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1.
J Postgrad Med ; 70(1): 36-42, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38197593

RESUMO

INTRODUCTION: Sleep apnea (SA) is an important comorbidity in end-stage renal disease (ESRD) patients. The association between SA and cardiac and neurological disease is known. This study investigates the relationship between SA and cardiovascular and cerebrovascular outcomes in the ESRD population. METHODS: In a retrospective cohort study, the United States Renal Data System was queried to identify ESRD patients aged 18-100 years in whom hemodialysis had been initiated between 2005 and 2013. Diagnoses of SA and clinical comorbidities were determined from International Classification of Disease-9 codes. Demographic variables were obtained from Centers for Medicare and Medicaid Services Form-2728. Logistic regression was used to examine the association of SA with myocardial infarction (MI) or with stroke, controlling for demographic and clinical variables. RESULTS: Of 858,131 subjects meeting the inclusion criteria, 587 had central SA, and 22,724 had obstructive SA. The SA cohort was younger, more likely to be male and Caucasian compared to the non-SA cohort. Patients with SA also had more tobacco and alcohol use, hypertension, heart failure, and diabetes. Central SA (aRR = 1.69, 95% CI = 1.28-2.23) and obstructive SA (aRR = 1.15, 95% CI = 1.09-1.21) were associated with an increased risk of stroke but not MI. CONCLUSION: In the ESRD population, a diagnosis of central SA or obstructive SA increased the risk of stroke, but not MI. Early identification and treatment of SA in the ESRD population may help reduce the risk of stroke in these patients.


Assuntos
Falência Renal Crônica , Infarto do Miocárdio , Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Acidente Vascular Cerebral , Humanos , Masculino , Idoso , Estados Unidos/epidemiologia , Feminino , Estudos Retrospectivos , Fatores de Risco , Medicare , Falência Renal Crônica/complicações , Falência Renal Crônica/epidemiologia , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia
2.
J Endocrinol Invest ; 46(10): 2125-2132, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37012521

RESUMO

PURPOSE: Hashimoto's thyroiditis (HT) is a common autoimmune thyroid disorder that can disrupt thyroid function and homeostasis. As HT results from a dysregulated immune system, we hypothesized that these patients might be more susceptible to transplant failure; however, literature on this association is limited. The purpose of this study is to examine the association of HT with the risk of renal transplant failure. METHODS: We utilized the United States Renal Database System dataset collected from 2005 to 2014 and compared the time from first renal transplant to transplant failure in end-stage renal disease (ESRD) patients with a HT diagnosis to ESRD patients without a HT diagnosis that underwent renal transplant. RESULTS: A total of 144 ESRD patients had International Classification of Disease-9 claim codes for HT prior to renal transplant, amongst a total cohort of 90,301 renal transplant patients aged 18-100 and meeting criteria. Patients with HT were significantly more likely to be female, white, and to have a diagnosis of cytomegalovirus compared to patients without. ESRD patients with a HT diagnosis that underwent renal transplant had a significantly increased risk of renal transplant failure compared to those ESRD renal transplant patients without an HT diagnosis. There was a significantly increased adjusted hazard ratio for graft failure in patients with a HT diagnosis compared to those without. CONCLUSION: Thyroid health and HT may play a significant role in the development of the increased risk of renal transplant failure observed in this study. Additional studies are needed to investigate the underlying mechanisms for this association.


Assuntos
Doença de Hashimoto , Nefropatias , Falência Renal Crônica , Transplante de Rim , Humanos , Feminino , Masculino , Transplante de Rim/efeitos adversos , Doença de Hashimoto/complicações , Falência Renal Crônica/etiologia , Falência Renal Crônica/cirurgia
3.
BMC Med Educ ; 23(1): 763, 2023 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-37828457

