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Abstract
This article describes cognitive behavioral therapy (CBT) for women with problematic menopausal symptoms, and provides the evidence from clinical trials of women going through the menopause, women with breast cancer treatment-induced symptoms and women with problematic symptoms in a work context. The CBT focus is primarily on vasomotor symptoms (VMS) but it also targets stress, low mood and sleep problems. CBT is a brief therapy (four to six sessions) that is theory- and evidence-based; it is acceptable to women and effectively reduces the impact of VMS, improves sleep and has benefits to quality of life. VMS frequency is also reduced significantly in some trials but not others. CBT has been found to be consistently effective when delivered in groups, self-help book and on-line formats (with or without additional support). The MENOS 1 and MENOS 2 CBT protocols are recommended for the treatment of VMS by the North American Menopause Society (2015); CBT has been recommended for the treatment of anxiety and depression for women during the menopause transition and post menopause (NICE, 2015); and telephone CBT has been shown to be an effective treatment for insomnia.
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Affiliation(s)
- M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Guy's Campus, London, UK
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2
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Buffart LM, Schreurs MAC, Abrahams HJG, Kalter J, Aaronson NK, Jacobsen PB, Newton RU, Courneya KS, Armes J, Arving C, Braamse AM, Brandberg Y, Dekker J, Ferguson RJ, Gielissen MF, Glimelius B, Goedendorp MM, Graves KD, Heiney SP, Horne R, Hunter MS, Johansson B, Northouse LL, Oldenburg HS, Prins JB, Savard J, van Beurden M, van den Berg SW, Brug J, Knoop H, Verdonck-de Leeuw IM. Effects and moderators of coping skills training on symptoms of depression and anxiety in patients with cancer: Aggregate data and individual patient data meta-analyses. Clin Psychol Rev 2020; 80:101882. [PMID: 32640368 DOI: 10.1016/j.cpr.2020.101882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/21/2020] [Accepted: 06/11/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE This study evaluated the effects of coping skills training (CST) on symptoms of depression and anxiety in cancer patients, and investigated moderators of the effects. METHODS Overall effects and intervention-related moderators were studied in meta-analyses of pooled aggregate data from 38 randomized controlled trials (RCTs). Patient-related moderators were examined using linear mixed-effect models with interaction tests on pooled individual patient data (n = 1953) from 15 of the RCTs. RESULTS CST had a statistically significant but small effect on depression (g = -0.31,95% confidence interval (CI) = -0.40;-0.22) and anxiety (g = -0.32,95%CI = -0.41;-0.24) symptoms. Effects on depression symptoms were significantly larger for interventions delivered face-to-face (p = .003), led by a psychologist (p = .02) and targeted to patients with psychological distress (p = .002). Significantly larger reductions in anxiety symptoms were found in younger patients (pinteraction < 0.025), with the largest reductions in patients <50 years (β = -0.31,95%CI = -0.44;-0.18) and no significant effects in patients ≥70 years. Effects of CST on depression (β = -0.16,95%CI = -0.25;-0.07) and anxiety (β = -0.24,95%CI = -0.33;-0.14) symptoms were significant in patients who received chemotherapy but not in patients who did not (pinteraction < 0.05). CONCLUSIONS CST significantly reduced symptoms of depression and anxiety in cancer patients, and particularly when delivered face-to-face, provided by a psychologist, targeted to patients with psychological distress, and given to patients who were younger and received chemotherapy.
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Affiliation(s)
- L M Buffart
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
| | - M A C Schreurs
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - H J G Abrahams
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - J Kalter
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands.
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - P B Jacobsen
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD, Florida, USA.
| | - R U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
| | - K S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.
| | - J Armes
- School of Health Science, University of Surrey, Surrey, UK.
| | - C Arving
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - A M Braamse
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Y Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - J Dekker
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - R J Ferguson
- Division of Hematology-Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
| | | | - B Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | - M M Goedendorp
- Department of Health Science, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - K D Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
| | - S P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, USA.
| | - R Horne
- UCL School of Pharmacy, University College London, London, UK.
| | - M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - B Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | - L L Northouse
- University of Michigan School of Nursing, Ann Arbor, MI, USA.
| | - H S Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - J B Prins
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, the Netherlands.
| | - J Savard
- School of Psychology, Université Laval and Laval University Cancer Research Center, Québec, QC, Canada.
| | - M van Beurden
- Department of Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - S W van den Berg
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, the Netherlands.
| | - J Brug
- National Institute of Public Health and the Environment, Bilthoven, the Netherlands.
| | - H Knoop
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - I M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery and Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, the Netherlands.
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Trevillion K, Ryan EG, Pickles A, Heslin M, Byford S, Nath S, Bick D, Milgrom J, Mycroft R, Domoney J, Pariante C, Hunter MS, Howard LM. An exploratory parallel-group randomised controlled trial of antenatal Guided Self-Help (plus usual care) versus usual care alone for pregnant women with depression: DAWN trial. J Affect Disord 2020; 261:187-197. [PMID: 31634678 DOI: 10.1016/j.jad.2019.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/30/2019] [Accepted: 10/09/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Depression is a common antenatal mental disorder associated with significant maternal morbidity and adverse fetal outcomes. However, there is a lack of research on the effectiveness or cost-effectiveness of psychological interventions for antenatal depression. METHODS A parallel-group, exploratory randomised controlled trial across five hospitals. The trial compared Guided Self-Help, modified for pregnancy, plus usual care with usual care alone for pregnant women meeting DSM-IV criteria for mild-moderate depression. The trial objectives were to establish recruitment/follow-up rates, compliance and acceptability, and to provide preliminary evidence of intervention efficacy and cost-effectiveness. The primary outcome of depressive symptoms was assessed by blinded researchers using the Edinburgh Postnatal Depression Scale at 14-weeks post-randomisation. RESULTS 620 women were screened, 114 women were eligible and 53 (46.5%) were randomised. 26 women received Guided Self-Help - 18 (69%) attending ≥4 sessions - and 27 usual care; n = 3 women were lost to follow-up (follow-up rate for primary outcome 92%). Women receiving Guided Self-Help reported fewer depressive symptoms at follow-up than women receiving usual care (adjusted effect size -0.64 (95%CI: -1.30, 0.06) p = 0.07). There were no trial-related adverse events. The cost-effectiveness acceptability curve showed the probability of Guided Self-Help being cost-effective compared with usual care ranged from 10 to 50% with a willingness-to-pay range from £0 to £50,000. CONCLUSIONS AND LIMITATIONS Despite intense efforts we did not meet our anticipated recruitment target. However, high levels of acceptability, a lack of adverse events and a trend towards improvements in symptoms of depression post-treatment indicates this intervention is suitable for talking therapy services.
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Affiliation(s)
- K Trevillion
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom.
| | - E G Ryan
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - A Pickles
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - M Heslin
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - S Byford
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - S Nath
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - D Bick
- Departmentof Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom
| | - J Milgrom
- University of Melbourne and Parent-Infant Research Institute, Melbourne, Australia
| | - R Mycroft
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - J Domoney
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - C Pariante
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - M S Hunter
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - L M Howard
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
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4
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Shelby ML, Gilbile D, Grant TD, Seuring C, Segelke BW, He W, Evans AC, Pakendorf T, Fischer P, Hunter MS, Batyuk A, Barthelmess M, Meents A, Coleman MA, Kuhl TL, Frank M. A fixed-target platform for serial femtosecond crystallography in a hydrated environment. IUCrJ 2020; 7:30-41. [PMID: 31949902 PMCID: PMC6949605 DOI: 10.1107/s2052252519014003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/15/2019] [Indexed: 05/19/2023]
Abstract
For serial femtosecond crystallography at X-ray free-electron lasers, which entails collection of single-pulse diffraction patterns from a constantly refreshed supply of microcrystalline sample, delivery of the sample into the X-ray beam path while maintaining low background remains a technical challenge for some experiments, especially where this methodology is applied to relatively low-ordered samples or those difficult to purify and crystallize in large quantities. This work demonstrates a scheme to encapsulate biological samples using polymer thin films and graphene to maintain sample hydration in vacuum conditions. The encapsulated sample is delivered into the X-ray beam on fixed targets for rapid scanning using the Roadrunner fixed-target system towards a long-term goal of low-background measurements on weakly diffracting samples. As a proof of principle, we used microcrystals of the 24 kDa rapid encystment protein (REP24) to provide a benchmark for polymer/graphene sandwich performance. The REP24 microcrystal unit cell obtained from our sandwiched in-vacuum sample was consistent with previously established unit-cell parameters and with those measured by us without encapsulation in humidified helium, indicating that the platform is robust against evaporative losses. While significant scattering from water was observed because of the sample-deposition method, the polymer/graphene sandwich itself was shown to contribute minimally to background scattering.
