Fighting cervical cancer in Africa: a cross-sectional study on prevalence and risk factors for precancerous lesions in rural Uganda.

OBJECTIVE: To identify risk factors for precancerous cervical lesions and factors associated with treatment delay among women in the rural Busoga Region, Uganda. STUDY DESIGN: A retrospective cross-sectional study from a regional cervical cancer screening program and from cervical cancer patients enrolled in a region-wide palliative care program. METHODS: Logistic regression analysis was conducted to assess risk factors for screening positive for precancerous lesions. In a separate analysis, factors associated with treatment delay were assessed among women enrolled in the palliative care program. RESULTS: Three thousand nine hundred forty-six women were included from the screening program and 334 from the palliative care program. In total, 7.6% of screening participants had precancerous lesions. Within Busoga Region, the highest positivity rate was found in Bugweri and Namayingo Districts. Abnormal vaginal bleeding (adjusted odds ratio [aOR] 1.60; 95% confidence interval [CI] 1.15-2.21; p = 0.005) and older age at first menstrual period (aOR 1.08; 95% CI 1.01-1.16; p = 0.03) were associated with having a precancerous lesion. Among palliative care patients, a history of previous contact with the health care system was associated with a delay in enrolment (≥12 months from first symptom presentation until commencement in palliative care; aOR 5.23; 95% CI 1.16-36.54; p = 0.047). CONCLUSIONS: The results underline an unmet need for broad-scale cervical cancer screening focusing on all women in the reproductive age. Abnormal bleeding was the only substantial risk factor for precancerous lesions, indicating that specific algorithms to identify high-risk populations may not be applicable in this population. Increased awareness, resources, and funding are still necessary to achieve global cervical cancer elimination.

Multiscale modeling and cinematic visualization of photosynthetic energy conversion processes from electronic to cell scales.

Conversion of sunlight into chemical energy, namely photosynthesis, is the primary energy source of life on Earth. A visualization depicting this process, based on multiscale computational models from electronic to cell scales, is presented in the form of an excerpt from the fulldome show Birth of Planet Earth. This accessible visual narrative shows a lay audience, including children, how the energy of sunlight is captured, converted, and stored through a chain of proteins to power living cells. The visualization is the result of a multi-year collaboration among biophysicists, visualization scientists, and artists, which, in turn, is based on a decade-long experimental-computational collaboration on structural and functional modeling that produced an atomic detail description of a bacterial bioenergetic organelle, the chromatophore. Software advancements necessitated by this project have led to significant performance and feature advances, including hardware-accelerated cinematic ray tracing and instanced visualizations for efficient cell-scale modeling. The energy conversion steps depicted feature an integration of function from electronic to cell levels, spanning nearly 12 orders of magnitude in time scales. This atomic detail description uniquely enables a modern retelling of one of humanity's earliest stories-the interplay between light and life.

Use of computational modeling combined with advanced visualization to develop strategies for the design of crop ideotypes to address food security.

Sustainable crop production is a contributing factor to current and future food security. Innovative technologies are needed to design strategies that will achieve higher crop yields on less land and with fewer resources. Computational modeling coupled with advanced scientific visualization enables researchers to explore and interact with complex agriculture, nutrition, and climate data to predict how crops will respond to untested environments. These virtual observations and predictions can direct the development of crop ideotypes designed to meet future yield and nutritional demands. This review surveys modeling strategies for the development of crop ideotypes and scientific visualization technologies that have led to discoveries in "big data" analysis. Combined modeling and visualization approaches have been used to realistically simulate crops and to guide selection that immediately enhances crop quantity and quality under challenging environmental conditions. This survey of current and developing technologies indicates that integrative modeling and advanced scientific visualization may help overcome challenges in agriculture and nutrition data as large-scale and multidimensional data become available in these fields.

Crops In Silico: Generating Virtual Crops Using an Integrative and Multi-scale Modeling Platform.

Multi-scale models can facilitate whole plant simulations by linking gene networks, protein synthesis, metabolic pathways, physiology, and growth. Whole plant models can be further integrated with ecosystem, weather, and climate models to predict how various interactions respond to environmental perturbations. These models have the potential to fill in missing mechanistic details and generate new hypotheses to prioritize directed engineering efforts. Outcomes will potentially accelerate improvement of crop yield, sustainability, and increase future food security. It is time for a paradigm shift in plant modeling, from largely isolated efforts to a connected community that takes advantage of advances in high performance computing and mechanistic understanding of plant processes. Tools for guiding future crop breeding and engineering, understanding the implications of discoveries at the molecular level for whole plant behavior, and improved prediction of plant and ecosystem responses to the environment are urgently needed. The purpose of this perspective is to introduce Crops in silico (cropsinsilico.org), an integrative and multi-scale modeling platform, as one solution that combines isolated modeling efforts toward the generation of virtual crops, which is open and accessible to the entire plant biology community. The major challenges involved both in the development and deployment of a shared, multi-scale modeling platform, which are summarized in this prospectus, were recently identified during the first Crops in silico Symposium and Workshop.

