A survey of enteric organisms detected by real-time PCR assay in faeces of dogs in Western Australia.

This retrospective observational study reports the enteric organisms detected in dogs in Western Australia that had a faecal PCR (fPCR) submitted to a commercial veterinary laboratory. Of 2025 fPCR results, Clostridium perfringens alpha toxin gene was most frequently detected (87.2%), followed by Campylobacter spp. (37.8%), canine parvovirus (10.5%), Giardia spp. (9.7%), Salmonella spp. (7.0%), canine enteric coronavirus (2.3%), and canine distemper virus (0.3%). C.perfringens alpha toxin gene and Campylobacter spp. were the most common organisms co-detected. There was no statistically significant seasonal variation. Further studies are required to elucidate the role these organisms play in gastrointestinal disease in dogs.

Increasing facility delivery through maternity waiting homes for women living far from a health facility in rural Zambia: a quasi-experimental study.

OBJECTIVE: To report on the effectiveness of a standardised core Maternity Waiting Home (MWH) model to increase facility deliveries among women living >10 km from a health facility. DESIGN: Quasi-experimental design with partial randomisation at the cluster level. SETTING: Seven rural districts in Zambia. POPULATION: Women delivering at 40 health facilities between June 2016 and August 2018. METHODS: Twenty intervention and 20 comparison sites were used to test whether MWHs increased facility delivery for women living in rural Zambia. Difference-in-differences (DID) methodology was used to examine the effectiveness of the core MWH model on our identified outcomes. MAIN OUTCOME MEASURES: Differences in the change from baseline to study period in the percentage of women living >10 km from a health facility who: (1) delivered at the health facility, (2) attended a postnatal care (PNC) visit and (3) were referred to a higher-level health facility between intervention and comparison group. RESULTS: We detected a significant difference in the percentage of deliveries at intervention facilities with the core MWH model for all women living >10 km away (DID 4.2%, 95% CI 0.6-7.6, P = 0.03), adolescent women (<18 years) living >10 km away (DID 18.1%, 95% CI 6.3-29.8, P = 0.002) and primigravida women living >10 km away (DID 9.3%, 95% CI 2.4-16.4, P = 0.01) and for women attending the first PNC visit (DID 17.8%, 95% CI 7.7-28, P < 0.001). CONCLUSION: The core MWH model was successful in increasing rates of facility delivery for women living >10 km from a healthcare facility, including adolescent women and primigravidas and attendance at the first PNC visit. TWEETABLE ABSTRACT: A core MWH model increased facility delivery for women living >10 km from a health facility including adolescents and primigravidas in Zambia.

Faecal PCR panel results and clinical findings in Western Australian dogs with diarrhoea.

AIM: To describe faecal PCR (fPCR) results and clinical findings of dogs seen at a university teaching hospital for diarrhoea. DESIGN: Retrospective case series (April 2015 to July 2018). PROCEDURE: Data were collected from the hospital electronic medical records. Data extracted included signalment, history, clinical signs, treatment, fPCR panel results, other faecal diagnostic test results and antimicrobial use. RESULTS: One hundred and sixty-eight dogs with diarrhoea had a fPCR panel submitted. Most dogs (115, 68.5%) had diarrhoea of 3 days or less duration. Clostridium perfringens alpha toxin gene was most frequently detected (156, 92.9%) by fPCR, followed by Campylobacter spp. (55, 32.7%), canine parvovirus (CPV) (29, 17.3%), Salmonella spp. (14, 8.3%) and Giardia spp. (9, 5.4%). For the 45 dogs that had a negative point-of-care CPV test, 13 were CPV fPCR positive; some of which were adult dogs with current vaccination status. A total of 94/168 (56%) dogs received antimicrobials at some time during the treatment of diarrhoea. CONCLUSION: Faecal PCR panels can identify dogs with enteric organisms in their faeces that traditional faecal diagnostics may miss, thus contributing additional information to the diagnostic process. Nonetheless, fPCR results should be interpreted in light of the clinical findings, and particular consideration given to avoiding inappropriate use of antimicrobials. This study highlights that testing for C. perfringens alpha toxin gene is not likely to be diagnostically helpful, and that adult dogs with diarrhoea might be identified as CPV positive with PCR testing, despite a negative point-of-care CPV test result and a current vaccination status.

