Psychosocial outcomes after varying risk management strategies in women at increased familial breast cancer risk: a mixed methods study of patient and partner outcomes

Introduction Female carriers of BRCA1/2 genes have an increased lifetime risk of breast cancer. Options for managing risk include imaging surveillance or risk-reducing surgery (RRS). This mixed methods study aimed to identify factors affecting risk-management decisions and the psychosocial outcomes of these decisions for high-risk women and their partners. Methods Semi-structured qualitative interviews were performed with women at high breast cancer risk who had faced these choices. Partners were also interviewed. Analysis used a framework approach. A bespoke questionnaire was developed to quantify and explore associations. Results A total of 32 women were interviewed. Of these, 27 had partners of whom 7 (26%) agreed to be interviewed. Four main themes arose: perception of risk and impact of increased risk; risk-management strategy decision-making; impact of risk-management strategy; support needs and partner relationship issues. The questionnaire response rate was 36/157 (23%). Decision satisfaction was high in both surveillance and RRS groups. Relationship changes were common but not universal. Common causes of distress following RRS included adverse body image changes. Both groups experienced generalised and cancer-specific anxiety. Drivers for surgery included having children, deaths of close family from breast cancer and higher levels of cancer anxiety. Conclusions Levels of psychosocial and decision satisfaction were high for women choosing both RRS and surveillance but, for a minority, risk-reducing measures result in long-term psychosocial morbidity. Efforts to recognise women at increased risk of psychological morbidity may allow targeted support

The 2018 Otto Aufranc Award: How does genome-wide variation affect osteolysis risk after THA?

BACKGROUND: Periprosthetic osteolysis resulting in aseptic loosening is a leading cause of THA revision. Individuals vary in their susceptibility to osteolysis and heritable factors may contribute to this variation. However, the overall contribution that such variation makes to osteolysis risk is unknown. QUESTIONS/PURPOSES: We conducted two genome-wide association studies to (1) identify genetic risk loci associated with susceptibility to osteolysis; and (2) identify genetic risk loci associated with time to prosthesis revision for osteolysis. METHODS: The Norway cohort comprised 2624 patients after THA recruited from the Norwegian Arthroplasty Registry, of whom 779 had undergone revision surgery for osteolysis. The UK cohort included 890 patients previously recruited from hospitals in the north of England, 317 who either had radiographic evidence of and/or had undergone revision surgery for osteolysis. All participants had received a fully cemented or hybrid THA using a small-diameter metal or ceramic-on-conventional polyethylene bearing. Osteolysis susceptibility case-control analyses and quantitative trait analyses for time to prosthesis revision (a proxy measure of the speed of osteolysis onset) in those patients with osteolysis were undertaken in each cohort separately after genome-wide genotyping. Finally, a meta-analysis of the two independent cohort association analysis results was undertaken. RESULTS: Genome-wide association analysis identified four independent suggestive genetic signals for osteolysis case-control status in the Norwegian cohort and 11 in the UK cohort (p ≤ 5 x 10). After meta-analysis, five independent genetic signals showed a suggestive association with osteolysis case-control status at p ≤ 5 x 10 with the strongest comprising 18 correlated variants on chromosome 7 (lead signal rs850092, p = 1.13 x 10). Genome-wide quantitative trait analysis in cases only showed a total of five and nine independent genetic signals for time to revision at p ≤ 5 x 10, respectively. After meta-analysis, 11 independent genetic signals showed suggestive evidence of an association with time to revision at p ≤ 5 x 10 with the largest association block comprising 174 correlated variants in chromosome 15 (lead signal rs10507055, p = 1.40 x 10). CONCLUSIONS: We explored the heritable biology of osteolysis at the whole genome level and identify several genetic loci that associate with susceptibility to osteolysis or with premature revision surgery. However, further studies are required to determine a causal association between the identified signals and osteolysis and their functional role in the disease. CLINICAL RELEVANCE: The identification of novel genetic risk loci for osteolysis enables new investigative avenues for clinical biomarker discovery and therapeutic intervention in this disease

