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Traumatic brain injury (TBI) is clinically divided into a spectrum of severities, with mild TBI being the least severe form and a frequent occurrence in contact sports, such as ice hockey, American football, rugby, horse riding and boxing. Mild TBI is caused by blunt nonpenetrating head trauma that causes movement of the brain and stretching and tearing of axons, with diffuse axonal injury being a central pathogenic mechanism. Mild TBI is in principle synonymous with concussion; both have similar criteria in which the most important elements are acute alteration or loss of consciousness and/or post-traumatic amnesia following head trauma and no apparent brain changes on standard neuroimaging. Symptoms in mild TBI are highly variable and there are no validated imaging or fluid biomarkers to determine whether or not a patient with a normal computerized tomography scan of the brain has neuronal damage. Mild TBI typically resolves within a few weeks but 10-15% of concussion patients develop postconcussive syndrome. Repetitive mild TBI, which is frequent in contact sports, is a risk factor for a complicated recovery process. This overview paper discusses the relationships between repetitive head impacts in contact sports, mild TBI and chronic neurological symptoms. What are these conditions, how common are they, how are they linked and can they be objectified using imaging or fluid-based biomarkers? It gives an update on the current state of research on these questions with a specific focus on clinical characteristics, epidemiology and biomarkers. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the influence of body fat percentage and its distribution on sensory detection and pain sensitivity responses to experimentally induced noxious stimuli in otherwise pain-free individuals.Methods: Seventy-two participants were divided into three equal groups according to their body mass index (BMI: normal, overweight and obese). Percentage body fat was estimated using a four-site skinfold method. Measurements of cold pressor pain threshold, tolerance and intensity; contact thermal sensory detection and heat pain threshold and tolerance (TSA-II - NeuroSensory Analyzer, Medoc); and blunt pressure pain threshold (algometer, Somedic SenseLab AB) were taken at the waist and thenar eminence.Results: Mean ± SD pressure pain threshold of the obese group (620.72 ± 423.81 kPa) was significantly lower than normal (1154.70 ± 847.18 kPa) and overweight (1285.14 ± 998.89 kPa) groups. Repeated measures ANOVA found significant effects for site for cold detection threshold (F1,68  = 8.3, p = 0.005) and warm detection threshold (F1,68  = 38.69, p = 0.001) with waist having lower sensory detection thresholds than thenar eminence. For heat pain threshold, there were significant effects for site (F1,68  = 4.868, p = 0.031) which was lower for waist compared with thenar eminence (mean difference = 0.89 °C).Conclusion: Obese individuals were more sensitive than non-obese individuals to pressure pain but not to thermal pain. Body sites may vary in their response to different types and intensities of stimuli. The inconsistency of findings within and between research studies should catalyse further research in this field.Significance: This study provided evidence that body mass index and distribution of body fat can influence sensory detection and pain sensitivity. Obese individuals were more sensitive than normal range body mass index individuals to pressure pain but not to thermal pain. Pain response varied according to subcutaneous body fat at different body sites. These findings strengthen arguments that weight loss should be a significant aspect of a pain management programme for obese pain patients. [ABSTRACT FROM AUTHOR]

Prostate cancer is the second most common cancer in men worldwide, accounting for an estimated 1.1 million new cases diagnosed in 2012 (). Currently, there is a lack of specific guidance on supportive care for men with prostate cancer. This article describes a qualitative systematic review and synthesis examining men's experience of and need for supportive care. Seven databases were searched; 20 journal articles were identified and critically appraised. A thematic synthesis was conducted in which descriptive themes were drawn out of the data. These were peer support, support from partner, online support, cancer specialist nurse support, self-care, communication with health professionals, unmet needs (emotional support, information needs, support for treatment-induced side effects of incontinence and erectile dysfunction) and men's suggestions for improved delivery of supportive care. This was followed by the development of overarching analytic themes which were: uncertainty, reframing, and the timing of receiving treatment, information and support. Our results show that the most valued form of support men experienced following diagnosis was one-to-one peer support and support from partners. This review highlights the need for improved access to cancer specialist nurses throughout the care pathway, individually tailored supportive care and psychosexual support for treatment side effects. [ABSTRACT FROM AUTHOR]

