During the spring of 2003, Toronto was in the midst of the first of 2 phases of a SARS outbreak. As the principal tertiary referral hospital, Sunnybrook and Women's College Health Sciences Centre (SWC) admitted 71 patients with SARS, of whom 23 were health care workers, between Mar. 14 and May 24. Over 1000 patients were seen at the SWC SARS assessment clinic.The effect of SARS on the health care system in the greater Toronto area was dramatic. [1][2][3][4][5][6] At various times during the outbreak, 3 hospitals were closed. Health care workers were at increased risk and many were quarantined, which resulted in severe staff shortages. On Mar. 28, following the closure of a second hospital, new and intensive infection control directives were issued for all hospitals in the greater Toronto area and surrounding area. At SWC the directives included cancellation of all hospital-based outpatient clinics, significant visitor restrictions, mandatory wearing of surgical masks by all staff at all times (and N95 masks in patient care areas), limited hospital entrance and mandatory screening of everyone entering the building (symptom/exposure questionnaire and temperature reading). Health care workers were instructed to work at 1 health care institution only, and off-work contact between health care workers from different institutions was discouraged. The SWC SARS Management Team met daily to implement Ministry of Health directives, organize care of patients with and without SARS and deal with staffing issues. With clinic and operating room closures and quarantined staff, staff redeployment to screening at entrances and other essential services became necessary. After Apr. 17, staff not involved in patient care no longer had to wear masks; however, most of the other infection control directives were kept in place well into the summer months.Little is known about the psychological effects of this type of disease outbreak on health care and other hospital workers. Maunder and colleagues 1 described the experiences of a small number of patients and staff at a Toronto hospital during the initial SARS outbreak. They observed that the staff were fearful for their own and their family's health and found caring for colleagues as patients emotionally difficult. Mitchell and associates 7 reported increased feelings of stigmatization among nurses during an outbreak of vancomycin-resistant enterococci in a hospital in Australia; feelings of alienation and isolation were also noted. A literature review revealed no large, systematic studies of the effect of a returned, representing 27% of the total hospital employee population of 7474. The proportions of respondents who were allied health care professionals, nurses and doctors and who worked in areas other than patient care were representative of the hospital staff population as a whole. Of the 2001 questionnaires, 510 contained the GHQ-12. Two-thirds of the respondents reported SARS-related concern for their own or their family's health. A total of 148 respondents (29%) scored above the...

Supplementation with flaxseed modifies urinary estrogen metabolite excretion to a greater extent than does supplementation with an equal amount of soy. This modification by flaxseed is associated with an increase in urinary lignan excretion. Despite the shift in estrogen metabolism to favor the less biologically active estrogens, a negative effect on bone cell metabolism was not observed.

Neither dietary flaxseed nor soy flour significantly affected menopause-specific quality of life or hot flash symptoms in this study.