Multilocus Sequence Types of Invasive and Colonizing Neonatal Group B Streptococci in Poland

Objectives

The present study aimed to investigate the molecular characterization of Streptococcus agalactiae (group B streptococcus; GBS) strains isolated from newborns with invasive neonatal infections and healthy newborns in Poland.

Materials and Methods

Forty-two GBS isolates were characterized by combining different typing methods, i.e. multilocus sequence typing (MLST), molecular serotyping and protein gene profiling.

Results

Using MLST, a total of 16 sequence types (STs) were identified, and among these, 11 were clustered into the following 5 clonal complexes (CCs): CC23 (20; 49%), CC19 (7; 17%), CC17 (4; 10%), CC10 (4; 10%) and CC1 (1; 2%). A statistically significant relationship between ST-17 and invasive isolates (p = 0.0398) and ST-23 and colonizing strains (p = 0.0034) was detected. Moreover, 2 novel STs were detected (ST-637 and ST-638). Molecular serotyping showed that in the invasive isolates serotype III was predominant (11; 50%), followed by serotypes II (6; 27%), V (3; 14%) and Ia (2; 9%). In healthy newborns, serotype III was also dominant (12; 60%), followed by serotypes Ia (4; 20%), II (2; 10%), V (1; 5%) and Ib (1; 5%). Protein gene profiling indicated that the rib gene was predominant in the invasive strains (11; 59%), followed by bca (5; 22%), alp2 (2; 9%), alp3 (1; 5%) and epsilon (1; 5%), while in colonizing strains the alp2 gene was most common (10; 50%), followed by epsilon (5; 25%), rib (2; 10%), bca (2; 10%) and alp3 (1; 5%). A statistically significant relationship was noted between the rib gene and invasive GBS (p = 0.0329), whereas alp2 was related to the colonizing strains (p = 0.0495).

Conclusions

The investigated GBS isolates originating from infections in newborns and healthy neonates represented serotype III in more than half of the cases and differed from one another in terms of resistance to macrolides, ST type affiliation and the presence of genes encoding surface proteins from the Alp family. Further comparative genetic research on a larger number of strains is necessary for epidemiological investigation and vaccine development.Key Words: Group B streptococcus, Multilocus sequence typing, Newborns, Serotypes, Protein gene profiling, Anti-microbial resistance     

FOLFIRI Combined with Bevacizumab as First-Line Treatment for Metastatic Colorectal Cancer Patients with Hyperbilirubinemia after UGT1A1 Genotyping

Objective

To report a metastatic colorectal cancer patient with hyperbilirubinemia treated with a combination of bevacizumab and FOLFIRI (5-fluorouracil, leucovorin, and irinotecan) using uridine diphosphate glucuronosyl transferase (UGT1A1) genotyping.

Clinical Presentation and Intervention

A 46-year-old male was diagnosed with rectosigmoid colon cancer with liver metastases and hyperbilirubinemia presenting with severe jaundice. UGT1A1 genotyping was used before therapy to ascertain whether genotype-adjusted dosages of irinotecan plus bevacizumab could alleviate the toxicity. Then, the patient was treated with FOLFIRI.

Conclusion

The FOLFIRI regimen was successfully used in this patient without concerns regarding toxicity.Key Words: UGT1A1, Liver dysfunction, Hyperbilirubinemia, FOLFIRI, Bevacizumab     

Impact of Brief and Sequential Exposure to Nystatin on the Germ Tube Formation and Cell Surface Hydrophobicity of Oral Candida Albicans Isolates from Human Immunodeficiency Virus-Infected Patients

Objective

To evaluate the impact of brief and sequential exposure to nystatin on the germ tube formation and cell surface hydrophobicity of oral isolates of Candida albicans obtained from patients infected with human immunodeficiency virus (HIV).

Materials and Methods

After determining the minimum inhibitory concentration of nystatin, 10 oral isolates of C. albicans from 10 different HIV-infected patients were briefly (1 h) and sequentially (10 days) exposed to subtherapeutic concentrations of nystatin. Following a subsequent drug removal, the germ tube formation and cell surface hydrophobicity of these isolates were determined via a germ tube induction assay and an aqueous hydrocarbon assay, respectively. The data obtained from these assays for the control (unexposed to nystatin) and nystatin-exposed isolates were analyzed using Student''s t tests.