RESUMO

BACKGROUND: Replenishing the physician-scientist workforce constitutes a central mission of medical education, but the loss of qualified trainees to non-academic positions remains an ongoing threat. Among the barriers facing physician-scientists today is the game-like model of U.S. medical residency matching through the National Research Matching Program (NRPM), which applies several assumptions regarding the comparability of applicant qualifications, cohort size, and the institutional breadth of applicants' training needs. METHODS: The current report therefore summarizes the survey-based views and experiences of physician-scientist trainees obtained following the 2021-2022 application cycle for research-oriented residency programs, or physician-scientist training programs (PSTPs). From among this small cohort of applicants, we obtained survey-based feedback of 27 PSTP applicants across 17 U.S. medical universities, among whom 85% (23/27) matched into a PSTP. RESULTS: Among these PSTP applicants, 25/27 (93%) recognized "scientific community" as the most important feature of a postgraduate training program, with applicants identifying as female placing a higher value on the program's infrastructure of personal and/or family support. Most (18/27) respondents found "waiting for interviews" as the most stressful phase of their application cycle, and roughly half of all respondents encountered at least one NRMP policy violation through post-interview communication. Specifically, 93% (25/27) respondents were contacted by at least one PSTP following interviews, and 1/3 of them admitted to feeling pressured into sharing their ranking preferences. CONCLUSION: We highlight many previously unrecognized priorities among applicants to PSTPs, which include fostering community among its trainees and reinforcing structured mentoring. We uncover an inconsistency among PSTPs regarding the post-interview process, which represents an opportunity to better support applicants seeking to gauge programs according to their clinical, scientific, and academic interests as physician-scientists, while still adhering to NRMP policies.


Assuntos
Educação Médica , Internato e Residência , Médicos , Humanos , Feminino , Educação de Pós-Graduação , Emoções , Inquéritos e Questionários
4.
BJOG ; 128(4): 745-754, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32783300

RESUMO

OBJECTIVE: To assess psychosexual distress over a 12-month period among women receiving different human papillomavirus (HPV) and cytology results in the context of the English HPV primary screening pilot. DESIGN: Longitudinal, between-group study. SETTING: Five sites in England where primary HPV testing was piloted. POPULATION: Women aged 24-65 years (n = 1133) who had taken part in the NHS Cervical Screening Programme. METHODS: Women were sent a postal questionnaire soon after receiving their screening results (baseline) and 6 and 12 months later. Data were analysed using linear regression models to compare psychosexual outcomes between groups receiving six possible combinations of HPV and cytology screening results, including a control group with normal cytology and no HPV test. MAIN OUTCOME MEASURES: Psychosexual distress, assessed using six items from the Psychosocial Effects of Abnormal Pap Smears Questionnaire (PEAPS-Q). RESULTS: At all time points, there was an association between screening result group and psychosexual distress (all P < 0.001). At baseline, mean psychosexual distress score (possible range: 1-5) was significantly higher among women with HPV and normal cytology (B = 1.15, 95% CI 0.96-1.34), HPV and abnormal cytology (B = 1.02, 95% CI: 0.78-1.27) and persistent HPV (B = 0.90, 95% CI 0.70-1.10) compared with the control group (all P < 0.001). At the 6 and 12 month follow ups the pattern of results were similar, but coefficients were smaller. CONCLUSIONS: Our findings suggest receiving an HPV-positive result can cause psychosexual distress, particularly in the short-term. Developing interventions to minimise the psychosexual burden of testing HPV-positive will be essential to avoid unnecessary harm to the millions of women taking part in cervical screening. TWEETABLE ABSTRACT: Receiving an HPV-positive result following primary HPV testing can cause psychosexual distress, particularly in the short-term.


Assuntos
Detecção Precoce de Câncer/psicologia , Infecções por Papillomavirus/diagnóstico , Saúde Sexual , Estresse Psicológico/etiologia , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/psicologia , Adulto , Idoso , Estudos de Casos e Controles , Detecção Precoce de Câncer/efeitos adversos , Detecção Precoce de Câncer/métodos , Feminino , Seguimentos , Pesquisas sobre Atenção à Saúde , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/psicologia , Estresse Psicológico/diagnóstico , Estresse Psicológico/epidemiologia , Neoplasias do Colo do Útero/psicologia , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal/efeitos adversos
5.
Radiologia ; 63(6): 495-504, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-35368367

