PATHOLOGICAL SIGNIFICANCE OF CDH1/E-CADHERIN GERMLINE SEQUENCE VARIANTS IN BREAST CANCER PATIENTS

BACKGROUND

Germline alterations of the CDH1 (E-cadherin) tumor suppressor gene have been reported in several epithelial malignancies like hereditary diffuse gastric cancer and lobular breast cancer. E-cadherin plays a central role in proliferation, maintenance of cell-to-cell adhesion, polarity, and epithelial-mesenchymal transition of tissue cells. It is necessary to analyze the impact of the CDH1 germline sequence variants on protein and predict its clinical significance in breast cancer (BC) progression. The aim of the current study was to evaluate the impact and association of CDH1 gene potentially pathogenic variants/likely pathogenic variants (PVs/LPVs) with the initiation and progression of BC.

MATERIALS AND METHODS

In this study, the clinical data of 200 BC patients have been analyzed based on the type of BC, age, grade, stage, hormonal status, and risk factors. Blood samples from 50 healthy donors were used as a control. Furthermore, CDH1 gene molecular analysis, along with in silico analysis, was provided to assess the invasiveness and progression of BC caused by the E-cadherin protein.

RESULTS

Four variants were identified by genetic screening within the CDH1 gene that included variations in exons 7, 8, 10, 11, and 13. Exon 10 had splice site mutation at position c.1337C>A, affecting the protein structure. In exon 11, there was an insertion of T base at position 1669, resulting in truncated protein compared to a normal one that can lead to the disease-causing non- sense-mediated decay and exon 13 variant c.2076T>C has already known polymorphism. In silico analysis of CDH1 showed the presence of the different variants that indicated the overall disruption of protein structure and function.

CONCLUSIONS

The further functional analysis of these variants and their association with BC can be ensured by increasing the sample size and in vivo studies using mouse models.

Managing Minds at Work: development of a digital line manager training programme

Background

Mental ill health is the leading cause of sickness absence with high economic burden. Workplace interventions aimed at supporting employers with prevention of mental ill-health in the workforce are urgently required. Managing Minds at Work (MMW) is a digital intervention targeting support for line managers in any work setting to promote better mental health at work through a preventative approach.

Objectives

To describe the design and development of the MMW digital training programme, prior to feasibility testing. We adopted a collaborative participatory design involving co-design (users as partners) and principles of user-centred design (pilot and usability testing). Agile methodology was used to co-create intervention content with a stakeholder community of practice. Development processes were mapped to core elements of the Medical Research Council (MRC) framework for developing and evaluating complex interventions.

Results

The program covers five broad areas: (i) promoting self-care techniques among line managers; (ii) designing work to prevent work-related stress; (iii) management competencies to prevent and reduce stress; (iv) having conversations with employees about mental health; (v) building a psychologically safe work environment. Pilot and usability testing (n = 37 surveys) aligned with the Technology Acceptance Model (TAM) demonstrated that MMW was perceived to be useful, relevant, and easy to use by managers across sectors, organization types and sizes. We identified positive impacts on manager attitudes and behavioural intentions related to preventing mental ill-health and promoting good mental well-being at work.

Conclusions

MMW is a digital training programme for line managers that has been co-created using rigorous development processes and aims to support employers with primary prevention in mental health. The next step is to explore the feasibility and acceptability of this intervention with line managers in diverse employment settings.

Key messages

Functional characterization of the cis-regulatory region for the vitellogenin gene in Plutella xylostella

The vitellogenin gene promoter (VgP) is an essential cis-regulatory element that plays a significant role in transcription of the vitellogenin (Vg) gene, leading to the production of yolk protein in insects, including lepidopterans. However, the function of VgP is still not clear in Plutella xylostella. Here, we cloned a 5.1 kb DNA fragment of the cis-regulatory region adjacent to the 5' end of the Vg gene of P. xylostella (PxVg). We identified two promoter sites in that 5' upstream sequence of PxVg and performed in vitro analysis of two promoter sequences (PxVgP1, 4.9 kb, and PxVgP2, 2.9 kb) in the embryonic cell line of P. xylostella. PxVgP2 exhibited higher enhanced green fluorescent protein (EGFP) expression, so PxVgP2 was used for in vivo analysis. Strong EGFP fluorescence was observed in adult females and the fat body of females, with low expression in embryos. Our results suggest that PxVgP is an important stage-, tissue- and sex-specific endogenous cis-regulatory element in P. xylostella.