Results

The mean percentage reduction in the germ tube formation and cell surface hydrophobicity of the nystatin-exposed isolates compared to the controls was 30.12 ± 1.99 (p < 0.001) and 29.65 ± 2.33 (p < 0.001), respectively.

Conclusion

These data elucidate the possible pharmacodynamic mechanisms by which nystatin might operate in vivo in the modulation of candidal virulence.Key Words: Candida albicans, Cell surface hydrophobicity, Germ tubes, Nystatin     

Blood Group ABO Genotyping in Paternity Testing

Background

The ABO blood groups result from DNA sequence variations, predominantly single nucleotide and insertion/deletion polymorphisms (SNPs and indels), in the ABO gene encoding a glycosyltransferase. The ABO blood groups A₁, A₂, B and O predominantly result from the wild type allele A1 and the major gene variants that are characterized by four diallelic markers (261G>del, 802G>A, 803G>C, 1061C>del). Here, we were interested to evaluate the impact of ABO genotyping compared to ABO phenotyping in paternity testing.

Methods

The major ABO alleles were determined by PCR amplification with sequence-specific primers (PCR-SSP) in a representative sample of 1,335 blood donors. The genotypes were compared to the ABO blood groups registered in the blood donor files. Then, the ABO phenotypes and genotypes were determined in 95 paternity trio cases that have been investigated by 12 short tandem repeat (STR) markers before. We compared statistical parameters (PL, paternity likelihood; PE, power of exclusion) of both blood grouping approaches.

Results

The prevalence of the major ABO alleles and genotypes corresponded to the expected occurrence of ABO blood groups in a Caucasian population. The low resolution genotyping of 4 diallelic markers revealed a correct genotype-phenotype correlation in 1,331 of 1,335 samples (99.7%). In 60 paternity trios with confirmed paternity of the alleged father based on STR analysis both PL and PE of the ABO genotype was significantly higher than of the ABO phenotype. In 12 of 35 exclusion cases (34.3%) the ABO genotype also excluded the alleged father, whereas the ABO phenotype excluded the alleged father only in 7 cases (20%).

Conclusion

In paternity testing ABO genotyping is superior to ABO phenotyping with regard to PL and PE, however, ABO genotyping is not sufficient for valid paternity testing. Due to the much lower mutation rate compared to STR markers, blood group SNPs in addition to anonymous SNPs could be considered for future kinship analysis and genetic identity testing.     

Hypertonic saline reduces lipopolysaccharide-induced mouse brain edema through inhibiting aquaporin 4 expression

Introduction

Three percent sodium chloride (NaCl) treatment has been shown to reduce brain edema and inhibited brain aquaporin 4 (AQP4) expression in bacterial meningitis induced by Escherichia coli. Lipopolysaccharide (LPS) is the main pathogenic component of E. coli. We aimed to explore the effect of 3% NaCl in mouse brain edema induced by LPS, as well as to elucidate the potential mechanisms of action.

Methods

Three percent NaCl was used to treat cerebral edema induced by LPS in mice in vivo. Brain water content, IL-1β, TNFα, immunoglobulin G (IgG), AQP4 mRNA and protein were measured in brain tissues. IL-1β, 3% NaCl and calphostin C (a specific inhibitor of protein kinase C) were used to treat the primary astrocytes in vitro. AQP4 mRNA and protein were measured in astrocytes. Differences in various groups were determined by one-way analysis of variance.

Results

Three percent NaCl attenuated the increase of brain water content, IL-1β, TNFα, IgG, AQP4 mRNA and protein in brain tissues induced by LPS. Three percent NaCl inhibited the increase of AQP4 mRNA and protein in astrocytes induced by IL-1β in vitro. Calphostin C blocked the decrease of AQP4 mRNA and protein in astrocytes induced by 3% NaCl in vitro.

