Early psychological interventions for prevention and treatment of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in post-partum women: A systematic review and meta-analysis.

BACKGROUND: Pre-term or full-term childbirth can be experienced as physically or psychologically traumatic. Cumulative and trans-generational effects of traumatic stress on both psychological and physical health indicate the ethical requirement to investigate appropriate preventative treatment for stress symptoms in women following a routine traumatic experience such as childbirth. OBJECTIVE: The objective of this review was to investigate the effectiveness of early psychological interventions in reducing or preventing post-traumatic stress symptoms and post-traumatic stress disorder in post-partum women within twelve weeks of a traumatic birth. METHODS: Randomised controlled trials and pilot studies of psychological interventions preventing or reducing post-traumatic stress symptoms or PTSD, that included women who had experienced a traumatic birth, were identified in a search of Cochrane Central Register of Randomised Controlled Trials, MEDLINE, Embase, Psychinfo, PILOTS, CINAHL and Proquest Dissertations databases. One author performed database searches, verified results with a subject librarian, extracted study details and data. Five authors appraised extracted data and agreed upon risk of bias. Analysis was completed with Rev Man 5 software and quality of findings were rated according to Grading of Recommendation, Assessment, Development, and Evaluation. RESULTS: Eleven studies were identified that evaluated the effectiveness of a range of early psychological interventions. There was firm evidence to suggest that midwifery or clinician led early psychological interventions administered within 72 hours following traumatic childbirth are more effective than usual care in reducing traumatic stress symptoms in women at 4-6 weeks. Further studies of high methodological quality that include longer follow up of 6-12 months are required in order to substantiate the evidence of the effectiveness of specific face to face and online early psychological intervention modalities in preventing the effects of stress symptoms and PTSD in women following a traumatic birth before introduction to routine care and practice. PROSPERO REGISTRATION: CRD42020202576, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=202576.

Status report, The Public Health and Planning 101 project: strengthening collaborations between the public health and planning professions. / Rapport d'étape, Projet Santé publique et planification 101 : renforcer la collaboration entre les secteurs de la santé publique et de la planification urbaine.

INTRODUCTION: Land use planning is a complex field comprised of legislation, policies, processes and tools. A growing body of evidence supports the relationship between land use planning decisions, community design and health. The built environment has been shown to be associated with physical inactivity, obesity, cardiovascular disease, respiratory disease and mental illness. Consequently, there is a growing interest within public health to work with planners on land use planning initiatives such as official plans and transportation master plans. METHODS: Two surveys were developed: one for public health professionals and the other for planning professionals (survey questions available upon request to the corresponding author). The surveys were pilot tested in two separate focus group sessions with public health and planning professionals. Focus group volunteers helped to validate the surveys by verifying survey questions, design and overall flow. RESULTS: In early 2012, 304 public health professionals and 301 planning professionals completed the two separate surveys, comprising the total survey respondents for each respective profession used to calculate proportions. The survey results represent a convenience sample and are not generalizable to the entire population of public health and planning professionals in Ontario. Results compare survey responses from both groups where appropriate. Most respondents worked either as public health staff (78%) or planners/senior planners (58%). A smaller percentage of public health and planning professionals worked either as managers (15% and 11%, respectively) or directors (5% and 9%, respectively). CONCLUSION: Health is associated with how communities are planned and built, and the services and resources provided within them. Inspired by the results of our survey and based on user feedback from the pilot tests, a free online training program entitled "Public Health and Planning 101: An Online Course for Public Health and Planning Professionals to Create Healthier Built Environments" was launched in 2016 by OPHA as a collaborative project with OPPI and PHAC. This course is designed to bridge the gaps between the two professions, as well as provide greater opportunities for developing collaborative partnerships to help create and foster healthy built environments.