Disclosure of Type 1 diabetes at work among Finnish workers

AIMS

To determine which self-management factors and psychosocial work factors were associated with disclosing diabetes to colleagues, line managers and occupational health personnel among workers with Type 1 diabetes.

METHODS

A total of 767 working-aged respondents with Type 1 diabetes completed a Finnish cross-sectional survey named 'People with Type 1 Diabetes in Worklife'. Factor analysis was carried out, followed by logistic regressions to estimate the associations between self-management factors, psychosocial work factors and the likelihood of disclosure separately to colleagues, line managers and occupational health personnel. The models were adjusted for sociodemographic, diabetes-related and work-related variables.

RESULTS

A total of 52% of the respondents had disclosed their diabetes to their colleagues, 45% to occupational health personnel and 28% to their line manager. Receiving social support and having good psychosocial work ability were significantly associated with disclosure to colleagues, line managers and occupational health personnel. Relations at work were associated with disclosure to colleagues and the line manager. Furthermore, opportunity to self-manage diabetes at work was associated with disclosure to colleagues.

CONCLUSIONS

Line managers and colleagues have a remarkable role to play in providing workplace support to workers with Type 1 diabetes. Disclosure of Type 1 diabetes should be encouraged as line managers can provide workers with the right support, implement work adaptations and facilitate job retention. As only half of respondents disclosed their Type 1 diabetes at work, further research is required into the reasons for and consequences of not disclosing a diagnosis.

Providing NHS staff with height-adjustable workstations and behaviour change strategies to reduce workplace sitting time: protocol for the Stand More AT (SMArT) Work cluster randomised controlled trial

BACKGROUND

High levels of sedentary behaviour (i.e., sitting) are a risk factor for poor health. With high levels of sitting widespread in desk-based office workers, office workplaces are an appropriate setting for interventions aimed at reducing sedentary behaviour. This paper describes the development processes and proposed intervention procedures of Stand More AT (SMArT) Work, a multi-component randomised control (RCT) trial which aims to reduce occupational sitting time in desk-based office workers within the National Health Service (NHS).

METHODS/DESIGN

SMArT Work consists of 2 phases: 1) intervention development: The development of the SMArT Work intervention takes a community-based participatory research approach using the Behaviour Change Wheel. Focus groups will collect detailed information to gain a better understanding of the most appropriate strategies, to sit alongside the provision of height-adjustable workstations, at the environmental, organisational and individual level that support less occupational sitting. 2) intervention delivery and evaluation: The 12 month cluster RCT aims to reduce workplace sitting in the University Hospitals of Leicester NHS Trust. Desk-based office workers (n = 238) will be randomised to control or intervention clusters, with the intervention group receiving height-adjustable workstations and supporting techniques based on the feedback received from the development phase. Data will be collected at four time points; baseline, 3, 6 and 12 months. The primary outcome is a reduction in sitting time, measured by the activPAL(TM) micro at 12 months. Secondary outcomes include objectively measured physical activity and a variety of work-related health and psycho-social measures. A process evaluation will also take place.

DISCUSSION

This study will be the first long-term, evidence-based, multi-component cluster RCT aimed at reducing occupational sitting within the NHS. This study will help form a better understanding and knowledge base of facilitators and barriers to creating a healthier work environment and contribute to health and wellbeing policy.

TRIAL REGISTRATION

ISRCTN10967042 . Registered 2 February 2015.

