tbuckley/cabot-search huggingface dataset:
Medicine and books: Culture and Health
Authors: Kamran Abbasi
Journal: BMJ (1998)

Malcolm MacLachlan 

John Wiley & Sons, £15.99, pp 316 

ISBN 0 471 96626 6 

“This book offers a path through a forest,” promises Malcolm MacLachlan. The foliage in question is the tangled, intertwined confusion of today’s multicultural society: “At different times of day the light will play tricks on you with shadows pointing you to travel in one direction or another.” Many paths are false trails, but MacLachlan aims to guide us through with original concepts mixed in with worldwide examples of how culture complicates health. Cultural differences can seem both threatening and stimulating, he claims, especially as many diverse cultural streams are being governed by the healthcare system of the dominant culture. 

The health of ethnic minorities, especially mental health, is highly topical, and MacLachlan supports his arguments with recent research findings, as well as providing his own guidelines at the end of each chapter. To understand cultural differences, MacLachlan offers his picture portrait technique, which “seeks to convey a likeness of a person’s presenting problems through both words and images,” a means of gauging the influences on a patient’s ill health and subsequently governing treatment. 

The faith grid offers clinicians a way of thinking “through the interactions between themselves and their patients.” Patients from minority cultures, argues MacLachlan, may not have faith in clinicians or medical interventions that are being offered by the host society. Another of MacLachlan’s concepts is incremental improvements, whereby clinicians allow communities to determine the speed of health improvements rather than setting the healthcare agenda themselves. 

MacLachlan is at his most interesting when recounting tales of cultural diversity. While discussing culture bound syndromes, he focuses on koro, a condition in which patients believe that their sexual organs are shrinking, and lata, in which patients throw down whatever they are holding and shout expletives. He also discusses whether anorexia nervosa should be thought of as a culture bound syndrome confined to Western civilizations. 

These narratives are interesting, but their selectivity paints a rather patchy picture of society’s cultural diversity. MacLachlan travelled five continents and worked in three universities to research this book, and, although he manages to convey the extent of that diversity, his approach never gets to grips with the problems of any one particular society—as if he is still trying to make sense of that collision of influences in his own mind. Consequently, his observations are of more use to those seeking to broaden their understanding of cultural health differences rather than those needing specific answers. 

Currently director of the health psychology unit at Trinity College in Dublin, MacLachlan trained as a clinical psychologist at the Institute of Psychiatry in London. Culture and Health reflects his training, with the emphasis firmly on cultural differences in psychological illness.
Characteristic Pattern of Chromosomal Gains and Losses in Primary Large B-Cell Lymphomas of the Gastrointestinal Tract
Authors: Thomas F.E. Barth, Hartmut Döhner, Claudius A. Werner, Stephan Stilgenbauer, Magdalena Schlotter, Michael Pawlita, Peter Lichter, Peter Möller, Martin Bentz
Journal: Blood (1998)
Website of the Week: Injections
Authors: Ioana Vlad
Journal: BMJ (2003)

An article in this week's BMJ focuses on the overuse of injections—and unsafe practices in their delivery—in different countries (p 1075). Injections are generally simple procedures learnt in the early years at medical and nursing schools, and a wide range of healthcare professionals can give them. There is little commercial interest in injections, and consequently websites about their appropriate use is scarce.

One site that is worth visiting is that of the Safe Injection Global Network or SIGN (www.injectionsafety.org), which contains important facts about injection practices. SIGN is a voluntary coalition of stakeholders aiming to achieve safe and appropriate use of injections throughout the world. The Blood Safety and Clinical Technology Department of the World Health Organization provides the secretariat for the network. So those interested can find on this site useful information about WHO strategy for the safe and appropriate use of injections worldwide, such as its objectives and interventions at country level (www.who.int/injection_safety/about/en/). There are various resources available to download.

Children are the largest part of the vaccine-receiving population and the Children's Vaccine Program (www.childrensvaccine.org), launched with the support of the Bill and Melinda Gates Foundation, aims to promote equal access to new and lifesaving vaccines worldwide. At http://childrensvaccine.org/html/safe_injection.htm the site offers important information and advice regarding what it calls the “epidemic of unsafe medical injections.” There are policy statements and reports, manuals and curriculums on subjects such as the disposal and destruction of syringes and needles and reducing the number of injections given to patients.