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Affiliation(s)
- M. L. Shelby
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - D. Gilbile
- University of California at Davis, California, USA
| | - T. D. Grant
- Department of Structural Biology, Jacobs School of Medicine and Biomedical Sciences, Hauptman-Woodward Institute, SUNY University at Buffalo, Buffalo, New York, USA
| | - C. Seuring
- Center for Free-Electron Laser Science, Deutsches Elektronen-Synchrotron, Hamburg, Germany
| | - B. W. Segelke
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - W. He
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - A. C. Evans
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
- University of California at Davis, California, USA
| | - T. Pakendorf
- Center for Free-Electron Laser Science, Deutsches Elektronen-Synchrotron, Hamburg, Germany
| | - P. Fischer
- Center for Free-Electron Laser Science, Deutsches Elektronen-Synchrotron, Hamburg, Germany
| | - M. S. Hunter
- Linac Coherent Light Source, SLAC National Accelerator Laboratory, Menlo Park, California, USA
| | - A. Batyuk
- Linac Coherent Light Source, SLAC National Accelerator Laboratory, Menlo Park, California, USA
| | - M. Barthelmess
- Center for Free-Electron Laser Science, Deutsches Elektronen-Synchrotron, Hamburg, Germany
| | - A. Meents
- Center for Free-Electron Laser Science, Deutsches Elektronen-Synchrotron, Hamburg, Germany
| | - M. A. Coleman
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
- University of California at Davis, California, USA
| | - T. L. Kuhl
- University of California at Davis, California, USA
| | - M. Frank
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
- University of California at Davis, California, USA
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5
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Iliodromiti S, Wang W, Lumsden MA, Hunter MS, Bell R, Mishra G, Hickey M. Variation in menopausal vasomotor symptoms outcomes in clinical trials: a systematic review. BJOG 2019; 127:320-333. [PMID: 31621155 PMCID: PMC6972542 DOI: 10.1111/1471-0528.15990] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is substantial variation in how menopausal vasomotor symptoms are reported and measured among intervention studies. This has prevented meaningful comparisons between treatments and limited data synthesis. OBJECTIVES To review systematically the outcome reporting and measures used to assess menopausal vasomotor symptoms from randomised controlled trials of treatments. SEARCH STRATEGY We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to May 2018. SELECTION CRITERIA Randomised controlled trials with a primary outcome of menopausal vasomotor symptoms in women and a sample size of at least 20 women per study arm. DATA COLLECTION AND ANALYSIS Data about study characteristics, primary vasomotor-related outcomes and methods of measuring them. MAIN RESULTS The search identified 5591 studies, 214 of which were included. Forty-nine different primary reported outcomes were identified for vasomotor symptoms and 16 different tools had been used to measure these outcomes. The most commonly reported outcomes were frequency (97/214), severity (116/214), and intensity (28/114) of vasomotor symptoms or a composite of these outcomes (68/214). There was little consistency in how the frequency and severity/intensity of vasomotor symptoms were defined. CONCLUSIONS There is substantial variation in how menopausal vasomotor symptoms have been reported and measured in treatment trials. Future studies should include standardised outcome measures which reflect the priorities of patients, clinicians, and researchers. This is most effectively achieved through the development of a Core Outcome Set. This systematic review is the first step towards development of a Core Outcome Set for menopausal vasomotor symptoms. TWEETABLE SUMMARY Menopausal hot flushes and night sweats have been reported in 49 different ways in clinical research. A core outcome set is urgently required.
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Affiliation(s)
- S Iliodromiti
- Women's Health Division, Blizard Institute, Queen Mary University London, London, UK.,School of Medicine, University of Glasgow, Glasgow, UK
| | - W Wang
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - M A Lumsden
- School of Medicine, University of Glasgow, Glasgow, UK
| | - M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - R Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - G Mishra
- Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Australia
| | - M Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and The Royal Women's Hospital, Victoria, Australia
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6
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Abstract
Background Recent evidence suggests that some women experience menopausal symptoms that impact on their working lives, and that work environments can impact upon the experience of menopause. As a result, guidance for employers and other key stakeholders about this potential occupational health issue has emerged. To date there has not been a review of these documents to identify their main recommendations for policy and practice. Aims To provide a narrative overview of such guidance and summary of content. Methods Documents published in the UK and available in a major UK trade union library were searched systematically to identify guidance on the topic of menopause and work. An inductive thematic analysis was performed to identify the main themes addressed. Results Twenty-five relevant documents, on average eight pages long, were identified. A minority indicated that the use of scientific evidence informed the content. Five overarching themes were identified: (i) legislation; (ii) policy; (iii) information and training needs; (iv) workplace support; and (v) the physical work environment. Conclusions This overview of UK guidance revealed common areas of concern about reducing and managing difficulties experienced by working menopausal women. Possible areas for action were identified. Some recommendations were common across much of the guidance, whereas others were exclusive. Future guidance might include consideration of all these issues, while making reference both to the evidence base and sources of further information.
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Affiliation(s)
- C Hardy
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5th Floor Bermondsey Wing, Guy's Campus, London, UK
| | - M S Hunter
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5th Floor Bermondsey Wing, Guy's Campus, London, UK
| | - A Griffiths
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
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7
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Hunter MS, Nuttall J, Fenlon D. A comparison of three outcome measures of the impact of vasomotor symptoms on women's lives. Climacteric 2019; 22:419-423. [PMID: 30905177 DOI: 10.1080/13697137.2019.1580258] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 01/30/2019] [Accepted: 02/03/2019] [Indexed: 10/27/2022]
Abstract
Objective: Measures of the impact of vasomotor symptoms (VMS) have been used as outcomes in clinical trials but have not been compared. This study compares the Hot Flush Rating Scale (HFRS), the Hot Flash Related Daily Interference Scale (HFRDIS), and the shorter Hot Flash Interference (HFI) scale. Methods: Baseline data were taken from two studies including healthy women (menopause transition or postmenopause) and breast cancer patients experiencing VMS. Participants completed questionnaires on sociodemographics, the HFRS, the HFRDIS, the HFI, the Work and Social Adjustment Scale (WSAS), on depression (Generalized Anxiety Disorder 7), on anxiety (Patient Health Questionnaire 9), and on use of medical services. Results: A total of 169 women (129 with history of breast cancer and 40 without) aged 54.47 (standard deviation [SD] = 9.11) years took part. They had an average of 66 (SD = 40.94) VMS per week, with a mean HFRS problem-rating of 6.53 (SD = 1.99), HFRDIS score of 5.36 (SD = 2.22), and HFI score of 6.13 (SD = 2.30). The HFRS problem-rating, HFRDIS, and HFI were significantly associated (r = 0.61-0.85), had good internal reliability (α = 0.76-0.91), and had significant concurrent validity with mood, the WSAS, and use of medical services. VMS frequency was not associated with mood, the WSAS, or use of medical services. Conclusion: The HFRS problem-rating scale and the HFI are two brief, three-item measures that measure a similar concept of VMS interference/impact, with evidence of reliability and validity.
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Affiliation(s)
- M S Hunter
- a Institute of Psychiatry , Psychology and Neuroscience, King's College London , London , UK
| | - J Nuttall
- b Southampton Clinical Trials Unit , University of Southampton , Southampton , UK
| | - D Fenlon
- c Department of Nursing , Swansea University , Swansea , UK
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8
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Kalter J, Verdonck-de Leeuw IM, Sweegers MG, Aaronson NK, Jacobsen PB, Newton RU, Courneya KS, Aitken JF, Armes J, Arving C, Boersma LJ, Braamse AMJ, Brandberg Y, Chambers SK, Dekker J, Ell K, Ferguson RJ, Gielissen MFM, Glimelius B, Goedendorp MM, Graves KD, Heiney SP, Horne R, Hunter MS, Johansson B, Kimman ML, Knoop H, Meneses K, Northouse LL, Oldenburg HS, Prins JB, Savard J, van Beurden M, van den Berg SW, Brug J, Buffart LM. Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs. Psychooncology 2018; 27:1150-1161. [PMID: 29361206 PMCID: PMC5947559 DOI: 10.1002/pon.4648] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 01/02/2018] [Accepted: 01/10/2018] [Indexed: 01/25/2023]
Abstract
Objective This individual patient data (IPD) meta‐analysis aimed to evaluate the effects of psychosocial interventions (PSI) on quality of life (QoL), emotional function (EF), and social function (SF) in patients with cancer, and to study moderator effects of demographic, clinical, personal, and intervention‐related characteristics. Methods Relevant studies were identified via literature searches in 4 databases. We pooled IPD from 22 (n = 4217) of 61 eligible randomized controlled trials. Linear mixed‐effect model analyses were used to study intervention effects on the post‐intervention values of QoL, EF, and SF (z‐scores), adjusting for baseline values, age, and cancer type. We studied moderator effects by testing interactions with the intervention for demographic, clinical, personal, and intervention‐related characteristics, and conducted subsequent stratified analyses for significant moderator variables.Results: PSI significantly improved QoL (β = 0.14,95%CI = 0.06;0.21), EF (β = 0.13,95%CI = 0.05;0.20), and SF (β = 0.10,95%CI = 0.03;0.18). Significant differences in effects of different types of PSI were found, with largest effects of psychotherapy. The effects of coping skills training were moderated by age, treatment type, and targeted interventions. Effects of psychotherapy on EF may be moderated by cancer type, but these analyses were based on 2 randomized controlled trials with small sample sizes of some cancer types. Conclusions PSI significantly improved QoL, EF, and SF, with small overall effects. However, the effects differed by several demographic, clinical, personal, and intervention‐related characteristics. Our study highlights the beneficial effects of coping skills training in patients treated with chemotherapy, the importance of targeted interventions, and the need of developing interventions tailored to the specific needs of elderly patients.