The impact of colorectal cancer and self-efficacy beliefs on work ability and employment status: a longitudinal study

We examined how colorectal cancer patients' treatment and symptom management impacted perceptions of work ability and subsequent work decisions. Fifty patients completed questionnaires at baseline (post-surgery/pretreatment), 3 months and 6 months. Questionnaires assessed fatigue, depression, quality-of-life (QoL), cancer self-efficacy, job self-efficacy (JSE) and work ability. Factors related to perceived work ability were occupation (β= 0.31, P= 0.0005) and QoL (β= 0.42, P= 0.01) at baseline, treatment type (β=-0.19, P= 0.05) at 3 months, and JSE at 3 months (β= 0.57, P= 0.0005) and 6 months (β= 0.50, P= 0.006). Factors related to being on sick leave were lower levels of JSE (OR = 2.20, 95% CI: 1.17-4.13) at baseline and being employed in a manual occupation (OR = 0.03, 95% CI: 0.00-0.86), and perceived work ability (OR = 3.05, 95% CI: 1.00-12.80) at 6 months. Along with self-assessed work ability at baseline (β= 0.67, P= 0.0005), receiving chemotherapy or a combination of treatments (β=-0.24, P= 0.05) were the strongest predictors of poorer perceptions of follow-up work ability. Self-efficacy beliefs may add to understanding and should be considered in future research.

Developing occupational health services for active age management

AIMS

To review current occupational health (OH) approaches aimed at maintaining the health and workability of older workers.

METHODS

A literature review was undertaken to identify articles on OH interventions focused on maintaining the health of older workers (published since 2000). The inclusion criteria included studies that reported interventions aimed specifically at older workers.

RESULTS

A limited number of interventions targeting older workers were identified. A second literature search was therefore conducted that identified types of workplace interventions that, if used with older workers, may benefit their health, well-being and workability.

CONCLUSIONS

Very few OH interventions have addressed the health and workability of older workers and there is considerable scope for developing OH provision, which accounts for the needs of the older workforce.

Employment and the common cancers: correlates of work ability during or following cancer treatment

AIMS

To provide an in-depth review of the impact of cancer and cancer-related issues on work ability for those working during or following cancer treatment.

METHODS

Of total, 19 papers published between 1999 and 2008 on cancer and work ability were reviewed.

RESULTS

Studies have shown that most types of cancers result in decreased work ability compared to healthy controls or those with other chronic conditions. Some cancer types have more decreased work ability than other types. Decreased work ability is associated with type of treatment (chemotherapy), treatment-related side-effects (e.g. fatigue) and co-morbidity with other health conditions. For most cancers, work ability improves over time irrespective of age.

CONCLUSIONS

More longitudinal research is required to fully determine the impact of cancer and its treatment on work ability, occupational health services can help such employees make a full recovery and maintain employment by regularly assessing work ability and working hours so that work adjustment and support can be appropriately tailored.

The role of communication and support in return to work following cancer-related absence

OBJECTIVE

Many cancer survivors experience difficulties returning to work. However, there have been relatively few attempts to understand why problems with employer support and work adjustment occur. This paper aims to extend previous work in two ways: first, through exploring the way in which communication and support at work effect cancer survivors on their return to work and during the post-return period; and second, by drawing on a research sample working in the United Kingdom.

METHODS

In all, 26 cancer survivors took part in a semi-structured telephone interview. Interviews were transcribed and analysed using thematic analysis.

RESULTS

The analysis revealed three key findings. First, the central role of communication and support from (and between) occupational health, line managers, and colleagues was highlighted. Second, two discrete processes or periods of return to work were identified: the experience of return to work during the initial period of return and the experiences of post-return to work. Third, during the post-return period, the importance of the delayed impact of cancer on the ability to work, the lack of follow-up and monitoring, and the wear-off effect of empathy and support were highlighted as contributing to return-to-work difficulties.

CONCLUSIONS

This qualitative study highlights the importance of communication within the workplace with regard to the return-to-work process and the need to provide better support and guidance to cancer survivors, line managers and colleagues. Research is required in delineating how employers without occupational health or human resources support manage the return-to-work process.

