Expression of cancer-associated genes in prostate tumors.

BACKGROUND:  Prostate cancer is one of the most common male cancers in Western countries and takes the third place in morbidity in Ukraine. It is a highly heterogeneous disease. AIM: To analyze relative expression levels of the TGFB1, IL1B, FOS, EFNA5, TAGLN, PLAU, and EPDR1 genes in malignant and non-malignant prostate tissues. MATERIALS AND METHODS:  Total RNA was isolated from 16 prostate adenomas, 37 prostate adenocarcinomas, and 29 conventionally normal prostate tissues. To analyze relative gene expression levels the quantitative real-time polymerase chain reaction was performed. RESULTS: The significant alterations in the relative expression levels were found in all analyzed sample groups for 4 genes: FOS, EFNA5, IL1B, and TGFB1. We have found that FOS and EFNA5 were more frequently overexpressed in carcinomas with Gleason score ≤ 7, compared with adenomas. On contrary, PLAU expression levels were decreased more frequently in prostate cancers, compared with conventionally normal tissues. Noteworthy, we found positive correlation between IL1B expression level and PSA (for patients with slight PSA increase, no more than 20.0 ng/ml). CONCLUSION: The EFNA5, FOS, IL1B, PLAU, and TGFB1 genes that showed significant expression alterations in prostate tumors, compared with conventionally normal prostate tissue, may play role in prostate cancer development and should be further investigated.

Lessons for clinicians from physician-patient communication literature.

Research about the communication between physicians and patients contains information that can help clinicians be better diagnosticians and achieve greater compliance and can lead to improved patient health and satisfaction. We present research results that can be useful for the physician in daily clinical practice.

Can effective parent education occur during emergency room visits?

BACKGROUND: Parents might not feel the need to make as many visits to an emergency room (ER) for a sick child if they had more information about common illnesses and their management. This study measured the effect on future ER use of parent education on common childhood illnesses. METHODS: Children who were over 6 months old and had visited the ER at least twice in the preceding year were enrolled in an experimental group (n = 118) or in a control group (n = 128) over consecutive two-month periods. The intervention consisted of a pamphlet and a videotaped presentation that discussed the features and management of common childhood illnesses. RESULTS: Over the following year, an average of 0.43 (SD = 0.9) ER visits were made by experimental subjects compared to 0.52 (SD = 1.31) by control subjects (P = .30). Twenty percent (SD = .4) and 22% (SD = .4) of subsequent illnesses of experimental and control children respectively resulted in an ER visit. CONCLUSION: Our study demonstrated no effect of an educational intervention designed to decrease ER visits. Limitations of our study, however, suggest that further attempts to educate parents in this setting may still be warranted.

Knowledge of nephrologists and patients about autosomal dominant polycystic kidney disease (ADPKD).

Because of the availability of presymptomatic testing for autosomal dominant polycystic kidney disease (ADPKD), we assessed the response of nephrologists, patients, and at-risk relatives to the introduction of a genetic counselling program for ADPKD. Fifty-six of seventy-six nephrologists responded. Ninety-eight percent reported 'generally' telling their patients that the disease was hereditary, but fewer reported screening relatives (81% for children and 70% for siblings and parents). Ninety percent were interested in referring patients to the service. Fourteen of the 24 patients in one renal clinic and 18 of their at-risk relatives were interviewed. Ten of the patients but only five of the relatives stated that the disease was hereditary. The precise mechanism of inheritance was poorly understood by most patients and relatives. Of 21 patients offered genetic counselling, nine made appointments to see the genetic counsellor. There remains a large gap between advancing technology and the delivery of information to at-risk populations.

Measuring health status: an approach for family practice researchers.

Research in family practice frequently involves the measurement of subjects' perceived health status. Those who are unfamiliar with this area may find the task difficult and frustrating. This paper offers an approach to the selection and assessment of measures of health status and specifically examines issues of feasibility, instrument content, appropriateness for subjects, instrument construction, reliability, validity, sensitivity to change, and measurement strategy.

Presymptomatic Diagnosis of Genetic Disorders: Is it worth the anxiety?

Through recent advances in DNA technology, presymptomatic diagnosis of several genetic disorders is now possible. This technology can determine whether an at-risk individual is at greatly increased risk of having inherited the gene for a particular disorder many years before symptoms are expected to occur. To provide effective care, the family physician must be aware of the potential benefits and risks of presymptomatic testing.

Is maternity care different in family practice? A pilot matched pair study.

In this pilot study, 81 patients booked for delivery by family physicians were matched to patients booked for delivery by obstetricians. Patients in both groups were at low obstetric risk. They were matched by age, parity, blood pressure, gestational age at delivery, and socioeconomic status. Patients booked with family physicians experienced fewer artificial rupture of membranes, inductions of labor, episiotomies, and forceps deliveries than those booked with obstetricians. These patients also spent a shorter time in hospital in spite of longer second stages of labor. Infant outcomes were equivalent in the two groups. A simple method of audit of maternity care that permits comparisons of the care provided by family physicians and obstetricians for obstetrically similar patients is described. This methodology employs matching within a given institution and facilitates the multicentered studies required to obtain the large populations needed to compare the process and outcome of infant and maternal care provided by these two types of physicians.

Psychosocial problems: what help do rural and urban patients want from their family physicians?

We surveyed 399 patients of family physicians in two rural Canadian towns to determine what help with 30 psychosocial problems they wanted from their physicians. The patients completed a self-administered questionnaire in which they could choose from four levels of physician involvement: no involvement, knowledge of the problem but no help, knowledge of the problem and referral to a specialist, and treatment by the physician. Half of the patients wanted help with life-cycle problems, and over half desired treatment for sleeping problems, anxiety and depression. However, close to 50% of the patients desired no help for interpersonal problems, and over 50% wished to see a specialist for help in coping with a physical illness and long-term pain. Interestingly, English-speaking patients wanted significantly more physician involvement than did French-speaking patients. The results were similar to those of an earlier study of urban patients. Implications for family medicine training are discussed.

Clinicians' knowledge about the families of their patients.

This study was designed to determine what doctors and nurses in family medicine actually know about the families of their patients; to assess the accuracy of the professed knowledge; and to relate this knowledge to the patient's level of satisfaction and compliance. Clinicians completed questionnaires dealing with their knowledge of personal and family information about patients. These patients completed a mirror-image questionnaire--to assess the accuracy of the clinician's responses--and a questionnaire about their satisfaction with the consultation. At a follow-up visit by the patients, clinicians completed questionnaires which assessed patients' compliance. Clinicians thought they knew the patient's occupation in 86% of cases and were correct in 73% of the total. The respective percentages for the spouse's level of education were 49% and 35%. Clinicians and patients agreed on whether there was a marital or a financial problem 66% and 47% of the time respectively. High clinician knowledge scores were not associated with either high satisfaction or good compliance on the patient's side.