Residents from non‐English‐speaking countries of birth in Australian aged care facilities

Objective

To describe the activity of daily living and behavioural and complex care needs of residents born in non‐English‐speaking countries in Australian aged care facilities.

Methods

De‐identified cross‐sectional data were provided by the Australian Institute of Health and Welfare for all residents in government‐funded facilities on 30 June 2015. Analyses included t‐tests, chi‐squared tests and logistic regressions.

Results

A total of 33 168 (19%) residents were born in one of 188 non‐English‐speaking countries. Compared to residents born in English‐speaking countries, they were significantly younger, lived in larger facilities, were more likely to be male and live in an urban area. Their care requirements were greater for activities of daily living and behavioural and complex care. Residents from non‐English‐speaking countries living in ethno‐specific facilities had higher levels of these needs.

Conclusion

The needs of residents born in non‐English‐speaking countries should be considered when planning aged care services.

     

Radiographic methods in knee osteoarthritis: a further comparison of semiflexed (MTP), schuss-tunnel,and weight-bearing anteroposterior views for joint space narrowing and osteophytes

OBJECTIVE: Current radiographic evaluation of knee osteoarthritis (OA) depends primarily on the presence and severity of joint space narrowing (JSN) and osteophytes. Radiographic JSN is a function of the actual JSN caused by articular cartilage loss and the observable JSN artifactually caused when the tibial and femoral surfaces diverge due to variations in patient's knee position. Views yielding the greatest JSN are the most accurate. Osteophytes are also dependent on positioning. This study investigated the consequences of positioning on JSN and osteophytes in clinical studies in which the outcome of OA knee is scored. METHODS: In total, 1105 patients underwent 1175 paired radiographic examinations using weight-bearing (WB) standard anterior-posterior (AP) extended knee views (AP-WB), semiflexed WB posterior-anterior views with the knee in contact with the film and the 1st metatarsophalangeal (MTP) joint under the film plane (MTP) (method of Buckland-Wright), and WB PA views with the tip of the great toe at the film plane, 20 degrees of knee flexion and 5 degrees downward angulation of the x-ray tube (schuss-tunnel view). Careful attention was given to proper positioning. JSN and osteophytes were scored on a 0-3 scale. RESULTS: JSN was significantly greater by the MTP and schuss-tunnel methods than by the AP-WB method, but no difference was found between the MTP and schuss-tunnel methods. In addition, disagreement was identified in 34% of MTP and AP-WB scores. In 69.3% of disagreements the scores were more abnormal in the MTP view. When the disagreements were studied, the mean MTP score was 1.68 compared to 1.12 for the AP-WB score. Fifty-seven knees were scored as 3 by the MTP view and as 2 by the AP-WB, and 8 knees were scored as 3 by the AP-WB view and 2 by the MTP view. Little difference in osteophytes was noted among the 3 methods, although fewer osteophytes were identified by the schuss-tunnel method than the AP-WB method. CONCLUSION: Using the clinical reading methods of this study, the MTP and schuss-tunnel views were equivalent when compared to each other. When compared with the AP-WB view, the schuss-tunnel view resulted in a lower osteophyte score. These results, based on clinical readings, are similar to previous computerized analyses that indicated that the MTP and schuss-tunnel views were superior to the AP-WB, but that the MTP view was superior to the schuss-tunnel view.     

ALK- anaplastic large-cell lymphoma is clinically and immunophenotypically different from both ALK+ ALCL and peripheral T-cell lymphoma, not otherwise specified: report from the International Peripheral T-Cell Lymphoma Project

