Trainee health care professionals' knowledge of the health risks associated with obesity.

BACKGROUND: Trainee nurses, doctors and dietitians will direct the future of obesity treatment and prevention. To do so effectively, they must have sufficient knowledge regarding the health risks associated with obesity and feel that part of their professional role is to counsel obese patients regarding these risks. METHODS: An online survey collected data on professional roles, training needs and the Obesity Risk Knowledge-10 (ORK-10) scale from 38 dietetic, 88 nursing (Diploma), 74 nursing (Masters) and 389 medical students. RESULTS: Final-year dietetic students demonstrated higher ORK-10 scale scores than final-year nursing (Dip), nursing (MSc) and medical students (P < 0.001). The majority of students agreed that part of their profession's role was to counsel obese patients about the health risks associated with obesity. Dietetic students were more satisfied with the teaching they had received than each of the other student groups (P < 0.05). CONCLUSION: Future health care professionals recognize their responsibility to communicate health risk information to obese patients. Dietetic students have a sound knowledge base to support them in this. Educators of trainee nurses and doctors may like to respond to their students' lower levels of knowledge and desire for more training.

Impact of a multiple, IVF birth on post-partum mental health: a composite analysis.

BACKGROUND: This study explored the impact of a multiple IVF birth on maternal mental health in the early post-partum period. METHODS: A prospective study of 207 women who had conceived following IVF treatment and followed up at 6 weeks post-partum. Mothers rated their mood using the Edinburgh postnatal depression scale (EPDS) and their baby's behaviour using the Unsettled and Irregular Behaviour scale. Mothers' emotional well-being was explored using theme analysis of semi-structured telephone interviews. RESULTS: Of the 175 (84.5%) followed up post-partum, 56 (32%) had a multiple birth (7 triplets, 49 twins). Nearly 16% of mothers in the multiple group scored>12 on the EPDS indicating clinically significant symptoms, which represented a 3-fold increased risk compared to mothers of singletons (Odds ratio=3.4, Confidence Interval=1.011-11.618, P=0.048). Unsettled and irregular infant behaviour was another independent risk factor. Qualitative analysis of interviews identified 12 themes. Mothers of multiples were more likely to express negative themes including 'tiredness' (P<0.01), 'feelings of stress/depression' (P<0.05) and 'questioning parenthood' (P<0.05). Mothers of singletons were more likely to be 'feeling wonderful', reflecting their delight in parenthood (P<0.05). CONCLUSIONS: Mothers of multiples are at increased risk of poorer emotional well-being. Clinicians should focus on the psychological benefits of a singleton birth.

Quality of life in patients with chronic anal fissure.

OBJECTIVE: Little is known about the quality of life in patients with the distressing symptoms of chronic anal fissure. This was a prospective study assessing the physical and mental health of fissure patients before and after topical treatment. PATIENTS AND METHODS: New patients attending the fissure clinic were recruited prospectively into the study over a 2-month period. On first appointment, patients were given 2 questionnaires to complete: the Short-Form 36 Health Survey (SF-36) and a general questionnaire recording patients' demographic details, previous treatment, site and duration of fissure and symptoms on a visual analogue scale (VAS). Following an 8-week course of topical treatment, patients repeated the SF-36 and symptoms were again recorded on a VAS. Healing of fissure was noted. RESULTS: Fifty-four patients entered the study, of which 39 returned for follow-up; 16 male, 23 female; mean age 38.6 years (range 17-80 years). Median duration of fissure was 6 months (3 months - 10 years). Higher VAS ratings for fissure pain were associated with worse scores for all aspects of health-related quality of life, including mental health (P < 0.001), bodily pain (P < 0.001), vitality (P < 0.006) and social functioning (P < 0.001). Compared to age and gender matched norms for the SF-36, fissure patients had more bodily pain (P < 0.001, Wilcoxon) and poorer health perceptions (P < 0.02, Wilcoxon). Gender did not affect any of the SF-36 subscales. However, females did report significantly more bleeding (P = 0.05). On follow-up, healing was complete in 27 patients (69%). Symptoms of pain, bleeding and irritation were all significantly reduced in this group. Repeating the SF-36 showed an improvement in bodily pain, role-physical functioning and vitality (P < 0.05). CONCLUSION: Successful nonsurgical treatment of chronic anal fissure leads to symptomatic improvement and beneficially affects health-related quality of life.

