The patterns and predictors of disease disclosure by patients with cancer

Previous qualitative research has identified that disclosing a diagnosis to loved ones, is one of the hardest aspects of having cancer (Hilton et al, 2009). Although there is an extensive literature on disclosure of general information about the self, less is known about the extent to which people go on to talk about their diagnosis and the helpfulness of such disclosure within the specific context of cancer. Therefore the current study aimed to quantify disclosure patterns by measuring the degree of disclosure as well as the perceived helpfulness of disclosure. It also sought to determine the factors associated with disclosure and helpfulness of disclosure. The study was a cross-sectional postal questionnaire survey of 120 patients who had recently received a diagnosis of either lung, colorectal or skin cancer. Results indicated that the majority of patients disclosed to a variety of social targets, and most found it helpful to disclose. ‗Dispositional openness‘ and ‗perceived social support‘ were found to predict the extent of disclosure, as well as the helpfulness of disclosure. The results suggest that individual differences and situational factors may impact on disclosure and that medical professionals may play an important role in the disclosure process. With reference to the limitations, directions for future research are discussed, as well as the implications for clinical practice

The chronic and acute effects of (poly)phenols on sucrase isomaltase using the Caco-2/TC7 cell model

Evidence from animal models and human intervention studies indicates that polyphenols can potentially attenuate the postprandial glycaemic response by inhibition of α-glucosidases, critical for carbohydrate digestion, and by attenuation of monosaccharide transport across small intestinal enterocytes. Therefore, this study evaluated the effect of polyphenols, including an oleuropein-rich olive leaf extract, on sucrose hydrolysis and transport. Controlling the glycaemic response reduces the risk of development and progression of type 2 diabetes, much like the anti-diabetic drug acarbose. An in vitro inhibition assay for sucrase and maltase activity was optimised using Caco-2/TC7 cells as a human enzyme source and compared to a rat enzyme. Inhibitors were more effective on human compared to rat sucrase while the reverse was true for maltase. Chronic sucrose exposure led to altered N- and O-glycosylation and the sucrase Km increased by 15% compared to cells cultured in glucose. A chronic 3-day treatment with 1.5 mg/mL olive leaf extract reduced the sucrase specific activity by 31% and 26% for cells cultured in glucose and sucrose, respectively. Sucrase N-glycosylation increased in cells cultured in sucrose and this could have led to the decrease in Km. Oleuropein treatment decreased cell surface sucrase by 41% when cultured long-term in glucose but not sucrose. Transport studies for glucose-cultured cells showed that chronic treatment reduced sucrase hydrolysis and attenuated of fructose transport and GLUT2-mediated glucose transport. These results show for the first time that chronic treatment with olive polyphenols can reduce the sucrose hydrolysis and modulate glucose and fructose transport. Changes in post-translational modifications of sucrase with different treatments opens up new areas of research. Investigations are warranted regarding the use of olive leaf extract in humans for glycaemic control after sugar consumption with the suggestion that sugar intake might impact the effectiveness of the treatment

Bolshevism, Islamism, Nationalism: Britain’s Problems in South Asia, 1918–1923

As many scholars have noted, in the immediate years after the First World War, the British Empire faced important challenges to its future survival, not least of which was the growth of three key movements: Bolshevism, Islamism and nationalism. This thesis examines how Britain coped with these problems, by exploring the internal government debates regarding foreign policy formulation towards South Asia, specifically in the countries of Persia and Afghanistan. It is the contention of this work that the current literature on this subject suffers from certain flaws, the first being that not enough writers have discussed the interrelation of these three movements. Secondly, there has been a lack of focus on how officials in London and in Delhi thought quite differently on the issue of Britain’s foreign policy in South Asia after 1918. This thesis will address these, and other, gaps in the literature. It will contend that there were those within the Home government who displayed a particular mode of thought – a ‘Great Game mentality’ – towards this region. This mentality was influenced by the legacy of the earlier, 19th-century rivalry between Britain and Russia, and resulted in a tendency to over-emphasise the threat of Russian Bolshevism to Britain’s imperial interests in South Asia, whilst at the same time under-emphasising the threat of nationalism and pan-Islamism across Persia, Afghanistan and India. When the Indian government questioned this Great Game mentality, it was largely ignored and frequently maligned. The work will demonstrate how those of the Great Game mind-set dominated the creation of Britain’s policy towards Persia, Afghanistan and adjoining regions in 1918 and 1919, how events of 1920 and 1921 forced London to reassess this Great Game thinking, and how (by 1922 and 1923) this re-evaluation had developed into re-formulation of British foreign policy in South Asia

Occupational class differences in suicide: evidence of changes over time and during the global financial crisis in Australia

BACKGROUND: Previous research showed an increase in Australian suicide rates during the Global Financial Crisis (GFC). There has been no research investigating whether suicide rates by occupational class changed during the GFC. The aim of this study was to investigate whether the GFC-associated increase in suicide rates in employed Australians may have masked changes by occupational class. METHODS: Negative binomial regression models were used to investigate Rate Ratios (RRs) in suicide by occupational class. Years of the GFC (2007, 2008, 2009) were compared to the baseline years 2001-2006. RESULTS: There were widening disparities between a number of the lower class occupations and the highest class occupations during the years 2007, 2008, and 2009 for males, but less evidence of differences for females. CONCLUSIONS: Occupational disparities in suicide rates widened over the GFC period. There is a need for programs to be responsive to economic downturns, and to prioritise the occupational groups most affected

Review of outside pathology prior to treatment of cervical intraepithelial neoplasia: a cost analysis

Objectives: Academic institutions routinely require in-house review of pathology prior to treatment. However, it is unclear if pathology review is beneficial for the management of patients referred for cervical intraepithelial neoplasia (CIN). This study aims to determine if review of outside pathology for CIN at an academic medical center resulted in a change in the treatment plan and the associated cost for pathology review. Methods: A retrospective chart review of patients referred for treatment of CIN, including review of outside cytology and histology was performed from January 1 to December 31, 2007 after obtaining IRB approval. Data was analyzed to determine whether pathology diagnosis was changed from the outside facility interpretation; classified as minor if there was no change in clinical management and major if there was a change in treatment as a result of the internal review. Demographic and pathology information was collected from electronic medical records. Billing information was collected from the finance department. Data were analyzed using descriptive statistics. Results: Seventy-eight patients were identified of which 54 had outside pathology slides available for pathology review. Eleven had a minor change in the pathology diagnosis (20%). None of the changes in pathology diagnosis resulted in a change in treatment plan (major). The total pathology review charge was $14,679 for the 54 patients, with an average charge per patient of$272. Nine of the cases were charged twice to reflect the opinion of two separate pathologists (internal consultation). Of the 54 patients, 23 (43%) had state supported insurance, 24 (44%) had private insurance, and 7 (13%) were self-pay. A total of $12,969.29 was not covered/paid (88% of all charges) and thus absorbed by the institution. Conclusion: Mandatory review of outside pathology is a common practice. However, it may not be beneficial in all clinical situations. While this pathology review for CIN resulted in minor changes for 20% of patients referred to our academic/tertiary institution, it did not affect any treatment recommendations. Pathology review did increase the cost burden to the institution and the patient