Resource utilisation and costs of palliative cancer care in an interdisciplinary health care model.

This paper presents a detailed description of health care resource utilisation and costs of a pilot interdisciplinary health care model of palliative home care in Ontario, Canada. The descriptive evaluation entailed examining the use of services and costs of the pilot program: patient demographics, length of stay broken down by disposition (discharged, alive, death), access to services/resources, use of family physician and specialist services, and drug use. There were 434 patients included in the pilot program. Total costs were approximately CAN$2.4 million, and the cost per person amounted to approximately CAN$5586.33 with average length of stay equal to over 2 months (64.22 days). One may assume that length of stay would be influenced by the amount of service and support available. Future research might investigate whether in-home palliative home care is the most cost effective and suitable care setting for those patients requiring home care services for expected periods of time.

Analysis of factors related to development, regulatory level and change in municipal no-smoking by-laws in Ontario.

OBJECTIVES: This study explored and measured the presence, content and growth of municipal no-smoking by-laws and examined factors related to differences in by-law breadth and comprehensiveness. METHODS: By-laws from each jurisdiction across Ontario were collected and scored relative to their breadth and restrictiveness using the Asbridge-O'Grady Index. Kruskal-Wallis analysis of variance was used to compare the distributions of municipal characteristics among the regulatory level of municipal smoking legislation. RESULTS: Twenty-three percent of Ontario municipalities (215/951) had enacted smoking by-laws by the end of 1998 compared to 18% (169/951) in 1994. Larger municipalities tend to be significantly more restrictive than smaller municipalities. CONCLUSION: No-smoking legislation has become more extensive and restrictive in Ontario since the passage of the 1994 Tobacco Control Act. There was little legislative variability among the regions that contained tobacco-producing municipalities and those that did not.

Comparison of two human ovarian carcinoma cell lines (A2780/CP70 and MCAS) that are equally resistant to platinum, but differ at codon 118 of the ERCC1 gene.

ERCC1 is an essential gene within the nucleotide excision repair process. We studied two human ovarian carcinoma cell lines for cisplatin resistance, which differed with respect to ERCC1. The A2780/CP70 cell line has been extensively studied previously, and has the wild-type ERCC1 sequence. The MCAS cell line has a recently described ERCC1 polymorphism at codon 118, which is associated with an approximate 50% reduction in codon usage. These cells did not differ with respect to p53 sequence nor p53 mRNA induction following cisplatin exposure. The induction of ERCC1 mRNA was markedly reduced in MCAS cells as compared to A2780/CP70 cells. At the IC50 cisplatin dose for each cell line, MCAS cells were less proficient at cisplatin-DNA adduct repair than A2780/CP70 cells. In absolute terms, A2780/CP70 cells repaired 3-fold as much adduct (2.7 pg/microgram DNA over 6 h vs 0.86 pg/microgram DNA); and when expressed in terms of the maximal DNA adduct load, A2780/CP70 cells repaired 50% more adduct than MCAS cells. MCAS cells had increased cytosolic inactivation of drug at the IC50 dose level, which has been previously suggested to be a compensatory cellular response for reduced DNA repair capacity. These data suggest the possibility that this specific ERCC1 polymorphism, may be associated with reduced DNA repair capacity in human ovarian cancer cells. This association may be effected through a reduction in peak production of ERCC1 mRNA, and a consequent reduction in the translation of ERCC1 mRNA into protein.

Analysis of factors related to illegal tobacco sales to young people in Ontario.

OBJECTIVE: To identify and to discuss factors influencing illegal merchant sales of tobacco to underage people in Ontario, Canada. DESIGN: Results were obtained through random retail compliance checks of tobacco merchants. A multivariate analysis specified the relationship between selected independent variables and the willingness of tobacco merchants to sell to minors. The selected independent variables included retail operation type, community population size, the presence of tobacco production, signage, sex and age of volunteers, smoking prevalence rates, and enforcement rates. PARTICIPANTS: A random, stratified sample of 438 tobacco retailers in 186 communities in Ontario. MAIN OUTCOME MEASURE: Willingness of merchants to sell tobacco to minors. RESULTS: Older youths and girls were more likely to be sold tobacco products. Purchase attempts carried out in tobacco-producing regions were also statistically related to illegal sales. CONCLUSIONS: Policy efforts to control youth access to tobacco in Canada may need to invoke legislation requiring merchants to request proper identification from customers who appear to be under the age of 25, and who seek to purchase tobacco products. Further attention could also be directed at tobacco control policies and enforcement strategies that need to consider the unique challenges faced by jurisdictions where the tobacco industry is a powerful presence.

Associations between stomach cancer incidence and drinking water contamination with atrazine and nitrate in Ontario (Canada) agroecosystems, 1987-1991.