What is already known about this subject Approximately one-fifth of children in the UK are obese., There are currently few, effective interventions available in the UK., There are very little data on relative cost-effectiveness of childhood obesity interventions, which hampers the commissioning of future services., What this study adds Simple multi-component obesity interventions can be provided at relatively low cost per 0.1 body mass index standard deviation score ( BMI SDS) improvement., More intensive and effective interventions incur greater cost per 0.1 BMI SDS reduction but this may be justified given the improved overall BMI SDS reduction attained., Objective To describe the costs and outcomes of three models of care for childhood obesity previously evaluated in two 2-arm pilot randomized trials in England. The treatments were (i) a hospital clinic (control in both trials), comprising a multidisciplinary team of consultant, dietitian and exercise specialist; (ii) a nurse-led primary care clinic replicating the service provided by the hospital and (iii) an intensive intervention using Mandometer®, a behaviour modification tool aimed at encouraging slower eating and better recognition of satiety. Method Patient-level data on resources used to deliver each intervention were collected during the trials. Apart from the cost of the Mandometer® the majority of cost was staff time, dependent on discipline and grade. Outcome for both trials was body mass index standard deviation score ( BMI SDS) measured at 12 months. Results Cost and outcome data were available for 143 children in total. Cost per child was £1749 ( SD £243) in the Mandometer® group, £301 (£76) in the primary care group, and £263 (£88) and £209 (£81) in the hospital groups. Mean reduction in BMI SDS was 0.40 (0.35), 0.17 (0.26), 0.15 (0.25) and 0.14 (0.32), respectively. Conclusion Intensive management using Mandometer® was effective but costly (£432 per 0.1 reduction in BMI SDS) compared to conventional care (range £153-£173). A total of 26% children receiving conventional care achieved a clinically meaningful reduction in BMI SDS; however, use of Mandometer® training may be justified in children not responding to conventional lifestyle interventions. [ABSTRACT FROM AUTHOR]

Objective Recent studies have identified specific symptoms of ovarian cancer at all stages, raising the hope of reducing diagnostic delays. We aimed to devise a scoring system for symptoms of ovarian cancer in primary care. Design Secondary analysis of data from a case-control study. Setting Thirty-nine general practices in Exeter, mid-Devon and east Devon. Population Two hundred and twelve women with ovarian cancer and 1060 age-, sex- and practice-matched controls. Methods Conditional logistic regression was used to produce an additive scoring system and its receiver operator characteristic ( ROC) curve. Several different cut-offs were then tested using a simple costs model. Main outcome measures The ROC curve value. Results Each woman was assigned a score based on her symptoms in the year before diagnosis: we added a score for women aged ≥50 years, reflecting their increased incidence of ovarian cancer. The area under the ROC curve was 0.883 (95% confidence interval 0.853-0.912). The chosen cut-off had a sensitivity of 72.6% and a specificity of 91.3%. Conclusion This scoring system could potentially direct general practitioners to appropriate investigations for ovarian cancer on the basis of symptoms and save a substantial number of unnecessary ultrasound scans being requested. [ABSTRACT FROM AUTHOR]

Few studies have examined indoor air quality in First Nations communities and its impact on cardiorespiratory health. To address this need, we conducted a crossover study on a First Nations reserve in Manitoba, Canada, including 37 residents in 20 homes. Each home received an electrostatic air filter and a placebo filter for 1 week in random order, and lung function, blood pressure, and endothelial function measures were collected at the beginning and end of each week. Indoor air pollutants were monitored throughout the study period. Indoor PM2.5 decreased substantially during air filter weeks relative to placebo (mean difference: 37 μg/m3, 95% CI: 10, 64) but remained approximately five times greater than outdoor concentrations owing to a high prevalence of indoor smoking. On average, air filter use was associated with a 217-ml (95% CI: 23, 410) increase in forced expiratory volume in 1 s, a 7.9-mm Hg (95% CI: −17, 0.82) decrease in systolic blood pressure, and a 4.5-mm Hg (95% CI: −11, 2.4) decrease in diastolic blood pressure. Consistent inverse associations were also observed between indoor PM2.5 and lung function. In general, our findings suggest that reducing indoor PM2.5 may contribute to improved lung function in First Nations communities. [ABSTRACT FROM AUTHOR]

Background and Purpose: Morphine is an antagonist at 5-HT(3) A receptors. 5-HT(3) and opioid receptors are expressed in many of the same neuronal pathways where they modulate gut motility, pain and reinforcement. There is increasing interest in the 5-HT3B subunit, which confers altered pharmacology to 5-HT(3) receptors. We investigated the mechanisms of inhibition by morphine of 5-HT(3) receptors and the influence of the 5-HT3B subunit.Experimental Approach: 5-HT-evoked currents were recorded from voltage-clamped HEK293 cells expressing human 5-HT3A subunits alone or in combination with 5-HT3B subunits. The affinity of morphine for the orthosteric site of 5-HT(3) A or 5-HT(3) AB receptors was assessed using radioligand binding with the antagonist [(3) H]GR65630.Key Results: When pre-applied, morphine potently inhibited 5-HT-evoked currents mediated by 5-HT(3) A receptors. The 5-HT3B subunit reduced the potency of morphine fourfold and increased the rates of inhibition and recovery. Inhibition by pre-applied morphine was insurmountable by 5-HT, was voltage-independent and occurred through a site outside the second membrane-spanning domain. When applied simultaneously with 5-HT, morphine caused a lower potency, surmountable inhibition of 5-HT(3) A and 5-HT(3) AB receptors. Morphine also fully displaced [(3) H]GR65630 from 5-HT(3) A and 5-HT(3) AB receptors with similar potency.Conclusions and Implications: These findings suggest that morphine has two sites of action, a low-affinity, competitive site and a high-affinity, non-competitive site that is not available when the channel is activated. The affinity of morphine for the latter is reduced by the 5-HT3B subunit. Our results reveal that morphine causes a high-affinity, insurmountable and subunit-dependent inhibition of human 5-HT(3) receptors. [ABSTRACT FROM AUTHOR]

