Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study.

OBJECTIVE: To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion. DESIGN: We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study. SETTING: Economically disadvantaged areas in rural Australia. PARTICIPANTS: Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status. MAIN MEASURES: A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28). RESULTS: Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57-0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00-1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02-2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14-2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18-0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion. CONCLUSIONS: Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes.

Diagnostic test accuracy of serum procalcitonin compared with C-reactive protein for bone and joint infection in children and adolescents: a systematic review and meta-analysis.

OBJECTIVE: The objective of this review was to synthesize the best available evidence for the diagnostic test accuracy of serum procalcitonin compared with serum C-reactive protein for suspected osteomyelitis and septic arthritis in hospitalized children and adolescents. INTRODUCTION: Measurement of serum C-reactive protein remains a routine investigation for the diagnosis of osteoarticular infection in children and adolescents. Measurement of serum procalcitonin has been shown to outperform C-reactive protein in adults with osteomyelitis and septic arthritis. Before procalcitonin can be considered as a potential replacement or add-on test in children and adolescents, a systematic review and meta-analysis targeting this population should be conducted. INCLUSION CRITERIA: Original studies reporting the diagnostic accuracy of procalcitonin and/or C-reactive protein in children and adolescents between one month and 18 years of age admitted to hospital with suspected osteoarticular infection were included. Studies must have compared the index test to at least one reference test. Reference test was defined as positive culture or polymerase chain reaction confirmation of a pathogen from blood, bone biopsy, or joint fluid aspirate in combination with at least two of the following: i) purulent material from sterile site, ii) positive radiological findings consistent with osteoarticular infection, and ii) symptoms and signs consistent with osteomyelitis and/or septic arthritis. METHODS: The JBI methodology for systematic reviews of diagnostic test accuracy was followed. Information was sourced from four databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science) and four gray literature sources (MedNar, OpenGrey, Google Scholar, and ProQuest Dissertations and Theses). Only studies published in English were considered. The methodological quality of selected studies was formally evaluated, sensitivity and specificity data were extracted, and 95% confidence intervals determined. Meta-analysis was performed to estimate summary points using a bivariate model and to generate a hierarchical summary receiver operating characteristic (HSROC) curve with global measures of test accuracy performance, such as likelihood ratio and diagnostic odds ratio. A narrative was provided where meta-analysis was not appropriate. RESULTS: Eight studies were included in the review. Four of these studies used a common C-reactive protein test threshold of 20 mg/L. At this threshold, the estimated pooled sensitivity of C-reactive protein was 0.86 (0.68-0.96) and the pooled specificity was 0.9 (0.83-0.94). Using a hierarchical summary receiver operating characteristic model from six studies, the diagnostic odds ratio for C-reactive protein was estimated to be 39.4 (14.8-104.9) with a positive likelihood ratio 5.3 (2.3-11.9) and a negative likelihood ratio 0.1 (0.07-0.2). There were insufficient studies from this review to statistically evaluate the diagnostic accuracy of procalcitonin. CONCLUSION: Clinicians should continue to measure serum C-reactive protein as the preferred inflammatory marker in hospitalized children and adolescents with suspected osteomyelitis or septic arthritis. More evidence is needed before incorporating procalcitonin routinely into clinicians' diagnostic test strategy. Improvements with the design, quality, and reporting of procalcitonin diagnostic test assays in children and adolescents with osteoarticular infection is needed. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019140276.

Mapping Clinical Barriers and Evidence-Based Implementation Strategies in Low-to-Middle Income Countries (LMICs).