Returning to work following cancer: a qualitative exploratory study into the experience of returning to work following cancer

The experience of returning to work following cancer is a largely unknown area of cancer research. This preliminary study aimed to explore the factors that influence decisions about return to work either during or after cancer treatment and to identify the important aspects of returning to work. Qualitative data were collected using individual interviews (n = 19) and two focus groups (n = 4, n = 6), predominantly with breast cancer survivors. Patterns of returning to work were diverse and a variety of reasons influenced work decisions, including financial concerns and regaining normality. Participants also discussed their ability to work, health professionals' advice, side effects, support and adjustments, and attitudes towards work. Although the majority adapted well, a few encountered difficulties on their return. It is evident that more advice is required from health professionals about returning to work, along with reasonable support and adjustments from employers to ensure that cancer survivors are able to successfully reintegrate back into the workforce.

Dealing with self-management of chronic illness at work: predictors for self-disclosure

This paper explores the role of self-management of chronic illness at work, as a predictor for self-disclosure. The study reports findings from a survey sent to all staff at a UK university, of which 610 employees reported managing a chronic illness: arthritis, musculoskeletal pain, diabetes, asthma, migraine, heart disease, irritable bowel syndrome and depression. The study found that discrete self-management factors predicted different levels of disclosure: partial self-disclosure (employees informing line managers about the presence of a chronic illness) and full self-disclosure (employees informing line managers how that chronic illness affected them at work). For partial disclosure, a greater reported experience of chronic illness by employees was positively associated with self-disclosure. For full-disclosure, employees were more likely to report disclosure to line managers if they had already disclosed to colleagues, and if they perceived receiving support from their line managers in relation to their chronic illness as important. Except for academics who were least likely to disclose, occupational groups did not emerge as significant predictors for either partial or full disclosure. Except for diabetes, chronic illness itself was not a significant predictor or barrier to self-disclosure. Our findings suggest that chronically ill employees adopt a disclosure strategy specifically related to different self-management needs of chronic illness at work.

Theory of mind deficits in children with fragile X syndrome

BACKGROUND

Given the consistent findings of theory of mind deficits in children with autism, it would be extremely beneficial to examine the profile of theory of mind abilities in other clinical groups such as fragile X syndrome (FXS) and Down syndrome (DS). Aim The aim of the present study was to assess whether boys with FXS are impaired in simple social situations that require them to understand their own and others' mental states - in essence: do they have a 'theory of mind'?

METHOD

Well-standardized tasks of theory of mind, the location change false belief task and the appearance-reality tasks were employed to examine whether any impairment might be specific to the FXS or part of a more generalized developmental deficit.

RESULTS

The results suggest that children with FXS do have impairment in theory of mind that is comparable to the deficit reported in other groups with learning disabilities such as DS. However, closer inspection of the impairment between these groups revealed qualitative differences in error types (realist vs. phenomenist), suggestive of atypical development that goes beyond general cognitive delay.

CONCLUSION

The findings are discussed in terms of the teasing apart of different components of social cognition in order to identify syndrome-specific deficiencies and proficiencies.

Annotation: Deconstructing the attention deficit in fragile X syndrome: a developmental neuropsychological approach

BACKGROUND

Fragile X syndrome is one of the world's leading hereditary causes of developmental delay in males. The past decade has witnessed an explosion of research that has begun to unravel the condition at its various levels: from the genetic and brain levels to the cognitive level, and then to the environmental and behavioural levels. Our aim in this review is to attempt to integrate some of the extensive body of knowledge to move the research a step closer to understanding how the dynamics of atypical development can influence the specific cognitive and behavioural end-states frequently observed in children and adolescents with fragile X syndrome.

METHODS

We conducted a review of the current neuropsychological and neuropsychiatric approaches that have attempted to delineate the pattern of 'spared' and 'impaired' functions associated with the phenotype.

RESULTS

The profile of findings suggests that fragile X syndrome should not be viewed merely as a catalogue of spared and impaired cognitive functions or modules. Instead, there appears to be a process of almost gradual modularisation whereby cognitive mechanisms become domain specific as a function of development itself (Karmiloff-Smith, 1992). The results of a decade of intense research point towards an early weakness in one or more components of executive control rather than single, static higher-level deficits (e.g., spatial cognition, speech processing). This weakness affects both the development of more complex functions and current performance.