Public and private self-consciousness and smoking behavior in head and neck cancer patients.

Patients who continue to use tobacco following treatment for head and neck cancers are at a greater risk for cancer recurrence and earlier mortality. This study examined the unique effects of public and private self-consciousness and negative affect on smoking behavior in a sample of 40 patients with cancers of the head and neck. Measures of public and private self-consciousness and negative affect were administered and assessments of past and current smoking behavior were obtained. Only public self-consciousness was a significant predictor of continued smoking following oncologic treatment. Specifically, individuals with low levels of public self-consciousness were nearly 13 times more likely to continue smoking compared to those with relatively higher levels of public self-consciousness. This pattern is interpreted in the context of previous theorizing that suggests individuals high in public self-consciousness are more likely to discontinue habitual behavior that is perceived as socially undesirable or incorrect.

[Treatment of severe, accidental hypothermia with a warm air bed]. / Behandling af svaer, accidentel hypotermi med varmluftdyne.

Patients suffering from severe accidental hypothermia are by many authors recommended to be rewarmed by extra-corporal circulation. Some authors argue in favour of other approaches in treatment of severe hypothermia, as long as the patient has a sufficient circulation. One of these is rewarming using forced air warming. We rewarmed a patient with severe hypothermia using forced air warming. The patient arrived with a core temperature of 25.9 degrees C and had sufficient circulation despite of atrial fibrillation. The patient was rewarmed to a core temperature of 36.1 degrees C over seven hours. No other arrhythmias or complications were observed.

Predicting change in depression following renal transplantation: effect of patient coping preferences.

Improvement in patient quality of life is a central goal of renal transplantation. This study examined the hypothesis that change in depression following transplantation would vary as a function of patient coping preferences. Sixty patients were assessed with the Krantz Health Opinion Survey and the Beck Depression Inventory while on the waiting list for a cadaveric renal transplant. Patients were reassessed approximately 12 months later. Among the 33 patients receiving a transplant during the follow-up period, those with a high preference for health-related information exhibited a substantial reduction in depression. In contrast, patients low in preference for information showed a slight increase in depression. Among the 27 patients who were not transplanted during the follow-up period, preference for information had no effect on depression. Patient differences in preference for behavioral involvement did not exert a significant effect on depression.

Patient-by-treatment context interaction in chronic disease: a conceptual framework for the study of patient adherence.

OBJECTIVE: Previous reviews have concluded that there is little or no evidence supporting a predictable association between patient characteristics and regimen adherence in chronic illness. The primary objective of this article is to propose an alternative conceptual framework for the interpretation and design of adherence research. METHODS: The author's research involving adherence among patients with end-stage renal disease is reviewed and used to illustrate the patient-by-context interactive framework. RESULTS: Adherence is most favorable when the patient's characteristic or preferred style of coping with illness and treatment-related experiences is congruent with the contextual features or demands of the particular type of medical intervention the patient is undergoing. Among patients with end-stage renal disease, a more vigilant or active style of coping is associated with more favorable adherence only for patients undergoing home-based dialysis treatment modalities that are highly patient directed. Among patients receiving hospital-based, provider-controlled treatment, a less vigilant or more passive coping style is associated with more favorable dialysis regimen adherence. CONCLUSIONS: The patient-by-context interactive perspective can provide a useful framework for the interpretation and design of adherence research.

Smoking and drinking behavior in patients with head and neck cancer: effects of behavioral self-blame and perceived control.

Patients who continue to use tobacco or alcohol following treatment for head and neck cancers are at greater risk for cancer recurrence and mortality. The present study examined the effects of behavioral self-blame and perceived control over health on smoking and alcohol use in a sample of 55 patients with cancers of the head and neck. Measures of self-blame, perceived control, and depression were administered and an assessment of past and current smoking and drinking behavior was obtained. As anticipated, continued smoking after completion of oncologic treatment was predicted by the interaction of behavior specific self-blame and perceived control. Patients who attributed the cause of their cancer to their past substance use exhibited a lower likelihood of smoking only if they also held the expectancy that their future cancer-related health was contingent on their own behavior. Among patients not holding the belief that cancer recurrence was contingent on their own actions, self-blame was associated with a higher probability of continued smoking. Self-blame and perceived control had no effect on continued alcohol use.

A population-based study of children with cerebral tuberculosis in New South Wales.