Obstructive shock caused by right atrial thrombosis secondary to malignant pheochromocytoma in a dog.

BACKGROUND: Obstructive shock can be caused by any lesion leading to extraluminal compression or intraluminal occlusion of the cardiac chambers or major vessels. CASE REPORT: A 12-year-old, male castrated, Border Collie cross dog presented to a veterinary teaching hospital for collapse. A physical examination revealed severe vasoconstrictive shock and abdominal distension. Abnormalities on blood tests were consistent with systemic hypoperfusion. Cardiac underfilling, hepatomegaly with distended vasculature and ascites were identified by focused ultrasonography, raising suspicion of obstructive shock. This was supported by the radiographic findings of microcardia and a distended caudal vena cava (CVC). There was transient response to fluid therapy for blood volume expansion. Repeat focused ultrasonography during rapid intravenous fluid administration identified a right intra-atrial mass, assessed as likely to be causing obstruction of venous return. The dog was humanely euthanased given the guarded prognosis. At postmortem evaluation, a malignant pheochromocytoma in the left adrenal gland with tumour thrombus extending to the tricuspid valve through the CVC was found. The extensive thrombus caused the obstructive shock in this case. Metastasis in a peripheral lymph node and neoplastic emboli in the heart and lungs were also visible at the histopathological evaluation. CONCLUSION: To the best of authors' knowledge, this is the first report of severe obstructive shock secondary to extension of caval tumour thrombus into the right atrium in a dog with malignant pheochromocytoma. Tumour thrombus from a malignant pheochromocytoma should be included as a differential diagnosis of obstructive shock, with or without a visible right intra-atrial mass, in dogs. Serial focused ultrasonography during intravenous fluid administration can aid diagnosis.

Intramyocardial haematoma causing right ventricular outflow obstruction after brown snake (Pseudonaja species) envenomation in a dog.

A 15-month-old, male neutered Staffordshire Bull Terrier cross was presented to its referring veterinarian collapsed and agonal. He was immediately intubated, manually ventilated, and treatment commenced for presumptive snake envenomation with two vials of Tiger/Multi-Brown Snake Antivenom (minimum 7000 units/vial). The dog was transferred to a referral hospital intubated. Additional diagnostics performed following arrival at the referral hospital included a urine snake venom detection kit test, which was positive for brown snake immunotype. Three additional vials of Tiger/Multi-Brown Snake Antivenom (minimum 7000 units/vial) were administered until the dog was extubated and able to stand. Venom-induced consumptive coagulopathy (VICC) was diagnosed based on prolonged clotting times and scleral haemorrhage. Paroxysms of right ventricular outflow tract (RVOT) origin ventricular arrhythmias were treated with lignocaine and sotalol. Four days after presentation, a new-grade IV/VI systolic heart murmur was auscultated, prompting an echocardiogram. An anechoic and compartmentalised mass measuring 43 mm × 19 mm was visualized within the right ventricular wall at the RVOT, immediately adjacent to the pulmonic valve. The mass was causing a RVOT obstruction. Its appearance was suggestive of an intramyocardial haematoma, most likely secondary to VICC. The dog remained cardiovascularly stable, and treatment consisted of supportive care. Recheck echocardiograms at 2 and 7 weeks after discharge revealed progressive improvement of the intramyocardial mass and resolution of the associated heart murmur. Although intramyocardial haematomas are rare, it should be considered as a differential in dogs that develop a newly diagnosed heart murmur and/or cardiac arrhythmia following brown snake envenomation.

Impact of the take ACTION Train-the-Trainer model of opioid overdose education with naloxone distribution- who benefits?