Aims: Empagliflozin is a selective sodium glucose cotransporter-2 (SGLT-2) inhibitor in clinical development for the treatment of type 2 diabetes mellitus. This study assessed pharmacological properties of empagliflozin in vitro and pharmacokinetic properties in vivo and compared its potency and selectivity with other SGLT-2 inhibitors. Methods: [14C]-alpha-methyl glucopyranoside (AMG) uptake experiments were performed with stable cell lines over-expressing human (h) SGLT-1, 2 and 4. Two new cell lines over-expressing hSGLT-5 and hSGLT-6 were established and [14C]-mannose and [14C]-myo-inositol uptake assays developed. Binding kinetics were analysed using a radioligand binding assay with [3H]-labelled empagliflozin and HEK293-hSGLT-2 cell membranes. Acute in vivo assessment of pharmacokinetics was performed with normoglycaemic beagle dogs and Zucker diabetic fatty (ZDF) rats. Results: Empagliflozin has an IC50 of 3.1 nM for hSGLT-2. Its binding to SGLT-2 is competitive with glucose (half-life approximately 1 h). Compared with other SGLT-2 inhibitors, empagliflozin has a high degree of selectivity over SGLT-1, 4, 5 and 6. Species differences in SGLT-1 selectivity were identified. Empagliflozin pharmacokinetics in ZDF rats were characterised by moderate total plasma clearance (CL) and bioavailability (BA), while in beagle dogs CL was low and BA was high. Conclusions: Empagliflozin is a potent and competitive SGLT-2 inhibitor with an excellent selectivity profile and the highest selectivity window of the tested SGLT-2 inhibitors over hSGLT-1. Empagliflozin represents an innovative therapeutic approach to treat diabetes. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Flach C, Leese M, Heron J, Evans J, Feder G, Sharp D, Howard L. Antenatal domestic violence, maternal mental health and subsequent child behaviour: a cohort study. BJOG 2011;118:1383-1391. Objective To investigate the long-term impact of antenatal domestic violence on maternal psychiatric morbidity and child behaviour. Design Cohort study. Setting Avon, UK. Population or sample A birth cohort of 13 617 children and mother dyads were followed to 42 months of age. Methods Experiences of domestic violence and depressive symptoms were gathered at 18 weeks of gestation and up to 33 months after birth, together with maternal, paternal and child characteristics. Main outcome measures Child behavioural problems were assessed at 42 months using the Revised Rutter Questionnaire. Analysis Logistic regression with the use of multiple imputation employing chained equations for missing data. Results Antenatal domestic violence was associated with high levels of maternal antenatal (odds ratio [OR], 4.02; 95% confidence interval [CI], 3.4-4.8) and postnatal (OR, 1.29; 95% CI, 1.02-1.63) depressive symptoms after adjustment for potential confounders. Antenatal domestic violence predicted future behavioural problems at 42 months in the child before adjustment for possible confounding and mediating factors (OR, 1.87; 95% CI, 1.45-2.40); this association was not significant after adjustment for high levels of maternal antenatal depressive symptoms, postnatal depressive symptoms or domestic violence since birth. Conclusions Antenatal domestic violence is associated with high levels of both maternal antenatal and postnatal depressive symptoms. It is also associated with postnatal violence, and both are associated with future behavioural problems in the child at 42 months. This is partly mediated by maternal depressive symptoms in the ante- or postnatal period. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Barrett J, Sharp D, Stapley S, Stabb C, Hamilton W. Pathways to the diagnosis of ovarian cancer in the UK: a cohort study in primary care. BJOG 2010;117:610–614. Objective To identify the routes patients with ovarian cancer take between first symptom presentation and diagnosis. Design Cohort study. Setting The study took place in 39 general practices in Devon, UK. Population All ovarian cancer patients identified in the practices, with a diagnosis between 2000 and 2007 inclusive. Methods All patients had their cancer symptoms, referrals, and diagnoses identified and dated using their doctors’ records. Main outcome measures Numbers of patients taking specific routes to diagnosis, together with the time taken to diagnosis. Results Three main routes to diagnosis emerged. The first was the expected route of outpatient referral: 195 (92% of the total) had at least one of the seven ovarian cancer symptoms or an abdominal mass. A total of 123 (58%) were referred to a specialist, although only 65 (31%) were referred to a gynaecologist. Thirty-five (17%) were initially investigated within primary care by ultrasound scanning, and a further 35 (17%) were admitted as emergencies. The interval from first symptom to referral was similar across the different pathways, with a median (interquartile range) time between the first symptom presenting to primary care and first investigation or referral being 2.5 (0, 27.5) days. The median interval from first symptom reported in primary care to diagnosis was 74.5 (32, 159) days. Conclusions Only a minority of ovarian cancer patients follow the expected route to diagnosis, of urgent referral to a gynaecologist. In most women, GPs rapidly identified the need to investigate. Avoidable delays generally occurred after the decision to investigate was made. [ABSTRACT FROM AUTHOR]