Conclusions

Osmotherapy with 3% NaCl ameliorated LPS-induced cerebral edema in vivo. In addition to its osmotic force, 3% NaCl exerted anti-edema effects possibly through down-regulating the expression of proinflammatory cytokines (IL-1β and TNFα) and inhibiting the expression of AQP4 induced by proinflammatory cytokines. Three percent NaCl attenuated the expression of AQP4 through activation of protein kinase C in astrocytes.     

Emergence of Methicillin-Resistant Staphylococcus aureus in the Maternity Hospital,Kuwait

Objective

To establish the relatedness of methicillin-resistant Staphylococcus aureus (MRSA) isolates in the Maternity Hospital, Kuwait.

Materials and Methods

A total of 22 MRSA were isolated from 20 neonates and 1 mother in the Special Care Unit, Maternity Hospital, Kuwait. They were characterized using antibiogram, pulsed-field gel electrophoresis (PFGE), SCCmec typing, spa typing and multi locus sequence typing (MLST), and were screened for genes encoding Panton Valentine leukocidin (PVL) and capsular polysaccharide types 5 and 8.

Results

The isolates were resistant to cadmium acetate (n = 22 or 100%), trimethoprim (n = 13 or 59.1%), gentamicin (n = 7 or 31.8%), ciprofloxacin (n = 5 or 22.7%), erythromycin and clindamycin (n = 2 or 9.1%), tetracycline (n = 2 or 9.1%) and fusidic acid (n = 2 or 9.1%). Eight isolates contained genes for PVL while 15 and 6 carried genes for types 5 and 8 capsular polysaccharide, respectively. Molecular typing distinguished 12 clones. Ten of these clones consisted of 20 isolates belonging to ST60-SCCmec-IV-t3935 (5 isolates), ST6-SCCmec-IV-t6269 (4 isolates), ST194-SCCmec-IV-t6892 (3 isolates), ST1-SCCmec-V-t2962 (2 isolates) and 1 isolate each of ST77-SCCmec-IV-t339, ST935-SCCmec-V-t1084, ST1317-SCCmec-V-t1548, ST9-SCCmec-V-t5801, ST627-SCCmec-IV-t1340 and ST2148-SCCmec-IV-t2810.

Conclusion

The study demonstrated the emergence of MRSA including novel ST60 and ST194 clones at the Maternity Hospital in Kuwait.Key Words: Methicillin-resistant Staphylococcus aureus, Neonates, Molecular typing     

Implementation of electronic medical records: effect on the provision of preventive services in a pay-for-performance environment

Objective

To study the effect of electronic medical record (EMR) implementation on preventive services covered by Ontario’s pay-for-performance program.

Design

Prospective double-cohort study.

Participants

Twenty-seven community-based family physicians.

Setting

Toronto, Ont.

Intervention

Eighteen physicians implemented EMRs, while 9 physicians continued to use paper records.

Main outcome measure

Provision of 4 preventive services affected by pay-for-performance incentives (Papanicolaou tests, screening mammograms, fecal occult blood testing, and influenza vaccinations) in the first 2 years of EMR implementation.

Results

After adjustment, combined preventive services for the EMR group increased by 0.7%, a smaller increase than that seen in the non-EMR group (P = .55, 95% confidence interval −2.8 to 3.9).

Conclusion

When compared with paper records, EMR implementation had no significant effect on the provision of the 4 preventive services studied.     

A dream deferred: the rise and fall of recombinant activated protein C

Expanded abstract

Citation

Ranieri VM, Thompson BT, Barie PS, Dhainaut JF, Douglas IS, Finfer S, Gårdlund B, Marshall JC, Rhodes A, Artigas A, Payen D, Tenhunen J, Al-Khalidi HR, Thompson V, Janes J, Macias WL, Vangerow B, Williams MD: Drotrecogin alfa (activated) in adult patients with septic shock. N Engl J Med 2012, 366:2055-2064.

Background

There have been conflicting reports on the efficacy of recombinant human activated protein C, or drotrecogin alfa (activated) (DrotAA), for the treatment of patients with septic shock.

Methods

Objective

To test the hypothesis that DrotAA, as compared with placebo, would reduce mortality in patients with septic shock.

Design

A randomized, double-blind, placebo-controlled, multicenter trial, conducted from March 2008 through August 2011. Patients were followed until either 90 days or death.

