Barriers to effective cancer pain management: A survey of hospitalized cancer patients in Australia

The purpose of this study was to examine attitudinal barriers to effective pain management in a consecutively recruited cohort of 114 cancer patients from four Australian hospitals. When surveyed, 48% of this sample reported experiencing pain within the previous 24 hours. Of these, 56% reported this pain to be distressing, horrible or excruciating, with large proportions indicating that this pain had affected their movement, sleep and emotional well-being. Three factors were identified as potentially impacting on patients responses to pain-poor levels of patient knowledge about pain, low perceived control over pain, and a deficit in communication about pain. A trend for older patients to experience more severe pain was also identified. These older patients reported being more willing to tolerate pain and perceive less control over their pain. Suggestions are made for developing patient education programs and farther research using concepts drawn from broader social and behavioral models. J Pain Symptom Manage 2002:23:393-405. (C) U.S. Cancer Pain Relief Committee, 2002.

Body mass index-related human adipocyte agouti expression is sex-specific but not depot-specific

Objective: To determine if human adipocyte agouti signal protein (ASIP) mRNA expression is associated with obesity and is gender and/or depot specific. Research Methods and Procedures: Subjects included 8 men (64 +/- 3 years) and 14 women (56 +/- 15 years) undergoing elective abdominal surgery. ASIP mRNA levels in isolated omental and subcutaneous abdominal adipocytes were measured by quantitative reverse transcription polymerase chain reaction. Results: No significant depot difference was observed between genders; ASIP mRNA levels of omental and subcutaneous abdominal adipocytes were pooled for this analysis. BMI and ASIP gene expression were negatively correlated in men (p = -0.70; p < 0.05), whereas a positive relationship was observed in women (p = 0.48; p < 0.05). No significant difference was observed in age, body weight, body mass index (BMI), and waist circumference between groups. Hip circumference was significantly higher in women than in men (p < 0.05). Also, no significant difference in ASIP mRNA expression was observed between men and women, regardless of the fat depot. Discussion: These results show that men and women of similar age and BMI present similar ASIP mRNA levels in omental and subcutaneous abdominal adipocytes. However, a sexual dimorphism exists in the relationship between ASIP expression and BMI. If ASIP is involved in appetite regulation or energy homeostasis in humans, this observation may contribute to the recognized differences in these parameters between men and women.

Attitudes of paediatric medical ward staff to a dog visitation programme

No previous studies regarding either structured, strictly controlled pet visitation programmes in paediatric hospital wards or hospital staff attitudes towards them have been conducted in Australia. Information regarding these is essential in order to minimize problems during implementation of such programmes. The aim of the study was to analyse hospital staff perceptions regarding the introduction of a pet visitation programme in an acute paediatric medical ward prior to and following implementation of the programme and to compare attitudes between the various professional groups. The study consisted of two cross-sectional surveys. A total of 224 anonymous questionnaires were distributed to administrators, doctors, nursing staff and therapists 6 weeks before and 195 were distributed 12 weeks after the introduction of a pet visitation programme. Responses were received from 115 respondents (before the programme introduction) and 45 respondents (after the programme introduction). Prior to the introduction of the dog visitation programme, there were high staff expectations that the programme would distract children from their illness, relax children and that it was a worthwhile project for the hospital to undertake. Following implementation of the programme these expectations were strongly endorsed, in addition to the perception that the ward was a happier place, the work environment was more interesting and that nurses accepted the dogs. After implementation staff were less concerned about the possibility of dog bites and dogs doing damage to equipment. Allied health staff and non-clinical staff were more positive about the programme with respect to ward climate and acceptance than were doctors and nurses. We conclude that well-planned dog visitation programmes result in positive anticipation among staff and high levels of satisfaction following programme impact.

The effects of status on subgroup relations

Two experiments were conducted to assess the impact of status differentials on subgroup attitudes and behaviours. In Experiment 1, 73 maths-science students were led to believe they had higher or lower status than humanities students. They then performed a non-interactive decision-making task during which they were categorized exclusively as a university student (superordinate condition), or as a university student and maths-science student simultaneously (subgroups condition). Experiment 2 (N = 98) differed from Experiment I in that perceptions of relative subgroup status were measured rather than manipulated. Consistent with social identity theory, subgroup members tended to categorize themselves more at the superordinate (university) level the lower status they considered their subgroup to be. In Experiment 2, a series of interactions also emerged, showing that status and inter-subgroup bias were positively related when the participants had been categorized exclusively at the superordinate level. When superordinate and subgroup identities were activated simultaneously, perceptions of status had no effect on levels of bias. The results were interpreted in terms of participants' needs for identity enhancement and identity distinctiveness.

Overlarge sets of 2-(11, 5, 2) designs and related configurations

We consider the construction of several configurations, including: • overlarge sets of 2-(11,5,2) designs, that is, partitions of the set of all 5-subsets of a 12-set into 72 2-(11,5,2) designs; • an indecomposable doubly overlarge set of 2-(11,5,2) designs, that is, a partition of two copies of the set of all 5-subsets of a 12-set into 144 2-(11,5,2) designs, such that the 144 designs can be arranged into a 12 × 12 square with interesting row and column properties; • a partition of the Steiner system S(5,6,12) into 12 disjoint 2-(11,6,3) designs arising from the diagonal of the square; • bidistant permutation arrays and generalized Room squares arising from the doubly overlarge set, and their relation to some new strongly regular graphs.

