Once-per-week haemodialysis in a financial crisis: Predictors of interdialytic weight gain.

BACKGROUND: Several countries are experiencing challenges in maintaining standard haemodialysis services for people with kidney failure. OBJECTIVE: This study aimed to investigate the health profile of people receiving haemodialysis and to identify factors associated with interdialytic weight gain. DESIGN: A cross-sectional study. PARTICIPANTS: A total of 166 adults with kidney failure and receiving haemodialysis for at least 3 months were included. MEASUREMENTS: A structured chart audit form collected, demographic and haemodialysis treatment characteristics, recent biochemical and haematological results, and prescribed treatment regimens from clinical records. Data were analysed descriptively. Odds ratios (OR) were calculated to identify independent risk factors for interdialytic weight gain. RESULTS: Mean age was 52 years (SD = 12.5), over half were male (60.2%, n = 100), and most were receiving 4 h of haemodialysis once per week (87.3%, n = 145). Approximately half (51.8%, n = 86) had an interdialytic weight gain >2%. Being female (OR = 3.39; 95% CI, 1.51-7.61), increased comorbidities (OR = 1.50; 95% CI, 1.22-1.84) and having BMI outside of the normal range (overweight/obese [OR = 8.49; 95% CI, 3.58-20.13] or underweight [OR = 4.61; 95% CI, 1.39-15.31]) were independent risk factors for increased interdialytic weight gain. CONCLUSION: Most patients were receiving 4 h of haemodialysis once per week although only modest alterations in potassium, phosphate, and fluid status were observed. Understanding the patient profile and predictors of interdialytic weight gain will inform the development of self-management interventions to optimise clinician support.

Pharmacokinetics and pharmacodynamics of intranasal and intramuscular administration of naloxone in working dogs administered fentanyl.

BACKGROUND: Working dogs exposed to narcotics might require reversal in the field. OBJECTIVE: To explore the pharmacokinetic and pharmacodynamic effects of naloxone administered intramuscularly (IM) or intranasally (IN) to reverse fentanyl sedation in working dogs. ANIMALS: Ten healthy, working dogs aged 1.7 ± 1 year and weighing 26 ± 3 kg. METHODS: In this randomized, controlled cross-over study dogs received either 4 mg of naloxone IN or IM 10 minutes after fentanyl (0.3 mg IV) administration. Sedation was assessed at baseline and 5 minutes after fentanyl administration, then at 5, 10, 15, 20, 25, 30, 60 and 120 minutes after reversal with naloxone. Blood samples for naloxone detection were obtained at 0, 5, 10, 30, 60 and 120 minutes. Pharmacokinetic parameters and sedation scores were compared between IM and IN naloxone groups. RESULTS: There was a significant increase in sedation score from baseline (0.25 [-4 to 1] IM; 0 [-2 to 1] IN) after fentanyl administration (11 [5-12] IM; 9.25 [4-11] IN), followed by a significant reduction at 5 (0.5 [-0.5 to 1.5] IM; 1.25 [-1.5 to 4.5] IN) through 120 minutes (-0.5 [-2 to 1] IM; 0 [-4.5 to 1] IN) after reversal with naloxone. Route of administration had no significant effect on sedation score. Maximum plasma concentration was significantly lower after IN administration (11.7 [2.8-18.8] ng/mL IN, 36.7 [22.1-56.4] ng/mL IM, P < .001) but time to reach maximum plasma concentration was not significantly different from IM administration. CONCLUSION AND CLINICAL IMPORTANCE: Although IM administration resulted in higher naloxone plasma concentrations compared to IN, reversal of sedation was achieved via both routes after administration of therapeutic doses of fentanyl.

Feasibility of the McIntyre audit tool for haemodialysis nurses.

