The Canadian Forces' (CF) deployable hospital, 1 Canadian Field Hospital, was deployed to Haiti after an earthquake that caused massive devastation. Two surgical teams performed 167 operations over a 39-day period starting 17 days after the index event. Most operations were unrelated to the earthquake. Replacing or supplementing the destroyed local surgical capacity for a brief period after a disaster can be a valuable contribution to relief efforts. For future humanitarian operations/disaster response missions, the CF will study the feasibility of accelerating the deployment of surgical capabilities.
The Commission on the Future of Health Care in Canada asked whether Medicare is sustainable in its present form. Well, Medicare is not sustainable for at least six reasons. Given a long list of factors, such as Canada's changing dependency ratio, the phenomenon of diminishing returns from increased taxation, competing provincial expenditure needs, low labour and technological productivity in government-funded healthcare, the expectations held by baby boomers, and the evolving value sets of Canadians--Medicare will impoverish Canada within the next couple of decades if not seriously recast. As distasteful as parallel private-pay, private-choice healthcare may be to some policy makers and providers who grew up in the 1960s, the reality of the 2020s will dictate its necessity as a pragmatic solution to a systemic problem.
Abnormalities in lipid metabolism have been frequently observed in cancer and are associated with a poor prognosis. However, a detailed, longitudinal characterization of fatty acid status is lacking. This study aimed to assess plasma phospholipid fatty acids before chemotherapy, immediately after and 1 month following chemotherapy in a group of 50 patients newly diagnosed with lung cancer and explore factors which may contribute to aberrations in fatty acids. Their mean ± SD characteristics: age 64 ± 8.5 years, 75% advanced stage disease, body mass index 27.0 ± 5.4 kg/m², 6 month weight loss -4.6 ± 6.1%. Compared to patients with early stage disease, patients with advanced disease had abnormal fatty acid profiles including significantly lower (P
Child abuse and neglect is of growing concern in many American Indian and Alaska Native communities. The present paper represents one attempt to add to the existing, albeit sparse, knowledge base concerning the abuse and neglect of American Indian children. It reports the results of a survey of federal human service providers in which the subject of child abuse and neglect in Indian communities figured prominently. The study took place at several locations in Arizona and New Mexico. Data were obtained using the key-informant method from 55 federal service providers who identified 1,155 children, from birth to 21 years for inclusion in the survey. Children were included if they were currently in mental health treatment, if they were in need of mental health treatment, or if they were known to have been abused or neglected. Particular emphasis was given in the data collection to abuse- and neglect-related factors such as living arrangements, familial disruption, psychiatric symptoms, substance abuse, and school adjustment. The patterns evident in this sample closely resemble those trends identified among abused and/or neglected children in the general population. Sixty-seven percent of the sample was described as neglected or abused. The presence of abuse and/or neglect was strongly related to severe levels of chaos in the family. Children who were described as both abused and neglected had more psychiatric symptoms, greater frequency of having run away or been expelled, and greater frequency of drug use.
The use for hallucinogenic purposes of an indigenous mushroom, Psilocybe semilanceata indigenous to Britain is reported in three patients. Typical psychedelic, transient psychotic and more prolonged schizophrenia-like states were seen, with sympathomimetic signs noted in two cases, in one being prolonged. Enquiry about such mushroom abuse should be considered in individuals presenting to medical or psychiatric emergency clinics.
There is a high prevalence of smoking and physical inactivity among individuals with severe mental illness (SMI). The current study assessed the acceptability of introducing physical activity, including perceived advantages and disadvantages, as an adjunct to a smoking cessation service within this population.
109 participants with SMI who were receiving smoking cessation treatment completed a survey assessing perceived interest in physical activity and a 24-item decisional balance questionnaire reflecting potential advantages and disadvantages of becoming more physically active.
The majority of the participants reported being interested in assistance in becoming more active [63% (69/109)]. The highest rated advantages reported were 'It would improve my health or reduce my risk of disease' and 'It would improve how I feel about myself'. Cost, and being active by oneself were the most frequently reported barriers.
This study suggests that many individuals with SMI seeking treatment for smoking cessation may also be receptive to assistance in becoming more physically active. Such individuals endorse both advantages and disadvantages more frequently than those not interested.
