Love, faith and hope - a secondary analysis of prostate cancer survivors and their partners.

BACKGROUND: Men's experience of recovery from treatment for prostate cancer has been extensively researched with reports highlighting the physical side effects of treatments such as erectile dysfunction and incontinence. The psychological, emotional and spiritual burden of prostate cancer on men and their partners has received far less attention. DESIGN: In this study, a secondary thematic analysis of data from a series of separate but related qualitative studies with prostate cancer survivors and their partners was conducted to further explore themes of love, hope and faith within this population. RESULTS: This study identified unresolved needs related to the emotive concepts of love, hope and faith. The findings from this study can be employed to refine psychosocial assessments of men with prostate cancer, and provide a more comprehensive understanding of prostate cancer survivors supportive care needs.

Survival of bacteria on the ocular surface following double application of povidone-iodine before cataract surgery.

AIMS: This study assessed the effectiveness of one vs two applications of povidone-iodine in decontaminating the eye before cataract surgery. METHODS: This was a prospective, interventional study of 52 patients having elective unilateral phacoemulsification cataract surgery in a tertiary care centre. Each patient had two applications of povidone-iodine before phacoemulsification cataract surgery, separated by 10 min. Conjunctival swabs were taken before and after each application and cultured in 5% CO(2) and anaerobically. Statistical analysis was performed using McNemar's test for correlated proportions. RESULTS: In all, 15 of 52 (29%) patients had positive cultures before the first application and 21 of 52 (40%) patients had positive cultures after it. This was not statistically significant (P=0.239). A total of 25 of 52 (48%) patients were culture positive before the second application. This was not statistically significantly different from 10 min earlier (P=0.423). Six of 52 (12%) patients were positive after the second application (P<0.001). CONCLUSIONS: We conclude that the initial application of povidone-iodine was not effective in decontaminating the eye. Recontamination did not take place between applications. The difference in the proportion of patients with positive results before and after the second application of povidone-iodine was statistically significant. We infer from this that double application of povidone-iodine before cataract surgery is advisable.

Tumour-infiltrating lymphocytes and survival in patients with adenocarcinoma of the oesophagus.

INTRODUCTION: Tumor-infiltrating lymphocytes (TILs) and forkhead box transcription factor positive (FoxP3(+)) regulatory T-lymphocytes (TREGs) have been analyzed in a variety of tumors but not in oesophageal adenocarcinoma. PATIENTS AND METHODS: Tissue from 130 adenocarcinomas of the oesophagus was re-evaluated in the centre and periphery of tumour, respectively, using immunohistochemical staining with anti-CD3, anti-CD4, anti-CD8, anti-CD25 and anti-FoxP3 antibodies. Patients were stratified according neoadjuvant treatment. 106 patients proceeded directly to surgery and 24 underwent pre-operative radio-chemotherapy (RCT). RESULTS: In patients without RCT, TILs were found significantly more frequently in the periphery with the exception of CD25(+) cells. Patients with centrally low counts of FoxP3(+) TREGs had higher tumour stages than patients with high counts (p < 0.011). The number of FoxP3(+) TREGs was significantly associated with the number of CD8(+) cells (centre: p < 0.001, periphery: p = 0.002). The multivariate regression analysis identified UICC stage (IIB/III vs. I/IIA, hazard ratio 2.6, p = 0.011) and completeness of resection (no vs. yes, hazard ratio 2.3, p = 0.015) as independent predictors of survival. RCT significantly reduced the number of TREGs in the centre (p = 0.016) but not the number of the other TILs. CONCLUSION: UICC stage and completeness of resection but none of the TILs were prognostic markers for long-term survival. We found no morphologic evidence that TREGs suppress immunological response, represented by the infiltration of CD8(+) cells. Preoperative RCT affected the centre of tumours more than the periphery, which may indicate that it does not inhibit the host-to-tumour reaction. RCT affects TREGs more than the other TILs.

Risk prediction scores for postoperative mortality after esophagectomy: validation of different models.