BACKGROUND: Nurse-sensitive indicators (NSI) assess the quality of nursing care provided to patients. These indicators assess the structures (supportive measures), processes (nursing actions) and outcomes of care. The McIntyre Audit Tool (MAT) was developed to measure haemodialysis NSIs. OBJECTIVES: The objective of this study is to evaluate the feasibility and utility of the MAT in measuring haemodialysis NSIs in clinical practice. DESIGN: Multisite nonrandomized feasibility study. PARTICIPANTS: A convenience sample of nurses (n = 30) were recruited from two haemodialysis units in Australia. MEASUREMENTS: Participants completed the MAT once daily for 1 week, to measure the extent the clinical indicators were being met. Feasibility data including utility and acceptability of the tool was collected once from each participant. Data were analysed descriptively. RESULTS: Participants completed a total of 97 audits. Results revealed the majority of structural (75%) and process indicators (73%) were being achieved although some variation between sites was observed. Results for the outcome indicators showed more variation (5.9%-94.1). Feasibility results found most nurses (79%) took <5 min to complete the MAT and found the tool easy to use (91.7%). Most participants (83.3%) reported audits could be completed during a shift and auditing was easily implemented (79.2%). CONCLUSION: Use of the MAT in clinical practice is a feasible and acceptable way of auditing the quality of haemodialysis nursing practice. The tool could be used to establish minimum standards and improve the quality of nursing care in haemodialysis units, also enabling benchmarking between services.

Effectiveness of teach-back for chronic kidney disease patient education: A systematic review.

BACKGROUND: Education is an essential component in optimising chronic disease self-management. Teach-back is a robust approach in patient education, which is suitable for varying health literacy although its effectiveness in chronic kidney disease patient education is unknown. OBJECTIVE: To evaluate the impact of teach-back method in health education for improving self-management and adherence to treatment regimens in chronic kidney disease. DESIGN: Systematic review. PARTICIPANTS: Adults with any chronic kidney disease grade or treatment modality. MEASUREMENTS: A comprehensive search was undertaken in MEDLINE, CINHAL, EMBASE, Cochrane library, PsychINFO, Web of Science, ERIC, JBI library and WHO International Clinical Trial Registry to identify published studies from September 2013 to December 2022. The methodological quality of studies was assessed using Joanna Briggs Institute guidelines. RESULTS: Six studies involving 520 participants were retrieved for this review. A meta-analysis could not be conducted due to substantial heterogeneity between studies. Nevertheless, there was some evidence that teach-back could improve self-management, self-efficacy and knowledge. There was limited evidence on improvement in psychological outcomes or health-related quality of life. CONCLUSION: Teach-back seems to improve both objective and patient-reported outcomes, although further studies are needed. Using teach-back can improve both understanding of health information and the development of skills. Kidney care teams could use teach-back for all patients as it takes account of varying patient health literacy abilities. Teach-back assists with communicating important health information to improve patients' knowledge, confidence and skills in self-managing this disease and its treatment.

Exploring the delivery of phase II cardiac rehabilitation services in rural and remote Australia: a scoping review.

Objective Phase II cardiac rehabilitation (CR) reduces cardiovascular risk factors, morbidity and mortality after a cardiac event. Traditional Australian CR programs are located in metropolitan areas and delivered by an expert, multidisciplinary team. Referral and uptake barriers for people living in rural and remote locations are significantly affected by geographical isolation. This scoping review aimed to explore how phase II CR services in rural and remote Australia are being delivered. Methods A scoping review was conducted to obtain all published literature relating to CR service delivery for people living in rural and remote Australia. A literature search of the following databases was performed in December 2021: Cumulative Index to Nursing and Allied Health Literature, Embase, the Physiotherapy Evidence Database, and PubMed. Results Six articles met the inclusion criteria. Study designs varied and included mixed methods, cross-sectional design and narrative review. Overall, literature relating to CR programs in rural and remote Australia was limited. Three themes were apparent: (1) barriers to the delivery of phase II CR in rural and remote Australia remain; (2) community centre-based programs do not reach all people in rural and remote Australia; and (3) alternative models of CR are underutilised. Conclusions Phase II CR programs in rural and remote Australia do not align with current recommendations for service delivery. The use of technology as a primary or adjunct model of delivery to support people living in rural and remote Australia needs to be further developed and implemented. Further research exploring barriers to the uptake of alternative models of CR delivery is recommended.

