A Comparison Between the Rates of Radiation Oncologist and Urologist Consultations in Men Diagnosed With Prostate Cancer in Northern Ontario, Canada.

Purpose: Recommendations from Cancer Care Ontario stress the importance of multidisciplinary care from radiologists and urologists for prostate cancer treatment. The present study sought to examine what percentage of patients had a consultation with a radiation oncologist before undergoing a radical prostatectomy in Ontario, Canada, between 2010 and 2019. Methods and Materials: Administrative health care databases were used to analyze the number of consultations billed to the Ontario Health Insurance Plan from radiologists and urologists who treated men with a first prostate cancer diagnosis (n = 22,169). Results: In Ontario, 94.70% of Ontario Health Insurance Plan billings for patients with prostate cancer who had a prostatectomy within 1 year of a prostate cancer diagnosis were from urology, and 37.66% and 1.77% of billings were received from radiation oncology and medical oncology specialties, respectively. When sociodemographic variables were examined, having a lower neighborhood income (adjusted odds ratio [aOR], 0.69; confidence interval [CI], 0.62-0.76) and a rural residence (aOR, 0.72; CI, 0.65-0.79) were associated with lower odds of receiving a consultation from a radiation oncologist. When billings for consultations were examined geographically by region, Northeast Ontario (Local Health Integrated Network 13) had the lowest odds of receiving a radiation consultation compared with the rest of Ontario (aOR, 0.50; CI, 0.42-0.59). Conclusions: The results of this study show that differences in equitable access to multidisciplinary health care exist for men with a first prostate cancer diagnosis who reside in more northern and rural regions within Ontario, relative to the rest of the province. The reasons for these findings are likely multifactorial and may include factors such as patient treatment preference and distance/travel to receive treatment. However, as diagnosis year increased, so did the chances of receiving a radiation oncologist consultation, and this upward trend may reflect the implementation of Cancer Care Ontario guidelines.

Cigarette-smoking characteristics and interest in cessation in patients with head-and-neck cancer.

Purpose: Many patients diagnosed with head-and-neck cancer are current or former smokers. Despite the well-known adverse effects of smoking, continuation of smoking during cancer treatment is associated with reduced efficacy of that treatment and with cancer recurrence. In the present study, we examined smoking characteristics in patients with head-and-neck cancer near the time of cancer treatment. Methods: A prospective cohort of patients with head-and-neck cancer who attended a dental oncology clinic before receiving cancer treatment at a regional cancer centre were invited to participate in a study that involved completing an interviewer-administered questionnaire to assess smoking characteristics, intention to quit, motivation to quit, and strategies perceived to potentially aid in successful cessation. Results: The study enrolled 493 ever-smokers, with a response rate of 96.1% and a self-reported current smoker rate of 37.1% (n = 183). Most of the current smokers reported high nicotine dependence, with 84.7% (n = 155) indicating a time to first cigarette of 30 minutes or less. Most had previously attempted to quit smoking (77.0%), and many had prior unsuccessful quit attempts before resuming smoking again. Most were interested in quitting smoking (85.8%), and many (70.5%) were seriously considering quitting smoking within the subsequent 30 days. Conclusions: Patients with head-and-neck cancer reported high nicotine dependence and high interest in cessation opportunities near the time of treatment for cancer. Those results might provide support for provision of smoking cessation opportunities.

Access to cancer care in northwestern Ontario-a population-based study using administrative data.

