Responding to symptoms suggestive of lung cancer: a qualitative interview study.

BACKGROUND: Late diagnosis of lung cancer can impact on survival rates. Patients delay seeking help for a number of reasons. This study explored symptom appraisal and help-seeking decisions among patients referred to specialist respiratory services with symptoms suggestive of lung cancer. METHODS: In-depth qualitative interviews with patients as soon as possible after referral, ideally before diagnosis and mainly within 10 weeks, explored factors impacting on their pathways prior to referral. Framework analysis, underpinned by the Model of Pathways to Treatment, was used to explore the data with particular focus on patients' beliefs and experiences, disease factors and healthcare professional influences. RESULTS: 35 patients were interviewed (aged 41-88 years, 15 women, 17 with lung cancer). All described similar presenting symptoms and triggers to seek help. Appraisal of symptoms was influenced by whether they had a lung comorbidity; seriousness of symptoms was interpreted within the context of previous illness experiences. Help-seeking was triggered when: symptoms failed to respond as expected; there was an increased awareness of symptoms of lung cancer; the public nature of a cough meant others were able to endorse help-seeking. Almost half visited the general practitioner (GP) two or more times before referral; during this period they reinterpreted initial symptoms and appraised new symptoms. The meaning given to symptoms changed over time and many became increasingly concerned they may have lung cancer. The GP played a role in ensuring timely further help-seeking but often there was little guidance on how to monitor symptoms or when to reconsult. CONCLUSIONS: Patients diagnosed with and without lung cancer had similar symptom pathways. Findings provide guidance for lung cancer awareness campaigns on the importance of social networks in endorsing patient help-seeking. The importance of appropriate advice, monitoring and safety-netting procedures by GPs for people presenting with symptoms suggestive of lung cancer is also highlighted.This report presents independent research funded by the National Institute for Health Research Programme Grants for Applied Research programme (RP-PG-0608-10045).This is the final version. It was first published by BMJ Group at http://bmjopenrespres.bmj.com/content/1/1/e00006

Evaluating the relation between ADHD symptoms and externalizing behaviors in children with Autism Spectrum Disorder

The risk for externalizing behaviors (Bos et al., 2018) complicates the comorbidity between autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). To investigate whether the relation between ASD status (ASD vs typical development, TD) and externalizing behaviors would vary by differences in ADHD symptoms, parent-child dyads (3-7yo), 127 TD (47.7% female) and 81 children with ASD (16.7% female), participated. The linear regression tested model with significant main and interaction effects explained 43.3% of variance, overall. Consistent with research, externalizing problems were higher for both groups when ADHD symptoms were also high compared to low, an effect stronger for TD children

Career success across the globe: Insights from the 5C project

The Cross-Cultural Collaboration on Contemporary Careers (5C Project) conducted in-depth, longitudinal qualitative research into what career success means to people in a diverse range of countries; specifically: Australia, Austria, Belgium, Brazil, Canada, China, Colombia, Costa Rica, Finland, France, Germany, Greece, India, Israel, Italy, Japan, Korea, Malaysia, Mexico, Netherlands, Nigeria, Norway, Philippines, Portugal, Russian Federation, Serbia, Slovakia, Slovenia, South Africa, Spain, Thailand, Turkey, UK, and USA. This paper presents the seven major meanings of career success that emerged across these diverse global cultures and thus may be deemed relevant all around the world. These are financial security (being able to consistently provide the basic necessities for living), financial achievement (steadily making more money, wealth, incentives, and perks), learning and development (via continuous informal learning on the job and/or formal training and education), work-life-balance (between work and non-work, relationships, activities and interests), positive relationships (as signified by, for instance, enjoying working with people who you respect and admire), positive impact (by helping others in one’s immediate social environment and/or leaving some sort of legacy to a community, or society more broadly), and entrepreneurship founding one’s own enterprise or being able to invent and develop one’s own projects within the work context). We describe examples of each from different cultures and offer practical implications of these meanings for the primary stakeholders of career research: individuals, organizations, as well as counselors, coaches and consultants

