Topologically associating domains in the POLLED region are the same for Angus- and Brahman-specific Hi-C reads from F1 hybrid fetal tissue.

Horns, a form of headgear carried by Bovidae, have ethical and economic implications for ruminant production species such as cattle and goats. Hornless (polled) individuals are preferred. In cattle, four genetic variants (Celtic, Friesian, Mongolian and Guarani) are associated with the polled phenotype, which are clustered in a 300-kb region on chromosome 1. As the variants are intergenic, the functional effect is unknown. The aim of this study was to determine if the POLLED variants affect chromatin structure or disrupt enhancers using publicly available data. Topologically associating domains (TADs) were analyzed using Angus- and Brahman-specific Hi-C reads from lung tissue of an Angus (Celtic allele) cross Brahman (horned) fetus. Predicted bovine enhancers and chromatin immunoprecipitation sequencing peaks for histone modifications associated with enhancers (H3K27ac and H3K4me1) were mapped to the POLLED region. TADs analyzed from Angus- and Brahman-specific Hi-C reads were the same, therefore, the Celtic variant does not appear to affect this level of chromatin structure. The Celtic variant is located in a different TAD from the Friesian, Mongolian, and Guarani variants. Predicted enhancers and histone modifications overlapped with the Guarani and Friesian variants but not the Celtic or Mongolian variants. This study provides insight into the mechanisms of the POLLED variants for disrupting horn development. These results should be validated using data produced from the horn bud region of horned and polled bovine fetuses.

Opportunity to improve livestock traits using 3D genomics.

The advent of high-throughput chromosome conformation capture and sequencing (Hi-C) has enabled researchers to probe the 3D architecture of the mammalian genome in a genome-wide manner. Simultaneously, advances in epigenomic assays, such as chromatin immunoprecipitation and sequencing (ChIP-seq) and DNase-seq, have enabled researchers to study cis-regulatory interactions and chromatin accessibility across the same genome-wide scale. The use of these data has revealed many unique insights into gene regulation and disease pathomechanisms in several model organisms. With the advent of these high-throughput sequencing technologies, there has been an ever-increasing number of datasets available for study; however, this is often limited to model organisms. Livestock species play critical roles in the economies of developing and developed nations alike. Despite this, they are greatly underrepresented in the 3D genomics space; Hi-C and related technologies have the potential to revolutionise livestock breeding by enabling a more comprehensive understanding of how production traits are controlled. The growth in human and model organism Hi-C data has seen a surge in the availability of computational tools for use in 3D genomics, with some tools using machine learning techniques to predict features and improve dataset quality. In this review, we provide an overview of the 3D genome and discuss the status of 3D genomics in livestock before delving into advancing the field by drawing inspiration from research in human and mouse. We end by offering future directions for livestock research in the field of 3D genomics.

Full-Genome Sequences of Two Newcastle Disease Virus Strains Isolated in West Java, Indonesia.

The full-genome sequences of strains chicken/Indonesia/Cilebut/010WJ/2015 and chicken/Indonesia/ITA/012WJ/1951, isolated in West Java, Indonesia, in 2015 and 1951, respectively, were examined. Chicken/Indonesia/Cilebut/010WJ/2015 (genotype VII) caused a 2015 disease outbreak in Indonesia, and chicken/Indonesia/ITA/012WJ/1951 (genotype VI) is used as a standard strain for challenge in Newcastle disease virus (NDV) vaccine trials.

Association of antimicrobial resistance and gut microbiota composition in human and non-human primates at an urban ecotourism site.