BACKGROUND: Different prediction models for operative mortality after esophagectomy have been developed. The aim of this study is to independently validate prediction models from Philadelphia, Rotterdam, Munich, and the ASA. METHODS: The scores were validated using logistic regression models in two cohorts of patients undergoing esophagectomy for cancer from Switzerland (n = 170) and Australia (n = 176). RESULTS: All scores except ASA were significantly higher in the Australian cohort. There was no significant difference in 30-day mortality or in-hospital death between groups. The Philadelphia and Rotterdam scores had a significant predictive value for 30-day mortality (p = 0.001) and in-hospital death (p = 0.003) in the pooled cohort, but only the Philadelphia score had a significant prediction value for 30-day mortality in both cohorts. Neither score showed any predictive value for in-hospital death in Australians but were highly significant in the Swiss cohort. ASA showed only a significant predictive value for 30-day mortality in the Swiss. For in-hospital death, ASA was a significant predictor in the pooled and Swiss cohorts. The Munich score did not have any significant predictive value whatsoever. CONCLUSION: None of the scores can be applied generally. A better overall predictive score or specific prediction scores for each country should be developed.

Superficial heat or cold for low back pain.

BACKGROUND: Heat and cold are commonly utilised in the treatment of low-back pain by both health care professionals and people with low-back pain. OBJECTIVES: To assess the effects of superficial heat and cold therapy for low-back pain in adults. SEARCH STRATEGY: We searched the Cochrane Back Review Group Specialised register, the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to October 2005), EMBASE (1980 to October 2005) and other relevant databases. SELECTION CRITERIA: We included randomised controlled trials and non-randomised controlled trials that examined superficial heat or cold therapies in people with low-back pain. DATA COLLECTION AND ANALYSIS: Two authors independently assessed methodological quality and extracted data, using the criteria recommended by the Cochrane Back Review Group. MAIN RESULTS: Nine trials involving 1117 participants were included. In two trials of 258 participants with a mix of acute and sub-acute low-back pain, heat wrap therapy significantly reduced pain after five days (weighted mean difference (WMD) 1.06, 95% confidence interval (CI) 0.68 to 1.45, scale range 0 to 5) compared to oral placebo. One trial of 90 participants with acute low-back pain found that a heated blanket significantly decreased acute low-back pain immediately after application (WMD -32.20, 95%CI -38.69 to -25.71, scale range 0 to 100). One trial of 100 participants with a mix of acute and sub-acute low-back pain examined the additional effects of adding exercise to heat wrap, and found that it reduced pain after seven days. There is insufficient evidence to evaluate the effects of cold for low-back pain, and conflicting evidence for any differences between heat and cold for low-back pain. AUTHORS' CONCLUSIONS: The evidence base to support the common practice of superficial heat and cold for low back pain is limited and there is a need for future higher-quality randomised controlled trials. There is moderate evidence in a small number of trials that heat wrap therapy provides a small short-term reduction in pain and disability in a population with a mix of acute and sub-acute low-back pain, and that the addition of exercise further reduces pain and improves function. The evidence for the application of cold treatment to low-back pain is even more limited, with only three poor quality studies located. No conclusions can be drawn about the use of cold for low-back pain. There is conflicting evidence to determine the differences between heat and cold for low-back pain.

Randomized controlled trial of alendronate in airways disease and low bone mineral density.

BACKGROUND: Patients with airways disease have been demonstrated to be at risk of osteoporosis, and this is likely to be multifactorial. Our aim was to identify patients with low bone mineral density (BMD) using a screening program, and then evaluate the benefit of daily alendronate. METHOD: Subjects with hip or lumbar spine baseline T-scores < - 2.5, or Z-score < - 1.0 commenced on alendronate/calcium (10 mg/600 mg day) or placebo/calcium, in a double blind randomized controlled trial. BMD by dual emission X-ray absorptiometry (lumbar vertebrae 2-4, neck of femur, total femur) was repeated after 12 months, with adverse events recorded. RESULTS: 145 subjects (74 male, 71 female, mean age 67, median FEV1 1.0 litres = 43% of predicted) were enrolled; 66 alendronate/calcium, 79 placebo/calcium with 24 and 26 withdrawals, respectively. Per protocol but not intention to treat analysis of covariance demonstrated statistically significant improvements in T and Z scores for lumbar spine bone mineral density (P = 0.035, P = 0.040), with no improvement demonstrated at the hip. CONCLUSIONS: Improvement in bone mineral density has been demonstrated at the lumbar spine, but not hip, by per protocol analysis, with daily alendronate, at 12 months.

Impact on readmission rates and mortality of a chronic obstructive pulmonary disease inpatient management guideline.

