What skills do New Zealand clinicians have to provide first trimester abortion in primary care and are they willing?

OBJECTIVE: To determine the skills and intentions of health practitioners in New Zealand to provide first trimester abortion care.New Zealand achieved abortion law reform in 2020, changing how abortion could be delivered and experienced by pregnant people. However, little has changed in the way abortion care is provided. STUDY DESIGN: This survey, which was deployed to a range of health practitioners via regulatory bodies and professional groups, used an online free text and tick box survey. Questions included demographics, scope of practice, abortion care experience, philosophical perspective on abortion, and skills transferable to abortion care. Data was analysed using descriptive statistics and deductive and inductive thematic analysis. RESULTS: 128 respondents included doctors, nurses, midwives, counsellors, and social workers from a range of practice settings, the majority from primary health (51%). Most respondents indicated competency or proficiency in clinical skills relevant to provision of early medical abortion. However, practitioners were more likely to indicate "I do not have this skill" or "support required" for: calculating gestational age by bimanual examination (42%), LARC (implant and IUC) insertion (36%), undertake a pregnancy related consultation using tikanga best practice guidelines (19%).Analysis of qualitative data showed three main themes; (1) support for abortion access and for abortion provision in primary care (2) levels of intention to provide abortion (3) critical components for an action plan for abortion in primary care. CONCLUSION: Abortion care in the community has support from health practitioners. They identified needs including development of clinical skills, funding, and wider sector support.

Suicide in Australian pesticide-exposed workers.

BACKGROUND: Epidemiological research has observed that workers with exposure to anticholinesterase pesticides, and particularly those with a history of acute overexposure, may be at increased risk of depression. However, there is little published research about the risk of suicide in relation to pesticide exposure. AIMS: To investigate risk of suicide in relation to metrics of pesticide exposure and type of work. METHODS: A nested case-control study was performed within a retrospective cohort study of pesticide-exposed workers from various industries. Ninety male suicide deaths and 270 male controls were matched by age bands, state of residence and live status. Cholinesterase inhibition was determined using subject-specific biomonitoring records collected at the time of exposure. RESULTS: Suicide risk was not significantly elevated in relation to exposure to any particular pesticide classes nor in relation to pesticide overexposure, confirmed by blood test. While the risk of suicide associated with a history of cholinesterase inhibition was raised, this was not significant (odds ratio = 1.90, 95% confidence interval = 0.73-4.93). CONCLUSIONS: This study did not find an elevated suicide risk associated with use of any major class of pesticide and there was little evidence that overexposure was associated with increased risk of suicide. A non-significant association between overexposure to anticholinesterase pesticides may be consistent with previous research showing increased depression in workers with a history of cholinesterase inhibition and warrants further investigation.

Cancer incidence and mortality in a historical cohort of Australian pest control workers.

OBJECTIVES: To determine the rates of mortality and incident cancer in a historical cohort of pest control operators. METHODS: A retrospective cohort was assembled from former state government occupational health surveillance programmes. This cohort was linked to the Australian national registries of cancer and mortality and the results were compared with the general Australian population rates. RESULTS: 125 deaths and 89 incident cancers were found during the periods of observation (mortality 1983-2004 and cancer 1983-2002). Overall cancer incidence and mortality rates were not found to be significantly different from the general population. Among the specific causes of death, suicide (standardised mortality ratio; SMR 1.78; 95% CI 1.12 to 2.83) and unintentional falls (SMR 4.57; 95% CI 1.72 to 12.19) were significantly in excess, although the latter was based on only 4 deaths. Melanoma was the only specific incident cancer found significantly in excess (standardised incidence ratio 1.56; 95% CI 1.03 to 2.37). CONCLUSIONS: Pest control workers have overall mortality and cancer rates similar to the general population. Excess rates of incident melanoma and intentional self-poisoning mortality are of concern and warrant further investigation. Follow-up of this cohort as its members age, will provide more insight into these possible associations.

Relationships between alumina and bauxite dust exposure and cancer, respiratory and circulatory disease.