RESUMO

Objective: Initial COVID-19 reports described a variety of clinical presentations, but lower respiratory abnormalities are most common and chest CT findings differ between adult and pediatric patients. We aim to summarize early CT findings to inform healthcare providers on the frequency of COVID-19 manifestations specific to adult or pediatric patients, and to determine if the sensitivity of CT justifies its use in these populations. Methods: PubMed was searched for the presence of the words "CT, imaging, COVID-19" in the title or abstract, and 17 large-scale PubMed and/or Scopus studies and case reports published between January 1, 2020 and April 15, 2020 were selected for data synthesis. Results: Initial CT scans identified ground-glass opacities and bilateral abnormalities as more frequent in adults (74%, n = 698, and 89%, n = 378, respectively) than children (60%, n = 25, and 37%, n = 46). At 14+ days, CT scans evidenced varied degrees of improvement in adults but no resolution until at least 26 days after the onset of flu-like symptoms. In pediatric patients, a third (n = 9) showed additional small nodular GGOs limited to a single lobe 3-5 days after an initial CT scan. Conclusión: Early adult CT findings suggest the limited use of CT as a supplemental tool in diagnosing COVID-19 in symptomatic adult patients, with a particular focus on identifying right and left lower lobe abnormalities, GGOs, and interlobular septal thickening. Early pediatric CT findings suggest against the use of CT if RT-PCR is available given its significantly lower sensitivity in this population and radiation exposure.

6.
Tech Coloproctol ; 24(10): 991-1000, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32623536

RESUMO

BACKGROUND: The difficulty of performing total mesorectal excision (TME) for rectal cancer partly relies on the surgeon's subjective assessment of the individual patient's pelvic anatomy and tumour characteristics, which generally influences the choice of platform used (open, laparoscopic, robotic or trans-anal surgery). Recent studies have found associations between several anatomical pelvic measurements and surgical difficulty. The aim of this study was to systematically review existing data reporting the use of magnetic resonance imaging (MRI)-based pelvic measurements to predict technical difficulty and outcomes of TME, and determine whether pelvimetry could optimise patient-specific selection of a particular surgical approach. METHODS: MEDLINE, Embase and Cochrane Library databases were systematically searched for studies reporting MRI-based pelvic measurements in patients undergoing surgery for rectal cancer, and the effect of these measurements on surgical difficulty. RESULTS: Eleven studies reporting the association between MRI-pelvimetry measurements and rectal cancer surgical outcomes were included. Indicators for surgical difficulty used in the included studies were involved circumferential resection margin, longer operative time, incomplete TME, higher blood loss, anastomotic leak, conversion to open surgery and overall complications. Bony pelvic measurements which were associated with increased surgical difficulty in more than one study were a smaller interspinous distance, a smaller intertubercle distance, a smaller pelvic inlet and larger pubic tubercle height. Two studies identified larger mesorectal fat area as a predictor of surgical difficulty. CONCLUSIONS: Bony pelvic measurements may predict surgical difficulty during TME, however, use of different indicators of difficulty limit comparison between studies. Early data suggest MRI soft tissue measurements may predict surgical difficulty and warrants further investigation.


Assuntos
Laparoscopia , Neoplasias Retais , Feminino , Humanos , Imageamento por Ressonância Magnética , Pelvimetria , Pelve , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/cirurgia , Resultado do Tratamento
7.
Lupus ; 27(1): 17-24, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28530467

