An online Sexual Health and Rehabilitation eClinic (TrueNTH SHAReClinic) for prostate cancer patients: a feasibility study.

PURPOSE: The primary objective was to determine the feasibility of implementing the TrueNTH SHAReClinic as a pan-Canadian sexual health and rehabilitation intervention for patients treated for localized prostate cancer. METHODS: The feasibility study was designed to evaluate the accessibility and acceptability of the intervention. Participants from five institutions across Canada were enrolled to attend one pre-treatment and five follow-up online clinic visits over 1 year following their prostate cancer (PC) treatment. RESULTS: Sixty-five patients were enrolled in the intervention. Website analytics revealed that 71% completed the intervention in its entirety, including the educational modules, with an additional 10% completing more than half of the intervention. Five thousand eighty-three views of the educational modules were made along with 654 views of the health library items. Over 1500 messages were exchanged between participants and their sexual health coaches. At 12 months, the intervention received an overall average participant rating of 4.1 out of 5 on a single item satisfaction measure. CONCLUSION: Results support the TrueNTH SHAReClinic as highly acceptable to participants as defined by intervention adherence and engagement. The TrueNTH SHAReClinic demonstrated promise for being a feasible and potentially resource-efficient approach to effectively improving the sexual well-being of patients after PC treatment.

Bone without minerals and its secondary mineralization in Atlantic salmon (Salmo salar): the recovery from phosphorus deficiency.

Calcium and phosphorus (P) are the main bone minerals, and P deficiency can cause hypomineralized bones (osteomalacia) and malformations. This study used a P-deficient salmon model to falsify three hypotheses. First, an extended period of dietary P deficiency does not cause pathologies other than osteomalacia. Second, secondary mineralization of non-mineralized bone is possible. Third, secondary mineralization can restore the bones' mineral composition and mechanical properties. For 7 weeks, post-smolt Atlantic salmon (Salmo salar) received diets with regular P content (RP) or with a 50% lowered P content (LP). For additional 9 weeks, RP animals continued on the regular diet (RP-RP). LP animals continued on the LP diet (LP-LP), on a regular P diet (LP-RP) or on a high P diet (LP-HP). After 16 weeks, animals in all groups maintained a non-deformed vertebral column. LP-LP animals continued bone formation albeit without mineralization. Nine weeks of RP diet largely restored the mineral content and mechanical properties of vertebral bodies. Mineralization resumed deep inside the bone and away from osteoblasts. The history of P deficiency was traceable in LP-RP and LP-HP animals as a ring of low-mineralized bone in the vertebral body endplates, but no tissue alterations occurred that foreshadow vertebral body compression or fusion. Large quantities of non-mineralized salmon bone have the capacity to re-mineralize. If 16 weeks of P deficiency as a single factor is not causal for typical vertebral body malformations, other factors remain to be identified. This example of functional bone without minerals may explain why some teleost species can afford to have an extremely low mineralized skeleton.

Risk perception and psychological morbidity in men at elevated risk for prostate cancer.

OBJECTIVE: As prostate-specific antigen (psa) makes prostate cancer (pca) screening more accessible, more men are being identified with conditions that indicate high risk for developing pca, such as elevated psa and high-grade intraepithelial neoplasia (hgpin). In the present study, we assessed psychological well-being and risk perception in individuals with those high-risk conditions. METHODS: A questionnaire consisting of a psychological symptom survey, a trait risk-aversion survey, and a cancer-specific risk perception survey was administered to 168 patients with early-stage localized pca and 69 patients at high risk for pca (n = 16 hgpin, n = 53 psa > 4 ng/mL). Analysis of variance was used to examine differences in psychological well-being and appraisal of risk between the groups. RESULTS: Compared with the pca group, the high-risk group perceived their risk of dying from something other than pca to be significantly lower (p = 0.007). However, pca patients reported significantly more clinically important psychological symptoms. CONCLUSIONS: The identification of prostate conditions that predict progression to cancer might not result in the psychological symptoms commonly experienced by pca patients, but does appear to be related to a distorted perception of the disease's mortal risk. Patients with pca experience reduced psychological well-being, but better understand the risks of pca recurrence and death. Education on the risks and outcomes of pca can help at-risk men to view health assessments with reduced worry.

Enablers and barriers in delivery of a cancer exercise program: the Canadian experience.