Setting

Patients were enrolled from 208 sights in Europe, North and South America, Australia, New Zealand, and India.

Subjects

Subjects included 1,697 patients with infection, systemic inflammation, and shock who were receiving fluids and vasopressors above a threshold dose for 4 hours.

Intervention

DrotAA (at a dose of 24 μg per kilogram of body weight per hour) or placebo for 96 hours.

Outcomes

Death from any cause 28 days after randomization.

Results

At 28 days, 223 of 846 patients (26.4%) in the DrotAA group and 202 of 834 (24.2%) in the placebo group had died (relative risk in the DrotAA group, 1.09; 95% confidence interval (CI), 0.92 to 1.28; P = 0.31). At 90 days, 287 of 842 patients (34.1%) in the DrotAA group and 269 of 822 (32.7%) in the placebo group had died (relative risk, 1.04; 95% CI, 0.90 to 1.19; P = 0.56). Among patients with severe protein C deficiency at baseline, 98 of 342 (28.7%) in the DrotAA group had died at 28 days, as compared with 102 of 331 (30.8%) in the placebo group (risk ratio, 0.93; 95% CI, 0.74 to 1.17; P = 0.54). Similarly, rates of death at 28 and 90 days were not significantly different in other predefined subgroups, including patients at increased risk for death. Serious bleeding during the treatment period occurred in 10 patients in the DrotAA group and 8 in the placebo group (P = 0.81).

Conclusions

DrotAA did not significantly reduce mortality at 28 or 90 days, as compared with placebo, in patients with septic shock.     

Age-Related Differences in the Frequency of Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents

OBJECTIVE

We studied the prevalence of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in children in Finland.

RESEARCH DESIGN AND METHODS

From 2002 to 2005, data on virtually all children <15 years of age diagnosed with type 1 diabetes (n = 1,656) in Finland were collected.

RESULTS

DKA was present in 19.4% of the case subjects, and 4.3% had severe DKA. In children aged 0–4, 5–9, and 10–14 years, DKA was present in 16.5, 14.8, and 26.4%, respectively (P < 0.001). Severe DKA occurred in 3.7, 3.1, and 5.9%, respectively (P = 0.048). DKA was present in 30.1% and severe DKA in 7.8% of children aged <2 years.

CONCLUSION

The overall frequency of DKA in children is low in Finland at diagnosis of type 1 diabetes. However, both children <2 years of age and adolescents aged 10–14 years are at increased risk of DKA.The incidence of diabetic ketoacidosis (DKA) in children with newly diagnosed type 1 diabetes may be decreasing in developed countries (1,2).     

Changes in the Cell Surface Hydrophobicity of Oral Candida albicans from Smokers,Diabetics, Asthmatics,and Healthy Individuals following Limited Exposure to Chlorhexidine Gluconate

Objective

The objective of this study was to determine the cell surface hydrophobicity of 40 oral Candida albicans isolates obtained from smokers, diabetics, asthmatics using steroid inhalers, and healthy individuals, following brief exposure to subtherapeutic concentrations of chlorhexidine gluconate.

Materials and Methods

Forty C. albicans oral isolates (10 isolates each from smokers, diabetics, asthmatics using steroid inhalers, and healthy individuals) were exposed to 3 subtherapeutic concentrations of chlorhexidine gluconate (0.00125, 0.0025, and 0.005%) for 30 min. Thereafter, the antiseptic was removed and the cell surface hydrophobicity was measured by a biphasic aqueous-hydrocarbon assay.

Results

Compared to the unexposed controls, the cell surface hydrophobicity of C. albicans isolates was suppressed by 5.40% (p > 0.05), 21.17% (p < 0.05), and 44.67% (p < 0.05) following exposure to 0.00125, 0.0025, and 0.005% chlorhexidine gluconate, respectively.

Conclusions

A brief period of transient exposure to subtherapeutic concentrations of chlorhexidine gluconate may modulate the cell surface hydrophobicity of C. albicans isolates and thereby may reduce candidal pathogenicity.Key Words: Candida albicans, Cell surface hydrophobicity, Chlorhexidine gluconate     

Viridans Streptococci in Peritoneal Dialysis Peritonitis: Clinical Courses and Long-Term Outcomes

♦ Background:

The clinical courses and long-term outcomes of viridans streptococcus (VS) peritoneal dialysis (PD) peritonitis remain unclear.

