The breast cancer related burden of morbidity and mortality in six European coutries

Background: The burden of breast cancer expressed in Disability Adjusted Life Years (DALYs) was compared for six European countries and its sensitivity to different sources of variation examined. Methods: DALYs were calculated using country-specific epidemiological data and European Disability Weights. Epidemiological data for 1996 were obtained for Denmark, England and Wales, France, the Netherlands, Spain and Sweden. Disability weights were empirically derived. Results:  Denmark and the Netherlands lost the largest number of DALYs (approximately 1100 DALYs per 100,000 women). They were followed by England (87% of the Danish burden), France (72%), Sweden (68%) and Spain (67%). 70 to 80% of the burden was caused by mortality. Cross-national variation in disease epidemiology was the largest source of variation in the burden of breast cancer. Variation in disability weights and uncertainty in epidemiological data had smaller effects. Conclusion: To compare the burden of breast cancer and most other types of cancer mortality rates provide sufficient information.

Repeatable sediment associations of burrowing bivalves across six European tidal flat systems

Burrowing bivalves are associated with particular sediment types within sedimentary systems. The degree to which bivalve sediment associations are repeatable across systems has seldom been investigated. To investigate whether such repeatability exists across tidal flats, we compared adult and juvenile distributions of 3 bivalve species (Cerastoderma edule, Scrobicularia plana, Macoma balthica) across 6 European tidal flats. Across systems, the adult bivalves showed fairly repeatable distributions, with C. edule occurring in sandy sediments and M. balthica and S. plana occurring in muddy sediments. Exceptions were observed in systems composed primarily of muddy sediments (Aiguillon Bay and Marennes-Oléron Bay) and the Dutch Wadden Sea. Interestingly, juveniles and adults of C. edule and S. plana showed similar distributions across systems. M. balthica juveniles and adults showed habitat separation in 3 of the 6 studied systems; in 2 of these, it has been shown previously that juvenile M. balthica settle in mud at high tidal levels and migrate to lower sandier flats later in life. The high occurrence of juvenile M. balthica towards high sandy flats in Mont Saint-Michel Bay suggests that juveniles might choose high tidal flats rather than muddy sediments per se. A repeatable association in adults and juveniles with respect to sediment could suggest that juveniles actively settle in the proximity of the adults and/or that juveniles settling away from the adults incur a higher mortality due to either predation, physiological stress, or other factors.

Understanding ring strain and ring flexibility in six - and eight-membered cyclic organometallic group 14 oxides

A simple model was developed for the approximation of ring strain energies of homo- and heterometallic, six- and eight-membered cyclic organometallic group 14 oxides and the degree of puckering of their ring conformations. The conformational energy of a ring is modelled as the sum of its angular strain components. The bending potential energy functions for the various endocyclic M–O–M′ and O–M–O linkages (M, M′=Si, Ge, Sn) were calculated at the B3LYP/(v)TZ level of theory using H3MOM′H3 and H2M(OH)2 as model compounds. For the six-membered rings, the minimum total angular contribution to ring strain, ERSGmin was calculated to decrease in the order: cyclo-(H2SiO)3 (13.0 kJ mol−1)>cyclo-H2Sn(OSiH2)2O (7.0 kJ mol−1)>cyclo-H2Ge(OSiH2)2O (4.9 kJ mol−1)>cyclo-H2Si(OSnH2)2O (3.4 kJ mol−1)>cyclo-(H2SnO)3 (1.7 kJ mol−1)>cyclo-H2Si(OGeH2)2O (0.8 kJ mol−1)≈cyclo-H2Ge(OSnH2)2O (0.7 kJ mol−1)>cyclo-H2Sn(OGeH2)2O (0.1 kJ mol−1)≈cyclo-(H2GeO)3 (0 kJ mol−1). All of the six-membered rings were predicted to adopt (nearly) planar conformations (a=0.996<a<1). By contrast, all eight-membered rings were predicted to adopt strainless, but puckered conformations. The degree of puckering was predicted to increase in the order: cyclo-(H2SiO)4 (a=0.983)<cyclo-H2Sn(OSiH2O)2SiH2 (a=0.959)<cyclo-(H2SiO)2(H2SnO)2 (a=0.942)< cyclo-H2Si(OSnH2O)2SiH2 (a=0.935)<cyclo-(H2SnO)4 (a=0.916)<cyclo-(H2GeO)4 (a=0.885). The differences in ring strain and the degree of puckering were linked to the different electronegativities of Si, Ge and Sn. The results obtained are consistent with experimental ring strain energies; reactivities towards ring opening polymerizations or ring expansion reactions and observed ring conformations of cyclic organometallic group 14 oxides.

