Symptom awareness and cancer prevention: Exploratory findings from an at-risk population

Purpose: Secondary prevention programmes have traditionally employed mass screening approaches to assess for asymptomatic signs of cancer. It has been suggested that early detection strategies involving public education and self-referral may prove more cost-effective with low risk populations for cancers with symptomatic presentation. This study, which was commissioned to inform the development of a cancer awareness campaign, examines public perceptions of the early detection of cancer, the psycho-social barriers to self-referral amongst a key at-risk population and the implications for patient education. Methodology: An exploratory study using qualitative focus groups with an at-risk population of older people living in deprived communities in west-central Scotland. Findings: The findings reveal broad support for initiatives designed to raise symptom awareness. However fear of cancer can lead to apparently irrational responses to symptoms and subsequent delay , particularly amongst men who are less likely to seek support from lay networks. Implications: Early detection messages need to take account tone and symptom description to allay fears and ensure appropriate presentation. Consideration also needs to be given to the role played by lay and professional opinion formers to informing and supporting patients decision to present with suspicious symptoms, particularly when targeting harder to reach patients of men, older people, and people living in deprived communities

Rapid literature review of smoking cessation and tobacco control issues across criminal justice system settings

This review was undertaken to inform the development of the Regional Criminal Justice Coordinator role in the North West Region. It was conducted by the Institute for Social Marketing at the University of Stirling and involved a rapid review of literature on smoking cessation and tobacco control issues across criminal justice system (CJS) settings, namely prisons, probation services, police and courts

Learning and Change within Person-centred Therapy: Views of Expert Therapists

Aims Traditionally in person‐centred therapy (PCT), clients are counselled for as long as required. It is a nondirective process. Recently, financial constraints have introduced time limits for therapy in health care, so it seemed appropriate to revisit the practice of PCT in the current UK context. The aim was to explore the concepts of learning and change within PCT and to consider whether learning is facilitated. Method Five experienced person‐centred therapists, who were involved in educating therapists, participated in semi‐structured interviews. Questions explored their views on learning and change in therapy, whether learning processes can be facilitated in PCT—both philosophically and practically—and the outcomes of PCT. Therapists were not specifically asked about time pressure, but rather it was left to see if it emerged as an issue. Results Ten major themes emerged: learning and change, goals, learning process, PCT process, issues on nondirectivity/directivity, questioning, outcomes, assessment and diagnosis, and other methods used. The issue of time pressure permeated many of these themes. Views were often contradictory reflecting the inconclusive views in the literature, particularly in relation to how clients learn and the relationship between change and learning. Discussion The issue of directivity seemed to cause cognitive dissonance, with participants wanting to be directive to deal with time pressures, but not wanting to be disloyal to Rogers' PCT principles. Processes of learning and change were acknowledged as important, but little clarity was obtained on their current application

Developmental Regulation of an Adhesin Gene during Cellular Morphogenesis in the Fungal Pathogen Candida albicans

Peer reviewedPublisher PD

Erratum to: A mixed methods feasibility study of nicotine-assisted smoking reduction programmes delivered by community pharmacists - The RedPharm study

Following publication of this article [1], it has come to our attention that the author, Susan MacAskill, has had her name captured incorrectly. The correct spelling is the aforementioned

An evaluation to assess the implementation of NHS delivered Alcohol Brief Interventions: Final Report

Alcohol Brief Interventions (ABIs) have been identified as an effective strategy for treating people whose alcohol consumption is posing a risk to their health. As part of its Alcohol Strategy the Scottish Government established a health improvement target for NHS health boards, supported by additional funding. This required NHS Health Scotland to deliver 149,449 ABIs across three priority settings of primary care, Accident & Emergency (A&E) and antenatal care, between April 2008 and March 2011. A subsequent one year extension target was introduced. The evaluation aimed to assess the process of implementation of ABIs using both quantitative and qualitative methods. The focus was mainly on primary care but also includes some findings relating to A&E and antenatal settings. The evaluation found a considerable degree of variation across Scotland in organisational structures and models of delivery. However, a number of common features were also identified. Those which appeared to support implementation included: the availability of funding; nationally co-ordinated and locally supported training opportunities; and national, health board and setting level ‘leaders’ able to support and encourage implementation. Perceived barriers included: the lack of ‘lead in’ time to set up organisational structures; competing priorities; an initial lack of adequately trained staff and difficulties maintaining trained staff levels; and problems associated with the mechanisms for recording delivery. These within-setting and across-board differences and difficulties in recording ABI delivery made it difficult to accurately determine or compare who the programme was reaching. Nonetheless, by March 2011 most boards had met, if not exceeded, the three-year target