BACKGROUND: The rise of nature-based ecotourism in the past decade has introduced unprecedented challenges in managing the increasing interaction between humans and animals. The potential transmission of antibiotic resistant microbes between humans and non-human primate populations is a concern due to their genetic similarity. Malaysia is well known for hotspots of wildlife diversity where non-human primates like monkeys and orangutans have become popular tourist attractions. In this study, we assessed the prevalence of antimicrobial resistant Staphylococcus aureus, Enterococcus species, and other Enterobacteriaceae in the faeces of human (HS) and two non-human primates (NHP) in Malaysia, the Long-tailed macaque (Macaca fascicularis, MF) and Silvered leaf monkey (Trachypithecus cristatus, TC). In addition, the faecal bacterial composition was profiled to evaluate the potential association between antibiotic resistant profiles and composition of gut microbiota. RESULTS: We tested the isolated bacteria using a selection of antibiotics. The results showed that both the number of antibiotic resistant strains and resistance level were higher in humans than NHPs. Overall, the composition of gut microbiome and pattern of antibiotic resistance showed that there was higher similarity between MF and TC, the two NHPs, than with HS. In addition, samples with higher levels of antibiotic resistance showed lower bacterial richness. Homo sapiens had the lowest bacterial diversity and yet it had higher abundance of Bacteroides. In contrast, NHPs displayed higher bacterial richness and greater prevalence of Firmicutes such as Ruminococceae and Oscillospira. CONCLUSION: Higher antibiotic susceptibility in NHPs is likely related to low direct exposure to antibiotics. The lack of resistance may also suggest limited antimicrobial resistance transmission between humans and NHP. Nonetheless, continued monitoring over a long period will help mitigate the risk of anthropozoonosis and zooanthroponosis.

The impact of epilepsy on academic achievement in children with normal intelligence and without major comorbidities: A systematic review.

PURPOSE: To systematically examine published literature which assessed the prevalence of academic difficulties in children with epilepsy (CWE) of normal intelligence, and its associating factors. METHODS: A search was conducted on five databases for articles published in English from 1980 till March 2015. Included were studies who recruited children (aged 5-18 years), with a diagnosis or newly/recurrent epilepsy, an intelligent quotient (IQ) of ≥70 or attending regular school, with or without a control group, which measured academic achievement using a standardised objective measure, and published in English. Excluded were children with learning difficulties, intellectual disabilities (IQ<70) and other comorbidities such as attention deficits hyperactive disorder or autism. Two pairs of reviewers extracted the data, and met to resolve any differences from the data extraction process. RESULTS: Twenty studies were included. The majority of the studies assessed "low achievement" whist only two studies used the IQ-achievement discrepancy definition of "underachievement". Fourteen studies (70%) reported that CWE had significantly lower academic achievement scores compared to healthy controls, children with asthma or reported norms. The remaining six studies (30%) did not report any differences. CWE had stable academic achievement scores over time (2-4 years), even among those whose seizure frequency improved. Higher parental education and children with higher IQ, and had better attention or had a positive attitude towards epilepsy, were associated with higher academic achievement score. Older children were found to have lower academic achievement score. CONCLUSIONS: In CWE of normal intelligence, the majority of published literature found that academic achievement was lower than controls or reported norms. The high percentages of low achievement in CWE, especially in the older age group, and the stability of scores even as seizure frequency improved, highlights the need for early screening of learning problems, and continued surveillance.

Parents' perspectives on the important aspects of care in children dying from life limiting conditions: A qualitative study.

INTRODUCTION: The importance of Paediatric Palliative Care (PPC) is increasingly recognised worldwide, with the World Health Organzsation (WHO) and the American Academy of Pediatrics (AAP) endorsing the development and wide availability of PPC. When these children are in the terminal phase of their illness, PPC should be tailored to the different needs and desires of the child and the family, with the goal of providing the best possible quality of life (QOL) for the days that remain. METHOD: Malaysia has yet to develop a national PPC policy. In anticipation of this, as part of a needs based qualitative study, parents' views were solicited, as to the unmet needs of their children during the terminal phases of their illness. A purposive sampling was conducted amongst fifteen parents of nine deceased children (ages 2-14 years, eight cancer, one Prader Willi Syndrome) who had received care in the Paediatric Department, Malacca General Hospital, a Malaysian government hospital. Two focus group discussions and three in-depth interviews were conducted, based on a semi-structured interview guideline. The interviews were audiotaped with permission and the tape recordings were transcribed verbatim. The data were managed and analysed by NVivo 9 software using a thematic analysis approach. RESULTS: The frequently emerging themes were the strengths and weaknesses pertaining to the healthcare system, processes within palliative care. These were symptom control, closed communication and lack of support and anticipatory guidance as death approached. CONCLUSION: Dying Malaysian children and their families deserve to receive care that is more consistent with optimal palliative care.

Who decides? A qualitative study on the decisional roles of patients, their caregivers and doctors on the method of bladder drainage after spinal cord injury.

