Intergenerational Communication: Its Effect on Early Screening Activities in African-American Adult Daughters of Mothers with Breast Cancer

Health communication at numerous levels is vital to sustainability of healthy individuals. The notion of African-American mothers and adult daughters sharing breast health and breast cancer knowledge openly and honestly could be the initial step in addressing the high morbidity and mortality that continues to affect this population. Communication is a variable that has yet to be studied between African-American mothers diagnosed with breast cancer and their adult daughters. This study first examined whether this relationship existed, and secondly if it was strong enough in supporting and encouraging one another towards consistent breast health and breast cancer screening activities. The research also looked at whether knowledge, risk perception, self-efficacy, and communication were moderated by age, income, education, and employment status. In addition, the investigator assessed connectedness, interdependence, and trust in hierarchy subscales as utilized in the Mother and Adult-Daughter Questionnaire. Health care providers have yet been able to affect change in the overwhelming mortality rate in African-American women with breast cancer disease. The purpose of this descriptive, quantitative, feasibility study was to evaluate the affects of knowledge, risk perception, communication, self-efficacy, connectedness, interdependence, trust in hierarchy, and to identify independent variables most likely to encourage behavior change in adult daughters. The conceptual framework for this study was based on the Theory of Reasoned Action. Descriptive statistics, t-tests, contingency tables using chi square, and correlations were used to analyze data from a sample of 16 African-American mothers with breast cancer and their adult daughters without a diagnosis of breast cancer. This study found a positive correlation between mother- and adult daughter relationships and encouragement by mothers for their adult daughters to participate in breast health activities with this particular sample. As a feasibility study, the sample size prevented results with statistical power. Further studies are needed to fully appreciate the extent of this phenomenon

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Poetics and Politics of Shame in Postcolonial Literature

Poetics and Politics of Shame in Postcolonial Literature provides a new and wide-ranging appraisal of shame in colonial and postcolonial literature in English. Confronting the obscenity of the in-human, both in the colonial setting and in aftermaths that show little sign of abating, it entails the acute significance of shame as a subject for continuing and urgent critical attention. The essays included in it tackle shame and racism, shame and agency, shame and ethical recognition, the problem of shamelessness, the shame of willed forgetfulness. Linked by a common thread of reflections on shame and literary writing, they consider specifically whether the aesthetic and ethical capacities of literature enable a measure of stability or recuperation in the presence of shame\u2019s destructive potential. Cogently (see the Introduction, in particular), the question of how the relation of postcolonial literature to shame is to be qualified with respect to all other literature is given due emphasis. Chapters contributed (in their order) by David Attwell, Susanna Zinato, Rita Barnard, Sue Kossew, Annalisa Pes, Dolores Herrero, David Callahan, Angelo Righetti, Vincent Van Bever Donker. Afterword by Timothy Bewes