Medicine and Health Sciences Commons^™

Stem Cell Matching For Patients Of Mixed Race, Ted C. Bergstrom

Ted C Bergstrom

Patients with leukemia and other blood diseases stand a good chance of recovery and a return to normal life if they receive a stem cell transplant from a living donor. In the absence of a transplant, their survival prospects are grim. For a transplant to be successful, the human leukocyte antigens (HLA) of the donor and recipient must be a close genetic match. To facilitate non-sibling matches, the developed nations of the world have set up national volunteer registries. The larges such registry is the NMDP (National Marrow Donor Program). We estimate the distribution of HLA types for individuals of …

Corticosteroids For Pain Relief In Sore Throat: Systematic Review And Meta-Analysis, Gail Hayward, Matthew J. Thompson, Carl J. Heneghan, Rafael Perera, Paul P. Glasziou, Chris B. Del Mar

Christopher Del Mar

Objective: To evaluate whether systemic corticosteroids improve symptoms of sore throat in adults and children. Design: Systematic review and meta-analysis. Data sources: Cochrane Central, Medline, Embase, Database of Reviews of Effectiveness (DARE), NHS Health Economics Database, and bibliographies. Outcome measures: Percentage of patients with complete resolution at 24 and 48 hours, mean time to onset of pain relief, mean time to complete resolution of symptoms, days missed from work or school, recurrence, and adverse events. Results: We included eight trials, consisting of 743 patients in total (369 children, 374 adults). 348 (47%) had exudative sore throat, and 330 (44%) were …

Neuraminidase Inhibitors For Preventing And Treating Influenza In Healthy Adults: Systematic Review And Meta-Analysis, Tom Jefferson, Mark Jones, Peter Doshi, Chris Del Mar

Christopher Del Mar

Objectives: To update a 2005 Cochrane review that assessed the effects of neuraminidase inhibitors in preventing or ameliorating the symptoms of influenza, the transmission of influenza, and complications from influenza in healthy adults, and to estimate the frequency of adverse effects. Search strategy: An updated search of the Cochrane central register of controlled trials (Cochrane Library 2009, issue 2), which contains the Acute Respiratory Infections Group’s specialised register, Medline (1950-Aug 2009), Embase (1980-Aug 2009), and post-marketing pharmacovigilance data and comparative safety cohorts. Selection criteria: Randomised placebo controlled studies of neuraminidase inhibitors in otherwise healthy adults exposed to naturally occurring influenza. …

Transparent Development Of The Who Rapid Advice Guidelines, Holger J. Schunemann, Suzanne R. Hill, Meetali Kakad, Gunn E. Vist, Richard Bellamy, Lauren Stockman, Torbjorn Fosen Wisloff, Chris Del Mar, Frederick Hayden, Timothy M. Uyeki, Jeremy Farrar, Yazdan Yazdanpanah, Howard Zucker, John Beigel, Tawee Chotpitayasunondh, Tran Tinh Hien, Bulent Ozbay, Norio Sugaya, Andrew D. Oxman

Christopher Del Mar

Emerging health problems require rapid advice. We describe the development and pilot testing of a systematic, transparent approach used by the World Health Organization (WHO) to develop rapid advice guidelines in response to requests from member states confronted with uncertainty about the pharmacological management of avian influenza A (H5N1) virus infection. We first searched for systematic reviews of randomized trials of treatment and prevention of seasonal influenza and for nontrial evidence on H5N1 infection, including case reports and animal and in vitro studies. A panel of clinical experts, clinicians with experience in treating patients with H5N1, influenza researchers, and methodologists …

Whose Duty Is It Anyway?: The Kennedy Krieger Opinion And Its Implications For Public Health Research, Diane E. Hoffmann, Karen H. Rothenberg