Needles penetrating the skin are not only a potential source of infection—they can also arouse extreme phobia. But there is another way. The US Centers for Disease Control and Prevention offers interesting and up to date information on needle free injections (devices, manufacturers, safety, history) at www.cdc.gov/nip/dev/jetinject.htm
Impact of Aortic Valve Calcification, as Measured by MDCT, on Survival in Patients With Aortic Stenosis
Authors: Marie-Annick Clavel, Philippe Pibarot, David Messika-Zeitoun, Romain Capoulade, Joseph Malouf, Shivani R. Aggarwal, Phillip A. Araoz, Hector I. Michelena, Caroline Cueff, Eric Larose, Jordan D. Miller, Alec Vahanian, Maurice Enriquez-Sarano
Journal: Journal of the American College of Cardiology (2014)
Long-term protection of hematopoiesis against the cytotoxic effects of multiple doses of nitrosourea by retrovirus-mediated expression of human O6-alkylguanine-DNA-alkyltransferase
Authors: J Jelinek, LJ Fairbairn, TM Dexter, JA Rafferty, C Stocking, W Ostertag, GP Margison
Journal: Blood (1996)
Future of preschool vision screening
Authors: C Williams, R A Harrad, J M Sparrow, I Harvey, J Golding, J. Lee, G. Adams, J. Sloper, A. McIntyre, A. R Fielder, G W Aylward, J. Rahi, C. Dezateux
Journal: BMJ (1998)

<h3>Objectives</h3> The kinetics of the antibody response induced by meningococcal serogroup C (MenC) conjugate vaccination was analysed in patients with juvenile idiopathic arthritis (JIA) to assess their long-term protection against MenC disease. <h3>Methods</h3> In The Netherlands, a nationwide catch-up campaign was performed in 2002 during which children aged 1–19 years, including JIA patients, received the MenC conjugate vaccination. From 127 JIA patients, IgG antibody concentrations against MenC-polysaccharide were determined by a fluorescent-bead-based immunoassay in 402 serum samples collected between 2002 and 2010. Using a hierarchical linear regression model, the 8 years course of MenC-specific antibodies was analysed in four age groups (13–19, 9–12.9, 5–8.9 and 1–4.9 years), and in patients starting with methotrexate or biologicals. In 65 randomly selected samples, the correlation of MenC-specific IgG concentrations with serum bactericidal assay (SBA) titres was assessed. MenC-specific IgG concentrations at 4.2 years after vaccination were compared with those of 1527 age-matched healthy controls. <h3>Results</h3> MenC-specific IgG concentrations postvaccination were highest in patients aged 13–19 years at time of vaccination. Antibodies gradually waned over time in patients, but their estimated concentrations at 4.2 years postvaccination were similar to those measured in controls. MenC-specific IgG concentrations correlated well with SBA titres (r=0.72, p&lt;0.001). By contrast with methotrexate, starting treatment with biologicals induced a trend towards accelerated decline of MenC-specific antibodies. <h3>Conclusions</h3> Persistence of MenC-specific IgG antibodies in JIA patients is similar to healthy controls, but treatment with biologicals may induce accelerated antibody waning, resulting in unprotected patients who may need revaccination.
Commentary: patient's view
Authors: Maria Tomasa, Giorgina Barbara Piccoli
Journal: BMJ (2004)

My nickname is Tommy. At the time of the story I was 35 years old.1 I have been diabetic almost all my life, and this has had a big effect on me. I have wanted a baby since the day of my marriage, or even before that. Someone asked me if I wanted a baby to feel more “normal.” That is not the reason. I wanted a baby because it is a fundamental part of life and because I needed a child. I wanted it. When you deeply want something you have no particular reasons for doing it; you just want it day and night.