OBJECTIVES: To examine the associations between alumina and bauxite dust exposure and cancer incidence and circulatory and respiratory disease mortality among bauxite miners and alumina refinery workers. METHODS: This cohort of 5770 males has previously been linked to national mortality and national and state cancer incidence registries (1983-2002). In this paper, Poisson regression was used to undertake internal comparisons within the cohort based on subgroups of cumulative exposure to inhalable bauxite and alumina dust. Exposure was estimated using job histories and historical air monitoring data. RESULTS: There was no association between ever bauxite exposure and any of the outcomes. There was a borderline significant association between ever alumina exposure and cerebrovascular disease mortality (10 deaths, RR 3.8, 95% CI 1.1 to 13). There was some evidence of an exposure-response relationship between cumulative bauxite exposure and non-malignant respiratory disease mortality (seven deaths, trend p value: 0.01) and between cumulative alumina exposure and cerebrovascular disease mortality (trend p value: 0.04). These associations were based on very few cases and for non-malignant respiratory disease the deaths represented a heterogeneous mixture of causes. There was no evidence of an excess risk for any cancer type with bauxite or alumina exposure. CONCLUSIONS: These preliminary findings, based on very few cases, suggest that cumulative inhalable bauxite exposure may be associated with an excess risk of death from non-malignant respiratory disease and that cumulative inhalable alumina dust exposure may be associated with an excess risk of death from cerebrovascular disease. Neither exposure appears to increase the risk of incident cancers.

Is farm-related job title an adequate surrogate for pesticide exposure in occupational cancer epidemiology?

OBJECTIVES: Accurate assessment of exposure is a key factor in occupational epidemiology but can be problematic, particularly where exposures of interest may be many decades removed from relevant health outcomes. Studies have traditionally relied on crude surrogates of exposure based on job title only, for instance farm-related job title as a surrogate for pesticide exposure. METHODS: This analysis was based on data collected in Western Australia in 2000-2001. Using a multivariate regression model, we compared expert-assessed likelihood of pesticide exposure based on detailed, individual-specific questionnaire and job specific module interview information with reported farm-related job titles as a surrogate for pesticide exposure. RESULTS: Most (68.8%) jobs with likely pesticide exposure were farm jobs, but 78.3% of farm jobs were assessed as having no likelihood of pesticide exposure. Likely pesticide exposure was more frequent among jobs on crop farms than on livestock farms. Likely pesticide exposure was also more frequent among jobs commenced in more recent decades and jobs of longer duration. Our results suggest that very little misclassification would have resulted from the inverse assumption that all non-farming jobs are not pesticide exposed since only a very small fraction of non-agricultural jobs were likely to have had pesticide exposure. CONCLUSIONS: Classification of all farm jobs as pesticide exposed is likely to substantially over-estimate the number of individuals exposed. Our results also suggest that researchers should pay special attention to farm type, length of service and historical period of employment when assessing the likelihood of pesticide exposure in farming jobs.

Mortality and cancer incidence in workers in two Australian prebake aluminium smelters.

BACKGROUND: Exposures in the aluminium production industry have been declining and this study aimed to investigate cancer and mortality in two Australian prebake aluminium smelters. METHODS: The cohort included 4396 males who had worked in a prebake smelter for at least 3 months. They were matched against the National Death Index and the National Cancer Statistics Clearing House to obtain cause of death and type of cancer. Standardised Mortality Ratios (SMRs) and Standardised Incidence Ratios (SIRs) were calculated for the whole cohort, for production or maintenance work categories and for duration of employment categories. RESULTS: The SMRs for all causes, circulatory, respiratory and injury deaths were at or below expected. Mesothelioma was the only significantly increased cause of death (SMR 3.52, 95% CI 1.47 to 8.46). Death from prostate cancer in production workers was elevated (SMR 2.39, 95% CI 1.29 to 4.44) and in those who had worked for more than 20 years in production or maintenance jobs (SMR 3.67, 95% CI 1.53 to 8.81). There were statistically significant excesses of incident stomach cancer, mesothelioma, and kidney cancer cases, while the SIR for melanoma was significantly reduced. There was no significant trend for duration of exposure for any type of incident cancer. CONCLUSIONS: This study found no overall excess of mortality or cancer, but incident mesothelioma and kidney cancer risks were elevated. The lack of excess risk for lung or bladder cancer or deaths from respiratory disease may be related to the different level and pattern of exposure between Søderberg and prebake smelters.

