Anna Taylor

Oestrogen and progesterone increase the levels of apoptosis induced by the human papillomavirus type 16 E2 and E7 proteins.

Human papillomavirus (HPV) type 16 infects the genital tract and is generally acknowledged to be a causative agent of cervical cancer. HPV infection alone is not sufficient to induce cervical cancer and other factors such as steroid hormones are thought to play a role in the establishment and/or progression of this disease. The HPV-16 E2 protein is required for virus replication and modulates viral gene expression whereas the HPV-16 E7 protein is required for cell transformation. We and others have shown that both the E2 and E7 proteins can induce apoptotic cell death in HPV-transformed and non-HPV transformed cell lines. Here we show that the steroid hormones oestrogen and progesterone can both increase the levels of E2- and E7-induced apoptosis. The oestrogen metabolite 16 alpha-hydroxyoestrone also increases E2- and E7-induced cell death and the dietary component indole-3-carbinol, which reduces the formation of 16alpha-hydroxyoestrone from oestrogen, blocks the effects of oestrogen. Thus the metabolism of oestrogen to 16 alpha-hydroxyoestrone appears to be required for the effects of this hormone on E2- and E7-induced cell death. We also show that the oestrogen receptor antagonist 3-hydroxytamoxifen blocks the effects of oestrogen on E2- and E7-induced cell death, whereas the anti-progesterone RU486 blocks the effects of both progesterone and oestrogen. We discuss these results in terms of the origin and progression of cervical cancer.

Jaundice in primary care: a cohort study of adults aged >45 years using electronic medical records

BACKGROUND Jaundice is a rare but important symptom of malignant and benign conditions. When patients present in primary care, understanding the relative likelihood of different disease processes can help GPs to investigate and refer patients appropriately. OBJECTIVE To identify and quantify the various causes of jaundice in adults presenting in primary care. DESIGN Historical cohort study using electronic primary care records. SETTING UK General Practice Research Database. METHODS Participants (186 814 men and women) aged >45 years with clinical events recorded in primary care records between 1 January 2005 and 31 December 2007. Data were searched for episodes of jaundice and explanatory diagnoses identified within the subsequent 12 months. If no diagnosis was found, the patients preceding medical record was searched for relevant chronic diseases. RESULTS From the full cohort, 277 patients had at least one record of jaundice between 1 January 2005 and 31 December 2006. Ninety-two (33%) were found to have bile duct stones; 74 (27%) had an explanatory cancer [pancreatic cancer 34 (12%), cholangiocarcinoma 13 (5%) and other diagnosed primary malignancy 27 (10%)]. Liver disease attributed to excess alcohol explained 26 (9%) and other diagnoses were identified in 24 (9%). Sixty-one (22%) had no diagnosis related to jaundice recorded. CONCLUSION Although the most common cause of jaundice is bile duct stones, cancers are present in over a quarter of patients with jaundice in this study, demonstrating the importance of urgent investigation into the underlying cause.

Barriers, facilitators, and survival strategies for GPs seeking treatment for distress: a qualitative study

BACKGROUND GPs are under increasing pressure due to a lack of resources, a diminishing workforce, and rising patient demand. As a result, they may feel stressed, burnt out, anxious, or depressed. AIM To establish what might help or hinder GPs experiencing mental distress as they consider seeking help for their symptoms, and to explore potential survival strategies. DESIGN AND SETTING The authors recruited 47 GP participants via e-mails to doctors attending a specialist service, adverts to local medical committees (LMCs) nationally and in GP publications, social media, and snowballing. Participants self-identified as either currently living with mental distress, returning to work following treatment, off sick or retired early as a result of mental distress, or without experience of mental distress. Interviews were conducted face to face or over the telephone. METHOD Transcripts were uploaded to NVivo 11 and analysed using thematic analysis. RESULTS Barriers and facilitators were related to work, stigma, and symptoms. Specifically, GPs discussed feeling a need to attend work, the stigma surrounding mental ill health, and issues around time, confidentiality, and privacy. Participants also reported difficulties accessing good-quality treatment. GPs also talked about cutting down or varying work content, or asserting boundaries to protect themselves. CONCLUSION Systemic changes, such as further information about specialist services designed to help GPs, are needed to support individual GPs and protect the profession from further damage.

Who cares for the clinicians?: The mental health crisis in the GP workforce

The fact that a significant proportion of the UK’s GPs are living with mental health problems has been known for some time. Studies have shown that many GPs are depressed, anxious, stressed, or ‘burnt out’ as a result of practice pressures such as organisational changes and increased workload, the negative media climate, and a sense of isolation.1 There is evidence that GPs have difficulty accessing appropriate mental health or support services,2 for reasons around availability or concerns about confidentiality. Doctors are more likely than the general population to die by suicide, with female doctors, anaesthetists, GPs, and psychiatrists being the most vulnerable.3 Some clinicians experience alcohol addiction as a result of the pressures of practice.4 Just as they would for any other member of the population, mental health difficulties take their toll on all aspects of GPs’ lives, including self-esteem, personal relationships, finance, work–life balance, and work performance. However, despite the clear and critical effect on GPs themselves, it is striking how frequently existing narratives suggest that physician health only matters because of its potential negative impact on patients. While doctors are encouraged to see their patients holistically, they are often not afforded the same treatment themselves.5 That doctors themselves can become patients is often overlooked,6 and there are many internal and external barriers to doctors adopting the patient role. The drive to support patients …

Access to healthcare for long-term conditions in women involved in street-based prostitution: a qualitative study.