Background: Despite universal access to health care in Canada, there are disparities relating to social determinants of health that contribute to discrepancies between rural and urban areas in cancer incidence and outcomes. Given that Canada has one of the highest-quality national population-based cancer registry systems in the world and that little information is available about cancer statistics specific to northwestern Ontario, the purpose of the present study was to estimate the percentage of cancer patients without documentation of a specialist consultation (medical or radiation oncology consultation) and to determine factors that affect access to specialist consultation in northwestern Ontario. Methods: This population-based retrospective study used administrative data obtained through the Ontario Cancer Data Linkage Project. For each index case, a timeline was constructed of all Ontario Health Insurance Plan billing codes and associated service dates, starting with the primary cancer diagnosis and ending with death. Specific factors affecting access to specialist consultation were assessed. Results: Within the 6-year study period (2010-2016), 2583 index cases were identified. Most (n = 2007, 78%) received a specialist consultation. Factors associated with not receiving a specialist consultation included older age [p < 0.0001; odds ratio (or): 0.29; 95% confidence interval (ci): 0.19 to 0.44] and rural residence (p < 0.0001; or: 0.48; 95% ci: 0.48 to 0.72). Factors associated with receiving a specialist consultation included a longer timeline (p < 0.0001; or: 1.32; 95% ci: 1.19 to 1.46), a diagnosis of breast cancer (p < 0.0001; or: 2.51; 95% ci: 1.43 to 4.42), and a diagnosis of lung cancer (p < 0.0001; or: 1.77; 95% ci: 1.38 to 2.26). Conclusions: This study is the first to look at care access in northwestern Ontario. The complexity and multidisciplinary nature of cancer care makes the provision of appropriate care a challenge; a one-size-fits-all disease prevention and treatment strategy might not be appropriate.

The amygdala differentially regulates defensive behaviors evoked by CO2.

CO2 inhalation can provoke panic attacks in humans, and the likelihood is increased in patients with panic disorder. Identifying brain sites involved could provide important mechanistic insight into the illness. In mice, the amygdala has been suggested to promote CO2 responses; however, recent studies in humans with amygdala damage indicate the amygdala is not required for CO2-induced fear and panic and might actually oppose these responses. To clarify the role of the amygdala, we produced lesions in mice paralleling the human lesions, and characterized behavioral responses to CO2. Compared to sham controls, we found that amygdala-lesioned mice froze less to 10% CO2, and unlike shams they also began to jump frenetically. At 20% CO2, controls also exhibited jumping, suggesting it is a normal response to more extreme CO2 concentrations. The effect of amygdala lesions was specific to CO2 as amygdala-lesioned mice did not jump in response to a predator odor or to an auditory conditioned stimulus. In amygdala-lesioned mice, jumping evoked by 10% CO2 was eliminated by co-lesioning the dorsal periaqueductal gray, a structure implicated in panic and escape-related behaviors. Together, these observations suggest a dual role for the amygdala in the CO2 response: promoting CO2-induced freezing, and opposing CO2-induced jumping, which may help explain the exaggerated CO2 responses in humans with amygdala lesions.

Faecal microbiota transplant for recurrent Clostridium difficile infection using long-term frozen stool is effective: clinical efficacy and bacterial viability data.

BACKGROUND: Faecal microbial transplant (FMT) for recurrent Clostridium difficile infection (rCDI) is greatly facilitated by frozen stool banks. However, the effect of frozen storage of stool for greater than 2 months on the viability of stool bacteria is unknown and the efficacy of FMT is not clear. AIM: To evaluate the viability of bacteria in stool frozen for up to 6 months, and the clinical efficacy of FMT with stool frozen for 2-10 months, for the treatment of rCDI. METHODS: Viability of six representative groups of faecal bacteria after 2 and 6 months of storage at -80 °C, in normal saline (NS) or 10% glycerol were assessed by culture on plate media. The clinical outcomes of 16 consecutive patients with rCDI treated with aliquots of stool frozen in 10% glycerol and stored for 2-10 months were also examined. RESULTS: Viability at both 2 and 6 months was similar to baseline, in specimens stored in 10% glycerol and at 2 months in stool stored in NS, but was reduced by >1 log at 6 months for Aerobes (P < 0.01), total Coliforms (P < 0.01) and Lactobacilli (P < 0.01) in NS. Using stool frozen for 2-10 months in 10% glycerol, the cure rate for rCDI was 88% with one FMT and 100% after repeat FMT in those who relapsed. CONCLUSION: Stool for faecal microbial transplant to treat rCDI can be safely stored frozen in 10% glycerol for at least 6 months without loss of clinical efficacy or viability in the six bacterial groups tested.

A prolonged outbreak of invasive meningococcal disease in an extended Irish Traveller family across three Health Service Executive (HSE) areas in Ireland, 2010 to 2013.

