Comparison of event and procedure rates following percutaneous transluminal coronary angioplasty in patients with and without previous coronary artery bypass graft surgery [the ROSETTA (Routine versus Selective Exercise Treadmill Testing after Angioplasty) Registry].
To compare 6-month post-percutaneous transluminal coronary angioplasty (PTCA) outcomes and cardiac procedure use among patients with and without prior coronary artery bypass graft (CABG) surgery, we examined 791 patients who were enrolled in the Routine versus Selective Exercise Treadmill Testing after Angioplasty (ROSETTA) Registry. The ROSETTA Registry is a prospective, multicenter registry that examines the use of functional testing after successful PTCA. Most patients were men (76%, mean age 61 +/- 11 years) who underwent single-vessel PTCA (85%) with stent implantation (58%). Baseline and procedural characteristics differed between patients with a prior CABG (n = 131) and patients with no prior CABG (n = 660), including Canadian Cardiovascular Society angina class III to IV (60% vs 49%, respectively, p = 0.03) and stenosis involving the proximal left anterior descending coronary artery (10% vs 22%, p = 0.004). Event rates among patients with prior CABG were higher than among patients with no prior CABG, including unstable angina (19% vs 11%, p = 0.02), myocardial infarction (2% vs 1%, p = 0.2), death (4% vs 2%, p = 0.08), and composite clinical events (22% vs 12%, p = 0.003). Furthermore, patients with prior CABG had higher rates of follow-up cardiac procedures, including angiography (24% vs 14%, p = 0.008) and PTCA (13% vs 7%, p = 0.04), but not repeat CABG (2% vs 3%, p = 0.8). A multivariate analysis that included baseline clinical and procedural characteristics demonstrated that prior CABG was a significant independent predictor of clinical events and cardiac procedure use (odds ratio 2.3, 95% confidence interval 1.5 to 3.5, p = 0.0001). Within the prior CABG group, patients with a PTCA of a bypass graft had a higher composite clinical event rate than patients with a PTCA of a native vessel (32% vs 17%, p = 0.05). In contrast, patients with a PTCA of a native vessel had event rates similar to those of patients with no prior CABG (17% vs 12%, p = 0.2). Thus, post-CABG patients have an increased risk of developing a cardiac event or needing a follow-up cardiac procedure during the 6 months after PTCA.
People who inject drugs (PWID) have worse health than non-injectors and are at heightened risk of incidents that necessitate hospital emergency department (ED) visits.
To describe ED visits by PWIDs in Melbourne, Australia, and compare reasons with those given in Vancouver, Canada.
In 2008-2010, 688 Melbourne PWIDs were interviewed about their ED visits; these data were contrasted with published data about ED visits by PWIDs in Vancouver.
Participants reported 132 ED visits in the month preceding interview--27.3% drug-related, 20.5% trauma-related (principally physical assault), 13.6% for psychiatric problems. Melbourne PWIDs are less likely to attend ED for soft-tissue injuries, and more likely to attend after physical assault than PWIDs in Vancouver.
PWID in Melbourne and Vancouver attend EDs for different reasons; information about PWID visits can help EDs cater for them and provide insights for prevention.
Suicide rates have widely been reported to peak in spring and summer. A frequent hypothesis is that increased sunlight exposure alters biological mechanisms. However, few attempts have been made to systematically untangle the putative suicidogenic risk of sunlight exposure from that of seasonality. We examined whether average hours of daily sunlight in a month confer additional risk over month of year when predicting monthly suicide rates.
We used 3 longitudinal studies (n=31,060 suicides) with monthly suicide and meteorological data from Greece (1992-2001), Victoria, Australia (1990-1998) and Norway (1969-2009).
We used a negative binomial regression to observe (1) the association of month of year with suicides, adjusting for different sunlight exposures, and (2) the association of sunlight exposure with suicides, adjusting for month of year. We then investigated claims that suicides were associated with daily sunlight exposures, defined by us as 2550 sunlight exposure combinations corresponding to a 1-50 days exposure window with lags of 0-50 days.