BACKGROUND: Low-to-middle income countries (LMICs) experience a high burden of disease from both non-communicable and communicable diseases. Addressing these public health concerns requires effective implementation strategies and localization of translation of knowledge into practice. AIM: To identify and categorize barriers and strategies to evidence implementation in LMICs from published evidence implementation studies. METHODS: A descriptive analysis of key characteristics of evidence implementation projects completed as part of a 6-month, multi-phase, intensive evidence-based clinical fellowship program, conducted in LMICs and published in the JBI Database of Systematic Reviews and Implementation Reports was undertaken. Barriers were identified and categorized to the Donabedian dimensions of care (structure, process, and outcome), and strategies were mapped to the Cochrane effective practice and organization of care taxonomy. RESULTS: A total of 60 implementation projects reporting 58 evidence-based clinical audit topics from LMICs were published between 2010 and 2018. The projects included diverse populations and were predominantly conducted in tertiary care settings. A total of 279 barriers to implementation were identified. The most frequently identified groupings of barriers were process-related and associated predominantly with staff knowledge. A total of 565 strategies were used across all projects, with every project incorporating more than one strategy to address barriers to implementation of evidence-based practice; most strategies were categorized as educational meetings for healthcare workers. LINKING EVIDENCE TO ACTION: Context-specific strategies are required for successful evidence implementation in LMICs, and a number of common barriers can be addressed using locally available, low-cost resources. Education for healthcare workers in LMICs is an effective awareness-raising, workplace culture, and practice-transforming strategy for evidence implementation.

Late mortality in people with cancer: a population-based Australian study.

OBJECTIVES: To investigate causes of death of people with cancer alive five years after diagnosis, and to compare mortality rates for this group with those of the general population. DESIGN, SETTING, PARTICIPANTS: Retrospective cohort study; analysis of South Australian Cancer Registry data for all people diagnosed with cancer during 1990-1999 and alive five years after diagnosis, with follow-up to 31 December 2016. MAIN OUTCOME MEASURES: All-cause and cancer cause-specific mortality, by cancer diagnosis; standardised mortality ratios (study group v SA general population) by sex, age at diagnosis, follow-up period, and index cancer. RESULTS: Of 32 646 people with cancer alive five years after diagnosis, 30 309 were of European background (93%) and 16 400 were males (50%); the mean age at diagnosis was 60.3 years (SD, 15.7 years). The median follow-up time was 17 years (IQR, 11-21 years); 17 268 deaths were recorded (53% of patients; mean age, 80.6 years; SD, 11.4 years): 7845 attributed to cancer (45% of deaths) and 9423 attributed to non-cancer causes (55%). Ischaemic heart disease was the leading cause of death (2393 deaths), followed by prostate cancer (1424), cerebrovascular disease (1175), and breast cancer (1118). The overall standardised mortality ratio (adjusted for age, sex, and year of diagnosis) was 1.24 (95% CI, 1.22-1.25). The cumulative number of cardiovascular deaths exceeded that of cancer cause-specific deaths from 13 years after cancer diagnosis. CONCLUSIONS: Mortality among people with cancer who are alive at least five years after diagnosis was higher than for the general population, particularly cardiovascular disease-related mortality. Survivorship care should include early recognition and management of risk factors for cardiovascular disease.

Screening for depression and anxiety among patients with acute coronary syndrome in acute care settings: a scoping review.

OBJECTIVE: The aim of this review was to scope the literature for publications on the practice of screening for depression and anxiety in acute coronary syndrome patients in acute care by identifying instruments for the screening of anxiety and/or depression; determining if screening for anxiety and/or depression has been integrated into cardiac models of care and clinical pathways; and identifying any evidence practice gap in the screening and management of anxiety and/or depression in this population. INTRODUCTION: Depression in acute coronary syndrome is bidirectional. Depression is an independent risk factor for cardiovascular disease, and comorbid depression is associated with a twofold greater risk of mortality in patients with cardiovascular disease. The presence of acute coronary syndrome increases the risk of depressive disorders or anxiety during the first one to two years following an acute event, and both depression and anxiety are associated with a higher risk of further acute coronary health concerns. Clinical practice guidelines have previously recommended routine screening for depression following a cardiac event, although many current guidelines do not include recommendations for screening in an acute setting. To date there have been no previous scoping reviews investigating depression and anxiety screening in patients with acute coronary syndrome in the acute care setting. INCLUSION CRITERIA: Adults (18 years and over) with acute coronary syndrome who are screened for anxiety and/or depression (not anxiety alone) in an acute care setting. METHODS: A systematic search of the literature was conducted by a research librarian. Research studies of any design published in English from January 1, 2012, to May 31, 2018, were included. Data were extracted from the included studies to address the three objectives. Purposefully designed tables were used to collate information and present findings. Data are also presented as figures and by narrative synthesis. RESULTS: Fifty-one articles met the inclusion criteria. Primary research studies were from 21 countries and included 21,790 participants; clinical practice guidelines were from two countries. The most common instruments used for the screening of depression and anxiety were: i) the Hospital Anxiety and Depression Scale (n = 18); ii) the Beck Depression Inventory (n = 16); and iii) the nine-item Patient Health Questionnaire (n = 7). Eleven studies included screening for anxiety in 2181 participants (30% female) using the full version of the Hospital Anxiety and Depression Scale. The State-Trait Anxiety Inventory was used to screen 444 participants in three of the studies. Four studies applied an intervention for those found to have depression, including two randomized controlled trials with interventions targeting depression. Of the seven acute coronary syndrome international guidelines published since 2012, three (43%) did not contain any recommendations for screening for depression and anxiety, although four (57%) had recommendations for treatment of comorbidities. CONCLUSIONS: This review has identified a lack of consistency in how depression and anxiety screening tools are integrated into cardiac models of care and clinical pathways. Guidelines for acute coronary syndrome are not consistent in their recommendations for screening for depression and/or anxiety, or in identifying the best screening tools.

