Self-reported fertility in long-term survivors of acute myeloid leukemia

Acute myeloid leukemia (AML) survival rates in younger patients have improved considerably since the 1970s. In order to evaluate the impact of AML and its treatment on fertility and family situation in adult long-term survivors, we used the Swedish population-based registries to identify 161 adult patients diagnosed with AML within the Leukemia Group of Middle Sweden (LGMS) 1973–2003, who survived for more than 5 years and were alive in 2010. Ninety-eight patients (61 %) completed a questionnaire including items on reproductive concerns, family situation, and infertility-related distress. After excluding women >45 years and/or postmenopausal women and men >55 years, 22 women and 38 men were included in the final analysis. Nine of the women (41 %) tried to conceive after treatment, but only three succeeded. Five (83 %) of the unwillingly childless women reported “a moderate” or “a lot” of distress caused by this. Among men in the same age group, all six who wanted children after treatment succeeded. None of the men 46–55 years old cryopreserved their sperm or tried to father a child. Among patients who wanted children after AML treatment, 46 % of the women and 40 % of the younger men reported that they were not, or not fully, informed about fertility-related issues. In contrast, among men 46–55 years, none reported they would have wanted more information. Infertility among young female AML survivors thus remains an important clinical issue, and there is a need for improved clinical counseling and education in this area.     

The involvement of parents in the healthcare provided to hospitalzed children

Objective

to analyze the answers of parents and health care professionals concerning the involvement of parents in the care provided to hospitalized children.

Method

exploratory study based on the conceptual framework of pediatric healthcare with qualitative data analysis.

Results

three dimensions of involvement were highlighted: daily care provided to children, opinions concerning the involvement of parents, and continuity of care with aspects related to the presence and participation of parents, benefits to the child and family, information needs, responsibility, right to healthcare, hospital infrastructure, care delivery, communication between the parents and health services, shared learning, and follow-up after discharge.

Conclusion

the involvement of parents in the care provided to their children has many meanings for parents, nurses and doctors. Specific strategies need to be developed with and for parents in order to mobilize parental competencies and contribute to increasing their autonomy and decision-making concerning the care provided to children.     