Between March 2010 and November 2013 eight laboratory-confirmed cases of serogroup B, invasive meningococcal disease (IMD) were identified in an extended Irish Traveller family across three Health Service Executive (HSE) areas of Ireland. Cases were aged between 5 and 46 months, and were either a cousin or sibling of another case. All eight cases survived. Chemoprophylaxis was given to relevant nuclear family members and close contacts on each occasion, but failed to prevent further cases. Neisseria meningitidis isolates from six cases were highly related, belonging to the ST-41/44 clonal complex, and shared the porA designation 7­2,4. In November 2013, the outbreak control team recommended that directly observed ciprofloxacin chemoprophylaxis be administered simultaneously to the extended family, and that the four component meningococcal B (4CMenB) vaccine be administered to family members aged 2 months to 23 years inclusive and relevant close contacts of the eighth case. Subsequently these recommendations were implemented at three regional clinics. Additionally pharyngeal swabs (n=112) were collected to assess carriage rates of N. meningitidis in this extended family. Pharyngeal carriage of N. meningitidis was detected in 15 (13%) family members. From the epidemiological investigation and carriage study overcrowding was the most likely risk factor identified in this outbreak. To date, the combination of directly observed ciprofloxacin chemoprophylaxis and use of 4CMenB vaccine have controlled the outbreak with no further cases diagnosed.

Exploring the compatibility of mental health nursing, recovery-focused practice and the welfare state.

Mental health nurses are expected to adhere to a range of professional values. The values of social integration that mental health nurses practise are somewhat at odds with the values of the British welfare state. Alternative systems of welfare support are demonstrated in other countries. Mental health nurses must consider models of practice, such as that described by Clifton et al. (2013b), to manage the disconnection between what is expected and what can be achieved. This discussion paper considers the implications for mental health nursing practice when working alongside individuals in receipt of state benefits. There is arguably a profound impact on an individual's recovery from mental ill health when that individual is also dependent on financial support from the government. Access to welfare benefits can have a significant impact on the recovery journey of that individual. This discussion paper will consider the practice implications for mental health nurses whose professional values include maxims such as 'challenging inequality' and 'respecting diversity', and will seek to examine the implications for practice when such values are divergent from those demonstrated in government policy. The paper will make comparisons with international welfare systems to demonstrate the way in which alternative configurations of state welfare can promote a system of social justice that is in greater equilibrium with the professional values of mental health nurses. Finally, the discussion will focus on the options for mental health nurses to either subscribe to government policy or to find compromise solutions that enable attention to remain focused and active on a strong value base of social justice and recovery-focused practice.

Access to oncology consultation in a cancer cohort in northeastern Ontario.

BACKGROUND: To enhance cancer symptom management for residents of Sudbury-Manitoulin District, an ambulatory palliative clinic (pac) was established at the Northeast Cancer Centre of Health Sciences North. The pac is accessed from a medical or radiation oncology consultation. The primary purpose of the present population-based retrospective study was to estimate the percentage of cancer patients who died without ever having a medical or radiation oncology consultation. A secondary purpose was to determine factors associated with never having received one of those specialized consultations. METHODS: Administrative data was obtained through the Ontario Cancer Data Linkage Project. For each index case, we constructed a timeline, in days, of all Ontario Health Insurance Plan billing codes and associated service dates starting with the primary cancer diagnosis and ending with death. RESULTS: Within the 5-year study period (2004-2008), 6683 people in the area of interest with a valid record of primary cancer diagnosis died from any cause. Most (n = 5988, 89.6%) had 1 primary cancer diagnosis. For that subgroup, excluding those with a disease duration of 0 days (n = 67), about 18.4% (n = 1088) never had a consultation with a medical or radiation oncologist throughout their disease trajectory. Patients who were older or who resided in a rural area were significantly less likely to have had a consultation. CONCLUSIONS: Specific strategies directed toward older and rural patients might help to address this important access-to-care issue.

Packaged baby and toddler foods: questions of sugar and sodium.