STUDY DESIGN: Qualitative study using individual in-depth interviews. OBJECTIVE: To explore the roles of patients, their caregivers and doctors when making decisions on the method of bladder drainage after spinal cord injury (SCI). SETTING: Five public hospitals in Malaysia. METHODS: Semistructured (one-to-one) interviews with 17 male patients with SCI, 4 caregivers and 10 rehabilitation professionals. RESULTS: Eight themes describing the respective decisional roles of patients, their caregivers and doctors emerged from the analysis: patient's right and responsibilities, patient as an informed decision maker, forced to accept decision; surrogate decision maker, silent partner; doctor knows best, over-ride patient's decision, or reluctant decision maker. Both patients and doctors acknowledged the importance of patient autonomy but not all patients had the chance to practice it. Some felt that they were forced to accept the doctor's decision and even alleged that the doctor refused to accept their decision. Doctors considered the caregiver as the decision maker in cases that involved minors, elderly and those with tetraplegia. Some patients considered bladder problems an embarrassing subject to discuss with their caregivers and did not want their involvement. Doctors were described as knowledgeable and were trusted by patients and their caregivers to make the most appropriate option. Some doctors were happy to assume this role whereas some others saw themselves only as information providers. CONCLUSIONS: A paternalistic model is prevalent in this decision-making process and there is a discrepancy between patients' preferred and actual decisional roles.

Differences between disease-associated endoplasmic reticulum aminopeptidase 1 (ERAP1) isoforms in cellular expression, interactions with tumour necrosis factor receptor 1 (TNF-R1) and regulation by cytokines.

Endoplasmic reticulum aminopeptidase 1 (ERAP1) processes peptides for major histocompatibility complex (MHC) class I presentation and promotes cytokine receptor ectodomain shedding. These known functions of ERAP1 may explain its genetic association with several autoimmune inflammatory diseases. In this study, we identified four novel alternatively spliced variants of ERAP1 mRNA, designated as ΔExon-11, ΔExon-13, ΔExon-14 and ΔExon-15. We also observed a rapid and differential modulation of ERAP1 mRNA levels and spliced variants in different cell types pretreated with lipopolysaccharide (LPS). We have studied three full-length allelic forms of ERAP1 (R127-K528, P127-K528, P127-R528) and one spliced variant (ΔExon-11) and assessed their interactions with tumour necrosis factor receptor 1 (TNF-R1) in transfected cells. We observed variation in cellular expression of different ERAP1 isoforms, with R127-K528 being expressed at a much lower level. Furthermore, the cellular expression of full-length P127-K528 and ΔExon-11 spliced variant was enhanced significantly when co-transfected with TNF-R1. Isoforms P127-K528, P127-R528 and ΔExon-11 spliced variant associated with TNF-R1, and this interaction occurred in a region within the first 10 exons of ERAP1. Supernatant-derived vesicles from transfected cells contained the full-length and ectodomain form of soluble TNF-R1, as well as carrying the full-length ERAP1 isoforms. We observed marginal differences between TNF-R1 ectodomain levels when co-expressed with individual ERAP1 isoforms, and treatment of transfected cells with tumour necrosis factor (TNF), interleukin (IL)-1ß and IL-10 exerted variable effects on TNF-R1 ectodomain cleavage. Our data suggest that ERAP1 isoforms may exhibit differential biological properties and inflammatory mediators could play critical roles in modulating ERAP1 expression, leading to altered functional activities of this enzyme.

Factors influencing bladder management in male patients with spinal cord injury: a qualitative study.

STUDY DESIGN: Qualitative study using individual in-depth interviews. OBJECTIVES: The objective of this study was to explore the factors influencing the choice of bladder management for male patients with spinal cord injury (SCI). SETTING: Public hospitals in Malaysia. METHODS: Semistructured (one-on-one) interviews of 17 patients with SCI; 7 were in-patients with a recent injury and 10 lived in the community. All had a neurogenic bladder and were on various methods of bladder drainage. Interviews were audio-recorded, transcribed verbatim and analyzed using thematic analyses. RESULTS: The choice of bladder management was influenced by treatment attributes, patients' physical and psychological attributes, health practitioners' influences and social attributes. Participants were more likely to choose a treatment option that was perceived to be convenient to execute and helped maintain continence. The influence of potential treatment complications on decision making was more variable. Health professionals' and peers' opinions on treatment options had a significant influence on participants' decision. In addition, patients' choices depended on their physical ability to carry out the task, the level of family support received and the anticipated level of social activities. Psychological factors such as embarrassment with using urine bags, confidence in self-catheterization and satisfaction with the current method also influenced the choice of bladder management method. CONCLUSION: The choice of bladder management in people with SCI is influenced by a variety of factors and must be individualized. Health professionals should consider these factors when supporting patients in making decisions about their treatment options.