BACKGROUND: Exercise is an important therapy to improve well-being after a cancer diagnosis. Accordingly, cancer-exercise programs have been developed to enhance clinical care; however, few programs exist in Canada. Expansion of cancer-exercise programming depends on an understanding of the process of program implementation, as well as enablers and barriers to program success. Gaining knowledge from current professionals in cancer-exercise programs could serve to facilitate the necessary understanding. METHODS: Key personnel from Canadian cancer-exercise programs (n = 14) participated in semistructured interviews about program development and delivery. RESULTS: Content analysis revealed 13 categories and 15 subcategories, which were grouped by three organizing domains: Program Implementation, Program Enablers, and Program Barriers. ■ Program Implementation (5 categories, 8 subcategories) included Program Initiation (clinical care extension, research project expansion, program champion), Funding, Participant Intake (avenues of awareness, health and safety assessment), Active Programming (monitoring patient exercise progress, health care practitioner involvement, program composition), and Discharge and Follow-up Plan.■ Program Enablers (4 categories, 4 subcategories) included Patient Participation (personalized care, supportive network, personal control, awareness of benefits), Partnerships, Advocacy and Support, and Program Characteristics.■ Program Barriers (4 categories, 3 subcategories) included Lack of Funding, Lack of Physician Support, Deterrents to Participation (fear and shame, program location, competing interests), and Disease Progression and Treatment. CONCLUSIONS: Interview results provided insight into the development and delivery of cancer-exercise programs in Canada and could be used to guide future program development and expansion in Canada.

Assessment of global proteome dynamics in carp: a model for investigating environmental stress.

Fish have to respond to a range of natural and man-made environmental stressors, which can lead to molecular changes within their tissues. Many studies focused on environmental stress in fish have examined the change in protein abundance or mRNA level. However, it is well-known that there is a disconnect between mRNA and protein expression. In order to bridge this gap, protein turnover must also be considered. We have developed an experimental strategy to determine the synthesis rates of individual proteins in the tissues of fish on a proteome-wide scale. This approach has been applied to the common carp ( Cyprinus carpio ), a key model species for investigating environmentally induced physiological plasticity. We have calculated the rates of protein synthesis for over a thousand individual proteins from the skeletal muscle and liver of carp. The median synthesis rate of proteins from liver was higher than that of skeletal muscle. The analysis further revealed that the same protein can have a different rate of synthesis depending on the tissue type. Our strategy permits a full investigation of proteome dynamics in fish and will have relevance to the fields of integrative biology and ecotoxicology.

Temperature sensitive regions of the Chinook salmon vertebral column: Vestiges and meristic variation.

Variation of vertebral centra numbers is common in vertebrates. Likewise, the number of associated elements such as ribs and neural and haemal arches can vary and affect all regions of the vertebral column. In mammals, only the number of cervical vertebrae is invariable. Variation of total vertebral centra numbers is well documented in teleost fish, often related to temperature. Less information is available about which part of the vertebral column and which associated elements are liable to variation. Here, variation in number of vertebral centra and associated elements is studied in Chinook salmon in six distinct anatomical regions. Animals are raised at 8 and 12°C to ask whether the vertebral centrum numbers, the pattern, and the frequency of variation in particular regions are temperature dependent. No significant difference concerning the total number of vertebrae was found, but regional differences occurred between the 8 and 12°C groups. Twelve specimens out of 60 of the 12°C group had three postcranial vertebrae compared to only one specimen in the 8°C group. The number of transitional vertebrae is significantly different in 8 and 12°C specimens. Fewer transitional vertebrae occur in more anterior positions in 8°C specimens. Most specimens of both temperature groups had two ural centra; however 17 specimens out of 60 of the 12°C group had up to five ural centra. Specimens of the 12°C group show more variation in the presence of the vestigial ribs associated with transitional vertebrae. Clearly, the postcranial, transitional, and ural regions are temperature sensitive. This study shows that nonsignificant differences in the total number of vertebrae can mask significant regional variation. Variation of vertebral numbers could be the consequence of loss or gain of vertebral centra and/or a change in the identity of the associated element on the vertebral centrum.

Alternative site self blood glucose testing is preferred by women with gestational diabetes.