BACKGROUND: Overdose education with naloxone distribution (OEND) is a key national strategy to reduce morbidity and mortality related to opioid overdoses. Train-the-trainer model has been one method to increase the pool of trainers to facilitate greater dissemination of OEND. This exploratory study seeks to (1) evaluate participant's change in knowledge and confidence, (2) examine if pre- and post-training test outcomes differed by occupation and level of experience, and (3) determine if train-the-trainer participants trained others 6 months later. Methods: Fifteen train-the-trainer sessions were delivered to staff from community organizations who served high-risk clients in four counties whose overdose death rates ranged from 11.2 to 32.8 per 100,000. Participants were administered pre- and post-training tests from September 2017 to December 2018. A follow-up survey was conducted 6 months post-training to evaluate outcomes. Final paired pre-and post-training surveys of 109 participants were used for analysis. Paired sample t-tests were used to evaluate changes in the knowledge and confidence in teaching others. One-way ANOVA compared the change scores across groups with different demographic or experiential characteristics. Kruskal-Wallis Test was used for Likert scales. Results: The one and one-half hour train-the-trainer curriculum increased participants' knowledge and confidence to teach others (p < .001). This was particularly true for participants who had no prior experience compared to those who had some experience with naloxone (p = .0003). Changes in confidence to teach others significantly improved among demographic subgroups of participants. At 6 months after completing the train-the-trainer curriculum, 14 participants had trained 243 new trainees. Conclusions: Implementing a train-the-trainer model for OEND increases knowledge and participants' confidence to teach others. This demonstrates the important potential of the train-the-trainer model to respond to the growing opioid overdose epidemic.

Large-Volume Crystalloid Fluid Is Associated with Increased Hyaluronan Shedding and Inflammation in a Canine Hemorrhagic Shock Model.

Shedding of the endothelial glycocalyx precedes leukocyte activation and adherence in acute inflammation. Rapid administration of crystalloid or colloid fluids for treating hemorrhagic shock may cause endothelial glycocalyx shedding, thereby increasing inflammation. This study aimed to compare the effect of different fluid treatments in a canine shock model on glycocalyx biomarker, hyaluronan, and inflammatory biomarkers. Greyhound dogs under general anesthesia subject to hemorrhage for 60 min were given 20 mL kg-1 of either fresh whole blood (FWB), hydroxyethyl starch (HES) 130/0.4, 4% succinylated gelatin (GELO), or 80 mL kg-1 of isotonic crystalloid (CRYST) over 20 min (n = 6 per group). Plasma biomarkers hyaluronan, interleukin (IL) 6, 8, 10, tumor necrosis factor-α, monocyte chemoattractant protein-1, keratinocyte chemokine-like, and atrial natriuretic peptide were measured at baseline, end of hemorrhage (Shock), end of fluid administration (T20), and then 40 (T60), 100 (T120), and 160 (T180) minutes later. Biomarker concentrations were compared between groups using the Kruskal-Wallis test or Fisher's exact test (measurable versus unmeasurable) (significance set at P < 0.05). Hyaluronan concentration peaked early in the CRYST group at T20, compared to HES (P = 0.005) and GELO (P = 0.018), and later in the GELO group at T60, compared to FWB (P < 0.001). The CRYST group had significantly more samples with measurable IL6 at T180 (P = 0.015), compared to GELO, and IL10 at T60, T120, and T180 (all P = 0.015), compared to FWB. There were no significant differences in other biomarker concentrations. In conclusion, rapid large-volume crystalloid administered for hemorrhagic shock was associated with increased hyaluronan and a greater inflammatory response.

Does misuse lead to a disorder? The misuse of prescription tranquilizer and sedative medications and subsequent substance use disorders in a U.S. longitudinal sample.

