Dynamic altruistic cooperation within breast tumors.

BACKGROUND: Social behaviors such as altruism, where one self-sacrifices for collective benefits, critically influence an organism's survival and responses to the environment. Such behaviors are widely exemplified in nature but have been underexplored in cancer cells which are conventionally seen as selfish competitive players. This multidisciplinary study explores altruism and its mechanism in breast cancer cells and its contribution to chemoresistance. METHODS: MicroRNA profiling was performed on circulating tumor cells collected from the blood of treated breast cancer patients. Cancer cell lines ectopically expressing candidate miRNA were used in co-culture experiments and treated with docetaxel. Ecological parameters like relative survival and relative fitness were assessed using flow cytometry. Functional studies and characterization performed in vitro and in vivo include proliferation, iTRAQ-mass spectrometry, RNA sequencing, inhibition by small molecules and antibodies, siRNA knockdown, CRISPR/dCas9 inhibition and fluorescence imaging of promoter reporter-expressing cells. Mathematical modeling based on evolutionary game theory was performed to simulate spatial organization of cancer cells. RESULTS: Opposing cancer processes underlie altruism: an oncogenic process involving secretion of IGFBP2 and CCL28 by the altruists to induce survival benefits in neighboring cells under taxane exposure, and a self-sacrificial tumor suppressive process impeding proliferation of altruists via cell cycle arrest. Both processes are regulated concurrently in the altruists by miR-125b, via differential NF-κB signaling specifically through IKKß. Altruistic cells persist in the tumor despite their self-sacrifice, as they can regenerate epigenetically from non-altruists via a KLF2/PCAF-mediated mechanism. The altruists maintain a sparse spatial organization by inhibiting surrounding cells from adopting the altruistic fate via a lateral inhibition mechanism involving a GAB1-PI3K-AKT-miR-125b signaling circuit. CONCLUSIONS: Our data reveal molecular mechanisms underlying manifestation, persistence and spatial spread of cancer cell altruism. A minor population behave altruistically at a cost to itself producing a collective benefit for the tumor, suggesting tumors to be dynamic social systems governed by the same rules of cooperation in social organisms. Understanding cancer cell altruism may lead to more holistic models of tumor evolution and drug response, as well as therapeutic paradigms that account for social interactions. Cancer cells constitute tractable experimental models for fields beyond oncology, like evolutionary ecology and game theory.

Superior gait performance and balance ability in Latin dancers.

Background: Latin dance consists of various fast and stability-challenging movements that require constant body adjustments to maintain proper posture and balance. Although human gaits are assumed to be symmetrical, several factors can contribute to asymmetrical behavior of the lower extremities in healthy adults. These include lower limb dominance, ground reaction forces, lower limb muscle power, foot placement angle, and range of joint motion. Gait impairment can lead to a high risk of falling, diminished mobility, and even cognition impairment. We hypothesized that Latin dancers might have a more symmetric gait pattern and better balance ability than healthy non-dancer controls. Methods: We investigated the impact of Latin dance training on gait behaviors and body balance. We recruited twenty Latin dancers and 22 normal healthy subjects to conduct walking experiments and one-leg stance tests, and we measured their kinematic data by inertial measurement units. We then defined four performance indexes to assess gait performance and body stability to quantify the potential advantages of dance training. Results: We found that the two gait asymmetric indexes during the walking test and the two performance indexes during the one-leg stance tests were better in Latin dancers compared with the healthy control group. The results confirmed the superiority of Latin dancers over the healthy control group in gait symmetry and balance stability. Our results suggest that Latin dancing training could effectively strengthen lower limb muscles and core muscle groups, thereby improving coordination and enhancing gait performance and balance. Conclusion: Latin dance training can benefit gait performance and body balance. Further studies are needed to investigate the effect of Latin dance training on gait and balance outcomes in healthy subjects and patients with gait disorders.

General practice service use and satisfaction among female survivors of childhood sexual abuse.

BACKGROUND: Because childhood sexual abuse (CSA) and adult violence are associated with poorer physical and mental health of women, our aim was to investigate the associations between CSA, adult violence experiences and general practice service use and satisfaction in a community sample of Australian women aged 28-33 years. METHODS: Data of 9058 women from the 1973-78 cohort who completed Survey 4 of the Australian Longitudinal Study on Women's Health were analysed. RESULTS: Logistic regressions conducted indicated that after controlling for demographic variables, women with experiences of lifetime violence were more likely to have higher general practice service use compared to those without violence experiences. CSA was not associated with an increase in service use but was significantly associated with a decrease in service satisfaction. This find-ing remained significant even when they visited the general practice more frequently. DISCUSSION: Implementing trauma-informed care is suggested as a way to improve the satisfaction of this patient group with complex needs.