OBJECTIVE: To determine the incidence of childhood cerebral tuberculosis (tuberculous meningitis [TBM] and tuberculoma) in a defined population. DESIGN: Retrospective, population-based study. SETTING AND PARTICIPANTS: All resident children aged up to 14 years in New South Wales diagnosed with cerebral tuberculosis, from 1982 to 1996. MAIN OUTCOME MEASURE: Population-based incidence of childhood TBM. RESULTS: 10 children with TBM and one with tuberculoma were identified in the 15 years. The incidence of TBM was 0.053 (95% CI, 0.025-0.097) per 100,000. Eight of the 10 TBM patients were born in Australia and five were of white European origin. Only one had been vaccinated with BCG vaccine. Three of the children died. CONCLUSIONS: The incidence of childhood TBM in New South Wales is low, and comparable with that in other First World countries.

Social environment and longevity in schizophrenia.

OBJECTIVE: The role of social support as a predictor of long-term survival among patients with schizophrenia was examined. METHODS: Social histories were abstracted from the medical records of a cohort of 133 deceased schizophrenic patients admitted for inpatient treatment between 1934 and 1944. Two independent raters assessed the quantity and quality of support available in each patient's social environment. RESULTS: Cox regression analysis revealed that higher quantity of social support was significantly related to survival time (p<.05) after controlling for marital status and quality of support. The Cox model indicated that a 1-point increase in the support quantity rating was associated with a proportional 25% decrease in the hazard rate. CONCLUSIONS: The present findings suggest that social environment, specifically the quantity of social support available to the patient, may impact longevity in psychiatric populations.

Assessment of irrational health beliefs: relation to health practices and medical regimen adherence.

The purpose of the present research was to provide initial validation of the 20-item Irrational Health Belief Scale (IHBS). Study 1 included 392 undergraduate psychology students. Results from Study 1 suggested that the IHBS total score is internally consistent and stable over an 18-month time period. Greater health-related cognitive distortion (higher IHBS scores) was associated with weaker internal health locus of control beliefs, lower positive affectivity, stronger chance health locus of control beliefs, and greater negative affectivity. Most important, greater cognitive distortion was uniquely and significantly associated with a less positive pattern of health practices. Study 2 involved 107 individuals with Type I diabetes mellitus. Results indicated that higher IHBS scores were significantly associated with both objective (hemoglobin HbA1) and self-reported diabetic regimen adherence independent of trait neuroticism and conscientiousness.

Family environment, intrusive ideation, and adjustment among renal transplant candidates.

Waiting for an organ transplant is a stressful experience frequently associated with symptoms of depression and anxiety. Little empirical work has examined patients during the stressful period prior to transplantation, particularly among patients waiting for a renal transplant. A large body of research has demonstrated that social and family support variables are associated with psychological adjustment in a variety of medical populations. Little research has examined the mechanism by which social support exerts its effects on psychological well-being. We examined two possible models of the role of intrusive thoughts on the relationship between a supportive family environment and both depression and anxiety in a sample of 75 patients with end-stage renal disease (ESRD) waiting for a kidney transplant. Path analyses provided modest support for a mediational model, showing that intrusive thoughts partly accounted for the relationship between family expressiveness and psychological distress. A moderational model examining the interactive effects of family environment and intrusive thinking on adjustment was not supported.

Health states following head and neck cancer treatment: patient, health-care professional, and public perspectives.

BACKGROUND: This study investigated the assignment of preference values to health states which may follow head and neck cancer (HNC) treatment. Preference values for these health states were provided by HNC patients, HNC health-care providers, and a group of college students representing individuals with little knowledge of HNC. METHODS: A time trade-off technique was used by participants to assign preference values to four health states in the domains of appearance, eating, speech, breathing, pain, and work/social functioning. RESULTS: Patients' and health-care professionals' rank-ordered preference value scores for health states in appearance, breathing, eating, and speech were not significantly different (p < .05). These two groups differed significantly in ranking four of the eight pain and work/social functioning health states. Patients and students differed significantly in ranking 21 of the 24 health states (p < .05). CONCLUSIONS: Health-care professionals and patients had very similar perspectives regarding health states in the HNC-specific domains, indicating that these professionals appear to be a legitimate proxy for patients' attitudes in these domains. Healthcare professionals placed a significantly greater value on avoiding both pain and social confinement than did patients. Students, representing individuals naive regarding HNC, differed from patients and health-care professionals in their rankings of these health-state outcomes.

Cynical hostility, powerful others control expectancies, and patient adherence in hemodialysis.