Heterogeneity of heart failure management programs in Australia

Background: Heart Failure Management Programs (HFMPs) have proven to be cost-effective in minimising recurrent hospitalisations, morbidity and mortality. However, variability between the programs exists which could translate into variable health outcomes.
Objective: To survey the characteristics of HFMPs throughout Australia and to identify potential heterogeneity in their organisation and structure.
Method: Thirty-nine post-discharge HFMPs were identified from a systematic search of the Australian health-care system in 2002. A comprehensive 19-item questionnaire specifically examining characteristics of HFMPs was sent to co-ordinators of identified programs in early 2003.
Results: All participants responded with six institutions (15%) indicating that their HFMP had ceased operations due to a lack of funding. The survey revealed an uneven distribution of the 33 active HFMPs operating throughout Australia. Overall, 4450 post-discharge HF patients (median: 74; IQR: 24–147) were managed via these programs, representing only 11% of the potential caseload for an Australia-wide network of HFMPs. Heterogeneity of these programs existed in respect to the model of care applied within the program (70% applied a home-based program and 18% a specialist HF clinic) and applied interventions (30% of programs had no discharge criteria and 45% of programs prevented nurses administering/titrating medications). Sustained funding was available to only 52% of the active HFMPs.
Conclusion: Inequity of access to HFMPs in Australia is evident in relation to locality and high service demand, further complicated by inadequate funding. Heterogeneity between these programs is substantial. The development of national benchmarks for evidence-based HFMPs is required to address program variability and funding issues to realise their potential to improve health outcomes.

Factors that influence women's disclosures of substance use during pregnancy : a qualitative study of ten midwives and ten pregnant women

The present study was designed to examine the factors that motivate or act as barriers to disclosure of substance use by pregnant women. Participants included 10 midwives and 10 pregnant women who attended two ante-natal clinics at an Australian maternity hospital. One clinic specialized in women who were substance users and one clinic was specifically for young women (under 19 years of age). Midwives and pregnant women were interviewed in-depth about disclosure of substance use. Interview transcripts were analyzed, and the results revealed six main themes: practice style, assessment of substance use, practice environment and privacy, child protection issues, health of the baby, and continuity of care. The findings are discussed in relation to recommendations for best practice in midwifery care when working with pregnant women who use substances.

Effect of six weeks of dura disc and mini-trampoline balance training on postural sway in athletes with functional ankle instability

Lateral ankle sprain (LAS) is one of the most common injuries incurred during sporting activities, and effective rehabilitation programs for this condition are challenging to develop. The purpose of this research was to compare the effect of 6 weeks of balance training on either a mini-trampoline or a dura disc on postural sway and to determine if the mini-trampoline or the dura disc is more effective in improving postural sway. Twenty subjects (11 men, 9 women) with a mean age of 25.4 ± 4.2 years were randomly allocated into a control group, a dura disc training (DT) group, or a mini-trampoline (MT) group. Subjects completed 6 weeks of balance training. Postural sway was measured by subjects performing a single limb stance on a force plate. The disbursement of the center of pressure was obtained from the force plate in the medial-lateral and the anterior-posterior sway path and was subsequently used for pretest and posttest analysis. After the 6-week training intervention, there was a significant (p < 0.05) difference in postural sway between pre- and posttesting for both the MT (pretest = 56.8 ± 20.5 mm, posttest = 33.3 ± 8.5 mm) and DT (pretest = 41.3 ± 2.6 mm, posttest = 27.2 ± 4.8 mm) groups. There was no significant (p > 0.05) difference detected for improvements between the MT and DT groups. These results indicate that not only is the mini-trampoline an effective tool for improving balance after LAS, but it is equally as effective as the dura disc.