Karen H. Rothenberg

In this article, the authors discuss the Maryland Court of Appeals decision in the case of Grimes v. Kennedy Krieger Institute, Inc. and its implications for the tort duty owed by researchers, in particular public health researchers, to their subjects. The Opinion resulted from two lawsuits alleging lead poisoning of children enrolled in a study conducted by the Kennedy Krieger Institute, a world renown pediatric research and treatment facility. The opinion shocked the research establishment with its scathing characterization of researchers and its apparent holding that in Maryland a parent cannot consent to the participation of a child in "nontherapeutic …

Colloquium - Gender, Law And Health Care: New Perspectives For Teaching And Scholarship: The Role Of Gender In Law And Health Care, Karen H. Rothenberg

Karen H. Rothenberg

No abstract provided.

Bisphenol-A And The Great Divide: A Review Of Controversies In The Field Of Endocrine Disruption, Laura Vandenberg, Maricel V. Maffini, Carlos Sonnenschein, Beverly S. Rubin, Ana M. Soto

Laura Vandenberg

In 1991, a group of 21 scientists gathered at the Wingspread Conference Center to discuss evidence of developmental alterations observed in wildlife populations after chemical exposures. There, the term “endocrine disruptor” was agreed upon to describe a class of chemicals including those that act as agonists and antagonists of the estrogen receptors (ERs), androgen receptor, thyroid hormone receptor, and others. This definition has since evolved, and the field has grown to encompass hundreds of chemicals. Despite significant advances in the study of endocrine disruptors, several controversies have sprung up and continue, including the debate over the existence of nonmonotonic dose …

Strategies For Recruiting Hispanic Women Into A Prospective Cohort Study Of Modifiable Risk Factors For Gestational Diabetes Mellitus, Lisa Chasan-Taber, Renee T. Fortner, Valerie Hastings, Glenn Markenson

Lisa Chasan-Taber

Background The purpose of this article was to describe effective strategies for recruitment of Hispanic women into a prospective cohort study of modifiable risk factors for gestational diabetes mellitus (GDM). Although Hispanic women have two to four times the risk of developing GDM compared with non-Hispanic white women, few GDM prevention studies have included Hispanic women. Methods The study was conducted in the ambulatory obstetrical practices of Baystate Medical Center located in a socioeconomically and ethnically diverse city in Massachusetts. The study employed a range of strategies to recruit Hispanic women based on a review of the literature as well …

Uptake Of A Team Briefing In The Operating Theatre: A Burkean Dramatistic Analysis, Sarah Whyte, Carrie Cartmill, Fauzia Gardezi, Richard Reznick, Beverley Orser, Diane Doran, Lorelei Lingard

Lorelei Lingard

Communication among healthcare professionals is a focus for research and policy interventions designed to improve patient safety, but the challenges of changing interprofessional communication patterns are rarely described. We present an analysis of 756 preoperative briefings conducted by general surgery teams (anesthesiologists, nurses, and surgeons) at four urban Canadian hospitals in the context of two research studies conducted between August 2004 and December 2007. We ask the questions: how and why did briefings succeed, how and why did they fail, and what did they mean for different participants? Ethnographic fieldnotes documenting the coordination and performance of team briefings were analyzed …

Nothing To Sneeze At! A Study Into Intra-Operative Contamination, David Graham, Benjamin Parkinson, Meghan Evans, Gerben Keijzers, Petra Derrington

Gerben Keijzers

Purpose: We performed a prospective study of sneezes from orthopaedic registrars to assess the potential for intra-operative contamination from a masked surgeon, and to determine if head position can alter the potential for contamination. Type of Study: Prospective controlled trial. Methods: Four orthopaedic registrars from the Gold Coast Hospital each inhaled pepper to precipitate a sneeze. Cultures were taken with and without standard Smith & Nephew™ surgical masks, in positions directly in front and to the sides of a masked registrar. The process was repeated three times for each registrar. A control plate was left exposed to the atmosphere. A …

Health Bills: What's At The Core, Robert B. Leflar

Robert B Leflar

Column 2 (of 5) on the health reform debate: explanation of the legislation.