Relative efficacy of different exercises for pain, function, performance and quality of life in knee and hip osteoarthritis: systematic review and network meta-analysis

Background: Guidelines recommend exercise as a core treatment for osteoarthritis (OA). However, it is unclear which type of exercise is most effective, leading to inconsistency between different recommendations. Objectives: To investigate the relative efficacy of different exercises (aerobic, mind-body, strengthening, flexibility/skill, or mixed) for improving pain, function, performance and quality of life (Qol) for knee and hip OA at, or nearest to, 8 weeks. Methods: We searched nine electronic databases up until December 2017 for randomised controlled trials that compared exercise with usual care or with another exercise type. Bayesian network meta–analysis was used to estimate the relative effect size (ES) and corresponding 95% credibility interval (CrI) (PROSPERO registration: CRD42016033865) Findings: We identified and analysed 103 trials (9,134 participants). Aerobic exercise was most beneficial for pain (ES 1.11; 95%CrI 0.69, 1.54) and performance (1.05; 0.63, 1.48). Mind–body exercise, which had pain benefit equivalent to that of aerobic exercise (1.11; 0.63, 1.59), was the best for function (0.81; 0.27, 1.36). Strengthening and flexibility/skill exercises improved multiple outcomes at a moderate level. Mixed exercise was the least effective for all outcomes and had significantly less pain relief than aerobic and mind–body exercises. Trend for exercise hierarchy was significant for pain (p=0.01), but not for function (p=0.07), performance (p=0.06) or QoL (p=0.65) Conclusion:The effect of exercise varies according to the type of exercise and target outcome. Aerobic or mind–body exercise may be the best for pain and function improvements

How roadway composition matters in analyzing police data on racial profiling

This article argues that roadway composition data is essential to the analysis of police behavior when studying racial profiling of motorists. Police data alone show only the number and proportion of stops of African American and White drivers. They do not show how these numbers relate to the number of African American and White drivers using the roads. Proxy measures, drawn from the number of African American residents or license holders, assume that all roads in the community contain the same proportion The authors acknowledge the generous assistance of the anonymous police department that provided access. The Roadway Observation Study was supported by the Oakland University research committee and Vice-Provost Randy Hanson. We thank our research assistant

Patients’ perceptions and experiences of living with a surgical wound healing by secondary intention : a qualitative study

Background: Most surgical wounds heal by primary intention, that is to say, the edges of the wound are brought together with sutures, staples, adhesive glue or clips. However, some wounds may be left open to heal (if there is a risk of infection, or if there has been significant tissue loss), and are known as ‘surgical wounds healing by secondary intention’. They are estimated to comprise approximately 28% of all surgical wounds and are frequently complex to manage. However, they are under researched and little is known of their impact on patients’ lives. Objectives: To explore patients’ views and experiences of living with a surgical wound healing by secondary intention. Design: A qualitative, descriptive approach. Settings: Participants were recruited from acute and community nursing services in two locations in the North of England characterised by high levels of deprivation and diverse populations. Participants: Participants were aged 18 years or older and had at least one surgical wound healing by secondary intention, which was slow to heal. Purposeful sampling was used to include patients of different gender, age, wound duration and type of surgery (general, vascular and orthopaedic). Twenty people were interviewed between January and July 2012. 2 Methods: Semi-structured interviews were conducted, guided by use of a topic guide developed with input from patient advisors. Data were thematically analysed using steps integral to the ‘Framework’ approach to analysis, including familiarisation with data; development of a coding scheme; coding, charting and cross comparison of data; interpretation of identified themes. Findings: Alarm, shock and disbelief were frequently expressed initial reactions, particularly to “unexpected” surgical wounds healing by secondary intention. Wound associated factors almost universally had a profound negative impact on daily life, physical and psychosocial functioning, and wellbeing. Feelings of frustration, powerlessness and guilt were common and debilitating. Patients’ hopes for healing were often unrealistic, posing challenges for the clinicians caring for them. Participants expressed dissatisfaction with a perceived lack of continuity and consistency of care in relation to wound management. Conclusions: Surgical wounds healing by secondary intention can have a devastating effect on patients, both physical and psychosocial. Repercussions for patients’ family members can also be extremely detrimental, including financial pressures. Health care professionals involved in the care of patients with these wounds face multiple, complex challenges, compounded by the limited evidence base regarding cost-effectiveness of different treatment regimens for these types of wounds