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Affiliation(s)
- J Kalter
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - I M Verdonck-de Leeuw
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands.,Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health research institute and Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - M G Sweegers
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P B Jacobsen
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, Maryland, FL, USA
| | - R U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - K S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - J F Aitken
- Menzies Health Institute Queensland, Griffith University, Southport, Australia.,Cancer Council Queensland, Brisbane, Australia.,Institute for Resilient Regions, University of Southern Queensland, Brisbane, Australia
| | - J Armes
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - C Arving
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - L J Boersma
- Department of Radiation Oncology, Maastricht University Medical Center (MAASTRO clinic), Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A M J Braamse
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - Y Brandberg
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S K Chambers
- Menzies Health Institute Queensland, Griffith University, Southport, Australia.,Cancer Council Queensland, Brisbane, Australia.,Prostate Cancer Foundation of Australia, Sydney, NSW, Australia
| | - J Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - K Ell
- Department of Adults and Healthy Aging, University of Southern California, Los Angeles, CA, USA
| | - R J Ferguson
- Division of Hematology-Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - M F M Gielissen
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - B Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - M M Goedendorp
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - K D Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - S P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - R Horne
- UCL School of Pharmacy, University College London, London, UK
| | - M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - B Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - M L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - H Knoop
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - K Meneses
- University of Alabama at Birmingham, School of Nursing, Birmingham, AL, USA
| | - L L Northouse
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - H S Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - J B Prins
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Savard
- School of Psychology, Université Laval and Laval University Cancer Research Center, Québec, QC, Canada
| | - M van Beurden
- Department of Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - S W van den Berg
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Brug
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - L M Buffart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,Department of Medical Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Gentry-Maharaj A, Karpinskyj C, Glazer C, Burnell M, Bailey K, Apostolidou S, Ryan A, Lanceley A, Fraser L, Jacobs I, Hunter MS, Menon U. Prevalence and predictors of complementary and alternative medicine/non-pharmacological interventions use for menopausal symptoms within the UK Collaborative Trial of Ovarian Cancer Screening. Climacteric 2017; 20:240-247. [PMID: 28326899 PMCID: PMC5448394 DOI: 10.1080/13697137.2017.1301919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 01/26/2017] [Accepted: 02/19/2017] [Indexed: 12/04/2022]
Abstract
OBJECTIVES The negative publicity about menopausal hormone therapy (MHT) has led to increased use of complementary and alternative medicines (CAM) and non-pharmacological interventions (NPI) for menopausal symptom relief. We report on the prevalence and predictors of CAM/NPI among UK postmenopausal women. METHOD Postmenopausal women aged 50-74 years were invited to participate in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). A total of 202 638 women were recruited and completed a baseline questionnaire. Of these, 136 020 were sent a postal follow-up-questionnaire between September 2006 and May 2009 which included ever-use of CAM/NPI for menopausal symptom relief. Both questionnaires included MHT use. RESULTS A total of 88 430 (65.0%) women returned a completed follow-up-questionnaire; 22 206 (25.1%) reported ever-use of one or more CAM/NPI. Highest use was reported for herbal therapies (43.8%; 9725/22 206), vitamins (42.6%; 9458/22 206), lifestyle approaches (32.1%; 7137/22 206) and phytoestrogens (21.6%; 4802/22 206). Older women reported less ever-use of herbal therapies, vitamins and phytoestrogens. Lifestyle approaches, aromatherapy/reflexology/acupuncture and homeopathy were similar across age groups. Higher education, Black ethnicity, MHT or previous oral contraceptive pill use were associated with higher CAM/NPI use. Women assessed as being less hopeful about their future were less likely to use CAM/NPI. CONCLUSION One in four postmenopausal women reported ever-use of CAM therapies/NPI for menopausal symptom relief, with lower use reported by older women. Higher levels of education and previous MHT use were positive predictors of CAM/NPI use. UKCTOCS Trial registration: ISRCTN22488978.
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Affiliation(s)
- A. Gentry-Maharaj
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - C. Karpinskyj
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - C. Glazer
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
- Department of Occupational and Environmental Medicine, Bispebjerg - Frederiksberg Hospital, Institute of Public Health, University of CopenhagenCopenhagenDenmark
| | - M. Burnell
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - K. Bailey
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - S. Apostolidou
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - A. Ryan
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - A. Lanceley
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - L. Fraser
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - I. Jacobs
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
- UNSW AustraliaSydneyAustralia
- Centre for Women's Health, Institute of Human Development, University of ManchesterManchesterUK
| | - M. S. Hunter
- Department of Psychology, Institute of Psychiatry, Guy’s Campus, King's College LondonLondonUK
| | - U. Menon
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
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Stagno JR, Liu Y, Bhandari YR, Conrad CE, Panja S, Swain M, Fan L, Nelson G, Li C, Wendel DR, White TA, Coe JD, Wiedorn MO, Knoska J, Oberthuer D, Tuckey RA, Yu P, Dyba M, Tarasov SG, Weierstall U, Grant TD, Schwieters CD, Zhang J, Ferré-D'Amaré AR, Fromme P, Draper DE, Liang M, Hunter MS, Boutet S, Tan K, Zuo X, Ji X, Barty A, Zatsepin NA, Chapman HN, Spence JCH, Woodson SA, Wang YX. Structures of riboswitch RNA reaction states by mix-and-inject XFEL serial crystallography. Acta Crystallogr A Found Adv 2017. [DOI: 10.1107/s0108767317099081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Affiliation(s)
- D. W. Sturdee
- Department of Gynaecology, Solihull Hospital, Birmingham, UK
| | - M. S. Hunter
- Unit of Psychology, Institute of Psychiatry (at Guy's), King's College London, London, UK
| | - P. M. Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - P. Gupta
- Women's Unit, Solihull Hospital, Birmingham Heartlands & Solihull NHS Trust, Birmingham, UK
| | - J. Sassarini
- Department of Obstetrics & Gynaecology, University of Glasgow, College of Medicine, Western Infirmary, Glasgow, UK
| | - J. C. Stevenson
- National Heart & Lung Institute, Royal Brompton Hospital, London, UK
| | - M. A. Lumsden
- Reproductive and Maternal Medicine, University of Glasgow, Glasgow, UK
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Affiliation(s)
- L. Medina-Perucha
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - O. Yousaf
- Department of Psychology, University of Bath, Bath, UK
| | - M. S. Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - E. A. Grunfeld
- Centre for Technology Enabled Health Research, Coventry University, Coventry, UK
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Sriprasert I, Pantasri T, Piyamongkol W, Suwan A, Chaikittisilpa S, Sturdee D, Gupta P, Hunter MS. An International Menopause Society study of vasomotor symptoms in Bangkok and Chiang Mai, Thailand. Climacteric 2017; 20:171-177. [DOI: 10.1080/13697137.2017.1284782] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- I. Sriprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Ma, Thailand
| | - T. Pantasri
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Ma, Thailand
| | - W. Piyamongkol
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Ma, Thailand
| | - A. Suwan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - S. Chaikittisilpa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - D. Sturdee
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - P. Gupta
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - M. S. Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Hunter MS, Asiimwe P, Himler AG, Kelly SE. Host nuclear genotype influences phenotype of a conditional mutualist symbiont. J Evol Biol 2016; 30:141-149. [DOI: 10.1111/jeb.12993] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/15/2016] [Accepted: 10/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- M. S. Hunter
- Department of Entomology University of Arizona Tucson AZ USA
| | - P. Asiimwe
- Department of Entomology University of Arizona Tucson AZ USA
| | - A. G. Himler
- Department of Entomology University of Arizona Tucson AZ USA
| | - S. E. Kelly
- Department of Entomology University of Arizona Tucson AZ USA
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Grunfeld EA, Hunter MS, Yousaf O. Men’s experience of a guided self-help intervention for hot flushes associated with prostate cancer treatment. PSYCHOL HEALTH MED 2016; 22:425-433. [DOI: 10.1080/13548506.2016.1195504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
OBJECTIVE Hot flushes and night sweats (HFNS) are common but under-researched in prostate cancer survivors undergoing androgen-deprivation therapy (ADT). We aimed to examine subjective reports and physiological measures of HFNS, and the influence of sociodemographic, clinical and psychological factors on HFNS in men undergoing ADT. METHODS Sixty-eight men undergoing ADT for prostate cancer attended an assessment interview, completed questionnaires (assessing HFNS frequency and problem-rating, mood, stress, optimism, somatosensory amplification, HFNS beliefs/behaviors) and wore an ambulatory sternal skin conductance (SSC) monitor for 48 h. RESULTS The sample had a mean age of 69.76 (standard deviation, SD = 8.04) years, were on average 27.24 (SD = 28.53) months since cancer diagnosis and had been on their current ADT regime for 16 months (range 2-74 months). The men reported frequent (weekly mean 51.04, SD = 33.21) and moderately problematic HFNS. Overall, 294 (20%) of the SSC-defined HFNS were concordant with prospective frequency (event marker), while 63% were under-reported and 17% were over-reported, under-reporting being more common than over-reporting. There were no significant predictors of HFNS frequency (subjective or physiological measures), but psychological variables (HFNS beliefs and behaviors (β = 0.56, p < 0.03), anxiety (β = 0.24, p < 0.01) and somatic amplification (β = 0.76, p < 0.04) were the main predictors of problematic HFNS, i.e. troublesome symptoms. CONCLUSIONS These results are consistent with those of studies of women during menopause and breast cancer survivors, i.e. subjective and physiological measures appear to identify different HFNS dimensions. Psychological variables (HFNS beliefs and behaviors, anxiety and somatic amplification) can be targeted, using cognitive behavior therapy, for symptom relief.