AIMS: Chronic obstructive pulmonary disease (COPD) is a common condition associated with considerable morbidity, mortality and hospital admissions. However, published COPD management guidelines have major limitations and lack practical summaries. We aimed to optimally develop, implement, and evaluate a multidisciplinary COPD inpatient management 'ACCORD' guideline, including prompts for comprehensive day one assessments through to a discharge criteria checklist. METHOD: Two intervention and two control public teaching hospitals in Adelaide, South Australia, took part, with pre-intervention (721 COPD admissions over 7 months) and intervention phases (509 COPD admissions over 7 months). During the intervention stage the ACCORD guideline was placed in the case notes on the day of admission or soon after. Readmissions were categorized as either emergency or elective and compared between the study arms, as were mortality and potential confounders (age, gender, number of comorbidities), with Poisson regression analysis. RESULTS: Of case notes of eligible COPD patients, 60% had the ACCORD guideline placed, of which 76% had evidence of use as judged by completion of guideline entry and tick boxes. The ACCORD guideline was associated with an increase in elective admissions and a reduction in emergency admissions in the intervention group in relation to the control group (P < 0.01), with no difference in overall admissions or death rates. CONCLUSIONS: The ACCORD guideline was associated with a shift from emergency admissions to more planned elective care, suggesting more proactive care of health problems, but without overall reduction in admissions.

Effect of caesarean section on breast milk transfer to the normal term newborn over the first week of life.

OBJECTIVE: To determine the effect of caesarean section on breast milk transfer (BMT) to the normal term infant over the first week of life. METHOD: A sample of 88 healthy nursing mothers who had a normal vaginal delivery, and 97 mothers who had a caesarean section were recruited from a teaching hospital. Mothers and midwives were instructed to weigh the infants before and after each feed throughout the study period using calibrated portable electronic scales. RESULTS: The volume of milk transferred to infants born by caesarean section was significantly less than that transferred to infants born by normal vaginal delivery on days 2 to 5 (p < 0.05), but by day 6 there was no difference between the two groups (p = 0.08). The difference could not be explained by any of the maternal and infant variables measured. Birth weight was regained by day 6 in 40% of infants born vaginally compared with 20% in those born by caesarean section. CONCLUSION: There is a lag in the profile of the daily volume of breast milk transferred to infants delivered by caesarean section compared with those born by normal vaginal delivery. This study also challenges the widely followed schedules of milk volumes considered to be suitable for the term infant, which appear to be excessive, at least for the first four to five days post partum.

Changes in airborne lead particulate in port pirie, South Australia, 1986-1996.

Port Pirie is 230 km north of Adelaide, the capital of South Australia. The major industry in the city is a lead smelter owned by Pasminco. Fume, dust, and fugitive emissions from the smelter have been deposited in and around Port Pirie over the past 100 years. The results presented in this paper are from an air monitoring station situated at the southeast entrance of the smelter, approximately 600 m from the blast furnace. Measurements include total suspended particulate (TSP) and total suspended particulate lead (TSPL) reported as concentrations (microgram/m3). Data are available from 1986 to 1996 and consist of 548 measurements. Analysis of geometric mean concentration levels by wind direction showed that while for TSP there was little relationship with wind direction, TSPL increased substantially as the wind came from the direction of the smelter. An analysis of geometric mean concentration levels by wind speed showed that TSP was significantly correlated with wind speed for all wind sectors apart from winds coming from the smelter production area. The lack of correlation between TSP and wind speed when the wind blows from the direction of the smelter is probably due to the dilution effect of particulate from a point source as wind speed increases. TSPL was significantly correlated with wind speed for all wind sectors apart from winds coming from the city. As expected, both TSP and TSPL concentrations were significantly lower on days when rain fell. Both mean geometric TSP and TSPL concentrations were lower in the period 1993-1996 than in 1986-1992. Multiple linear regression analysis was used to demonstrate that this decline was statistically significant after adjusting for weather conditions. Wind directions were divided into four sectors: winds from the smelter production area; winds from the smelter nonproduction area; winds from the zinc wharf and east of the city; and winds from the city. Structural equation models for each sector were used to demonstrate that the decline in geometric mean TSPL concentrations over the two periods were of a similar order of magnitude for all four sectors. The relevance of this to the lead abatement programs that have been undertaken both within the city of Port Pirie and inside the smelter itself is discussed.

Murray River water, raised cyanobacterial cell counts, and gastrointestinal and dermatological symptoms.