Electronic Cigarettes: Smoke-Free Laws,Sale Restrictions,and the Public Health

Consumer use of e-cigarettes is rising despite a lack of rigorous safety testing, manufacturing controls, and a well-understood risk profile. Many states and municipalities have prohibited e-cigarette sale to minors or amended their smoke-free laws to restrict public use. I discuss the public health impact of e-cigarettes and the current lack of Food and Drug Administration regulation, and advocate that states and localities reexamine their smoke-free laws and sale restrictions to appropriately regulate public use and youth access.Smoking consistently accounts for nearly 5.4 million deaths worldwide1 and approximately 443 000 in the United States each year.2 Heeding the significant health warnings and deadly statistics, smokers are increasingly turning to a new mode of nicotine intake: the electronic cigarette, or e-cigarette. Public awareness and use of e-cigarettes is skyrocketing as a result of targeted marketing tactics.3 The Centers for Disease Control and Prevention (CDC) report that e-cigarette use quadrupled in a 1-year period and continues to rise.4 Twenty-one percent of adult smokers in the United States have used e-cigarettes, 6% of all adults have tried e-cigarettes, and general awareness of e-cigarettes has risen to 60% of all adults, up from 40% the previous year.4 The CDC also report that use among US youths is staggering, having doubled among high-school students between 2011 and 2012.5 This most recent figure has led many nonsmoking advocates and health officials to question whether a troubling gateway effect of e-cigarettes for subsequent youth cigarette smoking is emerging after decades of decline in cigarette use by minors.6A core feature of the e-cigarette is that it looks and feels like a cigarette, satisfying psychological and behavioral stimuli for users who smoke. E-cigarettes, however, are smokeless, consisting of a replaceable nicotine cartridge, an atomizer that vaporizes the nicotine when the user inhales, and a battery that powers the device. The nicotine cartridge contains nicotine and various secondary chemical ingredients. When screwed together, the nicotine liquid from the cartridge contacts the atomizer and is carried to a metal coil heating element. The intake of air triggers a current from the battery through the atomizer, which heats up the nicotine liquid. Often, a light-emitting diode at the base mimics the burning ash at the end of traditional cigarette as the user inhales. Many products resemble a traditional cigarette, yet some are marketed in the shape of other household accessories such as pipes, pens, and lipstick. A single cartridge can hold the nicotine equivalent of an entire pack of cigarettes or more, and there is tremendous variation in the composition, strengths, and flavoring of the nicotine liquid.7E-cigarette advertisements, and the celebrities that frequent them, have emphasized the freedom to smoke anywhere; a lack of smell, tar, smoke, or toxic chemicals; an absence of social stigma; cost savings; and health advantages, often specifically reaching out to smokers aiming to quit or cut down.8 Some distributors also advertise their products as not emitting secondhand smoke or as ecologically friendly.8 The accuracy of these claims is unclear and contested. In fact, the Food and Drug Administration (FDA) and health care professionals alike have raised concern about the novel method of nicotine delivery, product ingredients, nicotine levels, safety of the various mechanical and electrical parts, dearth of data on product performance, and both explicit and implicit messages to users regarding health benefits.9 Scientific and clinical publications have only begun to target issues related to e-cigarette use.Consumer use, marketing and promotional claims, and technological characteristics of e-cigarettes have also raised decades-old questions of when the FDA can assert authority over particular products as drugs or medical devices. The 2010 DC Circuit case of Sottera v. FDA limited the FDA’s authority to regulate e-cigarettes as drugs or medical devices to instances where the manufacturer makes explicit health or disease-prevention claims for its products.10 Examining the language and congressional intent of the Family Smoking Prevention and Tobacco Control Act of 2009 (TCA), the court held that e-cigarettes fall within the literal definition of tobacco products because nicotine is “derived from tobacco,” as set forth in the TCA definitions. The FDA declined to appeal that decision and is currently assessing appropriate regulation and enforcement activities; the agency has issued a statement that it plans to assert regulatory authority over e-cigarettes as tobacco products.11While the FDA struggles to determine how to regulate these products at the federal level, state and local governments also have a role to play. The TCA, coupled with previous legislative authority, gives broad latitude to states and localities to enact laws and regulations relating to the sale, distribution, possession, and use of tobacco products.12 State and local regulatory efforts have focused on smoke-free laws and restrictions on use and sale. Thirty-six states and 3931 municipalities have laws in place restricting or prohibiting smoking in public places and workplaces.13 The scope of the laws varies, commonly directed at a combination of locations such as nonhospitality workplaces, restaurants and bars, and public areas. The overwhelming majority of the laws were drafted with cigarettes and traditional tobacco products in mind, with many specifically using the word “smoke” or “smoking” to define the restricted or prohibited action. However, e-cigarettes do not produce smoke; they produce vapor. States and localities must reexamine their smoke-free laws and access restrictions to appropriately regulate the use of e-cigarettes.As of September 2013, 27 states and localities have amended their smoke-free laws to explicitly include e-cigarettes within the ban on smoking in public places.14 For example, the New Jersey Smoke-Free Air Act prohibits smoking in indoor public places, workplaces, and in buildings or grounds of any public or nonpublic elementary or secondary school. It was amended in 2010 to include within the scope of smoking “the inhaling or exhaling of smoke or vapor from an electronic smoking device.”15 An electronic smoking device is further defined as “an electronic device that can be used to deliver nicotine or other substances to the person inhaling from the device, including, but not limited to, an electronic cigarette, cigar, cigarillo, or pipe.”15 Likewise, New York bans e-cigarette use within 100 feet of entrances and exits to public or private schools.16 In addition to the state laws, Somerset, Massachusetts; King County, Washington; Madison County, Kentucky; Savannah, Georgia; and Petaluma, California, are just a few cities and counties, among others, that have passed ordinances explicitly including e-cigarettes within the scope of their smoking bans.14 Both California and Oregon have settled in court with leading e-cigarette manufacturers and distributors, making the sale of their specific e-cigarette products unlawful in those states.14Thirty-four states and municipalities have also enacted laws banning sales of e-cigarettes to minors, although the age limitations vary from younger than 18 to younger than 21 years.14 Dozens of states include both a ban on smoking in public settings and a ban on sale to minors, and other laws contain individual nuances.14 For example, Hawaii prohibits the sale of e-cigarettes to minors younger than 18 years, and also requires in-person sales rather than sales through the Internet.14 Tacoma–Pierce County, Washington, includes a ban on free sampling unless within an e-cigarette retail store.14 In a September 2013 letter to the FDA, lawmakers joined the call, urging the agency to act swiftly at the federal level to address the epidemic of youths’ use of e-cigarettes.17 Federal legislators have also advocated hearings on the health risks and scope of FDA authority.17These state and local laws are merely a stopgap measure and fail to establish a uniform national policy for e-cigarettes. The best outcome to ensure the protection of the public health, and youths in particular, would be for the FDA to initiate rulemaking proceedings to deem e-cigarettes within the definitional scope of the TCA. This would allow the FDA to develop manufacturing requirements, reporting mechanisms, product standardization, ingredient listings, limitations on marketing claims, and various other procedures to install proper oversight of product development and distribution. As with any effort at content regulation, First Amendment challenges may arise. However, states and local governments also have a role in regulation and should proactively reassess their existing smoking bans, sale to minors, and other restrictions and decide whether to amend the language to include e-cigarettes. Failing to include a clear statutory definition leaves use and access to e-cigarettes as a significant loophole, and may thwart even the most well-intended public health laws.     