This study provides preliminary support for the acceptability of adding physical activity as a smoking cessation strategy with SMI individuals. Addressing salient barriers will be critical to integrating physical activity within this smoking cessation service.
AIM: To describe the clinical spectrum of achiasmia, a congenital disorder of reduced relative decussation at the optic chiasm. METHODS: A retrospective case note and patient review of nine children (four boys). Achiasmia was defined by the combination of a characteristic asymmetry of the monocular visual evoked potential (VEP) response to flash and neuroimaging showing reduced chiasmal size. RESULTS: Three of the children had an associated skull base encephalocele with agenesis of the corpus callosum. In two patients achiasmia was associated with septo-optic dysplasia. Three patients had no neuroimaging abnormalities other than reduced chiasmal size and have no known pituitary dysfunction. One child had multiple physical deformities but the only brain imaging abnormality was reduced chiasmal size. CONCLUSIONS: Some children with disorders of midline central nervous system development, including septo-optic dysplasia and skull base encephaloceles, have congenitally reduced chiasmal decussation. Reduced relative decussation may co-exist with overall chiasmal hypoplasia. Children with an apparently isolated chiasmal decussation deficit may have other subtle neurological findings, but our clinical impression is that most of these children function well.
Erratum In: Br J Ophthalmol. 2006 Jan;90(1):125Jeffery, G [corrected to Jeffrey, G]; Liassis, A [corrected to Liasis, A]
The purpose of this study was to determine the prevalence of acute distress-that is, clinically significant posttraumatic stress symptoms (PTSS) and depression-and to identify predictors of each in a sample of people who witnessed a fatal aircraft collision at the 2005 Saskatchewan Centennial Air Show.
Air Show attendees (N = 157) were recruited by advertisements in the local media and completed an Internet-administered battery of questionnaires.
Based on previously established cut-offs, 22 percent respondents had clinically significant PTSS and 24 percent had clinically significant depressive symptoms. Clinically significant symptoms were associated with posttrauma impairment in social and occupational functioning. Acute distress was associated with several variables, including aspects of Air Show trauma exposure, severity of prior trauma exposure, low posttrauma social support (ie, negative responses by others), indices of poor coping (eg, intolerance of uncertainty, rumination about the trauma), and elevated scores on anxiety sensitivity, the personality trait of absorption, and dissociative tendencies.
Results suggest that clinically significant acute distress is common in the aftermath of witnessed trauma. The statistical predictors (correlates) of acute distress were generally consistent with the results of studies of other forms of trauma. People with elevated scores on theoretical vulnerability factors (eg, elevated anxiety sensitivity) were particularly likely to develop acute distress.
Advanced glycation end products (AGE) accumulate in human tissue proteins during aging, particularly under hyperglycemia conditions. AGEs induce oxidative stress and inflammation via the receptor for AGEs (RAGE) and soluble RAGE (sRAGE) can neutralize the effects mediated by RAGE-ligand engagement.
We examined the association between N(e)-(carboxymethyl)lysine (CML), a prominent AGE, and sRAGE and colorectal cancer risk in a prospective case-cohort study nested within a cancer prevention trial among 29,133 Finnish male smokers. Among study subjects who were alive without cancer 5 years after baseline (1985-1988), we identified 483 incident colorectal cancer cases and randomly sampled 485 subcohort participants as the comparison group with the follow-up to April 2006. Baseline serum levels of CML-AGE, sRAGE, glucose and insulin were determined. Weighted Cox proportional hazard regression models were used to calculate relative risks (RR) and 95% CI.
Comparing highest with lowest quintile of sRAGE, the RR for incident colorectal cancer was 0.65 (95% CI, 0.39-1.07; P(trend) = 0.03), adjusting for age, years of smoking, body mass index, and CML-AGE. Further adjustment for serum glucose strengthened the association (RR = 0.52; 95% CI, 0.30-0.89; P(trend) = 0.009). Highest quintile of CML-AGE was not associated with an increased risk of colorectal cancer (multivariate RR = 1.20; 95% CI, 0.64-2.26).
Higher prediagnostic levels of serum sRAGE were associated with lower risk of colorectal cancer in male smokers.
This is the first epidemiologic study to implicate the receptor for AGEs in colorectal cancer development.
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Cites: Ann N Y Acad Sci. 2005 Jun;1043:725-3316037299