Patterns of urgent hoarseness referrals to ENT-When should we be suspicious of cancer?

BACKGROUND: Current UK referral criteria stipulate that hoarseness should be persistent to merit 2 week wait (2WW) or urgent suspicion of cancer (USOC) referral. This study delineates patterns of hoarseness presentation with a view to assisting referral pathways, and whereby reassurance could be provided. METHODS: A pre-existing database of patients referred with hoarseness under the urgent suspicion of cancer (USOC) category was analysed. Univariate and multivariate analyses were performed on a variety of demographic and comorbid features to produce odds ratios (OR) of features either related or not related to laryngeal cancer. RESULTS: Of 698 consecutive hoarseness referrals were studied. In these referrals there were 506(73%) with persistent hoarseness and 192(27%) with intermittent hoarseness. The most significant patient variables related to laryngeal cancer were persistent hoarseness (OR 4.97), recreational drug use (OR 4.94), male gender (OR 4.01) and weight loss (OR 3.75). Significant patient variables present not related to laryngeal cancer diagnosis were intermittent hoarseness (OR 0.2), the presence of cough (OR 0.2), globus sensation (OR 0.25) and recent viral infection (OR 0.29). CONCLUSION: The strongest association with cancer is seen in patients that are persistently hoarse. Patients with fluctuating hoarseness do not need an "urgent suspicion of cancer" referral. Additional demographic referral information could help to streamline the referral of these patients, and reassure others.

Intimate partner violence, HIV, and mental health: a triple epidemic of global proportions.

Intimate partner violence (IPV) is a global health problem of epidemic proportions, affecting a third of women across the globe and as many as 60% in heavily affected regions of Africa. There is strong evidence that risk of IPV is heightened in HIV-infected women, and emerging evidence linking experiencing IPV and/or HIV to a higher likelihood of experiencing mental health problems. This triple burden makes women in Africa, living in the epicentre of HIV, all the more vulnerable. In this synthesis, this study reviewed literature pertaining to the overlap of IPV, HIV, and mental health problems. It presents a series of geographical maps illustrating the heavy burden of IPV and HIV globally, and how these coincide with a growing prevalence of mental health problems in Africa. Furthermore, it presents evidence on: the association between IPV and HIV, shared risk factors, and health consequences. This synthesis sheds light on the fact that ∼30% of women are affected by these three burdens concurrently, and the need for intervention is essential. Promising large scale interventions which have taken place in Africa are described, and evidence is presented in support of integrated versus targeted screening.

Social competence and learning difficulties: Teacher perceptions.

BACKGROUND/AIM: Social competence has been linked to children's classroom performance with three out of four children with learning difficulties reported to have problems with social skills. Social participation remains a predominant childhood occupation and a key indicator of school performance. Occupational therapists work with teachers to accurately assess the social performance of children in context and to provide targeted intervention. There is limited research about what teachers perceive are the specific nature of social difficulties experienced by children with learning difficulties in the classroom. This study investigated teacher perceptions of the social competence of a small sample of Australian boys with learning difficulties within the classroom context. METHODS: The Teacher Skillstreaming Checklist was used to investigate teacher perceptions of the social abilities of 21 primary school aged boys with learning difficulties compared to a control group. A correlational analysis was used to examine the relationship. RESULTS AND CONCLUSIONS: The study identified that the boys with learning difficulties were perceived by their teachers as having poorer social performance across multiple domains when compared to their typically developing peers. Implications of these findings are that children's social performance may negatively impact learning and classroom participation and that for some children, social competence should be a focus of occupational therapy assessment and treatment.

The functions of natural antisense transcripts.

NATs (natural antisense transcripts) are widespread in eukaryotic genomes. Experimental evidence indicates that sense and antisense transcripts interact, suggesting a role for NATs in the regulation of gene expression. On the other hand, the transcription of a gene locus in both orientations and RNA hybrid formation can also lead to transcriptional interference, trigger an immune response or induce gene silencing. Tissue-specific expression of NATs and the compartmentalization of cells ensure that the regulatory impact of NATs prevails. Consequently, NATs are now acknowledged as important modulators of gene expression. New mechanisms of action and important biological roles of NATs keep emerging, making regulatory RNAs an exciting and quickly moving area of research.