Training and other predictors of personal protective equipment use in Australian grain farmers using pesticides.

OBJECTIVES: To investigate patterns of use of personal protective equipment (PPE) to reduce pesticide exposure in a sample of Australian farmers and also to assess the influence of possible predictive factors. METHODS: A cross-sectional survey of 1102 farmers recruited through the Victorian Farmers Federation (VFF) was conducted. A written questionnaire was filled out by participants at VFF meetings attended by a visiting research assistant. Participants answered questions about frequency of pesticide use and PPE items they usually used when doing two different pesticide-related tasks, mixing and application, of each of four classes of pesticides. They also answered questions about personal characteristics, farm characteristics, farming activities, career and health. RESULTS: Nearly all surveyed farmers had ever used pesticides, and over 87% had used Herbicides or Animal Health Products in the previous 12 months. Non-use of PPE was frequently reported, with up to 10-40% of farmers routinely using no PPE at all when using pesticides. Across all pesticide classes, PPE use was higher for pesticide mixing than for application. In multivariate analyses PPE use appeared to be most strongly associated with younger age and farm chemical training. CONCLUSIONS: PPE use across all pesticide classes was poor, indicating the possibility of clinically significant pesticide exposure in many farmers. Given that PPE use was found to be associated with farm chemical training, the authors suggest that training is likely to be an important intervention for reducing farmers' pesticide exposure. Poor uptake of farm chemical training by farmers and the aging farming workforce are causes for concern in the light of these findings.

The use of therapeutic drug monitoring in the management of protease inhibitor-related toxicity.

The aim of this project was to determine whether therapeutic drug monitoring (TDM) and subsequent dose modification is effective in the management of protease inhibitor (PI)-associated toxicity. A retrospective case-notes review of patients who had had TDM for suspected antiretroviral drug toxicity from November 2000 to March 2002 was carried out. This identified six symptomatic patients in whom high plasma drug levels of a PI had been found and subsequent dose modification was associated with improvement/resolution of symptoms. In 5/6 patients viral loads were below the level of detection prior to TDM and remained so after dose reduction of PI. TDM-directed dose modification of PI enables patients to continue effective regimens of highly active antiretroviral therapy, thus avoiding the need to switch the regimen.

Evolutionary relationships among virulence-associated histidine kinases.

A strong relationship between virulence-associated sensor histidine kinases of fungi and those in Streptomyces coelicolor was observed, and phylogenetic analysis suggested that bacterium-to-eukaryote horizontal gene transfer had occurred between ancestors of these organisms. Phylogenetic analysis also identified a group of histidine kinases orthologous to the Streptomyces proteins that includes Pseudomonas aeruginosa GacS. We provide evidence that GacS is important for swarming motility, lipase production, and virulence in mice and had evolved to have partial functional overlaps with PhoQ, a less-related virulence-associated histidine kinase.

PhoP-PhoQ homologues in Pseudomonas aeruginosa regulate expression of the outer-membrane protein OprH and polymyxin B resistance.

Rapid adaptation to environmental challenge is essential for the survival of many bacterial species, and is often effectively mediated by two-component regulatory systems. Part of the adaptive response of Pseudomonas aeruginosa to Mg2+ starvation is overexpression of the outer-membrane protein OprH and increased resistance to the polycationic antibiotic polymyxin B. Two overlapping open reading frames that encoded proteins with high similarities to the PhoP-PhoQ two-component regulatory system of Salmonella typhimurium were identified downstream of the oprH gene. A P. aeruginosa PhoP-null mutant, H851, was constructed by means of a phoP:xylE-GmR transcriptional fusion, and shown to be deficient in OprH expression. In contrast, an analogous PhoQ-null mutant, H854 (phoQ:xylE-GmR), exhibited constitutive overexpression of OprH. Normal Mg2+-regulated OprH expression could be restored in both mutants by complementation with a plasmid carrying the phoP and phoQ genes. Measurement of the catechol-2,3-dioxygenase activity, expressed from the xylE transcriptional fusion in strains H851 and H854, indicated that PhoP-PhoQ is involved in the regulation of phoP-phoQ as well as oprH. Reverse transcription polymerase chain reaction experiments and Northern blot analysis revealed linkage of oprH, phoP and phoQ into an operon that was demonstrated to be under the joint control of PhoP-PhoQ and Mg2+ ion concentration. In addition, studies of the polymyxin B resistance of the two mutant strains, H851 and H854, indicated that PhoP-PhoQ is involved in regulating P. aeruginosa polymyxin resistance in response to external Mg2+ concentrations.

