Systematic review of interventions by non-mental health specialists for managing fear of cancer recurrence in adult cancer survivors.

PURPOSE: Fear of cancer recurrence (FCR) affects 50-70% of cancer survivors. Evidence-based psychological interventions for FCR are effective but resource-/time-consuming. This systematic review identified interventions by non-mental health specialists addressing FCR, evidence of a relationship between specialist communication and FCR and stakeholder perspectives on how specialist communication can address FCR. METHODS: A systematic literature review was conducted using nine databases (Medline Ovid, EMBASE, Cochrane, CINAHL, Scopus, PsychINFO, Informit, Web of Science and Google Scholar). Included studies were English, published 1997-2018, on adult cancer patients examining 'fear'/'worry' and 'cancer recurrence'/'progression' and 'health communication'/'medical encounter'/'interventions'. Data was extracted, summarised and rated for quality by two authors. RESULTS: Of 6248 articles screened, 16 were included. No phase III randomised controlled trials were found. Five studies piloted an intervention, three were correlational studies, five were cross-sectional patient surveys and three were specialist surveys. Four out of five interventional studies were nurse-led: one trained patients in discussing FCR with their specialist while three delivered supportive counselling and/or taught strategies to manage FCR. The last intervention trained mixed health professionals to manage FCR through normalisation, education and lifestyle strategies. Three intervention studies measured FCR objectively, and two demonstrated a reduction in FCR in the short term. Consultation duration, empathy and clear information delivery were associated with FCR. Patients indicated desire to discuss FCR; however, specialists indicated discomfort with managing FCR. CONCLUSIONS: Research on non-mental health practitioner-led interventions to address FCR is lacking. Further studies on whether specialist interventions delivered during follow-up consultations are useful in managing FCR are required.

Retrospective Analysis of Patient Presentations at the Sydney (Australia) Royal Easter Show from 2012 to 2014.

Introduction Comprehensive studies on the relationship between patient demographics and subsequent treatment and disposition at a single mass-gathering event are lacking. The Sydney Royal Easter Show (SRES; Sydney Olympic Park, New South Wales, Australia) is an annual, 14-day, agricultural mass-gathering event occurring around the Easter weekend, attracting more than 800,000 patrons per year. In this study, patient records from the SRES were analyzed to examine relationships between weather, crowd size, day of week, and demographics on treatment and disposition. This information would help to predict factors affecting patient treatment and disposition to guide ongoing training of first responders and to evaluate the appropriateness of staffing skills mix at future events. Hypothesis Patient demographics, environmental factors, and attendance would influence the nature and severity of presentations at the SRES, which would influence staffing requirements. METHODS: A retrospective analysis of 4,141 patient record forms was performed for patients who presented to St John Ambulance (Australian Capital Territory, Australia) at the SRES between 2012 and 2014 inclusive. Presentation type was classified using a previously published minimum data set. Data on weather and crowd size were obtained from the Australian Bureau of Meteorology (Melbourne, Victoria, Australia) and the SRES, respectively. Statistical analyses were performed using SPSS v22 (IBM; Armonk, New York USA). RESULTS: Between 2012 to 2014, over 2.5 million people attended the SRES with 4,141 patients treated onsite. As expected, the majority of presentations were injuries (49%) and illnesses (46%). Although patient demographics and presentation types did not change over time, the duration of treatment increased. A higher proportion of patients were discharged to hospital or home compared to the proportion of patients discharged back to the event. Patients from rural/regional locations (accounting for 15% of all patients) were more likely to require advanced treatment, health professional review, and were more likely to be discharged to hospital or home rather than discharged back to the event. Extremes of temperature were associated with a lower crowd size and higher patient presentation rate (PPR), but had no impact on transfer or referral rates to hospital. CONCLUSION: This study demonstrated that analyses of patient presentations at an agricultural show provide unique insights on weather, attendance, and demographic features that correlated with treatment and disposition. These data can help guide organizers with information on how to better staff and train health care providers at future mass-gathering events of this type. Crabtree N , Mo S , Ong L , Jegathees T , Wei D , Fahey D , Liu J . Retrospective analysis of patient presentations at the Sydney (Australia) Royal Easter Show from 2012 to 2014. Prehosp Disaster Med. 2017;32(2)187-194.

Arrested Hematopoiesis and Vascular Relaxation Defects in Mice with a Mutation in Dhfr.

Dihydrofolate reductase (DHFR) is a critical enzyme in the folate metabolism pathway and also plays a role in regulating nitric oxide (NO) signaling in endothelial cells. Although both coding and noncoding mutations with phenotypic effects have been identified in the human DHFR gene, no mouse model is currently available to study the consequences of perturbing DHFR in vivo In order to identify genes involved in definitive hematopoiesis, we performed a forward genetic screen and produced a mouse line, here referred to as Orana, with a point mutation in the Dhfr locus leading to a Thr136Ala substitution in the DHFR protein. Homozygote Orana mice initiate definitive hematopoiesis, but expansion of progenitors in the fetal liver is compromised, and the animals die between embryonic day 13.5 (E13.5) and E14.5. Heterozygote Orana mice survive to adulthood but have tissue-specific alterations in folate abundance and distribution, perturbed stress erythropoiesis, and impaired endothelium-dependent relaxation of the aorta consistent with the role of DHFR in regulating NO signaling. Orana mice provide insight into the dual roles of DHFR and are a useful model for investigating the role of environmental and dietary factors in the context of vascular defects caused by altered NO signaling.

Folate and one-carbon metabolism and its impact on aberrant DNA methylation in cancer.

Folate is a methyl donor that plays an essential role in DNA synthesis and biological methylation reactions, including DNA methylation. Folate deficiency may be implicated in the development of genomic DNA hypomethylation, which is an early epigenetic event found in many cancers, particularly colorectal cancer (CRC). Numerous studies employing in vitro systems, animal models, and human interventional studies have tested this hypothesis. Here, we describe the role of folate as a methyl donor in the one-carbon metabolism cycle, and the consequences of cellular folate deficiency. The existing evidence on folate and its relationship to DNA methylation is discussed using CRC as an example. While there remain numerous technical challenges in this important field of research, changes to folate intake appear to be capable of modulating DNA methylation levels in the human colonic mucosa and this may potentially alter CRC risk.