Single parents of children with chronic illness: an understudied phenomenon

OBJECTIVE: To examine the chronic illness literature and evaluate the impact on single parenting and children and adolescents with chronic illness. METHODS: We conducted literature reviews of relevant research pertaining to single-parent families on PubMed, Medline, and PsychINFO and also surveyed pertinent book chapters and all of the articles from the Journal of Pediatric Psychology since 1987 for articles, specifically examining the potential associations of single (lone) parenting versus two-parent households on children's psychosocial functioning and the impact of the child's illness on caregiver functioning. RESULTS: While the literature has examined and discussed the stressors associated with parenting a child with an illness, including the impact of illness on finances, family roles, and caregiver burden, few studies have examined single parents of children and adolescents with chronic illnesses and related stressors stemming from being a lone caregiver. CONCLUSIONS: There is a dearth of studies examining the association between lone parenting and psychosocial functioning among children and adolescents with chronic illnesses. Specific questions necessitating future investigation are summarized and recommendations are made for future research in this important area of inquiry.     

Differing effects of exogenous and endogenous hydrogen sulphide in carrageenan-induced knee joint synovitis in the rat

Background and purpose:

Recent findings suggest that the noxious gas H₂S is produced endogenously, and that physiological concentrations of H₂S are able to modulate pain and inflammation in rodents. This study was undertaken to evaluate the ability of endogenous and exogenous H₂S to modulate carrageenan-induced synovitis in the rat knee.

Experimental approach:

Synovitis was induced in Wistar rats by intra-articular injection of carrageenan into the knee joint. Sixty minutes prior to carrageenan injection, the rats were pretreated with indomethacin, an inhibitor of H₂S formation (dl-propargylglycine) or an H₂S donor [Lawesson''s reagent (LR)].

Key results:

Injection of carrageenan evoked knee inflammation, pain as characterized by impaired gait, secondary tactile allodynia of the ipsilateral hindpaw, joint swelling, histological changes, inflammatory cell infiltration, increased synovial myeloperoxidase, protein nitrotyrosine residues, inducible NOS (iNOS) activity and NO production. Pretreatment with LR or indomethacin significantly attenuated the pain responses, and all the inflammatory and biochemical changes, except for the increased iNOS activity, NO production and 3-NT. Propargylglycine pretreatment potentiated synovial iNOS activity (and NO production), and enhanced macrophage infiltration, but had no effect on other inflammatory parameters.

Conclusions and implications:

Whereas exogenous H₂S delivered to the knee joint can produce a significant anti-inflammatory and anti-nociceptive effect, locally produced H₂S exerts little immunomodulatory effect. These data further support the development and use of H₂S donors as potential alternatives (or complementary therapies) to the available anti-inflammatory compounds used for treatment of joint inflammation or relief of its symptoms.     

Changes to the eligibility to bill on Medicare in Australia: a threat to New Zealand's medical workforce?

Previously, New Zealand citizens and those who studied medicine in New Zealand were subject to restrictions in terms of their eligibility to bill on Medicare in Australia. As of April 2010, those restrictions have been removed, making Australia an even more attractive destination for New Zealand doctors, particularly those who have completed their specialist training. At a time when the New Zealand health system can ill afford to lose more doctors overseas, this situation is of significant concern.     

Ovarian stimulation for oocyte vitrification does not modify disease-free survival and overall survival rates in patients with early breast cancer

Research questionDoes ovarian stimulation for oocyte vitrification affect disease-free survival and overall survival rates in women with early breast cancer?DesignThis cohort study included 259 patients with early breast cancer; 148 patients underwent ovarian stimulation, whereas 111 patients did not. Patients were treated between January 2008 and December 2016. To calculate the disease-free survival time and overall survival rate, the time of definitive surgery was defined as the starting point. The follow-up was conducted up to 5 years.ResultsExposed and non-exposed groups were comparable in tumour, node and metastases classification, Nottingham grade, hormonal receptor status, tumour molecular phenotype, histology and pathology stage. The exposed group was younger than the non-exposed. Recurrences occurred in 9/148 women (6.1%) in the exposed group and 15/111 women (13.5%) in the non-exposed group, with no significant difference. The mean disease-free survival time was 63.9 months (95% confidence interval [CI]: 61.5–66.4) in the exposed group and 60.6 months (95% CI: 56.9–64.2) in the non-exposed, with no significant difference (log-rank [Mantel–Cox] test). Overall survival rates were comparable; 2/148 (1.4%) and 4/111 (3.6%) patients died, in exposed and non-exposed groups, respectively, during the period analysed. Mean overall survival times were 67.2 months (95% CI: 66.2–68.2) in the exposed group and 65.9 months (95% CI: 64.0–67.9) in the unexposed, with no significant difference (log-rank [Mantel–Cox] test).ConclusionsThis study suggests that ovarian stimulation in patients with early-stage breast cancer is safe in the long term.     