OBJECTIVES: We used two waves of National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) data and examined whether the misuse of prescription tranquilizers or sedatives at Wave 1 was associated with either continued misuse, tranquilizer/sedative use disorder, or other substance use disorder (SUD) at Wave 2. METHODS: Prospective data were analyzed from structured diagnostic interviews using the Alcohol Use disorders and Associated Disabilities Interview Schedule: DSM-IV Version (AUDADIS-DSM-IV). A nationally representative sample of 34,653 of U.S. adults, 18years or older at Wave 1 (2001-2002), were re-interviewed at Wave 2 (2004-2005). After applying the survey weights, the sample represented a population that was 52% female, 71% White, 12% Hispanic, 11% African American, 4% Asian and 2% Native American or other. RESULTS: An estimated 79% of adults who engaged in tranquilizer or sedative misuse at Wave 1 had stopped using these drugs at Wave 2. Only a small percentage (4.3%) of misusers at Wave 1 had a tranquilizer or sedative use disorder at Wave 2. However, 45% (45.0%) of misusers at Wave 1 had at least one other SUD at Wave 2. Among those in remission from a sedative or tranquilizer use disorder at Wave 1, 4.8% had a tranquilizer or sedative use disorder while 34.7% had at least one other SUD at Wave 2. CONCLUSIONS: Most adults who engaged in the misuse of prescription tranquilizers or sedatives ceased using within 3years; however, their prior misuse was associated with higher prevalence of having a SUD three years later.

Effectiveness of letters to Cape Breton women who have not had a recent Pap smear.

Nova Scotia, and especially Cape Breton, has high cervical cancer incidence and mortality rates. Letters were sent to 15,691 unscreened and 6,995 under-screened women from Cape Breton Island encouraging them to obtain a Pap test. Controls were 61,510 unscreened women and 32,996 under- screened women in mainland Nova Scotia who were not sent letters. For this cohort study, the provincial Health Card Number database and Provincial Cytology Registry were linked. Having a Pap smear was associated with having received a letter (OR = 1.64), having been previously under-screened rather than unscreened (OR = 1.85), with youth and with higher income (OR = 1.13). After receiving a letter, women in Aboriginal, Mixed Black, Acadian, and rural communities had smear rates similar to those of other women. Being previously unscreened, rather than under-screened, was associated with higher rates of abnormalities (OR = 1.62), indicating greater need for early detection and treatment to prevent invasive cancer. While one-time letters to women improved the Pap smear screening rates, multiple, continuous interventions are needed to make a more substantive improvement in these rates.

Dealing with daily hassles: smoking and African-American adolescent girls.

PURPOSE: To examine cigarette use and its relationship to daily life hassles in an urban sample of African-American adolescent girls. METHODS: A sample of 105 African-American adolescent girls (mean age of 15.45 years) derived from a larger cross-sectional research project titled "Female Adolescent Substance Experience Study" funded by the National Institute of Drug Abuse comprised the sample. The sample was divided into adolescents who had ever smoked in their lifetime and adolescents who had never smoked before. Student's t-tests were conducted to determine whether there were differences between these groups on demographic characteristics and the number of daily life hassles. Pearson product moment correlations were also conducted to examine the association between age of smoking initiation and number of hassles. RESULTS: Less than 50% of the teenagers had ever smoked cigarettes in their lifetime, and of those who had ever smoked, the average age of initiation was 12.55 years (SD = 2.63). Furthermore, girls who had ever smoked, in contrast to girls who had never smoked, had a significantly greater number of daily life hassles, in general, and within the school/academic and family/economic domains in particular. Age of smoking initiation was negatively related to the number of hassles, indicating that girls who started to smoke at a younger age reported more hassles. CONCLUSIONS: These findings are discussed in terms of developing an understanding of gender and ethnic-specific correlates of smoking that can be used to better delineate the developmental smoking trajectory of African-American girls.

Variation in delivery of palliative radiotherapy to persons dying of cancer in nova scotia, 1994 to 1998.

