Attitudes and beliefs of non-participants in a population-based screening programme for colorectal cancer.

BACKGROUND: Uptake of colorectal cancer screening programmes needs to be improved or at least maintained in order to achieve projected reductions in mortality and morbidity. Understanding the origins of non-participation in screening is therefore important. OBJECTIVE: To explore the beliefs and experiences of individuals who had not responded either to their screening invitation or reminder. DESIGN: A qualitative study using in-depth interviews with non-participants from England's population-based colorectal cancer screening programme. Data collection and analysis were carried out using a grounded theory approach, with an emphasis on the constant comparison method, and continued until saturation (27 interviews). FINDINGS: The interviews provided an in-depth understanding of a range of reasons and circumstances surrounding non-participation in screening, including contextual and environmental influences as well as factors specific to the screening test. Non-participation in screening was not necessarily associated with negative attitudes towards screening or a decision to not return a kit. Reasons for non-participation in screening included not feeling that participation is personally necessary, avoiding or delaying decision making, and having some degree of intention to take part but failing to do so because of practicalities, conflicting priorities or external circumstances. Beliefs, awareness and intention change over time. DISCUSSION AND CONCLUSIONS: A range of approaches may be required to improve screening uptake. Some non-participants may already have a degree of intention to take part in screening in the future, and this group may be more responsive to interventions based on professional endorsement, repeat invitations, reminders and aids to making the test more practical.

Prefrontal cortex structural and developmental associations with callous-unemotional traits and aggression.

Youths with high levels of callous-unemotional (CU) traits and aggression are at an increased risk for developing antisocial behaviours into adulthood. In this population, neurostructural grey matter abnormalities have been observed in the prefrontal cortex. However, the directionality of these associations is inconsistent, prompting some to suggest they may vary across development. Although similar neurodevelopmental patterns have been observed for other disorders featuring emotional and behavioural dysregulation, few studies have tested this hypothesis for CU traits, and particularly not for aggression subtypes. The current study sought to examine grey matter correlates of CU traits and aggression (including its subtypes), and then determine whether these associations varied by age. Fifty-four youths (10-19 years old) who were characterized for CU traits and aggression underwent MRI. Grey matter volume and surface area within the anterior cingulate cortex was positively associated with CU traits. The correlation between CU traits and medial orbitofrontal cortex (mOFC) volume varied significantly as a function of age, as did the correlation between reactive aggression and mOFC surface area. These associations became more positive with age. There were no significant findings for proactive/total aggression. Results are interpreted considering the potential for delayed cortical maturation in youths with high CU traits/aggression.

The impact of acute violent videogame exposure on neurocognitive markers of emotional empathic state.

Research examining the purported association between violent gaming and aggression remains controversial due to concerns related to methodology, unclear neurocognitive mechanisms, and the failure to adequately consider the role of individual differences in susceptibility. To help address these concerns, we used fMRI and an emotional empathy task to examine whether acute and cumulative violent gaming exposure were associated with abnormalities in emotional empathy as a function of trait-empathy. Emotional empathy was targeted given its involvement in regulating not only aggression, but also other important social functions such as compassion and prosocial behaviour. We hypothesized that violent media exposure increases the risk of aberrant social behaviour by altering the aversive value of distress cues. Contrary to expectations, neither behavioural ratings nor empathy-related brain activity varied as a function of violent gaming exposure. Notably, however, activation patterns in somatosensory and motor cortices reflected an interaction between violent media exposure and trait empathy. Thus, our results are inconsistent with a straightforward relationship between violent media exposure and reduced empathy. Furthermore, they highlight the importance of considering both individual differences in susceptibility, and other aspects of cognition related to social functioning to best inform public concern regarding safe gaming practices.

Masking our emotions: Emotion recognition and perceived intensity differ by race and use of medical masks.

