Rapid Action of Retinoic Acid on the Hypothalamic Pituitary Adrenal Axis

FUNDING PS was funded by a British Society for Neuroendocrinology (BSN) Project Support Grant. EB was funded by a BSN undergraduate student laboratory experience grant. The support also came from Biotechnology and Biological Sciences Research Council (BBSRC) grant BB/P004806/1.Peer reviewedPublisher PD

Public awareness of cancer in Britain: a population-based survey of adults

*_Objective:_* To assess public awareness of cancer warning signs, anticipated delay, and perceived barriers to seeking medical advice in the British population. 
Methods: We carried out a population-based survey using face-to-face, computer-assisted interviews to administer the Cancer Awareness Measure (CAM), a newly-developed, validated measure of cancer awareness. The sample included 2216 adults (970 male and 1246 female) recruited as part of the Office for National Statistics Opinions Survey using stratified probability sampling.

*_Results:_* Awareness of cancer warning signs was low when open-ended (recall) questions were used and higher with closed (recognition) questions; but on either measure, awareness was lower in those who were male, younger, and from lower socioeconomic status (SES) groups or ethnic minorities. The most commonly endorsed barriers to help-seeking were difficulty making an appointment, worry about wasting the doctor’s time and worry about what would be found. Emotional barriers were more prominent in lower SES groups and practical barriers (e.g. too busy) more prominent in higher SES groups. Anticipated delay was lower in ethnic minority and lower SES groups. In multivariate analysis, higher symptom awareness was associated with lower anticipated delay, and more barriers with greater anticipated delay.

*_Conclusions:_* A combination of public education about symptoms and empowerment to seek medical advice, as well as support at primary care level, could enhance early presentation and improve cancer outcomes

"It's a can of worms": understanding primary care practitioners' behaviours in relation to HPV using the Theoretical Domains Framework

Background: The relationship between infection with high-risk human papillomavirus (HPV) and cervical cancer is transforming cervical cancer prevention. HPV tests and vaccinations have recently become available. In Ireland, as elsewhere, primary care practitioners play a key role in prevention. ATHENS (A Trial of HPV Education and Support) aims to develop a theorybased intervention to support primary care practitioners in their HPV-related practice. This study, the first step in the intervention development process, aimed to: identify HPV-related clinical behaviours that the intervention will target; clarify general practitioners’ (GPs’) and practice nurses’ roles and responsibilities; and determine factors that potentially influence clinical behaviour. A secondary objective was to informally assess the utility of the Theoretical Domains Framework (TDF) in understanding clinical behaviours in an area with an evolving evidence-base. Methods: In-depth semi-structured telephone interviews were conducted with GPs and practice nurses. The topic guide, which contained open questions and HPV-related clinical scenarios, was developed through literature review and clinical experience. Interview transcripts were content-analysed using the TDF as the coding framework. Results: 19 GPs and 14 practice nurses were interviewed. The major HPV-related clinical behaviours were: initiating a discussion about HPV infection with female patients; offering/recommending HPV vaccination to appropriate patients; and answering patients’ questions about HPV testing. While the responsibility for taking smears was considered a female role, both male and female practitioners dealt with HPV-related issues. All 12 theoretical domains arose in relation to HPV infection; the domains judged to be most important were: knowledge, emotion, social influences, beliefs about capabilities and beliefs about consequences. Eleven domains emerged in relation to HPV vaccination, with beliefs about consequences, social influences, knowledge and environmental context and resources judged to be the most important. Nine domains were relevant to HPV testing, with knowledge and beliefs about capabilities judged to be the most important. Conclusions: The findings confirm the need for an intervention to support primary care practitioners around HPV and suggest it should target a range of theoretical domains. The TDF proved valuable in analysing qualitative data collected using a topic guide not specifically designed to capture TDF domains and understanding clinical behaviours in an area with an evolving evidence-base

Do Interventions Designed to Support Shared Decision-Making Reduce Health Inequalities? : A Systematic Review and Meta-Analysis

Copyright: © 2014 Durand et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background: Increasing patient engagement in healthcare has become a health policy priority. However, there has been concern that promoting supported shared decision-making could increase health inequalities. Objective: To evaluate the impact of SDM interventions on disadvantaged groups and health inequalities. Design: Systematic review and meta-analysis of randomised controlled trials and observational studies.Peer reviewe

Risk factors for delayed presentation and referral of symptomatic cancer: Evidence for common cancers