OBJECTIVE: To investigate whether exposure to Murray River and allied water sources during a period of raised cyanobacterial cell counts was associated with gastrointestinal and dermatological symptoms. DESIGN: A case-control study selecting gastrointestinal and dermatological cases and controls from subjects attending 21 general practitioners in eight Murray River towns. The association between the proportion of consultations for such symptoms and mean log cyanobacterial count was also examined. SUBJECTS: 102 gastrointestinal cases, 86 dermatological cases and 132 controls. MAIN OUTCOME MEASURE: The relative odds of gastrointestinal and dermatological symptoms, respectively, as opposed to no such symptoms, according to water-contact history during the week preceding the medical consultation. RESULTS: After adjusting for concurrent risk factors, subjects drinking chlorinated river water rather than rain water had a raised risk of gastrointestinal symptoms (P = 0.008), and those using untreated river water for domestic purposes rather than rain water had a raised risk of gastrointestinal (P = 0.034) and of dermatological (P = 0.048) symptoms. The proportion of consultations for gastrointestinal and dermatological symptoms correlated on a weekly basis with the mean log cyanobacterial cell count, although statistical significance was not achieved for the correlation with dermatological consultations or for separate reaches of the river. CONCLUSIONS: The raised risks of gastrointestinal and dermatological symptoms in those using Murray River water for drinking and other domestic purposes are consistent with causal relationships. However, the evidence for adverse health effects is, at best, only suggestive. Further research is indicated.

Trends in prognostic factors of melanoma in South Australia, 1981-1992: implications for health promotion.

OBJECTIVE: To analyse trends in prognostic factors at diagnosis of melanoma to indicate targets for health promotion. METHODS: Cases of melanoma notified to the South Australian Cancer Registry during 1981-1992 (1361 in situ and 4509 invasive) were analysed by tumour site, histological type, stage, thickness, period of diagnosis and sociodemographic characteristics of the patient. RESULTS: The relative probability of being diagnosed with an in-situ, rather than a thin invasive, lesion increased progressively between 1984-1986 and 1990-1992. The relative probability of having an in-situ melanoma diagnosed was: lower among those aged 80 years or more; higher among patients residing in the upper socioeconomic areas of Adelaide; high for lesions on the face; and high for lentigo maligna as opposed to superficial spreading lesions. The relative probability of invasive lesions being diagnosed when more than 1.5 mm thick decreased progressively between the 1981-1983 and 1990-1992 diagnosis periods. The relative probability of thick lesions being diagnosed was higher among older patients and for nodular lesions compared with superficial spreading or lentigo maligna lesions. Facial lesions and those in males tended to be thicker. CONCLUSIONS: There are favourable trends towards earlier detection of melanomas in South Australia, probably reflecting the effect of skin-cancer awareness campaigns. Further campaigns should emphasise early detection in people aged 60 years and over, males and residents of less affluent areas. Early detection of nodular melanomas and invasive lesions of the face also warrants special attention.

South Australian hypertension survey. General practitioner experiences with drug treatment.

OBJECTIVE: To investigate prescribing habits, educational approaches and perceived needs of general practitioners in the drug treatment of hypertension. DESIGN, SETTING AND PARTICIPANTS: Of 156 randomly selected South Australian general practitioners 132 responded to a questionnaire survey. MAIN FINDINGS: Diuretics are the most commonly chosen drug for the initial management of uncomplicated moderate hypertension. Equivalent patients aged 45, 60 and 75 years would be prescribed a diuretic as drug of first choice in 41%, 55% and 68% of cases respectively. Despite this, there are wide differences in the choice of initial therapy between individual practitioners. These differences can have a substantial cost impact, given that in Australia the cost of diuretic therapy for one month can be as low as $1.97 compared with $34.08 for standard angiotensin converting enzyme inhibitor therapy for one month. There was also a perceived need, and demand, for patient education materials to assist practitioners in the drug treatment of hypertension.

South Australian hypertension survey. General practitioner knowledge and reported management practices--a cause for concern?

OBJECTIVE: To survey South Australian general practitioners to investigate their knowledge and reported management of patients with hypertension. DESIGN, SETTING AND PARTICIPANTS: Of 156 randomly selected SA general practitioners 132 responded to a questionnaire survey. RESULTS: This survey showed substantial differences between general practitioners in their knowledge about hypertension and in their reported practices for diagnostic levels, investigations to be undertaken once diagnosis had been made, levels at which pharmaceutical treatment should be initiated, at which level treatment was regarded as having attained satisfactory control, and length of time for routine review. There was also a demand for materials to be provided to assist in the management of this important condition. CONCLUSIONS: There is a perceived need for better and more appropriate educational materials and a need for a different approach to try and reduce the reported variability in management of patients with hypertension by general practitioners.