Co-administration of tilapia alpha-helical antimicrobial peptides with subunit antigens boost immunogenicity in mice and tilapia (Oreochromis niloticus)

Modern vaccines based on purified recombinant antigens have improved their safety; however they induce a suboptimal immune response without the help of adjuvants. Consequently, the development of new adjuvants to enhance the immunogenicity of purified subunit antigens and modulate resulting immune responses is of great interest. In the present study, we evaluated the ability of antimicrobial peptides Oreochromicins previously isolated from tilapia Oreochromis niloticus to enhance adaptive immune responses in mice and tilapia. When co-administrated with ovalbumin in mice, Oreochromicin-1 induced a T_H1 humoral immune response. Oreochromicin-2 and 3 induce a T_H1 cellular immune response characterized by the induction of interferon-γ in a dose depend manner. Additionally, co-administration of Oreochromicin-1 with the sea lice my32 from Lepeophtheirus salmonis antigen (my32-Ls) increases the humoral immune response in mice and tilapia. We also tested different combinations of these Oreochromicins with the sea lice antigen my32-Ls in mice. Humoral and cellular T_H1 responses were enhanced by co-administration of my32-Ls/Oreochromicin-3 and the combination my32-Ls/Oreochromicin-2/3. In agreement with these results, Oreochromicin-1 and 3 enhanced in vitro T_H1 cytokine IFN-γ production in Concanavalin A primed splenocytes from naïve mice after a 48 h incubation period. In summary, the results showed that tilapia alpha-helical antimicrobial peptides Oreochromicins are able to boost immune response in mammals and fish, encouraging their use as T_H1 molecular adjuvants to subunit antigens.     

Cluster analysis of cognitive deficits may mark heterogeneity in schizophrenia in terms of outcome and response to treatment