The Reproductive Revolution

Este texto fue publicado en 2009 por The Sociological Review. Rogamos que, a efectos de divulgación, docencia y cita bibliográfica se acuda a la publicación impresa (u online de la propia revista) y la cita sea esta: MacInnes, J., Pérez Díaz, J. (2009), "The reproductive revolution" The Sociological Review 57 (2): 262-284. Su versión html puede encontrarse en esta dirección:http://www3.interscience.wiley.com/cgi-bin/fulltext/122368561/HTMLSTART Quienes estén interesados en ampliar la información sobre nuestra Teoría de la Revolución Reproductiva pueden visitar la página web siguiente: http://www.ieg.csic.es/jperez/pags/RRweb/RRweb.htm También encontrarán en este mismo repositorio otra publicación con unaexposición en castellano de las mismas ideas y publicada en la REIS bajo el título “La tercera revolución de la modernidad: la reproductiva”.We suggest that a third revolution alongside the better known economic and political ones has been vital to the rise of modernity: the reproductive revolution, comprising a historically unrepeatable shift in the efficiency of human reproduction which for the first time brought demographic security.As well as highlighting the contribution of demographic change to the rise of modernity and addressing the limitations of orthodox theories of the demographic transition, the concept of the reproductive revolution offers a better way to integrate sociology and demography. The former has tended to pay insufficient heed to sexual reproduction, individual mortality and the generational replacement of population, while the latter has undervalued its own distinctive theoretical contribution, portraying demographic change as the effect of causes lying elsewhere. We outline a theory of the reproductive revolution, review some relevant supporting empirical evidence and briefly discuss its implications both for demographic transition theory itself, and for a range of key social changes that we suggest it made possible: the decline of patriarchy and feminisation of the public sphere, the deregulation and privatisation of sexuality, family change, the rise of identity, ‘low’ fertility and ‘population ageing’.Peer reviewe

Implementing video conferencing in mental health practice

The aim of this paper is to provide an overview of the evidence base regarding the use of video conferencing (VC), implementation issues, policies, procedures, technical requirements and VC etiquette. The paper is based on a literature review of VC within the mental health sector and the authors' experience in implementing VC. Six themes emerged from the literature review: applications of VC, VC assessments, treatment, training and supervision, practitioner anxiety, and VC administrative processes. The results of the review support the use of VC in mental health services. Guidelines for the implementation of VC are discussed, including the importance of staff and service user consultations, training in the use of VC, clear guidance for staff with regards to usage, confidentiality and data protection policies, and VC etiquette. Challenges that can arise when implementing VC in a mental health context are also discussed. Arguably, it is not the technology, but the cultural change it represents to staff which seems to be the most important factor regarding successful implementation

Efeito das condições de preparação na condutividade elétrica de blendas de poli(fluoreto de vinilideno) e poli(o-metoxianilina) Effect of preparation conditions on the electrical conductivity of blends of poly (vinylidene fluoride) and poly(o-methoxyaniline)

Neste trabalho estudou-se o efeito das condições de preparação na condutividade elétrica de blendas condutoras de poli(fluoreto de vinilideno) (PVDF) com poli(o-metoxianilina) (POMA). A condutividade elétrica e a qualidade dos filmes produzidos dependem significativamente do solvente, dopante e das condições de preparação das blendas. Filmes flexíveis e auto-sustentáveis da blenda PVDF/POMA dopada com o ácido p-tolueno sulfônico (TSA) foram obtidos em condições otimizadas. Estes apresentam condutividade elétrica em uma larga faixa (10-12 - 10-2 S/cm), onde para baixos teores de POMA-TSA (<2,0% em massa) já se atinge alto valor de condutividade (10-7 S/cm), não sendo definida uma composição mínima para percolação.<br>In this work, the effect of preparation conditions on the properties of conductive blends of poly (vinylidene fluoride) (PVDF) and poly(o-methoxyaniline) (POMA) was studied. The quality and conductivity of the films produced depend significantly on the solvent, dopant and preparation conditions of the blends. Flexible, free-standing films of PVDF/POMA blends doped with p-toluene sulfonic acid (TSA) were obtained in optimized conditions. These blends can exhibit electrical conductivity in a wide range (10-12 - 10-2 S/cm). Furthermore, relatively high conductivity values (10-7 S/cm) are reached starting from low contents of POMA-TSA (<2,0% weight) without definition of a percolation threshold