Effectiveness of discharge education strategies versus usual care on clinical outcomes in acute coronary syndrome patients: a systematic review.

OBJECTIVE: The objective of this review was to systematically review studies that evaluated the clinical effectiveness of hospital discharge education strategies provided to patients with acute coronary syndrome (ACS). INTRODUCTION: In an era of shortening lengths of stay for patients with ACS, bedside education opportunities are diminishing; however, the importance of discharge education on medication management, emergency procedures and safe recovery remains vital to prevent rehospitalization. INCLUSION CRITERIA: The following studies were considered for inclusion: English-language randomized controlled trials (RCTs) measuring educational strategies provided to adults with ACS as the only intervention prior to discharge or post-discharge from acute care, compared to usual care. METHODS: An electronic search was performed by an experienced research librarian. MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Australian New Zealand Clinical Trials Registry, ClinicalTrials.gov and WHO International Clinical Trial Registry Platform were searched for studies published between 2000 and 2017. All citations were collated and uploaded into EndNote where duplicates were removed. Titles and abstracts were screened by two independent reviewers. The reference lists of all included studies were screened for additional references. Risk of bias was assessed using the JBI critical appraisal instrument for all included studies. In the case of missing or incomplete data, corresponding authors were contacted. The primary outcomes of interest were knowledge relating to ACS diagnosis, treatment and procedures. Secondary outcomes included lifestyle modifications, medication adherence/knowledge, general practitioner follow-up, attendance to cardiac rehabilitation (CR), readmission and mortality (up to 12 months). As data were collected using different instruments in each study, meta-analysis was not performed. RESULTS: The electronic search identified 3445 records. Following deduplication, 2093 citations were screened with 47 papers selected for assessment of eligibility. Three RCTs involving 175 participants were identified for inclusion. The certainty of this evidence (Grading of Recommendations, Assessment, Development and Evaluation) was rated as low to moderate. The risk of bias for all included studies was moderate. In all studies, the impact of inpatient educational interventions was assessed in relation to attendance to a CR program, exercise rates and medication adherence. Interventions included targeted educational sessions (15-40 minutes) where participants prioritized their learning needs and were provided tailored cardioprotective risk factor and lifestyle modification advice and invited to attend a CR program. One study presented the education in animation. In one study, intervention groups reported increased attendance to CR compared to control (47.3%; n = 9, versus 21.1%; n = 4) and another demonstrated significantly increased exercise rates from baseline to follow-up. No significant difference was reported between the intervention and control for medication adherence, and none of the studies reported readmission or mortality rates. CONCLUSION: The current review found little to no evidence for the effectiveness of current discharge practices on clinical outcomes. There has been limited research on modes of delivery or what the essential components for ACS discharge education should be. This review has highlighted the need for comprehensive effectiveness studies to provide a strong evidence-base to support ACS discharge practices. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42018094781.

Diagnostic test accuracy of serum measurement of procalcitonin and C-reactive protein for bone and joint infection in children and adolescents: a systematic review protocol.

