Why do General Practitioners Decline Training to Improve Management of Medically Unexplained Symptoms?

BACKGROUND: General practitioners’ (GPs) communication with patients presenting medically unexplained symptoms (MUS) has the potential to somatize patients’ problems and intensify dependence on medical care. Several reports indicate that GPs have negative attitudes about patients with MUS. If these attitudes deter participation in training or other methods to improve communication, practitioners who most need help will not receive it. OBJECTIVE: To identify how GPs’ attitudes to patients with MUS might inhibit their participation with training to improve management. DESIGN: Qualitative study. PARTICIPANTS: GPs (N = 33) who had declined or accepted training in reattribution techniques in the context of a research trial. APPROACH: GPs were interviewed and their accounts analysed qualitatively. RESULTS: Although attitudes that devalued patients with MUS were common in practitioners who had declined training, these coexisted, in the same practitioners, with evidence of intuitive and elaborate psychological work with these patients. However, these practitioners devalued their psychological skills. GPs who had accepted training also described working psychologically with MUS but devalued neither patients with MUS nor their own psychological skills. CONCLUSIONS: GPs’ attitudes that suggested disengagement from patients with MUS belied their pursuit of psychological objectives. We therefore suggest that, whereas negative attitudes to patients have previously been regarded as the main barrier to involvement in measures to improve patient management, GPs devaluing of their own psychological skills with these patients may be more important

IFN-λ3, not IFN-λ4, likely mediates IFNL3-IFNL4 haplotype-dependent hepatic inflammation and fibrosis

Genetic variation in the IFNL3-IFNL4 (interferon-λ3-interferon-λ4) region is associated with hepatic inflammation and fibrosis. Whether IFN-λ3 or IFN-λ4 protein drives this association is not known. We demonstrate that hepatic inflammation, fibrosis stage, fibrosis progression rate, hepatic infiltration of immune cells, IFN-λ3 expression, and serum sCD163 levels (a marker of activated macrophages) are greater in individuals with the IFNL3-IFNL4 risk haplotype that does not produce IFN-λ4, but produces IFN-λ3. No difference in these features was observed according to genotype at rs117648444, which encodes a substitution at position 70 of the IFN-λ4 protein and reduces IFN-λ4 activity, or between patients encoding functionally defective IFN-λ4 (IFN-λ4-Ser70) and those encoding fully active IFN-λ4-Pro70. The two proposed functional variants (rs368234815 and rs4803217) were not superior to the discovery SNP rs12979860 with respect to liver inflammation or fibrosis phenotype. IFN-λ3 rather than IFN-λ4 likely mediates IFNL3-IFNL4 haplotype-dependent hepatic inflammation and fibrosis

Altruism as a mate signal in humans : the role of sexual selection in the evolution and social psychology of human altruism

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Showing off in humans: male generosity as a mating signal

We examined people's charity contributions while in the presence of an observer of the same sex, opposite sex, or no observer. Inspired by costly signaling theory, we hypothesized that men would be more generous in the presence of a potential mate. Men and women played a number of experimental games in which they could earn money. On completion of these games participants were asked what percentage of their earned money they would be willing to donate to charity. Our results show that men contribute more to charity when observed by a member of the opposite sex than by a member of the same sex or no observer. Conversely, female charity donations did not significantly vary across the three observer conditions. Findings support the notion that men's generosity might have evolved as a mating signal

Giving guys get the girls:Men appear more desirable to the opposite sex when displaying costly donations to the homeless

One of the evolutionary adaptive benefits of altruism may be that it acts as an honest (reliable) signal of men’s mate quality. In this study, 285 female participants were shown one of three video scenarios in which a male target took £30 out of a cash machine (ATM) and gave either a lot (£30), a little (£1), or nothing to a homeless man. The participants rated the male target on his attractiveness, their short-and long-term mate preferences towards him, and the degree to which they thought he was likely to possess various parenting qualities. The results showed that, regardless of whether the man was described as rich or poor, participants rated him as being more attractive when he donated money, but only when the donation was costly (£30). In addition, altruism was shown to be important in long-term, but not short-term mate choice, and displays of altruism were associated with positive parenting qualities. It is argued that displays of altruism act as a reliable (honest) mate signal for a potential long-term parental partner