♦ Methods:

We conducted a retrospective analysis of all PD patients in a single center with gram-positive cocci (GPC) peritonitis between 2005 and 2011, and divided them into 3 groups: VS, other streptococci and other GPC (apart from VS). Clinical characteristics and outcomes of the VS group were compared with the other streptococci and other GPC groups, with prognostic factors determined.

♦ Results:

A total of 140 patients with 168 episodes of GPC peritonitis (44% of all peritonitis) were identified over 7 years. Among these, 18 patients (13%) developed VS peritonitis, while 14 patients (10%) developed other streptococcal peritonitis. Patients with VS peritonitis had a high cure rate by antibiotic alone (94%), despite a high polymicrobial yield frequency (28%). We found that VS peritonitis carried a lower risk of Tenckhoff catheter removal and relapsing episodes than other GPC peritonitis (6% vs 11%), and a lower mortality than other streptococci peritonitis (0% vs 7%). However, after the index peritonitis episodes, VS, other streptococci, and other GPC group had a significantly increased peritonitis incidence compared with the period before the index peritonitis (all p < 0.01). Patients with VS peritonitis had a significantly higher incidence of refractory peritonitis compared with other streptococci or other GPC peritonitis in the long term (both p < 0.01).

♦ Conclusions:

VS poses a higher risk of subsequent refractory peritonitis after the index episode as compared with other streptococcal or GPC peritonitis. It might be prudent to monitor the technique of these patients with VS peritonitis closely to avoid further peritonitis episodes.     

Frequency and Clinical Association of Panton-Valentine Leukocidin-Positive Staphylococcus aureus Isolates: A Study from Kuwait

Objective

This study was undertaken to determine the frequency of Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus among strains isolated in our laboratory and to study the association of PVL-positive strains with clinical disease.

Materials and Methods

A total of 291 S. aureus isolates obtained from different clinical specimens from June 1, 2009, to March 31, 2010, at the Farwania Hospital Laboratory were investigated for antimicrobial susceptibility, carriage of genes for PVL, and SCCmec elements. Antimicrobial susceptibility testing was performed by standard methods. The presence of mecA genes for PVL SCCmec typing was determined by PCR.

Results

Of the 291 S. aureus isolates, 89 (30.6%) were methicillin-resistant S. aureus (MRSA), whereas 202 (69.4%) were methicillin susceptible (MSSA). Genes for PVL were detected in 13 (14.6%) and 24 (12.0%) of the MRSA and MSSA isolates, respectively. The majority of the PVL-producing MRSA and MSSA were isolated from 12 (30.7%) and 19 (21.8%) cases of skin and soft tissue infections (SSTI), respectively. Although both MSSA and MRSA strains were uniformly susceptible to rifampicin, teicoplanin, and vancomycin, multidrug resistance was observed among PVL-producing and nonproducing MRSA isolates. Both MRSA types carried SCCmec type III, IV, IVc, and V genetic elements.

Conclusion

This study revealed the presence of genes for PVL in both MSSA and MRSA, associated mostly with SSTI and respiratory tract infections, supporting previous observations that PVL production is widespread among S. aureus strains obtained from different clinical sources.Key Words: Staphylococcus aureus, Panton-Valentine leukocidin, Methicillin resistance     

Approach to adolescent suicide prevention

OBJECTIVE

To provide family physicians with an approach to suicide prevention in youth.

SOURCES OF INFORMATION

A literature review was performed using Ovid MEDLINE with the key words suicide, attempted suicide, and evaluation studies or program evaluation, adolescent.

MAIN MESSAGE

Youth suicide might be prevented by earlier recognition and treatment of mental illness. Family physicians can and should screen for mental illness in youth; there are many diagnostic and treatment resources available to assist with this.

CONCLUSION

Earlier detection and treatment of mental illness are the most important ways family physicians can reduce morbidity and mortality for youth who are contemplating suicide.     

