Oral Cavity and Pharynx Cancer Incidence Trends by Subsite in the United States: Changing Gender Patterns

Objective. To evaluate oral cavity and pharynx cancer (OCPC) patterns by gender. Methods. We used Surveillance, Epidemiology, and End Results program data for 71,446 cases diagnosed during 1975–2008 to classify OCPC by anatomic subsite as potentially HPV-related or not, with oral tongue cancer considered a separate category. Results. Total OCPC rates among men were 2–4 times those among women. Among whites, total OCPC rates rose in the younger age groups due to substantial increases in successive birth cohorts for HPV-related cancers, more rapid among men than women, and oral tongue cancers, more rapid among women than men. Among blacks, total OCPC rates declined among cohorts born since 1930 reflecting the strong downward trends for HPV-unrelated sites. Among Hispanics and Asians, HPV-unrelated cancer rates generally declined, and oral tongue cancer rates appeared to be converging among young men and women. Conclusions. Decreases in total OCPC incidence reflect reductions in smoking and alcohol drinking. Rising HPV-related cancers among white men may reflect changing sexual practices. Reasons for the increasing young oral tongue cancer rates are unknown, but the narrowing of the gender differences provides a clue

Becoming an older volunteer: A grounded theory study.

This Grounded Theory study describes the process by which older persons “become” volunteers. Forty interviews of older persons who volunteered for Habitat for Humanity were subjected to secondary content analysis to uncover the process of “becoming” a volunteer. “Helping out” (core category) for older volunteers occurs within the context of “continuity”, “commitment” and “connection” which providemotivation for volunteering.When a need arises, older volunteers “help out” physically and financially as health and resources permit. Benefits described as “blessings” of volunteering become motivators for future volunteering. Findings suggest that older volunteering is a developmental process and learned behavior which should be fostered in older persons by personally inviting them to volunteer. Intergenerational volunteering projects will allow older persons to pass on knowledgeand skills and provide positive role modeling for younger volunteers

Very Early Arterial Ischemic Stroke in Premature Infants

Early stroke in the premature infant has rarely been described. Presented here are the cases of 23 infants, born between 23 and 35 weeks gestational age, with focal arterial ischemic stroke occurring before 44 weeks gestational age. Ten (43%) were male. Five children (22%) were half of a twin pair; no co-twin died. The most commonly affected territory was the middle cerebral artery territory. Three children with extreme prematurity (≤26 weeks) had cerebellar infarcts. Twelve children had unilateral or bilateral intraventricular hemorrhages (grade 3 or higher in 8 of the 12). Twelve children had white matter injury: periventricular leukomalacia, hypoxic-ischemic encephalopathy, or both. Most children had multiple comorbidities, and the median neonatal intensive care unit stay was 63 days (range, 14-365). One child died in the neonatal intensive care unit (age 123 days). All 22 survivors were left with disabilities. Seventeen (77%) had cerebral palsy, 10 (45%) had epilepsy, and 17 (77%) had cognitive impairment. Arterial ischemic stroke appears to add to the neurologic disabilities commonly associated with prematurity

Attitude shifts and knowledge gains: Evaluating men who have sex with men sensitisation training for healthcare workers in the Western Cape, South Africa

Background: Men who have sex with men (MSM) in South Africa experience discrimination from healthcare workers (HCWs), impeding health service access.Objectives: To evaluate the outcomes of an MSM sensitisation training programme for HCWs implemented in the Western Cape province (South Africa).Methods: A training programme was developed to equip HCWs with the knowledge, awareness and skills required to provide non-discriminatory, non-judgemental and appropriate services to MSM. Overall, 592 HCWs were trained between February 2010 and May 2012. Trainees completed self-administered pre- and post-training questionnaires assessing changes in knowledge. Two-sample t-tests for proportion were used to assess changes in specific answers and the Wilcoxon rank-sum test for overall knowledge scores. Qualitative data came from anonymous post-training evaluation forms completed by all trainees, in combination with four focus group discussions (n = 28) conducted six months after their training.Results: Fourteen per cent of trainees had received previous training to counsel clients around penile–anal intercourse, and 16% had previously received training around sexual health issues affecting MSM. There was a statistically significant improvement in overall knowledge scores (80% – 87%, p < 0.0001), specifically around penile–anal intercourse, substance use and depression after the training. Reductions in negative attitudes towards MSM and increased ability for HCWs to provide non-discriminatory care were reported as a result of the training.Conclusion: MSM sensitisation training for HCWs is an effective intervention to increase awareness on issues pertaining to MSM and how to engage around them, reduce discriminatory attitudes and enable the provision of non-judgemental and appropriate services by HCWs

Believing is achieving: a longitudinal study of self-efficacy and positive affect in resettled refugees