Psychometric properties of the Malay version of the Breast Module (BR23).

INTRODUCTION: The Breast Module (BR23) is increasingly being used worldwide in breast cancer research. This study evaluates the appropriateness of the translated version (i.e. BR23-Malay version) as a useful tool for the Malaysian population who could understand Malay, and examines the reliability and validity of the BR23-Malay version. METHODS: This was a prospective study involving 68 Malaysian women who could understand Malay very well. They answered the BR23-Malay version at two evaluation points--three and ten weeks following surgery for breast cancer. Internal consistency, test-retest intraclass correlation coefficients (ICC), effect size index, sensitivity and discriminity of the scale were calculated. RESULTS: Internal consistencies were acceptable for the functional domains (0.87 for body image; 0.84 for sexual functioning) and symptomatology domains (0.82 for systemic therapy side effect; 0.82 for breast symptoms; 0.70 for arm symptoms). Test-retest ICC ranged from 0.26 to 1.00. Sensitivity of the scale was observed in all domains except sexual functioning. CONCLUSION: The Malay version of BR23 is a suitable tool to measure the functional and symptomatology domains of women diagnosed with breast cancer.

Somatisation disorder and its associated factors in multiethnic primary care clinic attenders.

BACKGROUND: Somatisation disorder (SD) has been reported as common in all ethnic groups, but the estimates of its prevalence have varied and the evidence for its associated factors has been inconsistent. PURPOSE: This study seeks to determine the prevalence of SD and its associated factors in multiethnic primary care clinic attenders. METHODS: This cross-sectional study was on clinic attenders aged 18 years and above at three urban primary care clinics in Malaysia. The operational definition of SD was based on ICD-10 criteria for SD for research, frequent attendance, and excluded moderate to severe anxiety and depression. The instruments used were the ICD-10 symptom list, the Hospital Anxiety and Depression Scale, a semi-structured questionnaire, and SF-36. RESULTS: We recruited 1,763 patients (response rate 63.8%). The mean age of respondents was 44.7 ± 15.8 years, 807 (45.8%) were male; there were 35.3% Malay, 30.1% Chinese and 34.6% Indian. SD prevalence was 3.7%; the prevalence in Malay was 5.8%, Indian 3.0% and Chinese 2.1%. Significant associations were found between SD prevalence and ethnicity, family history of alcoholism, blue-collar workers and the physical component summary (PCS) score of SF-36. Multivariate analysis showed that SD predictors were Malay ethnicity (OR 2.7, 95% CI 1.6, 4.6), blue-collar worker (OR 2.0, 95% CI 1.2, 3.5) and impaired PCS score of SF-36 (OR 0.92, 95% CI 0.90, 0.95). CONCLUSION: The prevalence of SD was relatively uncommon with the stringent operational criteria used. SD preponderance in blue-collar workers may be attributable to secondary gain from getting sickness certificates and being paid for time off work.

Knowledge and barriers towards cervical cancer screening among young women in Malaysia.

OBJECTIVES: This study examined the level of knowledge and barriers towards cervical cancer screening of female university students. METHODOLOGY: A cross-sectional design was used for 287 female students at a tertiary institution located in Selangor, Malaysia. A name list of all students in the all faculties were obtained from each faculty's registrar and the ethics committee of the Faculty of Health and Life Sciences, approved the study. Respondents completed a consent form before they were given the questionnaire consisting of four sections: socio-demographic characteristics (six questions); risk factor of cervical cancer (six); knowledge about cervical cancer and the Pap smear test (ten); and finally barriers to Pap screening (eleven). Data were analyzed using SPSS version 13. RESULTS: The prevalence of ever having had a Pap test was 6%. Majority of the participants had adequate knowledge about risk factors of cervical cancer. The highest knowledge about cervical cancer risk factor reported by the respondents was having more than one sex partner (77.5%), whereas the lowest was the relationship between HPV and cervical cancer (51.2%). Age, marital status, ethnicity, monthly family income and faculty were significantly associated with knowledge of cervical cancer screening (p=0.003; p=0.001; p=0.002; p=0.002; p=0.001 and p=0.002; respectively). The most common barriers of cervical cancer screening were the Pap smear test will make them worry (95.8%) whereas the least common barrier reported among participants was no encouragement from the partner (8.8%). CONCLUSION: Some misconceptions and barriers in uptaking Pap smear test are still serious problems among young women. Although knowledge about cervical cancer screening is adequate they have a very poor practice of Pap smear test. The introduction of reproductive health subjects is warranted for all university students.