Although medical masks have played a key role in decreasing the transmission of communicable disease, they simultaneously reduce the availability of nonverbal cues fundamental to social interaction. In the present study, we determined the collective impact of medical masks on emotional expression recognition and perceived intensity as a function of actor race. Participants completed an emotional expression recognition task involving stimuli with or without medical masks. Across six basic emotional facial expressions, medical masks were associated with significantly more emotional expression recognition errors. Overall, the effects associated with race varied depending on the emotion and appearance of masks. Whereas recognition accuracy was higher for White relative to Black actors for anger and sadness, the opposite pattern was observed for disgust. Medical mask-wearing exacerbated actor-race related recognition differences for anger and surprise, but attenuated these differences for fear. Emotional expression intensity ratings were significantly reduced for all emotions except fear, where masks were associated with increased perceived intensity. Masks further increased already higher intensity ratings for anger in Black versus White actors. In contrast, masks eliminated the tendency to give higher intensity ratings for Black versus White sad and happy facial expressions. Overall, our results suggest that the interaction between actor race and mask wearing status with respect to emotional expression judgements is complex, varying by emotion in both direction and degree. We consider the implications of these results particularly in the context of emotionally charged social contexts, such as in conflict, healthcare, and policing.

Aspirin users attending for NHS bowel cancer screening have less colorectal neoplasia: chemoprevention or false-positive faecal occult blood testing?

OBJECTIVE: The NHS Bowel Cancer Screening Programme (BCSP) uses faecal occult blood (FOB) testing to select patients aged 60-69 years for colonoscopy. AIM: To examine the association between aspirin use and the detection of colorectal neoplasia in screened patients undergoing colonoscopy. METHODS: Data were collected prospectively on individuals who underwent colonoscopy following a positive FOB test in the South of Tyne area between February 2007 and 2009. The relationship between the presence of colorectal neoplasia and age, gender, body mass index (BMI) and current aspirin use were evaluated using logistic regression analysis. RESULTS: 701 individuals underwent colonoscopy. 414 (59.1%) were male and 358 (51.1%) aged over 65 years. Males had a higher incidence of colorectal neoplasia (relative risk 2.26, 95% CI 1.65-3.10, p < 0.001). Current aspirin use was associated with a lower neoplasia detection rate (relative risk 0.79, 95% CI 0.50-0.98, p = 0.039). Increased age and BMI were not significantly associated with higher neoplasia detection. CONCLUSION: Amongst individuals undergoing colonoscopy following a positive FOB test in the BCSP, current aspirin use was associated with a lower incidence of colorectal neoplasia. This may represent the chemopreventative effect of aspirin or increased false positivity of FOB testing. Further work is needed to clarify the contribution of each and could reduce the number of unnecessary colonoscopies.

Dissociable effects of acute versus cumulative violent video game exposure on the action simulation circuit in university students.

There is an ongoing debate as to whether violent video game exposure (VGE) has a negative impact on social functioning. This debate continues in part because of methodological concerns and the paucity of identifiable neurocognitive mechanisms. Also, little attention has been given to how specific personality characteristics may influence susceptibility to the purported effects. Using a combined experimental and cross-sectional approach, we examined the impact of VGE on action simulation as a function of trait coldheartedness in a sample of university students. Healthy adults played a violent or nonviolent version of Grand Theft Auto V before completing an fMRI measure of action simulation circuit (ASC) activity. Simulation-related activity was not significantly different between groups; however, greater overall activation was observed in left inferior frontal gyrus for those in the violent condition. Contrary to predictions, no evidence was observed that trait coldheartedness significantly interacts with violent gaming to influence ASC activation. However, prior cumulative VGE was negatively correlated with simulation-related activity in a subsection of the ASC. This study highlights a potential dissociation between the effects of acute versus cumulative violent gaming and may challenge assumptions that the directionality of effects for cross-sectional associations always mirror those of acute exposure.

Predicting youth aggression with empathy and callous unemotional traits: A Meta-analytic review.