Evaluating first-year medical students' attitudes to learning communication skills before and after a communication skills course.

This longitudinal study explores 216 medical students' attitudes towards communication skills learning before (TI) and at the end (72) of their first-year communication skills course. They completed the Communication Skills Attitude Scale and a personal details questionnaire satisfactorily at Ti and T2. Univariate statistics established whether attitudes differed between TI and T2 for the whole sample and for the sample split by demographic and education-related characteristics. Students rated their communication skills slightly but significantly lower at the end of their communication skills course than before the start of the course. Positive attitudes towards communication skills learning became significantly lower by the end of the course compared with the start. Repeated measures ANOVAs indicated that significant two-way interactions existed between attitudes at TI and T2 and the demographic characteristics: gender, language and ethnicity. These findings are discussed in the paper, along with their implications for educational practice and further research.

Patient information leaflets for prostate cancer: which leaflets should healthcare professionals recommend?

This study evaluated 31 patient information leaflets (PILs) discussing treatment options for prostate cancer. In stage one, the authors evaluated the leaflets' quality, readability and suitability using objective measures: the DISCERN instrument; Flesch formula; and the Suitability Assessment of Materials (SAM) instrument, respectively. Although the leaflets varied in terms of their scores on each measure, it was possible to identify the best five leaflets across the three conditions. In stage two, eight men with prostate cancer took part in a focus group discussion or individual interview to outline their views regarding a number of leaflets, including the best five booklets or leaflets identified in stage one of the study. The interviews were audiotaped and analysed using a template analysis. Patients were able to discriminate between the best five leaflets or booklets and identify their preferred booklets. These were the booklets: "Understanding cancer of the prostate" by CancerBACUP, "Prostate cancer: everything you need to know" by the Prostate Cancer Charity and "The treatment of prostate cancer. Questions and answers" by the Covent Garden Cancer Research Trust. On the basis of their high ratings for the objective measures and patients' views, healthcare professionals are advised to recommend these three booklets to men with prostate cancer who want written information about the disease. However, randomised controlled trials are needed to examine the impact of these booklets on the psychosocial outcomes of men with prostate cancer.

Challenging behaviour and insecure attachment.

BACKGROUND: The present authors investigated a database about people with severe intellectual disability (ID) to explore whether secure/insecure attachment plays a role in challenging behaviour. METHODS: The study took the form of a survey of staff and carers involved with a cohort of 54 school-leavers with severe ID. RESULTS: Thirty-four per cent of students were rated by placement staff as 'over-investing in one or a few relationships which become a source of jealousy'. Students without such problems were significantly less likely to show challenging behaviours, while those with them were significantly more likely to be living outside the family home. CONCLUSIONS: These preliminary results justify more detailed and longitudinal research into the relationship between attachment status and challenging behaviour.

A qualitative study to explore undergraduate medical students' attitudes towards communication skills learning.

This qualitative study explores medical students' attitudes towards communication skills learning. Thirty-two medical students, including representatives from each year of the medical degree, participated in five focus-group discussions. Theme analysis of each transcript by two independent analysts produced two attitude-related themes: positive attitudes towards communication skills and negative attitudes towards learning communication skills. Students held both positive and negative attitudes towards different aspects of communication skills learning. Students' negative attitudes were related to communication skills being a subjective social science, which was viewed as 'non-academic' and 'common sense'. Students with negative attitudes towards communication skills learning were thought to be good communicators. Some reported being socialized into developing the negative attitudes held by older students and qualified doctors. The timing of communication skills learning was also thought to be important in determining attitudes. The findings within each of these themes and their educational implications are discussed in this paper.

Bullying and people with severe intellectual disability.

