Evaluation of the impact of the heat wave in the summer of 2003 on mortality

The effect of the elevated temperatures experimented in Europe during the summer 2003 on mortality was observed in several countries. This study, carried out in Spain, describes the mortality between the 1st June and the 31st August and evaluates the effect of the heat wave on mortality. Observed deaths were obtained from official vital Registers of the capital city of the 50 provinces. Deaths from 107 randomly selected rural villages were also obtained from the same source. Observed deaths were compared with expected estimated applying a Poisson regression model to historical mortality series adjusting for the upwards trend and seasonality observed. Meteorological information was provided by the National Institute of Meteorology. Spain experienced three heat waves. Total excess deaths associated was 8% (43,212 observed compared with 40,046 expected). Excess deaths were only observed among 65 years old and over (15%). The increased mortality was also observed in rural villages. This phenomenon is becoming an emerging public health problem because of its increasing attributable risk because of the aging of Spanish population. Alert and response systems based on monitoring of climate related risks, emergency rooms activity and mortality and the strengthening of social and health services response capacity should be considered.     

Physicians' use of electronic medical records: barriers and solutions

The electronic medical record (EMR) is an enabling technology that allows physician practices to pursue more powerful quality improvement programs than is possible with paper-based records. However, achieving quality improvement through EMR use is neither low-cost nor easy. Based on a qualitative study of physician practices that had implemented an EMR, we found that quality improvement depends heavily on physicians' use of the EMR-and not paper-for most of their daily tasks. We identified key barriers to physicians' use of EMRs. We then suggest policy interventions to overcome these barriers, including providing work/practice support systems, improving electronic clinical data exchange, and providing financial rewards for quality improvement.     

DAX-1 expression in human breast cancer: comparison with estrogen receptors ER-α, ER-β and androgen receptor status

Background  

So far there have been no reports on the expression pattern of DAX-1 (dosage-sensitive sex reversal, adrenal hypoplasia critical region, on chromosome X, gene 1) in human breast cells and its relationship to the estrogen receptors, ER-α and ER-β, and the androgen receptor (AR).     

First description of feline inflammatory mammary carcinoma: clinicopathological and immunohistochemical characteristics of three cases

Introduction

Inflammatory breast cancer is a special type of locally advanced mammary cancer that is associated with particularly aggressive behaviour and poor prognosis. The dog was considered the only natural model in which to study the disease because, until now, it was the only species known to present with inflammatory mammary carcinoma (IMC) spontaneously. In the present study we describe clinicopathological and immunohistochemical findings of three cats with IMC, in order to evaluate its possible value as an animal model.

Methods

We prospectively studied three female cats with clinical symptoms of IMC, identified over a period of 3 years. Clinicopathological and immunohistochemical evaluations of Ki-67, and oestrogen, progesterone and androgen receptors were performed.

Results

All three animals presented with secondary IMC (postsurgical) characterized by a rapid onset of erythema, severe oedema, extreme local pain and firmness, absence of subjacent mammary nodules, and involvement of extremities. Rejection of the surgical suture was observed in two of the cats. Histologically, highly malignant papillary mammary carcinomas, dermal tumour embolization of superficial lymphatic vessels, and severe secondary inflammation were observed. The animals were put to sleep at 10, 15 and 45 days after diagnosis. Metastases were detected in regional lymph nodes and lungs in the two animals that were necropsied. All tumours had a high Ki-67 proliferation index and were positive for oestrogen, progesterone and androgen receptors.

Conclusion

Our findings in feline IMC (very low prevalence, only secondary IMC, frequent association of inflammatory reaction with surgical suture rejection, steroid receptor positivity) indicate that feline IMC could be useful as an animal model of human inflammatory breast cancer, although the data should be considered with caution.

     

Maternal diet with diverse omega-6/omega-3 ratio affects the brain docosahexaenoic acid content of growing chickens

Eggs with diverse omega-6/omega-3 ratio produced by feeding breeder hens a wheat-soybean meal-basal diet containing 5% (wt/wt) sunflower oil (H(omega)6), 5% fish oil (H(omega)3) or 2.5% sunflower oil plus 2.5% fish oil (M(omega)3omega6) were incubated. The hatched chicks were fed a docosahexaenoic acid (DHA)-deficient diet up to 6 weeks of age. The fatty acid composition of chick brain was determined on 0, 2, 4 and 6 weeks and brain weight was taken on day 0 and day 42. The omega-6/omega-3 ratios were 37.12, 4.21 and 0.98 for the maternal diet; 28.36, 2.83 and 0.89 for the egg yolk; 1.94, 0.48 and 0.18 for hatched chick brain (p < 0.05). At 2 weeks of age, the omega-6/omega-3 ratios were 1.88, 0.81 and 0.60 for chicks hatched from hens fed H(omega)6, M(omega)3omega6 and H(omega)3 diets, respectively. The brain DHA contents at 0 and 2 weeks of age were Homega3 > M(omega)3omega6 < H(omega)6 (p < 0.05) and at 4 and 6 weeks of age H(omega)3 = M(omega)3omega6 > H(omega)6. Dietary C18:3omega3 in the starter and finisher diet did not increase brain DHA (p > 0.05). The significant increase in the content of C22:5omega3 at 6 weeks of age in group 1 birds with a concomitant reduction in DHA suggests a weak delta-4 desaturation but an effective delta-6 and delta-5 desaturation similar to human infants. Considering the role of DHA in early brain development and growth, the maternal supply of DHA during growth might be of importance when fed a DHA-deficient neonatal diet.