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Affiliation(s)
- M S Hunter
- a Department of Psychology , Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - E Stefanopoulou
- a Department of Psychology , Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
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Abstract
BACKGROUND Non-cardiac chest pain (NCCP) affects up to 80% of patients attending chest pain clinics, but its treatment is suboptimal. AIM To describe the outcomes of a pilot, stepped care, biopsychosocial management programme in terms of improvements in chest pain, psychosocial scores and use of healthcare resources. METHODS Of 198 referrals, 77 patients were suitable for the clinic and received a one hour biopsychosocial assessment. Stepped care consisted of assessment only, low intensity Cognitive Behaviour Therapy (CBT), or high intensity CBT. RESULTS The proportion with pain occurring more than once monthly fell from 100% at baseline to 61% at 3 months (p < 0.001). Pain interference reduced significantly (p < 0.001) from 5.9 [SD 2.2] at baseline to 3.2 [SD 2.6] at 3 months. Depression scores improved from a mean 8.8 to 5.4 (p < 0.05) and anxiety from 6.9 to 4.6 (p < 0.05). Use of healthcare resources improved with a fall in consultations for chest pain over 6 months from a mean 2.6 to 0.1 (p < 0.05). The impact on work and social functioning reduced from 10.4 [SD 10.4] to 3.9 [SD 7.5]: [t (70) = 6.3, p < 0.001). Further improvements occurred at 6 months for chest pain frequency (which fell to 51%, p = 0.003), interference (2.6 [SD 2.1], p < 0.05) and avoidance of exercise (p = 0.03). Otherwise improvements were maintained between 3 and 6 months. CONCLUSION A stepped-care biopsychosocial approach to NCCP is effective in reducing chest pain frequency and improving behaviour and wellbeing. It can be delivered in part by a nurse allowing integration into any chest pain clinic.
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Affiliation(s)
- J B Chambers
- Cardiothoracic Centre, Guy's and St Thomas Hospital, London, UK
| | - E M Marks
- Cardiothoracic Centre, Guy's and St Thomas Hospital, London, UK
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - V Russell
- Cardiothoracic Centre, Guy's and St Thomas Hospital, London, UK
| | - M S Hunter
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
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Chambers JB, Marks EM, Hunter MS. The head says yes but the heart says no: what is non-cardiac chest pain and how is it managed? Heart 2015; 101:1240-9. [PMID: 25882503 DOI: 10.1136/heartjnl-2014-306277] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 03/08/2015] [Indexed: 12/20/2022] Open
Affiliation(s)
- J B Chambers
- Cardiothoracic Centre, Guy's and St Thomas Hospital, London, UK
| | - E M Marks
- Cardiothoracic Centre, Guy's and St Thomas Hospital, London, UK Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Daley AJ, Thomas A, Roalfe AK, Stokes-Lampard H, Coleman S, Rees M, Hunter MS, MacArthur C. The effectiveness of exercise as treatment for vasomotor menopausal symptoms: randomised controlled trial. BJOG 2014; 122:565-75. [PMID: 25516405 DOI: 10.1111/1471-0528.13193] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the effectiveness of exercise as treatment for vasomotor menopausal symptoms. DESIGN Three-group randomised controlled trial, two exercise interventions and a control group. SETTING Primary Care, West Midlands UK. POPULATION Perimenopausal and postmenopausal women experiencing at least five hot flushes/night sweats per day and not taken MHT in previous 3 months were recruited from 23 general practices. METHODS Participants in both exercise interventions groups were offered two face-to-face consultations with a physical activity facilitator to support engagement in regular exercise. In addition, one exercise group received a menopause-specific information DVD and written materials to encourage regular exercise and the other exercise group was offered the opportunity to attend exercise social support groups in their communities. Interventions lasted 6 months. MAIN OUTCOME MEASURE The primary outcome was frequency of hot flushes/night sweats at 6-month up. RESULTS Two hundred and sixty-one women were randomised (n = 87 per group). Neither of the exercise intervention groups reported significantly less frequent hot flushes/night sweats per week than controls (exercise-DVD versus control: -8.9, 95% CI -20.0 to 2.2; exercise-social support versus control: -5.2, 95% CI -16.7 to 6.3). CONCLUSIONS This trial indicates that exercise is not an effective treatment for hot flushes/night sweats. Contrary to current clinical guidance, women should not be advised that exercise will relieve their vasomotor menopausal symptoms.
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Affiliation(s)
- A J Daley
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Omotade TO, Bernhards RC, Klimko CP, Matthews ME, Hill AJ, Hunter MS, Webster WM, Bozue JA, Welkos SL, Cote CK. The impact of inducing germination of Bacillus anthracis and Bacillus thuringiensis spores on potential secondary decontamination strategies. J Appl Microbiol 2014; 117:1614-33. [PMID: 25196092 DOI: 10.1111/jam.12644] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/03/2014] [Accepted: 09/03/2014] [Indexed: 12/22/2022]
Abstract
AIMS Decontamination and remediation of a site contaminated by the accidental or intentional release of fully virulent Bacillus anthracis spores are difficult, costly and potentially damaging to the environment. Development of novel decontamination strategies that have minimal environmental impacts remains a high priority. Although ungerminated spores are amongst the most resilient organisms known, once exposed to germinants, the germinating spores, in some cases, become susceptible to antimicrobial environments. We evaluated the concept that once germinated, B. anthracis spores would be less hazardous and significantly easier to remediate than ungerminated dormant spores. METHODS AND RESULTS Through in vitro germination and sensitivity assays, we demonstrated that upon germination, B. anthracis Ames spores and Bacillus thuringiensis Al Hakam spores (serving as a surrogate for B. anthracis) become susceptible to environmental stressors. The majority of these germinated B. anthracis and B. thuringiensis spores were nonviable after exposure to a defined minimal germination-inducing solution for prolonged periods of time. Additionally, we examined the impact of potential secondary disinfectant strategies including bleach, hydrogen peroxide, formaldehyde and artificial UV-A, UV-B and UV-C radiation, employed after a 60-min germination-induction step. Each secondary disinfectant employs a unique mechanism of killing; as a result, germination-induction strategies are better suited for some secondary disinfectants than others. CONCLUSIONS These results provide evidence that the deployment of an optimal combination strategy of germination-induction/secondary disinfection may be a promising aspect of wide-area decontamination following a B. anthracis contamination event. SIGNIFICANCE AND IMPACT OF THE STUDY By inducing spores to germinate, our data confirm that the resulting cells exhibit sensitivities that can be leveraged when paired with certain decontamination measures. This increased susceptibility could be exploited to devise more efficient and safe decontamination measures and may obviate the need for more stringent methods that are currently in place.
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Affiliation(s)
- T O Omotade
- Bacteriology Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), Frederick, MD, USA
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Hunter MS, Sharpley CF, Stefanopoulou E, Yousaf O, Bitsika V, Christie DRH. The Hot Flush Beliefs and Behaviour Scale for Men (HFBBS-Men) undergoing treatment for prostate cancer. Maturitas 2014; 79:464-70. [PMID: 25449665 DOI: 10.1016/j.maturitas.2014.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 09/16/2014] [Accepted: 09/29/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Hot flushes and night sweats (HFNS) are commonly experienced by men receiving treatment for prostate cancer. Cognitive behavioural therapy (CBT) has been found to be an effective treatment for HFNS in women, but cognitions and behavioural reactions to HFNS in men are under-researched. This study describes the development of the HFNS beliefs and behaviour scale for men. METHODS HFNS beliefs and behaviour items were generated from a qualitative study, from pilot interviews with men with prostate cancer and HFNS, and from scales used for women. 118 men with prostate cancer, aged above 18, English-speaking, who had minimum of seven HFNS weekly for at least 1 month, completed the initial measure, and measures of HFNS frequency, problem rating, anxiety and depression (HADS). Principal components analyses with orthogonal rotation determined the most coherent solution. RESULTS Exploratory factor analysis culminated in a 17-item HFNS beliefs and behaviour scale for men (HFBBS-Men) with three subscales: (1) HFNS social context and sleep, (2) Calm/Acceptance, (3) Humour/Openness. The subscales had reasonable internal consistency (Cronbach alpha 0.56-0.83). Validity was supported, by correlations between subscale 1, HFNS frequency, problem-rating and mood; men with locally advanced cancer more likely to adopt Calm/Acceptance and those with metastatic cancer Humour/Openness. CONCLUSIONS Preliminary analysis of the HFBBS-Men suggests that it is a psychometrically sound instrument, grounded in men's experiences. As a measure of cognitive and behavioural reactions to HF/NS, the HFBBS-Men should increase understanding of the mediators of outcomes of psychological interventions, such as CBT.