Roles of the Metabolic Syndrome, HDL Cholesterol, and Coronary Atherosclerosis in Subclinical Inflammation

OBJECTIVE

The metabolic syndrome (MetS) and coronary artery disease (CAD) frequently coincide; their individual contribution to inflammation is unknown.

RESEARCH DESIGN AND METHODS

We enrolled 1,010 patients undergoing coronary angiography. Coronary stenoses ≥50% were considered significant. The MetS was defined according to American Heart Association–revised National Cholesterol Education Program Adult Treatment Panel III criteria.

RESULTS

C-reactive protein (CRP) did not differ between patients with significant CAD and subjects without significant CAD (P = 0.706) but was significantly higher in MetS patients than in those without MetS (P < 0.001). The MetS criteria low HDL cholesterol (P < 0.001), large waist (P < 0.001), high glucose (P < 0.001), and high blood pressure (P = 0.016), but not high triglycerides (P = 0.352), proved associated with CRP. When all MetS traits were considered simultaneously, only low HDL cholesterol proved independently associated with CRP (F = 44.19; P < 0.001).

CONCLUSIONS

CRP is strongly associated with the MetS but not with coronary atherosclerosis. The association of the MetS with subclinical inflammation is driven by the low HDL cholesterol feature.Although serum C-reactive protein (CRP) is an important predictor of cardiovascular events (1), its cross-sectional association with the presence and extent of coronary atherosclerosis is unclear (2,3). It is therefore ambiguous whether subclinical inflammation in metabolic syndrome (MetS) patients is primarily due to the increased prevalence of (silent) coronary artery disease (CAD) in these patients or, conversely, whether elevated levels of inflammation in CAD patients are primarily due to a correlation with the MetS. Furthermore, it remains unclear which classical MetS traits are most strongly associated with CRP.     

Carriage of Mutant Dihydrofolate Reductase and Dihydropteroate Synthase Genes among Plasmodium falciparum Isolates Recovered from Pregnant Women with Asymptomatic Infection in Lagos,Nigeria

Objective

To assess N51I, C59R and S108N polymorphisms of dihydrofolate reductase (dhfr) and A437G and K540E of dihydropteroate synthase (dhps) genes of P. falciparum isolates recovered from pregnant women with asymptomatic malaria in a coastal setting in Nigeria.

Subjects and Methods

A total of 107 consenting and consecutively enrolled pregnant women (mean age ± standard deviation, 26.6 ± 4.5 years) attending antenatal care at the Iru/Victoria Island Primary Health Centre, Lagos, were screened for peripheral malaria by microscopy, by a histidine-rich protein-2-based rapid diagnostic test (RDT) and by polymerase chain reaction (PCR) using finger-pricked and dot blood samples. DNA was extracted from the blood and used for dhfr and dhps gene polymorphism analyses by PCR and restriction fragment length polymorphism. The sociodemographic and parasite data obtained were analysed.

Results

Of the 107 patients, 34 (31.8%), 46 (43%) and 40 (37.4%) were found to be P. falciparum infected using microscopy, RDT and corrected RDT-PCR, respectively (p < 0.05). The prevalence of P. falciparum isolates with mutant and mixed genotypes of dhfr at codons 51, 59 and 108 was 70, 75 and 80%, respectively, and the triple mutation in the homozygous form was 35%. The prevalence of the homozygous quintuple dhfr plus dhps mutant was 5%, while that of the P. falciparum isolates with mutant or mixed genotypes of dhps at codons 437 and 540 was 37.5 and 22.5%, respectively.

Conclusion

This study revealed the emergence of the K540E mutation among the parasite population in Lagos. However, it supports the implementation of the intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine with continuous effectiveness monitoring in the study area.Key Words: Sulphadoxine-pyrimethamine resistance, Asymptomatic malaria, Dihydrofolate reductase gene, Dihydropteroate synthase gene, Single-nucleotide mutations, Pregnant women, Nigeria     

Predictors of Willingness to Participate in Window-of-Opportunity Breast Trials

Objective

We conducted a pilot survey to evaluate breast cancer patients’ willingness to participate in a preoperative chemoprevention (ie, window-of-opportunity) study.

Design

A 27-question written survey was developed and administered to participants.

Setting

A breast cancer specialty clinic at the University of Wisconsin Hospital and Clinics.