Historically, empathy has been thought to motivate prosocial behaviour and inhibit aggressive behaviour. Contrary to current assumptions and theoretical support, a meta-analysis revealed a small effect of empathy on aggression among adults (Vachon, Lynam, & Johnson, 2014). The current study sought to determine whether broadening the focus from empathy to include other socially relevant affective characteristics (i.e., callous-unemotional traits) was advantageous in predicting aggressive behaviour. As little is known about the strength of this association among youth, the current study meta-analytically examined 192 unique effect sizes drawn from published and unpublished studies reporting on samples of children and adolescents. Analyses were conducted across general, cognitive, and emotional empathy, as well as callous-unemotional traits, and general, direct, indirect, proactive, and reactive aggression. Significant variability was noted across effect sizes. Consistent with a prior meta-analysis involving adults (Vachon et al., 2014), small to moderate associations were identified between aggression and traditional measures of empathy (i.e., general, emotional, cognitive); these effects ranged from r = -0.06 to -0.26. Among broader measures of emotional style (i.e., callous-unemotional traits), moderate to large effects were found; ranging from r = 0.30 to 0.37. Results suggested that broader affective measures may be more strongly associated with aggression than empathy alone. The results raise questions about the nature of empathy assessment and indicate the utility of targeting multiple emotion-related factors during treatment to effectively reduce aggressive behaviour. In particular, the results underscore of the importance of considering the limited prosocial emotions specifier (perhaps trans-diagnostically given the varied nature of the sample) when considering implications for prognosis and treatment targets.

Toxic Relationships: The Experiences and Effects of Psychopathy in Romantic Relationships.

Limited research exists on the impact of psychopathy within romantic relationships. We examined mental and physical health consequences reported by intimate partners of individuals with psychopathic traits. Additionally, we explored whether psychopathy severity and coping impacted the severity of posttraumatic stress disorder and depression symptoms. Four hundred fifty-seven former and current intimate partners of individuals with psychopathic traits were recruited from online support groups. Victims reported a variety of abusive experiences and various negative symptomatology involving emotional, biological, behavioral, cognitive, and interpersonal consequences. Psychopathy severity and maladaptive coping were significantly related to increased PTSD and depression, while adaptive coping was only related to decreased depression. Regression analyses revealed that experiencing many forms of victimization predicted increased PTSD and depression symptoms. Examining the specific consequences experienced by intimate partners of individuals with psychopathic traits can aid the development of individualized treatment interventions aimed at symptom mitigation, recovery, and prevention of future victimization.

The Effect of Hypervigilance on the Relationship Between Sexual Victimization and Gait.

Two studies investigated the relationship between hypervigilance, vulnerable gait cues, and a history of sexual victimization. In Study 1 (N = 130), gait was coded for traits relating to vulnerability where half of the sample was unaware of being videotaped (Unaware condition) and the other half was aware (Aware condition) to induce hypervigilance (between-subjects design). Gait was associated with a history of victimization, but only in the Unaware condition. A mediation analysis found that perceived impact of victimization mediated the association between victimization and vulnerable gait. In Study 2, female university students (N = 62) were measured on their victimization history and hypervigilance. Walking styles of participants were coded for the presence of vulnerability cues in both an Unaware and Aware condition (within-subjects design). A regression analysis revealed an association between hypervigilance and a reduced change in walking style between the two conditions. More notably, hypervigilance was found to moderate the relationship between sexual victimization and vulnerable gait but not violent victimization and vulnerable gait. These results suggest that hypervigilance may be an adaptive response that reduces perceived vulnerability in sexually victimized women.

Using specialist screening practitioners (SSPs) to increase uptake of bowel scope (flexible sigmoidoscopy) screening: results of a feasibility single-stage phase II randomised trial.