RESUMO

Background The incidence of end stage renal disease (ESRD) in patients with systemic lupus erythematosus (SLE) is rising. However, the relationship between osteoporotic fractures and SLE in the setting of ESRD remains uninvestigated. The purpose of this study was to compare the frequency of incident osteoporotic fractures in patients with ESRD with and without SLE, to identify risk factors for fractures in patients with SLE and ESRD, and to examine the contribution of these fractures to mortality. Methods Retrospective cohort study of patients with SLE ( n = 716) and a 5% random sample of controls without SLE ( n = 4176) in the United States Renal Data System (USRDS) from years 2006-2008 enrolled in Medicare Part D. Results Fractures occurred in 10.6% ( n = 76) of patients with SLE and ESRD and 12.1% ( n = 507) of patients with ESRD without SLE ( p = 0.24). Older age (adjusted relative risk 1.02, 95% confidence interval 1.01-1.04) was associated with an increased risk for fracture in patients with SLE and ESRD. In multivariable analyses, vertebral and hip fractures more than doubled the risk for mortality. Conclusions The frequency of osteoporotic fractures in patients with SLE and ESRD is similar to the general population of patients with ESRD. Vertebral and hip fractures are significant contributors to mortality in patients with SLE and ESRD. Fracture prevention, in particular, for elderly patients with SLE and ESRD, should be considered. Summary SLE is not an independent risk factor for fractures in patients with ESRD. However, among patients with SLE and ESRD, vertebral and hip fractures are significant contributors to mortality.


Assuntos
Falência Renal Crônica/complicações , Lúpus Eritematoso Sistêmico/complicações , Fraturas por Osteoporose/etiologia , Sistema de Registros , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/epidemiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia
8.
Org Biomol Chem ; 15(20): 4440-4448, 2017 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-28485453

RESUMO

Reduction of double bonds of α,ß-unsaturated carboxylic acids and esters by ene-reductases remains challenging and it typically requires activation by a second electron-withdrawing moiety, such as a halide or second carboxylate group. We showed that profen precursors, 2-arylpropenoic acids and their esters, were efficiently reduced by Old Yellow Enzymes (OYEs). The XenA and GYE enzymes showed activity towards acids, while a wider range of enzymes were active towards the equivalent methyl esters. Comparative co-crystal structural analysis of profen-bound OYEs highlighted key interactions important in determining substrate binding in a catalytically active conformation. The general utility of ene reductases for the synthesis of (R)-profens was established and this work will now drive future mutagenesis studies to screen for the production of pharmaceutically-active (S)-profens.


Assuntos
Anti-Inflamatórios não Esteroides/metabolismo , Oxirredutases/metabolismo , Propionatos/química , Anti-Inflamatórios não Esteroides/química , Cristalografia por Raios X , Modelos Moleculares , Estrutura Molecular , Estereoisomerismo , Nicotiana/enzimologia
9.
BJOG ; 124(9): 1402-1410, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28374937

RESUMO

OBJECTIVE: To estimate prevalence of post-colposcopy physical after-effects and investigate associations between these and subsequent psychological distress. DESIGN: Longitudinal survey. SETTING: Two hospital-based colposcopy clinics. POPULATION: Women with abnormal cytology who underwent colposcopy (±related procedures). METHODS: Questionnaires were mailed to women 4, 8 and 12 months post-colposcopy. Details of physical after-effects (pain, bleeding and discharge) experienced post-colposcopy were collected at 4 months. Colposcopy-specific distress was measured using the Process Outcome-Specific Measure at all time-points. Linear mixed-effects regression was used to identify associations between physical after-effects and distress over 12 months, adjusting for socio-demographic and clinical variables. MAIN OUTCOME MEASURES: Prevalence of post-colposcopy physical after-effects. Associations between the presence of any physical after-effects, awareness of after-effects, and number of after-effects and distress. RESULTS: Five-hundred and eighty-four women were recruited (response rate = 73, 59 and 52% at 4, 8 and 12 months, respectively). Eighty-two percent of women reported one or more physical after-effect(s). Multiple physical after-effects were common (two after-effects = 25%; three after-effects = 25%). Psychological distress scores declined significantly over time. In adjusted analyses, women who experienced all three physical after-effects had on average a 4.58 (95% CI: 1.10-8.05) higher distress scored than those who experienced no after-effects. Women who were unaware of the possibility of experiencing after-effects scored significantly higher for distress during follow-up. CONCLUSIONS: The prevalence of physical after-effects of colposcopy and related procedures is high. The novel findings of inter-relationships between awareness of the possibility of after-effects and experiencing multiple after-effects, and post-colposcopy distress may be relevant to the development of interventions to alleviate post-colposcopy distress. TWEETABLE ABSTRACT: Experiencing multiple physical after-effects of colposcopy is associated with psychological distress.