The introduction of a daily telephone advice service: how is it used and is it worth the effort?

Improving access to medical advice by telephone may reduce unnecessary consultations, limit interruptions through the day and provide a more flexible service to meet patient needs. We advertised and introduced a daily advice line for patients and found that it was used appropriately and to mutual benefit.

A thioredoxin fusion protein of VanH, a D-lactate dehydrogenase from Enterococcus faecium: cloning, expression, purification, kinetic analysis, and crystallization.

The gene encoding the vancomycin resistance protein VanH from Enterococcus faecium, a D-lactate dehydrogenase, has been cloned into a thioredoxin expression system (pTRxFus) and expressed as a fusion protein. The use of several other expression systems yielded only inclusion bodies from which no functional protein could be recovered. Experiments to remove the thioredoxin moiety by enterokinase cleavage at the engineered recognition site under a variety of conditions resulted in nonspecific proteolysis and inactivation of the protein. The intact fusion protein was, therefore, used for kinetic studies and crystallization trials. It has been purified to greater than 90% homogeneity by ammonium sulfate precipitation followed by phenyl Sepharose chromatography. Based on k(cat)/KM for pyruvate, it is 20% as active as native VanH. Michaelis constants for NADPH, NADH, and pyruvate, of approximately 3.5 microM, 19.0 microM, and 1.5 mM, respectively, were comparable to those reported for the native VanH (Bugg TDH et al., 1991, Biochemistry 30:10408-10415). Like native VanH, maximum activity of the fusion protein requires the presence of an anion (phosphate or acetate), however, in addition, a strongly reducing environment is needed for optimal efficacy. Competitive inhibition constants for ADP-ribose, NAD+, and oxamate have also been determined. Crystallization by hanging drop vapor diffusion produced two different crystal forms, one hexagonal and the other tetragonal. Flash-frozen crystals of the tetragonal form diffracted to 3.0 A resolution at a synchrotron radiation source.

Sexual assault: coping with crisis.

An unexpected long-distance phone call after midnight started the day. Susan, the daughter of an old friend, had been sexually assaulted. Mother and daughter had just returned from the emergency department, where Susan had been examined and treated. Now, they felt abandoned and hopeless. "Susan feels as if she was raped again by physicians, police and you nurses," shouted her mother. "I thought professionals were helpers!"

Single amino acid substitutions can further increase the stability of a thermophilic L-lactate dehydrogenase.

Lactate dehydrogenases are of considerable interest as stereospecific catalysts in the chemical preparation of enantiomerically pure alpha-hydroxyacid synthons. For such applications in synthetic organic chemistry it would be desirable to have enzymes which tolerate elevated temperatures for prolonged reaction times, to increase productivity and to extend their applicability to poor substrates. Here, two examples are reported of significant thermostabilizations, induced by site-directed mutagenesis, of an already thermostable protein, the L-lactate dehydrogenase (EC 1.1.1.27, 35 kDa per monomer subunit) from Bacillus stearothermophilus. Thermal inactivation of this enzyme is accompanied by irreversible unfolding of the native protein structure. The replacement of Arg171 by Tyr stabilizes the enzyme against thermal inactivation and unfolding. This stabilizing effect appears to be based on improved interactions between the subunits in the core of the active dimeric or tetrameric forms of the enzyme. The thermal stability of L-lactate dehydrogenase variants with an active site Arg residue, either in the 171 (wild-type) or in the 102 position, is further increased by sulfate ions. The two stabilizing effects are additive, as found for the Arg171Tyr/Gln102Arg double mutant, for which the stability of the protein in 100 mM sulfate solution reaches that of L-lactate dehydrogenases from extreme thermophiles. All mutant proteins retain significant catalytic activity, both in the presence and absence of stabilizing salts, and are viable catalysts in preparative scale reactions.