Health Care: Yellow Lights, Red Flags, Robert B. Leflar

Robert B Leflar

Column 1 (of 5) on the health reform debate

Post-Operative Extended Volume External Beam Radiation Therapy Is Safe For High Risk Esophageal Cancer Patients, Edward Yu, Patricia Tai, Jawaid Younus, Richard Malthaner, Larry Stitt, Pauline Truong, George Rodrigues, Robert Ash, Rashid Dar, Anna Tomiak, Mark Vincent, Walter Kocha, Brian Dingle, Richard Inculet

Edward Yu

Post-operative radiation therapy (RT) (1) and post-operative chemoradiation (2) have been used for esophageal cancer patients deemed high risk for recurrence after esophagectomy. Defining opitmal RT target volume after esophagectomy is difficult due to significant changes in patient anatomy and function. Some radiationon cologists advocated the inclusion of the anastomotic site within the irradiation volume due to concerns for potential increased relapse risk, while others did not subscribe to this practice due to concerns for increased treatment related toxicity. We have previously reported patient outcome benefit using extended volume RT In management with high risk esophageal cancer patients underwent esopagectomy(3). …

Extended Vs. Small Field Irradiation In High Risk Post Esophagectomy Patients Receiving Combined Chemoradiation Therapy: A Decade Experience In Treatment Of Esophageal Cancer, Edward Yu, Patricia Tai, George Rodrigues, Robert Ash, Larry Stitt, Rashid A. Dar, Pauline Truong, Gregory M. Videtic, Richard Malthaner, Richard Inculet, Anna Tomiak, Jawaid Younus, Brian Dingle, Walter Kocha, Mark Vincent

Edward Yu

OBJECTIVE: To assess the impact of extended field irradiation with anastomotic coverage on local recurrence in high risk resected esophageal cancerpatients. METHODS: From 1989-1999, high risk resected esophageal cancer cases receiving post-resection chemoradiation were reviewed. Adjuvant chemotherapy consisted of four cycles of fluorouracil-based regimens. Loco-regional irradiation with or without coverage of anastomotic site had radiation a dose range from 45-60 Gyat 1.8-2.0 Gy/fraction given with initial anterior-posterior/posterior-anterior arrangement with either extended (with anastomotic coverage), or small (without anastomotic coverage) field followed by oblique fields for boost. RESULTS: One hundred eighty-eight charts were reviewed. Seventy-two patients were eligible for post-resection chemoradiation. …

Effect Of Interval To Definitive Breast Surgery On Clinical Presentation And Survival In Early-Stage Invasive Breast Cancer, Olga Vujovic, Edward Yu, Anil Cherian, Francisco Perera, A. Dar, Larry Stitt, A. Hammond

Edward Yu

Purpose: To examine the effect of clinical presentation and interval to breast surgery on local recurrence and survival in early-stage breast cancer. Methods and materials: The data from 397 patients with Stage T1-T2N0 breast carcinoma treated with conservative surgery and breast radiotherapy between 1985 and 1992 were reviewed at the London Regional Cancer Program. The clinical presentation consisted of a mammogram finding or a palpable lump. The intervals from clinical presentation to definitive breast surgery used for analysis were 0-4, >4-12, and >12 weeks. The Kaplan-Meier estimates of the time to local recurrence, disease-free survival, and cause-specific survival were determined …

The Black, African And Caribbean Canadian Health (Blacch) Study: Phase I Preliminary Findings, Shamara Baidoobonso, Roxanne Longman, Greta Bauer, Mercy Nleya-Ncube, Daniel Pugh, Erica Lawson, Monica Abdelkader, Jan Jasnos, Sherin Hussien

Shamara M Baidoobonso, PhD

The Challenge: Most studies of HIV and health in African, Caribbean and Black (ACB) communities have taken place in large urban centres and rarely examine how the interactions between racism, gender, HIV-related stigma and multiple forms of oppression affect health and HIV vulnerability. This lack of information negatively impacts HIV prevention and health promotion efforts for ACB communities. Our Approach: The BLACCH Study uses a community-based approach to collect extensive information about the health of ACB communities in Middlesex County, Ontario. The first stage of the project consists of semi-structured interviews to collect information about the breadth of health-related experiences …

Lavichè: Haiti's Vulnerability To The Global Food Crisis, John Mazzeo

John Mazzeo, Ph.D.