Validation of the McIntyre Audit Tool to measure haemodialysis nurse sensitive indicators.

BACKGROUND: Nurse sensitive indicators measure the quality of nursing care. Although there are some haemodialysis nurse sensitive indicators, there are currently no validated audit tools available to measure the indicators. OBJECTIVES: To test the validity of the McIntyre Audit Tool. DESIGN: This study used a descriptive observation design conducted over two phases to assess face and content validity. PARTICIPANTS: An expert panel of haemodialysis nurses (n = 13). METHODS: Face validity (phase 1) involved 13 nurses in two focus groups who reviewed the audit tool with qualitative data generated analysed to identify common themes. Phase 2 used a modified version of the audit tool to test for content validity for each item and then scale level content validity was calculated by combining all item scores. MEASUREMENTS: Ten nurses rated 26 indicators in the audit tool using a 4-point Likert scale to assess each item for clarity, relevance, appropriateness, and ambiguity. RESULTS: All 26-haemodialysis nurse sensitive indicators achieved item content validity indices ranging from 0.825 to 1.00 with a scale content validity index average of 0.910. However, based on feedback from phase 2, 6 outcome indicators were removed from the audit tool to reduce staff burden and assist with ease of use. The final audit tool had an excellent average scale content validity index of 0.924. CONCLUSIONS: The McIntyre Audit Tool to measure 20 haemodialysis nurse sensitive indicators has been validated. It now requires feasibility and reliability testing before auditing the quality of haemodialysis nursing care.

Improving the health-related quality of life of adult Nigerians living with cancer and their family caregivers: intervention development.

BACKGROUND: Evidence for the effectiveness of interventions aimed at improving the health-related quality of life of people living with cancer and/or family members is compelling. However, most interventional research has been conducted in high-income countries, and no intervention had been tested in low-income countries such as Nigeria. It is critical to design a culturally theory-based intervention in a resource-poor setting to address the needs and support coping strategies of cancer patients and their family caregivers. METHODS: Theory, evidence, and practical issues were considered. The Medical Research Council framework for developing and evaluating complex interventions and Behaviour Change Wheel provided the framework for intervention design. Findings generated by a needs assessment of adult Nigerians with cancer and their family caregivers and relevant theories (the Spirituality and the Supportive Care Framework for Cancer) informed content development. RESULTS: A theory-based, culturally tailored socio-spiritual intervention was developed to address the specific needs of adult Nigerians with cancer and their family caregivers. A 4-week intervention included strategies designed to improve social and spiritual support, information and health literacy, and health-related quality of life. CONCLUSIONS: A systemic approach was used to conceptualise an evidence-based and theory-informed intervention tailored to address previously identified shortfalls in support available to adults living with cancer and their family caregivers, in Nigeria. If implemented and effective, such an intervention has the potential to improve the health-related quality of life of people living with cancer and their families in Nigeria.

Improving health-related quality of life in women with breast, blood, and gynaecological Cancer with an eHealth-enabled 12-week lifestyle intervention: the women's wellness after Cancer program randomised controlled trial.

BACKGROUND: The residual effects of cancer and its treatment can profoundly affect women's quality of life. This paper presents results from a multisite randomized controlled trial that evaluated the clinical benefits of an e-health enabled health promotion intervention (the Women's Wellness after Cancer Program or WWACP) on the health-related quality of life of women recovering from cancer treatment. METHODS: Overall, 351 women previously treated for breast, blood or gynaecological cancers were randomly allocated to the intervention (WWACP) or usual care arms. The WWACP comprised a structured 12-week program that included online coaching and an interactive iBook that targeted physical activity, healthy diet, stress and menopause management, sexual wellbeing, smoking cessation, alcohol intake and sleep hygiene. Data were collected via a self-completed electronic survey at baseline (t0), 12 weeks (post-intervention, t1) and 24 weeks (to assess sustained behaviour change, t2). The primary outcome, health-related quality of life (HRQoL), was measured using the Short Form Health Survey (SF-36). RESULTS: Following the 12-week lifestyle program, intervention group participants reported statistically significant improvements in general health, bodily pain, vitality, and global physical and mental health scores. Improvements were also noted in the control group across several HRQoL domains, though the magnitude of change was less. CONCLUSIONS: The WWACP was associated with improved HRQoL in women previously treated for blood, breast, and gynaecological cancers. Given how the synergy of different lifestyle factors influence health behaviour, interventions accounting for the reciprocity of multiple health behaviours like the WWACP, have real potential for immediate and sustainable change. TRIAL REGISTRATION: The protocol for this randomised controlled trial was submitted to the Australian and New Zealand Clinical Trials Registry on 15/07/2014 and approved on 28/07/2014 ( ACTRN12614000800628 ).