PURPOSE: To examine sociodemographic and clinical variables associated with provision of palliative radiotherapy (RT) to persons dying of cancer. METHODS: The Nova Scotia Cancer Registry was used to identify 9,978 adults who were dying of cancer between 1994 and 1998 in the Canadian province of Nova Scotia. RT records from between April 1992 and December 1998 were obtained from the provincial treatment database. Multivariate analysis identified factors associated with two sequential decisions determining provision of palliative RT in the last 9 months of life: likelihood of receiving an RT consultation with a radiation oncologist and, given a consultation, likelihood of being treated with palliative RT. RESULTS: The likelihood of having a consultation decreased with age (20 to 59 years v. 80+ years: odds ratio [OR], 4.43 [95% confidence interval, 3.80 to 5.15]), increased with community median household income (> $50,000 v. < $20,000: OR, 1.31 [1.02 to 1.70]), was higher for residents closer to the cancer center (< 25 km v 200+ km: OR, 2.47 [2.16 to 2.83]), increased between 1994 and 1998 (OR, 1.34 [1.16 to 1.56]), varied by cause of death (relative to thoracic cancers, head and neck: OR, 1.75 [1.31 to 2.33]; gynecologic: OR, 0.35 [0.27 to 0.44]), and was greater for those who had prior RT (OR, 2.20 [1.89 to 2.56]). Similar associations were observed when outcome was the provision of palliative RT given a consult, with one notable exception: prior RT was associated with a lower likelihood of receiving palliative RT (OR, 0.48 [0.40 to 0.58]). CONCLUSION: Variations observed in delivery of palliative RT should prompt further investigation into equity of access to clinically appropriate, palliative radiation consultation and treatment.

Associations between community income and cancer incidence in Canada and the United States.

BACKGROUND: Associations between socioeconomic status (SES) and the incidence of cancer have been reported previously in the U.S. Canada has more comprehensive health care and social programs than the U.S. The purpose of this study was to compare the strength of associations between SES and cancer incidence in Canada and the U.S. METHODS: The regions studied were the Canadian province of Ontario and the areas of the U.S. covered by the Surveillance, Epidemiology, and End Results (SEER) program. The populations at risk were defined using the 1991 Canadian Census and the 1990 U.S. Census. The populations of Ontario and of the SEER areas of the U.S. were each divided into deciles on the basis of median household income. Population-based cancer registries were used to identify incident cases. Age-standardized incidence rates for all major groups of malignant diseases were calculated for each SES decile in Ontario and in the U.S. Income-associated incidence gradients observed in Ontario and the U.S. were compared. RESULTS: The incidence of most types of cancer was similar in Ontario and the U.S. In both countries, there were moderately strong, inverse associations between income level and the incidence of carcinomas of the cervix, the head and neck region, the lung, and the gastrointestinal tract. In both Ontario and the U.S., several of these diseases were twice as common in the bottom income decile than they were in the top decile. In contrast, carcinoma of the female breast and carcinoma of the prostate were more common among higher income communities in both countries, but the observed associations were weaker in Ontario. CONCLUSIONS: Despite Canada's universal health insurance and more comprehensive social security system, the association between lower socioeconomic status and the incidence of many common cancers is just as strong in Ontario as it is in the U.S. The mechanisms responsible for these associations require further investigation.

Variation in suicidality among substance-abusing women: the role of childhood adversity.

The relationship of early adversity to suicidality in later life has been noted in diverse populations. Here we report such a relationship for a sample of African American women who smoke crack cocaine. This article is a secondary analysis of data from women (mean age = 31 years; range, 19-48) who were recruited from treatment settings (n = 152) or informal community contacts (n = 56). The present analyses focused on measures related to investment in self-preservation and development, particularly suicidal ideation and attempts. Multiple regression analyses were used to model the effect of early stress (sexual abuse, parental loss, and parental impairment) on the primary outcome measures (suicidality total, age at first consensual sexual relations, and years of education). Suicidality was associated with childhood adversity (sexual abuse, loss of mother). Of those who had experienced early sexual abuse, 42% had attempted suicide, compared to 19% of those who had not been sexually abused.

Putting drug use in context. Life-lines of African American women who smoke crack.

