Specific fatty acid intake and the risk of pancreatic cancer in Canada

The possible association of specific fatty acid (FA) intake and pancreatic cancer risk was investigated in a population-based case–control study of 462 histologically confirmed cases and 4721 frequency-matched controls in eight Canadian provinces between 1994 and 1997. Dietary intake was assessed by means of a self-administered food frequency questionnaire. Unconditional logistic regression was used to assess associations between dietary FAs and pancreatic cancer risk. After adjustment for age, province, body mass index, smoking, educational attainment, fat and total energy intake, statistically significant inverse associations were observed between pancreatic cancer risk and palmitate (odds ratios (ORs)=0.73; 95% confidence intervals (CIs) 0.56–0.96; P-trend=0.02), stearate (OR=0.70; 95% CI 0.51–0.94; P-trend=0.04), oleate (OR=0.75; 95% CI 0.55–1.02; P-trend=0.04), saturated FAs (OR=0.67; 95% CI 0.50–0.91; P-trend=0.01), and monounsaturated FAs (OR=0.72; 95% CI 0.53–0.98; P-trend=0.02), when comparing the highest quartile of intake to the lowest. Significant interactions were detected between body mass index and both saturated and monounsaturated FAs, with a markedly reduced risk associated with intake of stearate (OR=0.36; 95% CI 0.18–0.70; P-trend=0.001), oleate (OR=0.36; 95% CI 0.19–0.72; P-trend=0.002), saturated FAs (OR=0.35; 95% CI 0.18–0.67; P-trend=0.002), and monounsaturated FAs (OR=0.32; 95% CI 0.16–0.63; P-trend<0.0001) among subjects who are obese. The results suggest that substituting polyunsaturated FAs with saturated or monounsaturated FAs may reduce pancreatic cancer risk, independently of total energy intake, particularly among obese subjects

Surviving crack: a qualitative study of the strategies and tactics developed by Brazilian users to deal with the risks associated with the drug

<p>Abstract</p> <p>Background</p> <p>Due to marginalization, trafficking violence, conflicts with the police and organic and social psychological problems associated with the drug, crack is one of the most devastating drugs currently in use. However, there is evidence that some users manage to stay alive and active while using crack cocaine for many years, despite the numerous adversities and risks involved with this behavior. In this context, the aim of the present study was to identify the strategies and tactics developed by crack users to deal with the risks associated with the culture of use by examining the survival strategies employed by long-term users.</p> <p>Method</p> <p>A qualitative research method was used involving semi-structured, in-depth interviews. Twenty-eight crack users fulfilling a pre-defined enrollment criterion were interviewed. This criterion was defined as the long-term use of crack (i.e., at least four years). The sample was selected using information provided by key informants and distributed across eight different supply chains. The interviews were literally transcribed and analyzed via content analysis techniques using NVivo-8 software.</p> <p>Results</p> <p>There was diversity in the sample with regard to economic and education levels. The average duration of crack use was 11.5 years. Respondents believed that the greatest risks of crack dependence were related to the drug's psychological effects (e.g., cravings and transient paranoid symptoms) and those arising from its illegality (e.g., clashes with the police and trafficking). Protection strategies focused on the control of the psychological effects, primarily through the consumption of alcohol and marijuana. To address the illegality of the drug, strategies were developed to deal with dealers and the police; these strategies were considered crucial for survival.</p> <p>Conclusions</p> <p>The strategies developed by the respondents focused on trying to protect themselves. They proved generally effective, though they involved risks of triggering additional problems (e.g., other dependencies) in the long term.</p

Increased cardiovascular risk in rats with primary renal dysfunction; mediating role for vascular endothelial function

Primary chronic kidney disease is associated with high cardiovascular risk. However, the exact mechanisms behind this cardiorenal interaction remain unclear. We investigated the interaction between heart and kidneys in novel animal model for cardiorenal interaction. Normal Wistar rats and Munich Wistar Fromter rats, spontaneously developing renal dysfunction, were subjected to experimental myocardial infarction to induce cardiac dysfunction (CD) and combined cardiorenal dysfunction (CRD), respectively (N = 5–10). Twelve weeks later, cardiac- and renal parameters were evaluated. Cardiac, but not renal dysfunction was exaggerated in CRD. Accelerated cardiac dysfunction in CRD was indicated by decreased cardiac output (CD 109 ± 10 vs. CRD 79 ± 8 ml/min), diastolic dysfunction (E/e′) (CD 26 ± 2 vs. CRD 50 ± 5) and left ventricular overload (LVEDP CD 10.8 ± 2.8 vs. CRD 21.6 ± 1.7 mmHg). Congestion in CRD was confirmed by increased lung and atrial weights, as well as exaggerated right ventricular hypertrophy. Absence of accelerated renal dysfunction, measured by increased proteinuria, was supported by absence of additional focal glomerulosclerosis or further decline of renal blood flow in CRD. Only advanced peripheral endothelial dysfunction, as found in CRD, appeared to correlate with both renal and cardiac dysfunction parameters. Thus, proteinuric rats with myocardial infarction showed accelerated cardiac but not renal dysfunction. As parameters mimic the cardiorenal syndrome, these rats may provide a clinically relevant model to study increased cardiovascular risk due to renal dysfunction. Peripheral endothelial dysfunction was the only parameter that correlated with both renal and cardiac dysfunction, which may indicate a mediating role in cardiorenal interaction

How can pharmacists develop patient-pharmacist communication skills? A realist review protocol