BACKGROUND: Women with gestational diabetes (GDM) need to assimilate information and management skills rapidly for their diabetes to prevent adverse pregnancy outcomes. Strict glycaemic control is necessary and is improved by regular self-monitoring of blood glucose. The Softsense meter (MediSense Products, Witney, UK) is used on less sensitive body sites and combines lancing with testing. The study aim was to compare alternative site testing with traditional blood glucose monitoring in pregnancy. SUBJECTS AND METHODS: An open-label randomised crossover study using Softsense and Optium (MediSense Products) meters was performed in 33 women with GDM and 19 women with pre-existing diabetes. Each meter was used for 2 weeks. Ease of use and learning, pain, convenience, and effect on daily activities were assessed by a visual analogue questionnaire. RESULTS: Women with GDM found the Softsense less painful (P = 0.0001) and easier to use (P = 0.03). At the end of the study, 25 chose the Softsense meter in preference to the Optium meter for further testing (P = 0.0001). In contrast, women with pre-existing diabetes found the Optium significantly less messy, less disruptive, and easier to use outside the home. CONCLUSIONS: Women with GDM preferred the Softsense meter because of its ease of use and painlessness. Women with pre-existing diabetes found this meter less convenient, primarily because of its bulkiness.

The effect of bicycling on PSA levels: a systematic review and meta-analysis.

BACKGROUND: Recent literature has suggested that bicycling may be associated with increases in serum PSA levels, a diagnostic and prognostic marker for prostate cancer. To further investigate this relationship, we conducted a systematic review and meta-analysis of current literature in this field. METHODS: MEDLINE, CENTRAL, CINAHL and SPORTDiscus were searched using MeSH terms and keywords for English publications related to bicycle riding and PSA. Studies were included if PSA was measured relative to cycling activity in healthy men who were free of any prostatic condition. Case studies were excluded. RESULTS: Eight studies met our inclusion criteria, comprising 912 participants that engaged in, or self-reported, bicycling activity. Six studies investigated the acute pre-post change in PSA following bicycling activity that ranged from a single cycling bout of 15 min to a 4-day cycling event. Following cycling activity, two studies reported total PSA increased from baseline by up to 3.3-fold, free PSA increased in one study by 0.08±0.18 ng ml(-)(1) and did not change in four studies. One study compared PSA in elite/professional cyclists versus non-cyclists and demonstrated no significant difference in PSA measurements between groups. Data from six studies were meta-analyzed and demonstrated no significant increase in PSA associated with cycling from pre to post (mean change +0.027 ng ml(-)(1), s.e.m.=0.08, P=0.74, 95% confidence interval (CI)=-0.17-0.23). CONCLUSIONS: Our findings suggest that there is no effect of cycling on PSA; however, the limited number of trials and the absence of randomized controlled trials limit the interpretation of our results. Additionally, the median sample size only consisted of 42 subjects. Therefore, our study may have low statistical power to detect a difference in PSA. Although, a higher sample size may demonstrate statistical significance, it may not be clinically significant. Studies of higher empirical quality are needed.

Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis.

OBJECTIVE: To systematically review the evidence of pre-operative exercise, known as 'prehabilitation', on peri- and postoperative outcomes in adult surgical populations. DESIGN: Systematic review and meta-analysis. DATA SOURCES: CENTRAL, Medline, EMBASE, CINAHL, PsycINFO and PEDro were searched from 1950 to 2011. METHODS: Two reviewers independently examined relevant, English-language articles that examined the effects of pre-operative total-body exercise with peri- and postoperative outcome analysis. Given the nascence of this field, controlled and uncontrolled trials were included. Risk of bias was assessed using the Cochrane Risk of Bias Assessment tool. Only data on length of stay were considered eligible for meta-analysis due to the heterogeneity of measures and methodologies for assessing other outcomes. RESULTS: In total, 4597 citations were identified by the search strategy, of which 21 studies were included. Trials were generally small (median=54 participants) and of moderate to poor methodological quality. Compared with standard care, the majority of studies found that total-body prehabilitation improved postoperative pain, length of stay and physical function, but it was not consistently effective in improving health-related quality of life or aerobic fitness in the studies that examined these outcomes. The meta-analysis indicated that prehabilitation reduced postoperative length of stay with a small to moderate effect size (Hedges' g=-0.39, P=0.033). Intervention-related adverse events were reported in two of 669 exercising participants. CONCLUSION: The literature provides early evidence that prehabilitation may reduce length of stay and possibly provide postoperative physical benefits. Cautious interpretation of these findings is warranted given modest methodological quality and significant risk of bias.

Exercise in clinical cancer care: a call to action and program development description.