Determining the psychometric properties of the Greene Climacteric Scale (GCS) in women previously treated for breast cancer: A pooled analysis of data from the Women's Wellness after Cancer Programs.

OBJECTIVES: This paper examines the utility of a common climacteric symptoms scale, the Greene Climacteric Scale (GCS), in two groups of women with a history of breast cancer, those who were at menopause before commencing breast cancer treatment, and those who were not. STUDY DESIGN: This pooled analysis of 297 women previously diagnosed with breast cancer, aged 28-74 years, was undertaken on baseline data from two structured lifestyle interventions: the Women's Wellness After Cancer Program (WWACP) and the Younger Women's Wellness After Cancer Program (YWWACP). Data were split into two data subsets (women who were post-menopausal on commencement of breast cancer treatment and those who were either pre- or peri­menopausal). Multitrait/multi-item analysis was conducted to test scaling assumptions for each group separately. RESULTS: GCS domain scores were positively skewed, with significant floor effects for vasomotor symptoms and ceiling effects for sexual dysfunction. Multitrait analysis showed acceptable convergent validity (77% of items correlated ≥ 0.40 with their hypothesized domains) but weak discriminant validity for anxiety, depression, and somatic symptoms in both groups. The exploratory factor analysis in women who were menopausal at the commencement of breast cancer treatment and those who were not revealed distinct factor structures that accounted for 60.2% and 62.7% of the total variance, respectively. CONCLUSIONS: The original GCS factor structure was not replicated in this sample. Among women previously treated for breast cancer, the presence of multiple concurrent and severe menopausal symptoms with possible treatment-related causes underpins the need for a breast cancer-specific measure to enhance their identification and management. TRIAL IDS, AUSTRALIAN AND NEW ZEALAND CLINICAL TRIALS REGISTRY: WWACP, ACTRN12614000800628; YWWACP, ACTRN12614001087640.

Women's Wellness with Type 2 Diabetes Program (WWDP): Qualitative findings from the UK and Australian feasibility study.

AIMS: To undertake a qualitative study of a multimodal behavioural intervention and research protocol developed to improve wellness in women with type 2 diabetes mellitus (T2DM), the Women's Wellness with Type 2 Diabetes program (WWDP). METHODS: Semi-structured interviews were conducted with 15 participants who completed the WWDP. The interviews were transcribed verbatim and analysed thematically in an iterative process. RESULTS: Themes developing from interviews were broadly grouped into three domains, 1) Hope for a better everyday life; 2) Reflection of the program and its contents; and 3) Impacts on health and wellbeing. Participants viewed the WWDP as a necessary and valuable approach that was crucial in helping them adopt strategies to improve their wellbeing and prevent complications associated with T2DM. Some participants expressed ambivalence towards their adherence to the program due to day-to-day life commitments. The most appreciated feature of the program were the individualised approach adopted by the consultation nurse via skype, convenient appointments, the provision of credible and factual information and the accessible website. CONCLUSIONS: This study critically evaluated perceptions of participants towards the WWDP and provided important recommendations for improving the delivery and sustainability of the program in future. Participants perceived the program as an effective means of supporting their T2DM self-management and improving wellbeing.

International feasibility study for the Women's Wellness with Type 2 Diabetes Programme (WWDP): An eHealth enabled 12-week intervention programme for midlife women with type 2 diabetes.