Development and validation of the osteoporosis patient satisfaction questionnaire (OPSQ).

OBJECTIVES: To develop and validate the Osteoporosis Patient Satisfaction Questionnaire (OPSQ) and to assess the opinion of postmenopausal osteoporotic women towards pharmaceutical care. METHODS: A 16-item instrument was designed. Each response consists of a five-point Likert-like scale with higher scores indicating greater satisfaction. The face and content validity was established via consultation with an endocrinologist and three pharmacists as well as feedback from participants in a preliminary study. Postmenopausal osteoporotic women taking bisphosphonates were recruited and randomly allocated to the intervention (n=90) and control groups (n=90). Pharmaceutical care was provided at month 2 to the intervention group while the control group received standard pharmacy services. The OPSQ was administered at month 6 (end of the intervention period), to assess patients' satisfaction. Factor analysis was performed using varimax rotation. Internal reliability was established using Cronbach's alpha. Construct validity was performed by using the Mann-Whitney U test. RESULTS: The internal reliability of the OPSQ produced a Cronbach's alpha of 0.86. Factor analysis identified one component in the OPSQ, which measured patient satisfaction. The intervention group showed significantly better overall OPSQ score than the control group (91.89+/-7.22% versus 84.32+/-7.48%, p<0.001). This indicates that the OPSQ was able to differentiate between participants who received pharmaceutical care from those who did not. CONCLUSIONS: The 16-item OPSQ developed in this study has high internal reliability and is a valid instrument for assessing osteoporotic women's satisfaction with pharmaceutical care service in Malaysia.

Reliability and validity of the Brief COPE Scale (English version) among women with breast cancer undergoing treatment of adjuvant chemotherapy: a Malaysian study.

This paper validates the Brief COPE Scale in Malaysian women with breast cancer. Test-retest evaluation was undertaken at two/three weeks and ten weeks following surgery. Internal consistencies ranged from 0.25 to 1.00. Meanwhile, the Intraclass Correlation Coefficient (ICC) ranged from 0.05 to 1.00. Sensitivity of the scale was indicated by the mean differences as observed in most of the domains with Effect Size Index (ESI) ranged from 0 to 0.53. Significant differences between mastectomy and lumpectomy were observed for Active coping, Planning and Acceptance. Brief COPE Scale showed fairly good reliability and validity.

Knowledge and awareness of cervical cancer and screening among Malaysian women who have never had a Pap smear: a qualitative study.

INTRODUCTION: Cervical cancer is one of the commonest cancers in women worldwide. Despite the existence of effective screening using Pap smear, the uptake of screening is poor. A qualitative study was undertaken using face-to-face in-depth interviews to investigate knowledge, attitudes and beliefs on cervical cancer screening of Malaysian women. METHODS: In-depth interviews were conducted with 20 Malaysian women aged 21-56 years and who have never had a Pap smear test, with the aim to explore their knowledge and awareness of cervical cancer and its screening. RESULTS: A lack of knowledge on cervical cancer and the Pap smear test was found among the respondents. Many women did not have a clear understanding of the meaning of an abnormal cervical smear and the need for the early detection of cervical cancer. Many believe the purpose of the Pap smear test is to detect existing cervical cancer, leading to the belief that Pap smear screening is not required because the respondents had no symptoms. Despite considerable awareness of a link between cervical cancer and sexual activity, as well as the role of a sexually-transmitted infection, none of the respondents had heard of the human papillomavirus. CONCLUSION: The findings highlight the importance of emphasising accurate information about cervical cancer and the purpose of Pap smear screening when designing interventions aimed at improving cervical cancer screening for Malaysian women.

Mental health knowledge, attitude and help-seeking tendency: a Malaysian context.

