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Nagtegaal I.D.,Radboud University Nijmegen | Duffy S.W.,Wolfson Institute of Preventive Medicine
Breast Cancer Research and Treatment | Year: 2013

Population screening has brought about changes in both the incidence and mortality rates of patients with breast cancer. Large numbers of small screen-detected tumors have inspired discussions about overdiagnosis based on potential biological differences between screen-detected and symptomatic cancers. In the current systematic review, we analyzed the relation and the interaction of tumor size and nodal status in correlation with screening. Smaller tumors were more frequently screen detected (pT1 78.5 %) than symptomatic (pT1 61.7 %, p < 0.001), with a RR of 1.6 (95 % CI 1.4-1.8, n = 41,209). In the screened population, pT1 tumors were also more frequent (68.5 vs 49.9 %, n = 51,171, p < 0.001). Positive lymph nodes were less frequent in screen-detected tumors (26.8 vs 46.3 %, n = 43,705, p < 0.001) as well as in screened populations as a whole (24.1 vs 44.9 %, n = 49,581, p < 0.001). The relation between size and nodal status was not different between the screen-detected and the symptomatic tumors [pT2+N+ OR 2.42 (95 % CI 1.69-3.48) vs OR 2.91 (95 % CI 2.41-3.51)], suggesting that biological differences, if present, are small. In this systematic review, we confirmed both the association of screening with smaller tumor size at presentation and the consequent reduction in lymph node metastases. © 2012 Springer Science+Business Media New York. Source

Morris J.K.,Wolfson Institute of Preventive Medicine
American Journal of Medical Genetics, Part A | Year: 2012

The aim of this study was to quantify the maternal age-specific risk for trisomy 21 mosaicism. Data were obtained on 322 trisomy 21 diagnoses with mosaicism and 27,943 simple trisomy 21 diagnoses recorded in the National Down Syndrome Cytogenetic Register from 1989 to 2009 in England and Wales. Trisomy 21 cases with mosaicism have a mean maternal age of 33.1 years compared to 35.0 years for free trisomy 21 cases. Sixty-seven percent of trisomy 21 diagnoses with mosaicism are maternal age dependent, with a risk 0.8% that of the corresponding maternal age specific risk for simple trisomy 21. However 33% (0.8 per 100,000 births) are not maternal age dependent, indicating that maternal age is not the only risk factor for mosaicism. Trisomy 21 diagnoses with mosaicism are more likely to be female than free trisomy 21 diagnoses, however there was no association of fetal sex with maternal age which indicates that there is another factor involved in the presence of mosaicism not associated with maternal age, but associated with fetal sex. © 2012 Wiley Periodicals, Inc. Source

Bhui K.,Wolfson Institute of Preventive Medicine
British Journal of Psychiatry | Year: 2010

Evidence-based mental healthcare is evolving rapidly. There is a need for well-tested and effective interventions that are suited to culturally diverse populations. This editorial considers the findings from the SITARA study. There are a substantial number of implications for research, policy and practice. Source

Black and Minority Ethnic (BME) groups in receipt of specialist mental health care have reported higher rates of detention under the mental health act, less use of psychological therapies, and more dissatisfaction. Although many explanations have been put forward to explain this, a failure of therapeutic communications may explain poorer satisfaction, disengagement from services and ethnic variations in access to less coercive care. Interventions that improve therapeutic communications may offer new approaches to tackle ethnic inequalities in experiences and outcomes. The THERACOM project is an HTA-funded evidence synthesis review of interventions to improve therapeutic communications between black and minority ethnic patients in contact with specialist mental health services and staff providing those services. This article sets out the protocol methods for a necessarily broad review topic, including appropriate search strategies, dilemmas for classifying different types of therapeutic communications and expectations of the types of interventions to improve them. The review methods will accommodate unexpected types of study and interventions. The findings will be reported in 2013, including a synthesis of the quantitative and grey literature. A particular methodological challenge is to identify and rate the quality of many different study types, for example, randomised controlled trials, observational quantitative studies, qualitative studies and case studies, which comprise the full range of hierarchies of evidence. We discuss the preliminary methodological challenges and some solutions. (PROSPERO registration number: CRD42011001661). Source

Bhui K.,Wolfson Institute of Preventive Medicine
British Journal of Psychiatry | Year: 2016

This commentary takes up the notion proposed by Lewis-Fernández and colleagues that we need more balance in research priorities. Specifically, our reliance on neurobiology may be misplaced and likely to be unrewarding unless we ensure that: (a) research with better return for patients and the public is also pursued; (b) research findings are put into practice; and (c) we retain a focus on proportionate investment in service provision. Patient, public and economic perspectives should drive the decision making for better investment, and behaviour change might be better targeted at commissioners and policy makers rather than patients and providers. ©The Royal College of Psychiatrists 2016. Source

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