INTRODUCTION: La planification de l'aménagement du territoire est un domaine complexe fait de réglementations, de politiques, de processus et d'outils. De plus en plus de données probantes renforcent la validité du lien entre décisions sur l'aménagement du territoire, design urbain et santé. On sait désormais que l'environnement bâti est associé à l'inactivité physique, à l'obésité ainsi qu'aux maladies cardiovasculaires, respiratoires et mentales. Il y a de ce fait un intérêt croissant chez les professionnels de la santé publique pour participer aux initiatives de planification de l'aménagement du territoire, comme les plans officiels et les plans directeurs des transports. MÉTHODOLOGIE: Deux sondages ont été préparés : l'un pour les professionnels de la santé publique et l'autre pour les professionnels de l'aménagement (les questions des sondages sont disponibles sur demande auprès de l'auteur ressource). Les sondages ont fait l'objet d'essais pilotes dans deux groupes de discussion avec des professionnels de la santé publique et de l'aménagement. Des bénévoles des groupes de discussion ont aidé à valider les sondages en vérifiant les questions, la conception et la fluidité générale des sondages, lesquels ont ensuite été remaniés en fonction de la rétroaction fournie. La version finale a été envoyée en janvier et février 2012 aux membres permanents (planificateurs professionnels agréés) et provisoires de l'IPPO (par courriel) et aux professionnels de la santé publique (par l'intermédiaire des listes de diffusion du secteur de la santé publique). Les deux sondages avaient des questions similaires, visant à déterminer les connaissances, l'opinion et les croyances des répondants sur l'environnement bâti ou la santé, la réglementation et le mandat des professionnels de l'autre groupe, ainsi que le type de ressources nécessaires pour pouvoir mieux collaborer aux projets sur la santé et les environnements bâtis. RÉSULTATS: Début 2012, 304 professionnels de la santé publique et 301 professionnels de l'aménagement ont rempli leur sondage, constituant le nombre total de répondants utilisé pour le calcul des proportions pour chaque profession. Les résultats du sondage correspondent à un échantillon de commodité et ne sont pas généralisables à l'ensemble de la population de professionnels de la santé publique ou de la planification de l'aménagement du territoire de l'Ontario. CONCLUSION: La santé est liée à la manière dont les collectivités sont planifiées et construites, ainsi qu'aux services et aux ressources qu'on y trouve. Inspiré par les résultats de notre sondage et la rétroaction des participants aux essais pilotes, un programme gratuit de formation en ligne intitulé « Projet Santé publique et planification 101 : Cours en ligne pour les professionnels de la santé publique et de la planification urbaine en vue de la création d'environnements bâtis plus sains ¼ a été lancé en 2016 par l'ASPO en collaboration avec l'IPPO et l'ASPC. Le cours a été conçu pour combler les écarts entre les deux professions et pour fournir de meilleures occasions de bâtir des partenariats en vue de la création et de la promotion d'environnements bâtis sains.

The prognostic value of tumour regression grade following neoadjuvant chemoradiation therapy for rectal cancer.

AIM: To date, there is no uniform consensus on whether tumour regression grade (TRG) is predictive of outcome in rectal cancer. Furthermore, the lack of standardization of TRG grading is a major source of variability in published studies. The aim of this study was to evaluate the prognostic impact of TRG in a cohort of patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation therapy (CRT). In addition to the Mandard TRG, we utilized four TRG systems modified from the Mandard TRG system and applied them to the cohort to assess which TRG system is most informative. METHOD: One-hundred and fifty-three patients with a T3/T4 and/or a node-positive rectal cancer underwent neoadjuvant 5-fluorouracil-based CRT followed by surgical resection. RESULTS: Thirty-six (23.5%) patients achieving complete pathological response (ypCR) had a 5-year disease-free survival (DFS) rate of 100% compared with a DFS rate of 74% for 117 (76.5%) patients without ypCR (P = 0.003). The Royal College of Pathologists (RCPath) TRG best condenses the Mandard five-point TRG by stratifying patients into three groups with distinct 5-year DFS rates of 100%, 86% and 67%, respectively (P = 0.001). In multivariate analysis, pathological nodal status and circumferential resection margin (CRM) status, but not TRG, remained significant predictors of DFS (P = 0.002, P = 0.035 and P = 0.310, respectively). CONCLUSION: Our findings support the notion that ypCR status, nodal status after neoadjuvant CRT and CRM status, but not TRG, are predictors of long-term survival in patients with locally advanced rectal cancer.

Supportive therapy with extracorporeal membrane oxygenation for acute respiratory distress syndrome.