Participants

30 adult patients with newly diagnosed operable breast cancer participated after signing informed consent.

Methods

A convenience sample of 30 participants was recruited from July 2005 through January 2006. Participants were administered the survey in clinic. Univariate ordinal logistic regression models were used to identify predictors of willingness to participate in window-of-opportunity trials.

Results

Overall, 26.7% of respondents were willing to participate in a research trial between the time of breast cancer diagnosis and surgery. Univariate ordinal logistic regression models identified that women with a prior history of breast cancer (P=0.060), prior research participation (P=0.006), more education (P=0.034), and self-reported breast cancer knowledge (P=0.043) were more willing to participate. On average, women preferred to have surgery 7 days (range 1–14) after their diagnosis, but the actual average wait time between diagnostic biopsy and surgery was 37.5 days (standard deviation = 23.4 days).

Conclusion

There is ample time before breast surgery to conduct preoperative window-of-opportunity trials. Interventions aimed at expanding patients’ breast cancer knowledge may improve accrual to window-of-opportunity studies.     

Physical activity in youth: Prevalence, risk indicators, and solutions

Objective

To determine the unadjusted and adjusted associations between developmental, environmental, psychological, social, or demographic factors and meeting the Health Canada physical activity standard.

Design

Survey.

Setting

Saskatoon, Sask.

Participants

Every student in grades 5 to 8 in Saskatoon was asked to complete the Saskatoon School Health Survey; 4197 students did so.

Main outcome measures

Whether students met the Health Canada standard for daily physical activity and associated risk factors for not meeting the standard.

Results

Among the 4197 youth who participated in the survey, only 7% met the Health Canada standard of daily physical activity longer than 1 hour of somewhat hard intensity or higher. Although there were 23 unadjusted factors associated with youth meeting the Health Canada standard, only 5 were significant after multivariate adjustment: 1) their fathers were employed (odds ratio [OR] 2.29, P = .027), 2) their parents watched them participate in physical activities or sports every day (OR 1.23, P < .001), 3) their friends encouraged them to do physical activities or sports every day (OR 1.19, P < .001), 4) their friends or classmates did not tease them for not doing well at physical activities or sports every day (OR 1.20, P = .001), and 5) they played sports or physical activities with coaches or instructors more than 4 times a week (OR 1.44, P < .001).

Conclusion

Given the low rates of physical activity among youth, we believe that a reduced list of independent risk indicators is required to focus our limited human and financial resources for successful intervention in the community.     

Contraceptive practices and attitudes among immigrant and nonimmigrant women in Canada

Objective

To compare experiences, attitudes, and beliefs of immigrant and nonimmigrant women presenting for abortion with regard to contraception, and to identify difficulties involved in accessing contraception in Canada.

Design

A survey of immigrant and nonimmigrant women asking about women’s experiences with and attitudes toward contraceptives and any barriers to contraceptive access they have encountered. Demographic data including ethnicity, country of origin, and length of residence in Canada were collected.

Setting

Two urban abortion clinics.

Participants

Women presenting for first-trimester abortion.

Main outcome measures

Type of contraception used when the unwanted pregnancy was conceived, attitudes to contraceptives, and barriers to access of contraceptives.

Results

A total of 999 women completed questionnaires during the study period (75.9% response rate); 466 of them (46.6%) were born in Canada. Immigrant women presenting for abortion were less likely to be using hormonal contraception when they got pregnant (12.5% vs 23.5%, P < .001) and had more negative attitudes toward hormonal contraception (62.6% vs 51.6%, P < .003). They reported having more difficulties accessing contraception before the abortion (24.8% vs 15.3%, P < .001) than nonimmigrant women did. About half of all the women expressed fear about intrauterine device use. The longer immigrant women had lived in Canada, the more likely they were to have similar responses to those of Canadian-born women.

Conclusion

The information provided by this study might be valuable for family doctors and other clinicians to improve contraceptive information resources for immigrants to address existing knowledge gaps and other culturally relevant concerns. As about half of all women presenting for abortion expressed negative attitudes toward the more effective methods of contraception, it is important that family doctors educate all women at risk for unintended pregnancies.