Improving arteriovenous fistula patency : transdermal delivery of diclofenac reduces cannulation-dependent neointimal hyperplasia via AMPK activation

Creation of an autologous arteriovenous fistula (AVF) for vascular access in haemodialysis is the modality of choice. However neointimal hyperplasia and loss of the luminal compartment result in AVF patency rates of ~60% at 12months. The exact cause of neointimal hyperplasia in the AVF is poorly understood. Vascular trauma has long been associated with hyperplasia. With this in mind in our rabbit model of AVF we simulated cannulation autologous to that undertaken in vascular access procedures and observed significant neointimal hyperplasia as a direct consequence of cannulation. The neointimal hyperplasia was completely inhibited by topical transdermal delivery of the non-steroidal anti-inflammatory (NSAID) diclofenac. In addition to the well documented anti-inflammatory properties we have identified novel anti-proliferative mechanisms demonstrating diclofenac increases AMPK-dependent signalling and reduced expression of the cell cycle protein cyclin D1. In summary prophylactic transdermal delivery of diclofenac to the sight of AVF cannulation prevents adverse neointimal hyperplasic remodelling and potentially offers a novel treatment option that may help prolong AVF patency and flow rates

Smoking prevalence and smoking cessation services for pregnant women in Scotland

Over 20% of women smoke throughout pregnancy despite the known risks to mother and child. Engagement in face-to-face support is a good measure of service reach. The Scottish Government has set a target that by 2010 8% of smokers will quit. At present less than 4% stop during pregnancy. We aimed to establish a denominator for pregnant smokers in Scotland and describe the proportion who are referred to specialist services, engage in one-to-one counselling, set a quit date and quit 4 weeks later. In Scotland, a small proportion of pregnant smokers are supported to stop. Poor outcomes are a product of current limitations to each step of service provision - identification, referral, engagement and treatment. Many smokers are not asked about smoking at maternity booking or provide false information. Carbon monoxide breath testing can bypass this difficulty. Identified smokers may not be referred but an opt-out referral policy can remove this barrier. Engagement at home allowed a greater proportion to set a quit date and quit, but costs were higher

Improving arteriovenous fistula patency : transdermal delivery of diclofenac reduces cannulation-dependent neointimal hyperplasia via AMPK activation

Creation of an autologous arteriovenous fistula (AVF) for vascular access in haemodialysis is the modality of choice. However neointimal hyperplasia and loss of the luminal compartment result in AVF patency rates of ~60% at 12months. The exact cause of neointimal hyperplasia in the AVF is poorly understood. Vascular trauma has long been associated with hyperplasia. With this in mind in our rabbit model of AVF we simulated cannulation autologous to that undertaken in vascular access procedures and observed significant neointimal hyperplasia as a direct consequence of cannulation. The neointimal hyperplasia was completely inhibited by topical transdermal delivery of the non-steroidal anti-inflammatory (NSAID) diclofenac. In addition to the well documented anti-inflammatory properties we have identified novel anti-proliferative mechanisms demonstrating diclofenac increases AMPK-dependent signalling and reduced expression of the cell cycle protein cyclin D1. In summary prophylactic transdermal delivery of diclofenac to the sight of AVF cannulation prevents adverse neointimal hyperplasic remodelling and potentially offers a novel treatment option that may help prolong AVF patency and flow rates

'Prove me the bam!': victimization and agency in the lives of young women who commit violent offences

This article reviews the evidence regarding young women’s involvement in violent crime and, drawing on recent research carried out in HMPYOI Cornton Vale in Scotland, provides an overview of the characteristics, needs and deeds of young women sentenced to imprisonment for violent offending. Through the use of direct quotations, the article suggests that young women’s anger and aggression is often related to their experiences of family violence and abuse, and the acquisition of a negative worldview in which other people are considered as being 'out to get you' or ready to 'put one over on you'. The young women survived in these circumstances, not by adopting discourses that cast them as exploited victims, but by drawing on (sub)cultural norms and values which promote pre-emptive violence and the defence of respect. The implications of these findings for those who work with such young women are also discussed