Over the past few years, I have spent money and time trying to have a baby. Most of the doctors I met said that it was too risky and that I shouldn't even think about it. I therefore changed doctors several times, trying to find one who would say “yes,” until I found Giorgina and her father. They finally understood my opinions. They are special people.

I don't know, but maybe it's also because Giorgina has two children (and when I first met her, her first child was a baby). None of the previous doctors, for example, was able to answer this question: “What does high risk, or too risky mean?”

I knew that I would be risking my life and the life of the baby, but I also knew that I could make it. I was sure of that, and you have to follow your feelings. Even if the risk was as high as 70%, I wanted to try.

I understood why the doctors explained all the risks, but my wish was much stronger than they could understand. I think that the doctors should have supported my decision instead of trying to make me change my mind, sometimes too forcefully. Now my child is 2 years old. I call him many things: topolino, ciplollino (little mouse, little onion); he is very sweet. The first time I saw him I thought: “It's impossible it's my child. He's too beautiful.” And the nurses laughed and said: “No, of course he's yours.” He was small and was in the emergency room.

The first time I touched him, he had a tachycardic crisis. The doctor said that he probably needed a surgical intervention for his heart; the surgeon came over, and he talked to me. After 24 hours' observation, they told me that it was only the contact with my hands that had excited him. That day I thought I was dying, and I thought, “God, take me, not him.” He was well by the late evening.

Last week I went on the waiting list for a pancreas-kidney transplant. I'm scared, even though I know it's the best thing to do. I'm scared for my child, and I hope that this time too everything will be all right. I've been happy to let Giorgina tell my story, because I hope it will be useful for somebody else, perhaps someone who has diabetes and wants a baby.
Abstract 138: Transient Receptor Potential Channel C1 Deficiency Protects the Murine Heart from Pressure Overload
Authors: Malini Seth, Zhu-Shan Zhang, Lan Mao, Jarrett Burch, Victoria Graham, Howard A Rockman, Lutz Birnbaumer
Journal: Circulation (2007)

Transient receptor potential canonical (TRPC) channels are non-selective cation channels that are activated in response to G-protein coupled receptor activation, depletion of internal stores and mechanical stretch. Recent reports suggest that cardiac TRPC channels mediate calcineurin dependent cardiac hypertrophy, yet few details exist as to the mechanism for activation of these channels. Here, we provide evidence that TRPC1 channels are the dominant TRPC channel in mouse cardiomyocytes and cardiac TRPC1 protein expression is augmented by seven fold following thoracic aortic banding (TAC). In addition, we provide the first loss of function studies to show that mice lacking TRPC1 channels developed significantly less cardiac hypertrophy following pressure overload induced by thoracic aortic banding suggesting that TRPC1 may confer deleterious calcium entry. Whole cell voltage clamp studies of isolated adult cardiomyocytes reveal a non-selective cation current that is induced by pressure overload that is absent in TRPC1−/− cardiomyocytes and in which TRP blockers such as gadolinium, 2-amino biphenyl boric acid and SKF96365 inhibit the TAC induced current. Finally, neonatal cardiomyocytes lacking functional TRPC1 display reduced TRPC current in response to cell stretch or angiotensin-II; the functional consequence of which includes reduced calcium oscillation frequency and reduced BNP expression. These results provide the first loss of function evidence for TRPC1 channels in cardiac hypertrophy and implicate TRPC1 as a stretch activated channel.
Genetic testing for familial hypertrophic cardiomyopathy in newborn infants
Authors: J F Goodwin
Journal: BMJ (1995)

H pylon is common,6 this is not yet well estab- lished, and the article by Bytzer et al cannot be considered a serious evaluation of the cost effectiveness of such a policy.Studies to address this important question will also have to take into consideration some of the less tangible benefits of a "negative" result on endoscopy.
Psychiatric interview and psychometric predictors of cardiac transplant survival
Authors: R C Chacko, R G Harper, J Gotto, J Young
Journal: American Journal of Psychiatry (1996)