Background:It has been suggested that the known poorer survival from cancer in the United Kingdom, compared with other European countries, can be attributed to more advanced cancer stage at presentation. There is, therefore, a need to understand the diagnostic process, and to ascertain the risk factors for increased time to presentation.Methods:We report the results from two worldwide systematic reviews of the literature on patient-mediated and practitioner-mediated delays, identifying the factors that may influence these.Results:Across cancer sites, non-recognition of symptom seriousness is the main patient-mediated factor resulting in increased time to presentation. There is strong evidence of an association between older age and patient delay for breast cancer, between lower socio-economic status and delay for upper gastrointestinal and urological cancers and between lower education level and delay for breast and colorectal cancers. Fear of cancer is a contributor to delayed presentation, while sanctioning of help seeking by others can be a powerful mediator of reduced time to presentation. For practitioner delay, ‘misdiagnosis’ occurring either through treating patients symptomatically or relating symptoms to a health problem other than cancer, was an important theme across cancer sites. For some cancers, this could also be linked to inadequate patient examination, use of inappropriate tests or failing to follow-up negative or inconclusive test results.Conclusion:Having sought help for potential cancer symptoms, it is therefore important that practitioners recognise these symptoms, and examine, investigate and refer appropriately. © 2009 Cancer Research UK All rights reserved

Social inequalities in stage at diagnosis of rectal but not in colonic cancer: a nationwide study

We investigated stage at diagnosis in relation to socioeconomic status (SES) among 15 274 patients with colorectal adenocarcinoma diagnosed in 1996–2004 nationwide in Denmark. The effect of SES on the risk of being diagnosed with distant metastasis was analysed using logistic regression models. A reduction in the risk of being diagnosed with distant metastasis was seen in elderly rectal cancer patients with high income, living in owner–occupied housing and living with a partner. Among younger rectal cancer patients, a reduced risk was seen in those having long education. No social gradient was found among colon cancer patients. The social gradient found in rectal cancer patients was significantly different from the lack of association found among colon cancer patients. There are socioeconomic inequalities in the risk of being diagnosed with distant metastasis of a rectal, but not a colonic, cancer. The different risk profile of these two cancers may reflect differences in symptomatology

Heritability of type-D personality.

OBJECTIVE: To quantify the influence of genes and environment on individual differences in type-D status, and the type-D subcomponents negative affectivity and social inhibition. Type-D personality independently predicts poor prognosis in patients with cardiovascular disease. However, no previous study has determined the heritability of type-D personality. METHODS: This study determined type-D personality by applying the "combination of scales" method to survey data collected by the Netherlands Twin Register in 3331 healthy, young adult twins. Using structural equation modeling (SEM), the relative contributions of additive genetic, nonadditive genetic, and nonshared environmental factors to the variance in type-D and its subcomponents were determined. RESULTS: SEM indicated that type-D personality was substantially heritable (52%). The subcomponents negative affectivity and social inhibition were equally heritable, with broad heritability estimates of 46% and 50%. Although negative affectivity was determined by additive genetic effects and nonshared environment, individual differences in social inhibition were predominantly determined by nonadditive genetic effects and nonshared environment. CONCLUSIONS: This study provides strong evidence that genes are important in determining individual differences in type-D personality and the type-D subcomponents negative affectivity and social inhibition. Copyright © 2007 by American Psychosomatic Society

Eliciting taxpayer preferences increases tax compliance

Two experiments show that eliciting taxpayer preferences on government spending—providing taxpayer agency--increases tax compliance. We first create an income and taxation environment in a laboratory setting to test for compliance with a lab tax. Allowing a treatment group to express nonbinding preferences over tax spending priorities, leads to a 16% increase in tax compliance. A followup online study tests this treatment with a simulation of paying US federal taxes. Allowing taxpayers to signal their preferences on the distribution of government spending, results in a 15% reduction in the stated take-up rate of a questionable tax loophole. Providing taxpayer agency recouples tax payments with the public services obtained in return, reduces general anti-tax sentiment, and holds satisfaction with tax payment stable despite increased compliance with tax dues. With tax noncompliance costing the US government $385billion annually, providing taxpayer agency could have meaningful economic impact. At the same time, giving taxpayers a voice may act as a two-way "nudge," transforming tax payment from a passive experience to a channel of communication between taxpayers and government

POTENTIAL EFFECTS OF CLIMATE CHANGE ON ELEVATIONAL DISTRIBUTIONS OF TROPICAL BIRDS IN SOUTHEAST ASIA

Environmental conditions during the neonatal period can affect the growth, physiology, behavior, and immune function of birds. In many avian studies the nestling environment includes investigator handling of young, which may be stressful. While neonatal handling is known to affect the adult phenotype in rats, the effects of handling on development have rarely been examined in wild birds. We examined the effect of short, repeated periods of neonatal handling on avian growth and immune system development. We subjected American Kestrels (Falco sparverius) and European Starlings (Sturnus vulgaris) to 15 min of daily investigator handling throughout the nestling period, while controls remained undisturbed. Immediately prior to fledging we assessed cutaneous immunity, humoral immunity, mass, and degree of fluctuating asymmetry. Daily handling did not significantly affect any of these measurements. We also addressed the possibility that treatment differences would appear only when birds were challenged with a more substantial stressor by bringing birds into captivity for 24 hr. Captivity did not affect mass, but significantly lowered the cutaneous immune response, although this was independent of treatment. Therefore, brief periods of investigator handling did not appear to affect immune or morphological development in these species, whereas 24 hr of captivity resulted in suppressed cutaneous immune responses