INTRODUCTION: This study examines the general public's knowledge of mental health and explores effective tools to promote good mental health through a household survey of a representative sample of the Malaysian population residing in Klang Valley, Malaysia. METHODS: A total of 587 respondents, aged 18 years and older, responded to a series of questions in relation to mental health issues. Respondents were requested to specify how they learned about the information. Following that, an attitude scale was presented to the participants, and they were requested to rate how much they agreed to the statements. RESULTS: The findings indicated that the majority of the respondents did not have good knowledge of mental health. However, all respondents displayed a neutral attitude towards mental health issues. It was found that ethnic background, religion, educational level and residential location were the few demographic characteristics found to be significantly related to either the respondent's knowledge or attitude towards mental health issues. With regard to seeking help, while the respondents' ethnic background influenced their decisions, younger respondents and respondents with better attitude towards mental health were more willing to seek help. CONCLUSION: This study has implications for promoting the understanding of the general mental well-being as well as the importance of seeking help for mental health in the local population. Steps should be taken to improve the public's understanding of, and attitude towards mental health. These include the presentation of a positive image and the dissemination of accurate information by the mass media, the primary source for information on mental health.

Cervical cancer screening attitudes and beliefs of Malaysian women who have never had a pap smear: a qualitative study.

BACKGROUND: Attitudes toward cervical cancer and participation in early detection and screening services are well known to be profoundly affected by cultural beliefs and norms. PURPOSE: This study explored the attitudes and sociocultural beliefs on cervical cancer screening among Malaysian women. METHOD: In this qualitative study, in-depth interviews were conducted with 20 Malaysian women, ages 21 to 56 years, who have never had a Papanicolaou (Pap) smear. RESULTS: Respondents generally showed a lack of knowledge about cervical cancer screening using Pap smear, and the need for early detection for cervical cancer. Many believed the Pap smear was a diagnostic test for cervical cancer, and since they had no symptoms, they did not go for Pap screening. Other main reasons for not doing the screening included lack of awareness of Pap smear indications and benefits, perceived low susceptibility to cervical cancer, and embarrassment. Other reasons for not being screened were related to fear of pain, misconceptions about cervical cancer, fatalistic attitude, and undervaluation of own health needs versus those of the family. CONCLUSION: Women need to be educated about the benefits of cervical cancer screening. Health education, counseling, outreach programs, and community-based interventions are needed to improve the uptake of Pap smear in Malaysia.

The validity and reliability of the Malaysian Osteoporosis Knowledge Tool in postmenopausal women.

OBJECTIVES: To design a valid and reliable questionnaire, the Malaysian Osteoporosis Knowledge Tool (MOKT), to assess the knowledge of postmenopausal osteoporotic women in Malaysia, on osteoporosis and its treatment. METHODS: A 40-item instrument was designed and tested in this study. The scores ranged from 1 to 40, which were then converted into percentage. This was administered to 88 postmenopausal osteoporotic women who were taking alendronate (patient group) and 43 pharmacists (professional group). The MOKT was administered again to the patient group after 1 month. RESULTS: Flesch reading ease was 57, which is satisfactory, while the mean difficulty factor+/-S.D. was 0.73+/-0.25, indicating that the MOKT is moderately easy. Internal consistency of the instrument was good with Cronbach's alpha=0.82. The test and retest scores showed no significant difference for 38 out of the 40 items, indicating that the questionnaire has achieved a stable reliability. Level of knowledge on osteoporosis and its treatment was good with a mean score+/-S.D. of 69.0+/-13.9 and 81.6+/-9.5 in the patient and professional group, respectively. The difference in knowledge scores between the two groups was statistically significant (p<0.001). CONCLUSIONS: In conclusion, the 40-item questionnaire (MOKT) is a reliable and valid instrument for measuring knowledge on osteoporosis in the Malaysian setting. Therefore, it can be used to identify individuals in need of educational interventions and to assess the effectiveness of education efforts as part of osteoporosis management.

Perceived barriers to self-management in Malaysian women with breast cancer.

Naturalistic inquiry using focus group interviews was undertaken to explore experiences and perceived barriers to self management in women with breast cancer. The aim was to identify their perceived barriers to self management to aid the development of rehabilitation programmes. Successful programmes are strongly linked to patients' perceived needs. Four focus groups consisted of 39 women, were purposively recruited. Women's needs within the three areas of medical, emotional and role management of breast cancer were explored. The main barriers were unavailability of information, inability to access services-and-support, and socioeconomic-cultural issues (entrenched myths, low-socioeconomic status, and inadequate insurance-health legislative coverage). The findings provide the critically lacking 'expert-view' of survivors, who verified the importance of the medical, emotional and role management tasks, and highlighted barriers and structural solutions. With breast cancer becoming recognised as a form of chronic illness, this study is timely.