This study prospectively investigated the relation between pretransplant assessment of psychiatric diagnosis, coping skills, and social support and outcome measures of survival and health care utilization.Ninety-four heart transplant patients underwent structured interviews and completed a battery of self-report psychometric tests assessing coping style, health status, and psychosocial supports. Follow-up that ranged from 9 to 56 months after transplant produced a group of 63 survivors and 31 nonsurvivors, who were found to be comparable in terms of pretransplant cardiac status and severity of illness.Survival analysis showed that dimensional psychometric measures of coping and social support based on patient self-assessment were the best significant predictors of survival. Considered separately, interview-determined ratings of social support and pretransplant compliance with treatment regimens were also potential predictors. Formal DSM-III-R diagnoses were related specifically to posttransplant hospital utilization (axis I diagnoses) and posttransplant health behavior (axis II diagnoses).The data demonstrate the value of multifaceted assessment, since psychiatric diagnosis, coping style, and psychosocial support may contribute differently to prediction of such aspects of outcome as mortality and health care utilization.
Driving phobia in the city of Houston: a pilot study
Authors: R J Mathew, M L Weinman, K M Semchuk, B L Levin
Journal: American Journal of Psychiatry (1982)

To study the fear of driving phenomenon the authors contacted 48 subjects who, in response to a newspaper article, had expressed an intense fear of driving in the city of Houston and compared them with an age- and sex-matched control group. The information elicited from the subjects suggested the existence of a driving phobia. No significant differences emerged between the phobic subjects and the controls on relevant driving history and background. Although the phobic subjects reported significantly higher levels of anxiety while driving in normal and difficult situations, most of them reported anxiety of phobic intensity only about difficult driving situations, such as driving on freeways and in congested traffic.
Abstract 971: Inhibition Of Vascular Bk Channel Activity By Caveolae-mediated Angiotensin II Type I Receptor Signaling In Diabetic Vessels
Authors: Tong Lu, Xiaoli Wang, Hon-Chi Lee
Journal: Circulation (2007)

Angiotensin II (Ang II) type I receptor (ATR 1 ) trafficking into caveolae is essential for Ang II signaling, which is known to be abnormal in diabetic vessels. We have shown that the large conductance Ca 2+ actviated K + (BK) channels are also targeted to caveolae in vascular cells. The potential interaction between Ang II signaling and BK channel function in normal and diabetic vessels is unknown. Using whole-cell patch clamp recordings and molecular biology techniques, we examined the mechanisms through which caveolae targeting facilitates the regulation of BK channels by Ang II signaling. We found that in cultured human coronary arterial smooth muscle cells (CASMC) and in freshly isolated rat CASMC, BK channels, ATR 1 , and Src-family protein tyrosine kinases (Src-PTK) were colocalized and enriched in the low buoyant density, caveolae-rich fractions. 2 μM Ang II inhibited BK channel activity by ∼50% in rat and human CASMC and these effects were completely abolished by 2 μM Losartan (a selective ATR 1 inhibitor), 10 μM PP2 (a selective Src-PTK inhibitor), and by caveolin-1 (cav-1) knockdown using 60 nM siRNA. Similar results were obtained in HEK293 cells coexpressing hSlo, BK-β 1 subunit, ATR 1 , cav-1, and Src-PTK, indicating that inhibition of BK channels by Ang II was mediated through ATR 1 activation of Src-PTK and the integrity of caveolae is critical for Ang II signaling. Culturing human CASMC with high glucose (HG, 22 mM) enhanced Ang II-mediated BK channel inhibition (78.8±16.8% vs. 54.5±15.7% in 5 mM glucose, n=3, p&lt;0.05). Analysis of ATR 1 , Src-PTK, and BK channel distribution by sucrose gradient fractionation and by co-immunoprecipitation with anti-cav-1 antibodies showed that expression of ATR 1 and Src-PTK were up-regulated in human CASMC cultured in HG and in CASMC from streptozotocin-induced diabetic rats. Total BK channel protein in these cells was diminished, but the amount of BK channels co-immunoprecipitated with anti-cav-1 antibody was increased, suggesting increased caveolae targeting of BK channels in diabetes, which leads to enhanced Ang II-mediated BK channel inhibition. These results indicate that Ang II-BK channel interaction is critically dependent upon caveolae targeting under normal conditions and in disease states such as diabetes.
Abstract P295: The Association of Chronic Stress with Obesity among Hispanic/Latino Adults. Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Carmen R Isasi, Christina M Parrinelo, Linda C Gallo, Mercedes R Carnethon, Orit Birnbaum-Weitzman, Rebeca A Espinoza, Frank J Penedo, Krista M Perreira, Neil Schneiderman, Daniela Sotrez-Alvarez, Linda Van Horn
Journal: Circulation (2013)