Patterns of treatment in older adults with primary central nervous system lymphoma

BACKGROUND: The incidence of primary central nervous system lymphoma (PCNSL) has increased in recent decades and is highest in people aged >or=65 years. Radiotherapy (XRT) and systemic chemotherapy (CTX), alone or in combination, are reported to extend survival, but treatment-related toxicity is a particular concern in the elderly. The objective of the current study was to identify factors associated with the receipt and type of treatment in a population-based cohort of older PCNSL patients. METHODS: Using Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked with Medicare claims, the authors identified PCNSL cases in adults aged >or=65 years who were diagnosed between 1994 and 2002. Initial treatment was defined as XRT alone, CTX alone, combined CTX and XRT, or no treatment, based on Medicare claims in the 6 months after diagnosis. The authors assessed the effects of age, comorbidity, and sociodemographic characteristics on the odds of receiving treatment. RESULTS: Of 579 PCNSL patients, 464 (80%) received any treatment. XRT alone was the most common modality (46%), followed by combined therapy (33%) and CTX alone (22%). The type of treatment varied by age (P < .0001). The use of CTX alone or in combination with XRT decreased with increasing age, whereas the use of XRT alone increased with age. In adjusted analysis, younger age (P < .01) was found to be predictive of the receipt of any treatment. The use of CTX decreased with age (P < .0001). The median survival was 7 months (95% confidence interval, 6-8 months); no significant time trends were observed. CONCLUSIONS: Although the majority of older PCNSL patients received treatment, most did not receive optimal therapy. Age was found to have the greatest influence on treatment selection. Overall survival in elderly PCNSL patients appears to be poor.     

Mass treatment for intestinal helminthiasis control in an Amazonian endemic area in Brazil

The objective of the present study was to estimate the prevalence of soil-transmitted helminthiasis and evaluate the sanitary conditions and the role of a mass treatment campaign for control of these infections in Santa Isabel do Rio Negro. A cross-sectional survey was carried out in 2002, to obtain data related to the sanitary conditions of the population and fecal samples for parasitological examination in 308 individuals, followed by a mass treatment with albendazole or mebendazole with coverage of 83% of the city population in 2003. A new survey was carried out in 2004, involving 214 individuals, for comparison of the prevalences of intestinal parasitosis before and after the mass treatment. The prevalences of ascariasis, trichuriasis and hookworm infection were 48%; 27% and 21% respectively in 2002. There was a significant decrease for the frequency of infections by Ascaris lumbricoides (p < 0.05; OR / 95% CI = 0.44 / 0.30 - 0.65), Trichuris trichiura (p < 0.05; OR / 95% CI = 0.37 / 0.22 - 0.62), hookworm (p < 0.05; OR / 95% CI = 0.03 / 0.01 - 0.15) and helminth poliparasitism (p < 0.05; OR / 95% CI = 0.16 / 0.08 - 0.32). It was also noticed a decrease of prevalence of infection by Entamoeba histolytica / dispar (p < 0.05; OR / 95% CI = 0.30 / 0.19 - 0.49) and non-pathogenic amoebas. It was inferred that a mass treatment can contribute to the control of soil-transmitted helminthiasis as a practicable short-dated measure. However, governmental plans for public health, education and urban infrastructure are essential for the sustained reduction of prevalences of those infections.     