Alcohol and drug use in Australian male sex workers: its relationship to the safety outcome of the sex encounter

This paper describes the self-reporting patterns of alcohol and drug consumption among male sex workers (MSWs) in three Australian cities during commercial sex encounters, and examines to what extent alcohol and drugs are used and whether this is related to the safe/unsafe outcome of the commercial sex encounter. One hundred and eighty-six MSWs from Brisbane, Sydney and Melbourne completed a diary following each commercial sex encounter over a two-week period. MSWs reported 2,087 commercial sex encounters during the study period. Alcohol or drug consumption was reported in 50.5% of the encounters.

HIV discrimination : integrating the results from a six-country situational anaylsis in the Asia Pacific

The findings of the six independent studies on institutional forms of HIV discrimination in the Asia Pacific presented in this Special Issue of AIDS Care are integrated. At first glance, the general pattern of the results across the study sites suggests that discrimination is most pertinent in the domain of 'practice' rather than in the domains of law or institutional policy. On closer analysis, however, utilising the qualitative data, this conclusion does not take sufficient account of the cultural context within which the interpersonal interaction (practice) between the health carers and people living with HIV/AIDS occurs. Limitations on the use of anti-discrimination legislations and protective written policies for reducing discrimination in these contexts are discussed. The need for alternative approaches to thinking about discrimination intervention is raised and this is done through a consideration of the strategy of universal precautions.

An Asia Pacific six-country study on HIV-related discrimination : introduction

This paper outlines a six-country study of institutionalised forms of HIV/AIDS-related discrimination in the Asia-Pacific region. Although recognised as a barrier to disease prevention and treatment, very limited data are available on the effects of institutionalised HIV-related stigma and discrimination. Understanding the forms of discrimination within the institutions where they occur is the first step to identifying effective ways of promoting compassionate, non-discriminatory treatment of PLWHA. Thus, the goal of this research project was to document institutional discrimination against PLWHA, as guided by the UNAIDS Protocol for the Identification of Discrimination Against People Living with HIV (2000), in six Asian countries: India, Thailand, Philippines, China, Vietnam and Indonesia. As a precursor to the six individual studies, this paper provides a brief overview of the literature on HIV discrimination, and then describes the UNAIDS Protocol and the shared methodological considerations relevant to all of the study sites. Commonalities in sampling, procedures and analysis are also discussed.

Alterations in the proportions of skeletal muscle proteins following a unilateral lesion to the substantia nigra pars compacta of rats

It is well established that mammalian skeletal muscles exhibit a considerable degree of plasticity and one of the main determining factors of this plasticity is the activity pattern and duration of motoneurone discharge. Lesions to the right substantia nigra pars compacta (SNpc) of six adult rats were made to determine whether altered output from the SNpc ultimately leads to a change in the expression of proteins in contralateral skeletal muscles. After 4 months, altered motor performance was identified by the administration of amphetamine. After 7 months, 30–70% of dopaminergic cells in the SNpc had been destroyed. The protein content of muscles was then quantified from densitometric scans of gels, and expressed as a % of the amount of actin (the protein used as a reference in this study). The lesion affected the expression of different protein isoforms in the fast- and slow-twitch muscles. In slow-twitch soleus muscles, the lesion decreased the proportion of α-tropomyosin and increased the proportion of β-tropomyosin. In the fast-twitch extensor digitorum longus muscles, the lesion increased the proportion of the fast isoform of troponin-T_1f, and decreased the proportions of the two isoforms of myosin light chain. This study establishes a connection between the chronic effects of a lesion to the SNpc, with a loss of dopaminergic neurones, impaired motor performance, and altered expression of proteins in skeletal muscle. The implication of these results is that the altered motor function observed in Parkinson’s disease may be associated with alterations to the expression of skeletal muscle proteins.