BACKGROUND: Sugar and sodium levels in packaged foods is a critical consideration when it comes to the public health of Americans, yet little is known about the sugar and salt contained in packaged foods targeted at our youngest consumers. OBJECTIVES: To examine the sugar and sodium content of packaged baby and toddler foods sold in the American marketplace and to evaluate them in light of current intake recommendations and the current policy context. METHODS: Content analysis of baby and toddler foods (n = 240) found in nine US retail stores. Summary statistics were created for sugar and sodium; the products' per-serving sodium levels were assessed in light of the US Institute of Medicine's dietary reference intakes while the products' sugar levels were evaluated in light of American Heart Association recommendations. RESULTS: Fifty-eight percent of the products assessed either have a high level of sodium or >20% of calories from sugar. Sodium levels in toddler foods were of concern in certain product categories (i.e., toddler entrées) and 15% of toddler foods exceeded the 'moderate level' recommended for sodium. Sugar levels were high in 45% of the products coded, and over half of those products - 56% - were designed for babies. More than one in six products had sugar as the first or second ingredient. CONCLUSIONS: Baby and toddler foods are not, by definition, 'healthy' foods and some exceed normal expectations for sugar and sodium. A policy opportunity exists to consider placing limits on the allowable levels of sugar and sodium in these packaged food products.

Public-private partnerships in the response to HIV: experience from the resource industry in Papua New Guinea.

CONTEXT: Although Papua New Guinea (PNG) has made some progress in social development over the past 30 years, the country's Human Development Index has slowed in recent years, placing it below the regional average. In 2012, the estimated HIV prevalence for adults aged 15-49 years was 0.5% and an estimated 25,000 people were living with HIV. Although reduced from previous estimates, the country's HIV prevalence remains the highest in the South Pacific region. While the faith-based and non-governmental sectors have engaged in HIV interventions since the epidemic began, until recently the corporate sector has remained on the margins of the national response. In 2008, the country's largest oil and gas producer began partnering with national and provincial health authorities, development partners and global financing institutions to contribute to the national HIV strategy and implementation plan. This article provides an overview of public-private partnerships (PPPs) and their application to public health program management, and then describes the PPP that was developed in PNG. ISSUES: Innovative national and local PPPs have become a core component of healthcare strategy in many countries. PPPs have many forms and their use in low- and middle-income countries has progressively demonstrated increased service outputs and health outcomes beyond what the public sector alone could achieve. A PPP in PNG has resulted in an oil and gas producer engaging in the response to HIV, including managing the country's US$46 million HIV grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria. LESSONS LEARNED: Given the increasing expectations of the international community in relation to corporate responsibility and sustainability, the role of the corporate sector in countries like PNG is critical. Combining philanthropic investment with business strategy, expertise and organisational resource can contribute to enhancing health system structures and capacity.

Comparison of nonlaser nonendoscopic endonasal dacryocystorhinostomy with external dacryocystorhinostomy.

OBJECTIVE: To compare the success rate of nonlaser nonendoscopic dacryocystorhinostomy (EN-DCR) with that of externalDCR(EX-DCR). DESIGN: Retrospective chart review. PARTICIPANTS: Eighty-eight patients that underwent 102 consecutive EN-DCR or EX-DCR between November 1, 1995, and September 1, 2003. METHODS: All DCRswere performed by a single ophthalmologist. The surgical protocol remained constant, and surgical success was defined as a lack of symptoms that indicated DCR or normal canalicular irrigation. RESULTS: Eighty-eight patients were reviewed, equating to 102 cases ofDCR (56 EX-DCRand 46 EN-DCR). The average age of patients was 63.2±18.2 years old (range, 19-93 years), and the average duration of surgery was 32.1 minutes for EX-DCR and 23.3 minutes for ENDCR (p < 0.0001). Three cases of intraoperative bleed requiring nasal packing were documented in EX-DCR and 2 cases in EN-DCR. The success rates were 89.8% and 90.2% for EX-DCR and EN-DCR, respectively. There was no statistical difference between these 2 numbers. The average follow-up time was 12.8 months (median, 5 months; range, 2-97 months). CONCLUSIONS: We found that the endonasal approach to DCRs was quicker than the external approach and the success and complication rates of both methods were comparable.

Overestimation of the abundance of sulfate-reducing bacteria in human feces by quantitative PCR targeting the Desulfovibrio 16S rRNA gene.

The dominant genus of sulfate-reducing bacteria (SRB) in humans is Desulfovibrio, and quantitative PCR (QPCR) targeting the 16S rRNA gene is often used in assays. We show that the 16S rRNA gene assay overestimated SRB abundance in feces from 24 adults compared to QPCR assays using primers targeting two genes involved in SRB energy metabolism.

Resistant starch, large bowel fermentation and a broader perspective of prebiotics and probiotics.