A large and convincing body of evidence demonstrates the benefits of exercise for cancer survivors during and after treatment. Based on that literature, more cancer survivors should be offered exercise support and programming. Unfortunately, exercise programs remain an exception rather than the norm in cancer care. Not surprisingly, common barriers to the implementation of exercise programs in oncology include limited resources, expertise, and awareness of benefits on the part of patients and clinicians. To improve the accessibility and cost-effectiveness of cancer exercise programs, one proposed strategy is to combine the resources of hospital and community-based programs with home-based exercise instruction. The present paper highlights current literature regarding exercise programming for cancer survivors, describes the development of an exercise program for cancer patients in Toronto, Canada, and offers experiential insights into the integration of exercise into oncologic care.

A proteomics strategy for determining the synthesis and degradation rates of individual proteins in fish.

In order to study the protein dynamics in the tissues of fish we have developed a proteomics-based strategy to determine the rates of synthesis and degradation of individual proteins. We have demonstrated the feasibility of this approach by measuring the turnover of multiple isoforms of parvalbumin (ß1-7) in the skeletal muscle of common carp (Cyprinus carpio). A stable isotope-labelled amino acid ([(2)H(7)] l-leucine) was administered to the carp via the diet and its incorporation into the isoforms of parvalbumin in muscle over time was monitored by LC-MS analysis of signature peptides. The relative isotope abundance was calculated and used to deconvolute the data. The ß7 parvalbumin isoform had a rate of synthesis that was greater than the rate of degradation. In contrast the rate of degradation of the ß5 isoform exceeded its rate of synthesis, whilst the analysis revealed that the other parvalbumin ß-isoforms (ß1, ß2, ß3, ß4 and ß6) had a rate of synthesis that was equal to the rate of degradation. This work has addressed a number of technical challenges and represents the first study to use proteomic approaches to measure the turnover of individual proteins in fish.

Effect of reduced dietary sodium on blood pressure: a meta-analysis of randomized controlled trials.

OBJECTIVE: - To ascertain whether restriction of dietary sodium lowers blood pressure in hypertensive and normotensive individuals. DATA SOURCES: - An English-language computerized literature search, restricted to human studies with Medical Subject Heading terms, "hypertension," "blood pressure," "vascular resistance," "sodium and dietary," "diet and sodium restricted," "sodium chloride," "clinical trial," "randomized controlled trial," and "prospective studies," was conducted. Bibliographies of review articles and personal files were also searched. TRIAL SELECTION: - Trials that had randomized allocation to control and dietary sodium intervention groups, monitored by timed sodium excretion, with outcome measures of both systolic and diastolic blood pressure were selected by blinded review of the methods section. DATA EXTRACTION: - Two observers extracted data independently, using purpose-designed forms, and discrepancies were resolved by discussion. DATA SYNTHESIS: - The 56 trials that met our inclusion criteria showed significant heterogeneity. Publication bias was also evident. The mean reduction (95% confidence interval) in daily urinary sodium excretion, a proxy measure of dietary sodium intake, was 95 mmol/d (71-119 mmol/d) in 28 trials with 1131 hypertensive subjects and 125 mmol/d (95-156 mmol/d) in 28 trials with 2374 normotensive subjects. After adjustment for measurement error of urinary sodium excretion, the decrease in blood pressure for a 100-mmol/d reduction in daily sodium excretion was 3.7 mm Hg (2.35-5.05 mm Hg) for systolic (P<.001) and 0.9 mm Hg (-0.13 to 1.85 mm Hg) for diastolic (P=.09) in the hypertensive trials, and 1.0 mm Hg (0.51-1.56 mm Hg) for systolic (P<.001) and 0.1 mm Hg (-0.32 to 0.51 mm Hg) for diastolic (P=.64) in the normotensive trials. Decreases in blood pressure were larger in trials of older hypertensive individuals and small and nonsignificant in trials of normotensive individuals whose meals were prepared and who lived outside the institutional setting. CONCLUSION: - Dietary sodium restriction for older hypertensive individuals might be considered, but the evidence in the normotensive population does not support current recommendations for universal dietary sodium restriction.

Statistical issues in a metaregression analysis of randomized trials: impact on the dietary sodium intake and blood pressure relationship.

In a meta-analysis of randomized trials of the effects of dietary sodium interventions on blood pressure, we found substantial heterogeneity among the studies. We were interested in evaluating whether measurement error, known to be a problem for dietary sodium measures, publication bias, or confounding factors could be responsible for the heterogeneity. A measurement error correction was developed that corrects both the slope and the intercept and takes into account the sample size of each study and the number of measurements taken on an individual. The measurement error correction had a minimal effect on the estimates, although it performed well in simulated data. A smoothed scatter plot was used to assess publication bias. Metaregressions provide a convenient way to jointly assess the effects of several factors, but care must be taken to fit an appropriate model.