Interviews of 120 British adolescents and their parents (80% of a random sample of antenatal patients drawn from a representative urban population and followed longitudinally) revealed that 40 (33%) had been arrested and/or had a diagnosis of DSM-IV conduct disorder by 16 years of age; of those, 18 (45%) had committed violent acts. Depression in pregnancy significantly predicted violence in adolescence, even after controlling for the family environment, the child's later exposure to maternal depression, the mother's smoking and drinking during pregnancy, and parents' antisocial behavior. Mothers with a history of conduct problems were at elevated risk to become depressed in pregnancy, and the offspring of depressed women had a greater chance of becoming violent by age 16. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that dealing with cancer is associated with increased stress and burnout in health-care professionals. The aim of this study is to examine the prevalence of psychiatric morbidity and burnout in surgeons working in the National Health Service (NHS), and the putative relationship between psychiatric morbidity, burnout and the amount of cancer-related work. Methods: All consultant colorectal and vascular surgeons identified from their professional societies were sent a booklet consisting of questions about cancer-related and specialty-specific work load, job satisfaction and socio-demographics. It also included the General Health Questionnaire (GHQ-12), the Maslach Burnout Inventory (MBI) and the Coping Questionnaire. Logistic regression analysis was used to identify independent predictors of psychiatric morbidity (GHQ), burnout (MBI) and retirement intentions. Results: Five hundred and one questionnaire booklets were completed and returned (response rate 58.7%). The mean age of respondents was 47 years (range 31–65). The majority of the surgeons were male (460, 92%). One hundred and sixty-three (33%) surgeons scored in the positive range of the GHQ, and 154 (32%) had high burnout on at least one subscale of the MBI. Three hundred and eighty-three (77%) surgeons stated that they intended to retire before the statutory retirement age. Level of work satisfaction and perceived adequacy of training in communication and management skills were significantly negatively correlated with GHQ and MBI scores. Surgeons who planned to take early retirement or wished to retire as soon as they could afford to were more likely to have psychiatric morbidity and/or burnout. Surgeons who were married or cohabiting were less likely to have psychiatric morbidity, and younger surgeons were more likely to have higher levels of depersonalization (DP). Work satisfaction was negatively correlated with psychiatric morbidity and all three burnout scales. Colorectal surgeons had a greater cancer-related workload than vascular surgeons (48.6 vs 7.5%, respectively, U=2667, p<0.005). However, there were no significant differences between the two groups in psychiatric morbidity, personal accomplishment and emotional exhaustion. Vascular surgeons, however, had significantly higher levels of DP (p=0.04). Conclusion: Levels of psychiatric morbidity, burnout and work dissatisfaction are worryingly high in colorectal and vascular surgeons and are likely to impact adversely on patient satisfaction and service quality. The number of surgeons intending to retire early is also a cause for concern both in terms of the overall number of trained surgeons in the NHS and in the balance between senior and junior surgeons. Apart from DP, these indicators of stress, however, were unrelated to cancer workload. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background It has been suggested that changes to the organization of the National Health Service (NHS) and clinical practices in dealing with cancer are associated with increased stress and burnout in healthcare professionals. The aim of this study, therefore, was to evaluate stress and burnout in colorectal surgeons (surgeons) and colorectal clinical nurse specialists (nurses) working in the NHS. Method A list of all consultant surgeons and nurses was obtained from The Association of Coloproctology of Great Britain and Ireland. Participants were sent a questionnaire booklet consisting of standardized measures [General Health Questionnaire (GHQ), Maslach Burnout Inventory (MBI), Coping Questionnaire] and various ad hoc questions to obtain information about demographics, cancer workload and job satisfaction. Independent predictors of clinically significant distress and burnout were identified using logistic regression. Results Four hundred and fifty-five surgeons and 326 nurses were sent booklets. The response rate was 55.6% in surgeons and 54.3% in nurses. The mean age of the nurses was lower than that of surgeons (42.8 vs 47.7, P < 0.001). Psychiatric morbidity was similar in the surgeons and nurses as assessed using the GHQ (30.2% and 30.3% respectively). On the MBI, compared with nurses, surgeons had significantly higher levels of depersonalization (17.4% vs 7.4%, P = 0.003) and lower personal accomplishment (26.6% vs 14.2%, P = 0.002). Seventy-seven per cent of surgeons and 63.4% of nurses stated their intention to retire before the statutory retirement age. Coping strategies, especially those in which respondents isolated themselves from friends and family, were associated with higher psychiatric morbidity and burnout. Dissatisfaction with work, intention to retire early, intention to retire as soon as affordable and poor training in communication and management skills were also significantly associated with high GHQ scores and burnout in both groups. Discussion We found high levels of psychiatric morbidity and burnout in this national cohort of surgeons and nurses working in the NHS. However, psychiatric morbidity and burnout were unrelated to cancer workload. Nurses have lower burnout levels than surgeons and this may be related to their different working practices, responsibilities and management structure. [ABSTRACT FROM AUTHOR]