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Affiliation(s)
- M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - C F Sharpley
- Brain-Behaviour Research Group, University of New England, New South Wales, Australia; Centre for Autism Spectrum Disorders, Bond University, Queensland, Australia
| | - E Stefanopoulou
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - O Yousaf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - V Bitsika
- Centre for Autism Spectrum Disorders, Bond University, Queensland, Australia
| | - D R H Christie
- Brain-Behaviour Research Group, University of New England, New South Wales, Australia; GenesisCare, Queensland, Australia
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Stefanopoulou E, Gupta P, Mostafa RM, Nosair N, Mirghani Z, Moustafa K, Al Kusayer G, Sturdee DW, Hunter MS. IMS study of Climate, Altitude, Temperature and vasomotor symptoms in the United Arab Emirates. Climacteric 2014; 17:425-32. [DOI: 10.3109/13697137.2014.898266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
AIMS To determine the characteristics, clinical needs and level of health-care use of patients with non-cardiac (NCCP) and cardiac-chest pain (CCP) attending a Rapid Access Chest Pain Clinic in an inner-London Hospital. METHODS A cross-sectional comparison of NCCP and CCP patients on measures of pain, mood, beliefs, somatic symptoms and use of services completed by patients attending the Rapid Access Chest Pain Clinic over an 18-month period. RESULTS There were no significant differences between NCCP and CCP patients in terms of chest pain frequency, duration or severity or associated distress; however, NCCP were younger (53 vs. 60, OR = 1.05) and reported 'atypical' pain more frequently (82% vs. 50%, OR = 3.72). The NCCP group reported more panic-type beliefs about chest pain (5.8 vs. 4.3, P < 0.05) and lower 'illness coherence' (a patient's belief that the illness 'makes sense') (3.5 vs. 4.7, P < 0.05). Anxiety and depression scores were similar in both groups. Both groups had similar levels of health-care use but patients with NCCP saw more types of health-care worker (mean 1.7) than those with CCP (mean 1.4, P < 0.05). CONCLUSION Patients with NCCP are as disabled and distressed as patients with CCP however current services fail to meet their needs. We suggest that a biopsychosocial approach should be explored.
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Affiliation(s)
- E M Marks
- From the Cardiothoracic Centre, Guy's and St Thomas Hospital, London, SE1 9RT and Institute of Psychiatry, Department of Psychology King's College London, London, SE1 9RT, UKFrom the Cardiothoracic Centre, Guy's and St Thomas Hospital, London, SE1 9RT and Institute of Psychiatry, Department of Psychology King's College London, London, SE1 9RT, UK
| | - J B Chambers
- From the Cardiothoracic Centre, Guy's and St Thomas Hospital, London, SE1 9RT and Institute of Psychiatry, Department of Psychology King's College London, London, SE1 9RT, UK
| | - V Russell
- From the Cardiothoracic Centre, Guy's and St Thomas Hospital, London, SE1 9RT and Institute of Psychiatry, Department of Psychology King's College London, London, SE1 9RT, UK
| | - L Bryan
- From the Cardiothoracic Centre, Guy's and St Thomas Hospital, London, SE1 9RT and Institute of Psychiatry, Department of Psychology King's College London, London, SE1 9RT, UK
| | - M S Hunter
- From the Cardiothoracic Centre, Guy's and St Thomas Hospital, London, SE1 9RT and Institute of Psychiatry, Department of Psychology King's College London, London, SE1 9RT, UK
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Deas JB, Hunter MS. Egg and time limitation mediate an egg protection strategy. J Evol Biol 2014; 27:920-8. [DOI: 10.1111/jeb.12363] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 03/03/2014] [Accepted: 03/03/2014] [Indexed: 11/30/2022]
Affiliation(s)
- J. B. Deas
- Graduate Interdisciplinary Program in Entomology and Insect Science; The University of Arizona; Tucson AZ USA
| | - M. S. Hunter
- Department of Entomology; The University of Arizona; Tucson AZ USA
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Stefanopoulou E, Shah D, Shah R, Gupta P, Sturdee DW, Hunter MS. An International Menopause Society study of Climate, Altitude, Temperature (IMS-CAT) and vasomotor symptoms in urban Indian regions. Climacteric 2013; 17:417-24. [DOI: 10.3109/13697137.2013.852169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Eziefula CU, Grunfeld EA, Hunter MS. 'You know I've joined your club… I'm the hot flush boy': a qualitative exploration of hot flushes and night sweats in men undergoing androgen deprivation therapy for prostate cancer. Psychooncology 2013; 22:2823-30. [PMID: 23893467 DOI: 10.1002/pon.3355] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 06/17/2013] [Accepted: 06/25/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Hot flushes and night sweats are common amongst menopausal women, and psychological interventions for managing these symptoms have recently been developed for women. However, flushes in men with prostate cancer, which commonly occur following androgen deprivation therapy (ADT), remain under-researched. This study is a qualitative exploration of flush-related cognitive appraisals and behavioural reactions reported by a sample of these men. METHODS Semi-structured, in-depth interviews were conducted with 19 men who were experiencing flushes after receiving ADT for prostate cancer. Framework analysis was used to generate and categorise emergent themes and explore associations between themes. RESULTS Five main cognitive appraisals included the following: changes in oneself, impact on masculinity, embarrassment/social-evaluative concerns, perceived control and acceptance/adjustment. There were men who held beliefs about the impact of flushes on their perceptions of traditional gender roles, who experienced shame and embarrassment due to concerns about the salience of flushes and perceptions by others and who experienced feelings of powerlessness over flushes. Powerlessness was associated with beliefs about the potentially fatal consequences of discontinuing treatment. Two other dominant themes included awareness/knowledge about flushes and management strategies. Experiences of flushes appeared to be influenced by upbringing and general experiences of prostate cancer and ADT. CONCLUSIONS The range of men's appraisals of, and reactions to, flushes generated from this qualitative exploration were broadly similar to those of menopausal women but differed in terms of the influence of masculinity beliefs. These findings could be used to inform future research and psychological interventions in this under-researched field.
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Affiliation(s)
- C U Eziefula
- Institute of Psychiatry, King's College London, London, UK
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Abbas RA, Hammam RAM, El-Gohary SS, Sabik LME, Hunter MS. Screening for common mental disorders and substance abuse among temporary hired cleaners in Egyptian Governmental Hospitals, Zagazig City, Sharqia Governorate. Int J Occup Environ Med 2013; 4:13-26. [PMID: 23279794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 09/23/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Informal employment is common in developing countries, including Egypt. This type of employment may have significant consequences on mental health. OBJECTIVE To determine the prevalence and risk factors of common mental disorders and substance abuse among temporary hired hospital cleaners. METHODS A cross-sectional study was conducted on 242 adult temporary cleaners and 209 permanent cleaners working in 4 governmental hospitals in Zagazig City, Sharqia Governorate, Egypt. All participants were invited to complete a structured questionnaire through a semi-structured interview which included the self-reporting questionnaire 20 items (SRQ-20) and the work stress scale. Assessment of drug use included urine-based screening tests for common substances abused. RESULTS The prevalence of job stress, common mental disorders and substance abuse, particularly tramadol and cannabis (Bango), was significantly higher in the studied temporary cleaners compared to permanent cleaners. Risk factors associated with increased susceptibility of the temporary cleaners to common mental disorders were family history of substance abuse, high crowding index, history of physical illness, low educational level, and smoking; while being unmarried, male sex, family history of mental disorder, age ≥40 years, smoking, and length of service ≥8 years, were associated with substance abuse among the same group. CONCLUSION Temporary hired hospital cleaners suffered from impaired mental health more than permanent cleaners. Therefore, expanding the coverage of current laws and occupational safety and health standards to cover workers in the informal sector especially in developing countries is recommended.
