The Cannabis Expectancy Questionnaire for Men who have Sex with Men (CEQ-MSM): A measure of substance-related beliefs.

OBJECTIVE: Substance-related expectancies are associated with substance use and post-substance use thoughts, feelings and behaviours. The expectancies held by specific cultural or sub-cultural groups have rarely been investigated. This research maps expectancies specific to gay and other men who have sex with men (MSM) and their relationship with substance patterns and behaviours following use, including sexual practices (e.g., unprotected anal intercourse). This study describes the development of a measure of such beliefs for cannabis, the Cannabis Expectancy Questionnaire for Men who have Sex with Men (CEQ-MSM). METHOD: Items selected through a focus group and interviews were piloted on 180 self-identified gay or other MSM via an online questionnaire. RESULTS: Factor analysis revealed six distinct substance reinforcement domains ("Enhanced sexual experience", "Sexual negotiation", "Cognitive impairment", "Social and emotional facilitation", "Enhanced sexual desire", and "Sexual inhibition"). The scale was associated with consumption patterns of cannabis, and in a crucial test of discriminant validity not with the consumption of alcohol or stimulants. CONCLUSIONS: The CEQ-MSM represents a reliable and valid measure of outcome expectancies, related to cannabis among MSM. Future applications of the CEQ-MSM in health promotion, clinical settings and research may contribute to reducing harm associated with substance use among MSM, including HIV transmission.

Continuous low- to moderate-intensity exercise training is as effective as moderate- to high-intensity exercise training at lowering blood HbA(1c) in obese type 2 diabetes patients.

AIMS/HYPOTHESIS: Exercise represents an effective interventional strategy to improve glycaemic control in type 2 diabetes patients. However, the impact of exercise intensity on the benefits of exercise training remains to be established. In the present study, we compared the clinical benefits of 6 months of continuous low- to moderate-intensity exercise training with those of continuous moderate- to high-intensity exercise training, matched for energy expenditure, in obese type 2 diabetes patients. METHODS: Fifty male obese type 2 diabetes patients (age 59 +/- 8 years, BMI 32 +/- 4 kg/m(2)) participated in a 6 month continuous endurance-type exercise training programme. All participants performed three supervised exercise sessions per week, either 55 min at 50% of whole body peak oxygen uptake (VO(2)peak (low to moderate intensity) or 40 min at 75% of VO(2)peak (moderate to high intensity). Oral glucose tolerance, blood glycated haemoglobin, lipid profile, body composition, maximal workload capacity, whole body and skeletal muscle oxidative capacity and skeletal muscle fibre type composition were assessed before and after 2 and 6 months of intervention. RESULTS: The entire 6 month intervention programme was completed by 37 participants. Continuous endurance-type exercise training reduced blood glycated haemoglobin levels, LDL-cholesterol concentrations, body weight and leg fat mass, and increased VO(2)peak, lean muscle mass and skeletal muscle cytochrome c oxidase and citrate synthase activity (p < 0.05). No differences were observed between the groups training at low to moderate or moderate to high intensity. CONCLUSIONS/INTERPRETATION: When matched for energy cost, prolonged continuous low- to moderate-intensity endurance-type exercise training is equally effective as continuous moderate- to high-intensity training in lowering blood glycated haemoglobin and increasing whole body and skeletal muscle oxidative capacity in obese type 2 diabetes patients. TRIAL REGISTRATION: ISRCTN32206301 FUNDING: None.

[A 35-year-old man with gynaecomastia as the first symptom of hyperthyroidism]. / Een 35-jarige man met gynaecomastie als eerste symptoom van hyperthyreoïdie.

A 35-year-old man suffered painful bilateral gynaecomastia for 2 months due to serious Graves' hyperthyroidism. During treatment with propylthiouracil and levothyroxine, the plasma concentrations of thyroid hormone, sex hormones and sex hormone-binding globulin normalised and the gynaecomastia disappeared. Gynaecomastia occurs in 30 to 40% of men diagnosed with Graves' hyperthyroidism. However, gynaecomastia as a presenting symptom of this autoimmune disease is uncommon.

Primary hyperparathyroidism: pathophysiology, diagnosis and indications for surgery.