Global job satisfaction and facet description: The moderating role of facet importance

Recent research support sLocke's (1976) model of facet satisfaction in which the range of affect of objectively defined facet descriptions is moderated by subjective evaluations of facet importance (McFarlin & Rice, 1992). This study examined the utility of Locke's moderated model of face t satisfaction for the prediction of organizationally important global measures of job satisfaction. A large dataset of two groups of workers allowed testing over different time periods and across a broad range of satisfaction measures. The hypothesis derived from Locke's model, that global satisfaction would represent a linear function of facet satisfaction (i.e., facet description x facet importance), was not supported. Instead, a simple (have-want) discrepancy model (operationalized as facet description) provided the most consistent set of predictors. The results suggests that workers, when providing global measures of job satisfaction, may use cognitive heuristics to reduce the complexity of facet description x importance calculations. The implications of these data for Locke's model and directions for future research are outlined.

Severity of sports-related concussion and neuropsychological test performance

Concussion severity grades according to the Cantu, Colorado Medical Society, and American Academy of Neurology systems were not clearly related to the presence or duration of impaired neuropsychological test performance in 21 professional rugby league athletes. The use of concussion severity guidelines and neuropsychological testing to assist return to play decisions requires further investigation.

Characterization of the retinoid orphan-related receptor-alpha coactivator binding interface: A structural basis for ligand-independent transcription

The retinoid orphan-related receptor-alpha (RORalpha) is a member of the ROR subfamily of orphan receptors and acts as a constitutive activator of transcription in the absence of exogenous ligands. To understand the basis of this activity, we constructed a homology model of Rill using the closely related TRbeta as a template. Molecular modeling suggested that bulky hydrophobic side chains occupy the RORa ligand cavity leaving a small but distinct cavity that may be involved in receptor stabilization. This model was subject to docking simulation with a receptor-interacting peptide from the steroid receptor coactivator, GR-interacting protein-1, which delineated a coactivator binding surface consisting of the signature motif spanning helices 3-5 and helix 12 [activation function 2 (AF2)]. Probing this surface with scanning alanine mutagenesis showed structural and functional equivalence between homologous residues of RORalpha and TRbeta. This was surprising (given that Rill is a ligand-independent activator, whereas TRbeta has an absolute requirement for ligand) and prompted us to use molecular modeling to identify differences between Rill and TRbeta in the way that the All helix interacts with the rest of the receptor. Modeling highlighted a nonconserved amino acid in helix 11 of RORa (Phe491) and a short-length of 3.10 helix at the N terminus of AF2 which we suggest i) ensures that AF2 is locked permanently in the holoconformation described for other liganded receptors and thus 2) enables ligand-independent recruitment of coactivators. Consistent with this, mutation of RORa Phe491 to either methionine or alanine (methionine is the homologous residue in TRbeta), reduced and ablated transcriptional activation and recruitment of coactivators, respectively. Furthermore, we were able to reconstitute transcriptional activity for both a deletion mutant of Ill lacking All and Phe491 Met, by overexpression of a GAL-AF2 fusion protein, demonstrating ligand-independent recruitment of AF2 and a role for Phe491 in recruiting AF2.

Which aspects of socio-economic status are related to health in mid-aged and older women?

A population-based study was conducted to validate gender- and age-specific indexes of socio-economic status (SES) and to investigate the associations between these indexes and a range of health outcomes in 2 age cohorts of women. Data from 11,637 women aged 45 to 50 and 9,5 10 women aged 70 to 75 were analyzed. Confirmatory factor analysis produced four domains of SES among the mid-aged cohort (employment, family unit, education, and migration) and four domains among the older cohort (family unit, income, education, and migration). Overall, the results supported the factor structures derived from another population-based study (Australian Bureau of Statistics, 1995), reinforcing the argument that SES domains differ across age groups. In general, the findings also supported the hypotheses that women with low SES would have poorer health outcomes than higher SES women, and that the magnitude of these effects would differ according to the specific SES domain and by age group, with fewer and smaller differences observed among older women. The main exception was that in the older cohort, the education domain was significantly associated with specific health conditions. Results suggest that relations between SES and health are highly complex and vary by age, SES domain, and the health outcome under study.

Attitudes and practices of general practitioners in the diagnosis and management of attention-deficit/hyperactivity disorder

Objective: To assess understanding of, and actual and potential roles in management of attention-deficit/hyperactivity disorder (ADHD) among GPs. Methods: A cross-sectional questionnaire survey of Queensland GPs selected randomly from the Royal Australian College of General Practitioners directory of members was carried out. Main outcome measures were knowledge levels of ADHD, current management practices, referral patterns and self-perceived information and training needs. Results: Three hundred and ninety-nine GPs returned a completed questionnaire (response rate 76%). Roles identified by GPs were: the provisional diagnosis of ADHD and referral to specialist services for confirmation of the diagnosis and initiation of management; assistance with monitoring progress once a management plan was in place; education of the child and their family regarding the disorder; and liaison with the school where necessary. Perceived barriers to increased involvement of GPs were: time and resource constraints of general practice; concerns regarding abuse and addiction liability of prescription stimulants; complex diagnostic issues associated with childhood behavioural problems; and lack of training and education regarding ADHD. Conclusions: General practitioners identify a role for themselves in ADHD care that is largely supportive in nature and involves close liaison with specialist services.