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Affiliation(s)
- R A Abbas
- Department of Community, Environmental and Occupational Medicine, Zagazig University, Egypt
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Hunter MS, Gupta P, Chedraui P, Blümel JE, Tserotas K, Aguirre W, Palacios S, Sturdee DW. The International Menopause Study of Climate, Altitude, Temperature (IMS-CAT) and vasomotor symptoms. Climacteric 2012; 16:8-16. [DOI: 10.3109/13697137.2012.699563] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M. S. Hunter
- as the Writing Research Group of the Council of Affiliated Menopause Societies for the International Menopause Study (IMS-CAT)
| | - P. Gupta
- as the Writing Research Group of the Council of Affiliated Menopause Societies for the International Menopause Study (IMS-CAT)
| | - P. Chedraui
- as the Writing Research Group of the Council of Affiliated Menopause Societies for the International Menopause Study (IMS-CAT)
| | - J. E. Blümel
- as the Writing Research Group of the Council of Affiliated Menopause Societies for the International Menopause Study (IMS-CAT)
| | - K. Tserotas
- as the Writing Research Group of the Council of Affiliated Menopause Societies for the International Menopause Study (IMS-CAT)
| | - W. Aguirre
- as the Writing Research Group of the Council of Affiliated Menopause Societies for the International Menopause Study (IMS-CAT)
| | - S. Palacios
- as the Writing Research Group of the Council of Affiliated Menopause Societies for the International Menopause Study (IMS-CAT)
| | - D. W. Sturdee
- as the Writing Research Group of the Council of Affiliated Menopause Societies for the International Menopause Study (IMS-CAT)
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Loh ND, Hampton CY, Martin AV, Starodub D, Sierra RG, Barty A, Aquila A, Schulz J, Lomb L, Steinbrener J, Shoeman RL, Kassemeyer S, Bostedt C, Bozek J, Epp SW, Erk B, Hartmann R, Rolles D, Rudenko A, Rudek B, Foucar L, Kimmel N, Weidenspointner G, Hauser G, Holl P, Pedersoli E, Liang M, Hunter MS, Gumprecht L, Coppola N, Wunderer C, Graafsma H, Maia FRNC, Ekeberg T, Hantke M, Fleckenstein H, Hirsemann H, Nass K, White TA, Tobias HJ, Farquar GR, Benner WH, Hau-Riege SP, Reich C, Hartmann A, Soltau H, Marchesini S, Bajt S, Barthelmess M, Bucksbaum P, Hodgson KO, Strüder L, Ullrich J, Frank M, Schlichting I, Chapman HN, Bogan MJ. Erratum: Fractal morphology, imaging and mass spectrometry of single aerosol particles in flight. Nature 2012. [DOI: 10.1038/nature11426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Fromme P, Chapman H, Kupitz C, Hunter MS, Kirian RA, Barty A, White TA, Aquilla A, Stellato F, Beyerlein K, DePonte DP, Frank M, Schlichting I, Shoeman R, Lomb L, Steinbrenner J, Nass K, Boutet S, Bogan MJ, Williams G, Zatsepin N, Basu S, Wang D, James D, Fromme R, Grotjohann I, Bottin H, Cherezov V, Stevens R, Cobbe D, Cramer W, Stroud R, Doak RB, Weierstall U, Schmidt K, Spence JCH. Femtosecond nanocrystallography of membrane proteins opens a new era for structural biology. Acta Crystallogr A 2012. [DOI: 10.1107/s0108767312099461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Loh ND, Hampton CY, Martin AV, Starodub D, Sierra RG, Barty A, Aquila A, Schulz J, Lomb L, Steinbrener J, Shoeman RL, Kassemeyer S, Bostedt C, Bozek J, Epp SW, Erk B, Hartmann R, Rolles D, Rudenko A, Rudek B, Foucar L, Kimmel N, Weidenspointner G, Hauser G, Holl P, Pedersoli E, Liang M, Hunter MS, Hunter MM, Gumprecht L, Coppola N, Wunderer C, Graafsma H, Maia FRNC, Ekeberg T, Hantke M, Fleckenstein H, Hirsemann H, Nass K, White TA, Tobias HJ, Farquar GR, Benner WH, Hau-Riege SP, Reich C, Hartmann A, Soltau H, Marchesini S, Bajt S, Barthelmess M, Bucksbaum P, Hodgson KO, Strüder L, Ullrich J, Frank M, Schlichting I, Chapman HN, Bogan MJ. Fractal morphology, imaging and mass spectrometry of single aerosol particles in flight. Nature 2012; 486:513-7. [PMID: 22739316 DOI: 10.1038/nature11222] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 05/09/2012] [Indexed: 11/09/2022]
Abstract
The morphology of micrometre-size particulate matter is of critical importance in fields ranging from toxicology to climate science, yet these properties are surprisingly difficult to measure in the particles' native environment. Electron microscopy requires collection of particles on a substrate; visible light scattering provides insufficient resolution; and X-ray synchrotron studies have been limited to ensembles of particles. Here we demonstrate an in situ method for imaging individual sub-micrometre particles to nanometre resolution in their native environment, using intense, coherent X-ray pulses from the Linac Coherent Light Source free-electron laser. We introduced individual aerosol particles into the pulsed X-ray beam, which is sufficiently intense that diffraction from individual particles can be measured for morphological analysis. At the same time, ion fragments ejected from the beam were analysed using mass spectrometry, to determine the composition of single aerosol particles. Our results show the extent of internal dilation symmetry of individual soot particles subject to non-equilibrium aggregation, and the surprisingly large variability in their fractal dimensions. More broadly, our methods can be extended to resolve both static and dynamic morphology of general ensembles of disordered particles. Such general morphology has implications in topics such as solvent accessibilities in proteins, vibrational energy transfer by the hydrodynamic interaction of amino acids, and large-scale production of nanoscale structures by flame synthesis.
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Affiliation(s)
- N D Loh
- PULSE Institute, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
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Mann E, Singer D, Pitkin J, Panay N, Hunter MS. Psychosocial adjustment in women with premature menopause: a cross-sectional survey. Climacteric 2012; 15:481-9. [DOI: 10.3109/13697137.2011.647841] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hunter MS, Gentry-Maharaj A, Ryan A, Burnell M, Lanceley A, Fraser L, Jacobs I, Menon U. Prevalence, frequency and problem rating of hot flushes persist in older postmenopausal women: impact of age, body mass index, hysterectomy, hormone therapy use, lifestyle and mood in a cross-sectional cohort study of 10,418 British women aged 54-65. BJOG 2011; 119:40-50. [PMID: 22008610 DOI: 10.1111/j.1471-0528.2011.03166.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Hot flushes and night sweats (HFs/NSs) are the main menopausal symptoms, but few studies have been adequately powered to examine the dimensions or predictors of experiencing HFs/NSs. We report on these variables in a large UK cohort of postmenopausal women. DESIGN Cross-sectional cohort study. SETTING UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) cohort. POPULATION A cohort of 202,638 postmenopausal women, aged 50-74 years, without oophorectomy, recruited to UKCTOCS between 2001 and 2005. METHODS Women completed a follow-up questionnaire, and those aged 54-65 years were mailed a survey in July 2008. MAIN OUTCOME MEASURES Hot flush prevalence and hot flush rating scale. RESULTS Of the 15,000 women mailed, 10,418 returned completed questionnaires; 90% had previously had HFs/NSs. Despite being on average 10 years postmenopausal, 54% experienced HFs/NSs (frequency of 33 per week with mean problem rating 4/10) that persisted across the age range. Past hysterectomy (OR 1.50, 95% CI 1.19-1.86), ever having smoked (OR 1.27, 95% CI 1.11-1.46) and alcohol consumption (current units) (OR 1.05, 95% CI 1.01-1.09) predicted ever having had HFs/NSs. Anxiety (OR 3.09, 95% CI 2.57-3.72), hysterectomy (OR 2.74, 95% CI 2.32-3.25), depressed mood (OR 1.57, 95% CI 1.24-1.99), years since last menstrual period (OR 0.95, 95% CI 0.94-0.96) and education (above and below 18 years) (OR 0.98, 95% CI 0.97-0.99) predicted the current prevalence of HFs/NSs. Few predictors of frequency were identified, but problem rating was associated with depressed mood, hysterectomy, skirt size increase and frequency of HFs/NSs. Past hormone therapy users who had discontinued treatment were more likely to have HFs/NSs that were more frequent and problematic. CONCLUSIONS To date, this is the largest UK study of the experience of HFs/NSs amongst older postmenopausal women. HFs/NSs are more prevalent in this age band than has previously been assumed. These findings and the associations of smoking, hysterectomy, anxiety, depressed mood and hormone therapy use with the experience of HFs/NSs have implications for prevention and symptom management.
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Affiliation(s)
- M S Hunter
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK.
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Archer DF, Sturdee DW, Baber R, de Villiers TJ, Pines A, Freedman RR, Gompel A, Hickey M, Hunter MS, Lobo RA, Lumsden MA, MacLennan AH, Maki P, Palacios S, Shah D, Villaseca P, Warren M. Menopausal hot flushes and night sweats: where are we now? Climacteric 2011; 14:515-28. [PMID: 21848495 DOI: 10.3109/13697137.2011.608596] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE An overview of the current knowledge on the etiology and treatment of vasomotor symptoms in postmenopausal women. MATERIALS AND METHODS Acknowledged experts in the field contributed a brief assessment of their areas of interest which were combined and edited into the final manuscript. RESULTS Women around the world experience vasomotor symptoms as they enter and complete the menopause transition. Vasomotor symptoms, specifically hot flushes, are caused by a narrowing of the thermoneutral zone in the brain. This effect, although related to estrogen withdrawal, is most likely related to changes in central nervous system neurotransmitters. Peripheral vascular reactivity is also altered in symptomatic women. Estrogen replacement therapy is the most effective treatment for hot flushes. Of the other interventions investigated, selective serotonin and selective norepinephrine reuptake inhibitors and gabapentin show efficacy greater than placebo. Objective monitoring of hot flushes indicates a robust improvement with hormone replacement therapy but little to no change with placebo. These data suggest that the subjective assessment of responses to therapy for vasomotor symptom results in inaccurate data. Hot flushes have recently been associated with increased cardiovascular risks and a lower incidence of breast cancer, but these data require confirmation. CONCLUSIONS Vasomotor symptoms are experienced by women of all ethnic groups. They are caused by changes in the central nervous system associated with estrogen withdrawal and are best treated with estrogen replacement therapy. Objective monitoring of hot flushes indicates that placebo has little to no effect on their improvement. Subjective assessments of hot flushes in clinical trials may be inaccurate based on objective measurement of the frequency of hot flushes. Based on preliminary reports, women experiencing hot flushes have an increased risk of cardiovascular disease and a reduced incidence of breast cancer.