There is little debate about the primacy of surgery in the management of symptomatic or complicated primary hyperparathyroidism. Rather, the question has been what to do about the many patients with nonclassical disease. Recent prospective data have confirmed that patients with asymptomatic primary hyperparathyroidism who are not surgical candidates for parathyroidectomy appear to do well when they are managed conservatively. On average, these patients remain stable, with little progression to the more serious manifestations of hyperparathyroidism over 10 years. It would seem, therefore, that the overall population of older patients with mild asymptomatic primary hyperparathyroidism can be safely followed without intervention. A certain proportion of cases do progress, however, so surveillance is necessary. Individual patients can have worsening hypercalcemia or hypercalciuria, and in a small percentage of patients, bone density may decrease over time. In most patients, deferral of surgery is not a one-time decision, but rather one that is reviewed and reconsidered in conjunction with meticulous monitoring.

Congenital myasthenic syndrome: a rare, potentially treatable cause of respiratory failure in a "floppy" infant.

A four-month-old infant, thought to suffer from cerebral palsy, presented with respiratory failure on the background of a gradually deteriorating general level of function. Whilst being ventilated in intensive care he was noted to have severe muscle weakness. A disorder of the neuromuscular junction was suspected and he was subsequently demonstrated to have a congenital myasthenic syndrome. Anticholinesterase therapy produced a dramatic recovery. The congenital myasthenic syndromes and the diagnosis of a "floppy baby" are briefly reviewed.

Anemic loonie begins to affect health care sector.

Although most news surrounding the declining dollar has concentrated on its impact on Canadian shoppers, economists say it is bound to affect the financially strapped health care system too. They point out that many of the good purchased by Canadian hospitals come from the US, and the weak loonie means their price will rise.

Concern mounts as transfusion medicine loses its lustre.

Transfusion medicine is in trouble. Several factors, ranging from the tainted-blood scandal to changes in the way the system operates, mean that young physicians are avoiding the specialty. Dr. Antonio Giulivi of the Red Cross says the issue is serious because these specialists act as the system's overseers, and this fact won't change when the Red Cross gets out of the blood business in September.

Reference-based pricing: will other provinces follow the BC lead?

REFERENCE-BASED PRICING has had a major impact on medical practice in British Columbia. Anne Mullens discusses the new system's first 2 years. She says physicians outside BC should pay attention, because RBP may be heading their way. It is set to land in Australia next month.

"I think we have a problem in Victoria": MDs respond quickly to toxoplasmosis outbreak in BC.

More than 110 people, including 12 newborns, were infected with Toxoplasma gondii in Victoria last year. A team of doctors, researchers and public-health officials determined that the source of the world's largest recorded outbreak of the infection was the water supply. Anne Mullens looks at how the BC medical and scientific communities responded to a unique challenge.

The Dutch experience with euthanasia: lessons for Canada?

Anne Mullens used a recent fellowship provided by the Atkinson Foundation to take an in-depth look at euthanasia in the Netherlands. During her time in Holland, she discussed the issue with doctors who support and oppose euthanasia. She accompanied a doctor as he visited a patient who was dying of cancer and was beginning to consider the possibility of euthanasia. She talked to a nonphysician who is adamantly opposed to euthanasia and carries a card stating that. She visited a hospital in Amsterdam that has received requests from foreigners seeking euthansia. Mullens offers a comprehensive look at an issue that continues to provoke strong feelings among Canadian physicians and patients.

Oregon vote may mark watershed for right-to-die debate in Canada, US.

In November, Oregon became one of the first jurisdictions outside the Netherlands to allow physician-assisted suicide. Voters decided by a narrow 51% to 49% margin to pass a Death With Dignity Act, which allows terminally ill patients to receive a fatal prescription from a doctor after they meet several criteria. Observers note that the act's scope is narrow and that it would not have aided Sue Rodriguez, the British Columbia patient who went to court in an attempt to win the right to assisted suicide.

Peri-operative care for oesophagectomy patients.

The aim of this study was to evaluate factors relevant to morbidity and mortality in 54 patients undergoing oesophagectomy at Royal Newcastle Hospital between 1985 and March 1989. There was a high incidence of concurrent medical problems. Significant anaesthetic complications occurred in 6 patients. There were 16 serious general medical complications and 10 surgical complications. Respiratory complications included basal collapse (19), sputum retention (6), pulmonary oedema (2), pleural effusion/haemothorax (5), and severe aspiration syndrome (5). Seven patients required mechanical ventilation for more than 3 days. Two deaths occurred postoperatively. As a result of this audit, changes have occurred in patient selection, management of chylothorax, epidural analgesia and timing of tracheal extubation.