Assuntos
Colposcopia/efeitos adversos , Hemorragia/etiologia , Dor Processual/etiologia , Estresse Psicológico/etiologia , Doenças Vaginais/etiologia , Adulto , Colposcopia/psicologia , Feminino , Hemorragia/diagnóstico , Hemorragia/epidemiologia , Hemorragia/psicologia , Humanos , Modelos Lineares , Estudos Longitudinais , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Dor Processual/diagnóstico , Dor Processual/epidemiologia , Dor Processual/psicologia , Prevalência , Estresse Psicológico/diagnóstico , Estresse Psicológico/epidemiologia , Doenças Vaginais/diagnóstico , Doenças Vaginais/epidemiologia , Doenças Vaginais/psicologia
10.
Artigo em Inglês | MEDLINE | ID: mdl-28436064

RESUMO

The landscape of cervical cancer prevention is changing in many countries thanks to the introduction of vaccination against high-risk types of human papillomavirus (HPV) and the incorporation of HPV DNA testing into cervical screening algorithms. In addition to this, uptake of screening is falling year on year in the UK and elsewhere. These factors present challenges and opportunities for health professionals working in primary care-in terms of communicating programmatic changes to women; responding to questions about the meaning and implications of HPV test results; and delivering interventions to increase screening uptake.


Assuntos
Detecção Precoce de Câncer/tendências , Programas de Rastreamento/tendências , Atenção Primária à Saúde/tendências , Neoplasias do Colo do Útero/prevenção & controle , Comunicação , Feminino , Previsões , Humanos , Papillomaviridae , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus , Educação de Pacientes como Assunto , Prevenção Primária/tendências , Esfregaço Vaginal
11.
BJOG ; 123(1): 24-38, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26099164

RESUMO

BACKGROUND: Although colposcopy is the leading follow-up option for women with abnormal cervical cytology, little is known about its psychological consequences. OBJECTIVES: We performed a systematic review to examine: (1) what, if any, are the adverse psychological outcomes following colposcopy and related procedures; (2) what are the predictors of adverse psychological outcomes post-colposcopy; and (3) what happens to these outcomes over time. SEARCH STRATEGY: Five electronic databases (PubMed, PsychINFO, CINAHL, Web of Science, Scopus) were searched for studies published in English between January 1986 and February 2014. SELECTION CRITERIA: Eligible studies assessed psychological wellbeing at one or more time-points post-colposcopy. DATA COLLECTION AND ANALYSIS: Two reviewers independently screened titles and abstracts. Full texts of potentially eligible papers were reviewed. Data were abstracted from, and a quality appraisal performed of, eligible papers. MAIN RESULTS: Twenty-three papers reporting 16 studies were eligible. Colposcopy and related procedures can lead to adverse psychological outcomes, particularly anxiety. Ten studies investigated predictors of adverse psychological outcomes; management type and treatment had no impact on this. Seven studies investigated temporal trends in psychological outcomes post-colposcopy; findings were mixed, especially in relation to anxiety and distress. Studies were methodologically heterogeneous. CONCLUSIONS: Follow-up investigations and procedures for abnormal cervical cytology can cause adverse psychological outcomes among women. However, little is known about the predictors of these outcomes or how long they persist. There is a need for a more standardised approach to the examination of the psychological impact of colposcopy, especially longer-term outcomes. TWEETABLE ABSTRACT: Follow-up investigations for abnormal cervical cytology can cause adverse psychological outcome among women.


Assuntos
Ansiedade/etiologia , Colposcopia/psicologia , Detecção Precoce de Câncer/psicologia , Estresse Psicológico/etiologia , Displasia do Colo do Útero/psicologia , Neoplasias do Colo do Útero/psicologia , Detecção Precoce de Câncer/instrumentação , Feminino , Humanos , Neoplasias do Colo do Útero/patologia , Displasia do Colo do Útero/patologia
12.
J Dairy Sci ; 99(1): 634-43, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26506548