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Affiliation(s)
- D F Archer
- Eastern Virginia Medical School, Norfolk, VA 23507, USA
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Hunter MS, DePonte DP, Shapiro DA, Kirian RA, Wang X, Starodub D, Marchesini S, Weierstall U, Doak RB, Spence JCH, Fromme P. X-ray diffraction from membrane protein nanocrystals. Biophys J 2011; 100:198-206. [PMID: 21190672 DOI: 10.1016/j.bpj.2010.10.049] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 10/02/2010] [Accepted: 10/13/2010] [Indexed: 11/25/2022] Open
Abstract
Membrane proteins constitute > 30% of the proteins in an average cell, and yet the number of currently known structures of unique membrane proteins is < 300. To develop new concepts for membrane protein structure determination, we have explored the serial nanocrystallography method, in which fully hydrated protein nanocrystals are delivered to an x-ray beam within a liquid jet at room temperature. As a model system, we have collected x-ray powder diffraction data from the integral membrane protein Photosystem I, which consists of 36 subunits and 381 cofactors. Data were collected from crystals ranging in size from 100 nm to 2 μm. The results demonstrate that there are membrane protein crystals that contain < 100 unit cells (200 total molecules) and that 3D crystals of membrane proteins, which contain < 200 molecules, may be suitable for structural investigation. Serial nanocrystallography overcomes the problem of x-ray damage, which is currently one of the major limitations for x-ray structure determination of small crystals. By combining serial nanocrystallography with x-ray free-electron laser sources in the future, it may be possible to produce molecular-resolution electron-density maps using membrane protein crystals that contain only a few hundred or thousand unit cells.
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Affiliation(s)
- M S Hunter
- Department of Chemistry and Biochemistry, Arizona State University, Tempe, Arizona, USA
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Himler AG, Adachi-Hagimori T, Bergen JE, Kozuch A, Kelly SE, Tabashnik BE, Chiel E, Duckworth VE, Dennehy TJ, Zchori-Fein E, Hunter MS. Rapid Spread of a Bacterial Symbiont in an Invasive Whitefly Is Driven by Fitness Benefits and Female Bias. Science 2011; 332:254-6. [DOI: 10.1126/science.1199410] [Citation(s) in RCA: 348] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Watanabe M, Miura K, Hunter MS, Wajnberg E. Superinfection of cytoplasmic incompatibility-inducing Wolbachia is not additive in Orius strigicollis (Hemiptera: Anthocoridae). Heredity (Edinb) 2011; 106:642-8. [PMID: 20700141 PMCID: PMC3183903 DOI: 10.1038/hdy.2010.100] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 06/18/2010] [Accepted: 06/28/2010] [Indexed: 11/09/2022] Open
Abstract
Cytoplasmic incompatibility (CI) allows the intracellular, maternally inherited bacterial symbiont Wolbachia to invade arthropod host populations by inducing infertility in crosses between infected males and uninfected females. The general pattern is consistent with a model of sperm modification, rescued only by egg cytoplasm infected with the same strain of symbiont. The predacious flower bug Orius strigicollis is superinfected with two strains of Wolbachia, wOus1 and wOus2. Typically, superinfections of CI Wolbachia are additive in their effects; superinfected males are incompatible with uninfected and singly infected females. In this study, we created an uninfected line, and lines singly infected with wOus1 and wOus2 by antibiotic treatment. Then, all possible crosses were conducted among the four lines. The results indicated that while wOus2 induces high levels of CI, wOus1 induces very weak or no CI, but can rescue CI caused by wOus2 to a limited extent. Levels of incompatibility in crosses with superinfected males did not show the expected pattern. In particular, superinfected males caused extremely weak CI when mated with either singly infected or uninfected females. An analysis of symbiont densities showed that wOus1 densities were significantly higher than wOus2 densities in superinfected males, and wOus2 densities were lower, but not significantly, in superinfected relative to singly infected males. These data lend qualified support for the hypothesis that wOus1 interferes with the ability of wOus2 to cause CI by suppressing wOus2 densities. To our knowledge, this is the first clear case of non-additive CI in a natural superinfection.
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Affiliation(s)
- M Watanabe
- Graduate School of Biosphere Sciences, Hiroshima University, Hiroshima, Japan
| | - K Miura
- Graduate School of Biosphere Sciences, Hiroshima University, Hiroshima, Japan
- National Agricultural Research Center for Western Region, Hiroshima, Japan
| | - M S Hunter
- Department of Entomology, University of Arizona, Tucson, AZ, USA
| | - E Wajnberg
- INRA, 400 Route des Chappes, Sophia Antipolis Cedex, France
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Hunter MS, Haqqani JR. An investigation of discordance between subjective and physiological measures of vasomotor symptoms. Climacteric 2011; 14:146-51. [DOI: 10.3109/13697131003735585] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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White JA, Kelly SE, Cockburn SN, Perlman SJ, Hunter MS. Endosymbiont costs and benefits in a parasitoid infected with both Wolbachia and Cardinium. Heredity (Edinb) 2010; 106:585-91. [PMID: 20606691 DOI: 10.1038/hdy.2010.89] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Theory suggests that maternally inherited endosymbionts can promote their spread and persistence in host populations by enhancing the production of daughters by infected hosts, either by improving overall host fitness, or through reproductive manipulation. In the doubly infected parasitoid wasp Encarsia inaron, Wolbachia manipulates host reproduction through cytoplasmic incompatibility (CI), but Cardinium does not. We investigated the fitness costs and/or benefits of infection by each bacterium in differentially cured E. inaron as a potential explanation for persistence of Cardinium in this population. We introgressed lines infected with Wolbachia, Cardinium or both with the cured line to create a similar genetic background, and evaluated several parasitoid fitness parameters. We found that symbiont infection resulted in both fitness costs and benefits for E. inaron. The cost was lower initial egg load for all infected wasps. The benefit was increased survivorship, which in turn increased male production for wasps infected with only Cardinium. Female production was unaffected by symbiont infection; we therefore have not yet identified a causal fitness effect that can explain the persistence of Cardinium in the population. Interestingly, the Cardinium survivorship benefit was not evident when Wolbachia was also present in the host, and the reproduction of doubly infected individuals did not differ significantly from uninfected wasps. Therefore, the results of our study show that even when multiple infections seem to have no effect on a host, there may be a complex interaction of costs and benefits among symbionts.
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Affiliation(s)
- J A White
- Center for Insect Science, Arizona Research Labs, University of Arizona, Tucson, AZ, USA.
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Harris LR, Kelly SE, Hunter MS, Perlman SJ. Population dynamics and rapid spread of Cardinium, a bacterial endosymbiont causing cytoplasmic incompatibility in Encarsia pergandiella (Hymenoptera: Aphelinidae). Heredity (Edinb) 2009; 104:239-46. [PMID: 19812617 DOI: 10.1038/hdy.2009.130] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Cytoplasmic incompatibility (CI) is a common phenotype of maternally inherited bacterial symbionts of arthropods; in its simplest expression, uninfected females produce few or no viable progeny when mated to infected males. Infected females thus experience a reproductive advantage relative to that of uninfected females, with the potential for the symbiont to spread rapidly. CI population dynamics are predicted to depend primarily on the strength of incompatibility, the fitness cost of the infection and how faithfully symbionts are inherited. Although the bacterial symbiont lineage Wolbachia has been most identified with the CI phenotype, an unrelated bacterium, Cardinium may also cause CI. In the first examination of population dynamics of CI-inducing Cardinium, we used population cages of the parasitic wasp Encarsia pergandiella (Hymenoptera: Aphelinidae) with varying initial infection frequencies to test a model of invasion. Cardinium was found to spread rapidly in all populations, even in cases where the initial infection frequency was well below the predicted invasion threshold frequency. The discrepancy between the modeled and actual results is best explained by weaker CI than measured in the lab and a cryptic fitness benefit to the infection.
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Affiliation(s)
- L R Harris
- Department of Biology, University of Victoria, Victoria, British Columbia, Canada.
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Abstract
OBJECTIVES The Women's Health Questionnaire (WHQ) includes 36 items assessing nine domains of physical and emotional experiences of mid-aged women. The primary aim of the current research was to examine the psychometric properties of the WHQ across linguistic versions in view of the increased need for reliable health-related quality of life (HRQL) measures in multinational studies. METHODS In this paper, we examine the hypothesized structure of the questionnaire in a UK sample, to develop and verify a revised model to be used in multicenter, international studies. RESULTS AND CONCLUSIONS Content analysis and evaluation of missing data led to exclusion of 'Menstrual symptoms' and 'Sexual behavior' domains, retaining these as optional modules of the core questionnaire. Additionally, item 13 was excluded because it does not investigate the same concepts as other domains and the deletion of five additional items appeared to improve the questionnaire's factor structure. The revised WHQ comprises 23 items, investigating six domains. The cross-sectional psychometric properties of the 23-item WHQ were good and better than those of the 36-item version. The 23-item WHQ was assessed with multinational data, to evaluate cross-cultural equivalence of linguistically adapted versions. In addition, its reproducibility and responsiveness need to be documented.