Although bullying has been shown to reduce quality of life in many spheres, anti-bullying strategies have yet to be incorporated into services for adults with severe intellectual disability (ID). The present study employed a survey of staff and parent concerns about 54 previously surveyed students who had left a school for pupils with severe ID. A content analysis of follow-up interviews was performed in 10 cases. Staff identified 19% of the survey sample as bullying others and 11% as being picked on. Neither gender nor communication ability had an impact. There was no significant change in bully or victim status over time, although some people did change. Parents or staff raised bully/victim problems in more than half of the interviews. There is sufficient evidence of bullying behaviour to warrant the adoption of anti-bullying strategies.

Severe intellectual disability and transition to adulthood.

Institutional and psychological aspects of transition were explored with parents and staff involved with five young adults with severe intellectual disability whose challenging behaviour diminished after they made the transition, and five whose challenging behaviour remained high. They were selected from a previously surveyed cohort. Grounded theory analysis of interviews suggested little connection between the perspectives of parents and staff. The impact these differences have on communication about challenging behaviour was explored, and recommendations for service changes are made.

Parental information needs in chronic renal failure and diabetes mellitus.

UNLABELLED: The information needs of parents of children with end stage renal failure (ESRF) or with insulin dependent diabetes mellitus (IDDM) were assessed by questionnaires over a 2-year period. Questionnaires were posted on seven occasions at 4-monthly intervals and were sent to both mothers and fathers. Most information needs were reported to be for detailed test results, for new information about the condition and about the child's future social development. Questions responsible for the three highest scores were concerned with the future: the child's fertility; their social, career and marriage prospects; and the hope for a new improved treatment. For the IDDM mothers, scores were significantly different depending on age of the child (P = 0.02). Change in treatment mode had no significant effect on the information needs of parents of children with ESRF (P = 0.81). Occupation was significantly associated with the mean general information needs scores for parents, with occupations of a lower socioeconomic status associated with higher information needs scores. There were no significant differences between the reported mean general information needs scores of parents of children with ESRF and of parents of children with IDDM (P = 0.69) or between mothers and fathers mean general information needs scores (P = 0.58). CONCLUSION: Multidisciplinary team members need to tailor information to the needs of the individual families and be sensitive to socioeconomic factors and communication issues.

Stimulation of colorectal cancer cell line growth by ET-1 and its inhibition by ET(A) antagonists.

BACKGROUND: The vasoactive peptide endothelin 1 (ET-1) acts via two receptors, endothelin receptors A (ET(A)) and B (ET(B)). ET-1 is overexpressed by human cancers in vivo and in vitro and may be mitogenic for cancer cells. METHOD: To elucidate if ET-1 is a growth regulator the following were investigated in human colorectal cancer cell lines (LIM1215 and HT29): ET-1 production by ELISA; ET receptor expression using radioligand autoradiographic techniques; and responsiveness to ET-1, and to ET(A) and ET(B) antagonism by growth measurements. RESULTS: ET-1 was produced by LIM1215 and HT29 cells (21.3 and 41.7 fmol/ml/10(6) cells (24 hours); 22.6 and 71.7 fmol/ml/10(6) cells (48 hours), respectively). ET(A) and ET(B) receptors were expressed by both cell lines. Addition of ET-1 resulted in a dose dependent increase in cell numbers which was significant at 10(-8)-10(-9) M for LIM1215, with the greatest increase at 10(-8) M (32.7% and 28.4% increase above controls at 48 hours and 72 hours; p<0.05) and at 10(-8)-10(-9) M for HT29, with the greatest increase at 10(-9) M (13.4% and 15.7% increase above controls at 48 hours and 72 hours; p<0.05). ET(A) antagonists BQ123 and BQ610, but not the ET(B) antagonist BQ788, inhibited ET-1 induced proliferation of both LIM1215 and HT29 (p<0.05). CONCLUSION: ET-1 can stimulate the proliferation of colorectal cancer cell lines via the ET(A), but not the ET(B), receptor.

Impact of facial paralysis on patients with acoustic neuroma.