Research has shown that self-efficacy can play an important role in recovery from trauma (Benight and Bandura 2004). We hypothesised that for refugees, whose (often traumatic) experiences pre- and post-resettlement have been linked to a decrease in their wellbeing (e.g., Aspinall and Watters 2010), self-efficacy would play a key role in improving wellbeing. This paper investigates the link between self-efficacy and positive affect among resettled refugees (N = 180). Research used mixed methods. The longitudinal survey with three time points confirmed that higher levels of general self-efficacy were consistently associated with better positive affect at later time points. The reverse effects, from positive affect to later self-efficacy, were not significant. In addition, qualitative interviews with a subsample provide suggestions as to how self-efficacy of refugees might be improved: that is, by improving access to employment and language classes, by clarifying how British social and cultural systems work, including the practical information necessary to navigate daily life, and by providing more opportunities to increase social networks, all suggesting the necessity of a proactive role of the receiving society

The Metropolis and Evangelical Life: Coherence and Fragmentation in the ‘Lost City of London’

This article examines the interplay of different processes of cultural and subjective fragmentation experienced by conservative evangelical Anglicans, based on an ethnographic study of a congregation in central London. The author focuses on the evangelistic speaking practices of members of this church to explore how individuals negotiate contradictory norms of interaction as they move through different city spaces, and considers their response to tensions created by the demands of their workplace and their religious lives. Drawing on Georg Simmel’s ‘The Metropolis and Mental Life’, the author argues that their faith provides a sense of coherence and unity that responds to experiences of cultural fragmentation characteristic of everyday life in the city, while simultaneously leading to a specific consciousness of moral fragmentation that is inherent to conservative evangelicalism

Standing Genetic Variation in Contingency Loci Drives the Rapid Adaptation of Campylobacter jejuni to a Novel Host

The genome of the food-borne pathogen Campylobacter jejuni contains multiple highly mutable sites, or contingency loci. It has been suggested that standing variation at these loci is a mechanism for rapid adaptation to a novel environment, but this phenomenon has not been shown experimentally. In previous work we showed that the virulence of C. jejuni NCTC11168 increased after serial passage through a C57BL/6 IL-10-/- mouse model of campylobacteriosis. Here we sought to determine the genetic basis of this adaptation during passage. Re-sequencing of the 1.64Mb genome to 200-500X coverage allowed us to define variation in 23 contingency loci to an unprecedented depth both before and after in vivo adaptation. Mutations in the mouse-adapted C. jejuni were largely restricted to the homopolymeric tracts of thirteen contingency loci. These changes cause significant alterations in open reading frames of genes in surface structure biosynthesis loci and in genes with only putative functions. Several loci with open reading frame changes also had altered transcript abundance. The increase in specific phases of contingency loci during in vivo passage of C. jejuni, coupled with the observed virulence increase and the lack of other types of genetic changes, is the first experimental evidence that these variable regions play a significant role in C. jejuni adaptation and virulence in a novel host

The environmental stress sensitivities of pathogenic Candida species, including Candida auris, and implications for their spread in the hospital setting

We are grateful to Dr. David Stead, Evelyn Argo and Craig Pattison (Aberdeen Proteomics Core Facility) for their expert identification of Candida isolates by MALDI ToF MS, and to Dr Jill King and our colleagues in the Aberdeen Fungal Group for their helpful advice. AJPB and NARG were supported by a programme grant from the Medical Research Council [www.mrc.ac.uk] (grant number MR/M026663/1) and by the Medical Research Council Centre for Medical Mycology and the University of Aberdeen (grant number MR/N006364/1). AJPB was also supported by the UK Biotechnology and Biological Research Council [www.bbsrc.ac.uk] (grant numbers BB/F00513X/1, BB/P020119/1), and AWW by the Scottish Government’s Rural and Environment Science and Analytical Services (RESAS) division. NARG was also supported by grants from the Wellcome Trust [www.wellcome.ac.uk] (grant numbers 075470, 086827, 093378, 097377, 099197, 101873, 102705, 200208). DMM was supported by National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs) [www.nc3rs.org.uk] (grant numbers NC/S001557/1 and NC/N002482/1) and the UK Biotechnology and Biological Research Council [www.bbsrc.ac.uk] (grant number BB/P02050X/1). HH was supported by the John Duthie Scholarship from the University of Aberdeen’s Development Trust. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

National Standards for Diabetes Self-Management Education

Diabetes self-management education (DSME) is a critical element of care for all people with diabetes and is necessary in order to improve patient outcomes. The National Standards for DSME are designed to define quality diabetes self-management education and to assist diabetes educators in a variety of settings to provide evidence-based education. Because of the dynamic nature of health care and diabetes-related research, these Standards are reviewed and revised approximately every 5 years by key organizations and federal agencies within the diabetes education community. A Task Force was jointly convened by the American Association of Diabetes Educators and the American Diabetes Association in the summer of 2006. Additional organizations that were represented included the American Dietetic Association, the Veteran's Health Administration, the Centers for Disease Control and Prevention, the Indian Health Service, and the American Pharmaceutical Association. Members of the Task Force included a person with diabetes; several health services researchers/behaviorists, registered nurses, and registered dietitians; and a pharmacist. The Task Force was charged with reviewing the current DSME standards for their appropriateness, relevance, and scientific basis. The Standards were then reviewed and revised based on the available evidence and expert consensus. The committee convened on 31 March 2006 and 9 September 2006, and the Standards were approved 25 March 2007