The metabolic end products of the large bowel microbiota contribute significantly to human health. After weaning to solid foods, some of the most important of these are the short chain fatty acids (SCFA) produced by the fermentation of undigested dietary components and endogenous secretions. The main SCFA are acetate, propionate and butyrate which have numerous documented effects promoting large bowel function. Of the major acids, butyrate seems especially important. It is a major metabolic fuel for colonocytes and promotes a normal phenotype in these cells, potentially lowering the risk of diseases such as colo-rectal cancer. Imbalances in the microbiota are thought to predispose to large bowel dysfunction and probiotics are being developed to correct this. However, most commercial products contain bacteria (lactobacilli and bifidobacteria) which are dominant species in milk-fed infants but have limited roles in adults. Prebiosis is defined usually by the specific stimulation of these bacteria. However, the end products of most probiotics do not include butyrate or propionate which raises questions about their effectiveness in promoting bowel health in adults. Resistant starch (RS) is a dietary fibre component and its fermentation generally favours butyrate production. Dietary RS intakes and faecal butyrate levels are high in populations at low risk of diet-related large bowel diseases. Conversely, RS intakes and faecal butyrate levels are very low in high risk groups. This raises the possibility that greater RS consumption could be of health benefit. RS is not regarded widely as a prebiotic but (according to the accepted definition) most forms show the requisite features in stimulating specific bacteria, giving raised total SCFA and butyrate levels and a consequent benefit to the host. Current efforts to improve public health through increasing RS consumption could be facilitated by greater recognition of its prebiotic role.

Factors influencing mammography participation in Canada: an integrative review of the literature.

This integrative review critically examines quantitative and qualitative evidence concerning factors influencing the participation of Canadian women in mammography. Empirical studies published between 1980 and 2006 were identified and retrieved by searching electronic databases and references listed in published studies. Among the 1461 citations identified and screened, 52 studies met the inclusion criteria and were independently appraised by two researchers. Extracted data were categorized, summarized, compared, and interpreted within and across studies. The presentation of barriers and facilitators to mammography was guided by the Pender Health Promotion Model. Findings from this review showed that no published studies were specific to settings in Saskatchewan, Nova Scotia, Prince Edward Island, Newfoundland and Labrador, and the three Canadian territories. The most common barriers to screening were membership in an ethnic minority and concerns about pain, radiation, and embarrassment. The recommendation of a health care provider for mammography was found to be the most common facilitator for the engagement of women in this health behaviour. The targeting of specific strategies aimed at overcoming identified barriers and the enhancement of facilitators are essential to improving mammography participation rates throughout Canada.

Influenza A outbreak in a community hospital.

In January 2005, the Department of Public Health, HSE Eastern Region, received notification of an outbreak of influenza-like illness (ILI) in a community hospital for elderly patients. Influenza A (H3N2 subtype) was isolated in 12 of 18 (66%) throat swabs sent to the National Virus Reference Laboratory (NVRL). An outbreak control team was convened. Infection control measures were put in place. Immunisation clinics were organised for non-immunised staff. The epidemic curve confirmed peak onset of illness from 14th-17th January. Attack rates were high among patients (37/74: 50%). Mortalities were also reported. A high percentage of cases occurred in patients who had been immunised (19/34: 55.6%). Seventeen of 94 healthcare workers (HCWs) became ill (18.1%), of whom only 3 (3.2%) had been immunised. A questionnaire circulated to staff identified reasons for non-immunisation. In accordance with the National Institute of Clinical Excellence (NICE) guidelines and microbiological advice, antiviral medication was recommended for patients and non-immunised HCWs as treatment or chemoprophylaxis. This outbreak highlights the importance of immunisation of HCWs against influenza.

Lessons from a pre-season influenza outbreak in a day school.

An outbreak of an upper respiratory tract illness at a secondary school, which led to the hospitalisation of 23 cases, occurred in Ireland at the beginning of September 2003. Medical and laboratory examinations, initially for suspected meningitis, were carried out on the hospitalised cases and bacterial meningitis was ruled out. One hundred and seventy-nine students and teachers were interviewed and a retrospective cohort study was conducted among the sixth year students. One hundred and seven respondents met the case definition, but no associations were found between the environmental exposures investigated and illness. As it was before the expected influenza season, initial samples were not tested for influenza, but one month later the new influenza A/Fujian/411/2002 (H3N2)-like strain was confirmed and implicated in the outbreak. It was the first reported outbreak of influenza in Europe in the 2003 'winter' season and it demonstrated the need for vigilance for early and unexpected occurrence of influenza. It also provided valuable lessons for laboratory and epidemiological investigation and management of pre-season influenza.