Patients with chronic conditions are increasingly using complementary therapies. Asthma is the most common chronic disease in the UK. Qualitative research has suggested reasons why asthma patients use complementary therapies. However, there is little reliable quantitative evidence regarding the prevalence of complementary therapy use among asthma patients and predictors of use. A postal survey of complementary therapy use among asthma patients was therefore conducted via 27 general practices across seven Primary Care Trusts within the South West Strategic Health Authority (England), during August 2005 to May 2006. A total of 14,833 asthma patients were identified. A 1-in-4 random sample generated 3693 potential respondents, of whom 1320 (36%) returned questionnaires. Taking full account of the survey design, 14.5% (190/1308; 95% confidence interval 12.5% to 16.6%) had used complementary therapies for asthma; 54% of these patients had not disclosed their complementary therapy use to a health professional. The three therapies most commonly used were homeopathy, herbal medicine and relaxation. Just over half of those using complementary therapies for asthma reported that they usually or always helped; the most common reported benefits were symptom reduction, calming breathing and reducing panic. Multivariable analyses indicated an inverted U-shaped relationship between complementary therapy use for asthma and age, and increased likelihood of use among women, those with educational qualifications, those not usually helped by asthma medication, and those who have difficulty sleeping because of asthma symptoms. Dissatisfaction with conventional care was not associated with complementary therapy use for asthma. Asthma patients may use complementary therapies with or without the knowledge of their healthcare providers. Open communication between professionals and patients about complementary therapies may be valuable to give patients enhanced opportunities to discuss the impact of asthma on their quality of life and the effectiveness of their conventional treatment. [ABSTRACT FROM AUTHOR]

Objective Postoperative length of stay (LOS) is an important outcome after colorectal cancer surgery. The aim of this study was to evaluate the putative effects of personality, mood, coping and quality of life on LOS. Method A consecutive series of 110 eligible patients undergoing elective resection for colorectal cancer were invited to participate in the study. A battery of psychometric questionnaires including the Hospital Anxiety and Depression Scale, the Functional Assessment of Cancer Therapy (colorectal), the Courtauld Emotional Control Scale, the Positive and Negative Affectivity Scale and the Eysenck Personality Questionnaire (EPQ) were administered 5–12 days before surgery. Nonparametric correlations were computed for psychometric scores, demographic variables and the LOS. Factors found to be significantly correlated on this analysis were entered into a multiple regression model to determine the independent predictors of LOS. Results One hundred and four patients with colorectal cancer participated. Seventy were male (67%) and the mean age was 68 years (range 39–86). The median LOS was 10 days (range 4–108). LOS was negatively correlated with pre- and postoperative albumin levels, PANAS +ve affect, Functional Assessment of Cancer Therapy questionnaire with the colorectal module functional well-being score and EPQ extroversion score. LOS was strongly positively correlated with postoperative morbidity. LOS was positively correlated with CECS anger score, age and being male. Postoperative morbidity ( β = 0.379, P = 0.007) and extroversion ( β = −0.318, P = 0.05) were independent predictors of LOS. Conclusion Personality as measured by EPQ predicts postoperative LOS in patients with colorectal cancer. Extroverts have a higher pain threshold and this may be part of the explanation. [ABSTRACT FROM AUTHOR]

Objective Multidisciplinary teams (MDTs) are an integral part of the National Cancer Plan. However, there is surprisingly little empirical research on how these are perceived by colorectal surgeons (CRSs) and colorectal clinical nurse specialists (CNSs). The purpose of this study therefore was to obtain the views of a national cohort of CRSs and CNSs regarding various important aspects of MDT functioning and role of CNS in current setting. Method Two hundred and fifty-three CRSs and 177 CNSs, identified from the Association of Coloproctologists of Great Britain and Ireland, responded to an ad hoc postal questionnaire. Results 96.5% of respondents considered that MDTs improved the overall quality of care of colorectal cancer patients, and 78.6% thought MDTs were good for their morale. Eighty per cent considered that they improved training. Seventy-three per cent of surgeons and nurses thought that MDTs were cost effective, and 89% did not consider them to be a passing fad. However, more than half (50.4%) of the CRSs and 35.2% of the CNSs stated that their job plan did not contain adequate time to attend MDT meetings. Compared with CRSs, CNSs were significantly more likely to have positive views regarding the MDT ( P < 0.005). Conclusion CNSs and CRSs consider that colorectal MDTs have very beneficial effects on patient care, training and morale. However, many surgeons and nurse specialists consider that attendance at MDTs is not taken into account adequately in terms of their job plans, and this issue needs to be addressed. [ABSTRACT FROM AUTHOR]