Acute heart failure: determinants of outcome.

We prospectively studied 69 consecutive patients hospitalized with a primary diagnosis of acute left ventricular failure so as to assess the impact of vasodilators on incidence and morbidity of acute symptomatic left ventricular failure. The determinants of duration of hospitalization, in-hospital mortality and symptomatic status 2 months after discharge were examined. There were 9 in-hospital deaths (13%), and survival at 60 days was 77%. Median duration of hospitalization was 9 days, and 33% of the surviving patients remained in New York Heart Association functional class III-IV 60 days subsequent to discharge. Of the patients, 49 (76%) had previously received treatment for left ventricular failure: 30 (61%) of these had received vasodilators, most commonly angiotensin converting enzyme inhibitors and nitrates. Ischaemic chest pain was present in 34 (49%) of the patients. Acute utilization of vasodilators (45% of patients) was largely limited to nitrate therapy associated with ischaemic chest pain (P less than 0.01). Multiple logistic regression revealed previous left ventricular failure, advanced age and hypokalaemia as significant correlates of prolonged hospitalization (greater than 9 days). Previous left ventricular failure was also predictive of persistent severe disability two months subsequent to discharge. No factor was a significant predictor of in-hospital death. Although preceding treatment with digoxin and incremental angiotensin converting enzyme inhibitor therapy tended to predict brief hospitalization, the parameter of acute ischaemia, other biochemical anomalies and modes of acute or chronic therapy were not significant correlates of any end point. We conclude that preceding disability, rather than mode of treatment, predicts an adverse outcome in acute left ventricular failure.

"Sick of Smoking": evaluation of a targeted minimal smoking cessation intervention in general practice.

Several smoking intervention studies have been conducted overseas which use a minimal amount of general practitioners' time and are conducted within the constraints of a normal consultation. However, there are no published reports of minimal interventions in Australian general practice. This study reports on 1238 South Australian smokers who were assigned to a non-intervention control group or a group which received firm general practitioner advice to quit smoking plus literature. At one-year follow-up, 7.5% of smokers in the minimal advice group who had quit for six or more months remained non-smokers compared with 3.2% in the control group. If similar analytical procedures had been used in this study as were used in the benchmark study in England in 1979, the quit rate for this study would have been 11.3% in the intervention group, and 4.8% in the control group--a net gain of 6.5%. These results are discussed with regard to widespread implementation in Australian general practice.

Are general practitioners in favour of quality assurance?

A survey of established general practitioners in New South Wales and South Australia and of Family Medicine Programme trainees in South Australia was undertaken to investigate their attitudes towards a general practice based Quality Assurance Programme. Broad support for such a programme was found and was strongest among younger practitioners; those who had, or were undertaking, FMP training, those belonging to the RACGP; and those who hold the DipObstRACOG.

Ultralow volume application of organophosphate concentrate in grain terminals: a new occupational health hazard.

The introduction of ultralow volume (ULV) application of the organophosphate pesticide Fenitrothion in grain terminals presents a risk to workers of skin contact with concentrate. Blood testing, by the Ellman method, of a group of five grain terminal workers working on grain treatment showed a lowering of mean red blood cell cholinesterase (RBC ChE) activity to 23 units/gm Hb (normal value 28-40) with a range of 16-29. The probable cause was identified as percutaneous absorption of Fenitrothion concentrate by workers using ungloved hands to clean blocked drip feed nozzles. Modification of work practices was followed by a rise of mean RBC ChE to 33.6 units/gm Hb (range 32-36) during the following grain treatment season. RBC ChE activity measured during the intervening winter season--that is, a non-exposure period--showed a mean of 33.3 units/gm Hb (range 23-40).

Blood lead levels in children in the north-west of Adelaide.

Capillary blood lead levels were investigated in a sample of 513 children of preschool age who were drawn from an industrial working-class region of Adelaide. The geometric mean lead level was 16.3 micrograms/dL. Fourteen children (2.7%) had a blood lead level of at least 30 micrograms/dL, which is designated by the National Health and Medical Research Council as "the level of concern". Boys tended to have higher lead levels than did girls, and children who lived closer to the inner city generally had higher levels than did those who lived further away. Compared with most other Australian findings, the blood lead levels in this study tended to be high. We suspect that the age groups that were studied, and the industrial urban quality of the region that was included, would have had an important bearing on this finding. However, the proportion of children with elevated lead levels in this study did not seem high when compared with US data for children in a comparable age range.