Evaluation of sICAM-1, sVCAM-1, and sE-Selectin levels in patients with metastatic breast cancer receiving high-dose chemotherapy.

Soluble forms of some cell adhesion molecules (CAM), sICAM-1, sVCAM-1, and sE-selectin, are elevated in the sera and plasma of patients with inflammation, arthritis, diabetes, and cancer. Increased levels of these soluble molecules in patients with cancer have been shown to correlate with disease progression and survival. This suggests that increased expression of the soluble forms of CAMs may play an important role in cancer cell growth and metastasis and may be prognostic and/or predictive of malignant disease. In this retrospective study, we assessed the clinical significance of sICAM-1, sVCAM-1, and sE-selectin in 95 patients with metastatic breast cancer enrolled in clinical trials of high-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT). The significance of soluble HER-2 (sHER-2) and sFAS status, determined in previous studies for this group of patients, was also included in this analysis. Univariate analysis showed that sICAM-1, sVCAM-1, sFas, sHER-2 positive status, and the presence of liver metastases were significant prognostic factors for both progression-free survival (PFS) and overall survival (OS) in the total patient group. In multivariable analysis, HER-2 and sFAS were shown to be independent prognostic factors for PFS and OS. Within the various treatment groups examined, sICAM-1 was a prognostic factor for clinical outcome for patients with metastatic breast cancer enrolled in trials with cyclophosphamide- and carboplatin-based or vinblastine-based HDC, but not in trials with paclitaxeland cyclophosphamide-based HDC.

Muscle protein synthesis rate is altered in response to a single injection of insulin-like growth factor-I in seven-day-old Leghorn chicks.

To determine if a single injection of insulin-like growth factor-I (IGF-I) can affect muscle protein synthesis in chickens, 7-d-old male Single Comb White Leghorn chicks were injected s.c. with physiological saline (control) or 35 microg of recombinant human IGF-I. After 2 h 30 min, or 6, 12, or 24 h the chicks were injected with 3H-phenylalanine and killed, and the fractional synthesis rate (Ks) of breast muscle protein was measured. The Ks of IGF-I-treated birds were lower (P = 0.03) than controls at 2 h 30 min post-injection, higher (P = 0.07) than controls at 6 h post-injection, but not different from controls at later times. A second experiment examined serum changes during the 6 h after chicks were injected with IGF-I or saline as in the first experiment. Serum IGF-I concentration increased relative to almost undetectable levels (1 ng/mL) of controls to 216 +/- 59 ng/mL at 20 min after IGF-I injection (P < 0.001) and decreased to 12 +/- 6 ng/ mL by 6 h. Serum glucose and nonprotein nitrogen concentrations were significantly decreased for all or most of the 3 h after IGF-I injection, respectively, but only glucose concentration was the same as controls by 6 h. Low serum glucose and nonprotein nitrogen during the first few hours after IGF-I injection may contribute to the inhibition of Ks at 2.5 h, but the mechanisms behind the increased Ks at 6 h are not clear. These results support a role for IGF-I in the posthatching muscle development of chicks.

Enhancing clinical trials on the internet: lessons from INVEST.

The INternational VErapamil SR/trandolapril STudy (INVEST) is the first long-term, large-scale clinical trial being conducted primarily using Web-based technology. The Web is a powerful tool for enhancing clinical trial management because of its ability to centralize all study information and coordinate multiple trial processes in real time at lower cost. The result is improved efficiency, accuracy, and safety in clinical trials conduct. In Web-based clinical trials, sites are able to focus primarily on medicine and science, rather than on trial administration. Site training, study documentation, subject recruitment, randomization, medication dispensing, and management procedures are simplified by using Web-based software to enhance processes. This paper summarizes the advantages achieved for INVEST investigators, sponsor representatives, monitors, and subjects resulting from the centralization and coordination of multiple tasks through Web-based technology.