BACKGROUND: Nitrate and atrazine are two chemicals that are heavily used in certain sectors of agriculture. They are suspected to be associated with the development of certain types of tumours. METHODS: Existing data were obtained on the incidence of specific types of cancers, contamination of drinking water with atrazine and nitrate, and related agricultural practices for the 40 ecodistricts in the province of Ontario. The data were merged into a georelational database for geographical and statistical analyses. Weighted (by population size) least squares regression analyses were conducted while controlling for confounding socioeconomic and lifestyle factors. Maximum likelihood spatial error models were estimated when least square regression error terms were found to be spatially autocorrelated using the Moran's I statistic. RESULTS: Atrazine contamination levels (range 50-649 ng/l, maximum acceptable concentration [MAC] = 60000 ng/l) were positively associated (P < 0.05) with stomach cancer incidence and negatively associated with colon cancer incidence. Nitrate levels, (range 0-91 mg/l, MAC = 10 mg/l) were negatively associated with stomach cancer incidence. CONCLUSION: The associations found at the ecodistrict level, both positive and negative, if confirmed by other studies, raise serious questions about maximum allowable limits for atrazine, as well as possibilities of complex trade-offs among disease outcomes, and interactions of biophysical and social mechanisms which might explain them. Although the negative associations appear to have no direct biological explanations, such counter-intuitive outcomes may occur in complex systems where social and biological variables interact.

The measurement of cadmium in biological materials, using graphite furnace atomic absorption spectrometry with Zeeman background correction.

Cadmium (Cd), a toxic heavy metal and probable carcinogen in humans, appears to have potential anti-cancer activity in pre-clinical systems. This observation led us to develop a method for measuring cellular Cd and DNA-bound Cd following micromolar exposures to cadmium dichloride. Cultured human ovarian cancer cell lines were used. Following low level exposures to cadmium dichloride (CdCl2), atomic absorption spectrometry with Zeeman background correction was used to measure total cell associated Cd in wet-ashed cells, and the lower limits of detection was at 100 pg of Cd per 106 cells. In cellular DNA isolated by cesium chloride density gradient centrifugation, levels of 1.5 Cd lesions (Cd molecules) per 106 nucleotides were reproducibly detected. Standard curves with samples yielded 76.4 6.7% recovery when using picogram quantities of Cd. Manipulation of the total amount of biological material used, can further improve detection limits. Thus, this method is suitable for the detection of Cd in biological matrixes after low levels of Cd exposure, and shows good performance in terms of the level of sensitivity and reproducibility.

The relationship between smoking and self-esteem.

Tobacco use is recognized as the most significant cause of preventable morbidity and mortality. In recent years health professionals have shifted emphasis from treating adult smokers to preventing smoking among children. This has prompted a number of studies of the determinants of smoking behavior among adolescents. Although some recent research has associated low self-esteem with smoking, other work challenges the relationship between self-esteem and health behavior. This study examines the relationship between adolescent self-esteem and smoking among a large cohort (N = 3,567) of adolescents who were surveyed between the 6th and 10th grades. Findings suggest that self-esteem may be a factor in the smoking behavior of female adolescents in grades 6-8, but not for males in any grade. This suggests that females may have different motivations to initiate and maintain the smoking habit.

A comprehensive evaluation of the 1993 city of Toronto smoking by-laws.

Effective January 1, 1993, the City of Toronto's two smoking by-laws--one regarding workplaces and another regarding public places--were replaced and amended respectively. Smoking is now prohibited in all workplaces (unless in a designated smoking area), and in at least 50% of eating areas in restaurants. Through a workplace telephone survey and restaurant inspection records, the implementation and enforcement of the by-laws were evaluated. Eighty-three per cent of the workplaces were completely smoke-free and 7% had restricted smoking to a designated area. A majority (76%) of the managers and owners were in favour of regulatory controls on smoking in workplaces. Eighty-six per cent of restaurants complied with requirements for a minimum 50% smoke-free area and signage, and nearly 4% of the sampled restaurants banned smoking throughout the entire premises even though this is not currently required.

Compliance for Kids: a community-based tobacco prevention project.

This article reports on the findings of a pre-test/post-test evaluation of the Compliance for Kids program carried out in three different communities. It demonstrates that it is indeed possible for a locally directed program to influence community standards of behaviour. It also suggests that in larger areas, such programs might better be implemented at the neighbourhood than at the city-wide level; and that merchants are influenced more by threat of enforcement than knowledge of laws. Such findings reinforce the need both for continued community programming and comprehensive legislation and enforcement.

Prognostic significance of benign proliferative breast disease.