OBJECTIVE: The objective of this review is to synthesize the best available evidence for the diagnostic test accuracy of procalcitonin (PCT) compared to C-reactive protein (CRP) in diagnosing osteomyelitis (OM) and septic arthritis in hospitalized children and adolescents. INTRODUCTION: Serum measurement of PCT has been shown to outperform CRP in diagnosing adult osteoarticular infections. Before PCT can be considered as a potential diagnostic test in children and adolescents, a systematic review is required. INCLUSION CRITERIA: This review will consider studies with children and adolescents aged one month to 18 years, admitted to hospital with suspected acute osteoarticular infection. This review will consider original studies measuring the diagnostic accuracy of PCT and/or CRP in the diagnosis of acute OM or septic arthritis, defined as: positive culture or polymerase chain reaction (PCR) confirmation of an accepted pathogen from blood, bone biopsy or joint fluid aspirate and/or at least two of the following: i) purulent material from biopsy or aspirate specimen, ii) positive radiological findings of osteoarticular infection, and iii) symptoms and signs consistent with OM/septic arthritis. METHODS: JBI methodology for systematic reviews of diagnostic test accuracy will be utilized. A three-step search strategy will be undertaken to find relevant studies that will be assessed and reviewed using JBI SUMARI. A standardized critical appraisal tool will be used to assess methodological quality of studies. The main outcome will be pooled sensitivity and specificity measures with 95% confidence intervals for PCT and CRP in OM or septic arthritis. Results will be presented using paired forest plots, receiver operator characteristic curves, and narrative synthesis, and will include a Summary of Findings. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019140276.

Health deficits in community dwelling adults aged 40 to 75 years.

BACKGROUND: Middle and older years are associated with age related health deficits but how early this begins and progresses is poorly understood. Better understanding is needed to address early decline and support healthier ageing outcomes. METHODS: Seemingly healthy, community dwelling adults aged 40 to 75 years were recruited via local council and business networks. They completed online surveys about sleep quality, distress and physical activity, and two hours of objective testing of physiologic and anthropometric measures, mobility, cognition, grip strength, foot sensation, dexterity and functional hearing. Analysis compared outcomes for age, gender, and age and gender groups with population norms for 21 health assessments. The total number of non-compliant tests for each participant was calculated by summing the number of non-compliant tests, and the frequency of these scores across the sample was reported. Gender and age effects were tested using ANOVA models. Combined age and gender categories were used for subsequent logistic regression modelling, with females aged 40-49 years being the default comparator. RESULTS: Of 561 participants (67% female; mean age 60 years (SD 10.3)), everyone had at least one deficit and median deficits was 5 (IQR 2). More than 50% of participants did not meet anthropometric and exercise norms, while 30 to 40% had reduced functional hearing and cognition. Overall, men performed worse and deficits increased with age particularly for physical activity, audiology, mobility, anthropometry, oximetry and foot sensation. Heart rate, body temperature and dyspnoea were the only variables where compliance was within 95% of expected values. Multiple areas of functional decline were found in people aged in their 40s and 50s. CONCLUSIONS: The health deficits identified are mostly mutable hence identification and interventions to address the multi-system functional decline in people as young as 40 has the capacity to ensure healthier ageing.

The Keeping on Track Study: Exploring the Activity Levels and Utilization of Healthcare Services of Acute Coronary Syndrome (ACS) Patients in the First 30-Days after Discharge from Hospital.

The aim of this study was to investigate the impact of bedside discharge education on activity levels and healthcare utilization for patients with acute coronary syndrome (ACS) in the first 30 days post-discharge. Knowledge recall and objective activity and location data were collected by global positioning systems (GPS). Participants were asked to carry the tracking applications (apps) for 30⁻90 days. Eighteen participants were recruited (6 metropolitan 12 rural) 61% ST elevation myocardial infarction (STEMI), mean age 55 years, 83% male. Recall of discharge education included knowledge of diagnosis (recall = 100%), procedures (e.g., angiogram = 40%), and comorbidities (e.g., hypertension = 60%, diabetes = 100%). In the first 30 days post-discharge, median steps per day was 2506 (standard deviation (SD) ± 369) steps (one participant completed 10,000 steps), 62% visited a general practitioner (GP) 16% attended cardiac rehabilitation, 16% visited a cardiologist, 72% a pharmacist, 27% visited the emergency department for cardiac event, and 61% a pathology service (blood tests). Adherence to using the activity tracking apps was 87%. Managing Big Data from the GPS and physical activity tracking apps was a challenge with over 300,000 lines of raw data cleaned to 90,000 data points for analysis. This study was an example of the application of objective data from the real world to help understand post-ACS discharge patient activity. Rates of access to services in the first 30 days continue to be of concern.