BackgroundWomen involved in street-based prostitution (SBP) have well-documented health problems specific to their occupation, but access to care for other chronic health problems has not been explored. Primary care is seen as the optimal context to deliver care for people with long-term conditions because it is accessible, efficient, and can tackle inequalities related to socioeconomic deprivation. We aimed to explore the perspectives of women involved in SBP about access to health care for their long-term conditions.MethodsThis was a qualitative study with women accessing a third sector organization in North West England. Semi-structured interviews were conducted with sixteen women involved in SBP and accessing support. Data were analysed using the principles of constant comparison and a framework approach.ResultsWomen described how they were living with ill health, which they found difficult to manage, and often impacted on their work. Women reported poor access to care and viewed any ensuing consultations in primary care as unsatisfactory.ConclusionThis study highlights the unmet health needs of women who work in SBP, not just related to their occupation, but due to their co-morbid long-term conditions. Access to primary care was reported to be problematic and interactions with general practitioners not fulfilling their expectations, which impacted on future consultation behaviour. Understanding the health-seeking behaviours and self-management strategies of women involved in SBP with chronic health problems is essential in the design and commissioning of services and may reduce unscheduled care in this under-served group.

What are the sources of stress and distress for general practitioners working in England? A qualitative study

Objectives This paper reports the sources of stress and distress experienced by general practitioners (GP) as part of a wider study exploring the barriers and facilitators to help-seeking for mental illness and burnout among this medical population. Design Qualitative study using in-depth interviews with 47 GP participants. The interviews were audio-recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method. Setting England. Participants A purposive sample of GP participants who self-identified as: (1) currently living with mental distress, (2) returning to work following treatment, (3) off sick or retired early as a result of mental distress or (4) without experience of mental distress. Interviews were conducted face-to-face or over the telephone. Results The key sources of stress/distress related to: (1) emotion work—the work invested and required in managing and responding to the psychosocial component of GPs’ work, and dealing with abusive or confrontational patients; (2) practice culture—practice dynamics and collegial conflict, bullying, isolation and lack of support; (3) work role and demands—fear of making mistakes, complaints and inquests, revalidation, appraisal, inspections and financial worries. Conclusion In addition to addressing escalating workloads through the provision of increased resources, addressing unhealthy practice cultures is paramount. Collegial support, a willingness to talk about vulnerability and illness, and having open channels of communication enable GPs to feel less isolated and better able to cope with the emotional and clinical demands of their work. Doctors, including GPs, are not invulnerable to the clinical and emotional demands of their work nor the effects of divisive work cultures—culture change and access to informal and formal support is therefore crucial in enabling GPs to do their job effectively and to stay well.

Discrimination, harassment and non-reporting in UK medical education

Discrimination and harassment create a hostile environment with deleterious effects on student well‐being and education. In this study, we aimed to: (i) measure prevalences and types of discrimination and harassment in one UK medical school, and (ii) understand how and why students report them.

‘It’s personal to me’: A qualitative study of depression in young people with CFS/ME:

Background: Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) has a prevalence of 0.4–2.4% and is defined as ‘generalised disabling fatigue persisting after routine tests and investigations have failed to identify an obvious underlying cause’. One-third of young people with CFS/ME have probable depression. Little is known about why depression develops, the relationship between depression and CFS/ME, or what treatment might be helpful. Methods: We conducted nine semi-structured interviews with young people with CFS/ME (aged 13–17 years, 8/9 female) and probable depression, covering perceived causes of depression, the relationship between CFS/ME and depression, and treatment strategies. Results: Most thought CFS/ME caused depression. Many discussed a cyclical relationship: low mood made CFS/ME worse. A sense of loss was common. CFS/ME restricted activities participants valued and changed systemic structures, causing depression. There was no single helpful treatment approach. Individualised approaches using combinations of cognitive behavioural therapy (CBT), medication, activity management and other strategies were described. Conclusion: This study suggests that depression may be secondary to CFS/ME in young people because of the impact of CFS/ME on quality of life. Clinicians treating young people with CFS/ME need to consider strategies to prevent development of depression, and research is needed into approaches that are effective in treating CFS/ME with co-morbid depression.

Implementation of teaching on LGBT health care

Lesbian, gay, bisexual and transgender (LGBT) patients represent an important proportion of the population. Despite the health inequalities and barriers to health care noted within this group, there is little evidence of LGBT‐focused education within medicine, dentistry or nursing. We introduced and evaluated the effect of a half‐day teaching session focused on LGBT health care, delivered to year‐2 students.

Exploring the experience of young people with chronic fatigue syndrome (CFS) / myalgic encephalomyelitis (ME) and depression using qualitative methodology

This case study provides an overview of our experience of conducting qualitative interviews with young people with chronic fatigue syndrome/myalgic encephalomyelitis and co-morbid low mood. We interviewed young people with chronic fatigue syndrome/myalgic encephalomyelitis and low mood to gain insight into their views of the relationship between their fatigue and low mood, why they felt they developed low mood, the impact of illness on their lives, and treatment strategies they found helpful or unhelpful. In this case study, we outline our methods and results; discuss our specific methodological strengths, such as including young people in research design; and illustrate the ethical issues involved in interviewing this patient group. We also describe some of the challenges we encountered, such as difficulty recruiting. Finally, we outline some general recommendations for conducting interviews with young people (alone and with parents) and comment on some specific suggestions for mitigating the challenges we encountered.