The International Peripheral T-Cell Lymphoma Project is a collaborative effort designed to gain better understanding of peripheral T-cell and natural killer (NK)/T-cell lymphomas (PTCLs). A total of 22 institutions in North America, Europe, and Asia submitted clinical and pathologic information on PTCLs diagnosed and treated at their respective centers. Of the 1314 eligible patients, 181 had anaplastic large-cell lymphoma (ALCL; 13.8%) on consensus review: One hundred fifty-nine had systemic ALCL (12.1%) and 22 had primary cutaneous ALCL (1.7%). Patients with anaplastic lymphoma kinase–positive (ALK⁺) ALCL had a superior outcome compared with those with ALK^– ALCL (5-year failure-free survival [FFS], 60% vs 36%; P = .015; 5-year overall survival [OS], 70% vs 49%; P = .016). However, contrary to prior reports, the 5-year FFS (36% vs 20%; P = .012) and OS (49% vs 32%; P = .032) were superior for ALK^– ALCL compared with PTCL, not otherwise specified (PTCL-NOS). Patients with primary cutaneous ALCL had a very favorable 5-year OS (90%), but with a propensity to relapse (5-year FFS, 55%). In summary, ALK^– ALCL should continue to be separated from both ALK⁺ ALCL and PTCL-NOS. Although the prognosis of ALK^– ALCL appears to be better than that for PTCL-NOS, it is still unsatisfactory and better therapies are needed. Primary cutaneous ALCL is associated with an indolent course.     

Alloreactive CD4+ T lymphocytes can exert cytotoxicity to chronic myeloid leukaemia cells processing and presenting exogenous antigen

Existing evidence supports that CD4⁺ T lymphocytes play a role in the graft-versus-leukaemia (GVL) reaction after allogeneic bone marrow transplantation (BMT) for chronic myeloid leukaemia (CML), not only as initiators of the immune response but also as effectors of GVL. In BMT between HLA-identical pairs this CD4-mediated GVL would require CML cells to process and present antigens through MHC class II molecules. To investigate whether CML cells are capable of processing and presenting antigens, and suitable targets for CD4⁺ T-cell-mediated cytotoxicity, we generated HLA-DR1-restricted CD4⁺ cytotoxic T-cell clones that specifically recognized tuberculous purified protein derivative (PPD). We have shown that CML cells and B lymphoblastoid cell line (B-LCL) cells but not PHA-blasts from patients with CML processed exogenous antigen, PPD, and induced proliferative and cytotoxic CD4⁺ T-cell responses. Antigen presentation was blocked by antibodies to HLA-DR but not to MHC class I and by treatment with chloroquine and brefeldin. This indicates that CML cells use a classic MHC class II antigen processing pathway to present PPD antigens to CD4⁺ T cells. Cytotoxicity to CML was shown by antibody blocking studies to be mediated mainly through fas antigen. These findings indicate that donor CD4⁺ T cells alone are sufficient to mediate GVL effects following allogeneic BMT for CML.     

Multimodality management of a polyfunctional pancreatic endocrine carcinoma with markedly elevated serum vasoactive intestinal polypeptide and calcitonin levels

We present an unusual case of a 52-year-old woman with severe, uncontrollable, refractory diarrhea attributable to pancreatic endocrine carcinoma (ECA) with markedly elevated serum vasoactive intestinal polypeptide (VIP) and calcitonin levels. After initial correction of fluid and electrolyte abnormalities, the patient was treated with high-dose octreotide. Shortly thereafter, due to the intractable nature of her diarrhea, she underwent cytoreductive hepatic surgery. The pancreatosplenectomy specimen showed a poorly differentiated ECA of the distal pancreas, immunoreactive for synaptophysin, CD56, and S100 protein, with morphologically similar hepatic and lymph node metastases. Postoperatively, her diarrhea improved, along with decline in serum VIP and calcitonin levels. Systemic chemotherapy with etoposide and cisplatin did not result in any radiographic and biochemical improvement. Having radiologically stable disease with depot-octreotide and short-acting octreotide (Sandostatin), she was subjected to peptide receptor radiotherapy with [177Lu-DOTA0,Tyr]octreotate (LuTate) that resulted in marked clinical and biochemical improvement, along with dramatic reduction in the number and size of hepatic metastases. In summary, this is a unique case of metastatic VIP- and calcitonin-secreting pancreatic ECA with dramatic sustained clinical, biochemical, and objective tumor response to peptide receptor radionuclide therapy.     