Feasibility of population screening tests to establish a healthy ageing trajectory.

OBJECTIVES: There are no agreed comprehensive tests for age-related changes to physical, emotional, mental and social functioning. Research into declining function focuses on those 75 years and older and little is known about age-related changes in younger people. The aims of this project were (1) to ascertain a comprehensive test battery that could underpin community-based health screening programmes for people aged 40-75 years and pilot both (2) community-based recruitment and (3) the utility, acceptability, response burden and logistics. METHODS: A total of 11 databases were searched using a broad range of relevant terms. An identified comprehensive, recent, high-quality systematic review of screening instruments for detection of early functional decline for community-dwelling older people identified many relevant tools; however, not all body systems were addressed. Therefore, lower hierarchy papers identified in the rapid review were included and expert panel consultation was conducted before the final test battery was agreed. Broad networks were developed in one Australian city to aid pilot recruitment of community-dwellers 40-75 years. Recruitment and testing processes were validated using feasibility testing with 12 volunteers. RESULTS: The test battery captured (1) online self-reports of demographics, health status, sleep quality, distress, diet, physical activity, oral health, frailty and continence; and (2) objective tests of anthropometry; mobility; lung function; dexterity; flexibility, strength and stability; hearing; balance; cognition and memory; foot sensation; and reaction time. Recruitment and testing processes were found to be feasible. CONCLUSION: This screening approach may provide new knowledge on healthy ageing in younger people.

Cardiotoxicity after cancer treatment: a process map of the patient treatment journey.

BACKGROUND/AIM: Cardiotoxicity is a potential complication of anticancer therapy. While guidelines have been developed to assist practitioners, an effective, evidence based clinical pathway for the treatment of cardiotoxicity has not yet been developed. The aim of this study was to describe the journey of patients who developed cardiotoxicity through the healthcare system in order to establish baseline data to inform the development and implementation of a patient-centred, evidence-based clinical pathway. METHODS: Mixed-methods design with quantitative and qualitative components using process mapping at 3 large medical centres in 2 states between 2010 and 2015. RESULTS: Fifty (50) confirmed cases of cardiotoxicity were reviewed (39 medical record reviews, 7 medical record review and interviews and 4 internview only). The mean age at cancer diagnosis of this group was 53.3 years (range 6-89 years); 50% female; 30% breast cancer, 23% non-Hodgkin's lymphoma; mean chemotherapy cycles 5.2 (median 6; range 1-18); 49 (89%) presented to chemotherapy with pre-existing cardiovascular risk factors; 39 (85%) had at least one modifiable risk factor and 11 (24%) had more than 4; 44 (96%) were diagnosed by echocardiogram and 27 (57%) were referred to a cardiologist (only 7 (15%) before chemotherapy). Post chemotherapy, 22 (48%) patients were referred to a multidisciplinary heart failure clinic; 8 (17%) to cardiac rehabilitation; 1 (2%) to cancer survivorship clinic and 10 (22%) to a palliative care service. There were 16 (34%) deaths during the timeframe of the study; 4 (25%) cardiac-related, 6 (38%) cancer-related, 4 (25%) due to sepsis and 2 (12%) other causes not recorded. The main concerns participants raised during the interviews were cancer professionals not discussing the potential for cardiotoxicity with them prior to treatment, nor risk modification strategies; a need for health education, particularly regarding risks for developing heart failure related to cancer treatment; and a lack of collaboration between oncologists and cardiologists. CONCLUSIONS: Our results demonstrate that the clinical management of cancer patients with cardiotoxicity was variable and fragmented and not patient centered. This audit establishes practice gaps that can be addressed through the design of an evidence-based clinical pathway for cancer patients with, or at risk, of cardiotoxicity.

Examining adherence to activity monitoring devices to improve physical activity in adults with cardiovascular disease: A systematic review.