Objectives: Prior studies suggest that high stress levels are associated with obesity. However, few studies distinguish between type, duration or timing of stressful exposures. In this study, we examined the association of chronic and recent stress with excess weight in a diverse sample of Latino adults. Methods: HCHS/SOL is a multicenter cohort study of Latino adults (ages 18-74 years) from 4 US cities (Bronx, Chicago, Miami and San Diego).The Sociocultural Ancillary Study (2009-2011) is a sample of 5,253 participants (61% female) from HCHS/SOL. Overweight was defined as BMI 25-29.9 and Obese as BMI ≥30. Three indicators of stress were studied: chronic stress lasting for at least 6 months (Chronic Burden Scale), lifetime exposure to stressors (Traumatic Stress Schedule), and perceived stress during the last month (past month, Cohen’s Perceived Stress Scale). Odds ratios (OR) were calculated using multinomial regression models to describe the odds of obesity or overweight relative to normal weight; models were adjusted for study sampling design and potential confounders. Results: 37% of participants were overweight and 41% obese. Mean (standard error) scores of chronic stress, traumatic stress and perceived stress were 1.8 (0.04), 2.1 (.04), and 14.9 (0.16), respectively. After adjustment for confounders, the odds of obesity increased with number of chronic stress events. A higher number of traumatic events were associated with overweight but the association was not longer significant after adjustment for confounders (Table). No association between perceived stress with overweight or obesity was observed. Conclusions: Exposure to chronic stressors lasting ≥6 months is more relevant for obesity prevalence than recent exposure (past month) in Hispanics. As high stress and obesity are important problems among Hispanics, stress management techniques may need to be incorporated in obesity prevention and treatment programs for this population.
Soundings: Why doctors don't read research papers
Authors: Kevin Barraclough
Journal: BMJ (2004)

I have always rather liked mathematics. Patterns that are in no way discernible by intuition fall out with burning clarity when put under the lens of its methods. However, despite my awe, I find certain areas difficult. In particular I'm suspicious of algebra with its sleight of hand transformations of one thing into another. I see it this evening while watching my daughter doing her school prep. She obtains a simple formula, cranks the mechanical handle of algebraic manipulation, and out drops something else at the end. It is easy to lose sight of what is actually going on. The clarity is lost in the complexity of the method.

I find the same when trying to read medical papers. Sometimes it is the austere formulaic style of the prose that seems a bit dishonest. The authors affect the scientific style of the disinterested observer when in truth they are advocates of their idea. I find myself wanting to say: “Hey! If you want to persuade me to your view that this is important—be honest about it. Tell me what you think and then, honestly, why you think it.”

The volume of statistical argument also seems part of the same disingenuous process. How many doctors have a clue what it means? Of all the areas of mathematics, probability, and its inscrutable daughter statistics, are the most slippery to grasp. Yet authors routinely drop large chunks of this extremely difficult stuff into papers that are supposed to be there to illuminate practice for doctors. But most doctors, including myself, don't understand it. It comes across as a sort of dishonest sleight of hand that is also a little patronising. It may be obvious to the professor and his acolytes but to mere mortals (who after all are the ones who actually see the patients) it merely seems like obscuring jargon.

I think that before any author drops any complex inferential statistics into a paper they should be obliged to give a commonsense interpretation of the data first: “Eyeballing this data seems to show that as X increases so does Y. The statistics suggest this is unlikely to be a chance event that arose because we only sampled a part of the population. And you aren't thick if you don't understand that bit because, truthfully, I don't either.” There. That wasn't so hard.