Background: Vascular endothelial growth factor (VEGF) and psychosocial factors have both been shown to have independent prognostic value in colorectal cancer. Recently, an association between VEGF and psychosocial factors has been reported in patients with ovarian cancer. Methods: A consecutive series of eligible patients undergoing elective resection for colorectal cancer were invited to participate. Standardized measures of various aspects of quality of life (QoL) were administered 5–12 days before surgery, and again 6–8 weeks after the operation, blood samples were obtained at the same times. Solid phase ELISA was used for VEGF-A analysis using serum samples. Correlations and multiple regression analysis were used to examine the relationship between VEGF and psychosocial factors. Results: One hundred and four patients with colorectal cancer were recruited. Seventy (67%) were male and the mean age was 67.6 years. A significant positive correlation was found between preoperative VEGF level and preoperative depression (r=0.227, p=0.03). Preoperative VEGF was negatively correlated with preoperative cancer-related concerns (r=-0.273, p=0.009) and positive affectivity (r=-0.219, p=0.05). Linear regression using TNM stage as a covariate showed that cancer-related concerns were an independent predictor of preoperative VEGF levels (p=0.02). Preoperative cancer-related concerns and global QoL were negatively correlated with postoperative VEGF (r=-0.381, p=0.001, r=-0.264, p=0.005), whereas preoperative depression correlated positively with postoperative VEGF (r=0.333, p=0.003). Linear regression analysis showed that preoperative HADS depression (p=0.005) and cancer-related concerns (p=0.002) were independent predictors of postoperative VEGF levels. Postoperative VEGF was significantly correlated with postoperative anxiety (r=0.249, p=0.02), depression (r=0.289, p=0.01), and functional well-being (r=-0.242, p=0.03). Linear regression analysis showed that postoperative anxiety (p=0.048), depression (p=0.013) and functional well-being (p=0.046) independently predicted postoperative VEGF-A levels. Conclusion: Various psychosocial factors, particularly cancer-related concerns and depression, appear to be related to preoperative and postoperative VEGF level in patients with newly diagnosed colorectal cancer. However, the clinical significance of these findings needs to be addressed in longitudinal follow-up studies of recurrence and survival. Future prognostic studies involving VEGF and related cytokines should assess psychosocial variables at various time points and include these in a multivariate analysis of outcomes. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

BACKGROUND: Variable- and person-centred analyses were used to examine prediction of middle childhood behaviour problems from earlier child and family measures. METHOD: A community sample of 164 families, initially recruited at antenatal clinics at two South London practices, was assessed for children's behaviour problems and cognitive ability, maternal mental health, and the family environment when the children were 4 years old. At age 11, children, mothers, and teachers reported the child's disruptive behaviour, and mothers and children were interviewed to identify cases of disruptive behaviour disorders (DBD). RESULTS: Neither social class nor ethnicity predicted the child's disruptive behaviour at age 11. Rather, path analyses and logistic regression analyses drew attention to early behavioural problems, maternal mental health and the child's cognitive ability at 4 as predictors of disruptive behaviour at age 11. Cluster analysis extended these findings by identifying two distinct pathways to disruptive symptoms and disorder. In one subgroup children who showed intellectual difficulties at 4 had become disruptive by 11. In a second subgroup mothers and children both showed psychological problems when the child was 4, and the children were disruptive at age 11. The person-centred approach also revealed a high-functioning group of cognitively able 4-year-olds in supportive environments, at especially low risk for DBD. CONCLUSIONS: Combining variable- and person-centred analytic approaches can aid prediction of children's problems, draw attention to pertinent developmental pathways, and help integrate data from multiple informants. [ABSTRACT FROM AUTHOR]

Episodes of mental healthcare in specialist psychiatric services often begin with the assessment of clinical and psychosocial needs of patients by healthcare professionals. Particularly for patients with complex needs or severe problems, ratings of clinical and social functioning at the start of each episode of care may serve as a baseline against which subsequent measures can be compared. Currently, little is known about service variations in such assessments on referrals from primary care. We set out to quantify variability in initial assessments performed by healthcare professionals in three CMHTs in Bristol (UK) using the Health of the Nation Outcome Scales (HoNOS). We tested the hypothesis that variations in HoNOS total and sub-scale scores are related to referral source (general practices), healthcare assessor (in CMHTs) and the assessor's professional group. Statistical analysis was performed using multilevel variance components models with cross-classified random effects. We found that variation due to assessor substantially exceeded that due to referral source (general practices). Furthermore, patient variance differed by assessor profession for the HoNOS - Impairment scores. Assessor variance differed by assessor profession for the HoNOS - Social scores. As HoNOS total and subscale scores show much larger variation by assessor than by referral source, investigations of HoNOS scores must take assessors into account. Services should implement and evaluate interdisciplinary training to improve consistency in use of rating thresholds; such initiatives could be evaluated using these extensions of multilevel models. Future research should aim to integrate routine diagnostic data with continuous outcomes to address selection effects (of patients to assessors) better. [ABSTRACT FROM AUTHOR]