RESUMO

Heifer rearing is one of the largest production expenses for dairy cattle operations, which is one reason milking operations outsource heifer rearing to custom developers. The cost of harvested feedstuffs is a major expense in heifer rearing. A possible way to lower feed costs is to graze dairy heifers, but little research exists on this topic in the mid-south United States. The objectives of this research were to determine the cost of feeding bred dairy heifers grazing native warm-season grasses (NWSG), with and without legumes, and compare the cost of grazing with the cost of rearing heifers using 3 traditional rations. The 3 rations were corn silage with soybean meal, corn silage with dry distillers grain, and a wet distillers grain-based ration. Bred Holstein heifers between 15- and 20-mo-old continuously grazed switchgrass (SG), SG with red clover (SG+RC), a big bluestem and Indiangrass mixture (BBIG), and BBIG with red clover (BBIG+RC) in Tennessee during the summer months. Total grazing days were calculated for each NWSG to determine the average cost/animal per grazing day. The average daily gain (ADG) was calculated for each NWSG to develop 3 harvested feed rations that would result in the same ADG over the same number of grazing day as each NWSG treatment. The average cost/animal per grazing day was lowest for SG ($0.48/animal/grazing d) and highest for BBIG+RC ($1.10/animal/grazing d). For both BBIG and SG, legumes increased the average cost/animal per grazing day because grazing days did not increase enough to account for the additional cost of the legumes. No difference was observed in ADG for heifers grazing BBIG (0.85 kg/d) and BBIG+RC (0.94 kg/d), and no difference was observed in ADG for heifers grazing SG (0.71 kg/d) and SG+RC (0.70 kg/d). However, the ADG for heifers grazing SG and SG+RC was lower than the ADG for heifers grazing either BBIG or BBIG+RC. The average cost/animal per grazing day was lower for all NWSG treatments than the average cost/animal per day for all comparable feed rations at a low, average, and high yardage fee. Results of this study suggest that SG was the most cost-effective NWSG alternative to harvested feeds for bred dairy heifer rearing.


Assuntos
Bovinos/fisiologia , Indústria de Laticínios/economia , Silagem/economia , Animais , Cruzamento , Custos e Análise de Custo , Fabaceae , Feminino , Panicum , Tennessee , Trifolium , Zea mays
14.
Br J Cancer ; 112(3): 562-6, 2015 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-25535731

RESUMO

BACKGROUND: With growing concerns about risk of harm from cancer screening, particularly from overdiagnosis, this study aimed to assess public attitudes to cancer screening in Great Britain. METHODS: We used a population-based survey to assess attitudes to cancer screening, screening history and demographic characteristics, in men and women aged 50-80 years. Data were collected using face-to-face computer-assisted interviews in 2012. RESULTS: In our sample of 2024, attitudes to cancer screening were overwhelmingly positive with almost 90% believing that screening is 'almost always a good idea' and 49% saying they would be tested for cancer even if it was untreatable. Attitudes were particularly positive among those who had previously taken part in breast or colorectal screening. CONCLUSIONS: Our findings suggest that attitudes to cancer screening are very positive in Great Britain. Widespread enthusiasm for cancer screening may hamper attempts to encourage a greater appreciation of the limitations and potential harms of screening.


Assuntos
Atitude Frente a Saúde , Detecção Precoce de Câncer/psicologia , Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/psicologia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/psicologia , Participação da Comunidade/estatística & dados numéricos , Coleta de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Neoplasias/epidemiologia , Neoplasias/psicologia , Reino Unido/epidemiologia
15.
Br J Cancer ; 113(1): 119-22, 2015 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-25996205

RESUMO

BACKGROUND: Attendance for cervical screening is socially graded, but little is known about patterns of attendance for colposcopy following an abnormal screening result. METHODS: Logistic regression was used to regress colposcopy attendance status for 27 193 women against age and area-level deprivation, adjusting for ethnicity. RESULTS: Colposcopy attendance was high at 8 weeks (89%) and 4 months post-referral (94%) but women living in the most deprived areas were significantly less likely to attend. CONCLUSIONS: The high overall attendance rates at colposcopy are encouraging but lower attendance among women in the most income-deprived areas indicates that even when these women attend primary cervical screening, they remain at higher risk of missing out on the benefits of the programme.