OBJECTIVE: To assess the psychological distress, the ways of coping with that stress, and the self-esteem of patients with facial paralysis after acoustic neuroma surgery. Possible predictors and associations between these measures were also explored. STUDY DESIGN: Four validated questionnaires were completed by patients with facial paralysis after acoustic neuroma surgery: 1) the Derriford Appearance Scale (DAS) to measure psychological distress, 2) the COPE questionnaire to measure how patients cope with facial paralysis, 3) the Personal Report questionnaire to measure the self-esteem of patients, and 4) the Facial Paralysis Questionnaire (FPQ) to measure the severity of facial paralysis. PATIENTS: One hundred three patients with facial paralysis after surgical removal of acoustic tumors. RESULTS: Distress spanned a wide range in these patients. There was no statistically significant association between the level of distress and the grade of facial paralysis or between time since operation and levels of distress. Women had higher levels of distress (P = .02) and a significant negative correlation was found between levels of distress and age (r = -0.28, P = .005). High levels of distress were associated with low levels of self-esteem, as shown by the significant negative correlation between level of distress and self-esteem (r = -0.59, P = .01). A significant correlation between distress and maladaptive coping (r = 0.31, P = .002) was also found. Stepwise multiple regression of the distress scores revealed that self-esteem was the most important contributing factor (standardized coefficient beta -0.60, P = .0001), followed by age (beta -0.24, P = .006) and sex (beta -0.21, P = .04). This model explained 44% of the distress variance. CONCLUSION: Clinicians must be aware of the distress felt by some patients experiencing facial palsy after acoustic neuroma surgery and that the level of distress may not be related to the clinical grade of the facial nerve paralysis. People with low self-esteem, young people, and women suffer from more distress due to the facial palsy. Clinicians should thoroughly counsel patients before and after surgery and should implement measures that increase patients' self-esteem and decrease their distress, especially in these high-risk groups.

A comparison of patients requiring orthognathic treatment who subsequently refused or accepted surgery.

Forty-four patients who required combined orthodontic-surgical procedures were psychologically assessed in relation to stress, self-esteem, introspectiveness, and body satisfaction. Thirty patients accepted the surgical procedures, and 14 refused surgery. These two groups of patients were compared with respect to their psychologic profiles; statistical analysis detected no significant differences.

A comparison of 20 or 40 mg per day of carbimazole in the initial treatment of hyperthyroidism.

OBJECTIVE: The optimal dosage regimen for carbimazole (CBZ) in the treatment of hyperthyroidism remains uncertain, despite clinical use of the drug for approximately fifty years. We have compared the early clinical and biochemical responses to 20 or 40 mg/day of CBZ given as initial treatment for hyperthyroidism. DESIGN: Prospective open multicentre trial. PATIENTS: Sixty-three patients presenting with hyperthyroidism. MEASUREMENTS: Serum total and free thyroid hormones, serum TSH and SHBG were measured at baseline and at 4 and 10 weeks after start of therapy. Weight, pulse and a symptom questionnaire were also monitored at 6 and 12 weeks. RESULTS: Patients randomized to a starting dose of 40 mg/day CBZ had lower total (98 +/- 10 vs 158 +/- 11 nmol/l, P < 0.001) and free T4 (19.4 +/- 2.6 vs 35.2 +/- 3.7 pmol/l, P < 0.001) and total (2.6 +/- 0.3 vs 4.3 +/- 0.4 nmol/l, P < 0.001) and free T3 (8.3 +/- 1.0 vs 13.7 +/- 1.2 pmol/l, P < 0.01) at 4 weeks than those receiving 20 mg/day. Clinical responses at 6 and 12 weeks (weight, pulse, symptom score) and SHBG concentrations were similar. Drug-related hypothyroidism was less likely to occur at 4 and 10 weeks in those patient who initially received 20 mg CBZ/day, but this dose was less effective at controlling hyperthyroidism in those with more severe hyperthyroidism with baseline TT4 > 260 nmol/l. CONCLUSIONS: In treating hyperthyroidism, 20 mg/day carbimazole is effective, convenient and has a lower risk than 40 mg/day of iatrogenic hypothyroidism in patients with mild or moderate hyperthyroidism. Higher doses are required for those with severe hyperthyroidism.

A prospective study of the psychological effects of rhinoplasty.

