How black African and white British women perceive depression and help-seeking: a pilot vignette study.

BACKGROUND: The detection of psychological problems of black African people has been found to be substantially lower, compared with white British and black Caribbean people. This may be due to differences in patients' perceptions of illness. Little research has been carried out on factors that may influence the help-seeking behaviour of black Africans. AIMS: To assess differences in the perceptions of depression of black African and white British women that may influence lower detection and to investigate whether there are ethnic group differences in reasons for not seeking formal help. METHODS: A short quantitative illness perception measure, the Brief Illness Perception Questionnaire (BIPQ), was used in a community survey, using a standard text vignette methodology to control for variations in previous experiences of depression. Responses from women who indicated that they would not seek formal help for depressive symptoms were qualitatively analyzed. RESULTS: Differences in perceptions of depression were found between black African (n = 73) and white British groups (n = 72) on five of the nine BIPQ dimensions. Black women were more likely to perceive depression to have less serious consequences; to be associated with fewer symptoms; to be less chronic; to be less amenable to treatment; and more frequently attributed depression to social factors. Over half the participants (n = 74) said they would not seek formal help for depressive symptoms. Six qualitative response categories emerged to explain non-consultation. The most common factor for both groups related to GP consultation difficulties. Significantly more white women cited preferring alternative help sources as a reason for non-consultation. The greater number of black women citing anti-medication beliefs was marginally significant. There were no differences between the ethnic groups in their use of the remaining three categories: illness characteristics; service constraints; and stigma/shame. CONCLUSION: Differing perceptions of depression among black and white women could help explain GPs' lower detection rates of depressive problems of black women. Differences in views about the formal help available may explain ethnic differences in help-seeking.

Human CD8 responses to a complete epitope set from preproinsulin: implications for approaches to epitope discovery.

PURPOSE: In this study, we explored the breadth of CD8 T cell reactivity to preproinsulin (PPI) in type 1 diabetes. MATERIALS AND METHODS: We tested a complete peptide set in pools covering all 406 potential 8-11mer epitopes of PPI and 61 algorithm-predicted human leukocyte antigen (HLA)-A2-specific epitopes (15 pools) from islet-specific glucose-6-phophatase catalytic subunit-related protein (IGRP), using a CD8-specific granzyme B enzyme-linked immunosorbent spot assay. RESULTS: Responses were seen to 64 of the 102 PPI pools in two or more newly diagnosed patients (63%) compared to 11 pools in the control subjects (11%, p < 0.0001, Fisher's exact test). We identified five pools containing 20 peptides, which distinguished patients from control subjects, most of which had predicted low-affinity binding to HLA class I molecules. In contrast, fewer (5 of 15 = 33%) IGRP peptide pools, selected by higher binding affinity for HLA-A2 (present in seven of eight patients and five of seven control subjects), stimulated responses in two or more patients, and none stimulated responses in more than two control subjects (p = 0.042, Fisher's exact test). CONCLUSION: Thus, we conclude that CD8 T cell reactivity to PPI in patients with type 1 diabetes can be much broader than shown previously and more diverse than seen in control subjects. Furthermore, responses were often stimulated by peptides with low predicted HLA-binding affinities.

Does changing the order of threat and efficacy information influence the persuasiveness of threat messages?

OBJECTIVES: The aim of this study is to investigate the impact of changing the conventional threat-before-efficacy order of threat messages on the persuasiveness of a leaflet informing women smokers of the link between smoking and cervical cancer. DESIGN: The study used a between-groups design in which women smokers were sequentially allocated to one of three groups. Two groups received one of two leaflets aimed at providing information about the link between smoking and cervical cancer: one provided threat-before-efficacy information; the other provided efficacy-before-threat information. The third group received no leaflet. METHODS: Participants (N=178) were recruited by a commercial survey organization. Purposeful sampling was used to ensure that women with a wide range of ages and educational qualifications were included. Outcomes were intention to stop smoking, recall of information, and threat and efficacy perceptions. RESULTS: Although women in the 'efficacy-before-threat' group recalled more efficacy information, and those in the 'threat-before-efficacy' group recalled more threat information, the leaflets were similarly persuasive. Compared with women not given a leaflet, those given either of the two leaflets had greater intentions to stop smoking and higher threat and efficacy perceptions. CONCLUSIONS: Informing women of the link between smoking and cervical cancer increases their intentions to stop smoking. Changing the order of threat and efficacy information does not influence the persuasiveness of this message. Order effects may be more likely in experimental contexts using weaker messages or those that are not novel.

A comparison of Australian and UK obstetricians' and midwives' preferences for screening tests for Down syndrome.

OBJECTIVE: To establish and compare obstetricians' and midwives' preferences for hypothetical prenatal screening tests for Down syndrome. METHODS: A cross-sectional questionnaire survey was completed by 296 obstetricians and midwives at two teaching hospitals: one in Melbourne, Australia (n = 175), and one in London, UK (n = 94). Conjoint analysis was undertaken using random effects probit regression. RESULTS: No significant differences were seen in any measurements when comparing obstetricians in Australia and the UK or midwives in Australia and the UK. Obstetricians and midwives shared similar relative values regarding the importance of the detection rate of the screening tests. However, obstetricians placed higher relative values on both timing of prenatal tests and risk associated with the subsequent diagnostic test than did midwives when considering optimal tests to offer women. Marginal rates of substitution suggest that, compared with midwives, obstetricians would wait longer and accept a greater decrease in detection rate for a test if it was safer. Younger midwives placed higher value on both detection rate and safety of prenatal tests than older midwives. Female obstetricians placed higher value on the timing of a test than male obstetricians. CONCLUSION: Obstetricians in Australia and UK placed almost identical importance on test attributes, as did the midwives in the two countries. However, different attitudes towards tests were seen between obstetricians and midwives.