BACKGROUND: Activity monitoring devices are currently being used to facilitate and monitor physical activity. No prior review has examined adherence to the use of activity monitoring devices amongst adults with cardiovascular disease. METHODS: Literature from June 2012 to October 2017 was evaluated to examine the extent of adherence to any activity monitoring device used to collect objective physical activity data. Randomized control trials comparing usual care against the use of an activity monitoring device, in a community intervention for adults from any cardiovascular diagnostic group, were included. A systematic search of databases and clinical trials registers was conducted using Joanna Briggs Institute methodology. RESULTS: Of 10 eligible studies, two studies reported pedometer use and eight accelerometer use. Six studies addressed the primary outcome. Mean adherence was 59.1% (range 39.6% to 85.7%) at last follow-up. Studies lacked equal representation by gender (28.6% female) and age (range 42 to 82 years). CONCLUSION: This review indicates that current research on activity monitoring devices may be overstated due to the variability in adherence. Results showed that physical activity tracking in women and in young adults have been understudied.

Recommendations and practices for the screening of depression and anxiety in acute coronary syndrome: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to identify and map current recommendations and practices for the screening of depression and anxiety in acute coronary syndrome patients in the acute care setting.Specifically, the review questions are.

Cardiotoxicity and cardiovascular disease risk assessment for patients receiving breast cancer treatment.

BACKGROUND: Cardiotoxicity from anticancer therapy affects heart function and structure. Cardiotoxicity can also lead to accelerated development of chronic diseases, especially in the presence of risk factors. METHODS: This study aimed to develop and pilot a combined cardiovascular disease and cardiotoxicity risk assessment questionnaire to quantify the potential extent of risk factors in breast cancer patients prior to treatment. The questionnaire underwent content and face validity evaluation by an expert panel followed by pilot testing in a sample of breast cancer patients (n = 36). Questionnaires were self-administered while attending chemotherapy clinic, in the presence of a research assistant. RESULTS: Mean age of participants was 54.8 years (range 36-72 years). Participants reported CVD risk factors including diabetes 2.8%, hypertension 19.8%, hypercholesterolaemia 11% and sleep apnoea 5%. Lifestyle risk factors, included not eating the recommended serves of vegetables (100%) or fruit (78%) per day; smoking (13%) and regularly consuming alcohol (75%). Twenty five percent reported being physically inactive, 61%, overweight or obese, 24%, little or no social support and 30% recorded high to very high psychological distress. Participants were highly (75%) reluctant to undertake lifestyle changes; i.e. changing alcohol consumption; dietary habits; good emotional/mental health strategies; improving physical activity; quitting smoking; learning about heart-health and weight loss. CONCLUSION: This study is an important step towards prevention and management of treatment-associated cardiotoxicity after breast cancer diagnosis. We recommend that our questionnaire is providing important data that should be included in cancer registries so that researchers can establish the relationship between CVD risk profile and cardiotoxicity outcomes and that this study revealed important teaching opportunities that could be used to examine the impact on health literacy and help patients better understand the consequences of cancer treatment.

Culturally appropriate methodology in obtaining a representative sample of South Australian Aboriginal adults for a cross-sectional population health study: challenges and resolutions.

BACKGROUND: The considerably lower average life expectancy of Aboriginal and Torres Strait Islander Australians, compared with non-Aboriginal and non-Torres Strait Islander Australians, has been widely reported. Prevalence data for chronic disease and health risk factors are needed to provide evidence based estimates for Australian Aboriginal and Torres Strait Islanders population health planning. Representative surveys for these populations are difficult due to complex methodology. The focus of this paper is to describe in detail the methodological challenges and resolutions of a representative South Australian Aboriginal population-based health survey. METHODS: Using a stratified multi-stage sampling methodology based on the Australian Bureau of Statistics 2006 Census with culturally appropriate and epidemiological rigorous methods, 11,428 randomly selected dwellings were approached from a total of 209 census collection districts. All persons eligible for the survey identified as Aboriginal and/or Torres Strait Islander and were selected from dwellings identified as having one or more Aboriginal person(s) living there at the time of the survey. RESULTS: Overall, the 399 interviews from an eligible sample of 691 SA Aboriginal adults yielded a response rate of 57.7%. These face-to-face interviews were conducted by ten interviewers retained from a total of 27 trained Aboriginal interviewers. Challenges were found in three main areas: identification and recruitment of participants; interviewer recruitment and retainment; and using appropriate engagement with communities. These challenges were resolved, or at least mainly overcome, by following local protocols with communities and their representatives, and reaching agreement on the process of research for Aboriginal people. CONCLUSIONS: Obtaining a representative sample of Aboriginal participants in a culturally appropriate way was methodologically challenging and required high levels of commitment and resources. Adhering to these principles has resulted in a rich and unique data set that provides an overview of the self-reported health status for Aboriginal people living in South Australia. This process provides some important principles to be followed when engaging with Aboriginal people and their communities for the purpose of health research.