Fifty-three consecutive patients referred for rhinoplasty within the National Health Service by their General Practitioner were evaluated prospectively to determine the psychological impact of this procedure. The patients were independently assessed before surgery, and then 1 week and 4 months after the surgery using the Derogatis Stress Profile, a Self-Esteem Inventory, an Introspectiveness Inventory and a range of questions relating to their expectations of the surgery. Photographs were taken at their initial visit and at 4 months after surgery. These were rated at random order by 28 independent lay people. Pre-operatively, the surgeon also documented his objectives and later assessed how well he had achieved them. Surgical intervention had strong effects in improving self-esteem ratings. These effects became more marked from the first post-operative assessment to those at four months making it likely that this is a real effect of surgery.

Neuroanatomical bases of electrodermal hypo-responding: a cluster analytic study.

Schizophrenics and other psychiatric patients have been found to have a high incidence of electrodermal hypo-responding. Different neural mechanisms may underlie hypo-responding in these groups. The present study utilized cluster analysis of magnetic resonance imaging (MRI) and electrodermal orienting data to examine the neuroanatomical correlates of electrodermal hypo-responding in 15 schizophrenics, 15 psychiatric controls (predominately affective disorders), and 15 normal controls. The number of electrodermal responses was recorded during a standard orienting paradigm. MRI scans were obtained, yielding area measures for the pre-frontal cortex and lateral ventricle-brain ratios (VBRs). The number of electrodermal orienting responses and the MRI measures were transformed into zeta-scores and entered into an agglomerative hierarchical cluster analysis, which yielded three clusters. A 3 x 3 Chi-square analysis revealed that the three clusters significantly differed according to diagnostic group. Analyses of variance (ANOVAs) revealed that the first two clusters had significantly fewer electrodermal orienting responses than the third cluster (predominately normals). Further, the first cluster (predominately schizophrenics) had significantly smaller frontal lobes than the other two clusters. Additionally, the three normals in the first cluster had relatively high levels of schizotypy. The second cluster (predominately affective disorders) had significantly larger VBRs than the other two clusters. Schizophrenics in the three clusters differed with respect to gender composition and positive symptoms. Thus, diminished pre-frontal area may underlie electrodermal hypo-responding in a subgroup of schizophrenics and schizotypals, while enlarged ventricles may underlie the same phenomenon in the affective disorders and another subgroup of schizophrenics.

A prospective study of factors associated with delayed discharge in school-aged children undergoing ward-based minor surgery.

This study found a high rate of post-operative overnight stay in a group of 93 children aged between 5 and 12 years admitted to a paediatric ward for day-case procedures. Those children detained were older, had had later operations, were more worried pre-operatively and had been less happy about going to school than were children discharged on the day of surgery. Social factors, maternal worries and pre-medication also predicted delayed discharge. At a follow-up there were no differences between the day-case and in-patient groups in terms of children's psychological outcome but difficulties associated with ward-based day-case surgery were highlighted.

Lamellar keratoplasty with lyophilized tissue for treatment of corneal scarring.

BACKGROUND: A pilot study was carried out in Pakistan to assess the feasibility of the use of lathed freeze-dried corneal tissue in the treatment of corneal scarring. METHOD: Six eyes underwent lamellar keratoplasty and were followed up for 18 months. RESULTS: Visual improvement was obtained in every eye. In one eye, the procedure was complicated by delayed epithelialization of the graft, but in the remaining five patients, the grafts epithelialized rapidly. CONCLUSIONS: The use of freeze-dried donor tissue simplifies storage and distribution of corneas and may offer the best hope of treatment in developing countries for patients with corneal scarring.

Deep lamellar keratoplasty on air with lyophilised tissue.

Deep lamellar keratoplasty on air involves injecting air into the corneal stroma to expand it to several times its normal thickness. This method is designed to facilitate dissection of the deep stroma and reduce the risk of perforation of Descemet's membrane when carrying out deep lamellar keratoplasty. We have modified the technique by using prelathed freeze-dried donor tissue and report our results in a series of patients with corneal stromal scarring owing to a variety of corneal problems, namely, keratoconus, pterygium, and herpes zoster ophthalmicus. All patients achieved best corrected postoperative visual acuity of 6/12 or better without problems associated with graft failure or rejection. Histopathological examination of corneal tissue following air injection showed surgical emphysema within the cornea and separation of deep stromal fibres from the underlying Descemet's membrane.