Background: Good patient-pharmacist communication improves health outcomes. There is, however, room for improving pharmacists’ communication skills. These develop through complex interactions during undergraduate pharmacy education, practice-based learning and continuing professional development. Research is needed to determine how best to approach teaching patient-pharmacist communication. Methods: The aim of the research is to understand how educational interventions develop patient-pharmacist interpersonal communication skills produce their effects. A realist review approach will be used to synthesise the literature to make sense of the complexities of educational interventions. Our review will iteratively progress through the various stages of clarifying scope, locating existing theories, searching for evidence, appraisal of papers, data extraction and synthesis. A scoping review revealed a number of substantive theories, which will be used to build an initial programme theory. This will be explored through available published evidence, which we will find by searching databases such as Medline, EMBASE, PsychInfo, ERIC, Scopus and Web of Science. Judgements will be made on the relevance and rigour of the retrieved literature and will be taken into consideration during analysis and synthesis. Synthesis, testing and refinement of the theories will describe and explain the links between contexts, mechanisms and outcomes of educational interventions for communication development in pharmacy. Discussion: The realist review will provide an analysis of what works when, for whom, how and why, for educational interventions for interpersonal patient-pharmacist communication development. We will also explore barriers to successful communications training and acknowledge any limitations. Ultimately, we plan to provide pharmacy educators with evidence for how best to incorporate educational interventions for communications skills development into pharmacy curricula and for life-long learning opportunities for pharmacists

The unsupported upper limb exercise test in people without disabilities: assessing the within-day test–retest reliability and the effects of age and gender

Purpose: To estimate the within-day test–retest reliability and standard error of measurement (SEM) of the unsupported upper limb exercise test (UULEX) in adults without disabilities and to determine the effects of age and gender on performance of the UULEX. Method: A cross-sectional study was conducted with 100 adults without disabilities (44 men, mean age 44.2 [SD 26] y; 56 women, mean age 38.1 [SD 24.1] y). Participants performed three UULEX tests to establish within-day reliability, measured using an intra-class correlation coefficient (ICC) model 2 (two-way random effects) with a single rater (ICC[2,1]) and SEM. The effects of age and gender were examined using two-factor mixed-design analysis of variance (ANOVA) and one-way repeated-measures ANOVA. For analysis purposes, four sub-groups were created: younger adults, older adults, men, and women. Results: Excellent within-day reliability and a small SEM were found in the four sub-groups (younger adults: ICC[2,1]=0.88; 95% CI: 0.82, 0.92; SEM∼40 s; older adults: ICC[2,1]=0.82; 95% CI: 0.72, 0.90; SEM∼50 s; men: ICC[2,1]=0.93; 95% CI: 0.88, 0.96; SEM∼30 s; women: ICC[2,1]=0.85; 95% CI: 0.78, 0.91; SEM∼45 s). Younger adults took, on average, 308.24 seconds longer than older adults to perform the test; older adults performed significantly better on the third test (p0.05). Conclusion: The within-day test–retest reliability and SEM values of the UULEX may be used to define the magnitude of the error obtained with repeated measures. One UULEX test seems to be adequate for younger adults to achieve reliable results, whereas three tests seem to be needed for older adults.Objectif : évaluer la fiabilité d'un test-retest en une même journée et l'erreur type de mesure (ETM) du test d'exercice des membres supérieurs sans appui (UULEX) chez des adultes sans incapacités et déterminer les effets de l'âge et du sexe sur leur exécution. Méthodologie : les chercheurs ont réalisé une étude transversale auprès de 100 adultes sans incapacités (44 hommes, d'un âge moyen de 44,2 ans [ÉT 26], et 56 femmes, d'un âge moyen de 38,1 ans [ÉT 24,1]). Les participants ont effectué trois UULEX pour établir la fiabilité du test-retest en une même journée, mesurés à l'aide du modèle 2 de coefficient de corrélation intraclasse (ICC, effets aléatoires bilatéraux) comportant un ICC(2,1) et une ETM à un seul évaluateur. Les chercheurs ont examiné les effets de l'âge et du sexe à l'aide d'une analyse de variance bifactorielle à mesures mixtes et d'une analyse de variance unifactorielle à mesures répétées. Pour les besoins de l'analyse, les chercheurs ont créé quatre sous-groupes: jeunes adultes, adultes plus âgés, hommes et femmes. Résultats : les quatre sous-groupes affichaient une excellente fiabilité en une même journée et une petite ETM (jeunes adultes: ICC[2,1]=0,88 [IC 95% : 0,82, 0,92] et ETM∼40 secondes; adultes plus âgés : ICC[2,1]=0,82 [IC 95 % : 0,72, 0,90] et ETM∼50 secondes; hommes: ICC[2,1]=0,93 [IC 95% : 0,88, 0,96] et ETM∼30 secondes; femmes: ICC[2,1]=0,85 [IC 95 % : 0,78, 0,91] et ETM∼45 secondes). En moyenne, les jeunes adultes ont effectué le test pendant 308,24 secondes de plus que les adultes plus âgés; ceux-ci ont obtenu un résultat nettement meilleur au troisième test (p0,05). Conclusion : il est possible d'utiliser la fiabilité de test-retest en une même journée et les valeurs d'ETM de l'UULEX pour définir l'importance de l'erreur obtenue lors de mesures répétées. Un UULEX semble suffire pour que les jeunes adultes obtiennent des résultats fiables, tandis que trois tests semblent nécessaires chez les adultes plus âgés