Cognitive impairments are central to schizophrenia, but their clinical utility for tagging heterogeneity in lifetime outcome and response to treatment is not conclusive. By exploiting four cognitive domains consistently showing large deficits in studies, we tested whether cluster analysis would define separate subsets of patients and then whether the disease heterogeneity marked by these clusters would be related to lifetime outcome and response to treatment. A total of 112 schizophrenia patients completed a neuropsychological evaluation. The PANSS, GAF-S and GAF-F were rated at the onset and endpoint of the illness trajectory. A blind judgment of the lifetime response to treatment was made. The first cluster presented near-normal cognitive performance. Two other clusters of severely impaired patients were identified: one generally impaired in the four cognitive domains and another selectively impaired in visual episodic memory and processing speed, each relating to a different lifetime evolution of disease and treatment response. Although the two impaired clusters were clinically indistinguishable in symptom severity and functioning at disease onset, patients with selective cognitive impairments demonstrated better improvement at outcome, whereas the generally impaired patients were more likely to be treatment refractory. The findings have implications for the management of patients and for clinical trials since particular combinations of cognitive deficits in patients would influence their treatment response.     

Quality of life and fecal incontinence after transanal endoscopic microsurgery for benign and malignant rectal lesions

Background

Transanal endoscopic microsurgery (TEM) is a minimally invasive treatment used to excise a variety of rectal lesions. Potential overstretching of the sphincter’s musculature due to dilation of the anal canal to allow placement of a 40-mm-wide scope combined with partial resection of the rectum and subsequent loss of rectal volume creates a concern regarding anorectal function postoperatively. Data regarding patient satisfaction with anorectal function and quality of life after TEM are scant. This report presents data on patient satisfaction gathered during a period of 10 years.

Methods

A prospectively maintained database of patients undergoing TEM from 1997 to 2007 was queried to identify patients to survey using the Fecal Incontinence Quality of Life Scale questionnaire, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) questionnaire version 3, and a questionnaire designed by the authors to assess satisfaction with quality of life. From a group of 86 patients, 57 (66 %) responded to the questionnaires. Patient satisfaction outcomes were determined by age, preoperative diagnosis, tumor level in the rectum, excision method, and radiation treatment.

Results

Most of the patients (94.7 %) preferred TEM to having a stoma. Age (p = 0.03) and nature of the lesion (p = 0.03) were the only factors that affected coping. Depression was affected only by the presence of malignancy (p = 0.001). Excision method was the only factor that significantly influenced overall lifestyle (p = 0.002). Neither tumor level (p = 0.8) nor radiation therapy (p = 0.9) affected patient satisfaction with lifestyle after TEM. The presence of malignancy (p = 0.004) and full-thickness excision (p = 0.02) were related to more problems with fecal incontinence.

Conclusion

Satisfaction with fecal continence generally is high after TEM. Tumor level, size of tumor, and radiation therapy do not affect the level of satisfaction after TEM. Younger age and benign nature of the lesion help patients to cope better with lifestyle changes and reduce depression. Patients with submucosal excision have a significantly higher level of satisfaction.     

Compliance with infection prevention and control in oral health‐care facilities: a global perspective

Many publications are available on the topic of compliance with infection prevention and control in oral health‐care facilities all over the world. The approaches of developing and developed countries show wide variation, but the principles of infection prevention and control are the same globally. This study is a systematic review and global perspective of the available literature on infection prevention and control in oral health‐care facilities. Nine focus areas on compliance with infection‐control measures were investigated: knowledge of infectious occupational hazards; personal hygiene and care of hands; correct application of personal protective equipment; use of environmental barriers and disposable items; sterilisation (recirculation) of instruments and handpieces; disinfection (surfaces) and housekeeping; management of waste disposal; quality control of dental unit waterlines, biofilms and water; and some special considerations. Various international studies from developed countries have reported highly scientific evidence‐based information. In developed countries, the resources for infection prevention and control are freely available, which is not the case in developing countries. The studies in developing countries also indicate serious shortcomings with regard to infection prevention and control knowledge and education in oral health‐care facilities. This review highlights the fact that availability of resources will always be a challenge, but more so in developing countries. This presents unique challenges and the opportunity for innovative thinking to promote infection prevention and control.     

Benefit of continuous positive airway pressure on work quality in patients with severe obstructive sleep apnea

Sleep and Breathing - The objective of this prospective study was to assess the effect of CPAP therapy on job productivity and work quality for patients with severe obstructive sleep apnea (OSA). A...