AIMS: The current study aimed to examine feasibility of participant recruitment and retention rates for the Women's Wellness with Type 2 Diabetes program (WWDP), and to assess initial efficacy of the program in improving wellbeing outcomes. METHODS: 70 midlife women with type 2 diabetes mellitus (T2DM) participated in a 12-week wellness-focused intervention, the WWDP. The WWDP involved a structured book (with participatory activities), an interactive website and nurse consultations. This study had an Australian and a UK arm. Analyses were conducted using chi-square, McNemar, paired t-test, and Wilcoxon signed-ranks tests. RESULTS: The attrition rate for the sample was 22.2%. Overall, significant improvement was observed in diabetes distress (DD), diabetes self-efficacy, weight, BMI, menopausal symptoms and sleep symptoms from baseline to program completion at 12 weeks. Australian participants were also more likely to meet fruit recommendation guidelines and had significant waist- and hip-circumference reductions. CONCLUSIONS: Good retention rates and initial efficacy findings indicated feasibility of the WWDP as a promising 12-week health and wellness program for women with T2DM. They also suggest incorporating a focus on self-efficacy and gendered information may be important in improving wellness and health outcomes related to distress and menopause.

The Association Between Web-Based or Face-to-Face Lifestyle Interventions on the Perceived Benefits and Barriers to Exercise in Midlife Women: Three-Arm Equivalency Study.

BACKGROUND: Noncommunicable diseases pose a significant threat to women's health globally, with most diseases being attributed to modifiable risk factors such as physical inactivity. Women perceive a range of benefits and barriers to exercise; however, there is little evidence about the effect of different lifestyle intervention delivery modes on perceptions of exercise. OBJECTIVE: This study aimed to compare the effect of a multiple health behavior change (MHBC) intervention called the Women's Wellness Program. This intervention was delivered in 3 different modes on perceived exercise benefits, perceived exercise barriers, and actual physical activity and exercise in midlife women. METHODS: Women aged 45 to 65 years were recruited via the study website. They were assigned in blocks to 3 different treatment groups (A: Web-based independent; B: face-to-face with nurse consultations; and C: Web-based with virtual nurse consultations). All participants received the 12-week intervention that utilizes principles from social-cognitive theory to provide a structured guide to promote healthy lifestyle behaviors with an emphasis on regular exercise and healthy eating. Data were collected using a self-report Web-based questionnaire at baseline (T1) and postintervention (T2) including perceived exercise benefits and barriers and exercise and physical activity. A data analysis examined both within- and between-group changes over time. RESULTS: Participants in this study (N=225) had a mean age of 50.9 years (SD 5.9) and most were married or living with a partner (83.3%, 185/225). Attrition was 30.2% with 157 participants completing the final questionnaire. Women in all intervention groups reported a significant increase in positive perceptions of exercise (P<.05); a significant increase in exercise and overall physical activity (P<.01) with moderate-to-large effect sizes noted for overall physical activity (d=0.5 to d=0.87). Participants receiving support from registered nurses in the face-to-face and Web-based groups had a greater magnitude of change in benefit perceptions and physical activity than those in the Web-based independent group. There was no significant change in exercise barrier perceptions within or between groups over time. CONCLUSIONS: The results of this study suggest that the (MHBC) intervention is effective in increasing exercise benefit perceptions, overall physical activity, and exercise in midlife women. Although Web-based programs are cost-effective and flexible and can be delivered remotely, providing a range of options including face-to-face group delivery and personalized electronic health coaching from registered nurses has the potential to enhance participant engagement and motivation.

Perspectives on the management of overweight and obesity.

•While obesity prevalence is similar in men and women, men are less likely to participate in weight-loss programs•Women and men differ in their biology, social roles, and their position in the community•New models of obesity management are needed to account for gender differences and broader social and environmental factors.

A Randomized Cross-Over Trial Comparing the Effect of Intramuscular Versus Intranasal Naloxone Reversal of Intravenous Fentanyl on Odor Detection in Working Dogs.