OBJECTIVE: To determine the feasibility of specialist screening practitioners (SSPs) offering patient navigation (PN) to facilitate uptake of bowel scope screening (BSS) among patients who do not confirm or attend their appointment. DESIGN: A single-stage phase II trial. SETTING: South Tyneside District Hospital, Tyne and Wear, England, UK. PARTICIPANTS: Individuals invited for BSS at South Tyneside District Hospital during the 6-month recruitment period were invited to participate in the study. INTERVENTION: Consenting individuals were randomly assigned to either the PN intervention or usual care group in a 4:1 ratio. The intervention involved BSS non-attenders receiving a phone call from an SSP to elicit their reasons for non-attendance and offer educational, practical and emotional support as required. If requested by the patient, another BSS appointment was then scheduled. PRIMARY OUTCOME MEASURE: The number of non-attenders in the intervention group who were navigated and then rebooked and attended their new BSS appointment. SECONDARY OUTCOME MEASURES: Barriers to BSS attendance, patient-reported outcomes including informed choice and satisfaction with BSS and the PN intervention, reasons for study non-participation, SSPs' evaluation of the PN process and a cost analysis. RESULTS: Of those invited to take part (n=1050), 152 (14.5%) were randomised into the study: PN intervention=109; usual care=43. Most participants attended their BSS appointment (PN: 79.8%; control: 79.1%) leaving 22 eligible for PN: only two were successfully contacted. SSPs were confident in delivering PN, but were concerned that low BSS awareness and information overload may have deterred patients from taking part in the study. Difficulty contacting patients was reported as a burden to their workload. CONCLUSIONS: PN, as implemented, was not a feasible intervention to increase BSS uptake in South Tyneside. Interventions to increase BSS awareness may be better suited to this population. TRIAL REGISTRATION NUMBER: ISRCTN13314752; Results.

Spirituality, Religion, and Suicidality Among Veterans: A Qualitative Study.

This qualitative study explores the relationship between veterans' spirituality/religion and suicide ideation and attempts. Qualitative semi-structured interviews were conducted with 30 veterans who either endorsed chronic suicidal ideation or had made suicide attempt(s). Interviews explored the bi-directional relationship between spirituality/religion (e.g., beliefs, practices, and experiences), and suicide ideation and behaviors. Interviews were analyzed using thematic analysis. Veterans' responses indicate that spirituality/religion can discourage or permit suicidal ideation, help in coping with ideation, and facilitate meaning making and coping in the presence of self-perceived suffering. Veterans who survived a suicide attempt explored the impact of their spirituality/religion on their recovery. Findings highlight a complex and diverse relationship between spirituality/religion and suicidality. These findings may inform further research on treatment strategies that assess the function of spirituality/religion, and incorporate protective aspects of spirituality/religion into mental health treatment.

Childhood Abuse, Nonsuicidal Self-Injury, and Suicide Attempts: An Exploration of Gender Differences in Incarcerated Adults.

The relationship between types of childhood abuse, suicide attempts, and nonsuicidal self-injury (NSSI) was examined in a sample of 415 incarcerated adults (268 men, 147 women). Men and women were equally likely to experience childhood abuse, although women were more likely to report sexual abuse and men were more likely to report emotional neglect. Sexual abuse was the only type of abuse found to predict NSSI and suicide attempts in women. For men, physical abuse and physical neglect were significant predictors of NSSI and suicide attempts, respectively. Gender differences exist and should be examined in future research in this area.

Using Specialist Screening Practitioners (SSPs) to increase uptake of the Bowel Scope (Flexible Sigmoidoscopy) Screening Programme: a study protocol for a feasibility single-stage phase II trial.