No abstract provided.

Tobacco Use Policymaking And Administration In Bhutan, Michael S. Givel

Michael S. Givel

No abstract provided.

Early Psychosis: A Novel Gateway For Suicide Prevention, Amresh Srivastava, Megan Johnston

Amresh Srivastava

Early psychosis: A Novel Gateway For Suicide Prevention

Amresh Shrivastava 1, Megan Johnston 2 Address: 1. Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada); Mental Health Foundation of India (PRERANA Charitable Trust) and Silver Mind Hospital, 209 Shivkripa Complex, Gokhale Road, Thane, Mumbai, Maharashtra, India 400 602 (Present Address: Regional Mental Health Care, 467 Sunset Drive, St. Thomas, Ontario, Canada N5H 3V9; 2. Department of Psychology, University of Toronto.

Early psychosis and early intervention initiative in by now a well established model for treatment …

Duration Of Untreated Psychosis & Long-Term Outcome Of First Episode, Hospitalized Schizophrenia: Search For A Missing Link In A Linear Correlation, Amresh Srivastava, Nilesh Shah, Meghana Thakar, Larry Stitt, Gurusamy Chinnasamye

Amresh Srivastava

Duration of untreated psychosis & Long-term outcome of First episode, hospitalized schizophrenia: Search for a missing link in a linear correlation Amresh Shrivastavaa,*, Nilesh Shahb, Meghana Thakarc, Larry Stittd, Gurusamy Chinnasamye a Excecutive Director , Mental Health Foundation of India (PRERANA Charitable trust) and Silver Mind Hospital, 209 Shivkripa Complex, Gokhale Road, Thane, Mumbai, Maharashtra, India 400 602, Currently: Assistant Professor of Psychiatry, The University of western Ontario, & associate Scientist, Lawson Health Research Institute, London, Ontario,Canada, E Mail : amresh.edu@gmail.com b Professor of Psychiatry LTMG Hospital, University of Mumbai, Sion, Mumbai, Maharashtra, India 400 022 c Clinical psychologist, Silver …

John Contracts Skin Disease At Spa, Donna M. Hughes Dr., Melanie Shapiro Esq

Donna M. Hughes

Current Practice In Physical Child Abuse Forensic Reports: A Preliminary Exploration, Marcellina Mian, Catherine Schryer, Marlee Spafford, Jan Joosten, Lorelei Lingard

Lorelei Lingard

No abstract provided.

Innovation Powered By Partnerships To Transform Health Professions Education In American Indian And Alaska Native Communities - Community/Public Health Education In Native Communities, Round Table Discussion, Tim Dunnagan

Tim Dunnagan

No abstract provided.

What Factors Predict Outcome At Relapse After Previous Esophagectomy And Adjuvant Therapy In High-Risk Esophageal Cancer?, Edward Yu, Patricia Tai, Richard Malthaner, Larry Stitt, George Rodrigues, Rashid Dar, Brian Yaremko, Jawaid Younus, Michael Sanatani, Mark Vincent, Brian Dingle, Dalilah Fortin, Richard Inculet

Edward Yu

Management of patients who have disease relapse after completion of surgery and adjuvant chemo-radiation (CRT) is controversial. Some oncologists would advocate intensive therapeutic intervention due to promising experience on treatment for recurrence disease while others would recommend palliative support due to the concerns for poor patient outcome post disease recurrence. In Addition, it is not clear if patient outcome is improved post adjuvant CRT when patients at risk have resection margin involvement and if time interval to recurrence can affect patient survival post relapse. The present study was conducted to determine what factors will affect patient outcome at relapse after …

Community Demographics And Access To Care Among Us Hispanics, Carole Gresenz, J. Rogowski, Jose Escarce

Carole Roan Gresenz

No abstract provided.