Fentanyl is a potent opioid used clinically as a pain medication and anesthetic but has recently seen a sharp rise as an illicit street drug. The potency of fentanyl means mucous membrane exposure to a small amount of the drug can expose first responders, including working canines, to accidental overdose. Naloxone, a fast-acting opioid antagonist administered intranasally (IN) or intramuscularly (IM) is currently carried by emergency personnel in the case of accidental exposure in both humans and canines. Despite the fact that law enforcement relies heavily on the olfactory abilities of canine officers, the effects of fentanyl exposure and subsequent reversal by naloxone on the olfactory performance of canines are unknown. In a block-randomized, crossover trial, we tested the effects of IN and IM naloxone on the abilities of working dogs to recognize the odor of Universal Detection Calibrant (UDC) prior to, and two, 24, and 48 h after intravenous fentanyl sedation and naloxone reversal. No detectable influence of fentanyl sedation and naloxone reversal on the dogs' olfactory abilities was detected. We also found no difference in olfactory abilities when dogs received IN or IM naloxone. Together, results suggest no evidence that exposure to intravenous fentanyl followed by naloxone reversal impairs canine olfactory ability under these conditions.

Case Study: Applying Rapid Flow Cytometry Analysis to CAPD Effluent.

Peritoneal dialysis (PD) peritonitis cases require rapid clinical interventions to ensure the best possible patient outcomes. Culture-dependent microbiology tools are slow and cannot provide clinicians with evidence to guide antimicrobial prescription practices in an appropriate time frame. Genotypic methods have met with limited success for analyzing continuous ambulatory PD effluent, with most centers still relying on culture-dependent microbiology. We present a case study in which we apply flow cytometry techniques to antibiotic-compromised effluent. We demonstrate, with supporting evidence, direct enumeration of bacterial and human immune cells, with results reported within 2 hours of receiving the clinical specimen.

Involvement of Pro-Inflammatory Macrophages in Liver Pathology of Pirital Virus-Infected Syrian Hamsters.

New World arenaviruses cause fatal hemorrhagic disease in South America. Pirital virus (PIRV), a mammarenavirus hosted by Alston’s cotton rat (Sigmodon alstoni), causes a disease in Syrian golden hamsters (Mesocricetus auratus) (biosafety level-3, BSL-3) that has many pathologic similarities to the South American hemorrhagic fevers (BSL-4) and, thus, is considered among the best small-animal models for human arenavirus disease. Here, we extend in greater detail previously described clinical and pathological findings in Syrian hamsters and provide evidence for a pro-inflammatory macrophage response during PIRV infection. The liver was the principal target organ of the disease, and signs of Kupffer cell involvement were identified in mortally infected hamster histopathology data. Differential expression analysis of liver mRNA revealed signatures of the pro-inflammatory response, hematologic dysregulation, interferon pathway and other host response pathways, including 17 key transcripts that were also reported in two non-human primate (NHP) arenavirus liver-infection models, representing both Old and New World mammarenavirus infections. Although antigen presentation may differ among rodent and NHP species, key hemostatic and innate immune-response components showed expression parallels. Signatures of pro-inflammatory macrophage involvement in PIRV-infected livers included enrichment of Ifng, Nfkb2, Stat1, Irf1, Klf6, Il1b, Cxcl10, and Cxcl11 transcripts. Together, these data indicate that pro-inflammatory macrophage M1 responses likely contribute to the pathogenesis of acute PIRV infection.

Life stress and symptoms of anxiety and depression in women after cancer: The mediating effect of stress appraisal and coping.