Exclusively breastmilk‐fed preterm infants are at high risk of developing subclinical vitamin K deficiency despite intramuscular prophylaxis at birth

Background: There is near-global consensus that all newborns be given parenteral vitamin K1 (VK1) at birth as prophylaxis against VK deficiency bleeding (VKDB). Breastmilk has a low VK content and cases of late VKDB are reported in exclusively breastmilk-fed preterm infants despite VK prophylaxis at birth. Objectives: To assess the prevalence of functional VK insufficiency in preterm infants based on elevated under-γ-carboxylated (Glu) species of Gla-proteins, factor II (PIVKA-II) and osteocalcin (GluOC), synthesized by liver and bone respectively. Patients/Methods: Prospective, multi-center, observational study in preterm infants born <33 weeks’ gestation. Blood samples and dietary history were collected before hospital discharge, and post discharge at 2-3 months corrected age. Outcome measures were serum VK1, PIVKA-II, and %GluOC (GluOC as a percentage of the sum of GluOC plus GlaOC) compared between exclusively breastmilk-fed and formula/mixed-fed infants post-discharge. Results: Post discharge, breastmilk-fed babies had significantly lower serum VK1 (0.15 vs. 1.81 μg/L), higher PIVKA-II (0.10 vs. 0.02 AU/mL) and higher %GluOC (63.6% vs. 8.1%) than those receiving a formula/mixed-feed diet. Pre-discharge (based on elevated PIVKA-II), only 1 (2%) of 45 breastmilk-fed infants was VK insufficient. Post-discharge, 8 (67%) of 12 exclusively breastmilk-fed babies were VK insufficient versus only 1 (4%) of 25 formula/mixed-fed babies. Conclusions: Preterm infants who remain exclusively or predominantly human breastmilk-fed post neonatal unit discharge are at high risk of developing subclinical VK deficiency in early infancy. Routine post-discharge VK1 supplementation of breastfed infants to provide intakes comparable to those from formula milks should prevent this deficiency

Careers in context: An international study of career goals as mesostructure between societies’ career-related human potential and proactive career behavior

Careers exist in a societal context that offers both constraints and opportunities for career actors. Whereas most studies focus on proximal individual and/or organisational‐level variables, we provide insights into how career goals and behaviours are understood and embedded in the more distal societal context. More specifically, we operationalise societal context using the career‐related human potential composite and aim to understand if and why career goals and behaviours vary between countries. Drawing on a model of career structuration and using multilevel mediation modelling, we draw on a survey of 17,986 employees from 27 countries, covering nine of GLOBE's 10 cultural clusters, and national statistical data to examine the relationship between societal context (macrostructure building the career‐opportunity structure) and actors' career goals (career mesostructure) and career behaviour (actions). We show that societal context in terms of societies' career‐related human potential composite is negatively associated with the importance given to financial achievements as a specific career mesostructure in a society that is positively related to individuals' proactive career behaviour. Our career mesostructure fully mediates the relationship between societal context and individuals' proactive career behaviour. In this way, we expand career theory's scope beyond occupation‐ and organisation‐related factors

Shortcuts for accelerating food system transitions

In light of ongoing global challenges of health, climate change, and food security, there is urgent need to transform our food systems. Here, we call for stakeholders to leverage collective wisdom garnered from more than two decades of sustainability transitions research into developing and implementing systemic approaches to shortcut theory to action and accelerate the transformation of global food systems