Assuntos
Colposcopia , Programas de Rastreamento/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Feminino , Humanos , Estudos Retrospectivos , Medicina Estatal , Neoplasias do Colo do Útero/prevenção & controle
16.
Br J Cancer ; 113(5): 833-9, 2015 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-26171938

RESUMO

BACKGROUND: Women from Black, Asian and Minority Ethnic (BAME) backgrounds are less likely to attend cervical screening than White British women. This study explored sociodemographic and attitudinal correlates of cervical screening non-attendance among BAME women. METHODS: Women (30-60 years) were recruited from Indian, Pakistani, Bangladeshi, Caribbean, African and White British backgrounds (n=720). Participants completed structured interviews. RESULTS: BAME women were more likely to be non-attenders than white British women (44-71% vs 12%) and fell into two groups: the disengaged and the overdue. Migrating to the United Kingdom, speaking a language other than English and low education level were associated with being disengaged. Being overdue was associated with older age. Three attitudinal barriers were associated with being overdue for screening among BAME women: low perceived risk of cervical cancer due to sexual inactivity, belief that screening is unnecessary without symptoms and difficulty finding an appointment that fits in with other commitments. CONCLUSIONS: BAME non-attenders appear to fall into two groups, and interventions for these groups may need to be targeted and tailored accordingly. It is important to ensure that BAME women understand cancer screening is intended for asymptomatic women and those who have ceased sexual activity may still be at risk.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Adulto , África/etnologia , Bangladesh/etnologia , Região do Caribe/etnologia , Inglaterra , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Paquistão/etnologia , Aceitação pelo Paciente de Cuidados de Saúde
17.
Int J Sports Med ; 36(7): 542-9, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25806587

RESUMO

This study sought to examine the effects of partial vascular occlusion (PVO) on oxidative stress markers in response to resistance exercise and at rest in young resistance-trained males. 12 resistance-trained males performed 6 conditions in random counterbalanced order: rest (R), low-intensity (LIRE: 30% 1RM) and moderate-intensity (MIRE: 70% 1RM) resistance exercise with or without PVO. Blood samples were obtained before and immediately after each condition and plasma protein carbonyls (PC), glutathione ratio, oxygen radical absorbance capacity (ORAC), and xanthine oxidase (XO) were evaluated. The addition of PVO resulted in significantly greater plasma PC and glutathione ratio in the rest condition. During LIRE the addition of PVO significantly attenuated plasma PC. The MIRE condition, independent of PVO, resulted in significantly higher PC concentration and glutathione ratio compared to the rest and LIRE conditions. The addition of PVO during MIRE resulted in a significant increase in PC. Thus, this study revealed that PVO increased oxidative stress at rest and enhanced the oxidative stress response to MIRE, but when combined with LIRE oxidative stress was attenuated. These findings suggest that the utilization of PVO during LIRE may alter ROS-induced accumulation in the blood which may influence cellular signaling.


Assuntos
Exercício Físico/fisiologia , Estresse Oxidativo/fisiologia , Espécies Reativas de Oxigênio/metabolismo , Treinamento Resistido , Adulto , Biomarcadores/sangue , Glutationa/sangue , Humanos , Masculino , Carbonilação Proteica/fisiologia , Descanso/fisiologia , Xantina Oxidase/sangue , Adulto Jovem
18.
Br J Cancer ; 111(9): 1831-5, 2014 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-25167224

RESUMO

BACKGROUND: There is concern about public understanding of overdiagnosis in breast cancer screening, and uncertainty about the likely impact on screening participation. METHODS: In a population-based survey of 2272 women, we assessed understanding of overdiagnosis and screening intentions before and after exposure to an explanation of overdiagnosis, and one of the three information formats providing an estimate of the rate of overdiagnosis based on the findings of the UK Independent Review. RESULTS: Subjective and objective comprehension of overdiagnosis was moderate across information formats (64% and 57%, respectively). Following overdiagnosis information, 7% of women showed a decrease in screening intention, with a stronger effect among women below screening age (<47 years), and receiving the estimate of the rate of overdiagnosis in a simple ratio format (one life saved to three overdiagnoses). CONCLUSIONS: Brief written information on overdiagnosis was incompletely understood, but reduced breast screening intentions in a proportion of women, regardless of comprehension. Subjective comprehension was lower among women who had not yet reached screening age but the deterrent effect was higher.