Acute respiratory distress syndrome is a severe form of respiratory failure characterized by acute onset of significant hypoxaemia (PaO2:FiO2<200mmHg) with diffuse bilateral pulmonary air-space shadowing on chest X-ray, without clinical signs of heart failure (Bernard et al, 1994). It has a heterogeneous aetiology with wide-ranging pulmonary and extra-pulmonary causes.

Early discharge policy of patients with acute colonic diverticulitis following initial CT scan.

INTRODUCTION: Diverticulitis develops in 15-20% of individuals with diverticulosis. Severity ranges from mild to severe. Mild diverticulitis is uncomplicated confined per colonic inflammation commonly treated conservatively. Recent literature suggests it could be managed in an outpatient setup. AIMS: To determine if patients with mild acute colonic diverticulitis (ACD) on early CT scan can be treated and discharged at an early time. METHODOLOGY: Retrospective review of patient's charts admitted during 2005 with ACD confirmed by CT scan performed within 24 h of admission. Severity of ACD was determined according to CT classification. RESULTS: Forty-two (31 women, 11 men) patients included, mean age 66 years, CT severity classification: 61.9% mild, 7.1% moderate, and 31.0% severe diverticulitis. Patients with mild ACD were discharged safely, had no recurrence of their symptoms, and needed no readmission within 6 months of follow-up. CONCLUSION: Patients with mild ACD on CT scan performed within 24 h could be safely discharged and treated according to protocols of outpatient management of diverticulitis.

Incidence and prognostic influence of lymph node micrometastases in rectal cancer.

AIMS: The aim of this study was to determine the rate of lymph node micrometastases and evaluate their prognostic significance in rectal cancer. METHODS: Patients with either Dukes A or B rectal carcinoma who had undergone curative resection by either low anterior resection or abdominal perineal resection between 1991 and 2000 were selected from a prospectively collated database. None of the patients had metastasis at the time of surgery and none received adjuvant or neoadjuvant therapy. A single section from each lymph node was stained with haematoxylin and eosin (H+E) and with CAM 5.2 by immunohistochemistry. Statistical analyses were performed with Chi-square test. RESULTS: A total of 774 lymph nodes with a median of 14 lymph nodes per patient were examined, from a cohort of 56 patients with a median age of 66 years. In the 56 patients in whom lymph node metastases were not detected by haematoxylin-eosin staining, cytokeratin staining was positive in 15 lymph nodes from 10 patients. Nine patients had disease recurrence at a median follow-up of 98 months. The presence of lymph node micrometastases by immunohistochemistry did not predict either disease-free (p=0.44) or overall survival (p=0.63). CONCLUSION: Immunohistochemical staining detects micrometastases in rectal cancer which are not observed with H+E staining. However, no significant relationship was observed between disease relapse and rectal micrometastases detected by immunohistochemistry.

Laparoscopic Nissen fundoplication: predicting outcome from peri-operative evaluation.

BACKGROUND: Although laparoscopic Nissen fundoplicaton is a safe, effective treatment for gastrooesophageal reflux (GOR), questions remain about the durability of the procedure and patient selection criteria. AIMS: To review a single surgeon's experience of laparoscopic Nissen fundoplicaton and to determine which factors, if any are likely to influence long term outcome. METHODS: Data were collected on all 124 patients who underwent laparoscopic Nissen fundoplication over a five-year period, and a detailed questionnaire was used to evaluate outcome. RESULTS: Eighty-nine per cent of patients were satisfied with the results of surgery whilst 8.8% of patients had significant recurrence of symptoms. Time since surgery was longer in those patients with symptom recurrence who were also more likely to be female. Pre-operative age, body mass index (BMI),Visick Score, endoscopic findings or pH analysis scores were not predictive of outcome, nor were intra-operative findings or post-operative complications. CONCLUSION: Although laparoscopic Nissen fundoplication is a safe and effective treatment for GOR, it is difficult to predict the small but significant group of patients with poor longterm outcome based on pre-operative assessment and peri-operative parameters alone.

Cryptorchidism: a general surgical perspective.

