Is health care seeking behaviour affected by response to chest pain amongst South Asians and Whites?

Coronary heart disease (CHD) is the leading cause of death in the UK. Despite this declines in death rates have been experienced within the UK since the 1970’s but these declines have not been experienced by South Asians. Studies on access have highlighted inconsistencies between South Asians and Whites. The present study was conducted to explore factors which may affect health care seeking behaviour following symptoms of angina amongst South Asians and Whites. 40 face to face interviews were conducted using a purposive sample from a quantitative survey (Chaturvedi et al, 1997). This sub-sample consisted of White and South Asian male and female participants aged between 35-55 years. A further 4 focus groups were conducted with another purposive sample of White and South Asian males and females aged between 35-55 years. This second sample was selected using the same sampling frame (Chaturvedi et al, 1997). Focus groups were only conducted with those participants who had not taken part in the individual face to face interviews. The individual face to face interviews consisted of 10 South Asian male and 10 South Asian female participants and 10 White male and 10 White female participants. The focus groups consisted of 5-6 participants each. The focus groups were homogenous for ethnicity and sex. The epistemological framework used to guide the analysis was social constructionism. Results indicated that trust was an important factor which affected health care seeking behaviour amongst South Asians and Whites. South Asians had high trust of their GP, were over reliant on the GP and had lower expectations following chest pain. White participants had low trust of their GP, were less reliant on the GP and had high expectation following symptoms of chest pain. Issues of trust affected response to symptoms of angina, with Whites stating that they were less likely to delay seeking health care during an acute crisis compared to South Asians who stated they would phone the GP for advice before going to A&E. Conclusion Access to appropriate health care following chest pain is likely to result from patient related factors which include response to chest pain, expectation from the health service following chest pain and most importantly an overly trusting GP patient relationship

Feedback from the heart: emotional learning and memory is controlled by cardiac cycle, interoceptive accuracy and personality

Feedback processing is critical to trial-and-error learning. Here, we examined whether interoceptive signals concerning the state of cardiovascular arousal influence the processing of reinforcing feedback during the learning of ‘emotional’ face-name pairs, with subsequent effects on retrieval. Participants (N = 29) engaged in a learning task of face-name pairs (fearful, neutral, happy faces). Correct and incorrect learning decisions were reinforced by auditory feedback, which was delivered either at cardiac systole (on the heartbeat, when baroreceptors signal the contraction of the heart to the brain), or at diastole (between heartbeats during baroreceptor quiescence). We discovered a cardiac influence on feedback processing that enhanced the learning of fearful faces in people with heightened interoceptive ability. Individuals with enhanced accuracy on a heartbeat counting task learned fearful face-name pairs better when feedback was given at systole than at diastole. This effect was not present for neutral and happy faces. At retrieval, we also observed related effects of personality: First, individuals scoring higher for extraversion showed poorer retrieval accuracy. These individuals additionally manifested lower resting heart rate and lower state anxiety, suggesting that attenuated levels of cardiovascular arousal in extraverts underlies poorer performance. Second, higher extraversion scores predicted higher emotional intensity ratings of fearful faces reinforced at systole. Third, individuals scoring higher for neuroticism showed higher retrieval confidence for fearful faces reinforced at diastole. Our results show that cardiac signals shape feedback processing to influence learning of fearful faces, an effect underpinned by personality differences linked to psychophysiological arousal

A network-based analysis of the preterm adolescent brain using PCA and graph theory

The global increase in the rate of premature birth is of great concern since it is associated with an increase in a wide spectrum of neurologic and cognitive disorders. Neuroimaging analyses have been focused on white matter alterations in preterm subjects and findings have linked neurodevelopment impairment to white matter damage linked to premature birth. However, the trajectory of brain development into childhood and adolescence is less well described. Neuroimaging studies of extremely preterm born subjects in their adulthood are now available to investigate the long-term structural alterations of disrupted neurodevelopment. In this paper, we examine white matter pathways in the preterm adolescent brain by combining state-of-the-art diffusion techniques with graph theory and principal component analysis (PCA). Our results suggest that the pattern of connectivity is altered and differences in connectivity patterns result in more vulnerable premature brain network

Acceptability and perceived utility of different diagnostic tests and sample types for trachoma surveillance in the Bijagos Islands, Guinea Bissau

BACKGROUND: Trachoma is the leading infectious cause of blindness worldwide and is nearing elimination as a public health problem in Guinea Bissau. It is imperative that elimination is followed by a successful postvalidation surveillance programme. The aim of this study was to determine the acceptability and perceived utility of different diagnostic tests and sample types that could be used for postvalidation trachoma surveillance in the Bijagos Islands, Guinea Bissau. METHODS: Semistructured interviews with community members and stakeholders involved in trachoma elimination were followed by focus group discussions with community members, covering experiences with trachoma and views on trachoma diagnostic methods and sample types. RESULTS: In this setting, all diagnostic tests and sample types used for trachoma surveillance were generally considered acceptable by communities. A preference for laboratory-based testing and finger-prick blood samples was expressed as these results were considered more accurate and applicable to a range of diseases beyond trachoma. CONCLUSIONS: Appropriate community and stakeholder engagement and communication regarding the purpose and processes around diagnostic practice prior to trachoma programme implementation are crucial for long-term successful disease-elimination efforts

