivariate-trait responses were diverse. Finally, we found that the strength of relationships between core ‘leaf economic’ traits altered across local environmental variability. Our results highlight the divergent trait evolution on serpentine and non-serpentine communities and reinforce other findings presenting species-specific responses to environmental variation.     

Clarifying the relationship between body size and extinction risk in amphibians by complete mapping of model space

In vertebrates, large body size is often a key diagnostic feature of species threatened with extinction. However, in amphibians the link between body size and extinction risk is highly uncertain, with previous studies suggesting positive, negative, u-shaped, or no relationship. Part of the reason for this uncertainty is ‘researcher degrees of freedom’: the subjectivity and selectivity in choices associated with specifying and fitting models. Here, I clarify the size–threat association in amphibians using Specification Curve Analysis, an analytical approach from the social sciences that attempts to minimize this problem by complete mapping of model space. I find strong support for prevailing negative associations between body size and threat status, the opposite of patterns typical in other vertebrates. This pattern is largely explained by smaller species having smaller geographic ranges, but smaller amphibian species also appear to lack some of the life-history advantages (e.g. higher reproductive output) that are often assumed to ‘protect’ small species in other taxa. These results highlight the need for a renewed conservation focus on the smallest species of the world''s most threatened class of vertebrates, as aquatic habitats become increasingly degraded by human activity.     

Relationship of Self-Rated Health with Fatal and Non-Fatal Outcomes in Cardiovascular Disease: A Systematic Review and Meta-Analysis

Background

People who rate their health as poor experience higher all-cause mortality. Study of disease-specific association with self-rated health might increase understanding of why this association exists.

Objectives

To estimate the strength of association between self-rated health and fatal and non-fatal cardiovascular disease.

Methods

A comprehensive search of PubMed MEDLINE, EMBASE, CINAHL, BIOSIS, PsycINFO, DARE, Cochrane Library, and Web of Science was undertaken during June 2013. Two reviewers independently searched databases and selected studies. Inclusion criteria were prospective cohort studies or cohort analyses of randomised trials with baseline measurement of self-rated health with fatal or non-fatal cardiovascular outcomes. 20 studies were pooled quantitatively in different meta-analyses. Study quality was assessed using Newcastle-Ottawa scales.

Results

‘Poor’ relative to ‘excellent’ self-rated health (defined by most extreme categories in each study, most often’ poor’ or ‘very poor’ and ‘excellent’ or ‘good’) was associated over a follow-up of 2.3–23 years with cardiovascular mortality in studies: where varying degrees of adjustments had been made for cardiovascular disease risk (HR 1.79 (95% CI 1.50 to 2.14); 15 studies, I2 = 71.24%), and in studies reporting outcomes in people with pre-existing cardiovascular disease or ischaemic heart disease symptoms (HR 2.42 (95% CI 1.32 to 4.44); 3 studies; I2 = 71.83%). ‘Poor’ relative to ‘excellent’ self rated health was also associated with the combined outcome of fatal and non-fatal cardiovascular events (HR 1.90 (95% CI 1.26 to 2.87); 5 studies; I² = 68.61%), Self-rated health was not significantly associated with non-fatal cardiovascular disease outcomes (HR 1.66 (95% CI 0.96 to 2.87); 5 studies; I2 = 83.60%).

Conclusions

Poor self rated health is associated with cardiovascular mortality in populations with and without prior cardiovascular disease. Those with current poor self-rated health may warrant additional input from health services to identify and address reasons for their low subjective health.