The perception of disability by community groups: Stories of local understanding, beliefs and challenges in a rural part of Kenya

Cultural narratives on disability have received much attention over the past few decades. In contexts of poverty, limited information and everyday challenges associated with having, or caring for someone with a disability, different understandings have emerged. A project was set up to promote disability awareness in neighborhood communities in a rural part of Kenya, using a process of reflection and education. This paper reports on the first aspect–reflection. The aim was to investigate local understanding of disability as a co-constructed concept. The research questions were: 1. What cultural beliefs shape local understanding of disability? 2. What challenges are perceived to be associated with disability? A phenomenological approach was adopted. Focus group discussions were conducted with twenty-one community groups involving 263 participants and audio-recorded. The data were transcribed and thematic analysis was carried out. Visual maps were created to illustrate any interconnections, before establishing the final conclusions. Local beliefs attributed disability to: human transgression of social conventions, particularly concerning inappropriate family relations, which invoked a curse; supernatural forces affecting the child; the will of God; unexplained events; and biomedical factors. Challenges associated with disability related to the burden of caregiving and perceived barriers to inclusion, with stress as a shared bi-product. Local understanding of disability in this rural part of Kenya demonstrated overlapping explanations and plurality of beliefs. Two possible interpretations are offered. Firstly, oscillation between explanatory lines demonstrated instability, affecting broader acceptance of disability. Secondly, and more positively, in the face of challenges, the desire to make sense of the existing situation, reflected a healthy pluralism

Nottingham Clinico-Pathological Response Index (NPRI) after Neoadjuvant Chemotherapy (Neo-ACT) accurately predicts clinical outcome in locally advanced breast cancer

Purpose: There is a need to identify more sensitive clinico-pathological criteria to assess the response to Neo-ACT and guide subsequent adjuvant-therapy. Experimental Design: We performed a clinico-pathological assessment of 427 patients who had completed Neo-ACT for locally advanced breast cancer (LABC) with a median follow-up of 5-years. Patients were divided into a training set treated with anthracycline combination chemotherapy (AC, n=172); an internal validation set treated with AC and taxane (n=130); and an external validation set treated with AC with or without taxane (n=125). Results: A multivariate Cox regression model demonstrated the absence of fibrosis, presence of lympho-vascular invasion, and increasing number of lymph node metastases were significantly associated with short disease-free survival (DFS) and breast-cancer specific survival (BCSS, p<0.01), whilst reduction of tumour size was associated with DFS (p=0.022). Nottingham Clinico-Pathological Response Indexes (NPRIs) were calculated and four prognostic groups (NPRI-PGs) were identified. Patients in prognostic group 2 (NPRI-PG2) for DFS (n=63/172; 36.6%) and BCSS (66/172; 38.4%) have the same prognosis as those who achieved pCR (NPRI-PG1; 15%). Receiver operating characteristic (ROC) curves indicated that the NPRI outperformed the currently used prognostic factors and adding NPRI improved their performance as a predictor for both DFS (AUC=0.87) and BCSS (AUC= 0.88). Conclusions: The NPRI predicts DFS and BCSS, with a higher sensitivity than pCR. The NPRI can also improve the sensitivity and specificity of clinico-pathological response as a study end-point, for assessing response to Neo-ACT, and can serve as a valuable tool for the discovery of future predictive molecular markers