Implementation of human biomonitoring in the Dehcho region of the Northwest Territories,Canada (2016–2017)

Background

Human biomonitoring represents an important tool for health risk assessment, supporting the characterization of contaminant exposure and nutrient status. In communities where country foods (locally harvested foods: land animals, fish, birds, plants) are integrated in the daily diet, as is the case in remote northern regions where food security is a challenge, such foods can potentially be a significant route of contaminant exposure. To assess this issue, a biomonitoring project was implemented among Dene/Métis communities of the Dehcho region of the Northwest Territories, Canada.

Methods

Participants completed dietary surveys (i.e., a food frequency questionnaire and 24-h recall) to estimate food consumption patterns as well as a Health Messages Survey to evaluate the awareness and perception of contaminants and consumption notices. Biological sampling of hair, urine and blood was conducted. Toxic metals (e.g., mercury, lead, cadmium), essential metals (e.g., copper, nickel, zinc), fatty acids, and persistent organic pollutants (POPs) were measured in samples.

Results

The levels of contaminants in blood, hair and urine for the majority of participants were below the available guidance values for mercury, cadmium, lead and uranium. However, from the 279 participants, approximately 2% were invited to provide follow up samples, mainly for elevated mercury level. Also, at the population level, blood lead (GM: 11 μg/L) and blood cadmium (GM: 0.53 μg/L) were slightly above the Canadian Health Measures Survey data. Therefore, although country foods occasionally contain elevated levels of particular contaminants, human exposures to these metals remained similar to those seen in the Canadian general population. In addition, dietary data showed the importance and diversity of country foods across participating communities, with the consumption of an average of 5.1% of total calories from wild-harvested country foods.

Conclusion

This project completed in the Mackenzie Valley of the Northwest Territories fills a data gap across other biomonitoring studies in Canada as it integrates community results, will support stakeholders in the development of public health strategies, and will inform environmental health issue prioritization.

     

Selective blockade of 5-hydroxytryptamine (5-HT)7 receptors enhances 5-HT transmission, antidepressant-like behavior, and rapid eye movement sleep suppression induced by citalopram in rodents

Evidence has accumulated supporting a role for 5-hydroxytryptamine (5-HT)7 receptors in circadian rhythms, sleep, and mood disorders, presumably as a consequence of the modulation of 5-HT-mediated neuronal activity. We hypothesized that a selective 5-HT7 receptor antagonist, (2R)-1-[(3-hydroxyphenyl)sulfonyl]-2-[2-(4-methyl-1-piperidinyl)ethyl]-pyrrolidine (SB-269970), should increase activity of 5-HT neurons and potentiate the effect of selective serotonin reuptake inhibitors (citalopram). In rats, administration of 3 mg/kg s.c. citalopram alone increased the extracellular concentration of 5-HT. This effect of citalopram on extracellular 5-HT concentration was significantly enhanced by an ineffective dose of SB-269970. Combining this dose of SB-269970 with a low dose of citalopram also resulted in a significant increase in extracellular concentration of 5-HT, suggesting a potentiation of neurochemical effects. In mice, citalopram and SB-269970 dose-dependently decreased immobility time in the tail suspension test. The dose-effect curve of citalopram was shifted leftward by coadministration of an effective dose of SB-269970. Furthermore, combining ineffective doses of citalopram and SB-269970 also resulted in a significant decrease of immobility time in the tail suspension test, suggesting potentiation of antidepressant-like effects. In rats, SB-269970 potentiated the increase of rapid eye movement (REM) latency and the REM sleep decrease induced by citalopram. SB-269970 also reversed the increase in sleep fragmentation induced by citalopram. Rat plasma and brain concentrations of citalopram were not affected by coadministration of SB-269970, arguing for a pharmacodynamic rather than a pharmacokinetic mechanism. Overall, these results indicate that selective blockade of 5-HT7 receptors may enhance the antidepressant efficacy of citalopram and may provide a novel therapy to alleviate sleep disturbances associated with depression.     

Health beliefs, disease severity, and patient adherence: a meta-analysis

BACKGROUND: A large body of empirical data exists on the prediction of patient adherence from subjective and objective assessments of health status and disease severity. This work can be summarized with meta-analysis. OBJECTIVES: Retrieval and summary analysis of r effect sizes and moderators of the relationship between patient adherence and patients': (1) beliefs in disease threat; (2) rated health status (by physician, self, or parent); and (3) objective disease severity. METHODS: Comprehensive search of published literature (1948-2005) yielding 116 articles, with 143 separate effect sizes. Calculation of robust, generalizable random effects model statistics, and detailed examination of study diversity with moderator analyses. RESULTS: Adherence is significantly positively correlated with patients' beliefs in the severity of the disease to be prevented or treated ("disease threat"). Better patient adherence is associated with objectively poorer health only for patients experiencing disease conditions lower in seriousness (according to the Seriousness of Illness Rating Scale). Among conditions higher in seriousness, worse adherence is associated with objectively poorer health. Similar patterns exist when health status is rated by patients themselves, and by parents in pediatric samples. CONCLUSIONS: Results suggest that the objective severity of patients' disease conditions, and their awareness of this severity, can predict their adherence. Patients who are most severely ill with serious diseases may be at greatest risk for nonadherence to treatment. Findings can contribute to greater provider awareness of the potential for patient nonadherence, and to better targeting of health messages and treatment advice by providers.     

Developing service provision for patients in primary care

This article outlines the government's changes to the way that primary and community health services will be commissioned and provided. It also discusses the opportunities that exist for nurses to lead and develop services for the benefit of patients in the implementation of changes.     

Why are fewer medical students in Florida choosing obstetrics and gynecology?

OBJECTIVES: To determine why there has been a decrease in the amount of applicants to Florida-based obstetrics and gynecology (OB/GYN) residency programs, and how this has been affected by the current medical liability climate. METHODS: Fourth year Florida medical students were surveyed about their concerns of a career in OB/GYN. The students were then grouped into three categories: students never interested in OB/GYN, students at one point interested in OB/GYN, and students pursuing a career in OB/GYN. The groups were analyzed for differences in their concerns about OB/GYN and the impact it had on their final career decisions. Finally, we addressed the question of whether or not medical liability played a significant role in their career choice. RESULTS: From September to November of 2005, 198 total students were surveyed. Of those surveyed, 10.8% were applying for OB/GYN, 47.7% had considered OB/GYN but chose another field, and 41.5% never considered OB/GYN as a specialty. The primary and secondary reasons for not choosing OB/GYN were the same in the two groups pursuing different specialties; "more interested in a different specialty" and "desire a specialty with more predictable work hours/lifestyle," respectively. Approximately 27% of those who considered OB/GYN but did not choose it ranked "fear of being sued" first or second, compared with 6.7% of those who never considered it (P < 0.01). Of the 21 students who will pursue careers in OB/GYN, 85.7% stated they are considering leaving Florida because of high malpractice/litigation. CONCLUSIONS: There is a subgroup of students in Florida who were initially interested in OB/GYN but may have been deterred by current medical liability issues. Florida is a state known as being in a professional liability crisis and this survey demonstrates evidence that this has adversely affected students' decisions to pursue OB/GYN.     

Spigelian hernia presenting as an appendicular mass

Incarcerated spigelian hernias are a rare cause of acute abdomen. The clinical diagnosis of incarcerated spigelian hernia can be a challenge in the absence of definite signs. Reported here is a case of a strangulated spigelian hernia that mimicked an appendicular mass and was discovered on CT scan of the abdomen and pelvis.