Using monthly data, the association between month of year and suicides remained after adjusting for mean daily hours of sunlight and change in the mean daily hours of sunlight. Adjusted for month of year, the associations between sunlight exposure and suicides became non-significant and attenuated towards the null (the coefficient estimate for mean daily hours of sunlight decreased in absolute magnitude by 72%). The findings were consistent across all 3 cohorts, both when analysed separately and combined. When investigating daily sunlight exposures, we found no significant results after correcting for multiple testing.
Using monthly data, the robustness of our month of year effects, combined with the transient and modest nature of our sunlight effects, suggested that the association between sunlight exposure and suicide was a proxy for the association between seasonality and suicide.
The city has become a defining feature of contemporary human experience, supporting diverse risk and enabling environments. Whilst urban risk environments have been the subject of numerous innovative research projects in recent years, the figure of the enabling environment is less well understood. This paper seeks to develop this figure through reference to recent scholarship in social theory, human geography and urban sociology.
This figure will be illustrated throughout with data drawn from various qualitative research projects conducted in Melbourne, Australia and Vancouver, Canada. This qualitative research highlights the array of enabling characteristics present in urban drug use contexts, characteristics that have yet to be fully explored in relation to the development of innovative settings-based harm reduction strategies.
This research draws attention to the ways particular urban settings support the development of affective and relational networks of "social repair" vital to the maintenance of health and wellbeing. These enabling characteristics serve to build social ties and enhance local networks; increase belonging and "connection to place"; and reinforce local "cultures of care". They also represent resources of enormous potential for harm reduction policy and practice.
Greater attention to the array of assets and opportunities present in urban settings offers fresh insights into the nature of enabling environments and their role in reducing drug related harms and facilitating healthy growth and development.
A full ophthalmic examination was performed on 40 Siberian husky dogs using direct and indirect ophthalmoscopy, gonloscopy and nasolacrimal cannulation. Eight (20%) of the dogs were found to have distichia, 10 (25%) had excessive medial caruncular hairs, 8 (20%) had absence, displacement, or narrowing of the nasolacrimal puncta, 2 (5%) had bilateral corneal crystalline opacities, and 2 (5%) had unilateral areas of lateral corneal lipidosis. Fifty percent of the dogs had some abnormality of the iridocorneal (drainage) angle. However, in only one of these was the deformity severe enough to require glaucoma prophylaxis. An association between blue iris colour and malformation of the iridocorneal angle was noted.
PURPOSE. To compare the characteristics of early cortical cataract localization in three groups in cataract epidemiologic surveys performed in Reykjavík, Melbourne, and Singapore. METHODS. Individuals who had right eyes with an area of cortical opacity less than 20% of the pupil when dilated 7 mm or more were selected as subjects. This included 197 subjects from the Reykjavík Eye Study, 231 from the Vitamin E, Cataract, and Age-Related Maculopathy (VECAT) study in Melbourne, and 92 from the Singapore-Japan Cooperative Cataract Study, all showing early-stage cataract in pupils dilated to 7 mm or more. Scheimpflug and retroilluminated photographs were used to locate opacities. Localization of cortical cataract was determined by dividing the retroillumination image into seven concentric circles with diameters of 1 through 7 mm, and eight sections of 45 degrees radial octants. The positive rate of opacification was then calculated for each quadrant. RESULTS. The highest positive rate of opacification was observed in the lower nasal quadrant in all groups. The relative risk of the prevalence of cortical opacity in the lower nasal oblique hemisphere to the upper temporal oblique hemisphere was the highest in the Singaporean subjects followed by those of Melbourne and then of Reykjavík. CONCLUSIONS. The prevalence of cortical cataract was higher in the lower nasal quadrant than in the other quadrants for all subjects of diverse race in three climatically different locations. This higher prevalence was most pronounced in subjects living at low latitude. These results support the view that solar UV exposure is a possible risk factor for development of human cortical cataract.