The purpose of this exploratory study was to describe a group of African American women who smoke crack. Using aggregate data from 208 interviews with women crack smokers, we randomly selected 25 women's interview data to create the 25 life-lines. These life-lines were developed in a similar manner to the time-line analysis described by Fullilove and her colleagues (1992); we focused on events that are either extraordinarily disturbing (e.g., rape, incest, death of a child, etc.), events that are usual but often stressful (e.g., birth of a child, death of a parent, etc.), and on periods of drug use. We chose this method of analysis so as to highlight the context in which many women come to use crack cocaine. The life-lines provided a retrospective (but time-ordered) perspective and in several ways provided preliminary support for a stress-diathesis perspective.

Effects of active chronic cocaine use on cardiac sympathetic neuronal function assessed by carbon-11-hydroxyephedrine.

UNLABELLED: Cardiac toxicity of cocaine has been linked to its inhibitory effect on norepinephrine reuptake by sympathetic nerve terminals of the heart. Carbon-11-hydroxyephedrine is a positron-emitting tracer that has been validated as a highly specific marker for norepinephrine transporter activity of the sympathetic nerve terminals and thus makes possible in vivo assessment of the effect of cocaine on norepinephrine reuptake and storage in the cardiac sympathetic nerve terminals. The aim of the study was to use the catecholamine analog 11C-hydroxyephedrine with PET to determine whether active chronic use of cocaine in women modifies the function of sympathetic nerve terminals of the heart. METHODS: Six normal female volunteers and nine female active chronic cocaine users were studied. Cardiac regional 11C-hydroxyephedrine uptake and blood flow, as assessed with 13N-ammonia, were determined using semi-quantitative polar map analysis of myocardial tracer distribution. Carbon-11-hydroxyephedrine cardiac retention was quantified using dynamic data acquisition and kinetic analysis of blood and tissue activity. RESULTS: Active chronic cocaine users showed small areas of abnormal blood flow and 11C-hydroxyephedrine retention in the heart in comparison with normal volunteers. The extent of abnormalities expressed as a percent of the total polar map area averaged 2.0% +/- 2.6% and 2.5% +/- 2.7% for blood flow and 11C-hydroxyephedrine uptake, respectively. Myocardial 11C-hydroxyephedrine retention was significantly reduced by 22% in active cocaine users (0.109 +/- 0.017 min-1), as compared to normal controls (0.140 +/- 0.027 min-1). CONCLUSION: PET imaging with 11C-hydroxyephedrine permits quantitative assessment of cardiac norepinephrine transporter function in active chronic cocaine users. The results of this study suggest prolonged reduction of norepinephrine uptake and storage capacity in the cardiac sympathetic nerve terminals which may reflect the effect of repetitive elevation of norepinephrine levels induced by cocaine exposure.

Nicotine and alcohol abuse in African American women who smoke crack cocaine.

The purpose of this descriptive study was to characterize the nicotine and alcohol use of African American women who smoke crack. Particular attention was paid to treatment status and whether treatment influenced perceptions of alcohol addiction and nicotine consumption. Two hundred and eight African American women who smoke crack comprised the convenience sample. One hundred and fifty-two women were in drug treatment, and the rest were "on the streets" still using crack cocaine. In a 3-hr interview, women were asked about their drug and alcohol use, family, and social, health, and drug-related behaviors. All women were administered the CAGE and asked questions about their nicotine use. There were no statistical differences between treatment and nontreatment groups on the CAGE or on smoking. As expected, women in treatment were significantly more likely to report that their behaviors were indicative of an alcohol addiction, although they did not differ from the nontreatment group in potential problems identified by the CAGE.

Women and illicit drugs: sexuality and crack cocaine.

As part of a larger, federally funded study, the purpose of this preliminary, descriptive study was to describe the sexual feelings and sexual functioning of women who used large amounts of crack cocaine. A structured interview with questions pertaining to the effect of crack use on sexual feelings and sexual function was conducted with 100 African-American women who either were in treatment for crack abuse or were currently using the drug. The data did not support the commonly held notions that crack is an aphrodisiac for women and that crack makes women want sex. Furthermore, the women in this study had a higher level of sexual dysfunction than was found in a previous study of women who used alcohol. More research on the sexual experiences of women who use illicit drugs such as crack is needed if practitioners are to base their interventions on women's realities, not on stereotypes.