BACKGROUND: The NHS Bowel Scope Screening (BSS) programme offers men and women aged 55 years a once-only flexible sigmoidoscopy (FS), a test that can help reduce colorectal cancer (CRC) incidence and mortality. However, the benefits of BSS are contingent on uptake. This National Institute for Health Research-funded single-stage phase II trial will test the feasibility of using patient navigation (PN), an intervention that offers support to patients to overcome barriers to healthcare, to increase BSS uptake within a socially deprived area of England. METHODS/DESIGN: All individuals invited for BSS at South Tyneside NHS Foundation Trust during the 6-month recruitment period will be invited to take part in the study. Consenting participants will be randomised to receive PN or usual care in a 2:1 ratio. PN involves non-attenders receiving a phone call from a Specialist Screening Practitioner (SSP) who will elicit reasons for non-attendance and offer educational, practical, and emotional support as needed. If requested by the patient, another appointment for BSS will then be arranged. We anticipate 30 % of participants will be non-attenders. Using A'Hern single-stage design, with 20 % significance level and 80 % power, at least 35 participants who receive PN need to subsequently attend for PN to be considered worthy of further investigation in a definitive trial. The primary outcome measure will be the number of participants in the PN group who re-book and attend their BSS appointment. A qualitative analysis of the PN transcripts, and interviews with the SSPs, will also be conducted, alongside a quantitative analysis of completed patient-reported experience questionnaires. An economic analysis will calculate the costs of delivering PN. DISCUSSION: This feasibility study will be instrumental in deciding whether to conduct the first definitive trial of PN in BSS in England. If PN is subsequently shown to be cost-effective at increasing uptake of BSS, NHS policies could be modified to implement PN as a standard service. The results will be disseminated in peer-reviewed journals and at scientific conferences. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number, ISRCTN13314752.

A role for NF-kappa B binding motifs in the differential induction of chemokine gene expression in human corneal epithelial cells.

PURPOSE: The interleukin (IL)-8 promoter possesses a NF-kappa B-binding site with affinity to p50p65 and p65p65 complexes while the monocyte chemoattractant protein (MCP)-1 promoter's NF-kappa B-binding site has exclusive affinity to p50p65 heterodimers. The purpose of this study was to determine whether the two NF-kappa B sites play a role in the capacity of tumor necrosis factor (TNF)-alpha-stimulated human corneal epithelial cells (HCECs) to produce nanogram amounts of IL-8 in the absence of MCP-1 synthesis. METHODS: IL-8 and MCP-1 promoters were cloned into luciferase reporter vectors. Site-directed mutagenesis of wild-type promoters was used to mutate the NF-kappa B-binding motif in the wild-type IL-8 reporter plasmid into a motif with exclusive affinity to p50p65 and to mutate the NF-kappa B binding motif in the wild-type MCP-1 reporter plasmid into a motif with affinity to p65p65. Luciferase activity was determined after transfection of reporter vector constructs into TNF-alpha-stimulated HCECs. The chromatin immunoprecipitation assay was used to confirm binding of NF-kappa B subunits to IL-8 and MCP-1 promoters in vivo. RESULTS: Promoters with affinity to p65p65 homodimers were active in driving the expression of the reporter gene, whereas promoters with affinity to p50p65 heterodimers did not induce significant reporter gene expression. Incorporation of a CCAAT enhancer-binding protein (C/EBP)-binding site immediately upstream of p65p65-binding sites significantly enhanced promoter activity. CONCLUSIONS: The results suggest that the interaction of p65p65 homodimers and C/EBP transcriptional factors with IL-8 promoters and not MCP-1 promoters account for the capacity of HCECs to produce IL-8 selectively, in the absence of MCP-1 production.

Faculty and student dialogue through journal writing.

ISSUES AND PURPOSE: To explore how journal writing promotes and fosters an ongoing dialogue between students and faculty during an acute care pediatric clinical experience. DESIGN AND METHODS: Unstructured, self-report data were collected via students' clinical journal entries and during a focus group interview. Content analysis was used to identified recurrent themes. RESULTS: Two themes were generated: building a bond of trust and saving face. PRACTICE IMPLICATIONS: The findings have implications for preceptors of nursing professionals. Implementing journal writing as a component to teaching-learning in the practice environment provides a means to recognize the affective outcomes of learning, such as increasing self-awareness and professional growth.

High yield of colorectal neoplasia detected by colonoscopy following a positive faecal occult blood test in the NHS Bowel Cancer Screening Programme.