Panic disorder and agoraphobia is a prevalent clinical condition which places heavy demands on treatment resources in primary care. The efficient delivery of evidence-based psychological treatment for this disorder is therefore important. Previous research has investigated both individual and group treatment formats for cognitive behaviour therapy (CBT) for panic disorder and agoraphobia. These two modalities of treatment delivery are, however, rarely compared within the same study format. Also little is known of patients' preferences regarding treatment delivery formats. The present study investigated the relative efficacy of a group treatment CBT and an individual treatment CBT in comparison with a waiting list control group in the treatment of panic disorder with or without agoraphobia in primary care. Ninety-seven patients suffering from DSM-IV panic disorder with or without agoraphobia were randomly allocated to receive either group CBT, individual CBT, or waiting list control. All patients were seen by the same therapist and all received an identical treatment manual. Treatment response was measured by blind assessor, therapist and patient-rated measures of anxiety, depression, and agoraphobic avoidance, and was analysed in terms of both traditional statistical significance and clinical significance of outcome. At treatment end-point, in terms of traditional statistical significance, both the group and individual CBT were significantly superior to waiting list control but did not differ significantly from each other. When clinical significance of outcome at treatment end-point was considered, individual CBT showed a significant advantage over both group CBT and waiting list control. At 3-month follow-up, however, the individual CBT treatment group showed significant superiority to the group CBT treatment on clinical significance of outcome on one outcome measure only. This was principally due to a reduction in the proportion of patients achieving criteria of clinically significant change in the individual CBT treatment group over the 3-month follow-up period. When given a free choice of group or individual CBT at the end of the waiting list period, the overwhelming majority (95%) of the waiting list patients chose individual CBT. The implications of these findings for future research and for wider clinical practice are discussed. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives – Our objectives were to quantify glial fibrillary acidic protein (GFAP) in brains of Alzheimer's disease (AD) cases, and non-AD controls to determine the regions with the most severe gliosis in AD. Material and methods – In a case–control design, we used an enzyme-linked immunosorbent assay (ELISA) to quantify GFAP in frozen brain from four areas of neocortex in 10 AD cases, 10 age-matched controls, and 10 younger controls from the Honolulu-Asia Aging Study autopsy archive. Results – Median age at death was 83.5 years for cases and age-matched controls, and 77 years for younger controls. For the AD cases compared with the age-matched controls, levels of GFAP in occipital (P =0.01), parietal (P =0.028), and temporal lobes (P =0.004) (but not frontal) were significantly higher in the cases. The median GFAP excess in AD cases compared with age matched controls was highest in the temporal lobe. Conclusions – Regional quantification of GFAP reveals that the glial response is most prominent in the temporal lobe in AD. [ABSTRACT FROM AUTHOR]

Objective To identify and summarize rigorous evaluations of psychosocial and educational interventions aimed at the primary prevention of alcohol misuse by young people aged up to 25 years, especially over the longer term (>3 years). Methods Cochrane Collaboration Systematic Review. Data sources A comprehensive search of 22 databases and recursive checking of bibliographies for randomized and non-randomized controlled trials and interrupted time-series studies. Main outcome measures Objective or self-report measures of alcohol use and misuse. Results Fifty-six studies were selected for inclusion in the systematic review. Twenty of the 56 studies showed evidence of ineffectiveness. No firm conclusions about the effectiveness of prevention interventions in the short- and medium term were possible. Over the longer term (>3 years), the Strengthening Families Programme (SFP) showed promise as an effective prevention intervention. The Number Needed to Treat (NNT) for the SFP over 4 years for three alcohol initiation behaviours (alcohol use, alcohol use without permission and first drunkenness) was 9 (for all three behaviours). One study also highlighted the potential value of culturally focused skills training over the longer-term (NNT= 17 over 3.5 years for 4+ drinks in the last week) Conclusions (1) Research into important outcome variables needs to be undertaken; (2) the methodology of evaluations needs to be improved; (3) the SFP needs to be evaluated on a larger scale and in different settings; (4) culturally focused interventions require further development and rigorous evaluation; and (5) an international register of alcohol and drug misuse prevention interventions should be established and criteria agreed for rating prevention interventions in terms of safety, efficacy and effectiveness. [ABSTRACT FROM AUTHOR]