CONCLUSIONS

The prevailing tendency to interpret developmental disorders in terms of fixed damage to distinct modular functions needs to be reconsidered. We offer this review as an example of an alternative approach, attempting to identify an initial deficit and its consequences for the course of development. Through better definition of the cognitive and behavioural phenotype, in combination with current progress in brain imaging techniques and molecular studies, the next decade should continue to hold exciting promise for fragile X syndrome and other neurodevelopmental disorders.

[A neuropsychological and behavioural profile of attention deficits in fragile X syndrome]

INTRODUCTION

Fragile X syndrome is a well-recognised cause of developmental delay in males and to a lesser extent females. The aim of the present study was to present a detailed cognitive and behaviour analysis of the core attention impairments frequently associated with fragile X.

PATIENTS AND METHODS

Two complementary studies were conducted. Study 1 examined the severity and range of behavioural problems in a group of 25 fragile X boys with fragile X compared with five control groups: a learning disabled comparison group (Down's syndrome-Trisomy 21) and four groups of normal developing control children. Two well validated rating scales were used as measures of behaviour: Study 2 examined performance by the above groups on a novel computerised task of attention that measured the ability to inhibit irrelevant responses.

RESULTS

Findings from Study 1 revealed that fragile X children were significantly more hyperactive, inattentive and impulsive in comparison with the Down's syndrome children but not in comparison to the poor attention control groups. The findings from Study 2 revealed that the main impairment in fragile X was in inhibiting repetition of successful responses and in switching attention from one type of response to another in a sequence, whether it has been successful or not.

CONCLUSION

Emerging evidence now supports the hypothesis that the fundamental deficit in fragile X is in controlling the flow of sequences of input and output. It is suggested that this control require inhibition.

The nature of attentional differences between groups of children differentiated by teacher ratings of attention and hyperactivity

Two groups of children, one with good attention and low hyperactivity and the other with poor attention and high hyperactivity, were formed on the basis of teachers' ratings. The groups were tested on a large number of tests of attentional performance, covering selective attention, divided attention, sustained attention and executive function. Analysis of group differences, with verbal and non-verbal intelligence controlled statistically, indicated that the groups demonstrated significant differences on a variety of measures. Principal components analysis of the tests of attention isolated two components, one of which significantly distinguished the two groups. It is suggested that this component reflected aspects of executive control of attention. The measures which discriminated the groups most clearly were efficiency of visual search involving two targets in alternation, the number of correct responses on a specially devised version of the Wisconsin Card Sorting Task and a task measuring the ability to inhibit a dominant response. It is suggested that all these tasks required a combination of selective attention and executive control. It was also noted that the poor attention group produced bigger individual differences on all measures, indicating that this group may include a variety of weaknesses which require more precise analysis to distinguish them.

Differential impact of the FMR-1 full mutation on memory and attention functioning : a neuropsychological perspective

Memory and attention processing were examined in a group of 15 adult Fragile-X syndrome (FXS) males with Fragile-X mental retardation 1 (FMR-1) full mutation and compared to two control groups: a learning disabled (LD) control and a normal functioning control. Performance was assessed across a wide range of tasks including working memory, recognition memory, selective attention, sustained attention, and attentional switching. All three groups performed at a comparable level on recognition memory tasks, and the Fragile-X males and LD control group performed worse than the control group on tasks of working memory and sustained attention. On a task of executive function, the Fragile-X males demonstrated a significant deficit in comparison to the LD control group and the normal control group, but performed better than the LD control group and at a comparable level to the control group on tasks of selective attention. Molecular analyses of the lymphocyte DNA provided little evidence for a correlation between expansion size and performance on tasks of memory and attention. The findings from the present study are discussed in the context of functional neuroimaging and brain-behavior-molecular correlates.

Nature of the working memory deficit in fragile-X syndrome

Working memory performance in a group of young Fragile X males with FMR-1 full mutation was compared to a learning disabled comparison group comprising Down's syndrome males and two control groups of mainstream schoolchildren. Performance was assessed on a battery of tasks tapping the three components of working memory-phonological loop, visual-spatial sketch pad, and the central executive. The results indicated that the Fragile X group displayed a general impairment on working memory tasks that cannot be attributed to a single working memory component per se. Instead, the results suggest that Fragile X males have a working memory deficit that may be attributed to how much attentional resource a specific task requires and their overall available executive capacity, irrespective of the working memory subsystem.