Increasing women's intentions to stop smoking following an abnormal cervical smear test result.

BACKGROUND: The aim of this study is to assess the impact of two leaflets upon intentions to stop smoking in the next month in women receiving abnormal cervical smear test results. METHODS: 330 women smokers who received an abnormal smear test result were randomly allocated to one of three groups: Group 1: sent a leaflet about the threat of cervical cancer from smoking and the benefits to cervical health in stopping, containing a detailed explanation of how smoking harms the cervix; Group 2: sent the same leaflet but without the detailed explanation; Group 3: no leaflet. Questionnaires were completed 1 month later. RESULTS: Women in Group 1 had higher intentions to stop smoking compared with Group 3. This effect was mediated by perceived coherence of the link between smoking and cervical cancer and moderated by self-efficacy (confidence): only women with high levels of self-efficacy had higher intentions to stop smoking. CONCLUSION: Explaining the link between smoking and cervical cancer increases intentions to stop smoking in women receiving abnormal cervical smear test results. Further studies are needed to determine how self-efficacy can be increased and whether, in addition to the detailed leaflet, this increases rates of smoking cessation.

Women and health care professionals' preferences for Down's Syndrome screening tests: a conjoint analysis study.

OBJECTIVE: To describe and compare women and health care professionals' preferences for Down's Syndrome screening tests with different test characteristics. DESIGN: Cross sectional questionnaire based conjoint analysis study. SETTING: London teaching hospital. SAMPLE: 291/383 women in their first or second trimester of pregnancy and 98/122 health care professionals (41 obstetricians, senior house officers and above and 57 qualified midwives) providing care at the same hospital. METHODS: Women completed a questionnaire while attending a clinic visit for a dating scan or a routine 20-week anomaly scan. Health care professionals completed a postal questionnaire. MAIN OUTCOME MEASURES: The relative values participants attach to Down's Syndrome screening test attributes: time of test, detection rate and risk of miscarriage of a baby unaffected by Down's Syndrome as a result of subsequent diagnostic tests. RESULTS: Pregnant women and health care professionals shared broadly similar relative values regarding the importance of safe tests, conducted early and with high detection rates. When asked to choose between different Down's Syndrome screening tests, health care professionals valued earlier tests more highly than did women. CONCLUSIONS: While pregnant women and health care professionals share similar relative values regarding optimal prenatal tests, health care professionals place a higher value on earlier tests. This may result in screening policies that overweight timing in the selection of a test to the relative neglect of tests associated with lower miscarriage rates and higher detection rates but conducted later in pregnancy.

Autoreactive T cell responses show proinflammatory polarization in diabetes but a regulatory phenotype in health.

According to the quality of response they mediate, autoreactive T cells recognizing islet beta cell peptides could represent both disease effectors in the development of type 1 diabetes (T1DM) and directors of tolerance in nondiabetic individuals or those undergoing preventative immunotherapy. A combination of the rarity of these cells, inadequate technology, and poorly defined epitopes, however, has hampered examination of this paradigm. We have identified a panel of naturally processed islet epitopes by direct elution from APCs bearing HLA-DR4. Employing these epitopes in a sensitive, novel cytokine enzyme-linked immunosorbent spot assay, we show that the quality of autoreactive T cells in patients with T1DM exhibits extreme polarization toward a proinflammatory Th1 phenotype. Furthermore, we demonstrate that rather than being unresponsive, the majority of nondiabetic, HLA-matched control subjects also manifest a response against islet peptides, but one that shows extreme T regulatory cell (Treg, IL-10-secreting) bias. We conclude that development of T1DM depends on the balance of autoreactive Th1 and Treg cells, which may be open to favorable manipulation by immune intervention.

Increasing readiness to stop smoking in women undergoing cervical screening: evaluation of two leaflets.

This study evaluated the impact of informing women smokers of the link between smoking and cervical cancer. Women smokers aged 20-64 years from two general practices in the United Kingdom were randomly assigned to receive an extended leaflet, a brief leaflet, or no leaflet. Both leaflets informed women of the threat of cervical cancer, how stopping smoking would decrease their vulnerability to it, and the effectiveness of smoking cessation services. The extended leaflet included an elaborated explanation of how smoking adversely affects the cervix. Questionnaires were completed by 172 women. The main outcome was readiness to stop smoking within the next 6 months. Secondary outcomes were perceptions of severity and vulnerability to cervical cancer, beliefs about the effectiveness of reducing susceptibility by stopping smoking, and self-efficacy in stopping smoking. Women sent the briefer leaflet were more likely to be ready to stop smoking within the next 6 months compared with those sent the extended leaflet (75% vs. 46%, 95% CI=11%-48%) and those not sent a leaflet (75% vs. 40%, 95% CI=19%-52%). Compared with smokers not sent a leaflet, those sent either of the two leaflets perceived their vulnerability to cervical cancer as higher and had greater expectations that stopping smoking would reduce this risk. In conclusion, providing women with brief written information about the link between smoking and cervical cancer increases their readiness to stop smoking. The impact on smoking cessation of combining such information with advice from health professionals conducting cervical screening needs to be evaluated.