OBJECTIVE: The present study examined the joint role of cynical hostility and powerful others health locus of control expectancies in predicting regimen adherence in a sample of center hemodialysis patients. METHOD: Forty-eight hemodialysis patients completed the Cook-Medley Hostility (Ho) Scale and the Powerful Others Health Locus of Control (PHLC) scale. Adherence to the fluid-restriction and phosphorus reduction components of the treatment regimen was assessed by examining patients' interdialysis session weight gains and serum phosphorus (P) levels. RESULTS: In a hierarchical regression analysis, higher hostility was associated with significantly higher serum P levels indicating poorer dietary and medication adherence. The main effect for hostility was qualified by the interaction of hostility and PHLC. This pattern indicated that the deleterious effect of hostility on adherence was most pronounced among patients possessing the expectancy that positive health outcomes are not strongly contingent on the actions or advice of powerful others (eg. health care providers). Similar analyses failed to show significant effects for hostility or PHLC in the prediction of interdialytic weight gain. CONCLUSIONS: The present findings suggest that jointly assessing hostility and health-related expectancies may be useful in identifying chronically ill patients who are potentially at risk for difficulties in performing a prescribed regimen.

Monitoring attentional style and medical regimen adherence in hemodialysis patients.

Previous research involving individuals facing chronic health problems suggests that an attentional style characterized by pronounced monitoring of threat-relevant information is associated with poorer behavioral and emotional adjustment. This study examined the hypothesis that a pronounced monitoring style would be associated with poorer medical regimen adherence in a sample of 51 chronic hemodialysis patients. Hierarchical regression analyses (controlling for demographic factors and trait anxiety) revealed that "high monitors" exhibited higher interdialysis weight gains and higher serum K values reflecting poorer adherence to fluid-intake and dietary restrictions. However, monitoring was not associated with a measure of medication adherence. Partial support was found for a model suggesting that a lack of perceived control is responsible for the relationship between higher monitoring and poorer adherence.

Hostility, social support, and ambulatory cardiovascular activity.

The present study compared ambulatory blood pressure in male and female subjects preselected for high and low hostility levels and investigated interpersonal daily stress as a possible mediational mechanism. Ambulatory blood pressure and heart rate were measured in 48 male and female students previously classified as high or low on the Cook-Medley Hostility (Ho) Scale. Subjects wore an ambulatory monitor for a working day and also completed measures of perceived social support, daily interpersonal stress, and health behavior information. Results indicated that subjects scoring high on the Ho scale had higher mean levels of ambulatory systolic blood pressure than low Ho subjects, even when controlling for traditional risk factors, such as cigarette smoking. High Ho subjects also reported greater daily interpersonal stress and less social support than low Ho subjects. Perceived interpersonal stress partially accounted for the relationship between hostility and blood pressure. Subjects high in hostility showed greater mean ambulatory systolic blood pressure levels. Consistent with the transactional model of hostility and health, the relationship between hostility and blood pressure appears to be partially accounted for by the daily experience of interpersonal stress.

Parental influence on gender and marital role attitudes: implications for intervention.

This study examined parental influence on specific attitudes toward marital and parental roles and nonspecific gender-role attitudes. Respondents included 173 young adults (127 women and 46 men) and their parents. Young adults' scores on the Role Orientation scale of the Marital Satisfaction Inventory and on masculinity and femininity scales from two self-report inventories (the MMPI-2 and the Personal Attributes Questionnaire) were correlated with their parents' scores on a subset of these same measures. Results indicated that (a) marital and parental role attitudes among young adults are strongly related to specific marital role attitudes of their parents but only modestly related (for women) or unrelated (for men) to nonspecific gender-role attitudes of their parents; (b) broader gender-role attitudes of young men are moderately correlated with their father's attitudes but generally uncorrelated with their mother's attitudes regarding gender roles; and (c) the relationship of young women's gender-role attitudes to both maternal and paternal attitudes is generally weaker and more complex than for young men. Clinical implications of these findings for assessment and intervention with distressed couples are discussed.

Health beliefs, personality, and adherence in hemodialysis patients: an interactional perspective.

Research examining the main effects of health beliefs and personality on medical regimen adherence has yielded inconsistent results. This study tested the hypothesis that health beliefs and personality predict adherence in an interactive manner. Components of the Health Beliefs Model, Conscientiousness (C) from the NEO-Five Factor Inventory, and regimen adherence were assessed in a sample of 70 in-center hemodialysis patients. In a hierarchical regression analysis, the interaction of health beliefs and C failed to explain a significant portion of the variance in interdialysis weight gain, a measure of adherence to fluid restrictions, after controlling for demographic characteristics. The interaction did significantly predict individual differences in serum phosphorus levels, a measure of diet and medication adherence. The effect was primarily attributable to the interaction of C and perceived severity. However, the combination of high C and high perceived severity was associated with poorer patient adherence. Such a pattern may be the result of defective coping patterns associated with high levels of anxious arousal and has implications for therapeutic interventions targeted at modifying health beliefs among chronically ill patients following prescribed medical regimens.