A neuropsychological profile of attention deficits in young males with fragile X syndrome

Different processes of attention were examined in a group of 25 fragile X boys with FMR-1 full mutation and compared with three control groups: a learning disabled comparison group comprising 25 boys with Down's syndrome, matched to the fragile X boys on verbal mental age; and 50 mainstream school boys (controls) matched to the fragile X boys on verbal mental age. The controls were further divided into those matched on "poor attention" to the fragile X boys and a "good" attention group, as rated by the ACTeRS questionnaire. Four categories of attention tasks were employed: selective attention, divided attention, sustained attention and executive functioning. The main findings of the study indicate that fragile X boys display an attention deficit at higher levels of attention function/executive functioning and that this profile is different from the profile identified in Down's syndrome boys and more extreme than the profile identified in the poor attention control group. These findings are discussed in the context of functional neuroimaging and brain-behaviour correlates in fragile X syndrome.

Spatial cognition in males with Fragile-X syndrome: evidence for a neuropsychological phenotype

Spatial performance in a group of young Fragile-X syndrome males with FMR-1 full mutation was compared to a learning disabled control group comprising young Down's syndrome males and two control groups of mainstream schoolchildren. Performance was assessed across a wide range of spatial tasks including visuo-construction, visuo-spatial memory, visuo-motor, and visuo-perception. The findings indicate a task-specific rather than global deficit in spatial performance in Fragile-X males with visuo-constructive and visuo-motor skills most vulnerable. Molecular analysis of the lymphocyte DNA found minimal evidence for a correlation between CGG expansion size and spatial performance, although tasks with a visuo-perceptual component correlated negatively with expansion size indicating that the further away the number of repeats are from the 200 threshold the poorer the performance.

Cognitive functioning in children with typical cri du chat (5p-) syndrome

This study is the first attempt to assess systematically the cognitive functioning in children diagnosed with typical cri du chat syndrome (CDCS) using neuropsychological test measures. Twenty-six children aged between 6 years 4 months and 15 years 5 months (mean 8 years 3 months) completed a battery of tasks measuring IQ level, receptive and expressive language skills, and articulation. Twenty-four children were in the severe learning-disability range with no specific verbal or performance profile. Using more finely tuned measures of cognition, however, a clear discrepancy in the pattern of language functioning was found with better receptive than expressive language skills. One implication of these findings is that parents and professionals should be more optimistic about the capacities of children with CDCS to understand more complex verbal commands than their expressive language skills would suggest.

The nature of the spatial deficit in young females with Fragile-X syndrome: a neuropsychological and molecular perspective

Spatial performance in a group of young Fragile-X syndrome females with FMR-1 full mutation was compared to two control groups of mainstream schoolchildren. Performance was assessed across a wide range of spatial tasks including visuo-spatial, visuo-construction, visuo-motor, visuo-perception and spatial-memory. A spatial deficit emerged only on those tasks which comprised a visuo-constructive component, with the Fragile-X group performing worse overall. All other tasks were performed at a comparable level across the three groups. Molecular analysis of the lymphocyte DNA found minimal evidence for a correlation between expansion size and spatial performance. In addition, there was no evidence for a correlation between the proportion of active to inactive unmethylated FMR-1 genes (activation ratio) and spatial performance. These results conflict with recent reports of a correlation between activation ratio and intellectual functioning.

Receptive and expressive language skills in children with cri-du-chat syndrome

Receptive and expressive language skills were assessed in 13 children with cri-du-chat syndrome. Two patterns of performance were found. One pattern was the discrepancy between the children's chronological ages and their presumed language ages. The second pattern was the receptive-expressive discrepancy with reduced expressive skills compared to receptive skills. One implication of these findings is that remediation that focuses on receptive skills may be more effective than traditional verbal methods.