How children eat may contribute to rising levels of obesity children's eating behaviours: An intergenerational study of family influences

The term ‘obesogenic environment’ is rapidly becoming part of common phraseology. However, the influence of the family and the home environment on children's eating behaviours is little understood. Research that explores the impact of this micro environment and intergenerational influences affecting children's eating behaviours is long overdue. A qualitative, grounded theory approach, incorporating focus groups and semi-structured interviews, was used to investigate the family environment and specifically, the food culture of different generations within families. What emerged was a substantive theory based on ‘ordering of eating’ that explains differences in eating behaviours within and between families. Whereas at one time family eating was highly ordered and structured, typified by the grandparent generation, nowadays family eating behaviours are more haphazard and less ordered, evidenced by the way the current generation of children eat. Most importantly, in families with an obese child eating is less ordered compared with those families with a normal weight child. Ordering of eating' is a unique concept to emerge. It shows that an understanding of the eating process is crucial to the development and improvement of interventions targeted at addressing childhood obesity within the family context

Elevated level of anterior gradient-2 in pancreatic juice from patients with pre-malignant pancreatic neoplasia

<p>Abstract</p> <p>Background</p> <p>Pancreatic intraepithelial neoplasias (PanINs) are precursors of malignant pancreatic cancer, an ideal stage for early cancer detection. We applied quantitative proteomics to identify aberrantly elevated proteins in pancreatic juice samples derived from patients with PanIN3.</p> <p>Results</p> <p>Twenty proteins were found elevated in all three PanIN juices by at least two-fold. Among these proteins, anterior gradient-2 (AGR2) was found to be 2-10 fold elevated in PanIN3 juice samples analyzed by quantitative proteomics. An ELISA assay was developed to evaluate AGR2 levels in 51 pancreatic juice samples and 23 serum samples from patients with pancreatic cancer, pre-malignant lesions (including PanIN3, PanIN2, Intraductal Papillary Mucinous Neoplasms (IPMNs)) and benign disease controls (including chronic pancreatitis). AGR2 levels in the pancreatic juice samples were found significantly elevated in patients with pre-malignant conditions (PanINs and IPMNs) as well as pancreatic cancer compared to control samples (p ≤ 0.03). By ROC analysis, the AGR2 ELISA achieved 67% sensitivity at 90% specificity in predicting PanIN3 juice samples from the benign disease controls.</p> <p>Conclusions</p> <p>These results suggest that elevation of AGR2 levels in pancreatic juice occurs in early pancreatic cancer progression and could be further investigated as a potential candidate juice biomarker for early detection of pancreatic cancer.</p

Ultrahard magnetic nanostructures

The performance of hard-magnetic nanostructures is investigated by analyzing the size and geometry dependence of thin-film hysteresis loops. Compared to bulk magnets, weight and volume are much less important, but we find that the energy product remains the main figure of merit down to very small features sizes. However, hysteresis loops are much easier to control on small length scales, as epitomized by Fe-Co-Pt thin films with magnetizations of up to 1.78 T and coercivities of up to 2.52 T. Our numerical and analytical calculations show that the feature size and geometry have a big effect on the hysteresis loop. Layered soft regions, especially if they have a free surface, are more harmful to coercivity and energy product than spherical inclusions. In hard-soft nanocomposites, an additional complication is provided by the physical properties of the hard phases. For a given soft phase, the performance of a hard-soft composite is determined by the parameter (Ms - Mh)/Kh

Tumour infiltrating lymphocytes correlate with improved survival in patients with oesophageal adenocarcinoma

BACKGROUND: Oesophageal adenocarcinoma (OAC) is increasingly common in the west, and survival remains poor at 10-15 % at 5 years. Immune responses are increasingly implicated as a determining factor of tumour progression. The ability of lymphocytes to recognise tumour antigens provides a mechanism for a host immune attack against cancer providing a potential treatment strategy.MATERIALS AND METHODS: Tumour infiltrating lymphocytes (TILs: CD3+, CD4+, CD8+ and FOXp3+) were assessed by immunohistochemistry using tissue microarrays in a contemporary and homogeneous cohort of OAC patients (n = 128) undergoing curative treatment.RESULTS: Multivariate analysis identified three independent prognostic factors for improved cancer-specific survival (CSS): increased CD8+ TILs (p = 0.003), completeness of resection (p &lt; 0.0001) and lower pathological N stage (p &lt; 0.0001). Independent prognostic factors for favourable disease-free survival included surgery-only treatment (p = 0.015), completeness of resection (p = 0.001), increased CD8+ TILs (p &lt; 0.0001) and reduced pathological N stage (p &lt; 0.0001). Higher levels of TILs in the pathological specimen were associated with significant pathological response to neoadjuvant chemotherapy (NAC). On multivariate analysis increased levels of CD4+ (p = 0.017) and CD8+ TILs (p = 0.005) were associated with significant local tumour regression and lymph node downstaging, respectively.DISCUSSION: Our results establish an association of TILs and survival in OAC, as seen in other solid tumours, and identify particular TIL subsets that are present at higher levels in patients who responded to NAC compared to non-responders. These findings highlight potential therapeutic strategies in EAC based on utilising the host immunological response and highlight the immune responses biomarker potential