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Abstract
OBJECTIVES First, to examine the experience of menopause and quality of life in a migrated Asian population from the Indian subcontinent living in Birmingham, UK, and, second, to compare their experience with a matched sample of Caucasian women living in the same geographical area and also with a sample of Asian women with similar socioeconomic background living in Delhi, India. METHODS In this cross-sectional study of 153 peri- and postmenopausal women aged 45-55 years, 52 Asian women originating from the Indian subcontinent living in Birmingham (UKA, mean age 51.4 years), 51 Caucasian women (UKC, mean age 52.3 years) and 50 Asian women living in Delhi, India (DEL, mean age 49.72 years) were interviewed to collect information about their lifestyle, general health, menopause experience and help-seeking behavior. The Women's Health Questionnaire and the Menopause Representation Questionnaire (both translated and linguistically validated in Hindi) were used to examine the prevalence of physical and emotional symptoms and the extent to which these were attributed to the menopause. RESULTS The two Asian groups (UKA, DEL) reported poorer health and generally more physical and emotional symptoms than the UKC group. However, for menopausal symptoms (hot flushes and night sweats) there was a different pattern; the DEL group reported significantly fewer symptoms compared to the UKA and UKC groups (hot flushes: UKC 60.8%, UKA 75%, DEL 32% (p < 0.001); night sweats: UKC 50%, UKA 56.9%, DEL 24% (p = 0.002)). The prevalence of vaginal dryness was highest in the UKA group and lowest in the DEL group (UKC 21.6%, UKA 38.2%, DEL 7.3% (p = 0.005)). The number of symptoms attributed to menopause was significantly lower in the DEL group (9.3 +/- 7.8) compared to the two UK groups (UKC 18.9 +/- 7.4, UKA 19.8 +/- 10.7), but the UKA women tended to attribute some physical symptoms to the menopause such as breathlessness, weight gain and stiff joints that might have other causes. CONCLUSIONS The UK Asian women's experience of the menopause is more similar to the Caucasian women in the UK than that of the women in Delhi. However, Asian women living in the UK and the Indian subcontinent shared the experience of poor health and reports of more physical and emotional symptoms in general. The possible reasons for these differences are discussed.
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Affiliation(s)
- P Gupta
- Women's Unit, Solihull Hospital, Heart of England NHS Foundation Trust, Solihull, West Midlands
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Hunter MS, Gupta P, Papitsch-Clark A, Sturdee DW. Mid-Aged Health in Women from the Indian Subcontinent (MAHWIS): a further quantitative and qualitative investigation of experience of menopause in UK Asian women, compared to UK Caucasian women and women living in Delhi. Climacteric 2009; 12:26-37. [DOI: 10.1080/13697130802556304] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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White JA, Kelly SE, Perlman SJ, Hunter MS. Cytoplasmic incompatibility in the parasitic wasp Encarsia inaron: disentangling the roles of Cardinium and Wolbachia symbionts. Heredity (Edinb) 2009; 102:483-9. [PMID: 19223921 DOI: 10.1038/hdy.2009.5] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Many bacterial endosymbionts of insects are capable of manipulating their host's reproduction for their own benefit. The most common strategy of manipulation is cytoplasmic incompatibility (CI), in which embryonic mortality results from matings between uninfected females and infected males. In contrast, embryos develop normally in infected females, whether or not their mate is infected, and infected progeny are produced. In this way, the proportion of infected females increases in the insect population, thereby promoting the spread of the maternally inherited bacteria. However, what happens when multiple endosymbionts inhabit the same host? The parasitoid wasp Encarsia inaron is naturally infected with two unrelated endosymbionts, Cardinium and Wolbachia, both of which have been documented to cause CI in other insects. Doubly infected wasps show the CI phenotype. We differentially cured E. inaron of each endosymbiont, and crossed hosts of different infection status to determine whether either or both bacteria caused the observed CI phenotype in this parasitoid, and whether the two symbionts interacted within their common host. We found that Wolbachia caused CI in E. inaron, but Cardinium did not. We did not find evidence that Cardinium was able to modify or rescue Wolbachia-induced CI, nor did we find that Cardinium caused progeny sex ratio distortion, leaving the role of Cardinium in E. inaron a mystery.
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Affiliation(s)
- J A White
- Center for Insect Science, University of Arizona, Tucson, AZ, USA.
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Giorgini M, Monti MM, Caprio E, Stouthamer R, Hunter MS. Feminization and the collapse of haplodiploidy in an asexual parasitoid wasp harboring the bacterial symbiont Cardinium. Heredity (Edinb) 2009; 102:365-71. [DOI: 10.1038/hdy.2008.135] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
Reproductive manipulations of hosts by maternally inherited bacterial endosymbionts often result in an increase in the proportion of infected female hosts in the population. When this involves the conversion of incipient males to genetic or functional females, it presents unique difficulties for symbionts invading hosts with sex-specific reproductive behaviours, such as the autoparasitic Encarsia pergandiella. In sexual forms of this species, female eggs are laid in whitefly nymphs and male eggs are laid in conspecific or heterospecific parasitoids developing within the whitefly cuticle. Further, eggs laid in the 'wrong' host do not ordinarily complete development. This study explored the role of a bacterial symbiont, Cardinium, in manipulating oviposition behaviour in a thelytokous population of E. pergandiella. Oviposition choice was measured by the number and location of eggs deposited by both infected and uninfected adult waSPS in arenas containing equal numbers of hosts suitable for the development of male and female waSPS. Uninfected waSPS included antibiotic-treated female waSPS and (untreated) daughters of antibiotic-treated female waSPS. The choices of waSPS in the thelytokous population treatments were compared with those of a conspecific sexual population. We found that offspring of antibiotic-cured thelytokous waSPS reverted to the behaviour of unmated sexual waSPS, laying their few eggs almost exclusively in hosts appropriate for male eggs. Infected thelytokous waSPS distributed their eggs approximately evenly between host types, much like mated sexual female waSPS. The antibiotic-treated female waSPS exhibited choices intermediate to waSPS in the other two treatments. The change in the observed behaviour appears sufficient to allow invasion and persistence of Cardinium in sexual populations. Lastly, our results suggest a reduction in host discrimination as a possible mechanism by which Cardinium influences this change.
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Affiliation(s)
- S G Kenyon
- Université de Neuchâtel, Institut de Zoologie, Neuchâtel, Switzerland.
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Burgess CC, Potts HWW, Hamed H, Bish AM, Hunter MS, Richards MA, Ramirez AJ. Why do older women delay presentation with breast cancer symptoms? Psychooncology 2007; 15:962-8. [PMID: 16511900 DOI: 10.1002/pon.1030] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Women who delay their presentation with breast cancer for three months or longer are more likely to be diagnosed with later stage disease and have poorer survival. Older women, who are at greater risk of developing breast cancer, are also more likely to delay their presentation. Factors associated with delayed presentation were assessed in 69 women (>65 years) with breast cancer. Previous factors identified for women of all ages were confirmed (having a non-lump symptom p=0.003) or strengthened (non-disclosure of symptom discovery to a relative or close friend p=0.001). Additional factors for delay in this older group included reservations about seeing their GP (p=0.02) and fear of the consequences of cancer (p=0.04). These factors should inform the design of interventions to reduce delays.
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Affiliation(s)
- C C Burgess
- Cancer Research UK London Psychosocial Group, Adamson Centre, St Thomas' Hospital, London SE1 7EH, UK.
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50
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Abstract
This study evaluates the distress experienced by women attending gynecology outpatient clinics (GOCs). We investigate causes of this distress and explore women's own experience of their distress. A questionnaire survey of 197 women attending GOCs was carried out, both quantitative and qualitative analyses were undertaken. Thirty-five percent of women showed clinical levels of anxiety, 13% had clinically significant depression and half reported feeling distressed. A range of feelings was reported, though commonly mixed emotions were expressed. Women had a low sense of personal control and uncertainty in relation to their gynecologic problem. Both coincidental stress, such as life changes, and the direct consequences of the gynecologic problem were predictive of anxiety. Qualitative analysis suggested four ways in which women experienced their distress and the gynecologic problem: (i) gynecologic symptoms were a direct cause of distress, (ii) gynecologic symptoms caused distress indirectly through reactions to diagnosis and treatment, (iii) gynecologic symptoms caused distress because of their impact on relationships, social life and self identity, and (iv) distress was unrelated to the gynecologic symptoms. Results highlight diversity and complexity in women's experiences and support the need for a fuller understanding of distress in this group in order to meet their needs adequately and appropriately.
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Affiliation(s)
- L Glover
- Department of Clinical Psychology, School of Medicine, University of Hull, Hull, HU6 7RX, UK.
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