PATTERN OF SEXUALLY TRANSMITTED DISEASES IN THE ARMED FORCES

Pattern of sexually transmitted diseases (STDs) in 1027 male patients admitted during 1990 to 1996 were analysed. Majority of cases (86%) were in age group of 20 to 40 years. Out of total 1027 STD cases 334 (32%) were having chancroid, 237 (23%) syphilis, 122 (11.9%) lymphogranuloma venereum, 130 (12.6%) gonorrhoea, 34 (3.3%) Herpes genitalis and 170 (16.5%) other STDs. 167 STD cases (163%) were found to have HIV infection. A rising trend in prevalence of HIV infection in STD patients from 2.8% (1990) to 27.8 (1996) was noticed contrary to declining trend of STDs from 213 cases in 1990 to 79 cases in 1996. The prevalence of HIV infection was 303% in LGV, 19.3% in chancroid, 13.5% in syphilis, 17.6% in herpes genitalis, 6.7% in gonorrhoea and 11.2% in other STD cases. Out of total 167 STD cases having HIV infection 65 (40%) cases were of chancroid, 37 (22.2%) of LGV, 32(19.2%) of syphilis, 8 (4.8) of gonorrhoea, and 6(3.6%) of herpes genitalis while 17 (10.2) cases were having other STDs.KEY WORDS: Chancroid, Gonorrhoea, Herpes genitalis, HIV infection, LGV, Sexually transmitted diseases (STDs), Syphilis     

Prostate biopsy tumor extent but not location predicts recurrence after radical prostatectomy: results from CaPSURE

PURPOSE: Prostate cancer biopsy information is important for patient risk assessment. Although the number and extent of positive biopsies have been used to predict recurrence, the impact of positive biopsy location and contiguity is less clear. We compared the ability of positive prostate biopsy location and pattern with number and percent positive biopsies to predict recurrence after RP. MATERIALS AND METHODS: From CaPSURE we identified 2,037 men treated with RP from 1992 to 2002 for whom detailed biopsy information and 2 or more followup PSA values were available. Treatment failure was defined as 2 consecutive PSA values of 0.2 ng/ml or higher, or a second treatment delivered more than 6 months after RP. Biopsy tumor volume (number and percent positive sites), location of disease (anatomical site, laterality), and contiguity of positive biopsies were entered into Cox proportional hazards models to predict risk of disease recurrence while controlling for Gleason grade, PSA and T stage. RESULTS: Higher number and percent of positive biopsy cores were associated with prostate cancer recurrence, risk stratification category and Gleason grade, p <0.0001, HR 1.09 (CI 1.02 to 1.16) and 1.01 (CI 1.00 to 1.01), respectively. Number of biopsy cores taken, laterality, contiguity and positive biopsy location were not associated with disease recurrence. CONCLUSIONS: The number and the percentage of biopsies positive for cancer correlated with treatment failure after radical prostatectomy. Contiguity, laterality and location were not associated with recurrence.     

Impact of increased number of biopsies on the nature of prostate cancer identified

PURPOSE: Increasing the number of cores obtained at the time of transrectal ultrasound guided prostate biopsy has increased the number of cancers identified. However, there is increasing recognition that many men with prostate cancer may not benefit from early, aggressive intervention and that over detection of prostate cancer has resulted in over treatment. We determined the impact of the greater number of prostate biopsies on the nature of cancer identified. MATERIALS AND METHODS: In the Cancer of the Prostate Strategic Urologic Research Endeavor database, a longitudinal disease registry of men with prostate cancer, we identified those men diagnosed between 1999 and 2002 with complete data on serum prostate specific antigen, Gleason score, clinical T stage, number of biopsies obtained and number involved with cancer. RESULTS: We identified 4,072 men with 6 or more prostate biopsies obtained at initial diagnosis. Of the men 30%, 47% and 24% underwent 6, 7 to 11, and more than 12 biopsies, respectively. The number of biopsies correlated significantly with numerous sociodemographic and clinical variables including prostate specific antigen, comorbidities and income. There did not appear to be differences in disease characteristics as assessed by Kattan and Cancer of the Prostate Risk Assessment scores among men with a biopsy number between 6 and 17. In the subset of 1,548 men undergoing radical prostatectomy, no differences in biochemical-free survival were observed among the various biopsy groups at a median followup of 2.2 years. CONCLUSIONS: The increasing number of prostate biopsies obtained at diagnosis increases cancer detection but the impact on disease characteristics remains unclear. Our data suggest that the risk stratification of prostate cancers is independent of biopsy number (6 or greater) in a contemporary cohort of men.