Management Of Patients With Cognitive Impairment After Stroke: A Survey Of Australian Occupational Therapists, Chia-Lin Koh, Tammy Hoffmann, Sally Bennett, Kryss Mckenna

Tammy Hoffmann

Background/aim: Cognitive impairment is a common and often debilitating consequence of stroke. The current practice patterns of Australian occupational therapists who work in this area are not clearly known. The aim of this study was to investigate the theoretical approaches, assessments, interventions and research evidence used by Australian occupational therapists who work with patients who have cognitive impairment poststroke.

Methods: A self-administered, purpose-designed online survey was used.

Results: Survey responses were received from 102 occupational therapists. The client-centred approach was the most commonly used theoretical approach, with 81.3% and 72% using it often or all of the time with inpatients …

First Episode Is The Best Episode: Lessons And Limitations In Duration Of Untreated Psychosis (Dup) And Outcome In Schizophrenia, Amresh Srivastava

Amresh Srivastava

First episode is the best episode: Lessons and limitations in duration of untreated psychosis (DUP) and outcom Amresh Shrivastavaa, *, Nilesh Shahb, Meghana Thakarc, Larry Stittd, Gurusamy Chinnasamye

a Executive Director , Mental Health Foundation of India (PRERANA Charitable trust) and Silver Mind Hospital, 209 Shivkripa Complex, Gokhale Road, Thane, Mumbai, Maharashtra, India 400 602, Currently: Assistant Professor of Psychiatry, The University of western Ontario, & associate Scientist, Lawson Health Research Institute, London, Ontario, Canada, E Mail : amresh.edu@gmail.com Professor of Psychiatry LTMG Hospital, University of Mumbai, Sion, Mumbai, Maharashtra, India 400 022 c Clinical psychologist, Silver Mind Hospital, Mumbai, …

Family Education For Psychosis, Amresh Srivastava

Amresh Srivastava

No abstract provided.

One Chance In A Million: Altruism And The Bone Marrow Registry, Ted Bergstrom, Rod Garratt, Damien Sheehan-Connor

Ted C Bergstrom

Transplants of donated stem cells save the lives of many patients with blood diseases. Donation is somewhat painful, butrarely has lasting adverse effects. Patients can accept transplants only from donors with compatible immune systems. Those lacking a sibling match must seek donations from the population at large. The probability that two persons of the same race are compatible is less than 1/10,000. Health authorities maintain a registry of several million genetically-tested potential donors who have agreed to donate if asked. We study the peculiar structure of voluntary public good provision represented by the registry, and compare the marginal benefits and …

Influence Of Prenatal Lead Exposure On Genomic Methylation Of Cord Blood Dna, Richard J. Pilsner, Howard Hu, Adrienne Ettinger, Brisa N. Sánchez, Robert O. Wright, David Cantonwine, Alicia Lazarus, Héctor Lamadrid-Figueroa, Adriana Mercado-García, Martha Maria Téllez-Rojo, Mauricio Hernández-Avila

J. Richard Pilsner

Background

Fetal lead exposure is associated with adverse pregnancy outcomes and developmental and cognitive deficits; however, the mechanism(s) by which lead-induced toxicity occurs remains unknown. Epigenetic fetal programming via DNA methylation may provide a pathway by which environmental lead exposure can influence disease susceptibility.

Objective

This study was designed to determine whether prenatal lead exposure is associated with alterations in genomic methylation of leukocyte DNA levels from umbilical cord samples.

Methods

We measured genomic DNA methylation, as assessed by Alu and LINE-1 (long interspersed nuclear element-1) methylation via pyrosequencing, on 103 umbilical cord blood samples from the biorepository of the …