Panic disorder with or without agoraphobia is a prevalent clinical disorder which places heavy demands on treatment resources in primary care. The efficiency of delivery of psychological treatments for this disorder is therefore important. Previous research has focused on psychological treatments delivered with reduced therapist contact but methodological problems preclude firm conclusions. The present study investigated the relevance of therapist contact in cognitive behaviour therapy for panic disorder and agoraphobia, taking account of previous methodological problems. One hundred and four patients suffering from DSM III-R panic disorder with or without agoraphobia were randomly allocated to receive cognitive behaviour therapy with either, ‘standard’ therapist contact, ‘minimum’ therapist contact or as a bibliotherapy. All patients were seen by the same therapist and all received an identical treatment manual. Treatment response, as measured by patient and therapist report scales of anxiety, depression, and agoraphobic avoidance, was analysed in terms of both traditional statistical significance and clinical significance of outcome. At treatment end-point the ‘standard’ therapist contact and ‘minimum’ therapist contact groups showed significant reductions pre- to post-treatment on all measures. Pre- to post-treatment reductions for the bibliotherapy group were significant on therapist- and patient-rated measures of anxiety only. The ‘standard’ therapist contact group was consistently significantly improved in comparison to the bibliotherapy group. Significant differences between the ‘standard’ and ‘minimum’ therapist contact groups were found on therapist-rated anxiety only. Assessment of clinical significance of treatment outcome showed further differences between treatment groups with the ‘standard’ therapist contact group showing the largest proportion of patients achieving clinically significant change on all measures both at treatment end-point and at 6-month follow-up. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The ability to predict post-treatment response on indices of pre-treatment condition is likely to have considerable clinical utility. Previous attempts to identify prognostic indicators are reviewed and methodological problems in such research discussed. The present study attempts improvements in study methodology including the use of standardized measures of outcome and predictor variables, and the controlled definition of the clinical significance of treatment outcome. In a sample of n =149 patients with DSM III-R panic disorder with and without agoraphobia, logistic regression analyses were used to predict clinically significant versus non-significant outcome following treatment with fluvoxamine, placebo and cognitive behaviour therapy used alone and in combination. Findings indicated good prediction of post-treatment response with predictor variables measuring anxiety level, frequency of panic attacks and extroversion all showing some predictive value over and above that found for treatment received. Prediction of outcome at 6 month follow-up was less impressive. Possible reasons for this are discussed. Copyright © 1999 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This study examined demographic characteristics of tobacco-using high school students in the United States from 1991 through 1995. Data about cigarette smoking and smokeless tobacco use among adolescent were collected in 1991, 1993, and 1995 using the Youth Risk Behavior Survey, part of the Youth Risk Behavior Surveillance System implemented by the Centers for Disease Control and Prevention. Data indicated current smoking increased 26.5% from 1991 to 1995 with one-third [31.2% (+/- 1.7)] of ninth grade students and 38.2% (+/- 3.5) of 12th grade students reporting current smoking in 1995. Smokeless tobacco use remained stable with 11.4% (+/- 1.7) of all students and one-fourth [25.1% (+/- 3.0)] of White male students reporting smokeless tobacco use in 1995. Many students already have begun using tobacco before reaching high school. Thus, interventions should begin well before high school to prevent adolescents from using and becoming addicted to tobacco. [ABSTRACT FROM AUTHOR]

There is evidence of increased alcohol consumption by young people. This review concentrates on the British epidemiological and psychological studies of adolescent drinking behaviour, with special reference to the cultural and developmental aspects. It is clear that drinking alcohol may be considered a normal part of adolescence and many young people are introduced to it by their parents. However, one area of concern is the amount of drunkenness reported. The way forward is to gain new insights into what drinking means to adolescents and how such meanings are propagated. [ABSTRACT FROM AUTHOR]

Purpose: The reported rates of incomplete excision of non-melanoma skin cancers varies widely (5–25%) among published literature. This study aims to compare the rate of incomplete excision of non-melanoma skin cancers performed by a plastic surgeon, skin cancer clinic and general surgery department in Toowoomba, Queensland. It also evaluates factors that affect the rate of incomplete excision. Methodology: Consecutive primary excisions of non-melanoma skin cancers were analysed for a six month period between 1 January 2008 and 30 June 2008 for three separate groups: plastic surgeon, skin cancer clinic and the general surgery department. The variables studied were age and gender of patients, histology, tumour site and size, adequacy of excision and method of repair. Results: A total of 663 skin cancers were excised between the three groups consisting of 392 basal cell carcinomas and 271 squamous cell carcinomas. The incomplete excision rates for the three groups were: plastic surgeon (6.1%), skin cancer clinic (5.2%) and general surgery department (12.9%). The incomplete excision rate between the general surgery department and other two groups was statistically significant (p < 0.03). Conclusions: Although the rate of incomplete excision was higher in the general surgery department, all three groups compare favourably with reported figures in the literature. Given that Queensland has one of the highest incidences of skin cancer in the world, the disparity between the groups could be examined further, with consideration given to the complexity of excisions being performed in the hospital setting. [ABSTRACT FROM AUTHOR]