BACKGROUND: The treatment of cryptorchidism has changed, with surgery now advocated before the age of two years. Delayed treatment affects fertility, malignant potential and psychological stress. AIMS: To assess the pattern of referral of cryptorchid patients to a surgical clinic, management and follow-up. METHODS: A four-year review of 114 cryptorchid patients examined age at presentation, waiting time, timing of surgery and length of follow-up. RESULTS: The mean age at presentation to the surgical clinic was 6.7 years (neonatal to 71). The mean age at orchidopexy was 5.6 years. Seventy per cent had a surgical procedure within eight weeks of presentation to a surgeon. Seven per cent were kept under surveillance until a maximum age of three years before orchidopexy was considered. Only 29% proceeded to surgery before the age of two. Seventeen were referred to a paediatric urology unit for further management. CONCLUSIONS: Orchidopexy seems prudent between one and two years of age. Only one-quarter of patients underwent early orchidopexy. It is vital that it is detected early, by paediatricians at birth or the general practitioners (GPs) at the six-week check up. Prompt referral to a surgeon with a paediatric interest is essential in order to permit surveillance or surgery.

Late presentation of small bowel obstruction following blunt abdominal trauma.

BACKGROUND: Motor vehicle accidents have increasingly become a major cause of serious blunt abdominal and chest injury, the pattern and mechanism of which has changed in recent years largely due to seatbelt legislation. AIM: A case of blunt abdominal and chest trauma is reported which resulted in a mesenteric tear--the small bowel subsequently herniated through and strangulated. CONCLUSION: This case highlights the need for clinical suspicion, serial physical examination and early surgery in the management of these injuries.

Functional and residential status transitions among nursing home residents.

BACKGROUND: The present study examines transitions in the functional status and discharge destination of new nursing home admissions who remain at least 100 days, and ascertains baseline covariates associated with transition patterns. METHODS: Using a fully observed, continuous-time Markov chain model for maximum likelihood estimation of probability intensities, transition processes are characterized. The long-stay cohort (n = 9,541) was derived from a sample of elders newly admitted to 48 National Health Corporation (NHC) nursing homes between 1983 and 1987. Assessment of functional status, using a modified Katz ADL scale, occurred during the first, second, and third months, and the second, third, and fourth quarters after admission. Four types of residential changes (e.g., mortality) were examined for the latter three quarters. RESULTS: While stability was the predominant pattern during the first 90 days in the nursing home, 51.5% of residents experienced a change in function. The probability of change was higher for modest (one level) rather than substantial change, and for such change to represent improvement rather than decline. Over 25% of this long-stay sample exited in the second quarter, 37% of them returning home. The rates for returns to home and for mortality were strongly related to functional level. Several sociodemography variables (e.g., age, source of payment), diagnostic indicators (e.g., cancer), and orientation status were consistently associated with transition rates within functionally homogeneous groups. CONCLUSIONS: Overall, findings underscore the heterogeneity and complexity of transition patterns for a subgroup historically treated as likely to decline or remain stable, and viewed as "permanent" residents. The model was useful in describing the volatile transition process among older long-stayers.

Propranolol reduces the anxiety associated with day case surgery.

OBJECTIVE: To find out if propranolol, a non-cardioselective beta-blocker, can reduce the anxiety associated with day case surgery. DESIGN: Prospective randomized double blind trial. SETTING: University hospital, Ireland. SUBJECTS: An unselected group of 53 patients undergoing day case surgery. INTERVENTION: Subjects randomised to receive either propranolol (10 mg) or placebo on the morning of operation. MAIN OUTCOME MEASURES: Blood pressure; pulse, anxiety, pain score and patient satisfaction. RESULTS: Mean (SD) Hospital Anxiety and Depression score was significantly lower in the propranolol group than in the control group (2.5 (0.7) compared with 4.6 (0.7), p < 0.0001) before discharge. CONCLUSION: A low dose of propranolol given on the morning of day case surgery significantly reduced patients' anxiety.

Results of a prospective randomized trial using DTIC and interferon as adjuvant therapy for stage I malignant melanoma.

This prospective randomized trial evaluated the effect of DTIC and interferon as adjuvant therapy for high risk stage 1 malignant melanoma in 26 patients. Both groups were well matched for depth of disease, site of melanoma and other prognostic criteria. Like other studies the findings of 2.6 times increased relative risk of mortality in the treatment arm do not support a rationale for adjuvant immuno-chemotherapy even in patients at high risk of recurrence.