Assuntos
Atitude Frente a Saúde , Neoplasias da Mama/diagnóstico , Erros de Diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Adulto , Idoso , Coleta de Dados , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Prognóstico
19.
Anim Genet ; 45(3): 439-41, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24666329

RESUMO

Fescue toxicosis is a common syndrome of poor growth and reproductive performance of beef cattle grazing endophyte-infected tall fescue infected with Lolium arundinaceum Schreb. Together with decreased feed intake, decreased growth rates and tissue necrosis due to vasoconstriction, depressed circulating serum prolactin concentrations are typically observed in cattle afflicted with fescue toxicosis. Polymorphisms within the XK, Kell blood group complex subunit-related family, member 4 (XKR4) gene located on BTA14 have been previously reported to be associated with rump fat thickness, residual feed intake, average daily feed intake and average daily gain in cattle. Associations also have been reported between XKR4 genotype and effectiveness of the dopamine antagonist iloperidone as a treatment of schizophrenia in humans. Domperidone, a related dopamine antagonist, mediates effects of fescue toxicosis on livestock, including restoring depressed concentrations of prolactin. A mixed-breed population of 592 beef cattle grazing endophyte-infected tall fescue was used to examine the association between XKR4 genotype and circulating prolactin concentrations. The SNP rs42646708 was significantly (P = 0.0002) associated with serum prolactin concentrations and explained 2.45% of the phenotypic variation. Effect of genotype at the SNP was tested across five breeds, with significant associations within both Angus (P = 0.0275) and Simmental (P = 0.0224) breeds. These results suggest XKR4 may play a role in mediating the negative effects of fescue toxicosis, and polymorphisms within this gene may be useful markers for selection for genetic resistance to the debilitating effects of endophyte-infected tall fescue.


Assuntos
Bovinos/genética , Lolium/química , Proteínas de Membrana Transportadoras/genética , Polimorfismo de Nucleotídeo Único , Prolactina/sangue , Ração Animal/análise , Animais , Bovinos/metabolismo , Dieta/veterinária , Feminino , Proteínas de Membrana Transportadoras/metabolismo , Radioimunoensaio/veterinária
20.
Anim Biotechnol ; 25(1): 1-12, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24299180

RESUMO

Fescue toxicosis (FT) reduces beef animal growth and fertility. Animals afflicted with FT typically have decreased circulating prolactin concentrations and thicker summer hair coats. Preliminary experiments examined the informativeness of a novel Dopamine Receptor 2 (DRD2) G/A SNP for resistance to FT. Steers grazed tall fescue containing a toxic (E+) or non-toxic (NTE) strain of endophyte. Decreased serum prolactin concentrations were observed in GG steers in May compared to AA steers when grazing E+ pastures (P < 0.02). In a second study, GG steers had decreased prolactin concentrations (P = 0.004) and increased hair coat scores (P = 0.01) relative to AA steers when grazing E+ pastures. Allele and genotypic frequencies were different (P = 0.016 and 0.026, respectively) between spring-calving and fall-calving herds grazing E+ pastures, such that the A allele and the AA genotype were more prevalent in spring-calving herds, suggesting active selection for the A allele. Regardless of calving season, AA heifers tended toward fewer days to first calf (733.6 ± 4.4 d) than did GG heifers (756.6 ± 9.2 days; P = 0.055). These results suggest that the DRD2 SNP may have use in selecting animals resistant to FT.


Assuntos
Doenças dos Bovinos/genética , Micotoxicose/genética , Polimorfismo de Nucleotídeo Único/genética , Receptores de Dopamina D2/genética , Animais , Sequência de Bases , Bovinos , Feminino , Genótipo , Lolium , Masculino , Dados de Sequência Molecular , Fenótipo , Prolactina/sangue
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