OBJECTIVE: This paper examines the direct and intermediary relationships between life stress, stress appraisal, and resilience, and increased anxiety and depressive symptoms in Australian women after cancer treatment. METHODS: Data examined from 278 women aged 18 years and older previously treated for breast, gynaecological, or blood cancer, participating in the Australian Women's Wellness after Cancer Program. Serial mediation models interrogated the effect of stressful life events (List of Threatening Experiences-Modified) mediated by appraisal and coping (Perceived Stress Scale and Connor-Davidson Resilience Scale), on symptoms of anxiety and depression (Zung Self-rating Anxiety Scale and Center for Epidemiologic Studies Depression Scale). RESULTS: Over one-quarter (30.2%) of participants reported 1 or more stressful life events, other than their cancer, in the previous 6 months. Results indicate that perceived stress fully mediated the relationships between life stress, anxiety (indirect effect = 0.09, Bias-corrected bootstrap 95% CI 0.02-0.18, Percent mediation = 0.51), and depressive symptoms (indirect effect = 0.11, Bias-corrected bootstrap 95% CI 0.02-0.23, Percent mediation = 0.71) and accounted for more than half of the relationship between predictor and outcome. CONCLUSIONS: Findings indicate that stress appraisal mediated the relationship between past life stressors and anxiety and depressive symptoms. This analysis also highlights the need to consider wellness within a broader care context to identify potentially vulnerable patients to possibly avert future health concerns.

Exposure to stress across the life course and its association with anxiety and depressive symptoms: Results from the Australian Women's Wellness After Cancer Program (WWACP).

OBJECTIVES: Earlier life stressors can increase the risk of persistent anxiety and depressive symptoms in women after cancer, though our understanding of the underlying mechanisms is limited. In this study, we tested alternative life course models to determine which best described associations between exposure to stressors in childhood, adolescence, and adulthood, and self-reported health in women previously treated for breast, gynaecological, and blood cancer. STUDY DESIGN: Data were drawn from 351 Australian women within 2 years of completing active cancer treatment who were participating in the Women's Wellness After Cancer Program (WWACP) randomised controlled trial. A model-building framework compared "accumulative risk" and "sensitive period" stress exposure hypotheses with the saturated model to determine best fit. MAIN OUTCOME MEASURES: Symptoms of anxiety and depression were measured using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Zung Self-rating Anxiety Scale (SAS). RESULTS: Participants with the greatest number of stressful life events (SLEs) reported higher anxiety scores and more depressive symptoms. Alternative life course models for psychological distress (measured through the CES-D and SAS) and stress were compared with the saturated model (i.e., the accumulative risk). The more restrictive "sensitive period" models were the best fit for depressive symptoms though none was significantly better than another. In contrast, an "early sensitive" model provided the best fit for anxiety data. CONCLUSIONS: Anxiety scores were higher in women with early life stressors. This study highlights the need for whole-of-life supportive care approaches for women previously treated for cancer, which should include targeted strategies for effective management of stress, anxiety and depression.

Analysis of early mesothelial cell responses to Staphylococcus epidermidis isolated from patients with peritoneal dialysis-associated peritonitis.

The major complication of peritoneal dialysis (PD) is the development of peritonitis, an infection within the abdominal cavity, primarily caused by bacteria. PD peritonitis is associated with significant morbidity, mortality and health care costs. Staphylococcus epidermidis is the most frequently isolated cause of PD-associated peritonitis. Mesothelial cells are integral to the host response to peritonitis, and subsequent clinical outcomes, yet the effects of infection on mesothelial cells are not well characterised. We systematically investigated the early mesothelial cell response to clinical and reference isolates of S. epidermidis using primary mesothelial cells and the mesothelial cell line Met-5A. Using an unbiased whole genome microarray, followed by a targeted panel of genes known to be involved in the human antibacterial response, we identified 38 differentially regulated genes (adj. p-value < 0.05) representing 35 canonical pathways after 1 hour exposure to S. epidermidis. The top 3 canonical pathways were TNFR2 signaling, IL-17A signaling, and TNFR1 signaling (adj. p-values of 0.0012, 0.0012 and 0.0019, respectively). Subsequent qPCR validation confirmed significant differences in gene expression in a number of genes not previously described in mesothelial cell responses to infection, with heterogeneity observed between clinical isolates of S. epidermidis, and between Met-5A and primary mesothelial cells. Heterogeneity between different S. epidermidis isolates suggests that specific virulence factors may play critical roles in influencing outcomes from peritonitis. This study provides new insights into early mesothelial cell responses to infection with S. epidermidis, and confirms the importance of validating findings in primary mesothelial cells.