OBJECTIVES: The UK National Health Service Bowel Cancer Screening Programme (BCSP) is based on a strategy of biennial faecal occult blood (FOB) testing. Positive results are classified as 'abnormal' or 'weak positive' based on the number of positive windows per kit or need for repeat testing. Colonoscopy is offered to both groups. We evaluate the relationship between FOB test positivity and clinical outcome in the BCSP. SETTING: The South of Tyne and Tees (UK) Bowel Cancer Screening Centres. METHODS: Data were collected prospectively on all individuals who were offered FOB testing and colonoscopy between February 2007 and February 2009. Univariable and multivariable analyses were performed to investigate the relationship between FOB test positivity and clinical outcome. RESULTS: Following FOB testing, 1524 individuals underwent colonoscopy, 1259 (83%) after a 'weak positive' and 265 (17%) an 'abnormal' result. Cancer was detected in 180 (11.8%) and adenomas in 758 (49.7%). Individuals with an 'abnormal' result were more likely to have cancer or be 'high risk' for the development of future adenomas (110/265, 41.5%) than those with 'weak positive' results, (236/1259, 18.7%, P < 0.0001). Those with Dukes stage B, C or D cancers or cancers proximal to the splenic flexure were more likely to have an 'abnormal' result. CONCLUSIONS: The majority of colonoscopies were performed following 'weak positive' FOB results. Those with an 'abnormal' result were more likely to be diagnosed with cancer. The high yield of pathology in both the 'abnormal' and 'weak positive' groups justifies the need for colonoscopy in both.

Emergency department visits for medical device-associated adverse events among children.

OBJECTIVES: The purposes of this study were to provide national estimates of emergency department (ED) visits for medical device-associated adverse events (MDAEs) in the pediatric population and to characterize these events further. METHODS: ED medical record reports from the National Electronic Injury Surveillance System All Injury Program database from January 1, 2004, through December 21, 2005, were reviewed. MDAEs among pediatric patients were identified, and data were abstracted. National estimates for pediatric MDAEs were determined according to medical specialty, device category and class, injury diagnosis, and patient characteristics and outcome. RESULTS: The total estimated number of pediatric MDAEs during the 24-month period was 144,799 (95% confidence interval: 113,051-183,903), involving devices from 13 medical specialties. Contact lenses accounted for most MDAEs (23%), followed by hypodermic needles (8%). The distribution of MDAEs according to medical specialty varied according to age subgroup. The most-prevalent types of injuries included contusions/abrasions, foreign-body intrusions, punctures, lacerations, and infections. The most-frequently affected body parts were the eyeball, pubic region, finger, face, and ear. The majority of pediatric MDAEs involved class II (moderate-risk) devices. The incidence of pediatric MDAEs decreased with increasing age from early to late childhood and then spiked after 10 years of age. More girls than boys were affected at older ages (16-21 years) and more boys than girls at younger ages (< or =10 years). Hospitalizations were more likely to involve invasive or implanted devices. CONCLUSIONS: This study provides national estimates of pediatric MDAEs resulting in ED visits and highlights the need to develop interventions to prevent pediatric device-related injuries.

Exposure Risk in the Handling and Administration of Chemotherapy Agents: A Review and Synthesis of the Literature.

PURPOSE: This paper synthesizes research findings on known exposure risks to and compliance among health care professionals in the handling of neoplastic agents and suggests implications for practice and future research. CONCLUSIONS: The exposure risk for experiencing mutagenicity and alterations in fertility from chemotherapy agents among health care professionals has been extensively studied. Exposure risk and its relationship to health care professionals' compliance to established protocols for the safe handling and administration of chemotherapy agents continues to be a concern for health care institutions. Research in this area has been mainly retrospective and most studies have used a causal-comparative design; the degree of mutagenicity has been quantified for an identified exposed group and compared with a group that has not been exposed to antineoplastic agents. The evaluation of exposure has been found to be a complex problem because of the considerable mediating factors that are multifactorial and interactive in nature. Despite these confounding factors, the findings of past studies suggest that unsafe practice leads to an increased risk of exposure. IMPLICATIONS: Findings from existing research indicate that compliance with established safety guidelines offers adequate protection to those health care workers involved in the handling, administration and care of patients receiving chemotherapy agents.