Childhood sexual abuse and its association with adult physical and mental health: results from a national cohort of young Australian women.

Childhood sexual abuse (CSA) occurs across the world, with a prevalence of 20% internationally. Our aim was to investigate the associations between CSA, CSA plus adult violence experiences, and selected self-reported physical and mental health in a community sample of women. Data from 7,700 women aged 28-33 years from the 1973-1978 cohort who completed Survey 4 of the Australian Longitudinal Study on Women's Health (ALSWH) were analyzed. Questions about prior abuse experience such as child sexual abuse, IPV, adult physical and sexual assaults, andphysical and mental health. Women who experienced CSA were 1.4 times more likely to experience bodily pain (adjusted odds ratio [AOR] = 1.37, confidence interval [CI] = [1.19, 1.58]), 1.3 times more likely to have poorer general health (AOR = 1.33, CI = [1.15, 1.54]), and 1.4 times more likely to be depressed in the past 3 years (AOR = 1.44, CI = [1.22, 1.71]) compared with those without abuse.. Women who experienced both CSA and adult violence were 2.4 to 3.1 times more likely to experience poor general (AOR = 2.35, CI = [1.76, 3.14]) and mental health (AOR = 2.69, CI = [1.98, 3.64]), and suffer from depression (AOR = 2.84, CI = [2.13, 3.78]) and anxiety (AOR = 3.10, CI = [2.12, 4.53]) compared with women with no abuse. This study demonstrates the importance of CSA in pain and poorer long-term mental and physical health.. It emphasizes how prior CSA may amplify pain and poorer long-term mental and physical health among women who are again exposed to violence in adulthood.

Establishing female-only areas in psychiatry wards to improve safety and quality of care for women.

OBJECTIVE: Our aim was to assess the impact of creating a female-only area within a mixed-gender inpatient psychiatry service, on female patient safety and experience of care. METHOD: The Alfred hospital reconfigured one of its two psychiatry wards to include a female-only area. Documented incidents compromising the safety of women on each ward in the 6 months following the refurbishment were compared. Further, a questionnaire assessing perceived safety and experience of care was administered to female inpatients on both wards, and staff feedback was also obtained. RESULTS: The occurrence of documented incidents compromising females' safety was found to be significantly lower on the ward containing a female-only area. Women staying on this ward rated their perceived safety and experience of care significantly more positively than women staying where no such gender segregation was available. Further, the female-only area was identified by the majority of surveyed staff to provide a safer environment for female patients. CONCLUSIONS: Establishing female-only areas in psychiatry wards is an effective way to improve the safety and experience of care for female patients.

Women survivors of child abuse - don't ask, don't tell.

BACKGROUND: Rates of disclosure of child abuse by women survivors are low, and general practitioners seldom ask women about such history. This study explored the experiences of women survivors: child abuse disclosure, GP service use and thoughts on being asked about their abuse experiences. METHODS: A cross-sectional study containing quantitative and qualitative questions was conducted with 108 women child abuse survivors. RESULTS: Only 5% of the women disclosed their child abuse to their GP and 19% were asked about their child abuse history. More than half of the women (58%) asked reported feeling hopeful or relieved and none reported feeling offended. DISCUSSION: Rates of child abuse inquiry by GPs and disclosures by women survivors remain low. With the majority of women survivors reporting feeling relieved and none offended when asked about their child abuse experiences, GPs should consider asking women who present to their practice about such experiences: This may facilitate early intervention.

Primary healthcare practitioners' screening practices and attitudes towards women survivors of child abuse.

Background Child abuse survivors have an increased risk of developing various mental illnesses in adulthood, which may lead survivors to access primary healthcare services, in particular primary care mental health services. Aim To determine the frequency with which different primary care mental health practitioners encounter child abuse survivors in their practice and differences in their views about routine screening, level of importance, confidence and comfort in screening and supporting survivors, a cross-sectional study was conducted with 186 practitioners. Method The sample consisted of general practitioners (13.9%), psychologists (67.9%) and other professions such as psychiatrists, social workers, counsellors, psychotherapists, mental health nurses and other specific mental health practitioners (18.2%). Results Over 91% of practitioners reported that child abuse was a healthcare issue and was a problem for women in their practice. However, only 51.4% believed that women should be routinely screened for child abuse experiences. Significant differences among practitioner groups were found in aspects of screening and responding to survivors. General practitioners were significantly less likely to screen routinely and reported lower levels of confidence and comfort in conducting screening of survivors when compared with psychologists and other practitioners. The majority of practitioners saw it as psychologists' role to routinely screen; however, 57-82% of practitioners within each group reported that they would benefit from further training in areas relating to asking about and supporting survivors. Conclusion Findings highlighted further education as a potential area of need to enhance the knowledge and capacity of different practitioner groups in responding to women survivors of child abuse.