Knowledge and Perceptions of Breast Health Among Free Clinic Patients

BackgroundBreast cancer is a significant women's health problem in the United States. However, critical information on specific populations is still lacking. In particular, it is not well known how free clinic patients perceive breast health. The purpose of this study was to assess knowledge and perceptions of breast health among uninsured women utilizing a free clinic that serves as a safety net for the underserved.MethodsA self-administrated survey that included knowledge and perceptions of breast health was conducted for female free clinic patients aged 40 or older in fall 2012. There were 146 participants. The participants were classified into three groups for comparison; U.S. citizen English speakers, non-U.S. citizen English speakers, and Spanish speakers.ResultsSpanish speakers had the highest average score on the knowledge of breast health, whereas the non-U.S. citizen English speakers had the lowest average score. Free clinic patients may consider breast health screening if recommended by health care providers. The non-U.S. citizen English speakers and Spanish speakers were more likely to have negative perceptions of breast health compared with the U.S. citizen English speakers.ConclusionsPromoting knowledge about breast health is important for free clinics. Recommendation by a health care provider is a key to increasing attendance at health education programs and breast health screening. Non-U.S. citizens and non-English speakers would need culturally competent interventions. Free clinics have limited human and financial resources. Such characteristics of free clinics should be considered for practice implementations.     

Bedbug Complaints among Public Housing Residents—New York City, 2010–2011

Few studies have evaluated population-level risk factors for having a bedbug infestation. We describe characteristics associated with bedbug complaints among New York City Housing Authority (NYCHA) residents. Unique households receiving bedbug extermination services in response to a complaint during January 1, 2010 to December 31, 2011 were identified from NYCHA’s central facilities work order database. We examined associations between household characteristics and having a bedbug complaint using a generalized estimating equation Poisson regression model, accounting for clustering by housing development. Of the 176,327 NYCHA households, 11,660 (6.6 %) registered a bedbug complaint during 2010–2011. Bedbug complaints were independently associated with households having five or more children versus no children (prevalence ratio [PR] = 2.0), five or more adults versus one adult (PR = 1.6), a head of household (HOH) with impaired mobility (PR = 1.3), a household member receiving public assistance (PR = 1.2), a household income below poverty level (PR = 1.1), and a female HOH (PR = 1.1). Infestations were less likely to be reported by households with employed members (PR = 0.9), and an HOH aged 30–44 years (PR = 0.9) or 45–61 years (PR = 0.9), compared with an HOH aged 18–29 years. These results indicate that bedbug control efforts in public housing should be targeted toward households with low income and high occupancy.     

Hazardous substances in frequently used professional cleaning products

Background:

A growing number of studies have identified cleaners as a group at risk for adverse health effects of the skin and the respiratory tract. Chemical substances present in cleaning products could be responsible for these effects. Currently, only limited information is available about irritant and health hazardous chemical substances found in cleaning products. We hypothesized that chemical substances present in cleaning products are known health hazardous substances that might be involved in adverse health effects of the skin and the respiratory tract.

Methods:

We performed a systematic review of cleaning products used in the Swiss cleaning sector. We surveyed Swiss professional cleaning companies (n = 1476) to identify the most used products (n = 105) for inclusion. Safety data sheets (SDSs) were reviewed and hazardous substances present in cleaning products were tabulated with current European and global harmonized system hazard labels.

Results:

Professional cleaning products are mixtures of substances (arithmetic mean 3.5±2.8), and more than 132 different chemical substances were identified in 105 products. The main groups of chemicals were fragrances, glycol ethers, surfactants, solvents; and to a lesser extent, phosphates, salts, detergents, pH-stabilizers, acids, and bases. Up to 75% of products contained irritant (Xi), 64% harmful (Xn) and 28% corrosive (C) labeled substances. Hazards for eyes (59%) and skin (50%), and hazards by ingestion (60%) were the most reported.

Conclusions:

Cleaning products potentially give rise to simultaneous exposures to different chemical substances. As professional cleaners represent a large workforce, and cleaning products are widely used, it is a major public health issue to better understand these exposures. The list of substances provided in this study contains important information for future occupational exposure assessment studies.