Human Mammary Tumor Virus (HMTV) sequences in human milk.

BACKGROUND: Retroviral sequences 90-95% homologous to the mouse mammary tumor virus (MMTV) were present in 38% of the breast cancers studied from American women and were not detectable in non-tumor breast tissue from the same patient. The entire proviral structure was described and viral particles were isolated from primary cultures of human breast cancer. This virus was designated as human mammary tumor virus (HMTV). Hormone response elements present in the HMTV Long-Terminal-Repeat (LTR) suggest a mechanism for association of HMTV with hormonally responding tissues. In fact, the incidence of HMTV sequences is higher in gestational breast cancers, which are associated with hormonal changes. Milk epithelial cells are also under hormonal regulation and therefore are excellent specimens for HMTV sequence detection. METHODS: The HMTV sequence was studied in milk samples from lactating women recruited with increased risk of breast cancer because they had undergone breast biopsies (Biopsy-Group) and lactating women without breast biopsies (Reference-Group). RESULTS: HMTV-env sequences were detected by PCR in milk of 7.61% of 92 women of the Reference-Group and in 20.55% of 73 women of the Biopsy-Group (p: 0.015). The sequences were 94-98% homologous to MMTV. HMTV-env and HMTV-env/LTR junction sequences were detected in high-speed pellet RNA, implying the presence of HMTV viral particles. PCR assays to detect the murine mitochondrial cytochrome oxidase gene and intracisternal-A-type particle sequences were performed to rule out mouse mitochondrial or genomic DNA contamination. Eight women of the 73 Biopsy-Group participants had breast cancer and the milk of only one of these eight women had HMTV-env sequences. In the remaining 65 women of the Biopsy-Group, under enough clinical suspicion to lead to biopsy, HMTV was detected in 14, nearly three times the number of milks as compared to the Reference-Group (21.54% versus 7.61%; p: 0.016). CONCLUSION: The significance of HMTV in milk from the Reference-Group, the greater frequency in the milk of women who had undergone a breast biopsy and its possible infectivity for infants are important questions under study. The similarity of HMTV to MMTV is striking and suggests one possible avenue for viral transmission in humans.

Human mammary tumor virus (HMTV) in endometrial carcinoma.

OBJECTIVE: Human mammary tumor virus (HMTV) is 90% to 98% homologous to mouse mammary tumor virus, the etiological agent of mammary tumors in mice. Human mammary tumor virus sequences were found in 40% of the breast cancers studied in both American and Australian women. In addition, 10% of endometrial carcinomas studied in Australian women also contained HMTV sequences. We have explored the possibility that endometrial cancer of American women may also contain HMTV. METHODS/MATERIALS: Nested polymerase chain reactions, radioactive internal probing, and sequencing were used to establish the presence of unique nucleotide sequences of HMTV in human genomic DNA. The genomic DNAs were tested to guarantee that they were free of murine DNA. Immunohistochemistry with a monoclonal antibody specific for HMTV envelope protein demonstrated that HMTV sequences were translated. RESULTS: Thirteen (23.2%) of 56 of the endometrial cancers studied contained HMTV sequences and proteins. Human mammary tumor virus sequences and protein were not detected in the 33 normal endometria studied. CONCLUSION: Human mammary tumor virus, an agent with high homology to mouse mammary tumor virus, was found in 23.2% of the endometrial cancers studied, thus opening the possibility of a pathogenic role.