To document subtype-specific clinical features of lymphoma of the eyelid, and their effect on patient outcome.
Retrospective observational case series.
Patient data were collected from 7 international eye cancer centers from January 1, 1980 through December 31, 2015. The cases included primary and secondary lymphomas affecting the eyelid. Overall survival, disease-specific survival (DSS), and progression-free survival were the primary endpoints.
Eighty-six patients were included. Mean age was 63 years and 47 (55%) were male. Non-Hodgkin B-cell lymphomas constituted 83% (n?= 71) and T-cell lymphomas constituted 17% (n?= 15). The most common subtypes were extranodal marginal-zone lymphoma (EMZL) (37% [n?= 32]), follicular lymphoma (FL) (23% [n?= 20]), diffuse large B-cell lymphoma (DLBCL) (10% [n?= 9]), mantle cell lymphoma (MCL) (8% [n?= 7]), and mycosis fungoides (MF) (9% [n?= 8]). EMZL had a female predilection (69% [22 of 32]), whereas MCL (71% [5 of 7]) and?MF (88% [7 of 8]) had a male predominance. MCL (57% [4 of 7]), DLBCL (56% [5 of 9]), and MF (88% [7 of 8]) were frequently secondary lymphomas. Localized EMZL and FL were mostly treated with external beam radiation therapy, whereas DLBCL, MCL, and high Ann Arbor stage EMZL and FL were frequently treated with chemotherapy. DLBCL and MCL had a poor prognosis (5-year DSS, 21% and 50%, respectively), whereas EMZL, FL, and MF had a good prognosis (5-year DSS, 88%, 88% and 86%, respectively).
Lymphoma of the eyelid consists mainly of the lymphoma subtypes EMZL, FL, DLBCL, MCL, and MF. High-grade DLBCL and MCL, as well as MF, are frequently secondary eyelid lymphomas. The main predictor of outcome was the histologic subtype: EMZL, FL, and MF had a significantly better prognosis than MCL and DLBCL.
To determine the risk factors associated with early repeat workers' compensation claims in Victoria, Australia and to compare our findings with those of a study on the Alberta's Workers' Compensation Board (WCB) in Canada.
We reviewed and described 178,630 claims from 1996-2009. Both persons with single and persons with multiple claims were included. Survival analysis was used to determine the impact of socio-demographic factors on the time between claims.
A total of 37% of persons with an initial claim lodged a second claim. A reduced time to a second claim was observed in younger males in the manufacturing industry. Earlier second claims were more common in workers exposed to mental stress, sound and pressure, or chemical and other substances. These findings are similar to those of WCB Alberta.
There is a potential to reduce the socio-economic burden of workplace injury in both jurisdictions by enacting prevention programs targeted at workers with an increased risk of repeat claims.
Simultaneous multiple intracerebral hemorrhages (SMICHs) are uncommon. Few single-center studies have analyzed characteristics and outcome of SMICH. We analyzed clinical characteristics and outcome of SMICH patients from 2 comprehensive stroke centers.
Baseline imaging from consecutive intracerebral hemorrhage (ICH) patients (n=1552) from Helsinki ICH study and Royal Melbourne Hospital ICH study was screened for SMICH. ICH pathogenesis was classified according to the structural lesion, medication, amyloid angiopathy, systemic/other disease, hypertension, undetermined classification system (SMASH-U). ICH caused by trauma, tumor, and aneurysmal rupture was excluded. Baseline clinical and radiological characteristics and 90-day mortality were compared between SMICH and single ICH patients. Association of SMICH with 90-day mortality was assessed in multivariable logistic regression models adjusted for predictors of ICH outcome.
Of 1452 patients, 85 (5.9%) were classified as SMICH. SMICH were more often female (58% versus 42%; P=0.004), had lower baseline Glasgow Coma Scale (12 versus 14; P=0.008), and more frequent lobar location (59% versus 34%; P