[IgE determination in a group of allergic patients in Cuba]. / Dosificación de IgE en un grupo de pacientes alérgicos en Cuba.

Because the importance of IgE in allergic phenomena and due to the fact that its measurement is not usual in our country, we decided to evaluate this immunoglobulin in 62 patients suffering one or more allergic symptoms. We used PRIST, the solid phase radioimmunoassay by the sandwich technique. IgE was increased in 75% of the patients. Factors influencing this find were analyzed: geographic, weather and environmental conditions, genetic and other factors.

Acid hydrolase activities in B cell chronic lymphocytic leukaemia lymphocytes: correlation of cytochemical reactions with immunological phenotype.

The cytochemical reactions of 5 acid hydrolases, alpha-naphthyl acetate esterase (ANAE), acid phosphatase (AP), beta-glucuronidase, beta-glucosaminidase and dipeptidylaminopeptidase IV (DAP IV) were investigated in lymphocytes from 30 patients with B cell chronic lymphocytic leukaemia (B-CLL). Based on ANAE and AP reactivities, 4 cytochemically distinctive subgroups were identified: Group 1: AP and ANAE less than 50% positive lymphocytes (5 cases); Group 2: AP greater than 50%, ANAE less than 50% positive lymphocytes (11 cases); Group 3: AP less than 50%, ANAE greater than 50% positive lymphocytes (7 cases); Group 4: AP and ANAE greater than 50% positive lymphocytes (7 cases). beta-Glucuronidase displayed similar patterns of reactivity to AP. beta-Glucosaminidase activity was observed in the majority of lymphocytes in most patients, whereas DAP IV activity was present in less than 20% of lymphoid cells. The study failed to establish any relationship between cytochemical grouping and patients' clinical status, peripheral lymphocyte counts, E or mouse rosette values, light or heavy chain cellular immunoglobulin (Ig) class. Attempts to correlate acid hydrolase and Ig heavy chain isotype expression, putative markers of B cell maturation, were unsuccessful and indicate that within the narrow spectrum of B cell differentiation seen in B-CLL these characteristics are unrelated.

Dipeptidylaminopeptidase IV activity in normal and leukemic T-cell subpopulations.

Dipeptidylaminopeptidase IV (DAP IV) cytochemical reactivity was investigated in monoclonal antibody defined T-lymphocyte subpopulations from normal blood and in cells from a series of T-cell leukemias of defined immunologic phenotype. A combined monoclonal antibody/immunocolloidal gold technic, which enabled simultaneous visualisation of immunogold label and DAP IV reactivity, was used to study enzyme reactivity in normal T-cell subpopulations. Single or several discrete granules of DAP IV reaction product were observed in 72% of OKT3+ and OKT4+ cells, whereas a significantly (P less than 0.01) lower percentage of OKT8+ cells (41%) displayed positivity; B-cells were invariably DAP IV negative. In the T-cell leukemias, DAP IV reactivity was strongest in T-lymphoblastic lymphoma and T-prolymphocytic leukemia cells. In contrast, DAP IV activity was absent or expressed in a minority of cells of the more immature T-acute lymphoblastic leukemia. The enzyme reaction also was negative in lymphocytes from other mature T-cell leukemias: T-chronic lymphocytic leukemia (OKT8+), adult T-cell lymphoma-leukemia, and Sezary syndrome (both OKT4+). DAP IV expression did not parallel that of acid phosphatase or alpha-naphthyl acetate esterase in leukemic T-lymphoid cells except in T-lymphoblastic lymphoma and T-prolymphocytic leukemia, where a strong reaction with the three hydrolytic enzymes was observed.