Evaluación del osteocoral como material de implante en bolsas infraóseas de dientes multirradiculares

Se evalúa la eficacia del osteocoral como material de implante en el tratamiento de bolsas infraóseas en dientes multirradiculares. Se analizaron 14 pacientes que se dividieron en 2 grupos: el primero incluyó a 6 pacientes con un total de 12 defectos, los cuales se evaluaron hasta los 6 meses. El segundo, con 8 pacientes y 16 defectos, que se reevaluaron a los 12 y 24 meses. En los 2 grupos se incluyeron pacientes de ambos sexos, que fueron implantados con osteocoral (grupo estudio) y con hidroxiapatita (grupo control). Se realizó reparación inicial que incluyó remoción de cálculo y pulido de la superficie dentaria, educación y motivación y evaluación del cepillado, que debía mostrar valores iguales o mayores del 80 % en la remoción de placa dentobacteriana. Posteriormente se realizó el implante mediante operación a colgajo. Se realizaron radiografías de control a los 14 días, 6 meses (para el primer grupo) y 12 y 24 meses (para el segundo grupo). Se controló sistemáticamente la higiene bucal en ambos grupos. Se controlaron nuevamente los indicadores clínicos a los 6 meses para el primer grupo, y a los 12 y 24 meses para el segundo. Se observó una disminución estadísticamente significativa en el índice gingival, profundidad de la bolsa y movilidad dentaria para ambos materiales implantológicos, sin que se reportaran grandes diferencias entre éstos. Radiográficamente se observó la presencia de relleno en el defecto original, y no hubo reacciones locales adversas, por lo que se consideró efectivo el tratamiento.

Effectiveness of osteocoral was assessed as material for implants at infraosseous pockets of multirooted teeth. 14 analised patients were divided into 2 groups: first, included 6 cases and 16 defects, which were evaluated ultil 6 months. Second, included 8 cases and 16 defects, evaluated at 12 and 24 months. In both groups, males and women, were included underwent to implants with osteocoral (study group) and hydroxiapatite (controls). Initial repair was performed including removal of calculus and polishing of denture surface, education, motivation, and assessment of tooth-brushing, which must show values similar or greater than 80 % in removal of dentobacterial plaque. Subsequently, implant was carried out by means of surgery or flap. Control X-rays were obtained within 14 days, 6 months (first group), and 12 and 24 months (second group). Systematically, we made control of oral hygiene in both groups. Again, clinical indicators were controlled within 6 months (first group) and 12 and 24 monts (second group). There was an statistically significant decrease in gingival index, pocket deep, and tooth loosening for both implant material, without large differences each another. Radiographically, we observed presence of filling material in original defect. There weren?t adverse local reactions and treatment was considered as effective.

Evaluación del osteocoral como material de implante en bolsas infraóseas de dientes multirradiculares / Assessment of osteocoral as implant material at infraosseus pockets of multirroted teeth

Se evalúa la eficacia del osteocoral como material de implante en el tratamiento de bolsas infraóseas en dientes multirradiculares. Se analizaron 14 pacientes que se dividieron en 2 grupos: el primero incluyó a 6 pacientes con un total de 12 defectos, los cuales se evaluaron hasta los 6 meses. El segundo, con 8 pacientes y 16 defectos, que se reevaluaron a los 12 y 24 meses. En los 2 grupos se incluyeron pacientes de ambos sexos, que fueron implantados con osteocoral (grupo estudio) y con hidroxiapatita (grupo control). Se realizó reparación inicial que incluyó remoción de cálculo y pulido de la superficie dentaria, educación y motivación y evaluación del cepillado, que debía mostrar valores iguales o mayores del 80 porciento en la remoción de placa dentobacteriana. Posteriormente se realizó el implante mediante operación a colgajo. Se realizaron radiografías de control a los 14 días, 6 meses (para el primer grupo) y 12 y 24 meses (para el segundo grupo). Se controló sistemáticamente la higiene bucal en ambos grupos. Se controlaron nuevamente los indicadores clínicos a los 6 meses para el primer grupo, y a los 12 y 24 meses para el segundo. Se observó una disminución estadísticamente significativa en el índice gingival, profundidad de la bolsa y movilidad dentaria para ambos materiales implantológicos, sin que se reportaran grandes diferencias entre éstos. Radiográficamente se observó la presencia de relleno en el defecto original, y no hubo reacciones locales adversas, por lo que se consideró efectivo el tratamiento(AU)