Subjective well-being, sociodemographic factors, mental and physical health of rural residents.

OBJECTIVE: To ascertain the relationship between subjective well-being and sociodemographic factors, mental and physical health of a sample of rural residents. DESIGN: Cross-sectional survey with stratified random sampling of persons based on the 2000 State Electoral Role. Questionnaire was forwarded to 23 000 residents throughout a rural area. SETTING: Households within Gippsland. PARTICIPANTS: Five thousand three hundred and ninety-one adults aged 18 years and above. MAIN OUTCOME MEASURES: Residents completed a self-reported questionnaire assessing life satisfaction/subjective well-being, psychological distress, sociodemographic factors, physical and mental health problems. RESULTS: Completed survey indicated that participants with lower levels of psychological distress, physical disability and mental disability had higher odds of being satisfied with their life. Participants with severe mental disability had the lowest odds of being satisfied with life. On average, participants were satisfied with their life (mean score of 21, SD = 5.9), are within the normal range of the Kessler-10 (mean score = 16.31, SD = 5.85), had no mental disability (mean score = 51.8, SD = 7.36) on the mental component of the Short Form-12 Health Survey, but are mildly physically disabled (mean score = 48.9, SD = 7.74). CONCLUSIONS: The results of this study indicate that sociodemographic factors, psychological distress, physical health and mental health contribute to subjective well-being. Compared with other age groups, those aged 66 years and above had the highest level of life satisfaction. Those living with partner/spouse without children, with no mental or physical disability and no psychological distress had highest level of life satisfaction. Women also had higher levels of life satisfaction compared with men.

Consequences of using SF-12 and RAND-12 when examining levels of well-being and psychological distress.

OBJECTIVE: To explore the consequences of using the Short-Forum Health Survey (SF-12) and the RAND-12 Health Status Inventory (RAND-12) for estimation of associations between its component scores and the levels of well-being and psychological distress. METHODS: Data from a rural community mental health survey of 5641 participants were analysed. Physical and mental health component scores of the SF-12 and RAND-12 were compared between participants with different rating on the Satisfaction with Life Scale and the Kessler-10. Descriptive graphical methods were utilized to explore the relationship between SF-12 and RAND-12 components scores against well-being and psychological distress. Proportional odds model was utilized to estimate the quantitative relationship between component scores of the SF-12 and RAND-12 against categories of well-being and psychological distress. RESULTS: Both SF-12 and RAND-12 component scores were generally positively associated with well-being and negatively associated with psychological distress. Median scores were similar despite scoring techniques used. However, distribution of scores differed whereby the RAND-12 yielded wider spread of scores in measures of well-being and psychological distressed when compared to the SF-12. A larger proportion of participants was classified as having moderate and severe disability under the RAND-12 compared to the SF-12. CONCLUSION: It is recommended that users of the SF-12 and the RAND-12 are aware of the implications of utilizing either of the scoring techniques. Scoring techniques used should ideally be based on the theoretical basis of the study with consideration of the target population. Researchers may wish to use the SF-12 if distinct uncorrelated physical and mental constructs are required and for studies on clinical populations. In contrast, RAND-12 should be used if correlated physical and mental constructs are required and if the study is on community or general populations.

Self-reported confidence and skills of general practitioners in management of mental health disorders.

OBJECTIVE: To identify the predictors of self-reported confidence and skills of GPs in management of patients with mental health problems. DESIGN: Cross-sectional survey, with questionnaire presented to 246 GPs working in 62 practices throughout Gippsland. SETTING: Rural general practices in Gippsland. PARTICIPANTS: One hundred and thirty-four GPs across Gippsland. MAIN OUTCOME MEASURES: GPs completed a questionnaire assessing self-perception of knowledge and skills in recognition and management of common mental health problems. RESULTS: Of 134 GPs, 45% reported that they have a specific interest in mental health, and 39% of GPs reported that they had previous mental health training. Only 22% of GPs describe having both an interest and prior training in mental health care. Age and years since graduation are not significantly related to self-reported confidence and skills. CONCLUSIONS: The results of this study highlight that self-professed interest and prior training in mental health are associated. Self-professed interest in mental health care predicts confidence and self-perceived skills in recognition, assessment and management of common mental health disorders. Similarly, prior training in mental health care predicts confidence and self-perceived skills in recognition, assessment and management of common mental health problems. Self-professed interest in mental health issues is also associated with hours of participation in continuing medical education related to mental health care. Unfortunately, only a minority described having both interest and prior training in mental health care.