BACKGROUND: Recent studies concerning an association between benign breast diseases and risk of subsequent breast cancer have focused on benign proliferative lesions recognized in biopsy specimens. Some have implicated atypical hyperplasia as being associated with the greatest risk. METHODS: The histologic sections of specified benign breast lesions from 1799 women were reviewed and reclassified, using published criteria for proliferative disease. Prognostic significance was assessed by relating the pathologic findings to the development of breast cancer observed during an average 21 years of follow-up, in which time 157 women developed the disease. RESULTS: Benign proliferative changes were recognized in 85% of the patients, with a corresponding relative risk of subsequent carcinoma equal to 2.2 times population rates (95% confidence limits, 1.9 and 2.6). Increasing levels of hyperplasia and atypia in lobules or ducts were associated with modest increases in risk, ranging from 2.1 to 2.3 to 3.0 for proliferative changes with no atypia, mild atypia, and moderate to severe atypia, respectively. This trend was not statistically significant. The most significant risk indicators in this study were the presence of adenosis (relative risk, 3.7), and moderate or severe atypia in ducts (relative risk, 3.9). CONCLUSIONS: Benign proliferative breast disease recognized in biopsy specimens is associated with an increased risk of future breast cancer, but fine distinctions among levels of hyperplasia and atypia did not significantly distinguish risk among patients in this study.

Predicting cigarette smoking among adolescents using cross-sectional and longitudinal approaches.

The ability to identify groups of children at risk of initiating a smoking habit may prove useful in developing effective smoking prevention programs. This report includes data collected over a three-year period, and attempts to predict adolescents' smoking behavior using both cross-sectional and longitudinal analyses. In addition, predictor variables reflecting both interpersonal and intrapersonal domains were included. Results indicated the highest rates of accurate classification into smoking categories were achieved with cross-sectional analyses. In addition, interpersonal variables emerged as most important in all analyses. Implications for smoking prevention programming are discussed.

Preventing cigarette smoking among children: results of a four-year evaluation of the PAL program.

The issue of prevention of tobacco use has received a great deal of attention in recent years. As an outgrowth of this interest, several smoking prevention programs based on a social influence approach have been developed. One example of these types of programs is the Peer Assisted Learning (PAL) prevention program which was produced by Health and Welfare Canada. We discuss the preliminary results of a prospective cohort evaluation of the PAL program. This evaluation suggests that the program has some utility in preventing the uptake of tobacco use among young males; however, its efficacy with females has been negligible. It is clear that prevention programming will have to consider targeting males and females in different ways.

The prevalence of smokeless tobacco and cigarette use among sixth, seventh and eighth grade students: a longitudinal investigation.

Few studies have reported on the prevalence of smokeless tobacco use among young children in Canada, although research conducted in the United States indicates a rising trend in smokeless tobacco use among school-aged children. We report on rates of smokeless tobacco experimentation and current use and its relationship to cigarette smoking in a large sample of students followed from Grade 6 through Grade 8 in Calgary, Canada. The rates of smokeless tobacco experimentation and use reported are low in comparison to the corresponding prevalence reported in the American findings. In accordance with the American findings, however, both experimentation and current use of smokeless tobacco were more prevalent among males. Also, a high correspondence between smokeless tobacco and cigarette use was observed.

Birth patterns: are the Chinese in Guangzhou City different?

Diurnal birth patterns in the City of Guangzhou, China and the City of Calgary in Canada were compared. Chinese data were abstracted from the labor room log book of one large general hospital located in the Hai Zhu district of Guangzhou. Calgary birth data were abstracted from birth notification forms submitted to Calgary Health Services. Information included day of birth, time of delivery, type of delivery and parity. Calgary births are concentrated on Tuesdays to Fridays whereas in Guangzhou weekly patterns varied tremendously according to whether it was assisted or unassisted. Calgary births are below average at night and during evening shift. The time of birth in Guangzhou varied substantially with above average rates for non-assisted births noted at 0800-2400 h, and above average rates for assisted births noted at 0800-1700 h. Differences in hour of birth appeared to be related to obstetric intervention practices. Knowledge of birthing patterns are useful for effective hospital management.

PIP: Diurnal birth patterns in the City of Guangzhou, China and the City of Calgary, Canada were compared. Chinese data were abstracted from the labor room log book of 1 large general hospital located in the Hai Zhu district of Guangzhou. Calgary birth data were abstracted from birth notification forms submitted to Calgary Health Services. Information included day of birth, time of delivery, type of delivery, and parity. Calgary births are concentrated on Tuesdays to Fridays whereas in Guangzhou weekly patterns varied tremendously according to whether it was assisted or unassisted. Calgary births are below average at night and during evening shift. The time of birth in Guangzhou variied substantially with above average rates for nonassisted births noted at 0800--2400 h, and above average rates for assisted births noted at 0800--1700 h. Differences in hour of birth appeared to be related to obstetric intervention practices. Several implications arise from the observations. 1st, better knowledge of birthing patterns could be used to help hospitals establish an appropriate schedule for personnel in the obstetric ward. The concern with safety combined with the reported increase in neonatal mortality associated with birth buring the night has been cited as a reason to examine the pattern. 2nd, considering the poor understanding of the normal physiological factors initiating labor, can the possible consequences of shifting birth patterns from a nighttime phenomenon to a daytime phenomenon be ignored? An explanation for these weekly and diurnal patterns, can, in a strict sense, only be speculative. Nevertheless, they do seem to suggest, especially in the case of assisted deliveries, that the pattern of birth appears to be related to the 24-h work rhythem of hospital personnel, especially in the Calgary hospitals.